Benefits Lapsed

Joey: Hmm that’s weird. I don’t remember being in a move called benefits lapsed.

Chandler: Okay, it’s not a check. They’re saying your health insurance expired because, you didn’t work enough last year.

Joey: Let me see that!

Joey: (reads it) Oh, I can’t believe this! This sucks! When I had insurance I could get hit by a bus or catch on fire, y’know? And it wouldn’t matter. Now I gotta be careful?!

Chandler: I’m sorry man, there’s never a good time to stop catching on fire.

Haha.. classic Friends. I love it. So I go to check my mail, expecting a few cards, a few invitations, a few packages and end up getting my annual notification from the district of our annual Insurance Benefits meetings, new medical and dental plans, and new premiums. Wonderful! Now I'm the first to admit that I know little about the districts decisions involving coverage, premiums and the company used to cover teachers medical costs, but I do have the basic understanding that what we are offered sucks. 4 different PPO plans, the two "middle of the road" plans being the most cost-effective for the average person are probably the biggest sellers. So why should it surprise me that they have increased the premiums and deductibles for these plans? Give me a break!

I rarely get sick. Most of my medical costs are preventative and wellness visits. So knowing full well that in the past 10 years I have needed to go to the doctor ONCE for an illness that needed medical intervention (Pink Eye.. thanks to my wonderful years in the daycare industry), I opted for the 2nd cheapest plan at $35 a month. Not too bad. First semester rolls by, barely a sniffle. I get past Christmas and back into the swing of things and the last day in January I get out of bed feeling a little.. slow. I go to work anyway and by 10AM I am not feeling great. Head into see our wonderful school nurse.. BAM: 100.7 degree temp. Having only taken one personal day for a family wedding in November, I opt to head home and nip this thing in the bud. Hah.. right. That night I shot up to 102.5, called into work, and slept the entire next day. Having not improved at all, I made an appointment w/ the doctor. Now the doctor I went to previously was a good hour drive from my home now, and feeling like absolute #$(&%#, I found a wonderful one 5 minutes away. Go in, a quick "breathe in, breathe out", explain the symptoms, swab of the nose, and confirmation of what I already knew. The lovely flu. I go to check out and clear my tab. That'll be $207.35. Um I'm sorry, I must be delirious. $200??? Hadn't met the deductible so I was paying out-of-pocket. Too sick to put up a fight, I hand over the plastic and head home with empty pockets and no medicine (not that it would have helped). Later that night, I have some sort of blood pressure drop or something because I about pass out on my floor, shake uncontrollably and my heart starts beating so fast I thought it was going to explode. Great.. that sounds normal. A (free) call to the doctor doesn't do much to reassure me.. "If it happens again, go to the emergency room." More sleep and the next day my fever spikes to 105.. I swear I was disconnected from reality. All downhill from there, but I end up taking 10 days off work with only 9 days to cover. My first day back was a blur. I still had a fever, about passed out during 3rd period and had to sleep in the clinic during lunch. Isn't life grand?

So I learned my lesson for next year... get a flu shot! That was my only run in with any doctor the entire year, and I paid $35 a month for my $200 bill. Now Thursday I get the joy of having the wellness visit I know all women look forward to as if it were Christmas, but these visits don't require a deductible so I'm hoping for a smaller bill. I'll wait til then to make my final decision, but the numbers don't lie. If I were to stay with the same plan next year, I'd be paying $50 a month for my coverage... which doesn't actually do anything for me until I reach the $1250 deductible (which will never happen) or I can pay $10 a month and still pay the same price out-of-pocket until I reach the $2000 deductible. And even IF I meet the deductible, I still have to pay 20-30%, depending on the plan.

Potential savings by switching plans: $480

Now as long as I don't get hit by a bus or catch on fire, the change will be worth it.