Our terrible health insurance

[kewb]

Or let people pick what is covered.   For example, I would be happy to eliminate mental health coverage.  

 

Have I entered the twilight zone?  First someone says the ahca will be replaced with something less expensive and better soon and now this.

 

This is not how insurance works.  It is not how any of this works.  I don't know how to explain that one should care about other people. Our disagreement is not merely political but a fundamental divide on what it means to live in a society.  Haven't we evolved past the family unit being your tribe and the only ones that need to survive.  Society by definition means there is an implied contract to each other.  We all matter when it comes to survival.

Edited July 26, 2017 by kewb

[Lang Syne Boardie]

I know, we could institutionalize or "warehouse" people with mental illness. That's never been tried, and I'm sure nobody would suffer. They'd be safe, and out of our way. Better for everyone.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

:(

[displace]

Hang in there. Any day now, congress will repeal the ACA and replace it with a plan that provides for more coverage at a lower rate.

😂🤣😆😂🤣😆

 

So funny! I needed a good laugh to balance out the stress.

[winterbaby]

Or let people pick what is covered.   For example, I would be happy to eliminate mental health coverage.  

 

Until someone in your family comes down with a life-threatening mental health condition requiring tens of thousands of dollars' worth of inpatient treatment. I wonder where one gets the confidence that something like this will never happen.

 

[mamaraby]

Why thank you.

 

It was more of a defense of motherhood, than Janeway. And of cows. And perhaps Pottery Barn.

But at least the apothecary table is real.

[Zinnia]

In the last 10 years, we went from an HMO plan with very low copays to our current high (ish) deductible plan.  This was the plan we had when we got married, and I think it cost an extra $10/paycheck to go from single to family coverage.

 

There are days that I lament the $20 doctor appointment, $50 ER visits, and $100 inpatient stays.  We pay a large amount every month, and we still have that ever present knowledge that we are one hospitalization from a huge to us bill.  We have a $4500 deductible (family, but there are not individual deductibles within that; it has to be met), and a $15,000 out of pocket.  If someone got a chronic illness, a few years of the $15,000 would have us in debt for a long, long time.  

 

Yes, I am thankful for insurance.  Yes, I am grateful for what we have.  Yes, what we have is average.  

 

But I still lament the loss of the "good ole days."   :)

Edited July 26, 2017 by Zinnia

[Mergath]

Until someone in your family comes down with a life-threatening mental health condition requiring tens of thousands of dollars' worth of inpatient treatment. I wonder where one gets the confidence that something like this will never happen.

 

Even the day to day treatment can be prohibitively expensive. If my dh didn't have insurance, his meds for his bipolar disorder would cost over $1k a month. Every month. For the rest of his life.

[Lanny]

I "liked" the OP because I think it is an important issue.  To pay less, if you did not pay $900 a month for the insurance you have, is something they should fix.  In your case, it is more of a catastrophic coverage insurance in that if (hopefully never) you have a catastrophic issue, they will pay part of it.  NOT GOOD...  As your thread title says, that IMO is terrible.

[MistyMountain]

I lament when we had better insurance and not a high deductible plan. I was so thankful then but I knew that way too many people did not have that. I am in the midst of a medical issue and it sucks to have to worry about the costs of needed procedures and I am sick just worrying about what we will owe and if everything will be approved and done by a network provider. The employer buys down the deductible but I am not sure if they buy down the max out of pocket because they switch plans so often and I am sure we will reach that. Small companies have much more expensive plans.

 

We do put money in a flexible spending account but if we do not use it most of it will not roll over so it is a gamble in how much to put in and we cannot put the family deductibles never mind max out of pocket in every year especially since we could lose it. Most years we barely have medical costs. We got hit this year with both an uncovered medical expense for one child and a health issue that will not be long term but will be very expensive in one year and the year is not over yet. The flexible spending account was already drained. I buy all clothes used, we have very old vehicles that can go at any time plus house expenses that could come up. We have no room in the budget.

 

If you look at the link nearly ten percent of people have no health insurance and many more have health insurance but still cannot afford the deductibles and coinsurance. You never know when a health issue can strike or if it is something that will be long term or with more then one family member. The system in this country does suck. I always advocated for a universal system that is not all private and employee based like every other industrialized nation manages. The health costs are much lower for everyone in those systems by a lot. No one should have to worry about medical costs and yes including mental health. Medical costs are a leading cause of bankruptcy.

Edited July 26, 2017 by MistyMountain

[Crimson Wife]

  And the disability thing..,that is even more maddening. If I admitted my child had autism, they were going to reject the Medicaid but I was still legally required to do something. I asked..isn't there some sort of Medicaid specific to kids with autism and got told there might be, don't know, by every single case worker I asked. 

 

That's untrue. Either the child qualifies for Medicaid on the basis of family income (with or without autism) or he qualifies BECAUSE of the autism (regardless of family income). There are 2 different funding sources and the Medicaid-through-disability has some advantages over the Medicaid-through-income such as picking up co-pays and deductibles from the family's primary insurance. But a child who qualifies through income will still do so if he has autism.

[hepatica]

In the last 10 years, we went from an HMO plan with very low copays to our current high (ish) deductible plan.  This was the plan we had when we got married, and I think it cost an extra $10/paycheck to go from single to family coverage.

 

There are days that I lament the $20 doctor appointment, $50 ER visits, and $100 inpatient stays.  We pay a large amount every month, and we still have that ever present knowledge that we are one hospitalization from a huge to us bill.  We have a $4500 deductible (family, but there are not individual deductibles within that; it has to be met), and a $15,000 out of pocket.  If someone got a chronic illness, a few years of the $15,000 would have us in debt for a long, long time.  

 

Yes, I am thankful for insurance.  Yes, I am grateful for what we have.  Yes, what we have is average.  

 

But I still lament the loss of the "good ole days."   :)

 

I understand this sentiment. Twenty five years ago I worked at a state university and had very good union negotiated state benefits. When we moved, my DH chose a job based on the very comprehensive medical benefits offered. We were in an HMO and I think we paid a total of about $10 each for the birth of my first two children.

 

However, the one good thing the ACA saga has done is make me better understand that my good benefits were made possible by the exclusion of so many people who were sicker and much more in need of medical care than I. When I think back on it now, I have something akin to a sense of shame. We now pay thousands each year in a high deductible plan, but our benefits are still above average.

 

There were no good ole days.

[lauraw4321]

Can you explain how this would be helpful? I know the money can be used tax free toward medical expenses. Is there any other advantage?

 

Sorry, just getting back to this. It is taken pre-tax, so it's a nice way to save for the deductible (like 401Ks and retirement). Plus, many companies will contribute to them separately. Sounds like Janeway's husband's new company is not one of those, however.

[Crimson Wife]

Given the attitudes in Texas, I wonder if all the paperwork is in place to discourage applicants?

 

Except that doesn't explain why bluest-of-the-blue-states CA *ALSO* has a nightmare of red tape when it comes to Medi-Cal and their other assistance programs (California Children's Services, Regional Center, Regional Paratransit Center, etc.) Bureaucracies just LOOOOOOVE paperwork.

[Arcadia]

Can you explain how this would be helpful? I know the money can be used tax free toward medical expenses. Is there any other advantage?

For us the main benefit of the HSA is that unused amount can be rollover to the next year unlike FSA which has a deadline of Feb/March for the funds to be used up. My husband's employer contributes to the HSA so that is the additional benefit for us.

[lauraw4321]

I have a high-deductible plan and a health savings account, which DH's employer contributes to. Was on this plan when pregnant, and the OB's office required me to fork over my entire deductible at my first visit, even though that was silly because it was 8 months before I delivered, and there would be payments to other doctors, which ended up meeting deductible before I delivered. The OB had to pay me back the $2,500. Every visit after that, they kept trying to make me pay more money, because the total delivery fee would be $6,000, and they wanted me to pay it up front and then me be reimbursed by insurance. I refused. Took forever. They eventually gave me my money back after I delivered and insurance covered all but our coinsurance amount (10%).

 

Then the insurance company tried to claim that I hadn't met my deducible and wouldn't cover my breast pump. Even though under ACA (this was post-ACA) breast pumps were supposedly required top be covered. Spent months battling that.

 

All that to say, insurance sucks.  It just does. Good plans. Bad plans. In between plans. Doesn't matter. So long as you have two or three entities trying to eek out a profit from a single transaction (providers, hospitals and insurers) it's going to continue to suck.

[goldberry]

Edited to add: But since she's not doing either one, it's a moo point. It's like a cow's opinion.

 

Unsinkable, can I just say that while I sometimes really disagree with your opinions, your sense of humor is a blessing!  I have laughed out loud over more than one of your posts.  Keep up the good work!  :lol:

[Crimson Wife]

Medicaid for Benjamin, complete with provider recommendations and obvious diagnoses, took me about 60 sheets of diagnostic information, six provider records releases, a third party liaison, and almost three months before approval.

 

It's not straightforward unless you're under the income guidelines around here. For poor kids? Easy. For the disabled? Nightmare time. I am crossing all my fingers that Ohio doesn't stink with regard to the filing process.

 

I believe it. Have you applied for SSI for him? That is a paperwork nightmare as well but getting him officially deemed "disabled" can cut down on future paperwork for other things. Even if your family's income doesn't qualify for a monthly benefit, it may be worth jumping through the hoops of applying.

[goldberry]

Until someone in your family comes down with a life-threatening mental health condition requiring tens of thousands of dollars' worth of inpatient treatment. I wonder where one gets the confidence that something like this will never happen.

 

 

Especially since many mental issues don't show up until adolescence.  

[goldberry]

Or let people pick what is covered.   For example, I would be happy to eliminate mental health coverage.  

 

Can I ask a question sincerely?  What understanding do you have how that would actually work given that the entire basis of insurance is shared risk?  If people opt out of what they *might* not use (which of course, can be wrong), then the only people signing up for that are people that know they would use it.  Hence it would become unaffordable to cover those people.  There is no spreading of the risk.  The only reason insurance can be affordable at all is the concept of a large pool sharing the risk.  Allowing people to order coverage a la carte eliminates that.

 

So under your system, why do you think that would work?

 

Side note, that is why I am amused when people say, "I shouldn't have to pay for someone else's healthcare!"  Um, if you have had a traditional health insurance policy, you have been paying for someone else's healthcare.  Your premiums do not go into an account waiting for you to use them.  You are *sharing the risk* with every other person in your insurance pool. 

[goldberry]

So long as you have two or three entities trying to eek out a profit from a single transaction (providers, hospitals and insurers) it's going to continue to suck.

 

Yes.  This. 

[goldberry]

Except that doesn't explain why bluest-of-the-blue-states CA *ALSO* has a nightmare of red tape when it comes to Medi-Cal and their other assistance programs (California Children's Services, Regional Center, Regional Paratransit Center, etc.) Bureaucracies just LOOOOOOVE paperwork.

 

This is very true.  My friend in California has had a nightmare time with paperwork. I'm beginning to think the amount of time and money single payer/universal would save in paperwork ALONE is being underestimated.

 

I cannot imagine the decrease in stress levels for the average person, just walking in somewhere and being treated, and not sorting through bills and negotiating and arguing for the next 6 months to a year or more afterward.  I hear about it, but I cannot imagine it.  

[justasque]

OP, have you had this kind of insurance before?  

We have found that you can't really look at it that a particular procedure early in the year costs a ton of money, and another towards the end is free or super-cheap.  Instead, we have a deductible and an out-of-pocket maximum.  We budget for somewhere in between those.  We know we will almost always meet the deductible.  It might be paid to the GYN for a pap smear, or the GP because of a nasty infection, or to the pediatrician because of an unusual rash or an asthma attack.  It really doesn't make sense for us to stress that one of these visits will be full-pay and another will cost us nothing out of pocket.  Instead, we view it as getting the health care we need, and with us paying the first $xxxx of it each year.  Lots of well-person checkups and tests are covered 100%, and we try to make sure we take advantage of those too.
If we have a co-pay, we pay up-front at the doctor's office.  Then we get the bill.  It typically says "x procedure, $300, Insurance company rate $150".  If it's the beginning of the year, we pay the $150.  If it's towards the end of the year, we pay nothing (beside the co-pay we already paid at the office).  

 

I think you would be happier if you created a budget for your family's health care.  Keep in mind that you may need more money at the beginning of the year (or partial-year, since you got this policy mid-year), and you may need less at the end if you've met your deductible.  Say, for example, if you put $250 a month aside for health costs.  Some months you might not need that much.  Put it into savings (or an envelope, or keep track on a spreadsheet) so that it's there later when you get a bill more than $250.  Read over your policy to see what the most you might expect to pay in a year is.  Do you have an out of pocket max?  That will help you figure it out.  Then budget for it.  Then you can pay them without stress.  It may take some time to transition to this, since your dh has been out of work, but give it a try.  

What you've described is how most insurance works.  There may be other folks who can give advice on how they budget for theirs.

Two more thoughts - 

1) MAKE SURE your kids are on your dh's insurance.  I know the Medicaid people are making a mess of things.  If they dump you, you may not have the choice to get on your dh's insurance again until the next open enrollment period.  So sign up for the company insurance even if you think Medicaid might still cover your kids.  You CAN have two insurance policies at once, so don't stress over that.

2) I am speaking very gently here.  You've mentioned your ds is autistic.  Have you ever considered whether you also have some autistic traits?  Some things seem much harder for you than they are for others, which is one sign that you might have a brain that has to work harder on certain things, which can be super-stressful.  It's something to consider.  Once you are insured, you might think about whether testing and/or counseling with this possibility in mind could be useful in reducing the stress that you are feeling.
 

[Χά�ων]

The end result of this health insurance is..it is just bad. That dollar amount was a deductible to be met before they started to pay. The copays kick in after the deductible is met. I had a doctor appointment last week and had to pay just over $170. I am supposed to have a procedure next week, outpatient, and turns out, it is going to cost me $2500. I told them I thought there was just a copay and was told they checked with my insurance and the copay only kicks in after I meet my deductible. I am paying $900/month for this insurance.

 

Here is the real kicker. IF we had no insurance, we would pay the self-pay rate which is lower than the insurance rate. So it is costing us for not just the insurance, but also for higher visit rates as a result. Last weeks appointment would have been just under $100 if I was self-pay and the procedure next week would have been $2025.

Go to Ikea, buy your daughter the cheapest wood frame and aome paint. Yse the reat of the money for the procedure.

[EKS]

Side note, that is why I am amused when people say, "I shouldn't have to pay for someone else's healthcare!"  Um, if you have had a traditional health insurance policy, you have been paying for someone else's healthcare.  Your premiums do not go into an account waiting for you to use them.  You are *sharing the risk* with every other person in your insurance pool. 

 

You're also paying for someone else's healthcare when you pay a hospital bills, since many (most? all?) hospitals don't turn away patients who lack the ability to pay.

[Carol in Cal.]

You should have the procedure. You will end up having to pay the deductible sooner or later anyway and it is not worth being in pain and sacrificing function (and sitting around only makes back problems worse!!!) because you don't want to pay money that you apparently could pay if you wanted to. It seems, frankly, like this is motivated more by self-pity and a desire to play the victim than by financial prudence. As a person for whom, as it seems from your postings over time, this type of money is in fact discretionary, it doesn't come off well.

Well, it's more than halfway through the calendar year already.

 

If I were in this situation, I'd probably try to wait until January, and get it done then, along with everything else I might have been postponing, to load up the 2018 calendar year with all the covered stuff I possibly could.

[scholastica]

You're also paying for someone else's healthcare when you pay a hospital bills, since many (most? all?) hospitals don't turn away patients who lack the ability to pay.

 

I hope you mean for Emergency Services. They are not required to treat people beyond stabilizing emergency conditions. They turn people away who cannot pay everyday.

[winterbaby]

Well, it's more than halfway through the calendar year already.

 

If I were in this situation, I'd probably try to wait until January, and get it done then, along with everything else I might have been postponing, to load up the 2018 calendar year with all the covered stuff I possibly could.

 

She's in pain and complaining of reduced functioning. It's particularly not a good plan for someone who apparently gets kind of overwhelmed by setbacks and stressors. Besides, wouldn't the deductible cover the twelve months since she enrolled, rather than the calendar year? In any case I don't think she should be encouraged to underconsume needed healthcare and stew in these dysfunctional feelings of being uniquely hard done by.

[Butter]

She's in pain and complaining of reduced functioning. It's particularly not a good plan for someone who apparently gets kind of overwhelmed by setbacks and stressors. Besides, wouldn't the deductible cover the twelve months since she enrolled, rather than the calendar year? In any case I don't think she should be encouraged to underconsume needed healthcare and stew in these dysfunctional feelings of being uniquely hard done by.

 

Deductibles are almost always calendar year.

[Carol in Cal.]

She's in pain and complaining of reduced functioning. It's particularly not a good plan for someone who apparently gets kind of overwhelmed by setbacks and stressors. Besides, wouldn't the deductible cover the twelve months since she enrolled, rather than the calendar year? In any case I don't think she should be encouraged to underconsume needed healthcare and stew in these dysfunctional feelings of being uniquely hard done by.

 

Every deductible I've ever had to satisfy was for a calendar year.

 

And I don't think your snark is particularly helpful.  Strategizing over where to place medical procedures in order to maximize medical benefits is something that people do all the time.  If she needs it now, she should have it.  If she can wait, there might be advantages to doing so.

 

[EKS]

I hope you mean for Emergency Services. They are not required to treat people beyond stabilizing emergency conditions. They turn people away who cannot pay everyday.

 

"Public hospitals may not deny patient care based on ability to pay (or lack thereof). Private hospitals may, in non-emergency situations, deny or discontinue care."

 

https://law.freeadvice.com/malpractice_law/hospital_malpractice/hospital-patients.htm

[Mimm]

Hang in there. Any day now, congress will repeal the ACA and replace it with a plan that provides for more coverage at a lower rate.

 

:lol:  (assuming you're being sarcastic)

 

And Unsinkable, my family says "It's a moo point" all the time. :)

[Crimson Wife]

This is very true.  My friend in California has had a nightmare time with paperwork. I'm beginning to think the amount of time and money single payer/universal would save in paperwork ALONE is being underestimated.

 

I cannot imagine the decrease in stress levels for the average person, just walking in somewhere and being treated, and not sorting through bills and negotiating and arguing for the next 6 months to a year or more afterward.  I hear about it, but I cannot imagine it.  

 

Having dealt with Army medicine, it would be trading one headache for another. Instead of fighting over bills, it would be fighting to get access to care when some bureaucrat decides they know better than patients in consultation with doctors. :thumbdown:

[Mimm]

Janeway... it kind of feels like you weren't aware of what a deductible is. That's pretty much how it works. Nothing you are describing sounds unusual in any way. You should look into setting up a health savings account. We put in enough money to cover our deductible every year. This is income that doesn't get taxed so it's a pretty good deal. Even if you can't set one up, you should try to save up enough to cover the deductible in a separate account if necessary. I know it's hard, but it is a real comfort being able to get whatever health care is necessary because that money is already set aside.

[TechWife]

"Public hospitals may not deny patient care based on ability to pay (or lack thereof). Private hospitals may, in non-emergency situations, deny or discontinue care."

 

https://law.freeadvice.com/malpractice_law/hospital_malpractice/hospital-patients.htm

This article links back to the official Medicare/Medicaid web site that simply states that an examination and treatment to stabilize must be provided at all hospitals that accept Medicare. The private/public status of a hospital doesn't come into play. It says nothing about non-emergency care. This is known as the Emergency Medical Treatment and Labor Act. If you have an original source that says non-emergency care must be provided regardless of the patient's ability to pay, I'd like to see a link.

 

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/

 

ETA: This includes definitions of emergency medical condition, participating provider and stabilize:

https://www.ssa.gov/OP_Home/ssact/title18/1867.htm#t

Edited July 27, 2017 by TechWife

[Frances]

Have I entered the twilight zone? First someone says the ahca will be replaced with something less expensive and better soon and now this.

 

This is not how insurance works. It is not how any of this works. I don't know how to explain that one should care about other people. Our disagreement is not merely political but a fundamental divide on what it means to live in a society. Haven't we evolved past the family unit being your tribe and the only ones that need to survive. Society by definition means there is an implied contract to each other. We all matter when it comes to survival.

This is the part that I just can't fundamentally understand. My family pays less than $50 per month for health, dental, and vision coverage with a $750 family deductible and very low copays. The only real restriction is that we need to go through our health medical home for referrals. The less than $50 per month also provides double insurance for my husband on everything and vision for me and my son through my husband's employer.

 

And still, I'm all for some sort of universal healthcare, preferably single payer. Because we are fortunate to also make a good income, there is no doubt that under such a system we would likely pay significantly more in taxes that we are currently paying in premiums, deductibles, and copays. But I'm completely fine with that. For me personally, it's not enough that my family has great access to care for very little money with no risk of medical bills taking us under. I want everyone in this country to have healthcare security.

[Guest]

I believe it. Have you applied for SSI for him? That is a paperwork nightmare as well but getting him officially deemed "disabled" can cut down on future paperwork for other things. Even if your family's income doesn't qualify for a monthly benefit, it may be worth jumping through the hoops of applying.

It's on my list of things to do in Ohio, once we have a new team who can vouch for him.

[goldberry]

This article links back to the official Medicare/Medicaid web site that simply states that an examination and treatment to stabilize must be provided at all hospitals that accept Medicare. The private/public status of a hospital doesn't come into play. It says nothing about non-emergency care. This is known as the Emergency Medical Treatment and Labor Act. If you have an original source that says non-emergency care must be provided regardless of the patient's ability to pay, I'd like to see a link.

 

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/

 

What I have discovered is that this varies widely by state, what type of care is available.  Many states have certain programs for specific diseases.  I read a story about a Colorado woman who was getting treatment for her breast cancer through a special program.  But knew people with other cancers (without health insurance) that could not get chemo anywhere.   It is not mandated by law that any place provide chemo, or regular diabetic control, or pharmaceuticals, or other non-emergency treatment.  Some states and some hospitals have programs to do so, but many don't.  

 

https://healthcare.uslegal.com/patient-rights/the-right-to-treatment/

 

However, once the emergency is over and a patient’s condition is stabilized, the patient can be discharged and refused further treatment by private hospitals and most public hospitals. If the individual seeks routine medical care or schedule a doctor’s appointment for non-emergency medical problems, doctors have a general right to refuse treatment if they have no insurance or any other means of paying for the provided care.

[Crimson Wife]

 And still, I'm all for some sort of universal healthcare, preferably single payer. Because we are fortunate to also make a good income, there is no doubt that under such a system we would likely pay significantly more in taxes that we are currently paying in premiums, deductibles, and copays. But I'm completely fine with that. For me personally, it's not enough that my family has great access to care for very little money with no risk of medical bills taking us under. I want everyone in this country to have healthcare security.

 

I don't want to pay more in taxes for worse healthcare than my family has now.

 

I don't mind paying somewhat more in taxes to expand Medicaid to all low-income folks and to subsidize the reimbursement of deductibles & out-of-pocket maximums for moderate income folks (and not just those on the exchanges). No problem either with only allowing non-profit organizations & member co-ops to sell health insurance to eliminate the profiteering off of insurance.

 

But those of us who rely on good private insurance should not be forced to give that up in the name of universal healthcare.

[EKS]

This article links back to the official Medicare/Medicaid web site that simply states that an examination and treatment to stabilize must be provided at all hospitals that accept Medicare. The private/public status of a hospital doesn't come into play. It says nothing about non-emergency care. This is known as the Emergency Medical Treatment and Labor Act. If you have an original source that says non-emergency care must be provided regardless of the patient's ability to pay, I'd like to see a link.

 

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/

 

ETA: This includes definitions of emergency medical condition, participatino provider and stabilize:

https://www.ssa.gov/OP_Home/ssact/title18/1867.htm#t

 

To be clear, I didn't say that all hospitals treated all patients all of the time.  What I said was that some care is provided by hospitals to people who can't pay.  That cost is passed along to the folks who are paying.  Same with any healthcare provider, actually.

 

Ergo--even if you don't have insurance, if you go to healthcare provider who has had patients who haven't paid, that is reflected in your bill.

[goldberry]

To be clear, I didn't say that all hospitals treated all patients all of the time.  What I said was that some care is provided by hospitals to people who can't pay.  That cost is passed along to the folks who are paying.  Same with any healthcare provider, actually.

 

Ergo--even if you don't have insurance, if you go to healthcare provider who has had patients who haven't paid, that is reflected in your bill.

 

I'm glad you clarified.  I've heard recently "no one goes without care in the U.S., that's propaganda."  I find that very insulting to all who have shared their actual stories about going without care. Lots of people really think you can just walk into a hospital and they have to help you with whatever you need.  It just doesn't work that way for non-emergent care.  If you live in the right area, and have the right problem, for which there just happens to be a program in your area to help, then maybe. It is NOT guaranteed.  And often takes long enough to access that it's too late to matter.

[madteaparty]

For us the main benefit of the HSA is that unused amount can be rollover to the next year unlike FSA which has a deadline of Feb/March for the funds to be used up. My husband's employer contributes to the HSA so that is the additional benefit for us.

Yes the roll over is huge. I can pay for two Lyme disease treatments at this moment, I feel so rich.

[displace]

I hope you mean for Emergency Services. They are not required to treat people beyond stabilizing emergency conditions. They turn people away who cannot pay everyday.

True.

 

But... there are plenty of Emergency conditions that cannot be stabilized and discharged. "Minor" car accidents that only result in broken bones that need surgery may be a few days of ER, hospitalization, surgery, and then discharged as stable.

 

But, serious accidents and illnesses cause countless people to be admitted to the ICU for weeks before they are out of critical condition. All of these people are treated and not discharged until stable, no matter the cost. One confounding factor in costs of healthcare in the US.

Edited July 27, 2017 by displace

[displace]

I understand the OP frustration with Medicaid providers and lack thereof. If our country does not have enough physicians (and it doesn't), and you live in a state that has even less percentage of providers per capita than the average (like Texas), and use insurance that is provided by even less providers (perhaps Medicaid), then it may be super challenging to find a physician.

 

The whole system is broken. ETA - and getting worse. I think I saw a statistic that physician shortages will be 17% worse by 2025.

 

But, yes, deductibles can be frustrating, upsetting, and confusing.

 

OP, you may consider calling around to ask costs of different providers for the same procedure. You will need the procedure code. Offices may charge differently, but the insurance will cover only X amount. So if the doctor you saw charges $2,000, but a different doctor charges $1,500, it may be worth it to change practices.

Edited July 27, 2017 by displace

[whitestavern]

I know it is tough right now for people who make a middle class income because of the high cost of buying an insurance plan and then having it not be very good. It is estimated that 1 million Americans fall in this bracket where they have endured sky rocketing insurance costs for less insurance over the past few years. It does need to be fixed. My husband luckily is provided amazing insurance through his job. We pay about $500 per month for both of us and 5 kids with no deductible. He really wants to go solo with his buddy and do a biotech start up but I have been begging him to reconsider. Any extra he would end up making would go to sky high insurance and student loans (since he has forgiveness at 10 years and is 3 years away in current job). Reading some of the posts here about what people are going through is sobering.

 

My dh owned a successful marketing consulting business. Our insurance costs were very high. Then he started consulting for a national health insurance provider and saw what was coming with the ACA. Our rates would've gone much higher. He went and got a job in the corporate world. Have your dh look into what insurance would cost before he makes the leap. It is sobering :(

[scholastica]

My dh owned a successful marketing consulting business. Our insurance costs were very high. Then he started consulting for a national health insurance provider and saw what was coming with the ACA. Our rates would've gone much higher. He went and got a job in the corporate world. Have your dh look into what insurance would cost before he makes the leap. It is sobering :(

Which is just one more reason why tethering health insurance to employment is untenable. It stifles innovation and ties people to jobs that are no longer a good fit for them.

[winterbaby]

Every deductible I've ever had to satisfy was for a calendar year.

 

And I don't think your snark is particularly helpful.  Strategizing over where to place medical procedures in order to maximize medical benefits is something that people do all the time.  If she needs it now, she should have it.  If she can wait, there might be advantages to doing so.

 

I'm sorry if I'm being too harsh but it's not actually intended as snark. Her sense that she's being personally persecuted by the system is unhealthy, and allowing herself to suffer physically over it is apt to intensify those perceptions.

[EKS]

I'm glad you clarified.  I've heard recently "no one goes without care in the U.S., that's propaganda."  I find that very insulting to all who have shared their actual stories about going without care. Lots of people really think you can just walk into a hospital and they have to help you with whatever you need.  It just doesn't work that way for non-emergent care.  If you live in the right area, and have the right problem, for which there just happens to be a program in your area to help, then maybe. It is NOT guaranteed.  And often takes long enough to access that it's too late to matter.

 

I was just responding to the "I don't want to pay for other people's healthcare" argument.

 

I totally get that there are a lot of folks out there that aren't getting healthcare that they need because they can't pay.

 

That is why I am emphatically for universal healthcare.

[Lanny]

The State of Vermont was on the way to Universal Health care a few years ago. When they discovered the true budget for that they dropped the idea. Now California is trying for a way to do that. If and when one of the states can do that successfully the Federal Gov. might use their model for a national plan. Having expensive insurance and not being able to afford medical care is sad.

 

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[EKS]

I should also mention that when we had individual health insurance (10+ years ago), we were paying $900/month, had $20-$100 copays (depending), and something like a $5000 deductible.  No prescription coverage and no mental health.  And this was for four people with the adults being well under 50.  Oh, and an autism diagnosis was considered a disqualifying condition (and I was dreading having to change insurance--which we had to do every two years to reduce the premium to an "affordable" level--because my son had just gotten an autism diagnosis).

 

So the OP's insurance seems to be better than that.

[Frances]

The State of Vermont was on the way to Universal Health care a few years ago. When they discovered the true budget for that they dropped the idea. Now California is trying for a way to do that. If and when one of the states can do that successfully the Federal Gov. might use their model for a national plan. Having expensive insurance and not being able to afford medical care is sad.

 

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The problem with one state doing it alone is that they miss out on much of the money that will come from the whole country doing it, such as

Federal tax exemption for employer and employee health insurance premiums

Federal tax exemption for health savings and flexible spending accounts

Administrative costs for the variety of federal programs, including VA, Tricare, Medicaid, Medicare, etc.

 

Plus, if one state isn't getting really adequate funding to implement it because they can't really tap into some of the areas of huge savings, it's likely that the reimbursement rates would be low and might cause doctors to move to another state, thus worsening access to providers.