Anyone notice.... (December 2001)

1. Double-check the fine print of your insurance policy. Even with an 80/20 rate of reimbursement, there is almost always a maximum out-of-pocket amount that you are expected to pay. We have always had 80/20 types of policies and this has always been the case, no matter which insurance co. we were covered under. So, basically, what this means is that insurance will only reimburse 80%, until you fulfill a maximum cap, after which they will normally pay the full 100%. There is usually a maximum cap per individual, as well as per family. The maximum out-of-pocket amounts, these days, are substantially higher than they used to be, but they should not even be close to the upwards of $10,000 pp that you may think you are obligated to pay, otherwise. (With BC/BS, for eg, the max. out of pocket per person used to be around $400/year, though it is now ~$1200/pp and ~$4000/family.) Either way, you should not have to be responsible for shelling out huge amounts, out-of-pocket. (Yes, you do have to pay for everything up front, which can lead to cash-flow problems, but the amounts should be reimburseable.) I realize that you are in a murky area with the formula being considered in the same way as a prescription drug, but if it's covered, your out of pocket expenses should be limited by the maximum cap amount.

2. Don't forget that you can deduct excess medical expenses on your income tax. Normally, it is difficult to meet the criteria for medical deductions, but with all the expenses that you are incurring, it sounds like you would be a prime candidate. Keep in mind that you can add in all the amounts that you pay for insurance premiums, travel to see doctors, etc. Most employers do not pay 100% of medical coverage, even though it seems like it, because the employee's contributions are directly deducted from the paycheck. But check your husband's paystubs. If he is expected to contribute a certain percentage of his salary to paying for medical insurance, it should show up there and the amounts are fully tax deductible.

3. Do you know how to use spreadsheet programs, like Excel? With an 80/20 type of policy, and large up-front outlays for medical expenses, the amount of paperwork is enormous and can easily become overwhelming. We also went through periods when we incurred huge medical expenses, and I found it very useful to keep track of all our claims on a spreadsheet. Otherwise it would have been virtually impossible to know how much we had spent, what claims had been paid, what claims were still outstanding, when we reached the deductible amounts, when we reached the maximum out-of-pocket amounts, etc., etc., etc. If you set up the worksheet right, you can get it to figure all the totals and percentages for you. It is also very helpful to have all information for the full year summarized on one sheet of paper, especially when haggling with the insurance companies. It was a little bit of work to set up the sheet, the way I wanted it, but well worth the effort in the time it saved, and peace of mind it gave, to know exactly where we stood at any given time.

Anyway, just a few tips that might help take some of the pressure off. Two children under 2 yo, pregnant, and on dex.......all things considered, I think you're handling everything remarkably well! I think I would probably just want to crawl into a hole until it was all over.....keep hanging in there!