Health Insurance

[hank4elk]

My $.02 opine is, it is not worth the paper it is written on.
Gone from golden parachute coverage ( I was told by many) to Medi-care...lol
I have Hank-Care now. It does not change without notice, it is always honored and I can afford it...lol

 

[Nameless Range]

It is a mess. I spent a couple hours on the phone one day after my wife had an outpatient procedure done. We had a significant bill from the anesthesiologist, which should have been covered. The answer I got was the anesthesiologist was an out of network provider. I asked why the hell our network physician used an out of network anesthesiologist. I was told “that was who was available today”.

Not the point of the OP but 3 years ago my daughter's appendix burst and it was misdiagnosed for a couple days. She ended up spending over 2 weeks in the hospital and was in serious trouble.

The final bill was enough to purchase a house. I have, I am told, insurance that is as good as it gets. Even with that, were on the hook for tens and tens of thousands. My wife, who works in healthcare and is a savage saint, spent dozens of hours on the phone, and that is not an exaggeration, contesting everything. The average person, like me, would’ve rage quit early on, and I think that’s what they count on. Nurses couldn't get the IV started? Call in the anesthesiologist and he'll get it going for a cool $300. Headache? Here's some tylenol at $5 a pill. My wife eroded the hell out of that bill. We still owe thousands, but only pay the minimum required every month, and over time, they have actually forgiven some of the debt. 1 year after we were still getting new bills.

To be clear, I would give everything I own for my daughter's health, and she is alive because of medical miracles and badass professionals. I guess my point is, you can seem to have some of the best coverage, and still get worked over. When I listen to people knowledgeable on the subject, I hear very different chunks of advice. Seems complicated as hell.

 

[Brandon270]

Insurance is a tough thing to navigate through, you're damned if you have it and you're damned if you don't. When my wife was pregnant she was just finishing up her teaching credential so I had insurance through the farm I was the mechanic for. I was paying $500 or so a month for just the two of us and the deductible was $4500 individual and $8000 max out of pocket. What we unfortunately came to find out was that out of network had no limit...

Our son had a rough time when he finally arrived and was immediately air lifted to the local children's hospital. He stayed in the NICU for 10 days. We were assured everything financially would be fine since we were "insured". We had put aside the $8,000 since we figured we would hit the max out of pocket with a normal unproblematic birth and we would be covered after that.

Apparently not only was the helicopter out of network but so was the children's hospital. The hospital bill was over $200k and the life flight was 50k. We are having the hospital review our case for hardship but that has been over a year now and we still don't have an answer for that. After going round and round between insurance and the life flight company, insurance paid for half and we got the life flight company to settle on us paying 10k instead of the remaining 25k. We have been paying non interest payments on that bill and will be for the next few years.

Be careful thinking "nothing can happy to me, I'm healthy" guys!

 

[ignorethefringes]

Negotiate, negotiate, negotiate.

We have been cash payers done I went self employed around 6 years ago with the exception of my daughter's birth when my wife was approved for pregnancy medicaid. The initial bill is just the starting point as several have mentioned. It is always worth calling and asking for discounts especially if you have some cash saved up and can, "Pay $$$ right now to settle it without going into payments...." Money now is almost always better for them than money later. But if that doesn't work, negotiate payments for the rest of your life of you have to.

Also, ask what the cash payer price is for things like tests (MRI's, etc.) You might be surprised to learn that it's sometimes lower than your copay or deductible.

Even when we had insurance we were able to negotiate our portion of the bill several times. There are plenty of people that can't or won't pay. Being a willing negotiating party up front will go a long ways.

 

[Nemont]

So much I could comment on but I will defer to the HT experts on here.

Nemont

 

[HighDesertSage]

It is a mess. I spent a couple hours on the phone one day after my wife had an outpatient procedure done. We had a significant bill from the anesthesiologist, which should have been covered. The answer I got was the anesthesiologist was an out of network provider. I asked why the hell our network physician used an out of network anesthesiologist. I was told “that was who was available today”.

That's so messed up. I'm sorry your dealing with that.

I'm currently battling with our insurance company to cover my son's dexcom and insulin pump. If they get their way, he would have to go back to finger pokes 5-8 times a day and insulin injections. Or I could pay the $1800/mo out of pocket for it myself.

 

[HighDesertSage]

Has anyone ever had luck negotiating with docs? I’ve only done it several, but they usually knock off 20% immediately without any kind of fight, which is pretty telling.

The costs are beyond comprehension. I can tell you it’s about $5,000/day for labor and delivery before insurance adjustments. Just paid the invoice for our son born in September which depleted our HSA.

My son was life flighted from Gunnison CO to Childrens hospital in Denver. Check you health plans, most do not cover a life flight. I was not aware of this and was sent a $26,000 bill. I was able to negotiate down to just under half and paid $12,600.

 

[MarvB]

Plus “things” change over time with policies/coverage and I can tell you that you WONT be notified of such.

First time I had a colonoscopy (age50) insurance said 100% covered as you’re being preventative and it’s cheaper for them to pay 100% for preventative testing than for me not to have it done and them potentially paying for cancer treatments! Made sense

Fast forward to my second preventative colonoscopy (age60) and two weeks later I get a bill for a 20% co-pay PLUS another bill from the anesthesiologist for $200. I called them up and said WTF? Oh sir your policy changed 5 years ago and also anesthesia is now “an option”
That’s a hard NO from me to be awake while roto-rooter is at work!

Short of it is, age 50 paid zero…age 60 paid nearly $550 and that was AFTER my annual deductible was met.

As I’ve said before we do have good insurance but it just takes a law degree and a crystal ball to know what you’ll be on the hook for

 

[MarvB]

One other thing about air flights…look into joining an AirMedCare Network.
Since we live a bit in the sticks and are older, we’ve joined one and it’s $65/yr. hope to NEVER need it but it only takes once!

 

[rustednuts]

It is a mess. I spent a couple hours on the phone one day after my wife had an outpatient procedure done. We had a significant bill from the anesthesiologist, which should have been covered. The answer I got was the anesthesiologist was an out of network provider. I asked why the hell our network physician used an out of network anesthesiologist. I was told “that was who was available today”.

If you are having any surgery it is good to ask beforehand if all personnel in the surgery are in network. Anesthesiologists it seems are often out of network.

 

[406dn]

All of these cases illustrate that our path is not sustainable. In order for a policy to be affordable in cost to most, the policies have trap doors that a small number of policy holders will fall thru.

When they fall thru and get a huge bill, they can try pay it, haggle for a lower price, or default on the bill. Either of the latter two choices set up the everyone for a larger expense in the future.

 

[OntarioHunter]

Good God! And here I was entertaining thoughts of moving back to th States. That would be nuts! I mean really, screwing parents around over an insulin pump for their kid? That thing likely will add YEARS to the child's life. Until he was on Medicare I bought my brother's insulin and shipped it to him in a lunch cooler. I paid $31 Canadian per vial at my Walmart (over the counter no prescription needed!). He paid TEN TIMES more in US funds per vial at Kalispell Walmart and had to have a prescription from a doctor (= more $$$). Without those shipments he would have had to go back to the cheap pig/cow crap and would probably be blind or crippled today. Yeah, socialized medicine is such an evil thing!

Once when I was crossing the border to send him his insulin the US customs guy asked me if I was bringing anything to leave behind. Yes, some insulin for my brother. I was okay with paying duty. He leans over: "Shh! I didn't hear that." Then with a wink: "I drive up there to get my sister's insulin. Have a nice day."

 

[DanWyo]

Medicine is dictated by insurance companies now. They determine if the imaging or medications I order are “appropriate” and will be covered.

 

[BuzzH]

What?

We have a problem with health care and the cost in the United States?

I thought we were number 1 in everything?

• 17.8% of Americans have medical debt
• Nearly 25 million American households (19%) battle to pay their medical debt off in full
• The Average medical debt for Americans in 2020 was $2,024

Nothing to see here...move along.

 

[HighDesertSage]

Good God! And here I was entertaining thoughts of moving back to th States. That would be nuts! I mean really, screwing parents around over an insulin pump for their kid? That thing likely will add YEARS to the child's life. Until he was on Medicare I bought my brother's insulin and shipped it to him in a lunch cooler. I paid $31 Canadian per vial at my Walmart (over the counter no prescription needed!). He paid TEN TIMES more in US funds per vial at Kalispell Walmart. Without those shipments he would have had to go back to the cheap pig/cow crap and would probably be blind or crippled today. Yeah, socialized medicine is such an evil thing!

Also the CGM's are a life saver, literally. It can wake us up out of a dead sleep when he drops dangerously low.

I have a 6 year old son who is a Type 1 Diabetic and a 9 year old son who is non-verbal autistic. My wife and I have become somewhat of an expert navigating the American healthcare system. I have seen it all, and I can tell you from first hand experience that it is an ugly and evil bitch. We can do better.

 

[Deleted member 18333]

What?

We have a problem with health care and the cost in the United States?

I thought we were number 1 in everything?

• 17.8% of Americans have medical debt
• Nearly 25 million American households (19%) battle to pay their medical debt off in full
• The Average medical debt for Americans in 2020 was $2,024

Nothing to see here...move along.

I think my parents should pay for my medical debt.

 

[HighDesertSage]

I have neglected the topic of premiums, deductibles, copays and coinsurance for too long. Any recommendation on places to go for meaningful education on health insurance 101 for dummies? I simply would like to understand if I am getting a good deal on a plan or not or if my company plan is crap.

Thank you! Stay safe!!

Sorry to take your 1.5 year old thread into the weeds, lol. To answer your original question, your best bet is to probably look to your employers plan. It's most likely the best deal, as your employer is able to negotiate a group discount. If you want to shop it, just go to healthcare.gov and you can price out a policy on the open market.

 

[OntarioHunter]

Also the CGM's are a life saver, literally. It can wake us up out of a dead sleep when he drops dangerously low.

Heh, heh. I know about that. Here in the trailer when we're hunting I go wake my brother up in the middle of the night. "Some asshole is trying to phone you at 3:00 a.m." "Yeah, that would be my monitor telling me my sugar is off." I have finally learned the difference between the sound of high and low blood sugar alarms. And I made him move his damn phone closer to HIS bed.

My late son was autistic. There is a twelve to forty percent chance your son will develop epilepsy, especially during teens. Do NOT let the doctors convince you to wait for more seizures before starting antiepileptic meds. If the first seizure occurs during sleep, it's pretty much 100% he will have recurring seizures. Also, do NOT let the Dr rely on the results of a single standard EEG. EGGs produce false negative for epileptiform activity in known epileptics more than 50% of the time. Test results that are positive for epileptiform activity are excellent for diagnosing epilepsy (only 2% false positive) but a negative result is essentially meaningless. We were not informed of all of this and lost our son to a seizure in the middle of the night (when most fatal seizures occur ... also not informed). He should have been medicated but the doctor convinced my wife to wait for more seizures (even though she, her mother, and both her mother's brothers were epileptic). Sorry for the derailment but thought that was important for you to know.

 

[OntarioHunter]

Medicine is dictated by insurance companies now. They determine if the imaging or medications I order are “appropriate” and will be covered.

So some clerk in the insurance company's steno pool does the diagnosing? That's scary.

 

[noharleyyet]

So some clerk in the insurance company's steno pool does the diagnosing? That's scary.

Not exactly but close...here's a true story.

3 years ago a Blue X Blue Shill premium payee for over 10 years sees the Ortho Sawbones...sawbones says hip needs replacing like yesterday...Blue Shill says not so fast....jump thru these therapy hoops while we run out the current year clock and chew up the deductible. That happens...start over on a new year and they finally agree to replace the hip. So, in two years, 28K in premiums and 13K in deductibles and patient now having femoral nerve issues. Patient has an 800 dollar intent to bring action letter sent to Blue Shill...crickets from BCBS, lawyer shrugs. Business as usual...