Frustrated in NC

cah0806
cah0806 Posts: 112
edited September 20 in Health and Weight Loss
Has anyone else had a problem with their health insurance and doctors??
I checked my company's website to see if a nutrionist/dietician visit would be covered. Yes, but as a specialist with a 60 dollar co-pay (up from 40 since last year). However, when I called to set up an appt I was informed that they can't see me without a referral. So, I called my doctor and they can't refer me without an appointment with them (my family doctor) first. Because my weight issues are not specifically documented in my file, she can't refer me. Hello...I am on anxiety medicine to help with overeating. And they have my yo-yo weights documented. Do you see where I'm going with this?
It's a vicious cycle. And that's not the best part...
My insurance company (which is the plan for state employees) is going to penalize people over a certain BMI starting in June. Those people won't get the best coverage/will have to pay for it. It is currently free to employees only. Then in 2012 the requirements are getting even tougher.
This doesn't take into account that most of us work 10 hours a day, cram down breakfast and lunch while working, and get home too exhausted to cook healthy, let alone exercise. Not to mention that they keep expecting more from us with less incentives and less planning. So I usually drag home half of my classroom with me every night.
Okay I am through with my pity party. :sad: Just didn't know if I was the only one who saw the irony in this.

Replies

  • Advengirl
    Advengirl Posts: 88 Member
    :(

    All I can say is ::hugs::

    And YOU won't have to worry about being over that certain BMI in June and in 2012...cause you've got mfp..and you are so so SO close to your goal. :D
  • cah0806
    cah0806 Posts: 112
    :(

    All I can say is ::hugs::

    And YOU won't have to worry about being over that certain BMI in June and in 2012...cause you've got mfp..and you are so so SO close to your goal. :D

    Thanks for the hug...just what I needed. :happy:
    True I'm close to my goal, but the sad part is I still don't think I'll be in "their" range. Oh well!
    I smell a lawsuit brewing anyway.
  • LittleSpy
    LittleSpy Posts: 6,754 Member
    Unfortunately that's just how HMO's work -- you have to be referred EVERYWHERE by your "primary care physician." And if your primary care physician is greedy (or maybe just if they haven't seen you for a while and want to be sure a nutritionist is actually what you need), they make you come in for an office visit first. If you had a PPO rather than an HMO, you wouldn't need a referral, you could just make the appointment and go.

    I'm a state employee, too (SC) so I understand where you're coming from. Our insurance company has promised us (I'm a Benefits Counselor) they won't be imposing any surcharges related to weight but they've penalized tobacco users beginning in 2010. But, count your blessings because I pay $10/month for my insurance that has a $3,000 deductible. Yes, that's $3,000 out of my pocket before it pays a dime. The next cheapest insurance offered to SC State employees is a PPO and it's $100/month with a $350 deductible. The 2 HMO's we are offered (which would be comparable to your insurance) are $190 and $250/month. These are the premiums for the employee only, mind you. Forget about adding your spouse or children. One of the HMO's is over $900/month for full-family coverage. And these are the parts of the premiums the employees pay. Each of the agencies pay a huge amount toward the premiums for their employees, too (in addition to the premiums above). So, if your insurance is free, it sounds like you guys have it pretty good. :flowerforyou: So, I guess that's the end of my "it could be worse" speech. :laugh:

    And, are they seriously going to go by a BMI chart? Or are they actually going to pay to measure every single employee's body fat correctly (read: expensive)? Because the BMI chart really doesn't apply appropriately to many people.
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