Ava
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Post by Ava on Aug 23, 2013 21:43:45 GMT -5
I changed jobs last years, so I changed health care coverage. My employer offers two insurance plans. I have the "expensive" one that covers a little more. I have a high deductible and then co-pays of 20% to 40% of whatever services cost after insurance negotiates. I've paid $750 so far out of pocket, besides premiums of $80 biweekly. That was just for treating a skin rush ($500) at a walk-in clinic and a yearly check up with my primary care doctor ($250). I still have to go for a mammography, but I'm waiting till I pay the bills to take on more. Of course I am now more aware of health care expenses. The old insurance covered everything except a co-payment of $20-$40 for office visits. Insurance premiums were about the same. A friend who still works there says now the insurance isn't as good as it used to be. I plan to stay with this employer around 12 to 18 more months. So for now I just smile and bear it. I'll try to get better insurance at my next job. I really have a hard time understanding how average working people afford health care. I don't have any chronic illness and it's making a dent in my finances as it is. I feel like doctors, nurses, etc. make a big deal of every little thing and want you to keep going and having tests, more visits, etc. I ask a lot of questions and try to get only what I really need and none of the extras. I also always ask "How much is going to cost me?". So far the answer has always been: "We don't know." What does your insurance cover? How much do you pay for premiums and such? Do you have any big medical bills? Where do we go from here as a nation? Are you happy with the system as it is or do you want changes?
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Post by The Walk of the Penguin Mich on Aug 23, 2013 22:34:48 GMT -5
I have always chosen jobs that have excellent health insurance. I pay $26 monthly, the balance (another $450ish) is paid by my employer.
My copays are $20 for in network providers, $40 for out of network. I have a $500 deductible, and then insurance pays 80% until I reach $1500 out of pocket ( 60% and $4500 for out of network).
Normally, I never hit my deductible but the last 2 years I have not only hit it, but have hit the deductibles for my out of network charges. My infection, which resulted in over 2 months total hospitalization, 3 weeks in a rehab unit and 4 orthopedic surgeries has cost me over $13,000 out of pocket at this point. My insurance company has paid out in excess of $750,000.
However, I chose a surgeon who was the best one that I could find and he is out of network.
Even though my disability only covers about 70% of my income, I've been able to pay off my medical debt fairly quickly. I just received a bill from my surgeon for $3500 for my last surgery in October. My insurance company finally paid that bill in June.
Had I not gone for the best treatment I could find in the US, my bills would have been only around $1500. I'd also likely be dead or in a wheelchair.
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Sharon
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Post by Sharon on Aug 23, 2013 22:39:07 GMT -5
Ava double check your plan. Part of the affordable care act (Obamacare) is that there are no co-pays on certain procedures. Things like mammograms and colonoscopies should no longer have co-pays because they want people to get these things done.
If the plan is grandfathered in you may still have to pay a co-pay but then again there is a chance that there will be no co-pay on the mammogram
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spartan7886
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Post by spartan7886 on Aug 23, 2013 23:03:06 GMT -5
Ava double check your plan. Part of the affordable care act (Obamacare) is that there are no co-pays on certain procedures. Things like mammograms and colonoscopies should no longer have co-pays because they want people to get these things done. If the plan is grandfathered in you may still have to pay a co-pay but then again there is a chance that there will be no co-pay on the mammogram I agree with this. I almost posted it, but thought maybe she was talking about lab fees for standard bloodwork. I know even though my visit was "free" I still got billed for those later. That's not an annual thing, though.
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Deleted
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Post by Deleted on Aug 23, 2013 23:14:54 GMT -5
What does your insurance cover? How much do you pay for premiums and such? Do you have any big medical bills? Where do we go from here as a nation? Are you happy with the system as it is or do you want changes? We pay $271/mo for standard insurance for the two of us thanks to DF's job; it deducts automatically. I don't have a line on my budget for more medical expenses though. Our insurance is mostly just in case we get mooshed in a car accident, we've never used it yet. *knocks on wood* DF is stupid hardy; since we moved to a rural area, he doesn't even have allergies anymore. Structurally I'm hardy and have good pain tolerance, but my immune system is very weak, and life threatening allergies to hormonal, pain killing, sleep inducing, and antibiotic medicines run in both sides of my family. I know I'm deathly allergic to birth control, penicillin, and aspirin, and that excedrin makes me puke. I haven't attempted anything else. So going to a hospital is double risky; I might catch something worse with my terrible immune system, and I might be given a medicine that'll create a violent allergic reaction. My family is all about brushing, flossing, exercise, and the holy trinity of food/water/sleep for infections or food poisoning. Injuries, we get stitched up if need be, but dad bit down on a gauze pad when he had a 16 stitch gash, because of his pain med intolerance. Muscle/nerve injuries are handled with ice and self done acupressure therapy and gentle strengthening exercises over time. Dad got some bad shoulder injuries from multi story fall (spent his whole working life as a roofer), but is 67 and still going strong with good massage tools and book data on nerves; he re roofed their 3 story house this summer. He works on his shoulder a bit every day to keep it limber. All that said, I do think the "we all have no idea how much anything costs" system is kind of screwed up. I'm hoping that as data becomes more and more synchronized and transparent, costs for things like simple medicine or getting a simple broken bone set will be more stabilized, instead of varying insanely as I understand to be the current case.
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Deleted
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Post by Deleted on Aug 24, 2013 7:13:30 GMT -5
I've got a high deductible plan too. I pay about 50 every other week. If I go to the doctor, I have to pay 100% of the price up to a certain amount. I think it's 1500. After that, it is 10% until I reach my OOP max which I think is 2100. After that, everything is free. Those are in network, I don't know out of network numbers,
I was annoyed because I planned on DDs birth costing us approx 2100 and the insurance company told me that DD was covered under me for the first 30 days. What they failed to mention (and I should have asked) is that she counts as a separate person with her own deductible. So her birth actually ended up costing about 4k. Big scheme of things? Not that bad, but I was annoyed because it wasn't what I had planned for.
So, this year I'm doing everything else medically that I need to get done since its effectively free now. Got my new IUD, going to a dermatologist, will get check ups before end of year, etc. next year, I think I'm going to go on DHs plan that is a more traditional copay plan.
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973beachbum
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Politics Admin
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Post by 973beachbum on Aug 24, 2013 8:49:01 GMT -5
We pay $362.55 a week for crappy family coversge with a $1500/$3000 ded and 60%/40% coin. I win.
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Nazgul Girl
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Babysitting our new grandbaby 3 days a week !
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Post by Nazgul Girl on Aug 24, 2013 9:26:03 GMT -5
I have always chosen jobs that have excellent health insurance. I pay $26 monthly, the balance (another $450ish) is paid by my employer. My copays are $20 for in network providers, $40 for out of network. I have a $500 deductible, and then insurance pays 80% until I reach $1500 out of pocket ( 60% and $4500 for out of network). Normally, I never hit my deductible but the last 2 years I have not only hit it, but have hit the deductibles for my out of network charges. My infection, which resulted in over 2 months total hospitalization, 3 weeks in a rehab unit and 4 orthopedic surgeries has cost me over $13,000 out of pocket at this point. My insurance company has paid out in excess of $750,000. However, I chose a surgeon who was the best one that I could find and he is out of network. Even though my disability only covers about 70% of my income, I've been able to pay off my medical debt fairly quickly. I just received a bill from my surgeon for $3500 for my last surgery in October. My insurance company finally paid that bill in June. Had I not gone for the best treatment I could find in the US, my bills would have been only around $1500. I'd also likely be dead or in a wheelchair. I have always considered your story to be one of courage and hope. Never give up. Never surrender. (Galaxy Quest, 1999 ).
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Ava
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Post by Ava on Aug 24, 2013 11:21:05 GMT -5
The company I work for focuses on employees remaining healthy and being responsible for their own health. It's all a money saving strategy, that's all. They offer $200 prices for people who stop smoking or loose weight. They also give a discount on your premiums ($100 I think) if you go through a check up where they take your weight, blood pressure, etc. and then they give you advice. All that is very well, but doesn't compensate the fact that coverage is horrible. I checked on mammograms and they are free, but I'm sure I'll get charged for visiting the gynecologist, associated fees, etc. Like I said, I don't mind too much because I don't need much care other than routine check-ups, and don't plan to stay there all that long. I will consider health-care coverage hard and long before I take a new job, for sure. Having bad coverage can financially kill you.
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JustLurkin
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This is what you look like right now.
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Post by JustLurkin on Aug 24, 2013 11:27:37 GMT -5
They also give a discount on your premiums ($100 I think) if you go through a check up where they take your weight, blood pressure, etc. and then they give you advice. Did you participate? My prior employer "offered" it as well, but I didn't trust them enough to participate. I think there was a long thread on the "old board" debating whether or not employers had access to the information.
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Pants
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Post by Pants on Aug 24, 2013 12:01:42 GMT -5
The company I work for focuses on employees remaining healthy and being responsible for their own health. It's all a money saving strategy, that's all. They offer $200 prices for people who stop smoking or loose weight. They also give a discount on your premiums ($100 I think) if you go through a check up where they take your weight, blood pressure, etc. and then they give you advice. All that is very well, but doesn't compensate the fact that coverage is horrible. I checked on mammograms and they are free, but I'm sure I'll get charged for visiting the gynecologist, associated fees, etc. Like I said, I don't mind too much because I don't need much care other than routine check-ups, and don't plan to stay there all that long. I will consider health-care coverage hard and long before I take a new job, for sure. Having bad coverage can financially kill you. If you get your annual ob/gyn checkup, the pap smear should also be free as part of the Affordable Care Act, as well as any other recommended annual tests. ETA to clarify: Not all recommended annual tests are covered, but ones that count as preventative care are.
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Post by The Walk of the Penguin Mich on Aug 24, 2013 12:09:26 GMT -5
They also give a discount on your premiums ($100 I think) if you go through a check up where they take your weight, blood pressure, etc. and then they give you advice. Did you participate? My prior employer "offered" it as well, but I didn't trust them enough to participate. I think there was a long thread on the "old board" debating whether or not employers had access to the information. Be aware that if this plan is offered by a third party, then the healthcare information that you offered is NOT covered under HIPAA. My employer offers this and if I volunteered my health information I could receive up to $300/year per member of family in the insurance plan. This is sponsored by a third party and nothing stops them from using your personal healthcare information. My employer also offers a lot of incentives to remain healthy as well. Preventative care is covered without copay. In fact, last year in the middle of my medical misadventures, the insurance company called me to remind me that I was waaaaay overdue for my mammogram (I was 2 years out when I got sick and wound up in the hospital.....the appointment got canceled). Discount gym memberships and various counsellors to stop smoking, drinking, start exercise, etc. are available for a phone call.
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Ava
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Post by Ava on Aug 24, 2013 14:01:48 GMT -5
I haven't participated in those programs, and I don't have any intention to do it in the future. They don't compensate the bad insurance we get, and I don't feel comfortable with employers trying to meddle with my healthy or unhealthy habits. Stay away from my personal life and my personal choices. I like that they have these initiatives available because some people like to participate, but not for me. They only give very little money for a lot of work. I guess if you are going to quit smoking or loose weight on your own, getting a couple hundred can't hurt. The other idea, the check up, involves a lot of work on your part. A check up with your doctor, fill and submit a questionnaire, upload a healthy recipe, etc.
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Deleted
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Post by Deleted on Aug 24, 2013 16:28:19 GMT -5
All that said, I do think the "we all have no idea how much anything costs" system is kind of screwed up. Yeah, this drives me up a wall. I'm all for patients having some financial skin in the game and making informed decisions based on possible side effects, likely outcomes, available alternatives, etc. but how do you make an informed decision when you have no idea what things will cost? To answer the OP's question: we have a high deductible plan with a $2,500 family deductible which we're guaranteed to blow through every year because of DH's chronic health issues. Coverage after that is decent if you stay in network and I think max out of pocket is $5K. They did caution us that out of network they cover a percentage of what's "reasonable and customary" and one employee got hit with tens of thousands of dollars for amounts in excess of "reasonable and customary". Ouch. We have a Wellness program and staying fully engaged (which isn't too hard) cuts our premiums from about $400/month to $200/month. I rack up mucho points because I'm healthy and active anyway (just did a 31-mile charity bike ride today- woo-hoo! ) and DH can manage enough to be classified as "engaged". Because of our status in the program I just paid $130 for two nights at a Marriott for our next trip that would have cost over $400 otherwise- and it includes free breakfasts. Some friends on FB were posting about insurance and some had annual deductibles of $8K. I understand the principle that insurance should be there for the expensive scary stuff and not all the nickel-and-dime stuff, but that's pretty skimpy coverage.
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Deleted
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Post by Deleted on Aug 24, 2013 19:31:12 GMT -5
About the only thing I know about my insurance is that it has a $30 copay for dr's visits and a $150 copay for outpatient procedures at hospitals. Because DH has Medicare as secondary, we never saw a bill for his many expensive surgeries. I think I may have to work forever to keep it that way.
My insurance would cost me $15 a month (this is BCBS) for single, and $162 for family. DH also pays a $28 smokers surcharge. I think it is an 80/20 plan for stuff like hospitalization, but that is also after they negotiate the rate down to about 10% of what the hospital "charges."
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wvugurl26
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Post by wvugurl26 on Aug 24, 2013 19:52:11 GMT -5
My insurance company threw me in a disease management program. I can choose not to participate. It is administered by a third party. However, my insurance company shared my claims/diagnoses with this company. I could be wrong but that kind of sharing better damn well be covered by HIPAA.
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Post by The Walk of the Penguin Mich on Aug 24, 2013 23:34:38 GMT -5
My insurance company threw me in a disease management program. I can choose not to participate. It is administered by a third party. However, my insurance company shared my claims/diagnoses with this company. I could be wrong but that kind of sharing better damn well be covered by HIPAA. You should be ok. Your insurance company shared your medical information with a HIPAA compliant company, otherwise they would be on the hook for a very large fine. The difference between what you have had happen and others is that you are offering up your own health information, you are not required to be HIPAA compliant yourself and you can share your own health information with anyone that you choose. However, once you have given out your information, they do not have to be HIPAA compliant. They may be, but many times they are not (IME). I had something similar happen when the bills first started rolling into my insurance company last year. I got a call from a nurse manager wanting to know if I needed any help with anything. I was pretty much on top of things, and while I had a few questions as to how my insurance policy dealt with certain bills (i.e. in network facility but assigned an out of network doctor), and the manager was pretty good in telling me how to navigate an appeal. I was called several times over 18 months, I think that she was also trying to see if I was depressed.
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