AAAARRRGGHH!!!

[tavalon]

Ever heard of a Health Reimbursement Account? Neither had I until last week and I work in the healthcare field. My stepson's (well, I call him that, but his dad and I are not married)parents both got switched over to high deductable insurance with HRA's. And after much gnashing of teeth and research, it became clear to me that this is even more draconian than an HMO and now we are the gatekeepers instead of our primary care provider (the one good thing, IMO). Now, if all three of these folks were supremely healthy, this would be a good thing but you see, our son has autism. His monthly medication's alone cost about $500, and then there are the current round of tests he's needing to evaluate him for probable narcolepsy (let's not even get into the monthly cost for the Xyrem that he will be prescribed if he does in fact, have narcolepsy) and then there are the usual visits to the pediatric neurologist and so on.

I've always been behind universal healthcare coverage, but this is the first time it has become truly personal. I don't like the idea that my child may have to forgo some needed care because we can't afford it.

I feel like I've been kicked in the gut and I'm really pissed.

[babylonsister]

1. Here's some info on HRAs, and there are some other links at the

wiki link, if only to better inform yourself. I wonder if talking to the employer, who agreed with this IRS-sanctioned plan to begin with, would help. :shrug:

http://en.wikipedia.org/wiki/Health_Reimbursement_Account

[tavalon]

2. Actually, I now know way more than that wikipedia entry on HRA's

My frustration is that until we reach our $3000 deductible, the only help we get is $150 per month from the employer. After that, we get a bit more help, but really it's not much better until we reach our out of pocket maximum of $6000 per year. Well, that's my kid's father's plan. His mother's is less Draconian on the deductible (only $1200, instead of $3000 and out of pocket maximum of $4000) but her company only contributes $300 per year so overall, it looks like they are similar plans coming from two slightly different perspectives. Now, both of them can contribute their own money as well and that is tax deductible, and if we were talking just regular old doctor bills and the occasional antibiotic, it would be fine, but that's not our situation. Our out of pocket just easily tripled.

[tavalon]

3. Well, what a relief!

The people who are supposed to do my kid's sleep study called back with the estimate of cost and between that and the first three month supply of his current medications, we will have hit the maximum out of pocket expenses for the year. Yep, just have to figure out how to scrape between 4-6 thousand dollars in the next two weeks and then we hit catastrophic and I think they cover the rest of the year. I think.

:sarcasm:

[tavalon]

4. I know I keep replying to my own thread, but I'm actually venting

I was cooking my son his dinner, and thinking back about how HMOs made the primary provider into the gatekeeper with financial incentives to keep people from accessing specialty care unless absolutely necessary and as we saw many times, the lure of the money was such that for some PCPs, there was no threshold at which they would allow you through that gate. It was and is immoral. I never, until this week, imagined that the health insurance companies could come up with something even more immoral. Silly me. I call that a serious lack of imagination on my part.

Hyperbole alert: It feels like they are putting me in the position of Sophie's Choice. It was bad enough when the doctor was blocking my child's care, now it becomes my job!

Now, as a RN who has worked in an ER, I have a lot of evaluation skills that laypeople don't necessarily have (and if necessary, can even do certain care that might be a bit out of my scope of practice but not outside my ability. I would rather not fragment my family's care that way nor jeopardize my license, but we'll just have to see) and I have already been very conservative with basic care with my kiddo, but since he has autism, there are some really high dollar items that allow him to have a bit more of a reasonable life. The HMO doctors might have tried to block that care (once, only, I assure you. I am not someone to be messed around with and have no problem reading the riot act to a doctor behaving badly), but I'm never going to do that. That's my "Sophie's Choice". I'll go into bankruptcy before I will allow my child to go without his necessary medical care. What astonishes me is that there are thousands of laypeople out there getting transferred to these kinds of "insurance" programs and they aren't going to have the knowledge or the savvy to navigate them without getting severely screwed over. Hell, even with all of my expertise, we will likely get screwed over pretty badly.