Wellness

[sidsmom]

---

@Laura14 wrote:
.......no one would be overweight, we would all skip to work, and half of the drug aisles in every store you walk into would not exist.  

---

Wouldn't that be lovely?!😊 I keep hoping...!

[Stray]

---

@Laura14 wrote:

Thanks @Stray  I was wondering how an insurance company would know what your test results are.  I would think that would be a major violation of HIPPA.  And high cholesterol is not always lifestyle choices.  It's hereditary too.  Unless the insurance wants to pay for the test to determine which kind you have, NONE of their business.  

If you are being surcharged for anything other than tobacco which my company also does (we have to submit to testing to prove it to get our discount), I don't think that's legal.  

And someone mentioned insurance for people without kids.  That's me and I have always done a single only policy.  I didn't realize other companies may not offer that.  You would think they would since it's the cheapest there is for them and me.  

My open enrollment is this week.  I just can't wait to see what I am in for.   

---

@Laura14- i think if your weight and other biometrics are in line, an insurer will not intervene and assume high cholesterol is genetic....I had to submit a progress report from WW and did not get reimbursed until a year later to show my loss and that I maintained it over time.  The health insurers do know their legal rights and to submit proof, is probably within their legal rights and might be in the fine print....if you want the reimbursement, you'll submit the proof but if you don't submit proof, no reimbursement so it gets down to choice....

i had a single plan before I was married and many spouses don't cover theirs as they may be insured through an employer....I think most people object to "family" whether it is one child or 10....

i dont know mine yet either but every year its a surprise and not in a good way....so I think the preventive services are a good thing and the only way to bring down costs. 

[Stray]

---

@151949 wrote:

@Stray Same for us - much better insurance at a much lower cost now that we are retired and on an advantage plan. I wouldn't change a thing. Glad to be out of the rat race. Whenever posters complain about medicare or SS I just have to SMH - I feel we are blessed to have this, and I have no complaints about it.

---

@151949- I agree.  I didn't realize how good it was until my husband was so ill....it seems I paid almost everything out of pocket when I was actively employed and in a private plan...

[Stray]

---

@sidsmom wrote:

---

@Stray wrote:

As much as people may not like it, tobacco use, high cholesterol, diabetes and obesity are risk factors, ones that can be controlled in some cases.  

---

Some?   I would say MOST.

Cholesterol?

Rare is the genetic cholesterol condition, Familial Hypercholesterolemia...and even in those rare genetic conditions, diet/lifestyle can reduce the risk significantly.

Type 2 Diabetes?  

We all know by now Type 2 is easily reversed/preventable through diet/lifestyle choices.

Tobacco?

100% user choice.   And that user should pay GREATLY in insurance premiums for that tobacco lifestyle. 

---

@sidsmom- true but I do know people with positive lifestyle choices with high cholesterol or genetic with family history and some diabetics have had it all their lives....but statistics show that most can control their risk factors and even if you can't it's almost more important to employ a healthy lifestyle.  I do think insurers charge higher premiums for smokers but offer incentives for other risk factors which I support as  a nurse and one in the pool of the insured affected adversely by expensive and frequent claims that could be prevented by positive lifestyle change. 

[Stray]

---

@Laura14 wrote:

---

@sidsmom wrote:

---

@Stray wrote:

As much as people may not like it, tobacco use, high cholesterol, diabetes and obesity are risk factors, ones that can be controlled in some cases.  

---

Some?   I would say MOST.

Cholesterol?

Rare is the genetic cholesterol condition, Familial Hypercholesterolemia...and even in those rare genetic conditions, diet/lifestyle can reduce the risk significantly.

Type 2 Diabetes?  

We all know by now Type 2 is easily reversed/preventable through diet/lifestyle choices.

Tobacco?

100% user choice.   And that user should pay GREATLY in insurance premiums for that tobacco lifestyle. 

---

With the exception of tobacco, I don't think it is the insurance companies right to start policing and punishing you for your health.  Especially when medical science is not absolute.  

High cholesterol is a great example.  Some doctors want to put you on meds for borderline numbers while others say statins shouldn't even be considered unless you already have heart disease because of potential side effects.  Others say cholesterol really shouldn't be demonized at all and we need to stop worrying so much about it.  Other health issues are more important to track.        

And prevention and/or reduction of anything, presupposes that the patient has the time, money, education, and access to better food and exercise options to turn their health around and change their lifestyle.  

I don't see many insurance companies paying for the day off to go to the gym, the daycare for those people who have children to make the time to go to the gym, or the gym membership fees and dues themselves.   I know my gym fees are all on me and if I don't work I don't get paid and therefore have no insurance.   And we haven't even started on food prices and finding stores that carry what you might need to eat.  

Sometimes I can get real cynical and wonder if the whole purpose of any of this is to penalize you to the point that you just give up and drop out of the insurance all together.  Oh wait, then there is a penalty for that.     

---

@Laura14- there are some plans that do give you discounts or even reimburse gym membership if you have a doctor's order.  Also, nutritionists are covered  and as discussed earlier, any legitimate weight loss programs and bariatric surgery.  I did get post weight loss plastic surgery paid for with documentation from three doctors.   

I dont think insurers want to police but reduce reduce risk factors thus, reducing premiums for all.  I don't know your choice of plans but maybe you should investigate other options.  I was happy for the help but must admit I was quite persistent. 

[Stray]

---

@sidsmom wrote:

@Tinkrbl44

I couldn't have said it better.

Yes, it DOES cost more to be sick than to be healthy!

That is why I'm so passionate about my nutritional posts.

It's dirt CHEAP to eat a low fat whole foods plant based diet.

Even the littlest little farm towns has the groceries to eat right.

Potatoes, rice, beans, corn, frozen/canned vegetables & fruit.

Good health starts first & foremost with the food.

---

@sidsmom- I would say, it's probably less costly to eat healthy rather than not.  Most companies have healthy cafeteria choices and work with the health insurance plans very closely.  When I worked, I spent more time there than home....plus, we had food we could order and take home and the meals were healthy and fresh....we were fortunate as we had a Company gym but early in my weight loss, I was very self conscious and did Richard Simmons tapes in my living room.  I was happy for the help from my health insurance company and didn't resent it.  You can change lifestyle a little bit at a time and it doesn't have to be expensive and now you can do exercise in increments a few times a day.  I got off the subway 2 blocks earlier, then, three and up....I worked in NYC and even in bad weather walked outside or around the building at lunchtime....it also cleared my head....

[Stray]

---

@goldensrbest wrote:

I am for a  health care program , similar to Canada, i have had obama care since my husband passed, i am low income , it has been great, turning 65 in December, going crazy trying to figure out medicare.

---

@goldensrbest- the Medicare is the easy part but medigap can be confusing....maybe a broker can assist you?  

[VaBelle35]

---

@shwarma wrote:

I went for my yearly exam.  When my doctor was writing up the blood work I reminded him to add my ferritin numbers.  I have heredity hemochromatosis.  He told me that the insurance will no longer pay for that test..what?  Now, if I go back to the doctor, tell him I feel bad then he can run the test!  Ridiculous..so I paid for the test myself.  Our premiums rise, co pay rises, less service.  Doctor was sorry but they have to follow rules!

---

Unbelievable.  I hate that we have to play games to get insurance to cover things.  My uncle's kidney doctor keeps his iron at a specific number because if his iron goes above that number, they will no longer cover the iron injections or the specialist visit.  He has 1 functioning kidney and that kidney is on it's last leg.  It's not like he wants the joy of injections every month.

[Gooday]

Let me share my tale of woe: DH is medicare and BC/BS PPO from the City of Chicago Police Dept.  He is 70 and I am 63.  He served 30 years and the contract between the city and the police dept. After a few years of negotiations between the Mayor and the FOP (Federation of Police Union), a class action suit was filed on behalf of the retirees.  This suit went before the Illinois Supreme Court who ruled in favor of the retirees but the city chose to fight back and the case got remanded to the lower Appelate Court.  That judge decided that in fact, the city had no responsibility to provide insurance benefits (even though $1215.00 a month came from DH's pension check this past year). 

We got a letter 10 days ago stating that as of 12/31/2016 we will no longer have coverage.  DH can enroll any time for a new supplement.  I on the other hand have to wait until Nov. 7th I believe.

In the meantime, the class action suit will continue according to the law firm handling the case.

We had heard this was coming but we really thought there would be an 11th hour reprieve.

Just think of the gravity of this and how you would feel if this were you faced with this.

I did tell DH that if there is a silver lining in all this is that even though the coverage was great, the premiums we have been paying the past 3 years were outrageous.  We have to do some comparison shopping and decide what will suit our needs.  He takes a lot of medication due to the fact he had a kidney transplant and from the anti-rejection drugs, he developed type II diabetes (he is not overweight) for which he takes 2 types of oral medications and a week injection of Trulicity.  You don't even want to know how expensive the anti-rejections meds cost.

The fly in the ointment is that I need full coverage because of my age.

I guess it could be worse and we will just have to figure it out.

[skuggles]

Gooday ....sounds outrageous. It really taps into that deep well of fear and anxiety that belies the gross exaggerations of the quality and condition of the health care system in America for those that use it the most as described by the "underwriters".