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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 by Kleine Hexe
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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.

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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.

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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.

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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.

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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.

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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

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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.

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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 by Momof3littles
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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.

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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.

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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:

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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."

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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.

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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.

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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.

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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.

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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.

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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.

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