Tags: prescription

Pages: 1

03/31/17

  01:42:00 pm, by The Dreamer   , 321 words  
Categories: Healthcare

Re-Updating my Eyeglass Prescription Progression 2016

TODO: finish upgrading the blog software....been having problems with this one and have had to restore old databases. Alternative, continue looking at migration to another platform...

Meanwhile, I had an eye exam back on May 16, 2016....so about due for another one. But, that update should look like this.

Nov 2003: OD -5.00 -1.00 075       OS -8.00
Apr 2005: OD -4.25 -1.00 080       OS -7.00 -0.75 045
May 2006: OD -4.50 -1.00 055       OS -6.50 -1.00 035
Apr 2008: OD -5.25 -1.00 060       OS -7.25 -1.00 025
Aug 2009: OD -5.00 -0.50 050       OS -7.00 -1.25 030
Oct 2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
Nov 2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
Feb 2013: OD -4.50 -0.75 040 +1.50 OS -6.75 -0.75 010 +1.50
Jun 2013: OD -5.25 -1.00 060 +1.75 OS -7.00 -0.75 040 +1.75
Oct 2013: OD -5.25 -0.50 060 +1.75 OS -7.25 -0.75 015 +1.75
Jul 2014: OD -4.75 -1.00 075 +2.00 OS -7.50 -1.00 030 +2.00
May 2015: OD -5.00 -0.75 025 +1.75 OS -7.00 -1.25 005 +1.75
Jun 2015: OD -5.50 +0.50 160 +2.00 OS -7.50 +0.50 125 +2.00
Jun 2015: OD -5.00 -0.50 070 +2.00 OS -7.00 -0.50 035 +2.00
May 2016: OD -5.50 -0.50 055 +2.25 OS -7.25 -1.50 020 +2.25

In more recent news, while looking to use up my FSA dollars, since I wasn't going to have an FSA for 2017. I came across a site offering the option to generate full-time intermediate or readers from my prescription. Full-time intermediate being the suggested for computer work, which has been causing lots of problems when I'm wearing progressives. Finding I have to sit closer to the screen, which makes it hard to see all of its 23" or 27"....or straining to see all of it because the tiny spot that's intermediate distance is too small...

Well, the full-time intermediates I got have been great. Wondering if I should get full-time readers to help with my Kindle/iPad usage.... have until the end of April to use up the last tiny bit of my FSA rollover. (~$25.) Wonder if it's possible to get intermediate/readers lenses done? Perhaps as a bifocal.

The only downside, is I got it with a gradient tint...forgetting that it's too dark at the top for my need, probably should've gotten a light uniform tint. Though as I recall, it wasn't an option for the site I had ordered from, and trying another site didn't work as they didn't support the full-time intermediate option and generating the numbers myself couldn't be verified by an upload of my prescription...(wonder if I should ask for a formal prescription for intermediates next time....)

06/03/15

  07:42:00 pm, by The Dreamer   , 350 words  
Categories: Healthcare

Updating my Eyeglass Prescription Progression

Guess I've been neglecting my blog in more ways than I thought...hadn't updated this progression since my post back in October 2013. But, have two recent prescriptions to add to the mix....one with my regular optometrist, and a second done as part of seeing a neuro-opthamologist at the Mayo Clinic as part of my ongoing quest to see if I have SCA, what it might be, and what its future holds for me....

But, anyways....

Nov 2003: OD -5.00 -1.00 075       OS -8.00
Apr 2005: OD -4.25 -1.00 080       OS -7.00 -0.75 045
May 2006: OD -4.50 -1.00 055       OS -6.50 -1.00 035
Apr 2008: OD -5.25 -1.00 060       OS -7.25 -1.00 025
Aug 2009: OD -5.00 -0.50 050       OS -7.00 -1.25 030
Oct 2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
Nov 2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
Feb 2013: OD -4.50 -0.75 040 +1.50 OS -6.75 -0.75 010 +1.50
Jun 2013: OD -5.25 -1.00 060 +1.75 OS -7.00 -0.75 040 +1.75
Oct 2013: OD -5.25 -0.50 060 +1.75 OS -7.25 -0.75 015 +1.75

Jul 2014: OD -4.75 -1.00 075 +2.00 OS -7.50 -1.00 030 +2.00
May 2015: OD -5.00 -0.75 025 +1.75 OS -7.00 -1.25 005 +1.75
Jun 2015: OD -5.50 +0.50 160 +2.00 OS -7.50 +0.50 125 +2.00
Jun 2015: OD -5.00 -0.50 070 +2.00 OS -7.00 -0.50 035 +2.00

Felt like there should've been a Feb 2014 in there somewhere.....but I don't have access to all my files at the moment, something I'm going to want to do something about when I get home. But, nothing in my usual cloud places ....

But, wonder which is right and which should I get in glasses....well, actually, I had already ordered new glasses after the May eye exam. Had they been ready in about 7 days, I'd be wearing them right now. But, didn't get the call about them until yesterday. Wonder if I'd get new glasses with the latest prescription now....there is a Lenscrafters here.... or wait until I get home. The new prescription actually looks like its in the same ballpark as what I had been told....hadn't actually looked at my May prescription until just now as well...

Meanwhile...does the Spinocerebellar Ataxia quest continue...

But, first where should I go for supper tonight?


Well, I opted to not visit Lenscrafters at all, though I had several wonderful suppers at Chester's Kitchen & Bar, including once from 'Garden Patio Seating' (where I was kittycater-corner from Lenscrafters.) :wave:

When I inquired back home in Manhattan, it was explained that the prescription needed to be converted from positive scale to negative scale to compare to last month's prescription. After conversion, the difference was considered within the range of what would happen if I were to get tested every day.

10/02/13

  02:11:00 pm, by The Dreamer   , 164 words  
Categories: General, Healthcare

Its been another 4 months, time for a new eyeglass prescription

Hopefully, this isn't a trend... but rather a strange problem that has now been treated (through the use of Muro 128 at night for the last few weeks and to taper off over the next couple...)

Nov 2003: OD -5.00 -1.00 075       OS -8.00
Apr 2005: OD -4.25 -1.00 080       OS -7.00 -0.75 045
May 2006: OD -4.50 -1.00 055       OS -6.50 -1.00 035
Apr 2008: OD -5.25 -1.00 060       OS -7.25 -1.00 025
Aug 2009: OD -5.00 -0.50 050       OS -7.00 -1.25 030
Oct 2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
Nov 2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
Feb 2013: OD -4.50 -0.75 040 +1.50 OS -6.75 -0.75 010 +1.50
Jun 2013: OD -5.25 -1.00 060 +1.75 OS -7.00 -0.75 040 +1.75
Oct 2013: OD -5.25 -0.50 060 +1.75 OS -7.25 -0.75 015 +1.75

Wonder if there's enough time to get a new pair of glasses online cheap, before my upcoming trip (Narcolepsy Network Conference). And, to use up the remainder of my limited use FSA, which is kind of surprising to have last this long this year. Probably because of the unstable nature of my eyeglass prescription this year, I didn't get what I really wanted in a second pair of glasses this year. Maybe I'll finally get around to it next year....

Just as long as I can see the best that I can for the 50th anniversary of Doctor Who! 8|

09/13/13

  06:24:00 pm, by The Dreamer   , 126 words  
Categories: General, Healthcare

Another eye exam, another pair of glasses?

Well, not yet...though I've been having trouble seeing more and more the last few weeks. And, there was a evidentally measurable change in the right eye.

But, today's exam was to see if I might have Glaucoma. Had gotten a retina imaging test back in February, did another today and things look the same, so probably not Glaucoma. Though today my field of vision testing was bad all over, like a more general loss of vision.

Since the shape of my cornea has changed over the last 3 exams, he suspects its changed again though the test wasn't during the initial testing of the appointment. It got done before I left.

Gonna try some eye drops for 2-3 weeks to see if things get better, worse or not.

06/21/13

  06:52:00 pm, by The Dreamer   , 522 words  
Categories: General, Healthcare

A shift in my vision

After I got my new glasses after my eye exam back on February 8th, things were great...but gradually they started getting back again, which was some what distressing. Especially since I had also gotten that call about the results of the Retinal Thickness Analyzer (?) showing some thinning and that I needed to plan a follow up test in about 6 months. At first the vision would start getting bad as I was heading home from work, and it subtle...though it would get pretty bad about mid evening.

But, then it was starting to get pretty bad around mid afternoon at work, so I decided I needed to get my eyes rechecked. In the inbetween time of making the appointment and the appointment today, I now feel that my vision starts getting bad before I leave for work, sometimes wonder if I should even bother (though I end up going in anyways and struggle until quitting time...)

So here's the next entry for my prescription progression...

Nov 2003: OD -5.00 -1.00 075       OS -8.00
Apr 2005: OD -4.25 -1.00 080       OS -7.00 -0.75 045
May 2006: OD -4.50 -1.00 055       OS -6.50 -1.00 035
Apr 2008: OD -5.25 -1.00 060       OS -7.25 -1.00 025
Aug 2009: OD -5.00 -0.50 050       OS -7.00 -1.25 030
Oct 2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
Nov 2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
Feb 2013: OD -4.50 -0.75 040 +1.50 OS -6.75 -0.75 010 +1.50
Jun 2013: OD -5.25 -1.00 060 +1.75 OS -7.00 -0.75 040 +1.75

Somehow my eyes are close to back to where they were in Nov 2011...

Nov 2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
Jun 2013: OD -5.25 -1.00 060 +1.75 OS -7.00 -0.75 040 +1.75

There's a slight change in the right eye, and even less of a change in the left eye....reading power another step up....

Seems a really strange jump and not really sure how to explain it. In what feels like an unusually rarity in my life, there hadn't been any medication changes from when I started having problems last fall to no, and no new diagnosis....though the latest problem that I've yet to receive a diagnosis for started mid-October....and it in November that my vision started getting bad (though with LISA and my mom's 70th birthday coming up, and thinking that I wanted to wait until I had FSA money...I had put off getting the eye exam. Plus it wasn't as bad as it has been lately...

As to why the shift...they had done a cornea surface mapping as they have done in all previous exams....and in comparison...my cornea surface was much more pointed in February while my current surface is similar to how it was back in November 2011. Not really sure how that came to be though. But, Optometrist said he would order up new lenses and that there would be no charge. Hopefully, they'll be able to get new lenses already pre cut for my glasses, as these are now my only pair....not having kept any of my old pairs this time around given the big change. (and not yet having gotten around to getting a second pair, because around when I was starting to think that I should get them...was when my vision started getting bad....)

Not sure where I'm at on getting a second pair now....will probably shoot for getting them before the upcoming NN Conference for sure.

Hopefully its not some kind of periodic variation, possibly similar to the variation in my sleep....which appears to still exist even with my Narcolepsy being pretty well controlled with medication now.

02/08/13

  04:42:00 pm, by The Dreamer   , 307 words  
Categories: General, Healthcare

The result of my latest Eye Exam

So, since my Narcolepsy Diagnosis, I've been having vision problems...since September. I suspected that some of it was due to my medication, and I did find that I was right...but learned from Facebook before the NN Conference in October that what I was experiencing was more associated as a side effect of my stimulant than the other. I might be starting too strong with it in the morning.

Making a change on that front, brought about an almost immediate improvement....and while at the conference, I learned of another thing to adjust and that also made for a pretty quick improvement.

However, I still felt that my prescription had changed...but didn't feel like I could get an eye exam and new glasses done in time for LISA, so I put it off....except I guess I put it off too long...because I finally got the eye exam today....but, I'm off to Gallifrey One next week. Not enough time to get a new pair of glasses. Manhattan, KS needs an 1 hour place....though do they do computer progressives in an hour? No, I need my own time machine.

So, here's the updated progression...

2003: OD -5.00 -1.00 075 OS -8.00
2005: OD -4.25 -1.00 080 OS -7.00 -0.75 045
2006: OD -4.50 -1.00 055 OS -6.50 -1.00 035
2008: OD -5.25 -1.00 060 OS -7.25 -1.00 025
2009: OD -5.00 -0.50 050 OS -7.00 -1.25 030
2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50
2013: OD -4.50 -0.75 040 +1.50 OS -6.75 -0.75 010 +1.50

With the updated equipment at there...they could show me very quickly what my vision is like with old prescription and new prescription, and how things compare with and without the reading power.

The large improvement in my right eye, seems to have contributed to generally poor vision distance and computer.

How will I survive now through Gallifrey One ??? We shall see...perhaps :roll:

Wonder if this will be the year to finally get prescription sunglasses, hopefully I won't be buying 3 pairs of eyeglasses in one year...to only have one good pair still. Though the big change also means I don't have any spares....

07/21/12

  06:13:00 pm, by The Dreamer   , 1047 words  
Categories: Stuff, Healthcare

Glasses are fixed

The previous posting How to check your PD, was a prelude to ordering a replacement pair of glasses online. Which seems to have turned into a mini-review of 3 online companies....

First: Given the hassle of getting dental costs reimbursed by my limited use FSA, for dental and vision expenses.... I was worried that I may have put too much into FSA this year.... So, I decided that I would probably be looking at getting a pair of prescription sunglasses this year. Somewhere after I've had time to adjust to my new progressive eyeglasses.

Which hasn't been going so well...so I was considering that a LASIK evaluation help spend down my FSA. And, plan on next year's FSA paying for that.

But, lately...the progression of my disease now has me falling a lot lately. (the latest casualty being my Casio Waveceptor watch....had thought it being atomic, solar and metal, would mean it would last forever....or more than a year or two. Alas, I fell yesterday and broke it. :..( )

So, anyways...back to breaking my glasses recently.... I found myself looking online for a temporary replacement...the damaged pair were semi wearable, but eventually to fully fix it...it would require a transplant. So, I checked a couple of online sites. Now, until this time, I have pretty much only been only dealing with one company for my online purchases of eyeglasses -- 39DollarGlasses.com But, now and then, I'll see listings on deals.woot.com for 'cheaper' deals. And, now I was thinking more cheap for this temporary/spare pair.

After pricing things out quickly...the base cost (frames + conventional single vision lenses) is rather negligible when you start piling on things like "As Thin As Possible" lenses, Free Form / Computer Progressive, and Anti-Scratch, UV Protection, Anti-Glare, Water Repellent coatings. It more comes down to how much the different companies charge for those options. That decides which is the better deal. As it happened, EyeBuyDirect has a first time customer discount that put it ahead of staying with 39DollarGlasses for this order.

Later, I poked around online to see where I could get the frames of my first pair could be had. And, there were a couple of places that still had the now-discontinued frame style, and I went with LensesRx.com.

This is where the mini-review part kicks in.

In all 3 cases, I normally go for the free USPS delivery option. Which is Priority Mail. And, with 39DollarGlasses.com and EyeBuyDirect.com, it was just with regular Delivery Confirmation service. This means the letter carrier can leave safely locked up in the mail lockers outside my condo. And, I'll have my new glasses when I get home from work. With LensesRX.com, I was order just frames, no lenses....for $99.95....(first pair were like $350, the temp/spare that I got were $170.)....they opted to send it with Signature Confirmation. Which meant that I came home to an orange-ish delivery notice instead of the frames.

That was a Friday...July 13th. Since Saturday, July 14th was the day for the Virtual 5K walk/run for Narcolepsy Research...I decided that I would adjust my route to swing by the post office to pickup the frames. Except I got off to a late start, and by the time I got there...they were closed.

Pages: 1· 2

07/02/12

  04:29:00 pm, by The Dreamer   , 440 words  
Categories: Stuff, Healthcare

How to check your PD

Since I seem to have this problem recently, that seems to lead to unexplained damage to eyeglasses....I thought I should acquire some cheap spares. Like using offers that appear via deals.woot.com or such sites now and then.

But, I had a bad experience before, because my PD wasn't right.

Now, I had noticed that there was a different PD measurement listed on my prescriptions that I've been getting from Eyecare Associates....which are probably right, but I thought I should see if there was some way to check for myself.

Searching the Internet, I found these instructions.

Self measure PD in front of a mirror: you need a mirror and a MM ruler.

  • Stand with you face about 20 cm (8 inches) from the mirror.
  • Close your right eye and look only with your left eye.
  • Place a ruler flat against the mirror and align it horizontally with the millimeter scale pointing up.
  • Look over the top of the ruler and align the zero mark in the center of your left pupil.
  • Open your right eye and close the left, but do not move your face or the ruler.
  • Read the millimeter measurement corresponding to the center of your right pupil.
  • Repeat the procedure several times to make sure you have a consistent measurement.

But this is rather difficult....well, there's another procedure:

  1. Hold the mm ruler on the bridge of your nose for stability. Pretend you can look through the mirror (X-ray vision) to see the horizon far away. This keeps your eyes from rotating in toward your nose.
  2. Point your face [nose] straight into a mirror.

    --- CLOSE your left eye to avoid parallax error. ---
  3. Align the ruler's zero to the center of your right pupil. The pupil is the black spot in the middle of the eye.
  4. Without moving the ruler, close your right eye and open your left eye.
  5. Read the millimeter line under your left pupil (careful -- backwards in mirror!).

    --- Keep you face "square" to the mirror to avoid parallax error. ---
  6. Repeat two or three times to confirm accuracy.

Using this second procedure, seems to confirm the PD on record for my prescription from Eyecare Associates.

65mm.

That's kind of a big difference than the number entered at Lenscrafters (62mm). Probably explains why buying glasses from anywhere other than Lenscrafters had always been a disaster. Which they don't use in the store, rather marking PD locations on the demo lenses and making the pair from that....within an hour.

Time to see if a few $9 pairs will really work....well, they'll end up much more than that, because I'll add in things like anti-scratch, anti-glare, high-index and progressive....and maybe I'll tint one.

11/03/11

  10:16:49 pm, by The Dreamer   , 178 words  
Categories: General, Healthcare

Eyeglass Prescription Nov 3, 2011

Today I had my latest eye exam....

Updating the progression of prescriptions:

2003: OD -5.00 -1.00 075 OS -8.00
2005: OD -4.25 -1.00 080 OS -7.00 -0.75 045
2006: OD -4.50 -1.00 055 OS -6.50 -1.00 035
2008: OD -5.25 -1.00 060 OS -7.25 -1.00 025
2009: OD -5.00 -0.50 050 OS -7.00 -1.25 030
2010: OD -5.50 -0.75 050 +1.25 OS -7.00 -1.00 040 +1.25
2011: OD -5.50 -0.75 050 +1.50 OS -7.00 -1.00 040 +1.50

Now I'm conflicted...do I get a new pair of glasses this year, to make use of this year's vision insurance benefit. Or wait until next year...where I'll have next year's vision benefit and FSA money available. Or both.

Been thinking sunglasses, the slight change in reading power would make more sense in regular pair....but regular pair is currently fine, though could probably use a spare. Except that again...new pair being slight new script would not be the spare.

Could go new lenses I suppose....and then sunglasses next year?

:hmm:

Probably won't be in a position to decide if there's going to be anything this year until like near Christmas....

Full story »

10/08/11

  12:42:00 pm, by The Dreamer   , 2750 words  
Categories: General, Healthcare

QHDHP, HSA and Chronic conditions

This month is annual open enrollment at work....time to review plan changes and make selections for January 1st, 2012. This year, premiums have jumped up a lot...particularly for single people. The implication is that for the last few years, they had drifted from the mandate that employer pays 95/55 of the health insurance costs (95% of single, 55% of family). Guess that means they had been paying more than 95% of my cost? Because my BCBS Plan A premium jumped by 44%. Plus every 3 years they renegotiate plans...and this was the year they did that.

Other than the premium jump...which was much greater compared to previous years (which hadn't jumped up as much as I had seen with previous employers). There were only a few changes this year.

The coverage on the 3 plans (A, B, C) have all stayed the same. All plans are PPO, Plan A has a 20% co-insurance rate versus 35% co-insurance rate for Plan B (in-network, all are 50% for out-of-network)...and Plan A has higher co-payments than Plan B...and higher deductible. New next year, is that BCBS will be offering Plan C (QHDHP). Other changes, is that Coventry and PHS have now merged, and United Health Care is now the 3rd provider option (though technically there were 4 provider choices last year, with addition of UMR... a sister company of UHC, but with a smaller network...and Coventry and PHS not yet merged.)

When I first started, they were HMO, PPO, QHDHP plans....and I had gone with PPO, even though all my providers were in network. When I had first moved to the US, I had started on an HMO plan...and it was bad. Like the time I went out of my way to go to what was supposed to be a Quest collection site for labwork, instead of letting my doctor do the labwork on site. And, end up getting fully charged for using an out of network lab, because the site had cancelled its contract with Quest the week before (but I had called Quest the morning of the test...so they shouldn't have misled me)....I complained, they apologized....but I never got the refund they said they would do.

Using Quest was only part of the HMO plan, so switching to PPO was good. Though later things changes to where if the practice where your primary has their own lab, the lab is automatically considered as in-network....so there was further savings, but I stayed with PPO because. Later they brought Quest in for PPO with some providers....I just picked the PPO provider that didn't use Quest.

Anyways....in my current job...Quest had jumped into the plans....though its optional. And, the Quest collection site isn't anywhere that can be reached on foot (and I'm kind of down to just the one foot now)...and the doctors in my area won't participate with Quest. At first it was part of the HMO, later it extended to Plan A & Plan B (since all 3 plans are PPO now). But, its still optional, and the labs that my doctors do use are in-network.

When I started, I went with BCBS....because I hadn't established relationships with local doctors, but BCBS had the larger network...both in state and out of state, and with relatives scattered around the country/world....access to a large out of state network was important. Plus now that I also attend conferences, conventions and such...it is hopefully less of a worry.

But, when they switched from HMO, PPO, QHDHP to the Plan A, B, C naming....I switched to Plan A. Which was at first explained as the HMO plan with PPO features. But, now they just say all 3 are PPO plans....just different cost structures.

I never really considered the QHDHP option...because I never really understood FSA/HSAs in the beginning....wasn't until 2009 that I started using an FSA. And, the steep deductible scared me (still is scary). Though one thing that intrigued me at this job, was that the prescription plan on the QHDHP/Plan C option was different from the HMO/PPO/Plan A&B one. The A&B plan was co-insurance, no deductible...the typical 3 tiers with some extras classes. When I started, it wasn't an issue...since most of the stuff I took was either generic or preferred brand (well, when I first moved to Kansas I was on Prevacid, which wasn't a preferred brand....but primary switched me back down to Prilosec which is generic. Though can't help wonder if my health taking its turn for the worse didn't start when that change was made...and now that Prevacid is available as generic....:hmm:) Anyways...Plan C's prescription plan was co-pays after deductible, which was the kind of prescription coverage I bad before I came here. Not always a good thing though...since $10 co-pay for generic.. where as I have a couple of generics where the 20% co-insurance is less...some generics I've had fill come out to $0.92, $2.02, $3.53, $1.58, $1.39....on the other hand...the co-insurance on branded meds were costing me much more than co-pay....and the worse ones were yet to come.

So, in open enrollment 2008 (for 2009), I decided that it was time to see what all this FSA business was about. I went with a minimal contribution....$300 for the year. Well, I didn't know at the time, that combined with the results of my first 'free' Healthquest screening from work and my annual physical (Well Man Exam) that I'm not supposed to be sleepy all the time, have experience that surge in weight gain during the summer, fall asleep easily during the day, including at least one uncontrolled nap each day.... I just knew that in 2009, co-insurance was change from 10% to 20%, and co-pays were going up.... But, I had my first sleep study in December 2008. I got initial setup that month...so 10% co-insurance versus 20% was a good thing, plus deductible was less, and already met, in 2008 than in 2009.

But, because of the OSA dx, I quickly met my deductible (which had gone from $50 to $150) and spent my entire FSA amount in the first week of 2009.

So, in open enrollment 2009, I decided that I should put more into FSA....but I didn't expect that I would have the same kind of major expenses that I had, so I increased my amount to only $1200. This was even though I had an accident in august of 2009, and it had cost me quite a bit. But, it was the accident that kept on giving....When I got my teeth cleaned in Jan 2010, it was discovered that I had cracked some teeth in the accident....so the $1200 was gone in a couple of months.

Meanwhile...in 2010, I was introduced to Provigil and Lunesta. The co-insurance on Provigil was about $380 a month, and Lunesta was about $112 a month. Plus then I had an accident in November of 2010, and another sleep study in December. What I discovered though was what happens when I hit my co-insurance maximum for 2010. I still have to pay co-pays...but after than everything is covered in full. While reading over the plans on co-insurance maximum, I saw that the prescription plan had a separate co-insurance max of $2850. I wasn't going to reach it in 2010, with the Provigil costs....and Lunesta didn't count towards it (even though they said if you had tried two other prescriptions before it, they would...which I had....they did require my pharmacist to call in to get permission to fill it, even though they would already know that I had been on prescribed 3 different ones before it. Though I guess 2 of them were off-label? Though the PDL only lists one drug for the class, which I had been on, and only generics...they have no preferred brand.) Provigil is also alone, as the preferred brand....though it is quite different than the other types of stimulants (Ritalin, Adderall, Concerta, Dex, etc.)

So, in open enrollment 2010, I considered switching to Plan C. They still keep telling everybody that Plan C/QHDHP is only for super healthy people. But, because of the co-pay structure of the prescription plan (after deductible)...I wondered if it might not be the better way to go.... It would take 1.5 months worth of Provigil to meet the deductible..and then I would only have to pay a $30 co-pay. Maybe sooner, depending on what else happened at the start of the year. I didn't know I was going to break my foot in November 2010. What I did find out was that one of my meds was capped at $20 a month (Singulair), where as it would be $30 co-pay with Plan C. The Plan C prescription plan didn't have the specialty tiers for things like diabetes, asthma, anti-cancer.... and it wasn't like I was on Xyrem or something super expensive. Though I had looked, and Xyrem is on the list of specialty meds, so its a $75 co-pay.

But, I had missed the open enrollment presentation (because I had gone to the NN Conference) and I didn't have a lot of answers on why they only consider Plan C for super healthy types....and not somebody like me.

The other problem is that with an FSA I can spend all the money I plan to put into it before the money is actually in it. While with an HSA, the money needs to be there first. They did say the first year is the hardest.... So, running out of time, I quickly locked in my discount status, staying with Plan A & BCBS and other stuff...and went with putting the out-of-pocket maximum of Plan C into my FSA (which is less than the current maximum that I could put into an FSA.) I had skimmed the networks of the other providers...to see if my current doctors were in, and whether they offered any other choices that BCBS didn't....

Well, I spent all my FSA for this year in about 4.5 months...and only because I switched to only submitting the bigger claims after I got my tax refund.... Though this year the the deductible did feel more painful. It had gone from $150 to $300...but I also didn't have the big expenses early in the year...so it was a bunch of little things where I had to pay the full discounted amount... Not sure where I stand on reaching co-insurance max this year for health ($1400)....

Had I still been on Provigil...I would've reached co-insurance max on the prescription plan around July...but as I had been warned at the NN Conference, I would build tolerance to it...and it stopped working in spring time.....where I was then switched to Ritalin.... And, I quickly built tolerance to that....so at the end of August I was switched to Nuvigil....which seems to be working better, and apparently its the other isomer that is in Provigil that we build tolerance to. I briefly tried Provigil again between refills, and it did little for me.

Problem with Nuvigil though is that its the non-preferred brand...so it doesn't count towards my co-insurance max....though I'm about $1000 away, so I probably won't hit it this year....even if I could've gotten the override (having tried Provigil and Ritalin before, should've met the tried two other drugs from the PDL first....also the co-pay coupon from Cephelon apparently doesn't work. Just as the co-pay coupon for Lunesta didn't work. They both say they won't work with plans that are state/federal government funded....so no discount for us poor state employees).

The other change this year is the prescription plan for Plan C has changed...its more like the Plan A&B one, except adjusted to fit the QHDHP. So instead of co-pays after deductible and continuing after out of pocket max is reached. It is just co-insurance after deductible and then 100% when out of pocket max is reached. And, tier 3 drugs count towards the out of pocket max (as do drugs on the anti-cancer tier).... Also with Plan C, there's no co-pays to see doctors....so once out of pocket max it reached....they're covered 100% in full. Didn't seem a huge deal before 2010...because PCP and sleep doctor were in the same medical home, so $25 co-pay for either....the only specialist where I had to pay $45 co-pays were related to physical therapy...and I didn't do that this year (though wonder if maybe it would help my walking issues since broken foot incident....maybe next year if things continue to worsen...)

Given how quickly my FSA went this year, and my current projected expenses (and the changes this year)....it shouldn't be that hard to reach the $1500 deductible or the $3000 out of pocket max in 2012...so it'll be interesting to see what it is like to have things covered 100% in full after that point. Especially since the current co-insurance on Nuvigil + Lunesta x 12 is more than the out of pocket max. I had considered asking about Nuvigil sooner, because paying 60% of it (non-preferred brand)...instead of 35% for preferred brand)....is about half the 35% I pay for Provigil. But, when the Provigil stopped working, doctor wanted to try Ritalin instead first....which did work in the beginning....but it didn't seem to matter to insurance on when I did get to be on Nuvigil. I decided that I would more strongly consider the switch to Plan C.

The fact that BCBS offered it was certainly a big factor, since I had concerns over network last year. And, during an open enrollment presentation..somebody asked why Plan C didn't work even if they hit the out of pocket max in the year (and all the money they put into the HSA)...

for an individual/in-network
Plan A has $300 deductible + $1400 co-insurance max & Rx has $2850 co-insurance max (where tier 3 doesn't count towards it)
Plan B has $150 deductible + $3000 co-insurance max & Rx has $2850 co-insurance max (where tier 3 doesn't count towards it)
Plan C has $1500 deductible -> $3000 out of pocket max & Rx works with the same deductible/out of pocket max (and tier 3 counts).

So sounds like if you know you're going to be out of pocket more than $3000 in a year...plan C is the way to go.

Plus with Plan A & B, the co-pays continue after the co-insurance max is hit. Plan A is $25 (Primary/Urgent Care), $45 (Specialist) and $100 (ER). Plan B is $20 (Primary), $25 (Urgent Care), $40 (Specialist) and $100 (ER)....there's an advantage for families, where co-pay for children is $10 (Primary) or $25 (Specialist)....

In addition to no co-pays with Plan C (versus Plan A)....there are two other differences, the Manipulation Therapy (IE: Chiropractor) is reduced to max of 26 per year (from 30). And the Durable Medical Equipment maximum is lowered to $1000/year (from $5000/year).

Since I just got a new CPAP machine this year, I don't anticipate my DME expenses to be more than $1000...in fact the new machine plus supplies this year shouldn't break the $1000 mark. But, who knows what the future holds.

So, since United Health Care is a new provider this year....I started to think that I should check out its network as to whether to stay with BCBS or not. In the first open enrollment presentation, I didn't stay for the HSA presentation. Because I was at first thinking that I would stay with Plan A, and this time put the $5000 max into FSA....before healthcare reform lowers the max to $2500. But, in the time between the morning presentation and the afternoon one, I started the research on Plan C/HDHP/HSAs, etc. And, decided I wanted to hear the HSA presentation.

Fortunately, they did that one first in the afternoon session.

So, I instead looked at the HSAs associated with the 3 providers....and decided that BCBS would be who I would go with.

The BCBS HSA has a maintenance fee that falls between the other two (close to the low end, where the high end one is significantly higher...and the one for UHC). The interest rate structures differed, but all were insignificant for low balances. The other two, offer maintenance fee elimination with a minimum balance. The lower one waives off at $3000, the higher one waives off at $5000....there's differences in investment options and additional fees. BCBS HSA has a lot less in the additional fees area. And, what investment options it offered seemed ok.

But, given that I'm expecting to hit out-of-pocket max (which is the contribution max for the HSA)....how much the HSA will cost for little or no balance weighed in. Though I will probably build some of my HSA over time...since initial expenses will be before the HSA is sufficiently funded, and I may or may not chose to use HSA funds to meet all my later out of pocket expenses.

On the additional side, I opted to go with $600 for a limited use FSA (Dental and Vision....I have one dental related prescription, and I anticipate the buying a new pair of glasses every year to be a trend that continues indefinitely.) I kept my Vision insurance.

Now to see how 2012 goes....

1

Now instead of subjecting some poor random forum to a long rambling thought, I will try to consolidate those things into this blog where they can be more easily ignored profess to be collected thoughts from my mind.

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