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Insurance insanity

I realize that I have to have insurance. It was right around this time last year that I made my choice. I spoke with a representative and discussed my health issues. They tried to explain it to me; but unfortunately, it’s very difficult to understand. I just didn’t know what I didn’t know. It has led to the past year being a year of insurance insanity.

If you work for a major corporation, you may have insurance provided for you. If you are a type one diabetic, please check into Medicare coverage for yourself on the Medicare.gov website. There are some type two diabetics that are not old enough to qualify for Medicare coverage. Part-time workers, small business owners and independent contractors need to find independent insurance. The deadline for Marketplace Insurance this year is January 15 for coverage to start February 1.

I looked up insurance on the internet. I got redirected to the marketplace health insurance website. This also got my name and phone number into a database for all the insurance companies on the planet to either call or text me. I talked to multiple people from different companies.

I explained to each representative that I was a type two diabetic; and that I lived in a tri-state area. I wanted to be able to go to the best doctors to take care of my health. I went on ahead and picked an insurance provider that I thought would cover me, Blue Cross/Blue Shield Anthem Pathway of Georgia. I was wrong.

I started with a basic check up with my primary care physician. That bill was refused because my doctor was in Tennessee. I followed up with a mammogram. A basic service every woman needs to check regularly. That service was refused because I used a hospital, Erlanger, in Tennessee.

For my diabetic care, I tried to go see an endocrinologist. My endocrinologist was actually in Georgia. I even asked in advance if they took my insurance. They said they did; but once they saw the pathway at the end of my insurance, they did not.

Earlier, I had tried to take care of my big toes. They both had infections in the toenails. I had seen a coworker and my father lose their toes because they didn’t take care of them. Since I’ve had these infections for years and wasn’t able to reverse them with expensive medications and treatments, I decided to have the nails removed. Toenails no longer serve a purpose. Again, the doctor was in Tennessee, so they refused to pay anything again.

I didn’t understand that I had to go with their list of doctors. I didn’t realize that my insurance company didn’t travel across state lines. I knew I had an out-of-pocket limit to meet with no copays. The insurance policy only covered emergency care. The billing and refusal of insurance companies took so long that I had amassed a large amount of debt before I even realized that I had chosen the wrong insurance.

This was about the time I learned I had a mass in my left breast. I had a second mammogram to ensure there were no mistakes on the first. I went back to Erlanger. Then I started learning how insurance worked. Now the bills were starting to come in. I saw the insurance company wasn’t covering anything.

I disputed the refuse charge on my toenail surgeries to remove the infection and prevent future toe amputation. I asked for their help in finding a doctor that they worked with for their insurance to do my breast biopsy. They found me a doctor in Marietta Georgia. It’s only 121 miles away and takes an hour and a half to get there. There are two different medical complexes locally, Erlanger and CHI Memorial Hospitals, but they want me to waste my time and gas driving out of town. I explained this to them, but it did no good. They did not come up with any other options, even changing insurance plans to a more expensive better plan.

After two months going back-and-forth with my insurance providers and trying to get help from Erlanger, I went to the CHI Memorial system. I went on ahead and had the biopsy done anyway. Since my mother had just gone through having the same type of breast cancer a year before, it was terrifying! I also told my insurance company about mother's cancer, but they didn't help me find a local provider to do the biopsy leaving me to my own devices.

As each and every bill has come in, I've had to contact each and every doctor or hospital to negotiate my bills. Yes, you can work with medical professionals that would like to get paid. It’s interesting that in some doctors’ offices the billing departments are extremely difficult to contact. With tenacity or calling every number you can find, you can reach a human being and discuss your bill.

The interesting fact is that there are three different costs for every service. There is the large corporation insurance cost. There is the small plan insured cost. There is the underinsured/no insurance cost. I discovered I was in the last group.

When we are stressed, sometimes it’s nice to have comfort food. This week’s recipe is sweet with a good amount of natural fiber built in. The sweet butternut squash pie that I made is delicious. The detailed recipe is a bit like working with a sub-par insurance company, challenging with plenty of work, but the result is worth it in the end.

Sweet Butternut Squash Pie


Ingredients:

  • 1 large butternut squash, roasted & mashed makes 2 cups

  • 2 tablespoons olive oil

  • 4 oz or 1 stick of olive oil butter, softened (15 seconds in the microwave)

  • 2 eggs, separated

  • 1 cup coconut palm sugar

  • 1/4 teaspoon salt

  • 1/2 teaspoon cinnamon

  • 1/2 teaspoon ginger

  • 1/2 teaspoon nutmeg

  • 1/2 cup almond milk

  • 1/4 cup Morena Sugar

Directions:

  1. Preheat the oven to 350°.

  2. Rinse the squash, cut both ends off, and cut in half.

  3. Line a baking sheet with aluminum foil flat side up.

  4. Coat the inside of the butternut squash with olive oil and place face down on the baking sheet.

  5. Cook for 40 minutes. Remove and allow it to cool for 10 minutes. Separate the squash from the skin. If the squash doesn't fall right off the skin, cook for 10 more minutes.

  6. In a large bowl, combine the butternut squash, coconut palm sugar, egg yolks, milk almond milk, cinnamon, salt, ginger, and nutmeg and mix thoroughly. I prefer to use my mixer.

  7. Use a small food processor to beat the egg whites until they form stiff white peaks for approximately 4 minutes. Then mix in the Morena Sugar.

  8. Fold the egg white mixture into the butternut squash mixture; and pour into a 9-inch pie dish.

  9. Cook at 400° for the first 10 minutes. Drop the heat down to 350° and cook 30 more minutes. Remove it from the oven and allow it to cool for 10 minutes.

You will have to limit your slices. The sugar in this recipe can cause a temporary spike in blood sugar. It won’t sabotage weight loss goals because butternut squash is high in fiber. The gut scrubbing fiber will help cleanse your stomach leaving excess tummy sludge in the toilet while you get to eat a spectacular treat for energy if you have to deal with the mess from an insurance company.

Each time I got hold of a medical provider, I was extremely polite and explained my situation. There were a lot of shocked people. They were very kind and helped me work through the situation. I ended up paying 20% on average of what the actual bill was.

This year, of course, I’m switching. I contacted a friend that used to sell insurance. She set me up with a different insurance broker. When I called them, the representative was quite nice after I told her my story. She commiserated with me and told me how she had the same experience and paid full price. I explained to her about what I had done. She was amazed to learn that medical bills can and should be discussed.

I explained to her that I needed my insurance to cover doctor visits in Alabama, Georgia, or Tennessee. She told me this was not possible. I told her it was; and I was going elsewhere unless she could help me. She went to her supervisor and found out that it was possible.