I have some health issues that are pretty tough to manage, including multiple autoimmune disorders. My primary care provider knows my medical history and has been prescribing my pain medications.
Finding a new doctor willing to prescribe my pain medications, especially in the doses I require, is really hard. My rheumatologist wants my PCP to keep managing my pain, since I deal with severe lupus and Sjogren’s as my major conditions.
It’s not just my PCP who’s affected; most doctors around here are off my insurance list except for one state-run facility that’s not known for great care.
Is there any way I can keep my current doctors on this insurance plan?
We are considering changing insurance, but we’re not sure if that’s possible through the marketplace since it’s not open enrollment time. We had a change in income… could that allow us to change plans?
I went through something similar. I ended up negotiating lower self-pay rates with my doctor. You might want to consider asking your doctors about that. With RFK Junior now involved, I worry it might only get worse.
If you’re on regular medications, you might only need to see the doctor a couple of times a year. Ask your pharmacy about contacting your PCP for refills. Look for self-pay rates or telehealth options as an out-of-network patient which might save you some cash in the short run rather than switching insurances.
@Remi
I go for checkups every 3 months. I just had a virtual appointment. It seems doing a virtual visit each time could work.
Unfortunately, they cut coverage for our pharmacy too. The nearest one is an hour away in one direction or 1.5 hours in the other direction. It’s not an easy situation living in Montana.
There are a couple of main doctor groups in the nearest city but they excluded the ones I normally see, and the new covered group really lacks in quality. I’ve heard that their mental health services might be decent, based on my daughter’s past experience. The wait times are crazy and it seems like their care isn’t great.
The new insurance isn’t worth the prices they are charging, and I’m currently challenging what they have or haven’t paid since October.
For instance, a part of my infusion in September was $287.25. In October, I got a charge for bloodwork of $102.44, but now our part is $933.33.
We would prefer paying a bit more for better health insurance instead of their new inadequate plan.
Thanks for the suggestion on virtual visits; I often forget that’s still an option.
@Haru
Reading your message, I’m more worried about the pharmacy situation now. Many medications can go through mail order, and that’s probably what they aim for. Be cautious with controlled substances, though. You can also check out options like GoodRx or SingleCare if you have to, as they might lower your costs further.
Your doctors should likely be willing to work with you as a longtime patient. Just be upfront with them about your insurance troubles. In the meantime, it might be a good idea to talk to your HR department about how this new insurance isn’t doing it for you; they might consider this for next year’s benefits.
Sorry to hear you’re having to deal with this… Such is the hassle of healthcare in the US!
P.S. Is it possible to do infusions and bloodwork at an in-network facility while keeping your doctors for visits and prescriptions?
@Remi
I’m on over 15 prescriptions, many of which are costly. Even with discounts from GoodRx, we can’t manage the total, and my local pharmacy won’t accept that. It’s a small town pharmacy and doesn’t get the same deals as larger ones.
This might be a reason to switch insurance, honestly. They know us and our needs. Just my husband’s supplies for dexcom and ozempic would be way too much for us.
Changing pharmacies is possible, but not convenient during winter. Some of my pain meds are hard to find. My doctor had to call it into a pharmacy in the city since they were the only ones with it, and we’ll have to drive two hours round trip just to pick it up.
Local pharmacies are better, but at Walmart, I feel like I’m treated like a criminal when filling my prescriptions. It’s frustrating!
(The first time I got a prescription for pain, they interrogated me for 20 minutes at Walmart. I was stunned with all their questions about my diagnosis and why I needed pain meds.)
@Haru
Have you thought about mail order pharmacies? It might be useful to see what your insurance prefers. Then you could call the pharmacy to check what meds they can mail to you.