insurance woes

[BakersDozen]

I hope this is in no way inflammatory and doesn't progress into a debate. Right now I am overly sensitive to this topic and the fact that my dh's work just sent out the new health care packet showing yet another substantial increase in premiums yet decrease in benefits has me frustrated to the point of tears.

 

We pay a large amount each month for health insurance. I'm thankful for the coverage yet angry at the constant hike in rates. The latest thing to be added on is a $100 charge for maternity services before any coverage begins. I'm fine with paying my OB $500, the hospital gets another $1000-1500 (and that's if I leave right away and have no complications). What I'm not fine with is this "penalty" for being pg, which is how I see it. What I'm also not fine with are my friends who are on taxpayer-funded insurance and have full coverage, who pay a whopping $1/office visit, who get an u/s "just to see the baby", and who have no limit whatsoever on the # of pregnancies that will be covered on the taxpayer dime. I was on gov't aid once and was thankful for it, yet I never dreamed of continuing to increase my family size without taking myself (and my dc) off of the aid and getting my own insurance. I'm frustrated that legislation is introduced every year in our state trying to limit the coverage past a certain # of pregnancies and it is shot down. I get that people need financial help (especially in today's economy), I get that health care costs are huge. What I don't get is why those on gov't aid have no "penalty" at all that I know of like those paying for private insurance have; heck, we're the ones paying over $1000/month for health care coverage (And that's just the premiums! Add in out-of-pocket and it comes to about $1700/mo.) - the last thing we need are penalties! Why not require those on gov't aid to pay more with each pregnancy? 1st pregnancy=full coverage; 2nd pregnancy=10% responsibility; 3rd pregnancy=20% responsibility; etc.

 

I'm sorry if this steps on anyone's toes, I truly am. I realize there are those who may truly need assistance and find themselves with a surprise pregnancy (I was one of those at one time). I guess I just don't see any fairness in this at all. I'm absolutely not for socialized health care - but getting rid of insurance companies, yes! I'd just like to see a bit more financial responsibility put on everyone, especially those who continue to utilize taxpayer-funded programs while growing their family size.

 

Am I wrong in feeling this way?

[SherryTX]

...wrong to feel this way at all.

I get it. I don't think it is fair either - not that I would wish harm on those that rely on public insurance - but I think that is one of the reasons costs are so high for the rest of us, because the government has very set prices and limitations, etc...you pay your taxes..plus you have to pay for your health insurance. To me, it is as bad as my neighbor next door having NO kids and having to pay his part of the property taxes for the local schools, and here we are next door, probably paying the same rate and we have 3 kids currently in public school. Just ain't right!

 

We are switched to a high deductible insurance plan a few years ago - our premiums are VERY low, but we have a 3K per person deductible (it maxes out for the whole family at $6 or $7K). We are supposed to have an HSA account with it to put money into so we have $ to meet the deductible if needed, but we are having issues getting it set up this year (I am not sure WHY they switched banks?).

 

Anyhoo - I bring this up because I am beginning to think more and more that if we had a different attitude towards health insurance - say the way we do towards auto insurance - we wouldn't be in such a mess with the cost of health insurance in this country. IF we could have a system (and I believe catastrophic care falls under this and the plan we have does some what as well) of insurance that pays for the big things, and get people to be able to focus on the small "maintenance" things, I do believe that costs of insurance would be much lower than is possible today. When we had a different plan, were paying at least $450 or so a month for coverage for the whole family - whether we used it or not. And then, after our co-pay, there was a 20% coinsurance that we were responsible for. When we signed up for the high deductible HSA plans, we did a LOT of math crunching and figured out that it would actually be cheaper to go that route, even if we did end up hitting the deductible.

 

And we did for 2008 AND 2007.

 

My biggest problem though right now is the whole "in network - out of network" thing. For example, if I go to the hospital for an xray, the hospital and the radiology services are all in network - but the radiologist that actually reviews the xray is not. That is a pain in the neck, because the costs are higher.

 

Not only THAT - but if you do reach your deductible and have to go to an out of network provider, the deductible limit is HIGHER, so it may not be covered unless you have hit that total higher amount.

 

Besides those two things, I don't have a lot of issues with it. We don't have a prescription plan - but do get discounted prescription rates, and most prescriptions are covered after the deductible is reached.

 

I think selecting and dealing with insurance can be one of the most frustrating things from a personal finance perspective. It requires a lot of homework nowadays. But, I have to say I would rather have to do that than throw another few hundred away each month regardless of whether I am using it or not.

[Samiam]

I TOTALLY get what you are saying, BUT, that being said, there is another thing to consider. For those who have very limited income, and are on Government insurance, and who get pregnant again, for whatever reason, if they thought that they had to pay a certain $$ and they didn't have that, they probably would not seek medical assistance until the very end of the pregnancy. This could delay treatments of several issues that can be dealt with in utero, causing health complications for both Mom and baby...thereby jacking up the bill, and possibly even long-term health issues, and thereby more $$$$.

 

Then there is that fact that the hospital is not going to turn away a woman in labor, hopefully. If that woman does not have the money to pay, of course that would not be known until after the fact. There is a good chance that the hospitals would be left with many unpaid bills relating to maternity costs. Who do you think is going to pay those bills in the end? One, taxpayers. Two, those of us with insurance will see our rates hike once again as the hospitals jack up their rates to cover their debt.

 

Alot of the insurance costs can be traced back to the health care system. They have made costs SO high, it is silly. What is happening is they try to make a profit on EVERY aspect of your care, not just cover their costs. I mean, at one point, Dr.'s and Hospitals were there to provide a service, not make a profit.....not sure that is the case these days.

 

It's just a twisted system altogether, and although I completely get your frustration, it's not that easy to point the finger at just one piece of the system.

[JFSinIL]

"My biggest problem though right now is the whole "in network - out of network" thing. For example, if I go to the hospital for an xray, the hospital and the radiology services are all in network - but the radiologist that actually reviews the x-ray is not. That is a pain in the neck, because the costs are higher."

 

If you did your homework and choose an in-network hospital - then your insurance should not penalize you because the hospital hired folks not in your network. My hubby has TWICE pointed this out to our insurance (a PPO) - we would use the local, in-network hospital, even an in-network doctor - then find out the radiologist or whomever was NOT in-network. Each time insurance agreed with us and redid the fees as if the radiologist, etc. was IN network. It is just a matter of complaining, in writing and by phone (if you can get a live body on the phone!!!). As long as you in good faith have chosen a hospital or doctor within your network you can not be penalized if the support staff are not in network.

 

Hubby is a lawyer who spends too much of his time dealing with medical insurance claims for Chicago Public Schools and some Teamsters.

[Melinda in VT]

I TOTALLY get what you are saying, BUT, that being said, there is another thing to consider. For those who have very limited income, and are on Government insurance, and who get pregnant again, for whatever reason, if they thought that they had to pay a certain $$ and they didn't have that, they probably would not seek medical assistance until the very end of the pregnancy. This could delay treatments of several issues that can be dealt with in utero, causing health complications for both Mom and baby...thereby jacking up the bill, and possibly even long-term health issues, and thereby more $$$$.

 

 

:iagree: This is one concern with raising rates for subsequent pregnancies.

 

I also worry it would encourage poor women to get abortions, and I'm not in favor of government policies encouraging abortion.

[MomLovesClassics]

Last year I spoke with an insurance agent. She told me that most private carriers are cutting out maternity benefits alltogether, and it is getting harder and harder to find maternity coverage.

[OneRoomSchoolHouse]

Our insurance rates generally go up about $150 each year. Dh is covered for free by his company, but wife and kids are not. For us it would have cost around $800/mth. I did some homework and found that I could get coverage for me only for $115/mth with comparable deductables, etc. The only catch is that it doesn't cover maternity. I think I am ready for #4 dc and am so very sad that we won't have insurance to cover until next April. We did put $5k in health savings and I feel it will be wasted now since I can't get pg without insurance, which isn't until next April and that would be covered under this years health savings money! :crying:

[Nestof3]

I understand your frustrations.

 

I see two problems. First is employee group coverage. These high rates are so because the rates have to cover everyone in the company as opposed to private insurance which is lower if you have no issues but higher if you do. My husband looked into group insurance because he is self-employed with a corporation and our monthly premium would go from $391 to $800. That's with a $5,000 deductible. We dropped maternity because we are finished having children and figured if something happened, we would just pay out of pocket.

 

The second issue I am in total agreement. One of the reasons we have such a difficult time meeting with people at our home church is because everyone is quiverfull, but if they don't have employer health care, they either go without or use taxpayer insurance. One family bought 20 acres of land and built a 4,000 square foot house, yet he qualifies for all of his children to be on state insurance. What a crock. We really have integrity issues with people who continue to increase their family size while living on gov't support. The husband in this one family even talked often of how he wouldn't go to work until 11:00 so they could pray through issues and do bible time -- making it clear that these spiritual needs were more important than providing for his family.

[Mommyof4ks]

I agree with OP.

 

Does your dh's employer offer a high deductible plan? We have that now, and it is CHEAP (we save $3800 a yr in premium payments). The out of pocket max is $5000 for a family, but with the money we save on premiums and the FSA (we don't have an HSA offered there) we don't spend nearly as much as we did with a copay plan. Of course we pay ALOT of medical bills with our son, but even if we did not use it as much it would be great for us. The normal reduction to a 'reasonable and customary' fee still applies even before the out of pocket max is reached. The coverage is awesome too; we were even able to get neuropsych testing done which is not something that many ins. pay for these days.

[Nestof3]

 

Alot of the insurance costs can be traced back to the health care system. They have made costs SO high, it is silly. What is happening is they try to make a profit on EVERY aspect of your care, not just cover their costs. I mean, at one point, Dr.'s and Hospitals were there to provide a service, not make a profit.....not sure that is the case these days.

 

It's just a twisted system altogether, and although I completely get your frustration, it's not that easy to point the finger at just one piece of the system.

 

High costs can also be traced back to people who make too much to qualify for state health insurance but who do not pay their bills. The money has to come from someone.

[Orthodox6]

"

If you did your homework and choose an in-network hospital - then your insurance should not penalize you because the hospital hired folks not in your network.

 

 

The problem word in that sentence is "SHOULD".

 

BTDT, and insurance is NOT going to budge on the issue. [snarling . . .]

 

I am not an economist, so only can speculate without proofs and hold a private opinion. I would abolish insurance programs and leave doctor pricing to "free market" regulation. I suspect that some costs would plummet. I do believe that many medical costs are artificially high -- salaries, medicines, procedures, and so on. Physicians drive up their fees in order to combat insurance companies and malpractice lawyers. Pharmaceutical firms rearrange one molecule in order to claim "difference" when a dozen equally effective drugs already exist, then snare legal protection for however many years now are the norm. Advertising costs for these competing drug companies drive up the sales prices of repetitive products.

 

The current strangulation [of patients] system does drive some physicians into the rebel zone of "will not accept insurance". Fine theory that is, but pointless when their charges remain as high as the "regular" doctors. Often I hear recommendations for "an excellent doctor" who refuses insurance policies, but I cannot afford to pay such fees unaided.

 

NOW get me rolling on the prejudicial and unjust "two-tier" system which exacts radically higher deductibles and co-pays for mental health care -- AND also limits the number of visits ! [snarling AND baring my fangs over this one. . .]

Edited May 23, 2009 by Orthodox6

[Orthodox6]

Last year I spoke with an insurance agent. She told me that most private carriers are cutting out maternity benefits alltogether, and it is getting harder and harder to find maternity coverage.

 

This sounds like fertile territory for lawsuits !

[stripe]

We have to be careful, because if we don't pay for maternity benefits for pregnant women who are poor, they may be encouraged to abort OR to not get medical care, and I don't believe either is appropriate. There's also no reason to suggest poor women get ultrasounds for any worse reasons than rich women. I find the issue of ultrasounds for amusement to be disturbing, but that has nothing to do with poverty.

 

I once saw a pompous insurance co representative on TV who was quite rude about why their company doesn't provide birth control coverage, comparing it to how car insurance doesn't pay for oil changes. Okay, but if you pay for births, then....?

 

Anyway, I think health care in this country is in one sad state.

[KatieJ]

"My biggest problem though right now is the whole "in network - out of network" thing. For example, if I go to the hospital for an xray, the hospital and the radiology services are all in network - but the radiologist that actually reviews the x-ray is not. That is a pain in the neck, because the costs are higher."

 

If you did your homework and choose an in-network hospital - then your insurance should not penalize you because the hospital hired folks not in your network. My hubby has TWICE pointed this out to our insurance (a PPO) - we would use the local, in-network hospital, even an in-network doctor - then find out the radiologist or whomever was NOT in-network. Each time insurance agreed with us and redid the fees as if the radiologist, etc. was IN network. It is just a matter of complaining, in writing and by phone (if you can get a live body on the phone!!!). As long as you in good faith have chosen a hospital or doctor within your network you can not be penalized if the support staff are not in network.

 

Hubby is a lawyer who spends too much of his time dealing with medical insurance claims for Chicago Public Schools and some Teamsters.

 

While I wish this were the case, our insurance company will not change their minds. Period. I too have been charged for reading of x-rays becuase the Dr. was not in network...insurance company would not be persuaded otherwise. Maybe if my hubby were a lawyer..

I recently had blood work drawn at my Dr.'s office. He is in network. The blood work is sent to an area hospitalwhich is in network. The hospital then sends the bill to my insurance company. Because the work was done at the hospital, they consider it outpatient and they refer it to my deductible. They call it the location code. If the bloodwork had stayed at my clinic, it would have been 100 percent covered. It makes me nuts.

[LizzyBee]

"My biggest problem though right now is the whole "in network - out of network" thing. For example, if I go to the hospital for an xray, the hospital and the radiology services are all in network - but the radiologist that actually reviews the x-ray is not. That is a pain in the neck, because the costs are higher."

 

If you did your homework and choose an in-network hospital - then your insurance should not penalize you because the hospital hired folks not in your network. My hubby has TWICE pointed this out to our insurance (a PPO) - we would use the local, in-network hospital, even an in-network doctor - then find out the radiologist or whomever was NOT in-network. Each time insurance agreed with us and redid the fees as if the radiologist, etc. was IN network. It is just a matter of complaining, in writing and by phone (if you can get a live body on the phone!!!). As long as you in good faith have chosen a hospital or doctor within your network you can not be penalized if the support staff are not in network.

 

Hubby is a lawyer who spends too much of his time dealing with medical insurance claims for Chicago Public Schools and some Teamsters.

 

I think it depends on the insurance company. BCBSNC has implemented this as of a couple years ago. It's great - no more expensive surprises!

[Murphy101]

timidly stepping in deep water here with another perspective...

 

you are presuming that those on gov't aid do not have private insurance. We do for example and it s**ks. after paying huge premiums, then copays, then out of pocket portion, we could easily still have a $1500+ bill. IF I were on state health, that would be covered only IF I saw their providers and did as directed.

 

BUT

 

I still didn't use it for my last pregnancy.

 

Why?

 

Because private drs on our private insurance woudln't take me unless I consented to a major surgery that I do not need (according to them) b/c their malpractice coverage doesn't cover them for VBACs (BTW the c/s was only my 3rd baby)

 

this did not change with state aid insurance, same party line only with a hateful attitude to add insult to injury.

 

I was very lucky.

 

I found a midwife that was willing to lower rates by a LOT and wait until I had funds to pay her.

 

Otherwise, I had basicly no right to make my own decisions regarding my health care if I went the state aid route. They have a limited number of drs and you get what you get and accept it or do without.

 

So I paid a bloomin fortune for private insurance via dh's work and applied for state insurance and still got no care or financial assistance whatsoever from either of them.:glare:

 

so aside form that...

 

I think blaming others for what you think they are getting lucky in doesn't help you or anyone else.

 

I have 9 children, but only my 2nd and 9th children were born while I was on state health insurance, and as noted we didn't even use it for the 9th. You can't assume that if a woman has several kids and happens to be on state healthcare that she's had them all while on the program. I had no idea when I got pregnant with baby #9 that VBAC rules had changed to strictly or that my dh would be getting laid off. Poo happens.

 

Even so, putting a limit on number of children covered wouldn't make a difference in how many children I have. If God sends me a baby, then I will welcome that baby with open arms no matter what our financial situation. I'll do my best to provide as best we can in every way on our own, but I wouldn't make my baby suffer doing without needed care for my pride either.

 

I hate the entire idea of universal health care.

I hate insurance companies.

I really, really dislike them both and think any benefit attributed to them is nothing more than a sad statement of how pathetic care is without them.

 

What I'd love to see is drs charging direct from the patient the majority of the time.

 

For major illness or longterm conditions, I'd like to see some combination of charitable hospitals and private funding and gov't. Not sure how it would mesh together to form decent care and yet have some checks and balances to it.

 

I feel your frustration and anger and worry and sheer annoyance. I share it in abundance.:grouphug:

 

I just wouldn't presume that those on state assistance are doing any better than you.:grouphug:

 

And if you really want to feel bad for someone, feel bad for MEN without insurance. If a woman gets pregnant or has kids - they are covered under most state plans. Men don't get ANYTHING unless they are on disability or workers comp. My dh will be out a job in June when his layoff hits and there will be no insurance at all to cover his type 1 diabetic equipment or insulin at all. I'm sure things will work out, but it's sure not going to be easy.

[Murphy101]

We have to be careful, because if we don't pay for maternity benefits for pregnant women who are poor, they may be encouraged to abort OR to not get medical care, and I don't believe either is appropriate. There's also no reason to suggest poor women get ultrasounds for any worse reasons than rich women. I find the issue of ultrasounds for amusement to be disturbing, but that has nothing to do with poverty.

 

I once saw a pompous insurance co representative on TV who was quite rude about why their company doesn't provide birth control coverage, comparing it to how car insurance doesn't pay for oil changes. Okay, but if you pay for births, then....?

 

Anyway, I think health care in this country is in one sad state.

 

many insurance companies do not cover maternity. the ones that do are via employment (such as my dh's group insurance at work covering it) there's some that cover it for individual insurance, but really they don't because it is so expensive there's no way most individuals can afford to add it to theri plan. if they can afford it, it'd be smarter to just set that portion aside and if they get pregnant - use that savings.

 

I have no issue with insurance not paying for birth control.:D

and no, I don't feel that way for religious reasons either.

[Loupelou]

:iagree: With the post from Martha, it was too long to quote!:)

 

My 1st and last were born while on state aid. With my first we were underemployed student/children:001_smile:. My last was a lovely surprise.

 

My husband had insurance through a previous employer and we kept it when he became self-employed, we had to drop it for the family and just keep me on it because I was expecting. After the birth we dropped it and obtained NASE insurance, with low monthly payments and a high deductible. When we moved to another state our insurance premiums tripled! We just couldn't afford it especially while trying to establish a business. Luckily we have always been very healthy, no antibiotics, allergies, major problems. Our local clinic has a sliding fee scale and we use that for any office visits we need to make, only two in the last year.

 

As I have researched insurance I can't believe how poor the coverage has become. We were not happy with NASE as there were so many exclusions.

 

The kind of care you receive on state programs is very limited, in some areas there is only one clinic who will accept these patients. I can't blame anyone who seeks these out, as I have needed the program before and I am grateful that such programs are available to those who have no other recourse.

 

You will always find those who use and abuse the system but if we seek to take their rights away we eventually limit our own.

[stripe]

I have no issue with insurance not paying for birth control.:D

and no, I don't feel that way for religious reasons either.

I was objecting to the insurance rep's phrasing, which I felt was dismissive and creepy. Auto insurance is for accidents. Health care is supposed to be about maintaining someone's health, not merely stitching them back together.

 

I've heard that some states have programs to pay for women's contraceptives and gyn exams. I have mixed feelings about that. I find it much more logical from a financial standpoint (if a plan pays for pregnancy), and I support increased availability of health care, but at the same time, eugenics and anything that seems like government pressure on (certain) people not to have children disturbs me. (Why does "family planning" usually mean let's have fewer brown children?)

 

I also don't think it's a good idea to attribute bad motives to poor people (e.g. that "their" ultrasounds are for entertainment, while "ours" are for medical reasons), or be angry that "they" have health coverage during pregnancy and "we" don't. I don't like the assumption that poor people and/or those on state aid are stupid and lack any common sense about self-care. Talking to parents about their children's diet and safety (or lead tests!), for example, shouldn't be only for poor kids.

[Danestress]

I was objecting to the insurance rep's phrasing, which I felt was dismissive and creepy. Auto insurance is for accidents. Health care is supposed to be about maintaining someone's health, not merely stitching them back together.

 

 

 

My Dad always said that insurance should be used for that which you absolutely can not afford. So he always encouraged me to have high deductibles to keep my rates down, and just think of insuring for the truly catastrophic.

 

I tend to think of health insurance that way too (right or wrong).

 

I can afford preventative health. I can afford a normal, safe birth or I wouldn't be having kids in the first place. I can afford to see a doctor when my child has a fever and sore throat. So the insurance I really want is the one that keeps premiums very low and covers more expensive, less predictable things. I really can't afford more than a round or two of Chemo, so I want that. I really can't afford a neurosurgery. I can't afford 6 weeks in the NICU. I know this isn't how insurance generally works, and we have insurance through DH's work, so I am not out insurance shopping for what I want (I don't think we pay premiums through work either, now that I think about it). But if I were in a position to choose my insurance, for MY family, I would choose no maternity (and be glad to have a chance to opt out in order to lower rates) no routine care and preventative care, etc.

 

On the other hand, to the extent my tax dollars are used to provide care for others, I assume they probably can't easily afford that routine and preventative care, and I would not want them to forego it, so I think a government run system will need to include those things. I am happy to pay for women to have their babies in a safe place where they are mostly likely to have a positive outcome and a healthy baby. I don't expect people who can't afford insurance to foot the bill for a pregnancy and delivery.

[Vida Winter]

A big part of the problem is lawyers. Limits need to be set on the amount of reward that a person can sue for, and I might add there should be penalties for bogus lawsuits. I know there are legitimate reasons to sue, and I am not arguing against those.

 

But you have to look at the whole picture and see who is really making the money. The lawsuits drive the whole cost of care up - doctors and hospitals pay staggering malpractice insurance, which gets passed on to the customer. Obstetricians in particular are getting the worst of the deal. Birth is a dangerous thing, and people are quick to sue if anything goes wrong, whether the doctor had any fault or not.

 

State health care is routinely abused, and I'm not referring to OB care. I'm talking about those who go to the ER for a routine problem (often a chronic problem that they have had for years) instead of going to a family doc simply because they know they won't have to pay a cent for the ER visit. But we all end up subsidizing this type of visit in the form of higher fees spread around.

 

I too am frustrated by insurance fees, but I simply want to point out that there is much more to it than the insurance companies.

[Murphy101]

I was objecting to the insurance rep's phrasing, which I felt was dismissive and creepy. Auto insurance is for accidents. Health care is supposed to be about maintaining someone's health, not merely stitching them back together.

 

hmm

see now I might disagree. I don't think insurance should be for general healthy people maintaining their health. To me that is somethign entirely in the person's own abilities. good nutrition, excercise, and so forth are not things one needs to see a dr for.

 

And really medicine is NOT geared towards that goal either. The goal is evaluating symptoms until something is found wrong and either cutting or giving a pill for it.

 

I also don't think it's a good idea to attribute bad motives to poor people (e.g. that "their" ultrasounds are for entertainment, while "ours" are for medical reasons), or be angry that "they" have health coverage during pregnancy and "we" don't. I don't like the assumption that poor people and/or those on state aid are stupid and lack any common sense about self-care. Talking to parents about their children's diet and safety (or lead tests!), for example, shouldn't be only for poor kids.

 

I'll agree. because honestly my expereince with state health is that it is very limiting in what medical choices they give to patients. And altho I know there are abusers of the system (any system of any kind has them), most are not. And I can't tell you how many people I know who are SMART, with college degrees and so forth and employeed who are on state assistance of some sort. Very often all those things just aren't enough. Which is what really makes me MAD, because it shoudln't be like that and to me that's a real statement about how over-regulated and ridiculously unneccessarily expensive many things in life are becomming.

 

My Dad always said that insurance should be used for that which you absolutely can not afford. So he always encouraged me to have high deductibles to keep my rates down, and just think of insuring for the truly catastrophic.

 

I tend to think of health insurance that way too (right or wrong).

 

I can afford preventative health. I can afford a normal, safe birth or I wouldn't be having kids in the first place. I can afford to see a doctor when my child has a fever and sore throat. So the insurance I really want is the one that keeps premiums very low and covers more expensive, less predictable things. I really can't afford more than a round or two of Chemo, so I want that. I really can't afford a neurosurgery. I can't afford 6 weeks in the NICU. I know this isn't how insurance generally works, and we have insurance through DH's work, so I am not out insurance shopping for what I want (I don't think we pay premiums through work either, now that I think about it). But if I were in a position to choose my insurance, for MY family, I would choose no maternity (and be glad to have a chance to opt out in order to lower rates) no routine care and preventative care, etc.

 

I agree.

 

On the other hand, to the extent my tax dollars are used to provide care for others, I assume they probably can't easily afford that routine and preventative care, and I would not want them to forego it, so I think a government run system will need to include those things. I am happy to pay for women to have their babies in a safe place where they are mostly likely to have a positive outcome and a healthy baby. I don't expect people who can't afford insurance to foot the bill for a pregnancy and delivery.

 

See now I totally agree. I just don't think gov't run is the way to do it.

 

I view care of the sick or infirm to be an act of chairty or a service bought.

 

We really can't have it both ways.

 

If it's chairtible - then they get what they get b/c beggers can't be choosers (myself included)

 

If it's a service bought, those who can afford better will always get better choices to chose from.

 

I would like to see a system with something in between there that helps the majority of citizens stay healthy in a reasonable manner.

[BakersDozen]

Thanks for the replies/insights. What is frustrating is that while putting "penalties" or financial responsibility on low-income women for pregnancy might lead to them not getting good prenatal care, the same thing is happening for those with private insurance, too. This last pregnancy I only went in every 2mo if that because of the copays and left the hospital when my baby was 4.5 hours old to avoid any more charges. I was exhausted, had the flu, and found myself at home 5 hours after giving birth just to not pay the huge charge for a recovery room. I still fight tears when I think of that, when I think of my friends getting the full 2 days of hospital stay and they didn't pay a dime.

[Nestof3]

:iagree: With the post from Martha, it was too long to quote!:)

 

My 1st and last were born while on state aid. With my first we were underemployed student/children:001_smile:. My last was a lovely surprise.

 

My husband had insurance through a previous employer and we kept it when he became self-employed, we had to drop it for the family and just keep me on it because I was expecting. After the birth we dropped it and obtained NASE insurance, with low monthly payments and a high deductible. When we moved to another state our insurance premiums tripled! We just couldn't afford it especially while trying to establish a business. Luckily we have always been very healthy, no antibiotics, allergies, major problems. Our local clinic has a sliding fee scale and we use that for any office visits we need to make, only two in the last year.

 

As I have researched insurance I can't believe how poor the coverage has become. We were not happy with NASE as there were so many exclusions.

 

The kind of care you receive on state programs is very limited, in some areas there is only one clinic who will accept these patients. I can't blame anyone who seeks these out, as I have needed the program before and I am grateful that such programs are available to those who have no other recourse.

 

You will always find those who use and abuse the system but if we seek to take their rights away we eventually limit our own.

 

You obviously do not live in VA. In VA, a broken arm cost us $700 at an emergency room (we have insurance we pay for on our own), while the aforementioned family only paid $5.00 at an emergency room for their son's broken arm.

 

And, yet they live in a 4,000 sq foot house while we live in an 1,100 sq ft house. Clearly, there is something wrong with this picture. Clearly, if this family chose to live in a smaller house with all of the children they chose to have, they could afford to pay for some medical care, I don't care what the state says. The only reason they qualify is because they have so many children, and they have control over that.

[Impish]

I am *not* saying this to upset anyone, allow me to make that clear from the start.

 

I'm in Canada, and I don't honestly understand the argument against socialized medicine, but that's not why I'm replying, or at least not the whole reason. I just wanted to say how scary it is, from an outsider's perspective that your insurance and health care can be so costly. I'm not going to say one system is better than another or anything like that, but when I read that a mom left the hospital 4.5 hrs after giving birth so as not to incur more costs, I almost cried. I thought it was bad here, with what I call 'the birth and turf'. I was home about 18 hrs after the birth of my youngest, and readmitted the next afternoon via ambulance with a raging kidney infection.

 

Every health care system can do with improving...nobody should have to be worrying about money while trying to recuperate.

[Renee in NC]

You obviously do not live in VA. In VA, a broken arm cost us $700 at an emergency room (we have insurance we pay for on our own), while the aforementioned family only paid $5.00 at an emergency room for their son's broken arm.

 

And, yet they live in a 4,000 sq foot house while we live in an 1,100 sq ft house. Clearly, there is something wrong with this picture. Clearly, if this family chose to live in a smaller house with all of the children they chose to have, they could afford to pay for some medical care, I don't care what the state says. The only reason they qualify is because they have so many children, and they have control over that.

 

That one family's experience is not indicative of all people on state assistance. It is unfortunate that this family is using the system this way (not abusing because I am sure it is all legal, but nevertheless using the system to subsidize their more luxurious lifestyle.)

 

And, not that it really needs pointing out - they don't have control over how many children they have after they have already had them. That is assuming, of course, that you aren't supporting families giving older children up for adoption because they can't afford them any longer.

 

It would bother me if someone lived in a luxurious home like that and used state assistance for more than a temporary need.

[Nestof3]

That one family's experience is not indicative of all people on state assistance. It is unfortunate that this family is using the system this way (not abusing because I am sure it is all legal, but nevertheless using the system to subsidize their more luxurious lifestyle.)

 

And, not that it really needs pointing out - they don't have control over how many children they have after they have already had them. That is assuming, of course, that you aren't supporting families giving older children up for adoption because they can't afford them any longer.

 

It would bother me if someone lived in a luxurious home like that and used state assistance for more than a temporary need.

 

That is why I prefaced the entire thing by mentioning that they are quiverfull families. They continue to have as many children without controling it beforehand.

 

As I stated before, all but one every quiverfull family I know in real life either has employer health care, has none (what will they use in emergency?) or has state care. 75% of them have state care. None have life insurance either. I just find that so irresponsible, because it's usually a question of WHEN catastrophe will strike rather than IF.

 

I just cannot imagine having 8 children and being in my mid 40's, still having student loans from my teens, and taking on a 30 year mortgage at that time.

Edited May 23, 2009 by nestof3

[Murphy101]

You obviously do not live in VA. In VA, a broken arm cost us $700 at an emergency room (we have insurance we pay for on our own), while the aforementioned family only paid $5.00 at an emergency room for their son's broken arm.

 

I suppose so. I have never understood the ER is cheaper than the dr theory. It sure isn't for us! Yet, I've met many people who use it instead of the drs office b/c they can't afford to miss work to go to a dr during business hours or because they simply didn't go in to ta regular dr and tried to "tough it out" and it got to the point they genuinely needed the ER.

 

Me? I avoid the ER like the plague. LOL man, if you aren't sick enough to need an ER then there's no way I'd risk my health catching something by sitting in the ER for 6+ hours waiting to get treatment.

 

And, yet they live in a 4,000 sq foot house while we live in an 1,100 sq ft house. Clearly, there is something wrong with this picture. Clearly, if this family chose to live in a smaller house with all of the children they chose to have, they could afford to pay for some medical care, I don't care what the state says. The only reason they qualify is because they have so many children, and they have control over that.

 

well maybe you know their financies better than I think, but here's some other posiblities...

 

maybe they saved for 15 years to put a down payment on a house in their price range like we did. and even doing that, it took an entire tax refund, yearly bonus, and selling everything I didn't want to pack to manage it. It could be that they aren't paying nearly what you think to live in that house. I KNOW I'm not paying what the neighbors around me are paying to move into this neighborhood. We shopped for 3 YEARS until the perfect storm of amazing house deal and finances converged to get this house. And we were a family of 7 - 10 for 6 years in a 1000 sq ft house prior to this.

 

also, again stupid expectations and regulations mean that large families can't always get smaller homes. No one will rent to a famiy with more than 4 kids and CPS would look very criticly at a family they perceive as dangerously over-crowded. (more than 2 kids of the same sex per room).

 

then there's the whole issue of my kids making me qualify for something. not really. 9 times out of 10 all I have to do is state my dh's income to qualify. What a LOT of people don't understand is how tight we budget everything on what my dh makes. Close friends are usually a bit horrified and shocked to hear how little my dh makes. Almost everyone thinks my dh makes at least 20K+ more than he does. We are able to live the way we do because we avoid all debt as much as possible, we do without a LOT of things to have things we feel personally are more important - liek homeschooling and our children.:)

 

Now, I'm not saying that the person you speak of does these things.

 

What I am saying is that apparently if you met me, you apparently might think a lot of things disparaging of me that simply are not true based on nothing more than my house and family size and hearing we qualify for state aid of some sort?

[TravelingChris]

I am in complete agreement with Dawn that no one should be having children they can't support. Sometimes aid is necessary and I have no problems with it - fires, catastrophes, job loss, etc. But unless a person is actually disabled, these situations should be temporary. It infuriates me to hear about some man not going to work full-time because he needs to pray with his family. That is fine if you can afford it without taking govt aid. Otherwise it is morally stealing and not something that I think is Godly at all. God gave us brains and says we are not supposed to lead children astray. We are supposed to feed and clothe and house our children.

[SherryTX]

"My biggest problem though right now is the whole "in network - out of network" thing. For example, if I go to the hospital for an xray, the hospital and the radiology services are all in network - but the radiologist that actually reviews the x-ray is not. That is a pain in the neck, because the costs are higher."

 

If you did your homework and choose an in-network hospital - then your insurance should not penalize you because the hospital hired folks not in your network. My hubby has TWICE pointed this out to our insurance (a PPO) - we would use the local, in-network hospital, even an in-network doctor - then find out the radiologist or whomever was NOT in-network. Each time insurance agreed with us and redid the fees as if the radiologist, etc. was IN network. It is just a matter of complaining, in writing and by phone (if you can get a live body on the phone!!!). As long as you in good faith have chosen a hospital or doctor within your network you can not be penalized if the support staff are not in network.

 

Hubby is a lawyer who spends too much of his time dealing with medical insurance claims for Chicago Public Schools and some Teamsters.

 

Thanks - we have done our homework and have tried to make sure everyone is in network before we see them. I am going to call our insurance this coming week and see what can be done about this. I appreciate your post very much!

[Aggie]

I've heard that some states have programs to pay for women's contraceptives and gyn exams. I have mixed feelings about that. I find it much more logical from a financial standpoint (if a plan pays for pregnancy), and I support increased availability of health care, but at the same time, eugenics and anything that seems like government pressure on (certain) people not to have children disturbs me. (Why does "family planning" usually mean let's have fewer brown children?)

 

 

 

When we lived in NY for the first time 14 years ago, the state paid for infertility treatments for women on welfare. Yup...no husband? No job? Let's make a baby for you at taxpayer expense!:glare:

 

Where do you get the idea that "family planning" means "let's have fewer brown children?" Do you have a source? I believe that's why PP was formed, but it certainly doesn't target a certain race now.

[ekarl2]

A big part of the problem is lawyers. Limits need to be set on the amount of reward that a person can sue for, and I might add there should be penalties for bogus lawsuits. I know there are legitimate reasons to sue, and I am not arguing against those.

 

But you have to look at the whole picture and see who is really making the money. The lawsuits drive the whole cost of care up - doctors and hospitals pay staggering malpractice insurance, which gets passed on to the customer. Obstetricians in particular are getting the worst of the deal. Birth is a dangerous thing, and people are quick to sue if anything goes wrong, whether the doctor had any fault or not.

 

State health care is routinely abused, and I'm not referring to OB care. I'm talking about those who go to the ER for a routine problem (often a chronic problem that they have had for years) instead of going to a family doc simply because they know they won't have to pay a cent for the ER visit. But we all end up subsidizing this type of visit in the form of higher fees spread around.

 

I too am frustrated by insurance fees, but I simply want to point out that there is much more to it than the insurance companies.

 

:iagree::iagree::iagree:

 

I may be mistaken, but the US is one of only a few countries that doesn't have "loser pays" laws. It's ridiculous! Imagine how many frivolous lawsuits you could avoid with a loser pays law. Follow the money trail. Doctors and hospitals set the rates for services. They factor in the cost of malpractice insurance. Those rates are ASTRONOMICAL because of the MILLIONS of dollars spent by those malpractice insurance companies to settle thousands of frivolous lawsuits files every year. It's cheaper to settle than to fight the suit in court if they have to pay their own court costs and lawyer fee regarless of the outcome. Health insurance companies then also raise THEIR rates to cover the high fees charged by doctors and hospitals. See the domino effect? One simple change would help immensely.

[Murphy101]

When we lived in NY for the first time 14 years ago, the state paid for infertility treatments for women on welfare. Yup...no husband? No job? Let's make a baby for you at taxpayer expense!:glare:

 

well I don't think anyone should get infertility treatments covered, insurance or not. my dh works for a company that covers infertility treatments for lesbian couples, so if a woman has a lesiban partner that wants to get pegnant - that partner can get IVF via company insurance. keep in mind the only "medical" condition she has that is keeping her from getting pregnant is a lack of desire to have sex with men.

 

to ME insurance is outragously expensive because the completly non-health issues that are covered. There's not a medical reaosn to get pregnant, just like there's not a medical reason for most women to be on birth control.

 

I don't think either should be covered by insurances or the state.

 

yet our insurance covered 3 women to have IVF despite no medical infertility condition and I paid out of pocket for the last baby I had because I didn't want an unneccessary surgery.

 

Where do you get the idea that "family planning" means "let's have fewer brown children?" Do you have a source? I believe that's why PP was formed, but it certainly doesn't target a certain race now.

 

because orignally that is exactly what it was about. Many of the early BC pushers/proponents were horribly racist and the first testing on humans was on very poor (read as very brown or otherwise ethnicly undesirables). A LOT of those early women died and the reaction was basicly so what because the goal was to reduce those populations anyways.

 

Children are a blessing. Everyone agrees on that.

 

At least that what they say... others might believe it too if it wasn't always followed by what I refer to as the "But Clause"

 

It usually goes like this, "Children are a blessing, BUT

not if you are poor

not if you are in any nation that is not a 1st world nation (we're supposed to ignore that most 1st world nations are predominately caucasion)

not if you already have 2 (esp if it's 1 boy and 1 girl)

not if you aren't in the good health

not if the baby won't be in good health (esp if you have a dc that isn't ideally healthy for some reason)

not if you aren't chrisitan

not if you don't have plenty of life/health insurance

 

and the list goes on, none of which are biblical or have anything to do with children most of the time. Not to mention some of the greatest reasons people have to better themselves is for their children. And if children are hope, who needs hope more than the poor and downtrodden and oppressed?

 

If we are going to gripe about where our taxes go, we could do and often actually do far worse than helping families care for their kids. Really they get very little. Food stamps, WIC and state health coverage for basic care is about it and none of those are enough to cover all food and medical for anyone I have met using the system.

 

And the truth is, if every citizen did more to help their neighbors and our gov't did tax and regulate us to death, state assistance wouldn't be needed and we'd all probably be better off for it.

[theresatwist]

There's a great book by Steven Jones called An Introduction to the U.S. Healthcare System. Anyway, this is a quote from it that I think it really interesting. All of what he says here refers exclusively to the American system.

 

"The term health insurance is a misnomer. Generically, "insurance" is a system that provides for the periodic collection of relatively small sums of money from large numbers of people to protect each of them against the financial consequences of a relatively rare negative event. However, over the course of a lifetime, for most people using health services is not a "relatively rare event.

 

Thus health insurance is not insurance in the conventional sense. Rather, it is a system for the collective, long-term prepayment for the costs of health services that each member of the group of people covered will, on average, use during the time period for which they are covered. Furthermore, the term is a misnomer in the sense that not much "health insurance" money actually pays for the maintenance and promotion of health. Rather, most of it goes to cover the costs of care during sickness."