#insurance::network
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Insurance: Details about Marketplace plans that were available to me
Based on notes I took while deciding on my new insurance plan, here are some limited details about Marketplace plans that were available to me in the state of Michigan. You may or may not have the same plans available.
Blue Cross Blue Shield PPO
-- Purchase decision: ✅
-- Certificate of Coverage published: ✅
-- -- No stated "one per lifetime" limitation on sterilization: ✅
-- -- Coverage for treatment of complications related to non-covered services: Doesn't exclude coverage: ✅
-- No referral to see specialist: ✅
-- Key providers and facilities in-network: ✅
-- Available plans: Secure, Extra, HSA
-- Reject reason: None
Blue Care Network HMO
-- Purchase decision: ❌
-- Certificate of Coverage published: ✅
-- -- No stated "one per lifetime" limitation on sterilization: ✅
-- -- Coverage for treatment of complications related to non-covered services: Doesn't exclude coverage: ✅
-- No referral to see specialist: ❌
-- Key providers and facilities in-network: ✅
-- Available plans: Select, Preferred, Local, Metro Detroit; some of these weren't available in my region
-- Reject reason: Need referral to see specialist
UnitedHealthcare HMO
-- Purchase decision: ❌
-- Certificate of Coverage published: ✅
-- -- No stated "one per lifetime" limitation on sterilization: ✅
-- -- Coverage for treatment of complications related to non-covered services: Explicitly includes coverage: ✅✅
-- No referral to see specialist: ❌
-- Key providers and facilities in-network: ❌
-- Reject reason: Need referral to see specialist; Key providers and facilities out-of-network, with smaller network overall
Molina Marketplace HMO
-- Purchase decision: ❌
-- Certificate of Coverage published: ✅
-- -- No stated "one per lifetime" limitation on sterilization: ✅
-- -- Coverage for treatment of complications related to non-covered services: Explicitly includes coverage: ✅✅
-- No referral to see specialist: ✅
-- Key providers and facilities in-network: ❌
-- Reject reason: Key providers and facilities out-of-network
MyPriority Health HMO
-- Purchase decision: ❌
-- Certificate of Coverage published: ❌
-- No referral to see specialist: ✅
-- Key providers and facilities in-network: ✅
-- Reject reason: Certificate of Coverage not published
McLaren HMO
-- Purchase decision: ❌
-- Certificate of Coverage published: ❌
-- No referral to see specialist: ✅
-- Key providers and facilities in-network: ✅
-- Reject reason: Certificate of Coverage not published
#insurance::marketplace#insurance::certificate#insurance::network#insurance::hmo-ppo#insurance::marketplace::bcbs#insurance::marketplace::bcn#insurance::marketplace::uhc#insurance::marketplace::molina#insurance::marketplace::mypriority#insurance::marketplace::mclaren#strategy::sterilization#strategy::self-pay
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I wish that people gave a shit about nonbinary people who don’t use they/them pronouns. You can literally give your friend group (which includes another nonbinary person) a list of your favorite pronouns, none of which include they/them, and mention several times that you don’t like they/them pronouns for yourself, but they’ll make the switch from she/her pronouns to…they/them. And feel super proud of themselves for being sooo progressive as to use they/them pronouns for you….when those aren’t your pronouns.
I think that saying “he she and they are my least favorite but are fine in combination with other things…I’m really fine with any neos but here’s a list of my faves that you can choose from!” Is polite and not a difficult request. I’m not good at being a pushy person, and I shouldn’t need to be.
#it screams#i guess I’ll pull the lists out again and re-link them#but the aforementioned friends view messages from me as a chore and check them rarely so when they do they’ve built up and so just skim#everything#which I’m fucking tired of#I’ve been going back and forth on whether it’s better to have no friends or a few friends who make you feel shitty#dunno which is worse#they also are extremely cavalier with covid while knowing I have no health insurance#and have supported some statements/actions that really make me sad#so idk I might be basically friendless at this point#i hold on for too long to people who have clearly moved on and don’t much care about being my friend anymore#I’ve tried reaching out a few times to no avail so idk I might just give up#try to cultivate online relationships more#which feels pretty impossible to me#sigh#I’ve been not able to sleep well#because of issues in my life with…all of the few people in it#issues that could be solved if I had kept a wider support network#instead of getting trapped with someone who was abusing me and my friends who don’t seem to give a shit about that and expressed more#concern for him than for me when the news was revealed to them#again I don’t have health insurance so no therapist#which I fucking desperately need right now#i have no one separate to talk to#the one who knows all of the different factors from all of the angles…is the abuser#i feel like I’m in so much fucking pain and I feel so alone and all of the people in my life who are supposed to be my loved ones#are standing around me ignoring me completely and acting like everything is okay#just causing me more and more pain#well this didn’t start out intended as a vent but it sure turned into one huh#i wish I could convey to y’all the desperation and loneliness and aching that I feel#vent
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i have an ear infection!! and possibly pneumonia. no wonder i havent been getting better
#apparently the stuff for the ear infection will treat the pneumonia if i have it (since its been a week) but#they gave me the option to have a chest xray to make sure but i figured if its gonna be treated anyways#she said i didnt have to so im not! paying for it#i also paid $180 instead of $35 bc for some reason my insurance wasnt going thru. lmao help me i picked a provider that was in network#i do understand how it be tho but i did NOT have $180. i should be reimbursed soon tho hopefully#mara's shit#yay more time off of work to die
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im going to do it for real this time (drop out and get a job)
#my bro got himself a job at some idk tech startup that works w u.s. moving companies and theyre still hiring so im thinking like#what the hell ill give it a shot id have to get training first anyways so if i dont like it ill just say 'this isnt for me buh bye'#and i mean. i could always quit after a few months etc. but uni?? im quitting that shit for good i am NOT coming back...#ill just wait till october and then just. not enroll for the next year..#which also gives me time to use the lovely student benefits (health insurance) before i drop out...#ive been putting off making those appointments so like. best to take advantage of it while i still can#and also the plan is to take a graphic design course or sth so i can have at least an online certificate or sth for employability#so if all else fails im going into graphic design and illustration NOT CLICKBAIT. hopefully some ppl i know could even get me into somewher#hashtag networking pays off#piksla.txt
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People love to pay a monthly premium for insurance and not know how to use it. God bless, you are all so stupid
#no your medical insurance is not dental insurance#it would be sosososo nice if they were the same thing#and sometimes they are#but often they are not#you should familiarize yourself with your coverage#and you should absolutely find out if the dentist you booked online bc it’s nearby is actually in network#you should also do this more than 2 hours before the appointment#I have opinions
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Today in "blatant misinterpretations of songs that I like better", I have decided that Ghost Riders In the Sky is about what happens to you if you stay as a seasonal worker forever
#you get killed via exhaustion and no health insurance and ride that company f150 forever in the sky#Johnny Cash#some NPS employees gave us career advice today and it's looking like a good chunk of years more of instability is the norm when#looking for work in this sort of thing#they emphasized luck lots of experience with low paying positions networking and novella length federal format resumes#listing every tool you've worked with and every potentially relevant Task you've ever done at work
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One of those days
#I feel like every time I go anywhere everyone around stares at me like they hate me or they're scared of me#between that and the wwgg debacle I feel like I'm actually going to go insane#everyone in the world wants nothing to do with me#I want to just stay inside and rot#and my birthday is coming up in a few days amd that's just a huge reminder that I pissed my life away#and now I probably will never get to move on from this place#cuz my folks are both in poor health and have no support network to speak of#plus that weird shit that happened with my eye last year has been going on for a few days#it feels like there's something serious wrong with my brain#cuz there's other concerning stuff too#but again I'm kind of in limbo with insurance so#idk#I'm just gonna sleep it off
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#rebecca traister#marriage#uspol#this article is honestly a bit of a muddle structurally#but i think she touches on some good points#and i also just. appreciate the invitation to give the increase in lobbying for Marriage a good skeptical squint#because honestly i've encountered very little skepticism about the institution even in liberal parts#and i do actually think it's like. seventeen weasels in uneasy harness#like fundamentally the fact that you get a tax break for being married is. what the actual fuck.#similarly i know it's like. considered irresponsible to be down on marriage because it's important for queer ppl to have equal access to it#in the face of a society that has often refused to recognize our relationships‚ and i get that#but like. in an ideal world i think more people ought to explicitly set up medical proxies‚ iron-clad wills‚ etc#rather than the current setup where Marriage is meant to serve as shorthand#for a bizarre assortment of statuses‚ some of which should be more broadly available—#people ought to be able to share their health insurance more broadly!#(i mean for that matter health insurance shouldn't depend on employment‚ for many reasons.)#(but like. it's a whole fucked up chain. you depend on a company affiliation; yr spouse depends on a spousal affiliation)#(and anybody who can't or won't get themself within the pale of a network that will shelter them? is just fucked)#—and some of which shouldn't exist at all. like. i'm sorry. governmental financial incentive to enter into wedlock???#anyway i don't think i've ever seen any skepticism/alienation wrt marriage on here except from soph#so i can't imagine this tag rant will be a particularly popular opinion#but it's like. marriage IS a conservative institution and societal pressure to engage in it is part and parcel of the machine#that's trying to grind us all back towards christian white supremacist cisheteropatriarchy etc etc etc.#(and yes there are many people of various marginalizations who dig marriage)#(and to whom their own personal marriage is imbued with its own individual meaning)#(and like. a marriage between marginalized people does not cause them to perfectly fit the trad model and receive perfect acceptance)#(like. just look at buttigieg.)#(but like. similarly it's true that the attempt to restrict abortion access is a deeply conservative project)#(even as there are more nuanced conversations it's possible to have about particular axes of reproductive justice)#(was that enough disclaimers?)
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After I got off a >1.5hr phone call with the health insurance company, F offhandedly mentioned that she wouldn't have the stamina anymore to do that and just... 😭
How do we have so many barriers to care for the sickest people???
#scheduled somewhere else again since the place we had appointments for next week is apparently out of network#(despite confirming it was in network with insurance beforehand)#the soonest neuro appointment was the end of June though - that's 6 months into the year we're trying to hit our (high) deductible 🙃#*sigh*
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so so so so excited to get these frames next month they make me feel glamorous
#i feel like elton john in them 🕺🏻#i never thought the cute arts district optometrist would be in-network but they areeee <333#i’m losing my insurance in january BUT ☝️ i’m gonna. use it while i got it and not hold back on my frame choice amen#elfies#photo diary
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Insurance: Certificates of Coverage for Marketplace plans -- is there no "one per lifetime" limitation?
I'll need to switch to a Marketplace plan effective 3/1 anyway, so I've been shopping for a plan.
What's a Certificate of Coverage?
Here's a good working definition: "A certificate of coverage is an official contract that outlines what an insured is entitled to, and what they aren't insured for, under a health insurance policy."
Of the Marketplace plans available to me, most haven't published Certificates of Coverage, but some have. In my unusual situation, I can only consider Marketplace plans that have published Certificates of Coverage.
Implications of Certificates of Coverage
Regarding the possibility of self-pay:
Some of the Marketplace plans' Certificates explicitly include coverage for treatment of complications related to non-covered services. Notably, none of them exclude this coverage. In contrast, my current private insurance plan explicitly excludes this coverage.
Regarding possible coverage as sterilization:
Under my current private insurance plan, coverage of sterilization under diagnosis code Z30.2 [Encounter for sterilization] is limited to one procedure per member per lifetime. However, these Marketplace plans' Certificates don't state the same limitation. Certificates are contracts, and typically insurers try to exclude everything they can; so, while the absence of an exclusion doesn't imply an inclusion, it's a good sign.
I also noticed that certain other procedures--like bariatric surgery, for example--are limited to one procedure per member per lifetime by these Marketplace plans' Certificates. That tells me that Marketplace plans can impose "one per lifetime" limitations in general, which makes it more notable that there is no stated "one per lifetime" limitation on sterilization coverage.
No stated limitation--I can't be sure yet that there is truly no such limitation, however.
Regarding possible coverage under gender-affirming care:
All Marketplace plans available to me cover gender-affirming care, so this is still a potential route.
Additional considerations
Network: I can only consider Marketplace plans under which all relevant providers and facilities are in-network.
No referral to see a specialist: I can only consider Marketplace plans that don't require a referral from a PCP to see a specialist. I haven't involved my PCP in this process at all. I'd prefer to keep it that way, even if it means I have to pay more for a PPO plan.
#insurance::marketplace#insurance::certificate#insurance::network#insurance::hmo-ppo#insurance::marketplace::bcbs#insurance::marketplace::bcn#insurance::marketplace::uhc#insurance::marketplace::molina#strategy::self-pay#strategy::sterilization#strategy::gac
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No wonder ppl don't go to dentists. Trying to find insurance that covers more than basic cleanings and cavities is a nightmare
#i just need this retainer off and my shitty insurances dont seem to have any in network orthodontists#mia posts a thing
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USAmerican healthcare in a nutshell:
Me, a person who has excellent insurance (the best in my area), on June 6th: colonoscopy & upper endoscopy costs $1,100 after insurance
Still me, same exact insurance, except on July 1st (the start of my insurance year): exact same colonoscopy & upper endoscopy costs $5,000 after insurance
#i'm so lucky to be disabled tbh#bc i'm able to still be on my mom's insurance#she pays $2k/mo btw#we have to pay $4k of qualified medical stuff before they'll start paying#and even then it isn't until we spend an additional $2k that they cover most things completely#any big thing like inpatient stuff we still have to pay 10% for in-network#i forget how much if it's out of network#it's relatively not bad#it's like 20%? 25%?
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looking at a text I got from my therapist about insurance ahaha I might perhaps be in trouble. Well.
#static.soundz#think i will be ending my therapy which is fine but ohhhh i am not in network for current insurance 😄 FUCK MY LIFEEE#it's fine bc i've not been up to going the last few times anyways... and was considering a new one anyways... ah well
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Just cancelled my much needed therapy appointment cause the service I used to find my provider no longer works with my insurance company. I feel like absolute dogshit, I’m so tired of this fucking bullshit, I can’t even help myself cause I can’t afford the cost of the appointment without insurance. Literally about to go cry in the shower, wtf do I do now
#mental health#american healthcare#universal healthcare#therapy#I’m too fucking broke for a healthier brain#i was so looking forward to this fucking appointment#i was like good on me for trying to get my shit together#and then the service was like#too bad bitch we are no longer in network#curl up in a ball and fucking die#my college insurance is shit anyway I can’t go anywhere with this bullshit
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there's something sooooooooooooooo metnally wrong with me
#im straight up hiding in my bed in physical terror thinking about insurance forms and linked in#like they make me feel physically unsafe#like theyre gonna come and take away my agency#which i acknowledge is kind of an insane thing for something thats literally a pet to say#but like idk my owner protects me from other outside control#like idk i dont live with her yet and i have very little control over my body still#and like idk my parents keep using medical concern to try and wrest more control from me regardless of if thats how they see it#thats what theyre doing#and fucking networking and linked in and all of it is just demanding i let the worst part of having a job rule my waking life#it makes me retch and crave the relief of vomit#idk id say i dont think im cut out for modern life but i think im just straight up not cut out for living in any kind of society
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