Update on Health Insurance and How it Has Affected My Life Today

Ali: Hello everybody, welcome back. it's been a minute. I took a a slight little hiatus, but I wanted to come on today and just give us a little update on life in general, but also my insurance disaster. So Life in general. S this summer has been was crazy. I mean, I I don't know, these kids are just getting older and I'm an Uber driver and it's always going somewhere, doing something. my daughter's big into soccer, so she's doing individual trainings and private sessions, and I gotta be here for an hour and there for an hour and take this one over here and this one over. I mean, I'm preaching to the choir. But I just feel like the age my kids are right now, they're more social, they have more they have goals that they're trying to set. So we're trying to like Meet them where they're at and make sure that they are as supported to meet their goals as they can be. And they could not be any further apart if they tried. my oldest is very academically driven. My youngest is more athletic, although she does well in school too, but yeah, it's just wild. So a lot of time traveling for sports, a lot of time in the car, a lot of time supporting my daughter and her love of reading and books and getting her friends and doing all the friends to come over and meet the pool and like you know, you know how summer goes. That's just kind of what it was. We traveled a lot. We had a surprise soccer tournament in Florida we weren't aware of in June, and that was a solid five or six days, seven hour drive, pretty intense. we had summer camps, sleepaway camps. My daughter went to Boston for a week, all of that. And I You know, the point of this episode is really to update on my insurance and all of s why I even bring all of that up is because I dropped the ball a lot. and then we had a family cruise for my parents' fiftieth wedding anniversary. We all and by we, my brothers and sisters, one aunt and another aunt and uncle went on a cruise in the Caribbean, well, Mexico, Belize, Honduras, for seven days and there was twenty two of us. And it was it was great. It was an awesome time. It was exhausting, but you know, there's a lot of prep leading up to that, a lot of prep afterwards. So I have let the insurance ball drop. While I was on the ship, I did get another bill for I don't know, six thousand six hundred and sixty-seven dollars and fifty cents due by August twenty-fifth. It's August twelfth today. And I got a text message yesterday about it. So I have an update based on that information, but none of it is resolved. the insurance company has still not made any payments. if you're new here and you missed it, basically I've been getting infusions since twenty twenty-two. I've had several different insurance companies over those years, but the last one I've had for well over a year, I think I started I don't know, maybe my first infusion with them was in February 2025. And every month I had to get an approval. The doctor's office runs your insurance again, gets you a pre-approval. They do it for the entire year in January, and you get a pre- a yearly pre-approval, but that's not good enough for them. They want to make they double down and they want to make sure that they're gonna get paid because the bottle that my rheumatologist uses is called a buy-in-bill model. That means that the rheumatologist buys the medications from the pharmaceutical company. And then they bill your insurance and the insurance and they they administer the medication in office and then they bill the insurance company and the insurance company pays. That's the buy and bill model. I forget what the other model is called, but it's a more traditional role where like the doctor writes the prescription, it goes to the pharmacy, the pharmacy gets the coverage, you pay the difference, and then you would go to an infusion center and have it infused there. That's not the model my doctor does. They do the first model. My insurance company is saying at one point they told me they only accept the second and they don't accept the first. Well, they approved the first for well over a year, and now I have an outstanding balance of close to $82,000, which I'm told is not my responsibility because it's on the business-to-business end. But it's my name is still attached to it. So until it's resolved, I don't feel good about it at all. I'm still getting bills. That one sneaked through according to I talked to the rheumatologist yesterday. They I'm not really sure how that one snuck through. We're still dealing with it. And this woman was so sweet and she was just said, Let me call the head of billing in the whole company and see where this lands and try to get some eyes on this and see what happens. Well, she called me back not ten minutes later and said, Yeah, they are well aware of who you are and what you are and this issue, and they are strongly working on it and I think there's attorneys involved at this point. I do think that they're moving forward with some sort of legal action to get paid. Which about an hour after that conversation I thought to myself, Hmm, should I get an attorney? Because ultimately my name is still attached to this. And let's say that, you know, these people are all good people and I've been in this office for seven years and they know me and they blah blah blah blah blah. And it's a big it's a big practice. There's multiple locations in the Char Charleston area, so they don't all know me. And what if they sell to some evil corporate empire and then they come after me for eighty two thousand? Or what if the lawsuit goes bad and they need to recoup some of it so they charge me for 82,000 I don't know. I mean anything is possible in this world, so I don't like it. Stress is my least favorite trigger on the whole planet. I you know, there's no fun in stress. Like it if I eat gluten, it usually tastes pretty good and there's a little bit of reward and then I'm miserable for a week afterwards. stress there's no reward to it. I don't like it. This is a nightmare situation. I I st I don't have coverage right now. I'm still just doing cash pay whenever I have to. I don't have any treatments going on right now. So I could go back on the marketplace and roll the dice. I did this once in between because I wasn't happy with this insurance. I let the year go out. It was renewal time. I tried a different insurance on the marketplace. I paid it. I they put an application to get my pre-approval. That takes time. That's not something that happens in a day. Because of this is like a an expensive $8,000. They bill $8,000 a month for this. Because it's so high, the approval process takes weeks. say I purchased something today. It's August 12th. My insurance wouldn't kick in until September first. And then I would have to go through the process of will they accept this or not? Now we're it could be the end of September and I still don't know. And now I've spent money and time and all this. So I the only reason I know this is because I've done this. I'm not like this is not something that it's theoretical. This is exactly the process. So it can be two months. I could get a new insurance, pay for it, and two months later find out no, they don't cover it. And then my options are if they cover the bill, they don't cover the buy and bill method, they'll cover the other method. but then I gotta get a new rheumatologist because they don't do that there. They only do the buy and bill there. So then that's you know, however long for me to get another rheumatologist, six months max, minimum, six months. So my options are shipped. I don't have any good options right now, and I don't I'm not like in a position where I can just put out thousands of dollars a month. And wait and see. And then hopefully I can get the money back. I did get the money back the last time when the previous insurance wouldn't cover it. I I was able to cancel and they did get it back. But I was without $2,400 for a couple of months while all of that figured out. And that's not a position that we're we're kind of tired of doing that. It's a lot of money to put up front and we don't want to do it. So we're hoping to try to get to open enrollment, which is in November, for my husband, so I can get on his insurance. Which had I known back in January or last October, this insurance was probably not gonna work well for me. I tried to get another one. I would have gone on his plan. It was gonna be more money. And money is tight right now, as it is for everybody. So I didn't do that. Had I known all of this was gonna be happen, I would have done it. But I didn't do it because I was like, well, this insurance is covering it. It's a little bit cheaper. We're gonna stick with this. It's kind of a shit insurance, anyways. It doesn't cover anything else, but I get my infusions and that's the main thing, and I can keep my doctor. Well, my last infusion was April 8th. So they stopped, they denied the May claim. And so I have not had any infusions since April. So I don't feel good. I'm taking a GLP one, which is helping with the reduction of inflammation, but after a week on a cruise ship. Where I have less control over what I'm eating, less sleep, more alcohol than I normally have, you know, just being up all day and night and just, you know, not my regular routine. I did come home not feeling well. I didn't feel there was three nights that I was in bed at nine o'clock though. I I just couldn't do it anymore. And one day on shore that we stayed on the boat. we went to Honduras first, the second day, it was three days in a row in port. So Honduras the next morning we were in Belize, the next morning we were in Casumal. And I was like, Belize it all the excursions were two hours in port. So I in my head I'm thinking, okay, so we're gonna spend the all day off boat in Honduras. Go to dinner, get up in the morning, and then we had to be like off the ship by seven AM, like six thirty in the morning if I was gonna do these excursions. And two hour bus ride to God only to the jungle to look at the Mayan ruins. It was like you didn't get back on the boat till like six o'clock at night, and then another two hours said, This is not gonna work for me. So my husband and kids are so great about it, and they were like fine with it. And my sister and a couple of other people had already been Belize and seen the ruin ruins and everything else that some of the other people are doing. So we stayed on the boat that day. And when I tell you I took three naps that day, I took three naps that day. I was in and out of my room all day long. I'm tired. I don't feel good. And then usually by like five or six o'clock at night, I start to feel better and I'm awake and then I stay awake for a while. It's just this vicious cycle. So not having health insurance for a cruise was a big deal for me. And yeah, we're rolling the dice a little bit. I did actually come home with a UTI and I needed an antibiotic and I had to go to urgent care and I paid $135 out of pocket and then another ten doll the antibiotics with coupons from good RX or wherever else. And that was fine. that's what I will continue to do until November. So there's no good options for me at this point. I don't have any real solid information. The insurance company has really screwed me over. I wish they had just told me from the get go a year and a half ago that they didn't cover this instead of every single month covering it and pretending to cover it. So I don't I don't know. I feel like I need an attorney too because they've screwed me big time. so that's where we stand with the health insurance update. It's not a good one, it's not a lot of information. I sharing it with you in hopes that if this ever happens to you, you don't feel so alone, you're not crazy, this is a nightmare, and the health insurance a scam. I did have to start taking prednisone on just a low dose, four milligrams at night. I might have to start taking it in the morning too. I don't know. we'll see. I'm I'm hopeful not. And I did have some on hand. I've been had this disease for seventeen years almost, and I know how to treat the times in between like flare times like this. And I have had that prednisone in my thing for it's probably expired. It's working. I don't care. don't be like me. Don't be like me. Have insurance. That's good. Don't take expired medication. I don't know if it has expired, but it's been in there for a while. don't be like me. I'm I'm not a doctor. I'm just a crazy mom on the other end, just trying to make it through the day, trying to get to November and figuring it out from there. But yeah, that's I I know if I had gone to the doctor, they would have put me on that anyway. They've done it, I've had five different doctors in 17 years and they all do the same thing. So there comes a point when you've lived enough of this that you know I I would venture to say I know more than a lot of the rheumatologists out there. Maybe they're only been in the business for a minute and I I have seventeen years of lived experience. So don't be like me. Don't do what I do. I'm just telling you what I do. That's about it. That's all I got. This is going to be a short episode. I am looking for new guests. So if you would please help support me and go to my website, the autoimmune mom.com. on socials, it's the autoimmune mom podcast, but my website is the autoimmune mom. So if you would go there and give me a review and s if you want to be on the show, please, if you have a topic, you can send me an email there. You can send an email to the autoimmune mom podcast at gmail dot com. if there's something that you want to hear about, then more than likely there's lot of people out there that want to hear about it. So this little podcast of mine is I have no idea what I'm doing. I've said that a million times. I'm very much winging it as I go. And it's starting to grow on its own. I did no episodes and no promoting on social media and nothing for a month. And I I did see it jump in and listens per episode. So but I I could use your help in getting it out there. There are other moms out there. You know them, I know them that need to hear this. And yeah. So if you want to be on the show, if you know a mom who would like to be on the show, if you want to nominate a mom, I'm happy to reach out in a non-aggressive way. the last thing I want is to force anyone into this. But yeah, if you have any suggestions of how I can build this bigger, if you're an influencer somewhere, that's the part I struggle with. I don't like The influencing side of it. not that there's anything wrong with that. It's just it's very hard for me. I I'm not one to be on my phone. Like, I don't know. I'm not a good self-promoter. I'm not in real estate either. I that's probably my biggest downfall in real real estate is I don't have this huge website and all that stuff. I I I will share pictures of my kids and my family because I'm a thousand miles away from my family. but that's about it. I'm terrible at that. So if you have any suggestions. Tips or tricks. I would love to hear from you. That's all I'm saying. Please share, like, subscribe, leave a review. That helps, I guess, on Apple and Amazon. That's what every podcaster says. So I guess I'll believe them. but you know, this is a niche podcast and it is small, and I know that, and I don't expect it to ever be huge, but I do think there's value. And sharing for other moms out there. So if I could, you know, get it to cover the expenses of having it, then that would be fabulous too. It's not my big draw. I don't do it for money. I'm not making any money. I'm spending a lot of money on it and not making a dime. but I think that there's value in it and so that's what I'm doing. So Anyways, have a great day. If your kids are back in school, congratulations. If they're not, and you still got a couple weeks left, I'm jealous. I love having my kids home. I like when they're in school too, because it does give us some structure and gives me some time to do this kind of stuff, which is hard to do when your kids are running around. but I love when they're home. You know, I'm next summer my daughter will probably be working most. And yeah, so I'm just enjoying the season that I'm in with them. The Uber driving, my Uber driving era, as they say. Anyways, thank you all. Hope you have a great day, and we'll see you soon.