Insurance stress: CDPHP, St. Peter’s

health insurance

CDPHPI am experiencing some insurance stress based on two pieces of mail my wife and daughter received the same day last week. If you want to write a blues song after reading this, feel free.

The letter was from St. Peter’s Health Partners. It runs most of the city’s hospitals, clinics, and doctors’ offices that aren’t part of the Albany Medical Center. All of our primary care physicians are part of SPHP.

“Our records show that at the time of your last visit…, you… receive your health through a CDPHP commercial health plan.” CDPHP is the Capital District Community Health Plan. “Please be aware that [SPHP] has engaged in negotiations with CDPHP for a more equitable agreement to ensure we can continue to deliver high-quality, community-based care.”

Didn’t we do this dance a few years ago, which got resolved at the 11th hour?

In bold: “Our current agreement is set to expire effective January 1, 2023; meaning some patients may have increased financial responsibility when seeking care from [SPHP] in 2023 because CDPHP no longer includes the following facilities in its network.” Over a dozen facilities, including St. Peter’s Hospital, Samaritan Hospital, and five Eddy facilities, are on the list. Interestingly, no related mail from CDPHP has arrived.

On the coverage

Meanwhile, my wife and my daughter also received a Benefits Bulletin from my former employer, the Research Foundation for The State University of New York, or SUNY RF. “If you are a retiree or an eligible dependent of a retiree and you are not eligible for Medicare, your current RF benefits will continue for 2023 unless you make changes during open enrollment.” That window is November 1-30.

Just in case we need to make a change, I went to the SUNY RF portal to see if I could find the forms to change their coverage, but none of them seemed appropriate. Some were for the retiree (me), while some were for the retiree and dependents. I am on a different plan for administrative reasons.

So I called the SUNY RF number on Monday and then a different one on Wednesday. I was offered the same form to make changes, even though it didn’t make sense to me. If I change my wife and daughter to a Blue Cross program, I hope SUNY RF does not muck it up.

CVS

Meanwhile, a good friend of mine writes on Facebook: “We’ve…just been notified by [CDPHP] that CVS will no longer take our prescription insurance effective 1/1/2023… This is very upsetting because CVS is very convenient to where we live, has a drive-through, and the closest to our house is one of the only 24-hour pharmacies in the Capital District.” We got no such letter from CDPHP.

I called my local CVS pharmacist. They said that CVS has declined to take the CDPHP price schedule, so it may very well cost more to fill prescriptions there, but they won’t really know until they start filling them next year.

This issue will be a primary concern of mine this month because I can’t wait until the CDPHP/SPHP issue gets resolved in December if, in fact, it does.

Unsettled. Deeply unsettled.

too much insurance

unsettled.face-on-the-sun.enIn early 2022, I have felt deeply unsettled. The snow/ice event was an amazing time suck. I spent a minimum of 12 hours chopping ice over five days, and it was exhausting.

Returning the unwanted devices made me anxious because I needed to get them within 14 days. Not two weeks from when I got them but a fortnight after their package was sent. I went to one of those FedEx drop boxes, which was very convenient, even though I felt the persons checking me out gave me the vibe that I was some sort of terrorist dropping off an explosive device. And I’m still unclear about whether I’ve been compromised, though Experian seems to think not.

One of those annoying things I, and most retirees, have to deal with is a ton of solicitations from Medicare Supplement providers. And for a time I had two of these insurance policies. This was NOT a good thing. This involved getting reimbursed for the insurance I no longer had, paying for the new insurance, and waiting for reimbursement for that. Plus the hassle of contacting all of my medical providers.

Other passings

I’ve discussed Paul Weinstein, who I had last seen when his daughter and my daughter were inducted into the honor society in November; I attended his funeral. The choir sang at the funeral of Michael Attwell, with whom I had sung on Christmas Eve.

I had briefly mentioned Kay Olin Johnson, a fellow member of the Olin Family Society, who I last spoke with on 15 January. Subsequently, she commented on my Facebook page how much she enjoyed talking with me. Then she died on 22 January. On 3 February I contacted someone in my old office for Reasons and discovered that Kay had sent mail to my wife and me there.

It was forwarded a week later. Kay had sent her holiday greetings. She wrote of home improvements she did finish in 2021 but promised pictures of the changes in December 2022. She likewise suggested some genealogical news in the coming year. But mostly, her letter was about her far-flung family, who she greatly appreciated, especially since her husband Don had died 31 years earlier.

Betty Curtis, who died 11 Feb was an extremely talented member of my church choir and very generous of spirit. She was the one person who dealt well with a certain cranky soul. She was active in that choir from at least the 1960s to just a few years ago. Her birthday was a couple of days after mine. And she LOVED her Butler Bulldogs men’s basketball team. Her funeral is upcoming.

Health Care in America

It’s always disturbing to me when people are forced to start, or their friends initiate a Go Fund Campaign for someone’s health care. It’s more irritating when it’s someone I know.  Ken Screven, a well-known TV reporter in this area “faces mounting medical bills.”  His friends started a GoFundMe campaign and raised over $33,000, crushing the goal of $25,000.

But should this be the way we do health in this country?

Lockdown

At my daughter’s high school this past Thursday, two freshmen got into an altercation. Then one cut both the other kid and a hall monitor. The school went into lockdown; my daughter texted me that neither the students nor the adults in her room were quiet, as is recommended. Incidentally, the alleged assailant, 14, was hiding in the cafeteria with the other students until he was found out.

I was most annoyed with the tease for WRGB’s news broadcast. “Violence boils over at Albany High School.” The following day was remote, the third school district that went to distance learning that week for non-COVID reasons.

My daughter had already had experienced a rough week, so this did not help.

I read the news today

A crazy lady was complaining about the gazpacho police. Another GOP MOC says Americans must own enough weapons to overthrow the government if 30-40% agree on “tyranny”.

But I was most distressed by a former president hiding or destroying government docs. This goes beyond mere politics. This is proof – once again – that he doesn’t understand that the Presidency is a trust.

Also, not just the country but much of the world is at war over COVID mandates. I’m not quite to the surrender mode yet, but I’m teetering. Hey, I could say, I’ve got my three shots, and I’d get a fourth if suggested. I’m going to keep wearing my mass indoors, so don’t bother me if you don’t like it. But it seems the fight is tearing the fabric of society apart. It is wearying, as is the possibility of another Greek letter.

There are other things, but these are the big ones. The cumulative effect has left me unsettled.

Cash: don’t carry; you need your phone

rejected

moneyMy oldest college friend complained on Facebook. “It is almost impossible to use cash in the airport. You’re SUPPOSED to use a QR code to download a Health/Travelers form because there’s No Paper, but you need to sign up for an ACCOUNT to do it!!”

Yes, that was worth at least two exclamation points!!

There are a number of places where cash is no longer king. Getting food on an Amtrak train, for instance. A lot of retailers at markets seem greenback-averse. My running joke at a store register is “Do you still take cash?” Apparently, you CAN accept cash and checks with the service Square. Are businesses required by law to accept cash? It depends on where they are

What countries are going cashless? China’s society is, its central bank is pushing backSweden and Zimbabwe, for two, are also getting resistance.

Also, increasingly, I NEED to have a cellphone. When I’m making a medical appointment, I get notices on my phone. When I get there, some places require that I check in via the device. And the photo of my vaccine card is stored therein.

Not covered

Speaking of medical things, I had gone to my doctor in September to get two shots during my annual physical. In October, I received a bill for $125 for services not covered. My physician’s office seemed to think it was because I had received both the flu shot AND the tetanus shot at the same time. But that wasn’t it.

Medicare had rejected the tetanus shot, the representative told me. Now, they would have covered it if I had been bitten by an animal or stepped on a rusty nail, or had another medical necessity. But since I was ONLY getting it because physicians believe I should get one once a decade, Medicare didn’t cover it. And since Medicare rejected it, my Medicare supplement carrier ALSO rejected it.

I’ll have to remember to step on a rusty nail in the fall of 2031.

Why Health Care Costs So Much in America

A provider is dealing with an insurance company that is claiming my wife has additional coverage, something she did actually have, but cancelled three years ago.

A worker in a health care provider’s office told me this story. It explains a lot.

A medical provider rendered services to a patient in 2008, and subsequently submitted a claim to the insurance company, which paid it.
In 2010, the insurance company decided to not pay for the service because the patient had other insurance coverage.
The provider had to go prove to the insurance company that the patient had no other coverage.
The provider resubmitted the claim to the insurance company.
The insurance company rejected the claim because it was not submitted in a timely manner!
The provider noted to the insurance company that it had PAID the claim two years earlier, then rejected the claim in error.
The insurance company finally paid – again.

I know this story is true because another provider is dealing with an insurance company that is claiming my wife has additional coverage, something she did actually have, but cancelled three years ago.
***
Take Out Some Insurance On Me, Baby (Uncensored) – The Beatles featuring Tony Sheridan.

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