You appear in excellent health and I would look into health deductible/savings accounts with high deductible plan and spend your yearly premium on that.

And if you have back issues, I strongly recommend walking for long periods of time as often as possible. I do that daily with audiobooks – it’s great.

Regards,
Paul

1) I’ve had recent personal experience with our PT benefit myself. I ripped up my ankle in June of 2008 and spent last summer – July and August – receiving superbly provided PT services from Peak Performance, a nearby PT provider. It worked, and it was amazing. I also posted on my experience (The Cost of Non-Compliance on my blog). For me, having 60 days and as many visits as I wanted during that period worked well – although I’m sure that’s not the case for everyone.

2) I totally get the frustration you feel with a structured benefit. Frankly, we thought we had to choose between managing for medical necessity (which BC/BS of MA and Tufts Health Plan do after 8 visits), or offering up a non-managed benefit with a defined window for services. We thought this was a better route – for practicioners and members.

3) We are not really positioned to change/negotiate plan designs in mid-stream. We’re expected – by regulators and purchasers – to provide what we sell, nothing more or nothing less – during a plan year. Changing plan designs in the middle of a plan year to meet particular needs of an individual customer – at least in this business – is considered bad policy. I think that’s because people worry about plan design changes in mid-year that work against members, not for them – and no one could figure out how to separate one from the other.

4) We are reviewing all of our PT & OT plan designs to see if we can come up with a wider service window, without getting too heavily into managing visits – which we’ve tried to stay away from. This should open up some new options for next year. Let me know if you’d like to discuss your experience with the people working on the re-design.

You should also know that we do have a prior approval process in place for all non-emergency high end radiology procedures (like MRI), and services like spine surgery require a number of sign-offs before they can move forward as well.

Again, we do appreciate your business.

He ends by writing, “We have one of the most expensive healthcare systems in the world, but do not get the value out of it.”

I encourage you to visit Bill’s blog to read his take on healthcare insurance and to benefit from his expertise in knowledge management.

Oh and it’d be nice if their “reasonable and customary rate” for out of plan coverage actually was an amount that people really charged

I have 2 insurances right now, which is ridiculous. And I still have problems getting affordable coverage/finding providers. How’s that happen? All the extra insurance has done is give me lots of paperwork to fill out and deal with them fighting with each other about who will pay for stuff and then finally the bill getting passed onto me.