Damned if I do, damned if I don't...

[Beth Andrea]

So this is "open enrollment" for next years' medical insurance...

I have two choices (if I want my employer to pay most of the premiums):

Group health, which says it's cutting out most non-GH providers (my PCP and therapist are both non-GH; frankly I haven't had good experiences with GH medical people). If I keep GH, they will still pay for my SRS in January though.

HMA is the other choice, but it is exempted from providing SRS benefits due to its being a private insurance...but my PCP and therapist are in-network, so I can keep them (if I get HMA).

SRS? Or my Dr. and therapist? Hmm...

[Sophia Sage]

SRS.

[sarah1972]

Tough decision. I guess switching Endo is on the easier side. Switching therapists is tough since you built a trust relationship.
I am not sure if you are already paying for your PCP out of pocket or if it is at least covered at the moment. If you are paying out of pocket for them right now, the choice seems easier given the cost of SRS. Especially with your timeline. It seems like you are already scheduled and unless you can come up with the funds I would most likely stick with what you have now.

I faced a similar debate earlier this year - I could significantly cut my monthly cost by switching insurance but they are currently covering everything and I made sure the therapist I picked is accepting my insurance. The cost savings would have been eaten up by having to save for SRS and all the other out of pocket expenses. So at l least until I am post op it seems I will be stuck with my current plan.

[Valkyrie_2]

Omg... don't get me started on health insurance...
Ever since obummer care came out, insurance has become more of a scam than ever. The only insurer in SC is Blue Crook Blue ->-bleeped-<-. There is no funding fir the healthcare exchanges so the poor never get respite. Then this obummer care garbage has generated a level of token policy that's $10 a month - cheaper than being fined by the IRS fir being unable to afford insurance. This token policy covers nothing.

I'd better stop there before I get accused of favoring one political psychopath over another!


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[Michelle_P]

Regarding insurance, be careful what you ask for.   You just may get it.  Before recent changes in federal US law regarding insurance, I was declined for individual insurance multiple times for preexisting conditions.

"Ah, yeah.  This transgender thing?  Our people say since it is something you were born with, it's a pre-existing condition, and not covered. Since you didn't disclose that on your insurance application, we're invoking recission and retroactively cancelling your policy.  Have a nice day!"

It will make individual insurance cheaper for some people if we roll back the ACA, at the expense of cancelling coverage for folks that might need relatively expensive treatment or have long term expenses.  Hint:  That would be us, among others.  We'd all have to find positions working full-time with large corporations to get our care covered.  I'm in my 60s and worked in a field with rampant age discrimination, so I know where that leaves me.    In a small urn on my wife's mantle...

[Beth Andrea]

I went with Group Health, because my surgery date is early Jan, and I don't think insurances can switch that fast...and the other insurance would only cover 90%, after the $100 deductible (for inpatient surgery) AND after the $750 individual deductible (I think that's what they call it).

I'll just deal with it.

[Valkyrie_2]

It will make individual insurance cheaper for some people if we roll back the ACA, at the expense of cancelling coverage for folks that might need relatively expensive treatment or have long term expenses.  Hint:  That would be us, among others.  We'd all have to find positions working full-time with large corporations to get our care covered.  I'm in my 60s and worked in a field with rampant age discrimination, so I know where that leaves me.    In a small urn on my wife's mantle...

The problem in SC is Obummer care does not exist. What Obummer care has done is led to people being fined for being unable to afford health insurance. And it has brought in fake health insurance policies. That's all it has done in SC. Basically, all negative. I was stuck without health insurance from Jan of 2014 because my new employers didn't pay much and provided no benefits. My current employer has a scam policy that's cheaper than being fined (I got fined) that covers nothing. In fact, it's cheaper to pay the doctor out of my own pocket than to use my insurance, if I ever could afford to visit the doctor!


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[Michelle_P]

The folks in your state may want to consider doing something about that. Insurance companies are regulated under state law, and the states insurance oversight is the first line of regulatory enforcement. You might have a slight case of regulatory capture, where the insurance regulators are effectively working for the insurance companies.

If enough people are frustrated and angry about the situation they might be able to force a change. That happened in my state about 25 years ago, and we saw improved coverage and lower rates within a year. ACA compliance was trivial as we already had required similar benefit levels.

Sounds like you might have a good political cause to fight. Don't let them con you into believing ACA is responsible while they line their pockets.


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[DawnOday]

So this is "open enrollment" for next years' medical insurance...

I have two choices (if I want my employer to pay most of the premiums):

Group health, which says it's cutting out most non-GH providers (my PCP and therapist are both non-GH; frankly I haven't had good experiences with GH medical people). If I keep GH, they will still pay for my SRS in January though.

HMA is the other choice, but it is exempted from providing SRS benefits due to its being a private insurance...but my PCP and therapist are in-network, so I can keep them (if I get HMA).

SRS? Or my Dr. and therapist? Hmm...

Group Health is merging with Kaiser so their doctors will also be available. My therapist is Kristi Conner in Tacoma and my GP is Peter Lightbody at the Kent clinic. My experience with Group Health whether saving my life during a heart attack. Saving my wife from gangrene. To my transition have all been preformed with the utmost compassion and professionalism. Also Emili at the Tacoma Mall location is giving me speech therapy. Of course I am on Medicare so there are certain things covered that are not in private insurance. They have even gone so far as offering an Orchi when I'm ready. There are surgical opportunities for generally considered cosmetic surgeries if there is medical necessity.

Omg... don't get me started on health insurance...
Ever since obummer care came out, insurance has become more of a scam than ever. The only insurer in SC is Blue Crook Blue ->-bleeped-<-. There is no funding fir the healthcare exchanges so the poor never get respite. Then this obummer care garbage has generated a level of token policy that's $10 a month - cheaper than being fined by the IRS fir being unable to afford insurance. This token policy covers nothing.

I'd better stop there before I get accused of favoring one political psychopath over another!


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You really need to direct your anger to Nikki Halley and Lindsey Graham, Tim Scott, Trey Gowdy among others. They failed to establish a state exchange, thus a limit to one provider. By being unreasonable and having success pulling the wool over peoples eyes, they have convinced folks that Obamacare is some sort of scheme to raise prices. Fact is the rates would rise no matter what. We are a liberal state in WA. So our government set up state exchanges and we have like 7 providers and 47 different plan selections, that was 2012 today there are considerably more choices. Also Halley has thwarted medicaid. At this point it is all self inflicted.