What's the point of insurance (vent)

amother

Wed, Apr 09 2014, 6:07 am

B'h we have health insurance, but we get so little for what we put in, I feel like what's the point. $1100/month comes out of my salary for the employee contribution, and we have a high deductible. I had a baby recently, and even though we met the deductible due to a surgery earlier in the year, we still had to pay 20% co-insurance, so it came out to $2,500 for the hospital. Then, we had a $1,000 bill for the OB (who missed the birth, btw, because he didn't believe I went from 6-10 cm in 20 minutes). We also got billed $400 for the pediatrician in the hospital who was out of network (I repeatedly requested one in network, hospital said you don't get to choose, it's who's on duty. And made me feel like a bad mother for asking for certain routine tests to wait until someone who wouldn't bill me was available. Like if the baby doesn't get the hearing test RIGHT NOW, something bad will happen, and I'm putting money over the well-being of my child). Also, $800 anesthesiologist fee when I didn't even have an epidural. That one, I managed to get them to drop. But there are other things too. I get nickel and dimed for everything. It's not like we can just shop for a different plan. We are not eligible for the health exchange because both of us have employers who offer plans, and even if we were, they seem worse, not better. And when you get through an employer, you're stuck with what the employer offers. This whole thing makes me want to punch insurance executives and hospital administrators in the head.

amother

Wed, Apr 09 2014, 6:12 am

Ugh, I am so sorry. And I COMPLETELY understand you. My insurance company "forgot to tell me" that my baby's plan had a dollar-amount maximum on her vaccinations that she hit at her first check-up, so we pretty much have to pay out of pocket for each and every one for the rest of the year. She's only 3 months old.

My advise though: Fight it. Fight everything you can. I called hysterically crying about other issues and was getting letters from debt collectors for doctors appointments I knew I didn't have to pay, and I finally spoke to someone with a brain and he fixed everything for me.

I'm so sorry you're going through this - I hope it gets better for you soon.

gp2.0

Wed, Apr 09 2014, 7:05 am

I was shocked at hospital prices too. The bills just kept coming and they were bizarre. $20 for each advil they gave me?

Finally by the time the fifth bill arrived with a random "service charge" on it I said that's it, if you can't tell me what this bill is for I'm not paying. I've paid enough. Well no one could tell me, it got referred to a collection agency for awhile, then they dropped it.

I've had this same type of problem a couple more times with medical groups. They bill for whatever they can and I don't think they expect to get paid half the time. That's my theory.

suzyq

Wed, Apr 09 2014, 7:06 am

gp2.0 wrote:

No idea, but is it possible to decline your employer insurance and go shopping for your own? I think its too late now for this year though.

1100 is really on the high end. For 1100 you could probably find a plan with zero deductible.

If your employer offers insurance, and it's coverage is considered adequate (cost to cover employee only is less than 10% of your salary), then you aren't able to use the exchanges, though I'm sure you could try to see if there are any private plans you could buy.

OP, I hear you. We pay quite a nice sum to have my whole family covered under my employer's plan. If you do have a high deductible plan, does your employer offer a Health Savings Account so you can put away money tax-free to pay for your medical expenses? That way, at least you get to use your income before paying taxes for these expenses - it's really a nice benefit that you should look into if possible.

grace413

Wed, Apr 09 2014, 7:08 am

The point is that if you chas ve'chalila, lo aleinu, have a catastrophic medical situation you won't be bankrupt. And while I wish each and every Imamother and her family only good health, it does happen. Even something like a small surgery can costs thousands.

For quite some time health insurance has really been for catastrophic care. Even 20 years when my kids were infants well child care and vaccinations were not covered. We lived in Skokie, where the municipality offers free immunizations so that was handy but I remember agonizing over whether the baby needed to see a doctor at $60 a visit.

causemommysaid

Wed, Apr 09 2014, 7:22 am

grace413 wrote:

with the way things are today you can go bankrupt even without a catastrophic event.

Our employer offered insurance has a $5,500 deductible then an OOP max of $11,000. This is for a family of 3 and up. So for a year that we have a baby we need to pay all our premiums plus $11,000 since the bills from the hospital, pediatrician, and OB are waaaaay more than that. yes I said 11 thousand not 11 hundred!!! the only reason we can swing it is because our employer contributes most of our premium and we withhold money pretax in HSA.

mandr

Wed, Apr 09 2014, 7:29 am

amother wrote:

That's really weird. I thought that now with the Affordable Care Act, preventative care (vaccinations, for example) are covered at 100%.

suzyq

Wed, Apr 09 2014, 7:29 am

causemommysaid wrote:

Just because you have an OOP max of $11,000 doesn't mean you have to meet it. That just means that all co-insurances and deductible and everything can't be over that amount. For example, in my plan, we have a $3,000 deductible with a $10,000 out of pocket maximum. I had a baby this year, so we met our $3,000 very quickly. Since then, we have paid NOTHING as long as we have used in-network doctors. The OB, the pediatrician, all that stuff has been covered. My DH even had an elective procedure since we had met our deductible and we didn't have to pay anything. I think if we needed some non-generic medications or used urgent care facilities, there are still some co-pays that we would need to pay, but those would be maxed at $10,000 a year. But since we haven't done that, we don't have to pay anything and our payout has been $3,000 for the year. (Obviously, that doesn't include our premiums, which are a nice amount also.)

happy12

Wed, Apr 09 2014, 10:11 am

amother wrote:

If you are in NY state (and many others) they are required to cover vaccines fully until age 19.

Also 1100 is not a lot in NYS. WE pay 1449 a month and have a $4000 deductible. And no- the exchange is not cheaper when you are not eligible for subsidies.

causemommysaid

Wed, Apr 09 2014, 10:17 am

suzyq wrote:

true but we for sure meet the $5,500 deductible and then co insurance kicks in but since our bills total around $20,000 just to give birth we pay $5,500 and then another 3-4K of coinsurance just for the birth. Then for the rest of the year we continue to pay coinsurance at 20% till we hit $11,000. That is a lot of money.

amother

Wed, Apr 09 2014, 10:17 am

Ask the Dr office and hospital for discounts. They will usually give you 10% without asking questions. You can also apply for financial assistance through most hospitals which can take up to 90% off your bill.

DH+Me make 90K/yr (before taxes) and still qualified for 75% discount at one hospital and 55%discount at another hospital.

Ask and apply!!

After having my baby 2 years ago I ended up paying $1,500 bec I hadn't met my OOP and Deductible and I didn't think I qualified for financial aid so I didn't bother to apply.

MiracleMama

Wed, Apr 09 2014, 10:22 am

grace413 wrote:

There used to be catastrophic only policies. Now if they even exist, they're very hard to find. Wish we could get that. I don't need to pay thousands of dollars just to be able to see a doctor cause I sneezed. Plus so many of our doctors don't even take insurance. I just want to be covered for those G-d forbid situations. In the meantime, I guess I just have to be glad our insurance company is making lots of money off of us. G-d forbid the alternative! But yes, its a frustrating situation.

amother

Wed, Apr 09 2014, 10:58 pm

This is why America is going down the drain. I am currently on Medicaid and I am motivated to get up and off it because I have certain values and also want a certain kind of future for my family. But I am seeing why in the population at large there is a huge disincentive for economic growth or any kind of initiative or industriousness. Even with my values and dreams I am pretty terrified to make the leap into a better job because I see what I have to look forward to. On medicaid all this stuff is covered. I am limited in what doctors I can see, especially specialists, but I have a primary care doctor, ob-gyn, and psychologist that I like and are 100% covered. Plus emergency room visits are completely covered without regard to network, so in an emergency I can go to any hospital (occasionally you get a bill from some hospital doctor who bills on his own, but that can usually be argued out until it's covered). I have some hassles with calling around to get what I need but it doesn't seem any worse than what you're describing on expensive plans. I know that if I had to pay each time I would second-guess the necessity of any doctor visit. Now I go whenever I have any reasonable concern - and this is a very good thing because sometimes something looks minor and really turns out to be serious, like the time I was bringing in an obviously sick child and decided on a lark to have the doctor look at my healthier child at the same time since I was there anyway (she had been sick the week before, why not follow up - which I probably would not have bothered with if I had to pay for it), and the healthy-looking one turned out to have a serious problem at the time which we were able to treat early and resolved well B"H. Or when a child gets a bad bump on the head and it's after hours and the doctor says "If you're worried, go to the ER" Well, I do because I don't have to worry about getting thousands of dollars of bills for it. Once in a long while when I need a specialist in a hurry and don't know about the ones in the network (in a hurry = can't research well, need to take first recommendations from family and friends) then I pay out of pocket, ask if they have a sliding scale for people who can't afford high fees (some do, some don't) and I STILL come out ahead of you guys.

I am not trying to toot my horn or anything. I am legitimately low income due to business failures and other circumstances, and it is hard in many ways - we live in a crummy place, don't get to buy nice things, feel a lot of financial stress and embarrassment. To me, it's worth trying to claw our way out even if it means there will be a bunch of years when we're too high for medicaid but too low to actually bring home money after paying for health insurance. But I'm just sharing this to make a point about the absurdity of the system.