About Me

Name:
Sue

Location:
Southern New Jersey

I am a Mom to 2 amazing and fun daughters and wife to a great guy and a wonderful father!

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Kayla
Kayla, my oldest. She is 4 1/2 and is a sweet, loving and silly little girl. She took us 2 ½ years and 3 IVF’s to conceive. Kayla is allergic to dairy. We manage her allergy and work to balance her safety with giving her a normal childhood. Kayla loves to read books and play games - she amazes me every day.


Alysa
Alysa, my youngest. She is 3 years old and is a silly little spitfire. She’s our monkey and loves to climb on everything. She was a “natural” baby, but it was only b/c of my wonderful doctors that we were able to stop an impending miscarriage. Alysa suffers from Acid Reflux Disease and sleep apnea. She may be little, but she has a big personality. She adores her big sister and is so much fun to be around. She keeps me laughing every day.


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Mothers Day 2009

Tuesday, January 15, 2008
Too Good to be True?
You know that feeling when things just seem to be going TOO good? You feel like it just can’t be – that you have to be missing something. Well that is how I’m feeling right now. I believe I mentioned about 3 months ago or so when J changed jobs that we had some insurance concerns. His new insurance company was an HMO, which means less freedom, referrals and just pain in the tush restrictions. Before he even accepted the jobs I checked on the doctors (their Pediatrician and our regular docs were all on the new company) and thought their allergist and gastroenterologist (both whom we love) were not on the plan [there are NO out of network benefits]. There was also the biggest scare – Prevacid. We were told initially that Prevacid was covered, but only the solutab (which Kayla can’t take b/c it has dairy in it) and there were dosage and time limits. This was the biggest scare b/c Kayla’s dose is over $300 a month and Alysa’s close to $200. This would have been so bad that we considered cobra’ing instead for the full 18 months. Then the owner’s insurance broker looked deeper and said that his prescription plan DID cover Prevacid. I was still skeptical though because I couldn’t call since we were not on the plan yet. This new insurance is the whole reason we are paying out of pocket for Alysa’s feeding therapy – she does not take the new plan, but she’s worth it to stay with her. And did I mention that our copays are going up? $30 for regular docs (unless it’s a check-up than there is no copay). And $30 for ALL prescriptions. We pay $20 for Prevacid now. So that’s an increase of $20 a month for both girls.

Fast forward to November – their allergist told me (his practice is new) that if he is not showing up under that plan yet, he will be by our next visit. He will be in network on our plan. I breathed a little easier.

Fast forward to yesterday. Our new insurance is now effective. I got our id cards over the weekend, so I called yesterday. First, I’ll say they were a pleasure to talk to. I don’t think I’ve ever used insurance company and pleasure in the same sentence before. But the best part is that Prevacid is covered and WITH no hoop jumping (oh the hoops that we had to jump through for Aetna to cover it). Not only that, but the copay is $30 for 90 days! Right now we pay $20 per MONTH, this means that our monthly copay goes DOWN to $10 a month. So it’s actually saving us money. This pretty much applies to all our prescriptions – they allow you to get a 90 day supply through your local pharmacy – no mail order hassles.

And…both their allergist and gastroenterologist are in network, AND the plan actually does NOT need referrals. All HMO means to Oxford Health Plans in NJ is that you don’t have out of network benefits. I can live with that, especially if I can keep my hassle-free doctor visiting.

I keep looking over my shoulder thinking this can’t be right. I’m waiting for someone to pop up behind me and yell PSYCHE!!! If I’m dreaming, please don’t wake me…


posted at 10:59 AM  
  4 comments



4 Comments:
At 11:37 AM, Anonymous Anonymous said...

Sue:

Aren't you glad that it's not April Fools Day?

What great news.

Love you much,

Mom :)

 
At 7:56 PM, Anonymous Christine@AreWeThereYetMom said...

That is wonderful news. Dealing with insurance companies can be a nightmare, I know!!

I'm glad you are having a good experience, and *shush*, I'll be quiet now, and knock on wood, got my fingers crossed the whole nine yards that this is really a GOOD thing!! :)
I am so happy for you!

 
At 9:10 PM, Blogger Carrie said...

Hoop jumping can be so exhausting! We had to deal with stuff like that when I was on Zofran* during my pregnancies. One pill cost $43.

How wonderful that God has provided for your family!

 
At 7:10 AM, Blogger Donna said...

That IS a pleasant surprise. Every time I have a claim over $50.00 my ins. rejects it on the basis that "I have other insurance". I haven't for years now and I must have made a hundred calls about it. I always tell the rep that I really feel sorry for people who are seriously ill and have to deal with this half baked company.

 

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