Health Insurance Rant

[llPa1nll]

Ok, first this isn't about Obama or his health care plan, period! If you want to talk about that please start another thread so it can get deleted!

This is strictly about my health insurance!

Let me first say that I work for a small company. When I say small I mean its just me and the owner. They get the health ins plan that we both use. I am not married nor do I have any kids. However my out of pocket for my health insurance is close to $500/mo.

I had a 3.5 day hospital stay on Memorial Day weekend, with some emergency surgery thrown in there. So my insurance at nearly $500/mo left me owing my full out of pocket expenses for the year in the amount of $3,000 ($1,000 deductible + 20% Co Ins $2,000).

I guess with an individual plan costing me close to $500 a month, you wouldn't think that my out of pocket would be $3,000.00. Now the kicker would be if I didn't have health insurance my hospital stay would have run me $23,500. I guess that is the bright side, that and I am back to normal. Steps off soap box.

[cart7t]

You need to shop around and find your own health ins.

Unless you have a pre-existing condition, I think you can easily beat $500 a month for an individual policy and get better coverage.

[SirSnookalot]

Just to give an example of how the healthcare insurances companies have changed over the years. About 40 years ago I had a 5 day stay in the hospital, my total bill was .25, that's right .25 and that was for my wrist name band, television was extra of course. Many other stories with my dad who had stays that amassed 100k or more and his personal outlay was a pittance.

Even the best plans have increased co pays, increased deductibles and some have even dropped prescriptions or gone to a 50/50 split. My first plan had no co pays for office visits and scripts were $2.00 co pays.

Your fortunate that you are at least in a group, individual plans are terrible compared to group and usually more costly, most don't offer prescriptions. Being in a small group is a definite disadvantage compared to group's like the uaw, teacher unions or congress, but so much better than individual plan. Also if you do get married and decide to have a family, most groups accept family members(if wife does have a pre existing they may put her on probation for a while then write her), not so with individual plans.

I don't know the nature of your stay but it's possible that you have that pre existing condition now.

Take it in stride and stay where you are at, individual plans just don't cut it like a group plan, next time it could be more serious.

I have had my own small group, been a part of large group and now being retired I have an individual plan......it stinks.

[Grey Wolf]

We are being raped by the insurance industry but what are our options ?

[SirSnookalot]

We are being raped by the insurance industry but what are our options ?

The goal of the insurance and drug companies is to make lots of money at your expense.  Even the best plans will be poor by todays standards in years to come.  I've read that in 20 years or so we may be paying as much as  30-50% of our income just for healthcare.

Most know the option........some just don't get it!  Our economy in years to come depends on it as well.

[Tin]

You need to shop around and find your own health ins.

Unless you have a pre-existing condition, I think you can easily beat $500 a month for an individual policy and get better coverage.

x2

[llPa1nll]

I did do some looking around and found that I cant even get an *** as an Individual, my only options are PPO or HSA. Granted those premiums are half as much as what I currently pay however the amount of coverage and large size of the deductibles the cost benefit ratio just isn't there, for instance the deductibles shoot up to $5k or $7k out of pocket.

[grimlin]

Yikes,$500 a month? When i was working i was only paying around $80 a month.Since I'm now unemployed,Looked at some health insurance numbers on what it would cost be now and it's around $250-$300.

I'd look around as well.If that's the ongoing average cost of health insurance by you then you are pretty much screwed.

[frogtog]

I would be more than happy to get by with $500 a month Then I would have $ 400 left out of my SS check to fish with. ;D

[done]

    I feel for ya man. I have family coverage and it is expensive. Last time I had emergency surgery (appendectomy), I had to argue for 2 hours with the claims person that is was an emergency (cause it was out of network) because apparently, just because the procedure code was "Emergency Appendectomy", did not mean it was an emergency. The only way you get reasonable coverage from any of these guys is to take a ton of time and complain, complain, complain, which does not make your employer to happy.

[SirSnookalot]

I did do some looking around and found that I cant even get an *** as an Individual, my only options are PPO or HSA. Granted those premiums are half as much as what I currently pay however the amount of coverage and large size of the deductibles the cost benefit ratio just isn't there, for instance the deductibles shoot up to $5k or $7k out of pocket.

See what I mean..........and that only scratches the surface of the difference.  Your best option is to see if your boss will get a better plan, but it will cost more.  Not to get nosy but does your employer pick up the healthcare tab, a portion, or just make it available to you at your expense?

[llPa1nll]

I did do some looking around and found that I cant even get an *** as an Individual, my only options are PPO or HSA. Granted those premiums are half as much as what I currently pay however the amount of coverage and large size of the deductibles the cost benefit ratio just isn't there, for instance the deductibles shoot up to $5k or $7k out of pocket.

See what I mean..........and that only scratches the surface of the difference. Your best option is to see if your boss will get a better plan, but it will cost more. Not to get nosy but does your employer pick up the healthcare tab, a portion, or just make it available to you at your expense?

Fair enough question this is the first year they have helped with paying basically $50 a month they contribute. Which isnt much but its a helpful contribution. They have the family plan which their premium is in the $875 area. Previous to this year they just made it so I could get my plan through them which was fine. When I first started getting Health Ins through them it wasn't that bad at $250/mo for better coverage. However 7yrs later and the way things are going the premiums increase and coverages decrease.

[moby bass]

Agreed, health insurance is a problem, but IMO, its because there is too much of it. Consider this, before insurance companies began footing the bill for every medical exam, procedure, etc. doctors and hospitals in the communities where they existed, charged their patients based on what people in that community could afford to pay. As insurance companies began to pay bills, prices began to rise. This is well known as the theory of deep pockets. Also, more people were now involved in processing all the paperwork, so doctors and insurance companies hire more staff. Prices go up. Couple this with lawsuits, sometimes legitimate, sometimes not, and no tort reform, prices go up. Health insurance does not reflect true supply and demand. We have health insurance through my wife's teaching position. I almost never use it. Yet, the district pays all that money to the insurance company, which of course, shows up as profit on their books because there are no "expenses" against it.

What if there were no health insurance for anyone, anywhere. The first thing that would happen is of course you'd have more money in your pocket. Maybe up to $6,000 a year or more. I'm sure a lot of people would stop going to the doctor for every little cough and cold, which automatically cuts down the demand for services. In a competitive market, prices will fall as demand decreases. Consider that many insurance plans do not provide for eye care. As a result,

since many people pay for that themselves, there is a lot of competition with the resulting reduction in cost.

Now, if we can reduce the everyday costs of health care to people,

such as normal doctor visits, cut down on unnecessary procedures that are done simply as doctor and hospital CYA because of fear of lawsuits, and severely reduce the staff necessary to process all of this paperwork, we only need to focus on catastrophic health care. With many other costs contained, this should be much more manageable.

I just don't believe blanket health care for everyone will help the situation by controlling costs. As prices rise, the insurance companies try to control costs, to protect profits, which of course leaves the individual paying the difference. If you have to pay $500 a month for insurance, a $3,000 deductible and a 20% co pay for a $10,000 procedure, wouldn't you be better off if you just payed for the whole thing yourself? And the procedure would likely be less than $10,000.

My mother went to the ER, several weeks ago, at the doctor's suggestion, because of a severe pain under her arm and across her chest. Based on what she told me she was doing at the time of the pain, I said did you pull a muscle? She said she didn't know. Anyway, after 6 hours in ER, blood work, EKG's and 2 additional days in the hospital for stress tests, etc., the results suggested it was a pulled muscle due to aging, shrinking and her spine compressing. I'm not a doctor, but a little common sense goes a long way. She didn't want to stay in the hospital and asked if she could leave the ER. The doctor said sure, but you could go home and die, so that's why we want to do the tests. True, but the tests were also to rule out any possiblity of lawsuit if she did go home and something else occurred.

Of course, Medicare paid for it, and my mom told me that if she had to pay for it, she wouldn't have stayed.

I'm fearing the same type of insurance fiasco is now beginning to occur in the auto repair business. Companies are now starting to offer insurance against costly auto repairs. What will happen to repair costs once someone the than the car owner pays the bill? How will the rest of us unfortunates cope with increased repair bills? Will this be the next thing to be negotiated into employment contracts.

Well, just my $.02.

[Bassn Blvd]

I don't have a general practice doctor. The only doctor I have is a cardiologist which I see about 2x a year. I recently started using the MedXpress clinics because hospital ER's are so overly abused and EXPENSIVE.

MedExpress is basically wait free, and the doctors seem to be pretty good.(Only been 2x)  

People go to the ER for so many stupid reasons.  My son sprained his ankle skateboarding and guess what?  His mom wants to go to the ER.  No fricking way.  It was 11pm so he can ice it and wait until morning to see his regular doctor.. That's all the ER woulda done and charged you $1000 for the visit. $500 for X-rays and another $700 for the Doc to read the X-rays, $250 for the Ace bandage.  Can you say Scam.

[Fishing Rhino]

I did do some looking around and found that I cant even get an *** as an Individual, my only options are PPO or HSA. Granted those premiums are half as much as what I currently pay however the amount of coverage and large size of the deductibles the cost benefit ratio just isn't there, for instance the deductibles shoot up to $5k or $7k out of pocket.

Is that a deductible, or do you have to pay the first three grand out of pocket for a year, then the insurance company picks up the tab thereafter?

There is a lot of confusion regarding the terms of various policies.

There are similar policies for meds.  You pay the first X dollars for the term of your policy, then the insurance pays for everything after you've kicked in your annual contribution for meds.

Do you have to pay the first three grand for every hospital visit, or the first three grand for the term of the policy?

[Root beer]

Insurance company gambles on us like we gamble on option security (especially if you do a buy-write). Not just health insurance, but home, auto, etc.

It was never design to cover all your emergency expense, it was design to lower the overall shell shacking of your bank account. For instance, if your house caught on fire and it cause you lose nearly 90% of your savings account asset to cover the cost of rebuilding, however, with insurance it was design to lower that loss. You was going lose money one way or another, but you would be better off than 90% loss.

That was idea behind insurance. It tangle web we weave in this world. I do agree with Moby Bass for most part. It just seems like supply and demand is not big issue with health, it just more of a long line of cost that are tied up to the health care industry. 300 million American in need of some form of health care and doctors paying 100,000.00 or more in students loans..Yeah there pretty big incentive keep price high, not mention the cost of research, and to pay off money borrow from researching, etc. It a messy business.

Also, it not just insurance trying to rape you, the hospitals themselves are trying to make a profit too.

[Maxximus Redneckus]

Best thing too do is get Insurance on yourself for being out of work from illness or injury .Some plans give you 100 bucks aday depending on your illness/injury no questions asked .We will allways have bills just do a IOU to the hospitals  ;D

[Bull Hurley]

Sounds like you need to get out of New Hampshire.   I have Anthem here and my policy is $125/month and my wifes is $325/month with maternity, both individual.  Her's is more due to a few surgeries including a miscarriage a few months ago.  

[Big Tom]

Sounds like you need to get out of New Hampshire. I have Anthem here and my policy is $125/month and my wifes is $325/month with maternity, both individual. Her's is more due to a few surgeries including a miscarriage a few months ago.

I am sorry to hear that, Tom.  My best wishes to you both.

[cart7t]

I did do some looking around and found that I cant even get an *** as an Individual, my only options are PPO or HSA. Granted those premiums are half as much as what I currently pay however the amount of coverage and large size of the deductibles the cost benefit ratio just isn't there, for instance the deductibles shoot up to $5k or $7k out of pocket.

See what I mean..........and that only scratches the surface of the difference. Your best option is to see if your boss will get a better plan, but it will cost more. Not to get nosy but does your employer pick up the healthcare tab, a portion, or just make it available to you at your expense?

Fair enough question this is the first year they have helped with paying basically $50 a month they contribute. Which isnt much but its a helpful contribution. They have the family plan which their premium is in the $875 area. Previous to this year they just made it so I could get my plan through them which was fine. When I first started getting Health Ins through them it wasn't that bad at $250/mo for better coverage. However 7yrs later and the way things are going the premiums increase and coverages decrease.

I don't know how old you are.  I guessed by looking at your picture to be 35.

I went to BC/BS in Missouri where I live.  I did a quick quote.

Plan name - Blue Access 100

Monthly Premium - $217.33.

Network Type - PPO

Out of pocket maximum - 500/1,500

Coinsurance - 0

Office visits - $25 copay

Prescriptions - generic and brand

Mental health - Yes.

That was a quick quote.  You can cut your premium by raising your out of pocket deductable.  Don't forget,  places like Walgreens and Walmart along with others provide generic drugs over the counter at $5 or less every day without using prescription coverage.  

[ilovefooffur]

Health insurance and hospital bills are ridiculous!!!  People don't really realize how much it costs until they use it or have to pay for it themselves.

[SirSnookalot]

I don't know how old you are.  I guessed by looking at your picture to be 35.

I went to BC/BS in Missouri where I live.  I did a quick quote.

Plan name - Blue Access 100

Monthly Premium - $217.33.

Network Type - PPO

Out of pocket maximum - 500/1,500

Coinsurance - 0

Office visits - $25 copay

Prescriptions - generic and brand

Mental health - Yes.

Rates and coverages vary from state to state, Florida blue cross is higher than in most other states.  The online quote is a starting point, once dialogue is established your background will be checked and at that point the rate may be adjusted upwards.

My Mich.B/X rate is about half of what it would be in Florida for a similar plan (still not as good) but they will not write us due to pre existing condition.  My wife had a stroke in 97 and presently takes heart and cholesterol medication and I have acid reflux (gerd) and they don't want me either.

My last group rate for 2 people in Michigan about 6 years ago was $1140 per month, can't imagine what it would be now.

[Lund Explorer]

I don't know how old you are. I guessed by looking at your picture to be 35.

I went to BC/BS in Missouri where I live. I did a quick quote.

Plan name - Blue Access 100

Monthly Premium - $217.33.

Network Type - PPO

Out of pocket maximum - 500/1,500

Coinsurance - 0

Office visits - $25 copay

Prescriptions - generic and brand

Mental health - Yes.

Rates and coverages vary from state to state, Florida blue cross is higher than in most other states. The online quote is a starting point, once dialogue is established your background will be checked and at that point the rate may be adjusted upwards.

My Mich.B/X rate is about half of what it would be in Florida for a similar plan (still not as good) but they will not write us due to pre existing condition. My wife had a stroke in 97 and presently takes heart and cholesterol medication and I have acid reflux (gerd) and they don't want me either.

My last group rate for 2 people in Michigan about 6 years ago was $1140 per month, can't imagine what it would be now.

It sure hasn't gone down!  The wife just came off of a three month layoff and the COBRA payment was $550 per/month.  Thankfully the new rules only required us to pay 1/3 of the premium.

[cart7t]

I don't know how old you are. I guessed by looking at your picture to be 35.

I went to BC/BS in Missouri where I live. I did a quick quote.

Plan name - Blue Access 100

Monthly Premium - $217.33.

Network Type - PPO

Out of pocket maximum - 500/1,500

Coinsurance - 0

Office visits - $25 copay

Prescriptions - generic and brand

Mental health - Yes.

Rates and coverages vary from state to state, Florida blue cross is higher than in most other states. The online quote is a starting point, once dialogue is established your background will be checked and at that point the rate may be adjusted upwards.

My Mich.B/X rate is about half of what it would be in Florida for a similar plan (still not as good) but they will not write us due to pre existing condition. My wife had a stroke in 97 and presently takes heart and cholesterol medication and I have acid reflux (gerd) and they don't want me either.

My last group rate for 2 people in Michigan about 6 years ago was $1140 per month, can't imagine what it would be now.

I didn't know his health history of course.  The fact that he's single with no kids is huge.  

IMO, this is where the ins. industry needs to be hit hard in order to fix it even before we start talking about universal, government paid for health care coverage.

If you're in a health ins. plan, have something happen like an illness that turns out to be a long term issue you're screwed.  You're literally locked into whatever coverage you have since most others won't take you if you want to switch or they have a grace period (for themselves) where they won't pay on a pre-existing condition for a year.

Sorry, if you're a health insurance provider in this country and you want to do business the person with a pre-existing condition must be allowed access to health care with any insurance company AND his cost, while being more than normal insured, shouldn't exceed a percentage of the normal cost of those w/o a pre-existing condition.  

[Fishing Rhino]

Health costs are very high.  But, have you really considered that you cannot use the cost of living as a means to determine that costs are spiraling out of control.

Here's why.

Medicine is a rapidly developing service.

A first grade teacher that I had back in 1946 would be able to teach first grade today.  A doctor from that era would not be qualified to practice as a nurse, let alone a doctor today.

When I was twelve, my dad had hernia surgery.  He was in for two weeks, and was in a ward.  Does anyone remember what a hospital ward is/was?

It was like a MASH unit with beds side by side in a large room.  The only privacy was a curtain that could be drawn around the bed.

Need oxygen?  Someone from maintenance would tote up a tank of oxygen on a hand truck to the bedside.  A plastic tent would be arranged over the bed with an oxygen hose arranged to dispense oxygen into the tent.

Today, my dad would have likely had that surgery done in a same day admission/discharge procedure.

You want to keep hospital costs on a pace with inflation?  No problem.  Go back to the dark ages of a few decades ago.

Also, you might want to consider this.  Many, if not most hospitals are operated on a non-profit basis.  And, were it not for philanthropy, many hospitals would be closed, since the fees received do not cover the costs of the services provided.