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[IP] re: Health Alliance Ins. -Ins. in general

HI Trish-
I hope all is well with you- sounds  little stressful right now so a big
Just wanted to say that I switched jobs in January and have new insurance-
which is brutal about covering supplies- I only signed on for the job
because my DME/pump would be covered 100%  (I was covered 100% at my old job
and new that was the only way we can afford therapy right now)
(after  signed on- before I actually started they decided we would have to
now buy our supplies through our RX plan (around $500 for copays every 3
months- nothing compared to what some people pay but between that and my
portion of the premium I'm earning thousands less than I was at my old job..
So as the only diabetic (in my office out of 200 folks I'm the only
one...co. wide with 55000 employees I bet there is someone else out there!
I'm one of the very few pump users the company may have-  I fought long and
hard- basically I said "if I'm the customer and I'm paying this much- here's
what I need to get" and how by putting my pump out of reach they were
disabling me and would see marked decreased sickdays and less "well dayS" at
the office...and forget productivity....Eventually they bent the policy in
my favor just a little bit (I can still buy my supplies through health
insurance not the rx provider- so they will be covered 100%)...
Companies are rather thoughtless in deciding on health plans-they try to get
the most for the least money and it ends up biting anyone who uses their
insurance for more than a yearly checkup in the arse...I know how irritating
the insurance co can be- but focus on the fact that they are only giving you
information as pre-defined by what your husband's employer has chosen to
purchase for their workers.
Definitely find someone in your husbands company who you can discuss this
with (I'm in a large co. and we have an HR/employee relations person...Call
HR and find out who you can talk to and don't just talk to a clerk)-it's his
companies decision to cover stuff like that not the insurance co....
Best of luck,
Sorry you are dealing with this headache!
Bekka Caruso
Type 1- 9.75 years
pumping- 2.75 years
15 weeks pregnant w/ "Leon"  (as in airplane "leon's getting larger!")

Date: Fri, 25 Apr 2003 09:15:37 -0500
From: "Trish Ober" <email @ redacted>
Subject: [IP] Health Alliance Ins.

I am wondering if anyone has ins. through Health Alliance - to be specific
this plan is called "Iowa Plus 200 with $7/$12/$25 RX".  My husband's
is merging and this is what they are proposing for health ins.  The cost of
$1,152.00 per month for a family plan.  Obviously I think the price is
outrageous to start with; but when reviewing the coverage worksheet and list
of formulary prescriptions I note the following and would like to know if
anyone has actually dealt with this company and/or this plan:
1.  Contract year maximum they will pay for pres. drugs if $2,000.00.
heard of that one on any other plan).
2.  The only meters/strips it says it will pay for are the One-touch Ultra.
(My BCBS will pay for any kind I chose and this new plan is not a HMO).
3.  The co-insurance you pay on Durable Medical Equipment and and pres.
does NOT apply to the Contract year out of pocket maximum that the
would pay.
4.  I printed the pres. formulary off the internet and it makes it very
that the MDL (maximum daily limit) for strips is 100 per month and ins. is 6
vials for month.  Now I have no problem with the ins. limit, but the strip
limit is another thing as I use about 12 per day.  On my BCBS all the endo
to do is write a presc. for the strips and put "dispense 400 per month for
approx. use of 12 per day" and the BCBS pays what its limit is for a 30 day
supply.  Is it that easy to get the MDL changed on Health Alliance?  My BCBS
formulary did not show any limit at all on strips, however I did have the
write the pres. that way just to be safe because prior to this year I just
strips whenever I needed them and after my deductible I always had a 20%
co-pay no matter how many I used but as of 1-1-03 they will only dispense a
day supply at a time so I got the presc. written up just so there weren't
questions on the amount.

If anyone can help me out who has this same plan it would be appreciated.
Right now we are on individual BCBS we applied for and received prior to my
getting type 1 at age 37 so I was thinking this was the perfect time to
to a group but we currently pay 607.00 per month for family coverage so I am
not sure it is worth switching.  My allergy shots of $27.00 per month are
covered under my current plan as it was a pre-existing condition and I had
sign a waiver to obtain the ins and obviously if we switch to the new group
the allergy shots would start to be covered again, but it looks to me like
diabetes scripts, etc. would not be paid nearly as well.

Thanks for any help and info.
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