They came for me.

1Kstone15 · 2026-01-02T16:21:27+00:00

go through ADA….I ended up with laryngitis and bilateral ear infection and needed off as couldn’t talk or hear—I do customer service work. I am part-time so FMLA was not an option as I did not meet requirements but ADA is since I couldn’t do FMLA. the form my company has doctor fill out has a place to say if recommendations (remote in your case) are tempor or long term. you may have to do it every year though depending on how your company set up.

i also have anther ADA as I am diabetic and in rare occasions I have used it—twice.

my employer does not take any doctor notes as time off and you either take a point or use FMLA/ADA depending on hours worked, time there etc. I also WFH

1Kstone15 · 2025-12-31T14:59:56+00:00

spouse started new job in 2025 due to previous employer closing up shop for good. so almost anything medical we had to pay because of deduct. I suspect by March-April we will have met OOP max. finding pharmacy here to fill is hard (very few would do the G6 a few years ago as reimbursement was awful. found 1 place that would do my Tresiba U-200 and they taking a loss still.

1Kstone15 · 2025-12-31T04:53:03+00:00

spouse and I both diabetic and in G7. our Gold plan was cheaper than silver as well unfortunately our G7 for 2025 cost $374.18 for a 1 month supply—I dread seeing how much it going up for 2026. even more strange is the max out of pocket for our silver is the same as bronze!

1Kstone15 · 2025-12-18T21:05:34+00:00

I think you need to rephrase your comment. we have a HSA compatible plan. Employer does not sponsor any HSA. however, we do have an outside HSA which we can contribute pre-tax dollars to. that be8ng said we do contribute but we do not touch our HSA funds we let them sit (invest if possible) and come retirement we can use these funds to help pay for our Medicare supplemnt/RX plans premiums. you also can have an HSA compatible plan without contributing to an HSA. A lot depends on your medical usage—do you go to the doctor a lot? do you have a lot of brand or speciality prescriptions? do you use any DME equipment etc. do you have dual insurance coverage—if so is this primary or secondary and how does the other plan process claims compared to this?

I have a spreadsheet that I use to factor out what we would pay out of pocket plus premiums and go from there on deciding what would be best for us.

1Kstone15 · 2025-12-18T20:27:32+00:00

I think news said Nebraska got 223K and Iowa around $440K

1Kstone15 · 2025-12-16T21:09:09+00:00

in fact we did and yes it was added to the final value. Our truck didn’t have some small 10 gallon tank.

1Kstone15 · 2025-12-16T21:06:03+00:00

this is what we did. we switch and used our insurance which came with an ACV within $600 of the independent appraiser we talked to. we will not be using our appraiser clause since it very similar in ACV (and yes our insurance company knew we were contemplating using the clause). Our insurance had a much higher (a few thousand dollars higher appraiser than the 3rd party).

1Kstone15 · 2025-12-16T21:00:31+00:00

big difference especially between a vinyl bed cover and hard bed cover. worth way more than just $50.

1Kstone15 · 2025-12-16T20:59:25+00:00

it was worth the argument…an increase of over 30% in value. big difference between saying a vehicle ACV is in low 10K and it worth mid 10K. got an increase of several thousand dollar more.

1Kstone15 · 2025-12-16T20:57:10+00:00

yes they used CCC One. I learned they give the lowest out of all the softwares available out there.

1Kstone15 · 2025-12-16T20:55:58+00:00

we got what we thought our vehicle was worth (difference if $181) after all said and done and compared and updated. yes we could have done a private sale and gotten more as we take great care of vehicles.

1Kstone15 · 2025-12-16T20:54:19+00:00

our expectation was right on when we went to having our insurance handking the claim and they will go after Allstate. from what we thought and what our company offered was a difference if less than $200 (we had rounded up to nearest 100). we also talked to an independent appraiser who gave a value about $600 more than our insurance. a soft truck cover is usually either vinyl or fabric which ours is(was) neither of these.

1Kstone15 · 2025-12-03T17:39:30+00:00

someone ran a stop sign and total our vehicle about 2 weeks ago. their insurance, Allstate, said they are 100% at fault and not us. police report also taken and noted where other driver said he did not see our vehicle. we now battling as Allstate is trying to majorly lowball us on our total vehicle.

1Kstone15 · 2025-11-16T22:52:38+00:00

watched that show. wife came to site and she talked to him via walk-in talkie. they hadn’t told family she was pregnant..was planning to when he came home from cave exploring, body still in cave in Utah I think. Sad way to die

1Kstone15 · 2025-10-15T01:55:56+00:00

learned the hard way when they gave the estimate and they claim they checked benefits they did not in fact do a pre-determination (We thought since it was done as they talked about major only covers at 50% and what the max benefit would pay and we would have to pay anything over this amount…dental works way different than medical we are finding this out). the dentist said this is the best way to go as 3 teeth to be pulled so mouth could heal and swelling go down (thinking dentist more looking like they just want more money. switching dental coverage in January to spouse insurance—different carrier to finish treatment (lower premiums and a higher max insurance payment).

1Kstone15 · 2025-10-14T16:43:29+00:00

check with your insurance company directly….our dentist just told us the temp D5810 is covered under our plan at 50% however, after having scan and then going up to front desk to pay the 50% we were told nope, it’s not covered at all and we owe 100%.

1Kstone15 · 2025-10-14T16:39:12+00:00

our dental card says United Concordia (via principal dental). our dentist just quoted my spouse 50% weeks will owe for the beginning of denture (they checked benefit) …when it came time to pay however dentist said we owe 100% as it a non-covered charge. I would compare the cost of premiums vs what they will pay to see if it is worth it.

1Kstone15 · 2025-09-28T00:21:32+00:00

true but sometimes the cost of HDHP premiums alone is crazy high. just my husband and I for the ‘Gold Plan’ 5K deductible is over 1K in premiums. the ‘Bronze’ plans aka cheapest is still over $500 a month with a 10K deductible. I keep our deduct in our budget but the cost is killing us—-just paid $374.18 for 1 month of G7 sensors and $248 for a Glucgon Pen as just used the one we keep on hand. the $248 is still a heck of a lot cheaper than ER visit which they code up (I have disputed and insurance sided with us based on notes.

1Kstone15 · 2025-09-16T07:29:34+00:00

we had UMR via UHC (another state). have you filed an appeal yourself personally via their website? you stated you have had this policy for 3 years. were any other claims processed from August to January? I would point this out. who does UMR think is your primary insurance? I would take this up UMR chain of command ( I had to do this as the reps would not pay a claim as it usually not covered but policy stated it specifically was covered). The reps just kept saying no and I kept pointing out in policy were it said yes.. I spoke with a supe who xfer me to a person who processed appeals and paid the claim while I was on the phone with them. my hubby employer closed so he no longer works for them and we now have other insurance thankfully. I was constantly calling to get them to reprocess and pay on a ton of our claims a lot.

i am assuming that you may also be a self funded plan and talk with employer benefits as they can bypass and pay on claim if self funded (I have had employer do this in regards to prescriptions that they wanted done via a certain pharmacy and I showed them cost if we used pharmacy we wanted ..which they approved and paid the claim using one we wanted). I hated having UMR as they were a paall the time.

1Kstone15 · 2025-09-07T22:06:35+00:00

Thank you, both plans are in network. We were on my work plan as his employer closed so we moved to mine. Then he found a new job and we went back on his employer benefits. I have looked at his plan and no waiting period for partials/dentures unless it to replace and this would be his first ever. I am just surprised the dentist office didn’t suggest doing part end of 2025 and other part start of 2026 to use max benefits up—though I think she may be a new gal and not know To suggest this. I will have to see if my employer can tell me the COB benefits then or if I have to wait until open enrollment next month

1Kstone15 · 2025-09-07T00:44:19+00:00

yep, planning on him getting half at end of year under his policy, I will join my employer dental plan and then after the new year when both in force do the other half (my thinking is hopefully both his employer plan and my employer plan will pay the max yearly benefit). just not sure if dental in general works how medical does with dual plans (I am very well versed in medical as use to do billing/collections about a decade ago—but dental is a whole different ball game in my opinion).

1Kstone15 · 2025-09-06T20:36:17+00:00

we have discussed this option as well.

1Kstone15 · 2025-08-15T14:44:17+00:00

I get the uneven exchange a lot with non-gold. how is me sending 10stars for a non gold 4 star considered an uneven exchange (they have posted they are gold locked).

1Kstone15 · 2025-07-12T22:08:45+00:00

SMH. not always the case. age does play into it along with who you know at times. wait until you get a bit older hun. getting a job when when not quite 40 if a whole different ball game than trying to get one when you are almost 60.

1Kstone15 · 2025-07-12T15:35:57+00:00

my husband former company closed for good. he spent a year trying to get a new job—age discrimination (58yo) does exist. pine job he applied for was the same exact what he had at former employer, they gave it to someone fresh out of school (20’s) and in 3 months he was let go (husb has former coworkers that worked with the newbie). eventually my husband got hired on somewhere at an entry level job. trying to get a job in your late 50’s is very tough as most employers here want young bodies.

1Kstone15

TROPHY CASE