Need some ideas for alternatives to health insurance...

[i.love.lucy]

I don't know what to search for, so if this has been discussed, please link.

 

I am so mad right now. :cursing:My husband and I pay $460/mo for health insurance for me and the 2 kids. DH is on his own with his work. We are not on their plan because to add me and the kids it would be over $775/mo. So we kept what we had. I have a $5000 deductible. My understanding at the time we purchased this insurance was that the deductible was for major medical hospitalizations etc. But we do not seem to be covered for the simplest of things.

 

I recently had to take my son to the ER for the first time ever for an asthma/croup episode. I was panicking a bit as a mom, my little boy can't breathe. So I take him to the ER where he is helped with steroids. (My experience with the wait time at an almost empty Children's Medical Center ER and the other people that were there is a topic for another thread:glare:). I just got a bill for over $1000 for this ER visit. At the time I took him he had started to feel better with the cold a/c in the car, and I was second guessing a little, but I figured we had good insurance and I should go ahead and go. This was not a frivolous decision and it was the first ER visit EVER with my children in almost 10 years.

 

He also had to have bloodwork last December to track his growth, and that wasn't covered. Over $400 in lab costs.

 

As it is, it seems the only thing that would be covered is any major catastrophe over the deductible. And we do have our doctor office visits covered, but we have a $40 copay. We only go to the doctor a couple of times a year.

 

I am just SO frustrated that we are paying over $5520 a year in insurance premiums but still have our emergency fund wiped out by a simple visit to the ER. There has to be a better way!!!!

 

Is there something else we can do? Aren't there some kind of groups you can join where you pool your monthly premiums, but they are less, or something? Seems like I heard about this but I tried to Google and got so many different links on health insurance it was overwhelming. I thought maybe you all would know of something that would be a better alternative for us.

 

TIA!

[milovany]

If you're church-going Christians, you can check out Medi-Share or Samaritan Ministries -- these are two Bible-based cost-sharing programs. They're not insurance, but if you submit allowable bills, then the fees from members pay for them (with MS they collect/distribute the money; with SM the members send the funds directly to you). Cost for families is between $250 and $450 a month last time I checked.

 

ETA: These are allowable / exempt (whichever term is correct) under the new health care changes that are coming. Also, I don't know if there are secular versions of this same thing. There may be.

Edited June 2, 2010 by milovaný

[creekland]

We're members of Samaritan's Ministries and have been for years. I can vouch for them based on two claims we had that we received payment for without any issues at all. One was a broken collar bone for my oldest, the other was when hubby passed out in our horse pasture for an unknown reason and went to the ER to have it checked out.

 

This group saves us a ton of money and I wouldn't switch back to regular insurance even if we could afford it. We pay $320/month for the whole family and an additional yearly fee ($175 I think) to belong. I think the deductible is $400, but it's been a while since I checked. I know it used to be $300, but I think they raised it to $400. After that, coverage applies up to $250,000 (certain things are excluded, so check that out). For higher than that, one can choose to belong to their "Save to Share" option (we do - an additional up to $400/year). Eons ago when we had regular insurance it was close to $600/month, $1000 deductible, and only 80% covered.

 

If you're a church-going Christian it's worth checking out. I'm never going "for profit" again.

[Liz CA]

Creekland, what is their stance regarding pre-existing conditions and Naturopathic care? I suppose I would pay consultation charges on my own and have them get involved for the bigger stuff like hospital bills?

[Cricket]

I go to a doctor who takes a once a year payment. I paid her $1000 for a year. I get regular visits at no cost and she will even do house calls if I'm too sick to go in to her office. I do pay extra for tests but she can arrange tests at a much lower rate than I would pay as a regular consumer. I have her cell phone number and can call her 24/7. My office visits are long too so lots of personal attention. We found her through word-of-mouth although I have seen her advertise now. I'm not sure how you would go about finding a doctor like that but they are out there. I have some ongoing health issues and no insurance so we figured this would be a good fit for us. No worry about pre-existing conditions either.

[sbgrace]

To use the Medi-share/Samiritan's purse you need to be very health before you joined (i.e. no pre-existing dx's/treatments) and be willing/able to cover preventative care and alternative care yourself. In the case of one or both it doesn't cover things under say $300. So basically you need to be able to either stay healthy or pay your routine bills yourself. I think it would work for a family without any medical things going on. For us it certainly wouldn't.

 

Whatever you do make sure you have some coverage for major medical--i.e. umbrella/catastrophic type coverage. A car accident wrecked my bil financially because he didn't have that.

[i.love.lucy]

Thanks for the ideas. I'm off to do some checking. The quick glance I made at Medi-Share said things like "we don't pay for conditions related to a sinful lifestyle" or something like that. Now I'm a believer, and I guess I can see how they would take that stance but it seems very subjective as to what they pay for. I am overweight. I eat about the same calories as my daughter and weigh A LOT more than her, would I be considered "a glutton":confused:. Not sure I want to get into all that.

 

I guess there is no such thing as the perfect healthcare situation. I'd like to just stop paying monthly and go out-of-pocket on our reg doc visits, but it's these once in a while emergencies like the ER visit or a car accident that can be devastating financially. I'd never go without that kind of coverage. Not sure there is an easy answer...

 

Thanks for the tips!

[Diane in CO]

The quick glance I made at Medi-Share said things like "we don't pay for conditions related to a sinful lifestyle" or something like that.

 

 

 

Wow, as a Christian I find that really offensive :confused:

[laundrycrisis]

A $5000 deductible means that for expenses that qualify for coverage, you pay the first $5000. They do not start kicking in money until the deductible has been met by you. (You still need to submit those expenses as claims though to have them applied to the deductible).

 

A policy with a higher deductible will have lower premiums than a policy with a lower deductible. The lower-premium policies may seem like a bargain, but only if you can afford the deductible. Some policies have a separate lower deductible for certain routine and preventative services, but unless this is specified, you have to assume that the regular deductible applies to all services.

 

Looking at your husband's group policy through work, the premiums may seem higher, but if the deductible and out-of-pocket expenses are lower, and coverage levels are higher, it may be a better deal. Whatever you choose, there is so much more to look at than just the premium. I hope you find something that works for you.

[milovany]

Wow, as a Christian I find that really offensive :confused:

 

No need to take offense. They're not judging people, they're making a wise business/ministry decision. They're talking about things like smoking, excessive drinking, promiscuity -- things that can cause a lot of health problems, you know? This helps to make sure that the money members have sent in is available to go to things like car accidents or an emergency C-sections or leukemia treatment. Hope that makes sense. Nobody has to buy into their type of system -- but for those that do, they certainly have a right to apply some basic principles for those who want to benefit by them to abide by.

 

To the OP: I've not seen anything in the guidelines regarding food-related issues. But I haven't signed up for either of them either, so haven't read the fine print. The things I've seen noted in relation to the "sinful lifestyle" is what I mentioned above (smoking, drug use or alcohol abuse, and promiscuity).

Edited June 3, 2010 by milovaný

[Brigitte]

Call the hospital and see if they will write some of it off, since your insurance is not paying. Also, set up a payment plan. They will usually give you one year to pay and they don't charge interest. Don't clean out your emergency fund until you have done that. Hospitals are so used to patients never paying the self-pay portion of bills, they generally are more than willing to work out terms with a patient who intends to pay, but need some time.

 

ETA: I am in the same boat with you with regards to the type of insurance plan we have. I often have to remind myself, though, that it is insurance not a savings account. We don't say a word about paying thousands of dollars in car insurance every year without getting "any back," yet we feel like we should be getting our money's worth with health insurance. Just think if you were in an accident and had tens of thousands in medical bills and only had to pay out your deductible....btw, I am not criticizing you here, I am guilty of the same feelings myself and have to remind myself of what insurance really is.

Edited June 3, 2010 by Brigitte

[NoPlaceLikeHome]

Thanks for the ideas. I'm off to do some checking. The quick glance I made at Medi-Share said things like "we don't pay for conditions related to a sinful lifestyle" or something like that. Now I'm a believer, and I guess I can see how they would take that stance but it seems very subjective as to what they pay for. I am overweight. I eat about the same calories as my daughter and weigh A LOT more than her, would I be considered "a glutton":confused:. Not sure I want to get into all that.

 

I guess there is no such thing as the perfect healthcare situation. I'd like to just stop paying monthly and go out-of-pocket on our reg doc visits, but it's these once in a while emergencies like the ER visit or a car accident that can be devastating financially. I'd never go without that kind of coverage. Not sure there is an easy answer...

 

Thanks for the tips!

 

IMHO I would not consider at all these non-insurance options such as Medi-Share since from what I understand there is no guarantee of coverage. As a person who worked in critical care and acute care and chronic care areas I have seen too many catastrophes and therefore I would explore all of your real health insurance options IMHO.

 

Is your husbands's insurance only about $300 more per month? I realize that is a lot but it may be cheaper if it covers more. Also, does your state have a children's health insurance option which may save money. Our state does and the income requirements are not stringent at all and the insurance is good.

Edited June 3, 2010 by priscilla

[TechWife]

No need to take offense. They're not judging people, they're making a wise business/ministry decision. They're talking about things like smoking, excessive drinking, promiscuity -- things that can cause a lot of health problems, you know? This helps to make sure that the money members have sent in is available to go to things like car accidents or an emergency C-sections or leukemia treatment.

 

Actually, they are judging people. By saying that they do not cover things that are a result of a sinful lifestyle, they are making a judgment about what they consider to be sinful. They are also not allowing grace and mercy to be given in any situation.

 

Hope that makes sense. Nobody has to buy into their type of system -- but for those that do, they certainly have a right to apply some basic principles for those who want to benefit by them to abide by.

 

Sure, they have the "right" to do so, but that doesn't mean it's right to do so.

 

The things I've seen noted in relation to the "sinful lifestyle" is what I mentioned above (smoking, drug use or alcohol abuse, and promiscuity).

I noted that they also do not pay for any mental health services. That means if you are addicted to drugs, not only will they not cover your emergency room visit for an overdose, they won't cover any recovery treatments, either. You're stuck just where you are with these folks - no hope for you. Additionally, if you lived a promiscuous lifestyle prior to becoming a believer, then you have no hope for coverage of treatment for any STD's - and some of them don't crop up for years. Grace and mercy? Also, routine screenings for breast and cervical cancer aren't allowed - did you realize that?

 

The list of things that they require pre-approval on is extremely long - and even if they give the pre-approval, it is no guarantee that they will actually approve the expense for "sharing." The wait time before they approve recurrence of cancer is amazingly long - no treatment for 15 years in some cases! You have to get prior approval before they will pay for medications longer than 6 months for chronic conditions. The very definition of chronic means that it doesn't go away!

 

Overall, the restrictions for this type of program are more restrictive and cumbersome than traditional insurance, and there is no guarantee that any expenses will be shared. Quite frankly, I don't find the way that these organizations operate to be any different from a insurance other than that they do make moral judgments.

[milovany]

I don't find the way that these organizations operate to be any different from a insurance other than that they do make moral judgments.

And cost significantly less (50% to 75% from the figures I've seen). And the cost is so much less partly because they don't cover things that are proven to be unhealthy practices.

 

Have a great evening!

 

= = = = =

"Watch your heart during all your life - examine it, listen to it, and see what prevents its union with the most blessed Lord. Let this be for you the science of all sciences, and with God's help you will easily...observe what estranges you from God, and what draws you towards Him and unites you to Him." { St. John of Kronstadt }

Edited June 3, 2010 by milovaný

[Remudamom]

I would be estactic to pay that per year. Our premiums went up to $36,000 this year. Needless to say, we are re-negotiating.

[Scrapmom3]

Honestly, I don't think you have a bad price with the premium for three of you since I pay $501 a month just for me. Mine is an individual policy and not a group which is why it costs more for less. Have you priced out your husband's health policy lately because it might be cheaper when you factor in deductible, copays? But like a pp said, you don't want to just look at the premium cost there is also coverage and choosing a deductible you can afford, etc.

 

I wouldn't empty an emergency fund to pay the ER bill. Contact the accounting dept to set up a payment plan. I have had good luck in doing this over the years.

[specialmama]

You can always move to Canada! No matter what (unfounded) jokes the U.S. says, I (and many others) love love love our health care. I honestly am 100% pleased in ALL aspects of our health care. And hey, Alberta still has lots of hiring going on! :D

[G5052]

IMHO I would not consider at all these non-insurance options such as Medi-Share since from what I understand there is no guarantee of coverage. As a person who worked in critical care and acute care and chronic care areas I have seen too many catastrophes and therefore I would explore all of your real health insurance options IMHO.

 

Is your husbands's insurance only about $300 more per month? I realize that is a lot but it may be cheaper if it covers more. Also, does your state have a children's health insurance option which may save money. Our state does and the income requirements are not stringent at all and the insurance is good.

 

The Medi-Share type of plans don't cover pre-existing conditions, and usually only one instance of cancer/heart surgery. If it comes back, you are sunk.

 

My DH was very healthy until six years ago, and that year his bills would have been $1.5 M, and every after would have broken us without insurance. Every year since then has been very hard financially, but would have been much worse without insurance. Not everyone will face ongoing catastrophic medical bills, but if you do, insurance going to be much better than a shared plan.

 

And yes, every doctor and hospital I deal with has a payment plan. Most will do interest-free as long as you pay at least 5% a month.

[creekland]

Creekland, what is their stance regarding pre-existing conditions and Naturopathic care? I suppose I would pay consultation charges on my own and have them get involved for the bigger stuff like hospital bills?

 

I'm answering for Samaritan's Ministries and am not familiar with Medi-Share other than the name.

 

Pre-existing conditions are not covered. While this seems to be "wrong" the business reason for it is that many people would not join until they had a problem otherwise - requiring payments out, but not having paid in. The program would quickly become way to expensive to support. It's the same reason the feds want universal "belonging" if and when they require universal coverage.

 

Right now naturopathic care is not covered either, so that would have to be out of pocket. Hospital stays are paid for. They (not you) often negotiate fees just as insurance companies do if prices seem extraordinarly high.

 

With regards to things others have mentioned...

 

Yes, all "routine" care, like physicals, are out of pocket expenses. We've found the money we save in monthly costs (over $3600/year) more than covers annual physicals for the 5 of us. Our doctor's office also charges us less since we pay cash. My middle son's Driver's Test physical and updated shots (so he can go on a mission trip) would have cost us $350, but since we paid cash up front, it was $178. That's their policy though and won't necessarily apply to everyone's doctor's office.

 

Yes, things like abortions, alcoholic injuries, and promiscuity "stuff" are not covered. I LIKE not having to pay for such things. It's one of the pluses to the program for us. If it's not for others, then yes, keep insurance of some sort.

 

It's also non-profit, so every $ we spend goes directly to someone with medical bills to be paid. Once a year our annual fee goes to keeping the office going (electric, salaries, etc). There are no stock holders or CEO's. I like that.

 

Since we sign up for "Save to Share," huge medical bills are covered. We've paid for people with cancer, heart disease, and other major issues. It is an extra cost ($400/year) that we find worthwhile. As of a recent vote, even without the extra, costs up to $250,000 are covered with their regular plan.

 

Yes, legally, since this is a sharing plan, coverage is not guaranteed, but we've personally experienced no problems and have seen this program work for quite a few years now. It IS right for quite a few people - not everyone, that's for sure, but as I said before, I wouldn't change back - ever. I'm glad these programs are approved under the new federal rules. I like sharing costs with others who believe similarly - and saving $$ in the process.

 

If it's right, I personally think it's terrific. There's not a single complaint I can think of. If it's not, there's always insurance. To each our own.

[emubird]

My husband already ran through his deductible this year with one ER visit, so now everything for him is paid for. Through the end of this year. So, on the bright side, maybe he'll make up his mind to go in for the surgery that's supposed to end these ER visits he keeps having to make. After all, it will be "free" this year.

 

But we knew this was a possibility when we went to the cheaper plan with a high deductible. We made the decision to save the money we wouldn't be spending on the insurance in case we needed to pay the deductible. It's generally worked out to be a savings for the rest of us. It's just my husband who's expensive.

 

A lot of these plans do pay for preventative things like physicals, but that doesn't mean they pay for other "little" things like ER visits.

[G5052]

It's just designed to soften the blow, not pay for everything. Especially if you have big, big bills, it will keep you from going under hopefully. I know that bills in the $1,000 are hard, but try major surgery followed by a month of hospitalization followed by months of rehab/home health. You can easily go into hundred's of thousands at that point. Even with insurance, you'll be paying for awhile but it's much more doable.

[TechWife]

And cost significantly less (50% to 75% from the figures I've seen). And the cost is so much less partly because they don't cover things that are proven to be unhealthy practices.

 

 

I guess the bottom line is more about money than it is about grace and mercy. I just find it hard to swallow when those who proclaim Christianity don't want to deal with the baggage people often bring with them. by the way, seeking help for mental illness is not an unhealthy practice, it's quite the opposite, as are cancer screenings.

[milovany]

I guess the bottom line is more about money than it is about grace and mercy.

 

Well, since it's a non-profit group I guess it can be said it's not about money (and you can check that out -- all the money spent on the monthly costs goes to pay the medical bills of others; the yearly fee sent to the organization covers operating expenses; no one's getting rich at Samaritan's).

 

I'm sorry you want it to be an either / or situation, but it's not. Samaritan's is a ministry designed for a very specific thing; it's not meant to be health care coverage for all people and all situations. It's a low cost alternative for people who meet certain healthful guidelines. For people who can't meet those guidelines, there are certainly other avenues they can pursue.

I'm not addressing the mental illness aspect in writing this; just the part that was brought up about the smoking, drug use, alcohol abuse and promiscuity.

[creekland]

Well, since it's a non-profit group I guess it can be said it's not about money (and you can check that out -- all the money spent on the monthly costs goes to pay the medical bills of others; the yearly fee sent to the organization covers operating expenses; no one's getting rich at Samaritan's).

 

I'm sorry you want it to be an either / or situation, but it's not. Samaritan's is a ministry designed for a very specific thing; it's not meant to be health care coverage for all people and all situations. It's a low cost alternative for people who meet certain healthful guidelines. For people who can't meet those guidelines, there are certainly other avenues they can pursue.

I'm not addressing the mental illness aspect in writing this; just the part that was brought up about the smoking, drug use, alcohol abuse and promiscuity.

 

:iagree:

 

And the money we save both monthly and annually is more than enough to pay for various screenings. We were paying more 10 years ago when we had regular insurance overall even though checkups came with just a co-pay than we are now 10 years later with paying cash for "regular" care and having Samaritan's there as a back-up in case anything goes wrong. We are saving a LOT more.

 

10 years ago we were with Fortis and paid $600/month for our family of 5. That came with a $1000 deductible and only paid 80% thereafter up to a certain amount out of pocket. Now we pay $320 a month, have the equivalent of a $400 (per incident) deductible, then get reimbursed at 100%. Before we had a co-pay for check-ups (I think it was $20). Now we pay $100 (+ extras like vaccinations out of pocket). Our last regular check up bill was $178 and included 4 vacs since my son is planning on an out of country trip. There's more than enough savings in that $3500/year to pay for those PLUS my insurance figures were from 10 years ago. Who knows what we'd be paying now.

 

For the two claims we had, we had to pay $300 each, then the rest was covered (these were prior to an increase). With insurance we'd have had to pay $1000 each and then just get 80% coverage.

 

Since I'm fine not needing coverage for abortions, drunk driving, and similar items, I fail to see how we don't do better with this type of program. Our doctor gives us a discount for paying cash. Our hospital is willing to wait until we get reimbursed prior to needing payment.

 

One important fact, of course, is that we were able to join well before any major item hit (heart disease, cancer, etc). If one already has those - or similar - this is not an option. Since we've been members for quite some time now, those will be covered if and when we deal with them.

 

IMO more groups ought to band together and come up with health cost sharing programs. They can opt to cover what they like. Being non-profit, it's still more inexpensive in the long run - AND we can choose any hospital or non-homeopathic doctor we choose - in any country - with no problems.

 

I'm still 100% pro Samaritan's (though realizing they don't work for everyone).

[FairProspects]

Can children join on their own for things like Samaritan's purse? I have a pre-existing condition that occurred in my twenties through no fault of my own, and it frustrates me that our whole family couldn't participate because of it. If I could sign just the children up, it might work for us and at least lower our bills.

[creekland]

Can children join on their own for things like Samaritan's purse? I have a pre-existing condition that occurred in my twenties through no fault of my own, and it frustrates me that our whole family couldn't participate because of it. If I could sign just the children up, it might work for us and at least lower our bills.

 

It's Samaritan Ministries, not Samaritan's Purse (that's a Franklin Graham world relief program), but otherwise, I'm not certain. I know a family costs $320 no matter how many members are in it ($400 more annually for Save to Share - amounts over $250,000). College students can join separately. If you join as a family, things other than the pre-existing condition will be covered - which could help with a deductible and such things. I suggest you call them and ask about specifics. Here's a link:

 

http://www.samaritanministries.org/

[TravelingChris]

I would just like to warn about mental health issues, particularly with older teens, young adults. It is so important to have good insurance to help with that. Insurance is now required to help with mental health in the same way that non mental health is covered. DIseases like major depression, bi-polar, and schizophrenia often first appear in late teens/early adulthood. These are very serious conditions and depression has a rather high mortality rate. While some can be treated with doctor visits and medications (which can be very expensive), others need hospitalization. In the two states I am familiar with, there aren't enough hospital beds for them. One reason the death rate is so high. It isn't something you expect to have when you have young kids, but unfortunately, it is something that can happen with older ones.