I can’t really explain how I ended up with a Florida Blue HMO plan, but it predictably turned into a problem. I say this because I’ve always elected a PPO where I could select my doctors rather than being restricted to the network. When I switched last year from United Healthcare (a PPO) to seemingly coincide with my wife’s coverage and choice of providers, all of my doctors were in the network, and this never failed until recently until it was pointed out that my card clearly stated Premier HMO. I added a supplemental dental plan to match my wife and we went to the same primary care provider, eye doctor, and dentist. However, back in Austin she had some issues with a detached retina, so she began to see a specialist while I continued with the surgeon that preformed my upper eyelid procedure (all covered except about $300 in co-pays). It was a few months ago when I decided to switch to this same ophthalmologist, thinking I had the same coverage. 

They took my card, not noticing the HMO distinction from my wife’s coverage, and proceeded with my exam that determined an immediate need for cataract surgery and a Prokera treatment. Fortunately, they only needed to polish the surface of my right eye, or the cost might have doubled. This $7,200 procedure was then denied by my insurance. I called this to their attention, with all of us thinking that I was covered, but as it turned out they do not accept the HMO arrangement with Florida Blue. They did agree that it was their fault but there were some out-of-pocket issues and did admit telling them I had the same coverage as my wife, so we ended up compromising at just under $1,200 – money I was not expecting to spend. If I had the PPO, it would have been simply a few co-pays. 

I immediately called Blue Cross & Blue Shield to switch my coverage during the open enrollment period. It was a painful hour or more on the phone because, of course, everyone jumps on this limited enrollment timeframe and the computers overload. Information had to be entered multiple times and I was already frustrated with the fact that I had bought this stupid HMO and wanted to make sure there wouldn’t be similar problems with my upcoming heart surgery that will certainly be a bit more than $7,200.

Sorting through this jungle of Social Security, Medicare, Medicaid, and related health financial decisions is a problem for even an educated individual like me. This HMO issue must have been a factor of a quickly softening retirement mind. I can only imagine some of the problems that the less fortunate have to deal with when it comes to medical ills and bills.