Health Insurance

[merlinmagic4]

I found the health insurance talk interesting on the "economy" thread so I thought I would bring it here.

What kind of coverage do you have and how much do you pay? We have the great insurance (BCBS of Mass) and pay about 125.00 week or 6500.00 per year.

Our doctor's visits are only 5.00 although most of our prescriptions are 25.00 (some are as low as 5 but not the ones we need!). We don't have a deductible.

I also wanted to note that people with health insurance can still become overwhelmed with costs associated with medical care. Having insurance does not protect you from many other costs associated with major illness/surgery/etc. I can definitely see a family with lesser means than ours facing serious financial problems if, say, their child had to have an organ transplant or go through cancer treatments. So, it is not only the uninsured people who risk losing it all for serious health problems. You can be completely responsible (having a house you can afford, good health insurance, older cars) and STILL run into trouble with when faced with medical issues. I just had to say that.

[gauvin4]

I am one of the fortunate ones that has my health coverage for my whole family paid by my employer at a cost of $1440.00 per month. I have good insurance (Anthem/BCBS of Maine) The health insurance is the main reason I am still at this job. I have, at times, gone without insurance (when we were covered through my husbands employer) because we could only afford to get it for the kids or for a time the whole family was without insurance. So I guess for the things (and people) that drive me crazy at my job, I will put up with it if it means we have insurance.

I know that in the future I may have to start paying for the insurance. All good things do eventually come to an end.

[murphy1]

Kelly, you said so many great things. I have a medical condition ( I have thyroid disease and an autoimmune form of it called "Hashimotos thyroiditis). I see my dr. every three to six months for care. I had half of my thyroid removed for a nodule with abnormal cells and now am going through watching the other side, so we might be facing another surgery. My treatment is "cheap" compared to others. But I will always depend on medical care, medication and health insurance. I have always been a very healthy, active and athletic person, too, so it upsets me to see people abuse drugs and do bad things to their body. Our insurance is filed, but we have to meet a deductible, sometimes have to pay a copay and sometimes don't and we pay different amts for prescriptions. When I was out of school, I had no health insurance, it was too expensive, so I see why some people have to do that. I can never go without it now.

I hope your son is doing well! My neighbor had a kidney transplant about 9 years ago and is still doing well. Yes, I am an organ donor!!

[Ian]

That is a good point about the potential for catastrophic health care costs even for the insured ... I've heard of that happening before, especially in the case of transplants.

Anyway, to respond to the OP's question ... we have Blue Cross of Minnesota. I pay, for family coverage, just a shade over $400 a month. That's for health insurance, dental, and vision care. My company picks up the balance of the expenses, which are approximately $900 a month additional.

Our coverage isn't great ... probably average. We have $25 copays, $25 prescription copays (with enforced use of generics whenever possible), but no annual deductible amount.

[murphy1]

I just checked on our, it's $800 a month out of the paycheck and then we are OOP the additional co-pays, prescrips, etc.

[Jimenyfan]

We are a family of 4 and pay just over $200 a month for our health care, its also pre-tax dollars so there is a small tax savings that brings the cost down a little.

We have BCBS of SC, medical,dental,vision. $25 co-pay and our prescriptions range from $5.00-$40 depending on the generic vs. name brand.

[princessjojo]

I can so go along with working not for pay or pleasure of the job, but for health insurance alone. When our boys were hurt in late 2004/early 2005 it was completely unexpected. DH was the only one working at the time because I was intending to go back to nursing school at that time. You would not believe how quickly medical expenses can rack up. And many times no one gives a second thought to their lifetime max. We do now because of their accident. In a 12month period, our medical bills exceeded at tax time $879,000. Try paying that bill on 1 income. But thanks to our less than par insurance plan at the time, and my obsessive compulsive needs, we only were responsible for a fraction of that amount. It was still more than I would have liked, and more than our income for 1 year as a 2 income family, but it wasn't $879k.

DH's company pays his premiums 100%, but not family. We average about $350/month. With that we have $25 co-pays for routine & specialist visits, $15/$25/$50 prescription co-pay after $400 deductible, $75 ER unless admission, all covered as in-network. Out of network is a standard 80/20 or 70/30 depending on location and services. There is a family deductibe with the in-network plan as well of $3000, but not under out of network. It does cover vision, dental, orthodontia, and mental/behavioral health services with max of 30visits/yr. as well as physical & occupational therapy maxing out at 120visits/year. With us, the kicker was our hospital was in network, but many of the doctors who treated us were out of network. If you're smart, you can get it appealed and have insurance pay it as in network, because in that setting you rarely have a choice of physicians.

And yes if it were to happen today, our choices may be different because of the economy. We wouldn't drive to Chapel Hill 3-5 day/week for therapy and clinic. We possibly couldn't have kept our home if it would have been like today. But it wasn't this bad then. And things worked themselves out.

One piece of advice I will offer to anyone with lots of med. bills, don't pay until you have everything together. Keep your itemized statememt of services, your actual bill, EOB, and cancelled check or receipt all attached. And pay each bill seperately, regardless of how many you get in the mail in one day. I did this and found roughly $3800 in overbilling errors. For us, it was worth the extra paperwork and space requirements for that much paper. That one overbilling could pay for a Disney trip!!!

[BronxTigger]

I'm VERY blessed with my insurance coverage!

It's $0 deductible.
It's $0 copay at the doctor's office AND at the ER.
It's $5 for generic prescription but some prescriptions have $35 oop for me.

To go to a specialist I have to have a referral from my PCP, and and I have to stay in network, but the network is large (but local). So far, I haven't had to deal with it on vacation, so I'm not sure what the protocol is for that.

[JanetMegan]

For some reason this week people keep bringing up topics I have a lot to say about...so here goes from an employers and employee's prospective.

First off, small businesses have a very hard time with health insurance. It's obvisouly a benefit we want to offer and we need for ourselves and here's a little breakdown...

We pay as a company approx. $450 per month for our employees each, this is just for the one person. They can add family coverage for about $1000 MORE per month. This is major medical ONLY. No dental, no vision etc. This is also WITH a $1,500 deductible for anything other than routine medical expenses (ie I had to pay for even a mammogram out of my own pocket.) Perscriptions are about $20 generic and $35 name brand. Sick and Well office visits are $35.

This is with Blue Cross/Blue Shield of GA. We are only getting this "great deal' because we all had that coverage under a similar plan with our old company and were able to transfer that. When shopping for cheaper plans, we couldn't even get insurance quotes due to health conditions (pre existing) in some of our employees. It was basically this or nothing.

[Jeff G]

In case you missed this on the other thread I pay $800/mon with Anthem/Blue Cross of Wisconsin. For this I have a $1000 deductible, $35 co-pay, no vision or dental.

Being a healthy family this is basically a catastrophic plan. We have never reached the deductible which means with the kids we we end up paying several thousand additional dollars on medical items.

[Ian]

I did this and found roughly $3800 in overbilling errors.!You know, this is really good advice. You'd be amazed at how routinely doctors and hospitals will bill patients for bills they aren't actually responsible for.

That's especially true for folks who have HMO/PPO types of coverage. I'll give you an example:

About 15 years ago I fractured my leg very badly in a rock climbing accident. I required four surgeries to fully repair the damage and the total medical bills were somewhere in the neighborhood of $100,000.

I used to get bills almost daily from the hospital and my doctors that would show my owing the difference between what they charge for their services and what the HMO paid. Luckily for me I worked for the company who provided my coverage at the time, so I knew that this was not the way it worked. When you're a provider and you sign up for an HMO or PPO, you agree to accept their payments for services rendered as full payment. The patient is NOT responsible for making up the difference.

I argued it and won and the final count showed that I had "saved" close to $10,000. Now had I been less educated about health insurance and HMO's I might have paid that money and you can bet that they would have kept it, too. They claimed at the time that those were just "statements" not bills. But of course it didn't say that anywhere ... at least not in readable size print. Now I've noticed that they print in big letters across the top of these "THIS IS NOT A BILL."

And just so you don't think this is an isolated occurance, the same thing happened to my Grandmother not once but twice, when she broke her ankle and her hip.

[princessjojo]

Ian, you are so right, and often times they count on you not knowing the difference or not being "insurance educated." Our case was due to overbilling or more specific the insurance company looking at services as duplicate entries leaving me to handle it with the hospital. In all actuality they were accurate (i.e. grafting of sites, or multiple similiar procedures performed like fluid record pressure checks) It appeared that this was entered more than once, but it was actually performed more than once.

I have probably fallen victim to the additional billing for cost not covered as a difference between cost charged and provider paid amounts.

Thanks to you I can be more careful of this in the future as well...

[LauraF]

I have Cigna for health insurance at a cost of $4 per week (as a single; if I were covering another person it jumps to $32 per week!)

The reason it's so cheap is that my company aggressively markets health care to its employees, not just because of the mandatory healthcare law in Mass, but also they figure by keeping costs low for us that we're more likely to go get preventative care instead of waiting. They do get us on prescription costs though . . . it's not unreasonable, just a few dollars more compared to other plans.

It must be working - the amount of claims from my company to Cigna actually dropped over the last three years running, so we've been getting freebies at work, like a fancy new gym, etc. They're on this big 'healthy body, mind and work' kick. I'm not complaining. :D

But Cigna is HORRIBLE in claims processing. I can't tell you the number of times I've had to call up and tell them they got something wrong. It's not much worse than any other company however, so I deal with it.

[DisneyDog]

I'm pretty happy with my plan. I have Aenta. My employer pays for it 100%. No deductible. I pay $10 for office visits, $15 for specialists. Prescriptions are either $10 or $15.

DH just started a new job and his insurance will be paid for as well.

DS has been on DH's insurance. If I want to add him to mine, it would cost the majority of my take home pay. At his new job, he would be paying $190 per paycheck if he puts DS on his insurance. We are currently looking at CHIP for our DS, which is Pennsylvania's health insurance for children. It is free for some families. It would not be free for us, since we earn too much. But, it would probably be around $160 per month (vs. $380 to be on DH's plan). It's good insurance, and covers everything. So, hopefully we'll be able to get him on that. He is covered on DH's old plan until the end of the month.

[poohluva]

We have Cinga POS from DH's company. We haven't had any problem with them yet, and we've had them for 16 years.

He's part of a union so he pays dues once a month, but nothing for health, vision or dental.

We pay $10 for office visits, none of us have needed prescriptions in a while, so I'm not sure how much we'd pay for them. When I had DD
(10), we didn't see a single bill. For DD (14) I think we had to pay $300.

We are eligible for one eye visit every 2 years with either glasses or contacts at no extra charge. The kids go every year with the same option. The only time I haver to pay a co-pay here is for a contact lens check.

As far as dental goes the only thing we pay for is what the insurance doesn't cover. There's 4 of us at 2x each year, but it's still not bad.

We're very lucky to have such great insurance. Our DD (22) was on our insurance until she graduated from college last May.

[Hammer]

Hey, Ian, look out your window in suburban Philadelphia as you may see a pig flying by as I am about to agree with you on something ;) ! It is so important for people to not blindly accept charges that their insurance tries to pass on to them. I'm currently fighting my insurance company right now for an expensive blood test that my doctor ordered when they were trying to figure out what was causing some health problems I am having. They keep saying it is not covered by my PPO though it clearly states that tests ordered by doctors that are within the network (which all of my doctors are in-network) . I think most of you can tell from my posts, they are not going to get away with that with me :) .

My health insurance is with Blue Cross/ Blue Sheild NJ and is a PPO. I pay around $40 a paycheck(bi-weekly) for myself (not married and no dependents) and that is medical, dental and vision. I think next year, after all the issues I'm having with IBX, I will take the Aetna PPO option we have available. I had an Aetna PPO before and I never had these issues about payment.

[Ian]

Hey, Ian, look out your window in suburban Philadelphia as you may see a pig flying by as I am about to agree with you on something ;) !:faint:

[Tinkerfreak]

My husband and I own a small construction business. We have 2 girls. We are paying $300 per month for a 15,000. deductible. They pay nothing until we have paid 15,000. We had a 5,000 ded. and it was costing us 600. We have Anthem BC/BS. We have shopped around and found nothing cheaper. It is very frustrating. We have one employee and we gave him the choice, either we covered some of his medical insurance or we covered none and paid him more per hour. He chose no coverage from us (he got his own) and more money per hour. We are not a big enough company to qualify for any kind of group rate so we are really stuck. I had thought about going back to work just for the medical coverage but I do alot of the paperwork for our business and my Dad had a stroke and I am going to have to help care for him during the day so I just don't know how I would have time to get a job. I have to admit it frustrates me sometimes when I hear people complaining about their job or how much they make when they have good insurance coverage. When someone is looking at jobs and benefits they really need to consider the insurance and realize how valuable it is. I would love to pay my employee more but because of the high cost of health insurance for my family and the unbelievably high cost of workers comp insurance for him we just can't do it.

[Ian]

We are not a big enough company to qualify for any kind of group rate so we are really stuck.Mmmm ... the size of the company doesn't always dictate whether or not you qualify for a group rate.

Many, many industries have insurance "groups" that are comprised of multiple small business owners like yourself. They pool their risk into one large group and are then able to qualify themselves for group rates.

You should look into it ... if you haven't already, that is.

[pogo]

This is an area where I might be able to help out. I run a small insurance firm in Upstate NY.

Most small business's can not afford health insurance on their own. Some join their Chamber of Commerce or can get affordable health insurance through trade groups or unions. Another place to look is associations.

Frivolous law suits are raising your Doctors malpractice insurance. This causes all kinds of problems for the population. Another reason health insurance premiums are sky high is because of the un-insured running to the ED for things like colds and flu.

I advise my clients to do several things that can help. Here's my list;

1) Make sure you have good disability coverage that can keep you earning money while you are sick or injured.

2) If your employer is not providing your health insurance, buy a high deductible plan with a HSA (Health Savings Account) attached and use a pre-tax deduction to help lower your cost.

3) If possible, purchase supplemental insurance to help with catastrophic costs.
Example: An Aflac Cancer Policy can pay you as much as $300 per day for chemo or radiation treatments. And there are many good companies that have almost the same thing.

4) Live a healthier lifestyle. Cut down on fats, carbs, and quit smoking ! Exercise can work wonders. (I know .... I need to do this more.)

If anyone has any questions and wants specific answers, you can PM me. I'm only licensed in NY, but I might be able to advise you on where to find information in your own state. :D

[Dakota Rose]

This topic is the bane of my existance.

We've been self-employed for 8 years. So we've also had to foot the entire bill for health insurance.

When we lived in CA, we had an HMO plan that cost about $500/month with a $1500 deductible and $40 co-pay. I don't remember RX prices. I thought this was just okay.

Now we have a high-deductible plan with an HSA. Now I truly feel ripped off. We pay $200/month but have to pay out of pocket for all of our expenses up to $6000 per year. Then our insurance kicks in. We also have a $25k maximum per family member per year. There's no dental coverage, no RX coverage and no maternity. If we added maternity, it would add $400/month and they'd up our deductible to $10,000 plus any pregnancy wouldn't be covered until we'd paid the maternity rider for 10 months.

I've figured out that on our old plan, with the higher premiums, we paid $6440 out of pocket to have our son in premiums/co-pays/deductible. If we were to add maternity to our high-deductible/hsa plan, we would pay $21,400 out of pocket for the same charges before insurance paid a single cent. I mean, we'd pay it out of our pre-tax HSA account but that's still $15,000 more than an HMO plan. How is that a good deal?

[kaerbear178]

I have decent insurance for my husband and I. I pay about $180 pretax a month for Health, Dental, and Vision. We have Great West in SoCal. We have the HMO plan and have a $20 copay for any office visit. We don't need referalls if we want to see a specialist within the network. Generic Drugs are $10 copay, name brands $20 and name brands not on the specified list are $40. For a hospital stay we pay $200 a day up to $1000, everything after that is covered.
Dental is ok, we get free cleanings, routine x-rays etc. twice a year. Basic work is pd 80% and major work is 50% pd.

[Johnno52]

Cost of health care $0.00
Resection of lung (removal) $0.00
Rotator Cuff Repair $0.00
Heart Bypass $0.00


Living in Canada..............PRICELESS!:cloud9:


But then again they say government run health care is not as good as private insurance.

[Johnno52]

I didn't mean to make fun of everyone's health costs and coverage as I know from relatives living in the US about your lack of public health care and high costs to acquire private coverage.
I just wanted to point out that with 3 major operations (2 life threatening) anyone including myself would have to re-mortgage or lose their home if we didn't have this coverage.
I just can't understand why the US and the richest in the world refuses to take care of its citizens in regards to their health care?
Many of you have some form of coverage and at a high price, but how many millions don't?
What happens when they get sick?

[BronxTigger]

What happens when they get sick?

They go into deep credit card debt, their credit score is ruined, all vacations are off, houses may get foreclosed, etc...

I know at least three people who are still in debt years after a medical issue. I'm sure most people know at least one person who is, at the very least, in credit card debt from medical problems during uninsured times. At the very least, little things do not get addressed and they grow worse over time.

[Johnno52]

Yes I belong to a US Cancer discussion group and I read about many members that have problems with Insurance companies not approving treatments. Many have also exhausted their limits and are on their own for costs.
It seems that your Health Insurance companies are very powerful in keeping the status quo.

[Disney Doll]

This is what happens when everything is motivated by profit. It just doesn't make sense for everything and I think health care is one of those things.

We are pretty lucky. I have really good coverage on myself through my employer (they use Aetna). I pay noting for the coverage. My office copay is $25.00. Prescriptions are $15.00 for a generic or $25.00 for a name brand. Although I paid $40.00 a month for my prenatal vitamins because they were "non-formulary"? The family plan at my place of employment is ridiculously expensive, but luckily my husband can get decent coverage for our son with his job. He pays $85.00 per month for himself and our son. They are on Cigna. The office copay is $25.00 and prescriptions are $25.00 name brand or $5.00 for a generic.

[Disney Doll]

But Cigna is HORRIBLE in claims processing. I can't tell you the number of times I've had to call up and tell them they got something wrong. It's not much worse than any other company however, so I deal with it.

Funny you should mention this. DH has Cigna. He hates the doctor and so he only goes if he has to- hasn't been in 10 years. He finally went last month to have a little growth removed from his eyelid. It was interfering with his vision- thus finally reaching the "have to go" status. Anyhow it was about the size of a BB and it took the doctor about 2 seconds to cut it off. No stitches no nothing just slice and done. All done by our family doctor in a regular office visit. Well we get a statement from the doctor- $600.00 for "surgery". We do have insurance so I wasn't too concerned, but it is irritating to see the inflated cost of things. Later we get a bill from the insurance company stating that it won't be coved. So we call, get put on hold, transfered to another customer service rep, put on hold again, on and on. All to find out that someone accidentally checked the wrong box and it somehow got coded as an impotence surgery. The doctor's bill clearly says facial surgery. Turns out it was covered after all, but it was a hassle and our burden to prove. DH took that as further evidence that doctor visits are a waste and vowed not to go again for another 10 years. Thanks Cigna.

[Dakota Rose]

They go into deep credit card debt, their credit score is ruined, all vacations are off, houses may get foreclosed, etc...


Or friends and family arrange for fundraisers to help off-set costs, but many go unpaid. And sometimes they just declare bankruptcy. Then there's those who don't even seek medical attention because they don't have insurance like my friend whose pregnant and hasn't seen a doctor for any sort of prenatal care b/c she has no insurance. She hasn't finished paying the bill for her last baby, so the hospital won't let her deliver there, so she's going to have a homebirth and she's high risk. The nearest "cash clinic" is a 3 hour drive.

And even the insured aren't fully protected either. There are limits and exceptions in every plan. When someone gets really sick and needs constant or major medical attention, like 2 friends of ours, insurance often quits paying. No insurance, no $ and some hospitals/doctors won't treat you at all. Or they'll only treat the symptoms and let the underlying problem go. Kaiser is infamous for this. Then there's the eventual rate increase or cancellation because you've used your insurance and now have a pre-existing condition.

On our current plan, there's no coverage for any sort of contraception whether it's birth control pills, a tubal or a vasectomy. There's also no coverage for maternity. And if we have an injury or illness resulting from a criminal act, act of war, act of God, or terrorism, that injury/illness isn't covered. Our insurance doesn't pay a penny until we meet the annual $6000 deductible, but will only pay up to $25,000 per year.

And like my friend who won't go to the doctor because she has no insurance, there are plenty of people who have high-deductible plans that also forego the doctor because they can't afford it.


I don't think our government really understands the insurance crisis in this country. They're all on plans with low deductibles, low co-pays, low premiums and a ton of flexibility.

I sure hope it gets fixed.....

[Quest4fun]

I didn't mean to make fun of everyone's health costs and coverage as I know from relatives living in the US about your lack of public health care and high costs to acquire private coverage.
I just wanted to point out that with 3 major operations (2 life threatening) anyone including myself would have to re-mortgage or lose their home if we didn't have this coverage.
I just can't understand why the US and the richest in the world refuses to take care of its citizens in regards to their health care?
Many of you have some form of coverage and at a high price, but how many millions don't?
What happens when they get sick?

The funny thing is that healthcare is pretty easy to get and most people consider anything that costs more than free is too expensive.

Everybody who has medical insurance here pays for it. People also have great options like flexible spending accounts that are tax-free and can be used to take care of additional medical costs. It's not like there aren't options.

The stinker is that many of these options involve saving which many people don't do anymore. Americans notoriously live beyond their means and would rather pocket as much of their checks as possible so they can buy stuff.

I'm most upset that a great deal of people who think our government should pay for everybody's health care thinks that they would just plant an "Insurance Tree" that everybody can just pick from. That insurance still needs to be paid for and it will be done with taxes so in essence we're still paying for insurance.

My advice to people who work for a company that offers insurance is to get it. It's not as expensive as everybody makes it out to be. There are also insurance options for people who don't work for companies that offer insurance or if they're self employed.

Here's some food for thought. Our public education system is funded by our government via our tax dollars. Needless to say it's far from fantastic. Would you rather have a government run insurance system that operates like our schools? Doctors on strike, lack of supplies, etc?

My advice for people who say they can't afford it should take a look at what they pay for each month. Would you rather have insurance for you and your kids or is that money better spent cable or satellite TV and that expensive auto lease. Sure the high def looks great and you can watch every game you want to see but little Billy has a fever and doesn't want to watch right now.

It's all about priorities.

I pay about $200/month for my wife and I and I don't consider that to be a high cost. My health is worth to me than a hearty channel line up in HD and a $400/month car payment.

Also, private health care is far superior to government run health care. Perscription medicine may be a bonus for the free-bees but it's the private health care industry that pioneers life saving medical procedures that save lives. If we were to put this industry in the hands of our stellar government don't expect to continue seeing advancements in medicine.

[Johnno52]

>If we were to put this industry in the hands of our stellar government don't expect to continue seeing advancements in medicine.<

I'm sorry Quest but are you saying that advancement in medicine is not coming from Countries that have national health care?

I think many countries throughout the world would disagree with you there.

Another problem for the poor is the cost of prescriptions. If we didn't have a drug plan our bill for medication per month would be $800. Many people are buying their drugs from Canada as they are less expensive.

[SteveL]

We have BC/BS of PA Personal Choice.
$5 office visits, $15 for specialists (no referrals needed), $15 for brand name prescriptions, $5 for generics, vision and dental.
Company pays it all - no employee contributions even for family coverage.

[Dakota Rose]

I think the real crux of the problem is that we don't have a health care program in the U.S. We have a sick care program and frankly it's broken. When people have to order drugs from Canada or go to Switzerland for a state-of-the-art treatment, that proves that the privatized "health care" system currently in place in the U.S. is broken. I don't support government-run health care; look at what they've done to our schools and social security. But something needs to be done about the out-of-control insurance rates and inflated medical bills. When I had DS, the hospital billed my insurance $3,000 for pain meds. I took 3 doses of vicodine. Even though I had that $ sitting in a savings account doesn't mean it was right for the hospital to inflate the cost of the drugs. Our society needs to get out of the mindset that if you have the $, you should be willing to spend it however someone says you should. I mean would someone pay full rack rate at WDW knowing a better price was available?

[Quest4fun]

>If we were to put this industry in the hands of our stellar government don't expect to continue seeing advancements in medicine.<

I'm sorry Quest but are you saying that advancement in medicine is not coming from Countries that have national health care?

I think many countries throughout the world would disagree with you there.

I think you missed my primary statement there. I'm not discounting other countries. I'm simply stating that putting the medical decision making in our government's hands would result in the same nickle and diming that is apparent in other aspects of our government and we will most certainly see a decline in the quality of medical care that people who are using privatized insurance would recieve.

I don't think a government that believes it is okay to pay $100 for a box of paperclips operates efficiently enough to properly provide efficient medical care without taxing the bujeezus out of everybody. Our tax system already takes a large chunk out of our paychecks to cover all of the other obsolete programs that have been around since FDR introduced them as part of the "New Deal."

I don't think Americans would want their lives in the hands of a government that operates this way. We're far better off using private medical care that is available for everybody. Communist ideals (yes, I believe government sponsored, "free" medical care falls in line with Communist fundamentals) tends to favor those that are unable to make good financial decisions.

I will admit that my beliefs are a little radical but I believe that everybody has control of their own destiny and if our government really wants to help they should provide free financial planning to those who are unable to do so on their own. They would not have access to their monthly checks until the funds were allocated appropriately among their expenses. Living beyond their means would be a thing of the past. Less people would have cell phones, cable, and Cadillacs but more people could feed their families and get them the medical help they need.

With a program like that in place we could actually determine who truly needs financial assistance and help them accordingly.

Of course I'm not the president nor do I work within the government.

[princessjojo]

Another big thing is your type of health insurance you currently have. When the doctors see that you are covered under a "contract" type plan such as those that many, not all, HMO & PPO companies provide, they will have to jump through hoops to get paid. Many times you have to get pre-authorized for a procedure regardless of how necessary and if you don't they won't pay. Under this same policy, they have the right to refuse to pay for the procedure if they can see a less expensive option. And that option may not be the best medical choice, but you as the insured have to sign over your first born to get the procedures approved. With the traditional 80/20 where no network or contracts are in place, you as the insured have more control over who you use and what procedures are performed. But these plans can sometimes be more expensive. When you don't have any real complicated health issues the HMO/PPO plans are usually the best choice financially.

[Dakota Rose]

You know, Quest4Fun, I actually agree with you to a point. I don't want government controlled healthcare in this country for exactly the reasons you mentioned, and also because here it wouldn't really be free. There would be some new tax or a cut to another useful service that would fund our new healthcare. And since the government also drives prices up, they wouldn't be any better than the current hospitals or insurance companies.

And it also irritates me that there are people in this country who abuse the systems we have in place like welfare and medicaid. My sister works for a medical billing/subsidy company that helps the underinsured and uninsured pay their medical bills. There are a great deal of people whom she helps that like Intercotees who work hard for their $, have insurance of some kind, but have been hit by a medical crisis and insurance has run out or decided not to pay, or whatever. Those people are grateful for any help she can give them.

Then there is the other group of people like my pregnant friend who has no job, no way to pay for insurance, yet continues to have children thinking someone else should pay. She's even asked her friends for money. Funny how she can find the money to remodel her house or go on vacation but can't pay her medical bills. She's a perfect candidate for your free financial planning service.

But I disagree with the notion that if you have the money to pay the astronomical bills, premiums and deductibles you should just pay. I think that the only benefit of these HSA accounts is that consumers will see the costs hospitals/doctors are charging and will begin to hold these agencies accountable for their inflated costs.

I don't mind paying reasonable fees for reasonable services, like when DS had to go to ER b/c his croup was so bad. He was seen by 2 doctors and a respiratory therapist plus received respiratory therapy and the bill was only $145. That's reasonable and well-worth my son's life. But $3,000 for 6 pills is ludicrous. $1500 for guaze and medical tape is crazy. Especially when I know how much these things cost at the local drugstore.

Makes me want to supply my own meds and supplies when I have DD in July.

[princessjojo]

Amen, Dakota Rose. :notworth:

[Mickey'sGirl]

Communist ideals (yes, I believe government sponsored, "free" medical care falls in line with Communist fundamentals) tends to favor those that are unable to make good financial decisions.It is actually a Socialist ideal.

That said -- I come from one of those other countries -- Canada. I truly believe that everyone makes choices and is directly responsible for their own lot in life. I think people should pay their own way, but I also absolutely 100% believe that anything other than Universal health care is inhumane. If there is expertise and treatment available to someone in need, it should be provided. Regardless of who you are, where you come from or what kind of plan you have. I will now get off my soap box. :D

Approximately 45% of our household income goes to taxes, 10% in taxes directly to healthcare. This is a very substantial amount of money. A large proportion of that amount is directed toward our healthcare system. Prescriptions and specialized services are not part of the universal healthcare program. In addition to the taxes, DH and I both have health care plans at work that provide coverage such as medications, specialized treatments, eyecare (including Optometry). We have dental plans that do likewise. These benefits cost employers x amount. Additional coverage, lesser deductibles, orthodonty, disability insurance etc. can be added on at a cost to the employee. I pay an additional $5,000 per year for higher benefit levels (3 of the 4 of us have healthcare issues that require regular treatment from specialists). DH has a standard plan through his employer. We are able to co-ordinate our benefits to optimize our coverage.

Putting all of this together, we pay about $2,000 per month on Health Care, and our employers cover the basics. We also experience out of pocket Health Care expenses at about $500 per month. Know what? I don't resent one cent of it. I know that the best care is available to me and my family at any time of the day. Regardless.

[A Big Kid]

I am one of the fortunate ones that has my health coverage for my whole family paid by my employer at a cost of $1440.00 per month. .

Dont kid yourself. Your company is not paying for it. You are. You are just not getting the money. They company pays it to the insurance company instead of to you.

[A Big Kid]

I think the real crux of the problem is that we don't have a health care program in the U.S. We have a sick care program and frankly it's broken. When people have to order drugs from Canada or go to Switzerland for a state-of-the-art treatment, that proves that the privatized "health care" system currently in place in the U.S. is broken. I don't support government-run health care; look at what they've done to our schools and social security. But something needs to be done about the out-of-control insurance rates and inflated medical bills. When I had DS, the hospital billed my insurance $3,000 for pain meds. I took 3 doses of vicodine. Even though I had that $ sitting in a savings account doesn't mean it was right for the hospital to inflate the cost of the drugs. Our society needs to get out of the mindset that if you have the $, you should be willing to spend it however someone says you should. I mean would someone pay full rack rate at WDW knowing a better price was available?


Dont compare apples and oranges. First of all, the US frug companies bear the brunt of making, testing, and marketing the drugs. Canada rides on the coattails. Canadian drugs are also "less expensive" because they are subsidized by the government. And guess where the government gets that money?

I always get amused by people that want to pay beer prices for childcare or healthcare but want champagne service for it.

[A Big Kid]

I didn't mean to make fun of everyone's health costs and coverage as I know from relatives living in the US about your lack of public health care and high costs to acquire private coverage.
I just wanted to point out that with 3 major operations (2 life threatening) anyone including myself would have to re-mortgage or lose their home if we didn't have this coverage.
I just can't understand why the US and the richest in the world refuses to take care of its citizens in regards to their health care?
Many of you have some form of coverage and at a high price, but how many millions don't?
What happens when they get sick?

This is my view on it. I abhor getting taxed to the hilt to pay for someone elses healthcare so that particular someone else can use their money to buy stuff that I cant afford anymore because all my money went to taxes to pay for someone elses healthcare and on and on and on..

[A Big Kid]

And what do I see as the biggest problem? People who dont pay for it through taxes or insurance. They have on concept what it costs therefore they use it willy nilly to the detrimnet of everyone else who does pay.

[conorsmom2000]

I feel very lucky to say that we have really good coverage for our insurance. Mike is with a Union, the IBEW, and I guess technically, we don't pay for it; whatever contractor he is working for does (Mike makes so much per hour, but his actual cost to the contractor is higher and out of that comes his benefits, annuity, etc. So, while it's part of his rate to them, it's money we'd never see anyway).

We have Horizon BCBS of NJ, and a PPO plan - that's probably the part I'm most grateful for - we can go to any doctor, without out a referal, though it's cheaper to go in network. His dental plan is amazing - each of us has $5000 worth of coverage per year, which seems unheard of compared to most plans. For Medical, our co-pays are $15 for doctor vists and $50 for ER. Most perscriptions are $5.

The only downside for us now is that the Union used to process all the claims in-house. Turn around time was very quick and handled very well. Now they've decided to outsource this to another company and it's been a nightmare. None of our Dr's are being paid directly, all payments are now being sent to us (made out to us), so we've got to go back and pay the Dr's. Mike was going for physical therapy for his back and it took months for them to get paid - at one point they wouldn't see him anymore until the previous bills had been paid. We've never dealt with that before. I don't know why it's suddenly being done this way - it's literally taking 3 times as long to process claims. The Union was so well known for being so great with the insurance claims that Conor's dentist, who normally would make a patient pay the bill in full and get personally reimbursed by the insurance co, never made us do that - we were one of the few that didn't have to pay, they just processed our claims and accepted the insurance companys payment. Now with this new 3rd party processing the claims, I'm afraid that deal will be over.

While it's now more of headache than in the past, I'm still grateful for what we do have.

[Ian]

MODERATOR ALERT!

We're getting a little close to a political discussion in portions of this thread, folks.

Let's turn back to the original topic at hand, which was what kind of health insurance do you have and how much do you pay for it.

Leave the socialized vs. privatized medicine debate for a politics board somewhere, okay?

[Quest4fun]

MODERATOR ALERT!

We're getting a little close to a political discussion in portions of this thread, folks.

Let's turn back to the original topic at hand, which was what kind of health insurance do you have and how much do you pay for it.

Leave the socialized vs. privatized medicine debate for a politics board somewhere, okay?

Here here!

I use Blue Cross/Blue Shield PPO for my wife and I. It's a little on the pricey side (though not nearly as much as some other people are paying) but our prescriptions are less expensive than they were when we were on United. My company will likely make us switch providers since that's what they do every year to try to get us better benefits. It's looking like we're going to be spending a lot next year on prescription medications and we'll probably try to have a baby soon as well so that Flexible Spending account will be a Godsend. I recommend it for anybody who spends a lot on medical bills and prescriptions every year.

Most everybody offers one and it's a good way to put away some money for a rainy day that Uncle Sam will keep his hands out of. If you don't know what they are ask the HR rep for your company or contact your insurance provider yourself and see if they offer one.

[SteveL]

Dont kid yourself. Your company is not paying for it. You are. You are just not getting the money. They company pays it to the insurance company instead of to you.

This isn't necessarily true. Our company pays at least the prevailing wage and often more than many companies that require employee contributions for health insurance, but they also pay the insurance premiums for us.