Is My Insurance Limited On How Much They Can Do?

@KrauseHome (33267)
United States
June 9, 2011 3:40pm CST
I am Glad I have Medical insurance and everything, but sometimes it lacks being there for major things, and I am wondering how much worse things can get. With being Diabetic even, since a lot of my problems are considered pre-existing conditions trying to get my Insurance to always cover something without having to almost fight it gets frustating. With being Diabetic this does make it quite interesting. Especially along with having these Chronic wounds as well. Would really Love for them to find a quicker easier solution before I have said I have spent over $20,000 out of my own pocket just to keep my leg with this Chronic wound. I have been dealing with this issue since 2003 on and off. It actually healed itself for quite a few yrs before coming back. Now it keeps on getting worse to where it is frustrating. Thing that is surprising is my Sugar levels are better than when the wounds were there the first time, but that is not a factor I think in the healing. I do have an apt. to go to a wound center again and see someone. Thing is I do need to check with my Insurance just to see if there are still limits etc. If there are still a lot of limits it makes me sometimes think what will it really take for them to solve this? I guess now I just make the Call and find out what my next steps are from here, but Prayers are appreciated with this for sure. Even made a comment yesterday while having the Neuro Stress test done, if some of the Chest pains I am having could be related to the wound? (Will have to wait until I get the results back to see if there is any connection.) So where do I go from here? I guess God will have to be the one to help from here. I am sure whatever it is it will always be for the Best. ~~TINA~~
6 people like this
12 responses
@toniganzon (39995)
• Philippines
10 Jun 11
Dear Tina, Insurance can only get us the monetary support we needed but i know you need more than that. Thus i am going to pray for your health as well as the strength to endure what you're going through. My uncle is diabetic too and actually the rest of my father's siblings are. It's hereditary but it's something that i don't want to inherit from them. I wish that i won't have it all so i'm being careful. Hope my prayer would help you somehow. Be strong have faith. Leave it all to God, He knows what's best.
3 people like this
@KrauseHome (33267)
• United States
16 Aug 11
That is definately the Truth I am learning in things where my Insurance will not cover like Gauze wrap, and other dressings for my leg, God is in control. The wound center has been helping out where they can when they can, and then my husband's work etc. has been helping where they can. I just continue to Pray and Trust god and know he is in control, and soon this too shall end.
1 person likes this
• United States
17 Aug 11
Prayer does work... and changing lifestyle... I have metabolic syndrome... I changed my diet completely when I went to visit my brother who was a bad diabetic on two kinds of insulin and pills. He had bad sores on his legs and was up to 362 pounds and now is down to 243 and has no more symptoms of diabetes. He eats very low fat, doesn't add fat at all.. except 2 teaspoons of extra virgin olive oil a day to his diet... no butter or margarine or anything... he eats lots of fruit and veggies.. at least 9 servings a day and eats his meals and counts his points.. weight watchers is awesome for diabetics... and he has no sign of diabetes... so I am doing what he is doing.. and my blood sugars are completely normal now and my A1C was also normal when I had it checked this time. I said all that to say that changing my diet will keep me out of the doctor's office and keep my medical bills down, therefore save me money on what insurances don't pay.
@celticeagle (114478)
• Boise, Idaho
10 Jun 11
I would keep a log of all they have you do, dates, who you talk to, etc. Just incase. I had a situation with my insurance where my nurse intern wasn't getting info to the insurance co. by the date they required it and I almost lost my benefits because of her. Chest pains are scarey. I left work one day in an ambulance with the symptoms of a heart attack. Found out I had pluerisy which can be very painful.
@KrauseHome (33267)
• United States
14 Jun 11
Well, it can be an interesting thing finding out how much all of this they are needing to do is going to cost me. Besides all the different doctors I am going to have to see with all these issues, anything not on the regular Medical that is approved, I know my limit out of pocket is $2000, and it will not take long until this is used up at the rate they are having to do things, but I would rather get them all found out now just to be safe.
1 person likes this
@celticeagle (114478)
• Boise, Idaho
14 Jun 11
Some companies have an account a person can sign up for that helps to pay for large medical bills. And medicaid has alot of plans for different things. They helped me pay for my meds for awhile. I would check into it. COuldn't hurt and might help alot.
1 person likes this
@KrauseHome (33267)
• United States
13 Aug 11
Well, I am Married so anytime that I usually check to see if I can get help somehow from somewhere they always want to go by our Incomes, instead of looking at my Medical needs, and our expenses, etc. just to see what we can really afford. I have even had Creditors come after me for Medical bills knowing I am still suffering from the same issues, and still ringing up charges. Totally I think somehow there needs to be an easier way.
1 person likes this
@Thoroughrob (11771)
• United States
10 Jun 11
First of all, you need to know your insurance. If you know what is in the policy, a lot of the times you can fight the denials and you will find that you get less denials. I have to deal with all of that kind of thing with my son. I used to have to spend hours on the phone, but most of it ended in my favor. I hope things start looking up for you. Keep on them and don't let up.
2 people like this
@KrauseHome (33267)
• United States
13 Aug 11
Well, it does seem like many times you have to Fight to get things going when it comes to denials, etc. and then sometimes it is after they pay their percentage that you still have huge bills, and everyone wants their $$ now instead of looking at can we really afford to pay and live as well. Sometimes makes you wonder how you are ever going to get thru this for sure.
@GardenGerty (90290)
• Marion, Kansas
9 Jun 11
Check with your insurance about whether or not it will cover the new wound clinic. Also ask if there is a way you can get case management. Case management is good because they can negotiate fees and advocate for you.
@KrauseHome (33267)
• United States
12 Jun 11
Well anytime I have checked into Case management with any of my Medical bills they always tell me since I am married, there is no way they can help me. Anytime I check the Income limits it is way below even what I make a month, but know that if I was single some places would offer to help. But I am doing a lot of questioning and checking especially with all these other New medical issues on top of this.
@daeckardt (6245)
• United States
9 Jun 11
I really don't understand why insurance companies have to have all these STUPID rules about pre-existing conditions. If someone is sick and needs care, they should get the care that they need and worry about how it will be paid for later! There has to be a better way to do things than the way it is done in America! I think I got lucky when I got back here. My brother had talked to doctors at the university hospital before I got here and they said that care would be given one way or the other. In fact, they allowed me to stay in the hospital for longer than was medically necessary because I didn't have anywhere to go until my brother had made arrangements to get me into this motel. I was approved for medicaid starting in February so my care is being taken care of by the state now, but when I was in the hospital in January things were up in the air. I was told recently that I was approved for January, but never got anything in writing on that so I don't know whether to believe it or not. It is really enough to make me want to move permanently to a different country where they have socialized medicine. It may not be an ideal situation, but it has to be better than what we have here (unless you are lucky enough to be able to afford medical insurance).
1 person likes this
@KrauseHome (33267)
• United States
12 Jun 11
Well the problem with the Health Care they are trying to get for everyone, is it is getting to where it is limiting the places even more on what help is out there. The costs continue to go up while the care does not. My Insurance is better than a lot of them out there. I just need to check some things, because no matter how much it covers, there will always be at least $2000 or more I have to pay for out of my own pocket as well.
1 person likes this
@daeckardt (6245)
• United States
12 Jun 11
I can't imagine having to pay that much out of pocket! I found out that when my disability kicks in I will have a spenddown of $102 before my medicaid will start covering expenses. That will be no problem as long as I am in chemo because each treatment they bill the insurance (medicaid) $5300 and adjust off over $10,000, but still that will eat up all the extra money that I will get over what my SSI gives me. I know the last time around (2003) I did have the state health plan since I had a state job and I had to pay 20% until I hit $2000 out of pocket. Fortunately, one of the appointments I had weekly billed the insurance a lot more than they asked me for and that was used up pretty quickly. Besides, chemo and surgery used a lot of that (Sept-Feb) so I didn't have to make payments other than copays after that. I hope your health improves soon!
1 person likes this
@KrauseHome (33267)
• United States
14 Jun 11
Well, with everything going on and all the Tests and such they want to do right now, even though we are in the middle of June and my Medical starts over again in September I think, I will easily reach the $2000. I just wish I could get help paying what my Insurance does not pay, but since I am married they say we make too much to get help even with all my Health problems. Somehow I wish there was a better way, and hoping for a Miracle of Health.
1 person likes this
• United States
17 Aug 11
Hi Tina, Sorry I'm late answering this one... I just saw it. I think we get what we pay for. I'm on Medicare, so mine doesn't pay a lot. I mean it pays for everything I have gone for, but it only pays the percent that it does.. and I get bills for the rest of the amount owed. I can't afford to buy more insurance, but I should probably look into it... but everything would be pre-existing, as you say... like arthritis, metabolic syndrome, breathing problems.. you name it.. I've had it before... so I'm not sure if it would pay or not to buy more insurance.
1 person likes this
@KrauseHome (33267)
• United States
17 Aug 11
Well, I have heard from my Doctor that starting in 2012 most pre-existing Health care problems out there have to be covered from the start, so that is a definate plus. My medical does do good with most things, it is how do I pay the 20% it does not pay when it is adding up to quite a bit. Makes it quite hard sometimes.
• United States
17 Aug 11
That as always been my problem too. Luckily I have changed my lifestyle enough that I am no longer making my doctor rich. One of my former docs said that my lifestyle habits and many other peoples lifestyle habits paid for new carpet throughout his house. That taught me something. My last trip to the ER was due to a wasp sting. That couldn't be helped. But my weight, blood pressure and metabolic issues are all under control, so my doc won't be getting rich off me.
1 person likes this
@KrauseHome (33267)
• United States
19 Aug 11
Well, my wound care doctor states now as little money as Insurance companies are actually wanting to pay, and make people pay anymore for Wound Care, he is not getting rich. He states he is shocked that there are still people out there wanting to become Doctors and are respected. But personally I feel I am doing things to help improve my situation for the Better even if it is not as fast as I would like.
• United States
10 Jun 11
Hi Tina! I would call your insurance and find out what your coverage is also ask for the nurse case manager who is assigned to your insurance, if the case is that you are limited. It is heart breaking to hear about limitations and or non-coverage. Right now I feel semi-blessed as I do not have major illnesses and I do not have any insurance coverage. I do let things linger on as I can't afford out of pocket to see anyone. In your case I think it is worth finding out if you have some case manager who can further get additional care at a different clinic which would be at lower cost and or withing the insurance range.
@KrauseHome (33267)
• United States
13 Aug 11
Well, with some of the things that have not been covered, we have been able to get the Wound clinic to work with us and give us enough stuff to get by for the week to change the dressings, etc. that need changed. And we have been able to get the stuff we need from other places as well. Actually since I have posted this, things have gotten a little better and found out they are getting easier to work with me, and the Doctors when their are issues out there regarding my Health for sure.
• United States
17 Aug 11
Tina I am very happy to hear that things have gotten a little better. Hallelujah my friend and prayers will continue my dear friend for yet more recovery and better job for you. Thank you for the BR!
@CatsandDogs (13964)
• United States
28 Jun 11
What about checking into getting some supplemental health insurance? I'm not sure how that works as far as existing conditions but I would think it wouldn't matter or you'd have to wait 6 months or so for the insurance to 'kick in'. 6 months or so isn't a lot of time and will go by fast and would help you a huge way in paying those darned expensive doctor bills. It's worth a try anyways.
1 person likes this
@KrauseHome (33267)
• United States
17 Aug 11
Well, when you usually are working somewhere unless you are over 50, or the place you work at offers AFLAC and you sign up for it, and take it I am not aware of anything else out there. I do have Insurance thru my job which is a Huge help for most things. It's just some things it does not cover, and then I still have Medical bills left over from the 20% it did not pay which adds up.
@ebuscat (5949)
• Philippines
10 Jun 11
For me yes it is the insurance it defends on the value of money you get.
1 person likes this
@KrauseHome (33267)
• United States
16 Aug 11
Well I know even with the complaints I have at times with the Insurance I have, it is still better than what I could have, and in many ways a lot better than the other ones out there.
@laydee (12815)
• Philippines
10 Jun 11
You should know by now that insurances or Insurance Companies are also businesses, these are not charity institutions and they won't really be that big if they're there for free. They can't cover pre-existing conditions because they know that these types of conditions would require higher coverage because of the conditions that follow them (like the wounds that you have stated). This is actually one of my fields and this is the main reason why people should buy insurances before they have conditions. No insurance company would ever cover anyone who already is sick - that is for sure. So, for those who are interested to get one, I think it would be best if you don't have a condition yet. As for where you are going from there, perhaps you could get those discount cards for meds and look for organizations with similar interests perhaps they know of places that you could get these services at a cheaper rate. You could also try learning how to take care of your wounds (like how to clean them properly and keep from having them by minding your feet and legs more attention). I know it's difficult, I too am diabetic. But since I have controlled diabetes, I don't have much problem about it. I have bought monitors and am very determined to document everything and treat myself (with doctor's guidance of course) so that I wouldn't have too much costs. I guess in this world, we can't really expect companies or other people to take care of us. We just need to know more and keep ourselves healthy. Being a diabetic doesn't stop you from being healthy, do monitor yourself as well you'll see that you'd feel better and there would be less problems. God be with you always and you take care of yourself. Have a great MyLot experience!
1 person likes this
@KrauseHome (33267)
• United States
16 Aug 11
Well, I have insurance thru my work. Most of the time the insurance is a lot better than what I might have if I worked elsewhere. It does have it's limits like everything else due to what they are allowed to cover. The main issues I find sometimes is with stuff like Gauze, etc. used for my leg while it is is being treated, and then certain medications which are deemed expensive. So in reality I guess it just really depends but I know it is better than a lot of places out there.
@Hatley (158039)
• Garden Grove, California
10 Jun 11
hi tina oh my G How old are you, are youo on Social Security as I got on social security and lucked out with my gap insurance Secure Horizons when they suggested I fit in the older poor people and enrolled me in Evercare which has the best insurance coverage I have had. they pay for all my testing supplies and hospitalization , doctors even specialists visits cost me nothing., I do have to pay 150 dollars per ambulance trip but ny hospitalization at Care House rehab hospital was covered for 20 days. Do call Secure Horizons a nd find out abut EverCare as it might help you, I am sending a ton of prayers for God to make your leg wound a lot better and three hugs from me, a fellow diabetic Hatley.
1 person likes this
@KrauseHome (33267)
• United States
13 Aug 11
Well, I just turned 47. I have been on Disability before, but was removed when I chose to work, and since it has been over 5 yrs. since I was last on it, I would have to start all over, and have to wait 6 months from time approved, if ever before I would get any help Financially and then probably 2 yrs. for Medical help from Medicare. So anymore you cannot win. I am also married so trying to get help from someone else just does not usually happen as well. All I can say is things have gotten better since I posted this, but there are some Gaps that still could be better for sure.
@jillhill (37354)
• United States
10 Jun 11
Yes...and you get by with a little help from your friends....so count me in! I'll also send up a prayer that you find solutions!
1 person likes this
@KrauseHome (33267)
• United States
14 Jun 11
Thanks my friend. It is going to be a long battle it looks like with everything going on Health wise, but I know God is in control.