Mom-ninja. Posted June 11, 2012 Share Posted June 11, 2012 (edited) Do you just have one of those catastrophe policies that covers expenses for major things, and you self pay for things like regular Dr. appointments? Do you like it? How does it work at the Dr's office? Have you run into problems? I'm trying to figure out what the average cost is for a regular visit. Our insurance is so awful. The irony is that dh works for a HOSPITAL and we have such crappy insurance as far as cost and coverage. For example he took our youngest to urgent care for a high fever. He was tested for strep. So the office visit and test cost with our insurance $175. Here's the kicker. If we were self pay patients the total cost for the SAME treatment costs $150. So we ended up paying MORE out of pocket through our insurance than if we were self pay. Talk about screwed up! Dh has been to HR many many times, and they shrug and say that's what we pay and be happy with it. Now, my cardiologist wants to have me wear a heart monitor. Our insurance doesn't cover any of it. So, we're looking at paying $800 out of pocket that will NOT be going to our deductible. We're seriously considering changing insurance on our own because dh's employer only offers the one (stupid sucky) plan. Edited June 11, 2012 by Kleine Hexe Quote Link to comment Share on other sites More sharing options...
aggieamy Posted June 11, 2012 Share Posted June 11, 2012 We have a high deductible plan and it's fairly reasonable each month. ($150 for me and $100 for DH) My yearly visit is covered so there's no fee in that but if I was to go to the doctor for anything else we'd pay out of pocket. So far it's been no big deal. DH thought he had strep throat so we went to a NP at Walgreens and it was $80 plus whatever we spent on medicine. Quote Link to comment Share on other sites More sharing options...
Mom-ninja. Posted June 11, 2012 Author Share Posted June 11, 2012 I honestly want to move back to Germany. :glare: Quote Link to comment Share on other sites More sharing options...
aggieamy Posted June 11, 2012 Share Posted June 11, 2012 Honestly, even regular office visits have gotten so expensive I can't imagine having to worry about paying for them. You never ever can tell what they will cost. Even the dumbest things. I haven't been to a doctor in 2 years. I went to the OBGYN. The lab that processed a pap smear charged $200 for that (even more than the doctor charged for the entire visit). Imagine if I didn't have insurance!? I would have paid almost $400 for one routine visit. I wouldn't personally go that route unless I couldn't afford my insurance anymore. But what if your insurance was $400 a month? Then paying $400 out of pocket for a once a year doctors visit isn't such a big deal. Quote Link to comment Share on other sites More sharing options...
Mom-ninja. Posted June 11, 2012 Author Share Posted June 11, 2012 But what if your insurance was $400 a month? Then paying $400 out of pocket for a once a year doctors visit isn't such a big deal. We pay a lot more than $400 a month. That's why dh and I are thinking of changing things. We could take what we pay monthly and set it into an interest bearing account for medical expenses. Quote Link to comment Share on other sites More sharing options...
ssavings Posted June 11, 2012 Share Posted June 11, 2012 We considered this before DH changed jobs in April, but with 4 kids, we'd pay a lot for office visits just for well-child checks! Quote Link to comment Share on other sites More sharing options...
aggieamy Posted June 11, 2012 Share Posted June 11, 2012 We pay a lot more than $400 a month. That's why dh and I are thinking of changing things. We could take what we pay monthly and set it into an interest bearing account for medical expenses. That's similar to what we did. We have an EF set aside in case we have any major medical problems but so far we've come out far ahead of what we would be paying for something other than a high deductible plan. It also makes you much more aware of what is a medical problem and what is a cold. I wouldn't hesitate to take DD to the doctor if she was really sick but for the little stuff I give it a day or two to see how she's doing. Quote Link to comment Share on other sites More sharing options...
aggieamy Posted June 11, 2012 Share Posted June 11, 2012 Double post. Oops. Quote Link to comment Share on other sites More sharing options...
aggieamy Posted June 11, 2012 Share Posted June 11, 2012 We considered this before DH changed jobs in April, but with 4 kids, we'd pay a lot for office visits just for well-child checks! Sometimes those are covered in a high deductible plan. We each get one yearly well visit that's fully covered by our plan. Quote Link to comment Share on other sites More sharing options...
ChristyB in TN Posted June 11, 2012 Share Posted June 11, 2012 My husband and I are both self employed and pay out the yazoo for Humana insurance. We have both had our insurance licenses in the past and know our way around the insurance industry, sort of, I guess, as much as we WANT to, anyway... The best way we have found has been to get the health insurance ( we like Humana, I guess, as much as a person can like their insurance...) and we have an astronomically high deductible, $10,000, actually. Then we have a health savings account that automatically drafts an amount of money from our checking account every month. We pay for all dr. visits, dental visits, optometrist costs, band aids, vitamins, prescriptions, etc with the debit card for the health savings account. The money we put into the account then makes our taxable income lower. Does that make any sense at all? I'm writing this while I answer the phone, I'm sure it is full of crazy errors. We sometimes hit the darn deductible and insurance actually covers something. Having the insurance makes the prescriptions and dr visits cost less (stupid, stupid system) and the gigantic deductible allows us to afford the insurance. I also like having to PAY for medical expenses. This concept has forced me to actually shop for lower prices on physicals, routine blood work, tests, etc. When there is competition, the system works so much better.:D Quote Link to comment Share on other sites More sharing options...
ChristyB in TN Posted June 11, 2012 Share Posted June 11, 2012 We pay a lot more than $400 a month. That's why dh and I are thinking of changing things. We could take what we pay monthly and set it into an interest bearing account for medical expenses. Yes! But don't drop insurance, it won't work. Get insurance with a gigantic deductible, no dental or optical, and a health savings account. The account is only used for medical purposes and will lower taxable income and save you money on taxes. Quote Link to comment Share on other sites More sharing options...
Momof3littles Posted June 11, 2012 Share Posted June 11, 2012 (edited) We have a high deductible private plan vs. DH's employer's plan. It would be 8-10K to add our family on, so we shopped around. DH's employer is a small company of only about 30 employees, hence the premiums. It was about 10K originally to add us on but they now have the price down to 8K. On our private ins. plan, we have a 6K per family (not per person) deductible. They cover 100 percent after that. We have an HRA and I think an HSA as well. His employers kick back what they would have paid for DH's insurance to us in one of those accounts, and we can use that for expenses we incur and can apply it toward our premiums. For us, it has worked well. We can use our HRA and HSA funds to cover copays, RXs, eyeglasses, etc. Our plan does include well child checks, fwiw. That was important to me as DS2 was a newborn when we started on that particular insurance plan. It is nice that we at least have an employer plan if we need it, depending on what happens with our private ins. premiums. DH's employer worked to get it down a bit this past year. We also don't run to the doc for every illness, so it makes a higher ded. plan work for us. We could swing the full deductible in a year if we had to. Once Dh's employers kick back some money to us, the overall cost isn't much more than most of our friends pay to add their family to a bigger corporation's plan for employees. Edited June 11, 2012 by Momof3littles Quote Link to comment Share on other sites More sharing options...
Mandylubug Posted June 11, 2012 Share Posted June 11, 2012 We have an HMO plan though DHs job. We pay about 200 a month pretax for our family plan (and that is a bargain, I know). We have a family yearly deductible of 250. After we have paid that; our office copays are only 20 a visit. 30 a visit for specialists such as ob/gyn or derm. No deductibles for urgent/er/pharmacy. We pay 30 for urgent care, 100 for er. Pharmacy copays are 10/20/30. We are quite pleased even though it is an HMO; all the doctors in our region are providers for the HMO and we can pick within their directory. No referrals required if in network, etc. as well. I can't imagine NOT having health insurance with four young kids. We only used it once last year and once this year so far but it is nice to know it is there. Quote Link to comment Share on other sites More sharing options...
ThisIsTheDay Posted June 11, 2012 Share Posted June 11, 2012 Do you just have one of those catastrophe policies that covers expenses for major things, and you self pay for things like regular Dr. appointments? Do you like it? How does it work at the Dr's office? Have you run into problems? I'm trying to figure out what the average cost is for a regular visit. Our insurance is so awful. The irony is that dh works for a HOSPITAL and we have such crappy insurance as far as cost and coverage. For example he took our youngest to urgent care for a high fever. He was tested for strep. We have a $2K deductible per person, up to $5K per family (or something like that). Once the deductible is met, we pay 20% up to another huge amount. Do I like it? Compared to what? :glare: I haven't really run into problems. Yet. We've had no truly major medical to deal with, just coming close to our deductible. I have an "in plan" doctor and am sure to use an "in plan" lab (which does not include the dr.'s office lab). I don't take as much for granted as I did five, ten, twenty years ago when our insurance was different and far better. We avoid the dr.'s office as much as possible, waiting out instances where we used to go right away to see if issues resolve on their own. Not necessarily the best strategy in all cases . . . but you're already in that boat too, it sounds like. Your insurance does sound stupid/sucky (quoting the OP here!). At this point, it may be more difficult for you to find comparable insurance with your current health issues. Obamacare was not some miracle plan that helped my family at all, but it sure did raise my insurance costs almost double. Quote Link to comment Share on other sites More sharing options...
Mom-ninja. Posted June 11, 2012 Author Share Posted June 11, 2012 Yes! But don't drop insurance, it won't work. Get insurance with a gigantic deductible, no dental or optical, and a health savings account. The account is only used for medical purposes and will lower taxable income and save you money on taxes. Yes, that's what we're considering. We already don't have optical. We have a $2K deductible per person, up to $5K per family (or something like that). Once the deductible is met, we pay 20% up to another huge amount. Your insurance does sound stupid/sucky (quoting the OP here!). At this point, it may be more difficult for you to find comparable insurance with your current health issues. Obamacare was not some miracle plan that helped my family at all, but it sure did raise my insurance costs almost double. We have a $1500 per person deductible up to $3000 per family.Then we pay 25% of the cost. For things that are covered. Apparently, there is quite a list of things they don't cover....like heart monitors. :glare: Primary dr. visit is $35, specialist is $50, ER is $175 and none of that goes toward deductible of course. Sigh, oh yes, that preexisting conditions crap. Let's not talk about politics right now in regards to health care. That does not help me try to make a decision. I don't want this to spiral into a politics debate which can easily happen. :tongue_smilie: Quote Link to comment Share on other sites More sharing options...
nono Posted June 11, 2012 Share Posted June 11, 2012 Check around and get quotes. We prefer a high deductible with an HSA. Guess what? For us in NJ, it costs MUCH MORE than a basic BC/BS plan without dental and eye (and we go to the dentist and eye doctors more than any other type of doc!). For a family of 4in NJ, the "bare bones" is $840 a month. The nice thing is that it actually covers a heck of a lot, not simply catastrophic. (Of course that's why this plan isn't $400 a month, but I digress....) So, my 2 cents is price all options and avenues. You never know in this crazy world which will turn out "right." Quote Link to comment Share on other sites More sharing options...
Kipling Posted June 11, 2012 Share Posted June 11, 2012 We have a really high deductible plan, and it works for us. It does include free annual visits for the children and me, and we're rarely sick enough to go to the doctor's office at other times. Last year, my son needed eye surgery, and my youngest DD broke her leg and had a separate trip to the er for something unrelated. We paid for everything based on the insurance company's adjusted rate, which was cheaper than the billed amount, but still high. Regardless, we still did not hit our deductible. That was an expensive year for us, but that's the risk we knew we were taking. So far this year, we have only had to pay for our monthly premiums - no doctor's visits other than well-visits. For the op, I think that it is okay to go with a high-ded plan or catastrophic coverage if your family is normally in good health. Yes, there will always be a risk, but you can plan for it with the savings account. For the specific bill you mentioned, can you have the doctor's office bill you as a self-pay patient and not go through insurance? My son has to see a pediatric ophthalmologist regularly. They bill us the adjusted rate for the insurance company, which is typically about $140/visit. This includes a $50 service that the doctor does routinely, but they don't charge the self-pay patients for it (just the insurance companies). One of the ladies who does the billing will take that $50 off of our bill because she says since we have to pay out of pocket, she'll treat us like self-pay patients. Otherwise, we'd be in a situation similar to yours, where the visit costs us more because we have insurance than if we didn't. Quote Link to comment Share on other sites More sharing options...
Nestof3 Posted June 11, 2012 Share Posted June 11, 2012 Yes, our plan is a high-deductible plan ($5,000 for family) we have primarily for catastrophic things. We used it as such when I needed a cardiac ablation for an electrical problem with my heart. The bill for that was $20,000. Our insurance, Anthem, does discount services, but I don't know how they compare to paying as an uninsured person. We pay $500 a month for a family of five. But, the most we can ever pay in one year is $5,000 for covered services. PS -- $91 a month of that goes toward dental which more than pays for two cleanings a year for five people, sealants on kids, and x-rays. Quote Link to comment Share on other sites More sharing options...
lea1 Posted June 11, 2012 Share Posted June 11, 2012 My husband just opened a new practice where he doesn't take insurance so he can charge lower rates. This type of practice is becoming more and more common. You might want to look for something like this in your area. This is how my husband has set up his practice: Option 1 (A-la-cart) is probably best for those people/families who see a doctor only a few times a year and involves just paying at the time of service. Sample costs are listed below. Option 3 is probably best for those people/families who see a doctor a lot throughout the year. This involves paying a monthly fee of $50 dollars for 1-2 person family or $75 dollars for 3+ person family. Then each visit costs $20 dollars with most medically necessary labs and procedures that the doctor can do in the office included. Option 2 is probably best for those people/families who see a doctor in between options 1 and 3. This involves paying a monthly fee of 25 dollars for 1-2 person family or $35 dollars for 3+ person family. Then each visit costs $50 dollars with most medically necessary labs and procedures that the doctor can do in the office included. Included with Options 2 or 3: labs: CBC CMP lipids PSA PAP smear TSH rapid strep test rapid flu test mono test urine pregnancy urine analysis INR FSH, LH, free testosterone Hemoglobin A1C x-rays up to 5 body part x-rays (Option2) and 10 body part x-rays (Option3) per year. some procedures included skin lesion removals (review by pathologist is extra charge) freezing of warts, other skin lesions removal of foreign bodies in skin, eyes, nose removal of ear wax nursemaid's elbow relocation suturing lacerations trigger point injections bursitis steroid injections B12 injections allergy steroid injections hangnail removal nebulizer treatment for asthma, COPD Not included: Suboxone Charges mentioned above mammograms vaccinations Sample of Visit types for A-la-cart and fees (any lab testing/x-rays/procedures required are extra): An acute visit - $ 55 Usually for a short-lived problem possibly requiring lab tests and a one-time medication - such as coughs, fevers, bladder infections, etc Chronic disease management - $ 55 - $ 75 Usually for diabetes, high blood pressure, high cholesterol, etc Physicals Adult - $75 - $150 may require 1 or 2 visits (first for the history & physical [PAP smear if needed] and getting any blood/urine testing done and the second for going over the lab testing and modifications to medications taken - second can be a phone call visit. If everything is normal and no change in medications - just a single visit charge. Child - $ 55 DOT physical - $ 55 School or sports physical - $ 25 Suboxone (labs extra) Initial visit - $200 Subsequent visits - $125 Phone visits Depend on the length and reason: Normal lab results - $ 0 Advice to go to an urgent care or emergency room - $ 0 Advice 0-10 minutes - $ 25 Advice 10-20 minutes - $ 50 Advice 20-30 minutes - $ 75 Prescribing for simple uncomplicated problem (pink eye, bladder infection) for established patients only- $40 Labs CBC - (blood count for infection and anemia) $ 8 CMP - (sugar, liver and kidney function, electrolytes) $ 13 Lipids - (total, good, and bad cholesterol, triglycerides) $15 Hemaglobin A1C - (measure of diabetic blood sugar control) $ 15 TSH - (screen for thyroid hormone disorders) $ 18 hsCRP - (one screening test for heart inflammation) $ 25 PSA - (prostate cancer screening test) $ 27 Pap smear $ 65 (but may be more if other tests need to be done such as HPV testing) X-rays Per body part (joint or bone) or chest x-ray - $ 39 Procedures Depends on what needs to be done. Quote Link to comment Share on other sites More sharing options...
Mom-ninja. Posted June 11, 2012 Author Share Posted June 11, 2012 For the specific bill you mentioned, can you have the doctor's office bill you as a self-pay patient and not go through insurance? My son has to see a pediatric ophthalmologist regularly. They bill us the adjusted rate for the insurance company, which is typically about $140/visit. This includes a $50 service that the doctor does routinely, but they don't charge the self-pay patients for it (just the insurance companies). One of the ladies who does the billing will take that $50 off of our bill because she says since we have to pay out of pocket, she'll treat us like self-pay patients. Otherwise, we'd be in a situation similar to yours, where the visit costs us more because we have insurance than if we didn't. $800 is the adjusted self pay amount. That's what my cardiologist is looking for. As he put it, "An electrical short circuit" in my heart. Thanks everyone for your responses. Quote Link to comment Share on other sites More sharing options...
FairProspects Posted June 11, 2012 Share Posted June 11, 2012 Unfortunately, I'm not sure you have much chance of changing at this point. I don't know of any high-deductible plans that will take you with pre-existing conditions. The denial rate is something like 40%. Insurance completely stinks. :grouphug: Quote Link to comment Share on other sites More sharing options...
Mergath Posted June 11, 2012 Share Posted June 11, 2012 Because dd and I both have multiple, complex diagnoses, we get free state insurance that covers everything. There aren't words for how thankful I am for that. Dh has insurance through his work. It's somewhere between $100 and $150 a month, and covers next to nothing. We only pay for it in case he has a major illness or something. Quote Link to comment Share on other sites More sharing options...
LillyMama Posted June 11, 2012 Share Posted June 11, 2012 It's very acceptable to ask a provider to tell you the cost and how much your insurance will cover, and choose whether to use it or not. I used to do that with dental procedures all the time- I would pay for my annual cleanings out of pocket so I could save my annual maximum for the tier-2 and 3 procedures. The key is to recognize how insurance companies and physician offices negotiate payments. You are best off paying for routine visits and lab work yourself, as the physician's office spreads the cost of their most common charges across all patients. For example, if they feel the correct cost for an office visit is $150, they may only get $120 or even as low as $75, from some carriers, but as much as $175 from others. So they over-charge people with good insurance because they can make up the losses from the people whose insurance pays less. This is going to happen more in highly common procedures, as these are the ones insurance companies negotiate to pay the least, under the "bulk" theory. Anyhow, I recommend asking how much office visits and lab work is before offering your insurance cards. Don't lu are entitled to let them hem and haw, you should be allowed to have access for that before you sign anything saying you are responsible for charges. Quote Link to comment Share on other sites More sharing options...
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