You know that feeling when things just seem to be going TOO good? You feel like it just can’t be – that you have to be missing something. Well that is how I’m feeling right now. I believe I mentioned about 3 months ago or so when J changed jobs that we had some insurance concerns. His new insurance company was an HMO, which means less freedom, referrals and just pain in the tush restrictions. Before he even accepted the jobs I checked on the doctors (their Pediatrician and our regular docs were all on the new company) and thought their allergist and gastroenterologist (both whom we love) were not on the plan [there are NO out of network benefits]. There was also the biggest scare – Prevacid. We were told initially that Prevacid was covered, but only the solutab (which Kayla can’t take b/c it has dairy in it) and there were dosage and time limits. This was the biggest scare b/c Kayla’s dose is over $300 a month and Alysa’s close to $200. This would have been so bad that we considered cobra’ing instead for the full 18 months. Then the owner’s insurance broker looked deeper and said that his prescription plan DID cover Prevacid. I was still skeptical though because I couldn’t call since we were not on the plan yet. This new insurance is the whole reason we are paying out of pocket for Alysa’s feeding therapy – she does not take the new plan, but she’s worth it to stay with her. And did I mention that our copays are going up? $30 for regular docs (unless it’s a check-up than there is no copay). And $30 for ALL prescriptions. We pay $20 for Prevacid now. So that’s an increase of $20 a month for both girls.

Fast forward to November – their allergist told me (his practice is new) that if he is not showing up under that plan yet, he will be by our next visit. He will be in network on our plan. I breathed a little easier.

Fast forward to yesterday. Our new insurance is now effective. I got our id cards over the weekend, so I called yesterday. First, I’ll say they were a pleasure to talk to. I don’t think I’ve ever used insurance company and pleasure in the same sentence before. But the best part is that Prevacid is covered and WITH no hoop jumping (oh the hoops that we had to jump through for Aetna to cover it). Not only that, but the copay is $30 for 90 days! Right now we pay $20 per MONTH, this means that our monthly copay goes DOWN to $10 a month. So it’s actually saving us money. This pretty much applies to all our prescriptions – they allow you to get a 90 day supply through your local pharmacy – no mail order hassles.

And…both their allergist and gastroenterologist are in network, AND the plan actually does NOT need referrals. All HMO means to Oxford Health Plans in NJ is that you don’t have out of network benefits. I can live with that, especially if I can keep my hassle-free doctor visiting.

I keep looking over my shoulder thinking this can’t be right. I’m waiting for someone to pop up behind me and yell PSYCHE!!! If I’m dreaming, please don’t wake me…