Maria Yeager

Home » Insurance

Category Archives: Insurance

The American Health Care System – How Do We Fix It?

Until about a year ago, I was totally uninterested in politics – those subjects were my absolute least favorite in school. So, I am surprised that today I watch the news on almost a daily basis. I don’t know what changed. Maybe it’s all the chaos surrounding this administration. But, at age 51, I am finally paying close attention to what is happening in the United States…and I don’t like it one bit.

When Obamacare was passed, I was concerned. At the time, I only watched Fox News and I was a Republican, so you can imagine what I thought at the time. Fox News did bring up many concerns regarding Obamacare …and those concerns were justified as there are serious problems with it that need to be addressed.

When Trump became President, I wasn’t happy at all even though I was a Republican. I lived in a highly narcissistic environment for about twenty years, and I saw the exact behaviors in this man that I saw personally in my own situation. This concerned me greatly. I tried to warn people about this man, but I was attacked on social media for daring to question Trump’s behavior. Since that time, I have watched on a daily basis the chaos in this administration, mostly a direct result of his narcissism. I shake my head in frustration all the time, and I am disgusted with Washington in general. During this time, I contacted my senator, Mark Warner, and my Congresswoman, Barbara Comstock, on several occasions about my concerns. I never thought I would contact a Democrat, but I am so glad I did. Mr. Warner responded every single time I contacted him. I never heard from Barbara Comstock (she is a Republican). That speaks volumes.

A few months ago, I decided to become an Independent. The Republican party as I knew it years ago has changed. This party no longer represents my beliefs as I don’t condone the behavior that I have witnessed in this administration. I have watched Mark Warner as he drilled members of the current administration about possible Russia collusion. I am very impressed with Mr. Warner, and he will always have my vote in the future because I believe that he truly wants the best for this country.

Now to healthcare. John McCain is my personal hero. Although I do have issues with Obamacare, the “skinny bill” was a “disaster”, as Lindsay Graham put it in his speech before the vote. It would have left 16 million without insurance if it was passed into law. It also would have hiked insurance premiums 20%!! If that doesn’t anger every single American out there, I don’t know what will! Thank you so much, Mr. McCain, for voting your conscience. You have no idea how many Americans consider you their hero today.

Here’s the way I see it – if you want to bring down the cost of healthcare, lower the cost of prescription drugs, medical supplies and insurance. DO NOT take it from people who barely have anything (Medicaid)! Specifically, I would love to see caps put on the salaries of the CEOs and other senior management of pharmaceutical and insurance companies.

I used to work for a pharmaceutical company, so I have an idea of how much money these companies pull in and how many “perks” employees receive. I also worked in the medical field as a laboratory technologist. We used to joke about how aluminum foil in a medical supplies catalog cost something like $50 per roll when you could go to Food Lion and get the same thing for $2…I’m not kidding!

The following is a list of the highest earning CEOs in the pharmaceutical industry (per research done by Tracy Stanton of FiercePharma.com) :

  1. Len Schliefer – CEO of Regeneron, $41.97 million
  2. Jeffery Leiden – CEO of Vertex Pharmaceuticals, $36.64 million
  3. Brent Saunders – CEO of Allergan, $36.61 million
  4. Martine Rothblatt – CEO of United Therapeutics, $33.21 million
  5. Lamberto Andreotti – CEO of Bristol-Myers Squibb, $27.06 million
  6. Heather Bresch – CEO of Mylan, $25.82 million
  7. Kenneth Frazier – CEO of Merck, $25.03 million
  8. Alex Gorsky – CEO of Johnson & Johnson, $24.99 million
  9. Robert Hugin – CEO of Celegene, $24.24 million
  10. Ian Read – Pfizer, $23.28 million

That is just the top ten!

These salaries are ridiculous. No one needs to make this kind of salary when we have American citizens out there that are struggling to make ends meet every single month. Personally, I am on disability because I have had three back surgeries and live in constant pain. I also have fibromyalgia, and just in the past month, I learned that my right knee has almost no cartilage behind the knee cap (due to 25+ years of ballet, jazz and hip hop dancing). I am in physical therapy and have received an injection, but it is highly probable that I will need knee replacement surgery in the near future.

I have Medicare parts A and B. I also bought extra coverage through United Healthcare to help pay the 20% that Medicare doesn’t cover. I am on Savella and Lyrica for pain/fibromyalgia. Six months into this year, I received a notice from United Healthcare that I was in the coverage gap for these medications which means more out-of-pocket costs for me. Well, the cost was too high for me, so I had to drop my Lyrica to one-half of what I was taking during the first part of the year. I now live with increased pain and will have to deal with this until the end of the year.

It angers me that Mitch McConnell and most Republicans put forth a bill to make drastic cuts to Medicaid while doing nothing to reduce the costs of health insurance and pharmaceuticals. There are millions of Americans who are suffering and are barely able to make it month to month while these CEOs are pulling in a salary of $20 to $30 million per year! This has to stop!

Why won’t Congress address the gross mishandling of funds in these industries? How can these executives rake in this kind of money, knowing that there are people out there who are struggling, and sleep at night? Come on, congressmen and women!! Someone get a backbone and take up this issue. John McCain stood up last night, and it was great…will he or someone else have the balls to finally take on these companies?? Mark Warner, will you take the lead on this?

My suggestion for the American people is to vote out those senators and representatives that are on the extreme left and the extreme right. Get moderates in Congress on both sides so they can sit down TOGETHER and hammer out a COMPROMISE (not doing things in secret behind closed doors). I also urge Congress to come up with some kind of law that puts a cap on the salaries of pharmaceutical, insurance and medical supplies executives. Putting this cap in place should redirect the money back to the consumers and drive down these ridiculously high prices. There is no need…EVER…for someone to have a salary of $20 to $30 million PER YEAR when other people are struggling to survive.

A copy of this blog will be sent to my senator and representative. Please feel free to send a copy to your senator and representative as well.

 

 

AARP Medicare Complete HMO is a nightmare!!

I usually like to write about things I know about, but today isn’t one of those days. I am a moron when it comes to insurance, and I really don’t care to learn more about it. But, in order to get by in life without major headaches, we really do need to have a basic knowledge of insurance. Otherwise, you may get into a mess just like the one I am in right now.

Since 2014, I’ve had Medicare for my insurance because I am on disability for complex spinal problems. I usually buy additional Part D coverage for my prescriptions. But last year, I had particularly high medical bills, so I looked for secondary coverage to help cover expenses this year. I looked up plans available in my area, and during my research, I came across the AARP Medicare Complete HMO.

This plan sounded great! For just $89 per month, there are no co-pays for visits to your primary care physician and $25 co-pays for visits to specialist. In addition this plan has some dental and hearing coverage which I need. Prescription coverage was good for me too as it covered most of my medications. I was so happy when I signed up and breathed a sigh of relief thinking that my coverage was very much improved.

That feeling of confidence quickly faded into nothingness this week. I have had problems with my right knee for years, but this past weekend, I injured it somehow which led to searing pain in the front of my kneecap. I was barely able to walk. Stairs were particularly hard – I had to take them one stair at a time without bending my hurt knee. A day after the injury, I was unable to fully straighten my knee, and any attempt to bend it resulted in severe pain. I put ice on it and rested for about 1 1/2 days, and the symptoms improved, but the pain never fully went away.

This week, I made an appointment to see an orthopedic surgeon, Dr. Hosick. I had seen him several times in the past about my hip and knee. He had even x-rayed my knee previously and determined that I had chondromalacia in my right knee. Yesterday, I went to his office only to find out that since I was now in a HMO, I had to have a referral before I could see him. Uugghh.

This morning, I had an appointment to see my primary care doctor, Dr. Baker. When I explained to her that I needed a referral, she looked confused. “But I thought you were on Medicare,” she said. I replied, “Yes, but I got additional insurance this year. It’s a HMO, and I guess I now need referrals to see specialists.” She looked confused and then told me that her office may not accept this new insurance. I was stunned. She left to check it out and came back without any further information. The billing manager for the office wasn’t there today, and she really couldn’t tell me if they would accept the new insurance or not, and she wasn’t sure if she could give the referral.

I went straight home, really angry and irritated by what I had just learned about this new insurance. Honestly, I have no idea how all this works. I don’t know all the specifics of how HMOs are run. I called United Healthcare and told the young lady on the other end of the phone that I was confused and irritated that I had been to two doctors, both of which could not treat my knee because of insurance issues. She explained that I still have Medicare, but it’s now all under United Healthcare. I’m still not exactly sure how it all works, but I did learn that I can’t go to any specialists without a referral. Everything has to go through a primary care doctor when insurance is a HMO.

At one point, she offered to give me a one-time referral while everything was being looked at regarding my primary care doctor. Well, it turns out that Dr. Hosick isn’t a preferred provider, so United Healthcare could not give a referral to that doctor. OK, so now my patience was running quite thin. Then I asked her to check and see if my spinal surgeon, Dr. Kalantar, was a preferred provider. This was of utmost importance to me as I had absolutely no intention of leaving him. After two failed spinal fusions, Dr. Kalantar was able to successfully fuse my spine in 2012. He had been my trusted spinal doctor since that time, and I will not go to anyone else.

Well, it turns out that Dr. Kalantar wasn’t a preferred provider either!! At that point, she said that one of the options was to discontinue this AARP plan and go back to original Medicare. I was confused…I thought we could only change plans during the open season (Oct – Dec). She said that I could still change it now, so  I agreed with her, saying that if Dr. Kalantar wasn’t in the plan, I had to leave. I asked her if I could get a Part D plan for prescription coverage, and she said yes. She put me on hold, and I waited for quite a while, but when she came back on the phone, she apologized for the wait and told me that she was going to get another lady on the phone who would be able to discontinue the plan. The call was transferred, and I began the discussion with the second lady.

This second lady proceeded to tell me that she could not discontinue the plan over the phone. WTH?? The first lady told me otherwise. Now I was really getting mad. She gave me a list of ways that I could discontinue, and I chose to do it online. She told me to go to http://www.aarpmedicareplans.com and fill out the form on the site. After asking me a bunch of questions, she told me that I could get part D ONLY if they approve my request to discontinue the plan. WTH?? They might not approve it?? So, I asked the lady for clarification – “So, they may NOT approve my request to discontinue the plan?” Her answer was “yes”. At that point, I was so disgusted that I ended the call.

I went to http://www.aarpmedicareplans.com and did not find any form to discontinue the plan. I decided to send an e-mail that detailed why I was so disgusted with United Healthcare and this AARP plan. They have since sent a notice to me that a case had been opened.

This plan is awful. If I stay with this plan, I would basically have to start over. All the doctors that I have been going to for years and who know all the details of my health over the past ten years or so are not included in this HMO plan – ALL of them!! I would have to start over with all new doctors. In addition, the first spine doctor that I had screwed up my back. It wasn’t until I went to Dr. Kalantar that my spine was finally stabilized. I am NOT willing to go to just any doctor….some doctor that some HMO says I can go to….to treat my complex spinal issues!!

Beware of the AARP Medicare Complete HMO plan. It’s one thing if just ONE of my doctors wasn’t in the plan….but NONE of them are in the plan!! This should be a BIG RED FLAG to all those looking for good health coverage through AARP. Shame on you, AARP, for promoting this insurance plan!!

Update: I received an e-mail saying that they are forwarding my complaint to the Appeals and Grievance Department and that they would get back to me in 30 days. 30 DAYS!!! What about now? I have this knee pain and need to see my orthopedic doctor now!! But God forbid that they do their job and address this now….no, go on ahead and take 30 days…that’s no problem at all (obvious sarcasm). By the time they finish pushing around all the papers, it will probably be open season again. Pathetic!

%d bloggers like this: