Self-Funded Health Insurance.... SUCKS!

So, I learned yesterday just why I'm having such a hard time with our health insurance company. It's self funded. Basically it means that the company my husband works for, Flying J, incurs the cost of all claims, they also are the ones that in the end get the premiums that we pay each pay period. I didn't know this until I got so pissed off that I called the Insurance Commissioner's office. This explains a lot. I surely didn't appreciate being treated like a piece of dirt by our plans benefit administator either. Honestly, if we could afford for my husband to quit, I'd tell him to tell those low lifes to kiss his ass and get the hell out of there!

What has happened at this point is that, although $4400+ has been paid out for my medication, by a co-pay assistance program, the insurance company, who had orginally told me this was fine and had applied the cost to my deductible, has now come back and told me that since I personally didn't pay the money, they are going to reverse the amount applied to my deductible and they will not pay the 70% that I should be getting at this point toward my medication. They consider it "double dipping" so to speak. What they want me to do now is to pay another $3000 in medical/prescription costs and they will apply THOSE to my deductible. Somehow they are not grasping that this co-pay assistance is to help people like me with these insanely high deductibles cover the total cost for medications (such as mine which is nearly $1500/mo), in essence it's a gift from the company/organization that issues the co-pay assistance. I don't have to pay it back, but it can only be used for my medication. I don't have a problem with that, I feel very greatful that there are programs out there that help people obtain there medications.

In the end, what it amounts to is, we will have to continue paying not only our premiums, but any doctors visits or prescriptions on our own until we reach that $3000 PER PERSON deductible. Considering I've been to the doctor 4 times since May, that means I'm now in debt to my doctor's for over $300. That does not make a dent in that damn deductible now does it???? And since it's an ANNUAL DEDUCTIBLE that must be met before the insurance plan will pay anything at all, I have to start over in January. In the meantime, no more medication for me. The funds attached to my co-pay assistance have been used, I've gone 2 months without medication while I was trying to get all of this sorted out and now, I have to apply with yet another co-pay assistance program, which is time consuming and no guarantee that I'll even qualify.

So - to any of you out there that are considering working for Flying J, Inc. I highly recommend that you not participate in their benefits program. It's not worth it. You will be lucky to reach your annual deductible and God help you if you do reach it, that reimbursement... well, self funded insurance programs can kind of change the rules as they go to suit them. Nowhere in the handbook does it say that I personally must pay that deductible, but now they come back and tell me that they can do whatever they want to and I can't do a damn thing about it. Personally, I'm just pissed enough to be on the hunt for an attorney. If you are going through anything even remotely close to what I am, take the time to pick up the phone and call your state's Insurance Commissioner's office. They can answer questions and if they can't, they will direct you to who can.