October 10, 2007 by Marj Hatzell
The Benefits Enrollment Package walked through our door last evening and nothing says romance more than, “Let’s look over our benefits options for next year.” Because Darling responded with, “Okay. When that’s done, let’s go snuggle.” I think I have finally learned after eleven years of marriage that even a mundane topic such as insurance can get a guy in the mood. So can drying paint. And thunderstorms. And Bugaboo’s evaluation report. And snuggle really means…ahem…
We perused our options for next year. We were previously in a tizzy over the fact that they were changing the plans yet again, especially since we finally found decent doctors for the kids and duPont might not take the new stuff. We did their handy-dandy online comparison and found that our new plan and current plan are nearly identical as far as what is covered, what is allowed, prescriptions, etc. Guess what? The new plan now has a YEARLY DEDUCTIBLE. After you meet your deductible you are then covered 80%. Until you reach your out-of-pocket maximum and then you are fully covered, in network. What that means is this: with the amount of doctor’s appointments and tests and such that the boys endure each month, we are looking at a jump from $2-3,000 (now) to $6-7,000 out of pocket before our coverage is 100% (this is estimated based on our ER visits, doctor visits, therapy and meds from last year). Now, co-pays are a thing of the past, and for that I appreciate that. We do not need referrals. We can literally go to any hospital, any doctor, any time. We don’t have to get all generic drugs. We now have DENTAL AND EYE PLANS, which were severely lacking before. Heck, they now cover mental health (a big plus!) because before they covered at 60% and then 40% after 20 visits (this sucked during the post-partum time).
I know I should appreciate that we even HAVE insurance. I should also breathe a sigh of relief that we aren’t dealing with horrible, chronic stuff (just semi-chronic, like GI tract and seizures). And thank goodness we have MA for the kids, since the qualify as children with a disability. It’s just that our budget is once again compromised. I love that they make sure it kicks in right after the holidays. And? Just for good measure? It’s called the Healthy People Plan. It should be called: Don’t you dare go to the doctor until you are bleeding out the eyes or coughing up a lung because you are gonna pay, pay, pay. We won’t cover you until you are no longer healthy. And even then we won’t cover speech and occupational therapy for your autistic child because, you know, it isn’t rehabilitation and he’ll never be cured. We’re nice like that.
At least my OB/GYN visits are now covered 100% with no copay. And mammograms. Yippee!