Tag Archives: insurance

Health Insurance Merry-Go-Round

I am ridiculously healthy, which I attribute to both good luck and determined effort. But I am one of the 10-13% of the American population who gets migraines. Given that proportion, if you don’t have them yourself, most likely you know someone who does.

There really is no such thing as a “mild” migraine, though they do range in intensity to extreme. They are disruptive by their nature. A few years ago, by luck, I was prescribed a medicine that takes the pain away. (I say “luck” because not everyone finds a solution that works for them.) I want to be clear, it doesn’t take the migraine away. But it makes the headache very tolerable for me. That prescription made my work life possible, as really no one gets 40-60 paid sick days a year, every year, for years on end.

Due to multiple circumstances, I hadn’t purchased that prescription using my current insurance. This spring was the first time, with this insurer, that I tried to. My prescription was denied. They would not cover it.

Instead my doctor and I each received notification that the insurer has a list of four approved migraine medicines in the same class. In order to consider an appeal to cover the one we know works, I would need to FAIL with at least three of the four approved ones. While this notice was frustrating, I’m game. If I can buy something that works as well and is cheaper for me and cheaper for the insurer, I’m all for that.

In fact, one of those four was the first thing prescribed for me years ago. It did not work. Strike one. So I only needed to fail at two more, or better yet, have one of them work, to stop the process. I thought…

In the following months my doc prescribed two others on the list. Neither works. Let me repeat: NEITHER WORKS. In fact, two of the worst headaches I’ve had in recent years were when trying them. Strikes two and three.

The doctor again prescribed the one we know works. The prescription was denied. Before the insurer will pay, they first need to consider the merits of my need. In other words, I need to file an appeal. Yes, that’s right. Covering the good one is not automatic. I need to appeal.

The doctor submitted an appeal, based on the criteria the insurer set out, that I needed to fail on at least three of four approved meds. It was denied. No reason given. Just denied.

The doctor submitted a request for review, and she requested the review be expedited. An “expedited” review can take 30 days. That request was faxed to the insurer last week.

This morning I received a phone call from the doc’s office. In order for the insurer to consider the appeal, I needed to go in and sign a release form authorizing disclosure of my protected health information. (I expect this restarts my 30-day expedited review period.) Here’s what it says, in part:

I understand that if the person or entity that receives the information requested is not covered by federal or state privacy laws, the information described above may be redisclosed and will no longer be protected by law.

In other words, there is NO PROTECTION, because if they don’t take care of my information, anyone could get it. Then they absolve themselves. Too bad for me.

Another interesting item was that requests for review must be received within 180 days of notification of their “adverse decision.” Which one? The initial one when I tried to fill the script in the first place?? If so, you could (in theory) easily go 180 days just playing their try-and-fail game. And if that last attempt is more than 180 days out, you’re screwed.

While we wait for a decision, my doctor wrote a prescription for codeine, which the insurance covers. Because it’s much better and safer cheaper to take a narcotic for pain than something that’s non-addictive.

Am I frustrated? You bet. And part of my frustration is not for me, but for people who are fighting their insurance companies every day for coverage of necessary health care. We have a close relative whose treatment is not covered at all, but is paid out-of-pocket.

There are solutions to this merry-go-round, but they will require broad agreement and not a piecemeal approach. Unfortunately our current government is a failure and can’t agree on the most fundamental things, much less complex problems like paying for health care.

[Note, please don’t tell me about your migraine solutions and how if I just do things differently, I’ll get relief. I’m sure you mean well, but I’m not looking for that kind of help.]







Inventory your stuff!

Wildfires, tornadoes, earthquakes, hurricanes, floods… every part of the country is susceptible to disaster; every one of us is vulnerable to natural (and human-instigated) phenomena. Climate change issues are likely to make these worse in the future.

Keeping ourselves and our loved ones safe is the highest priority for most of us, but these events also can lead to severe financial hardship. What can you do NOW to mitigate your financial harm when disaster strikes? INSURE. Know what your insurance covers. And be prepared to make a valid and complete claim by having an inventory of your stuff.

Anyone who owns a home (with or without mortgage) and anyone who rents (or stays rent-free with someone) should have insurance to reduce financial losses in a disaster.

Two Purposes of Homeowners’ and Renters’ Insurance

Two primary purposes of homeowners’ and renters’ insurance are to protect you from liability claims and to protect you from actual property losses.

Liability, when discussing insurance, is the legal responsibility to pay someone else for damages as a result of your actions or inaction. If you do not repair your sidewalk and a pedestrian trips, breaking her hip, you may be liable for the cost of her medical treatment. A renter may have liability, also. For example, if a renter turns down the thermostat too far over a winter vacation, and the pipes freeze and burst, the renter may be liable to the landlord to pay for damages. Both homeowners and renters need insurance, if only to protect them against liability claims.

Property insurance is the portion of your policy that covers losses due to damage or theft. You may experience actual physical losses of property or the use of your property, due to disaster.

I want to be very clear: I am not talking about insurance coverage of any business equipment, business malpractice, or business loss-of-revenue due to interruption of business activity. Please talk to your insurance agent about these concerns, as they likely fall outside the personal insurance I am discussing.

Some losses are not covered under typical homeowners’ policies. Flood, earthquake, and mold damage are not, generally, and require specific insurance, separate from the homeowners (or renters) policy.

From the National Flood Insurance Program note that

In 1968, Congress created the National Flood Insurance Program (NFIP) to help provide a means for property owners to financially protect themselves. The NFIP offers flood insurance to homeowners, renters, and business owners if their community participates in the NFIP. Participating communities agree to adopt and enforce ordinances that meet or exceed FEMA requirements to reduce the risk of flooding.

In addition, if you are eligible for flood insurance and wish to obtain it

It takes 30 days after purchase for a policy to take effect, so it’s important to buy insurance before the floodwaters start to rise.

Make sure you don’t wait until the water is rising. It’s just too late then. Similarly, this article last year from the Durango Herald noted homeowners can’t add insurance as the wildfires burn.

In addition, some household assets may need supplemental insurance for full coverage. For example, your valuable jewelry, musical instruments, computer or other electronic equipment, may need a rider or supplemental policy. Talk to your insurance agent to make sure you know what is covered under your policy, and whether you need additional coverage.

If You Need to Make a Claim

If disaster strikes and you need to make a claim due to property losses, you MUST know what is lost to submit a complete claim. That may not be easy for most of us, as we’d have trouble listing all the items in our home. For example, think of the cupboard closest to your stove. Can you list every item in the cupboard from memory? Can you list every item in your hall closet from memory? Probably not. Virtually every property insurance company recommends creating an inventory of assets, and many provide worksheets, spreadsheets, and other devices to do so. The task, though, would overwhelm many people, as even the least acquisitive of us typically own thousands of items. It would be ever more overwhelming while dealing with the distress of tragedy.

Instead, inventory the simple way. You’ll at least have a help in remembering what you own. Just use a camera, phone with camera, or video camera and make sure you take images of every room, all walls, and inside each drawer, cabinet, cupboard, and closet. If there are items of special value, such as antiques or high-end electronics, take close-ups of them. If you have receipts for valuable items, also create digital images of those. Though it’s still a time-consuming task, it gives you a huge boost in your ability to remember and claim all that was lost.

Then STORE those images away from your home. These days the easiest way to do that is to upload them to a photo service, or even email them to yourself.

If you lose use of your property and need to stay elsewhere for a period of time, keep all receipts for lodging to provide documentation for your claim. Also save receipts for repair, clean-up, and replacement costs. Your insurance agent will want copies of all of these to process your claims.

I hope none of us experience losses due to natural or man-made disasters. The probability is high, though, that many of us will. Please be prepared. INSURE. Know what your insurance covers. And be prepared to make a valid and complete claim by having an inventory of your stuff.


Note that state insurance laws vary. Please discuss your concerns and coverage with your insurance agent to optimize the value you get from the policies you buy.