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Medical Forum / Diseases and Disorders / Diabetes / October 2005

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Michael - 31 Oct 2005 16:32 GMT
My employer is throwing a curve ball at me...  or maybe it's my HMO.

For years, here in Metro Phoenix, I've been a Cigna HMO member, and
generally quite satisfied.  Not happy, but satisfied.

The company offers 3 plans:

   Company PPO (managed by Humana)
   HeathNet HMO
   Cigna HMO

The costs are changing radically such that it doesn't make sense to stay
with Cigna.  Can you say "more than double?"

Our biggest health concern is the DM T2 I was diagnosed with back in
May.  My A1c's:

   May:  10.1
   Aug:   5.8
   Sep:   5.3

My company's contractor's website, given my estimate of our health care
requirements for 2006, estimates a total cost (to me) of about $2600 for
either Company PPO or HealthNet HMO, and a total cost of about $3700 for
Cigna.

I don't think we mind changing health care providers in general...  but
we tend not to like change -- and all the extra work involved such as
finding new providers and facilities, etc.

I have a good friend who's a nurse manager at a hospital rehab unit.  
From his experience at getting coverage for his patients, he recommends

   1.  Humana
   2.  Cigna
   3.  HealthNet

He's had the most trouble and least flexibility with Healthnet.

So, I'm looking for suggestions and advise about

  1. Specific suggestions IF you know about any of these health care
     providers (especially in Metro Phoenix)
  2. General suggestions about how to go about this decision process.
     Having not had to make this decision for over 10 years, advise on
     how to proceed would be appreciated.

Staying with Cigna is a valid option, but obviously the increased cost
means we have to justify the decision.

thanks,

mt

 
Andrea - 31 Oct 2005 17:25 GMT
>I have a good friend who's a nurse manager at a hospital rehab unit.  
> From his experience at getting coverage for his patients, he recommends
[quoted text clipped - 4 lines]
>
>He's had the most trouble and least flexibility with Healthnet.

I'm not in Phoenix and I'm sure that changes everything.  With that said, I
have HealthNet and have been quite happy with them.  I think the big questions
you'd want to consider would relate to doctors, hospitals, and prescriptions.

Does the doctor you want to see accept the health plan you're considering?  
That's a biggie.  What would it take to get referrals to specialists you might
need?  I'm fortunate in that some of the best doctors in my area belong to a
multi-specialty medical group -- as does my primary care doctor -- so it's
easy for me to get the referrals I need to doctors I trust.

What about hospitals?  If you should need surgery or some type of
hospital-based treatment, can you get into the best hospitals in the area with
the insurance you're considering?

And prescriptions -- particularly for those of us with diabetes -- are a
biggie.  My plan has copays of $10 for generic prescriptions, $20 for brand
names in their formulary, and $35 for drugs not in their formulary.  When it
comes to testing supplies, they cover certain meters and strips but not
others.  If I use one of their covered meters, the strips are $20 for whatever
the doctor prescribes (so that could be for one box, two boxes, three boxes,
etc. depending on the prescription).  If you use their mail order pharmacy
(which I do and have never had problems) you pay for two months and get a
three-month supply.

All of these details will be different depending on your policy.

Good luck with figuring all of this out.  Insurance is a pain in the neck!

--
Lord, make me an instrument of your peace...
where there is hatred, let me sow love.

remove "spamtrap" for e-mail
Wooly - 31 Oct 2005 18:57 GMT
>My employer is throwing a curve ball at me...  or maybe it's my HMO.
>
[quoted text clipped - 6 lines]
>    HeathNet HMO
>    Cigna HMO

We're not in Phoenix.  That said, we have Humana PPO and are generally
satisfied - not happy, but satisfied - with it.  The two biggest
hassles we've had are

1.  Getting prescriptions filled.  Fortunately all diabetes medication
and supplies is a flat copay at any pharmacy counter.  Anything else
that's taken on an onging basis has to be filled through the
mail-order contract pharmacy lest one incur a hefty penalty in the
form of exhorbitant copays at the pharmacy counter.  My husband seems
to spend an inordinate amount of time chasing paper prescriptions,
filling out the mail-order pharmacy paperwork, and making phone calls
to ensure his orders arrive, are being processed, are shipped, etc.  

2.  Obtaining _consistent_ coverage information from the Humana 800#.
On more than one occasion we've been told one thing about our coverage
while providers are told another.  Be sure that both you and your
providers know up front how any given service should be billed lest
you have endless problems later straightening out the mistake.

Occasionally Humana rejects something for no obvious reason.  Back in
August my endo ordered a full bloodwork panel including assorted
choleesterol tests.  Humana 86'd a c ouple of them as "experimental"
even though they've been in the AMA IDC code book for years.  Go
figure.

+++++++++++++

Reply to the list as I do not publish an email address to USENET.
This practice has cut my spam by more than 95%.  
Of course, I did have to abandon a perfectly good email account...
 
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