Has anyone dropped health insurance?? I am so fed up!

[bzymom]

Warning: Ended up being a vent/rant as well as a question!

 

I just received the latest explanation of benefit forms from Aetna. We submitted over $2000 in medical receipts and will receive exactly nothing back. It is all going toward the ever-increasing deductibles, which now stand at $2000 per person, $7000 per family per year. The trick seems to be that they reduce all the bills to an "allowable amount" which is a fraction of reality so you never meet the thresholds. For example, out of a bill for $1435, they ALLOWED $426.

 

We pay insurance premiums ourselves, without any employer contribution, under COBRA. Our monthly payment for the family is $1600. So I am looking at nearly $20,000 per year just in premiums. Add co-pays, which are at least $30 per covered visit, more commonly $50, pharmaceutical co-pays which have run as high as $140 for a single prescription, and all the things they do not cover or reduce, and my medical expenses are simply not affordable anymore. And this is without any major medical problems!

 

I am considering picking up some kind of catastrophic coverage and banking $$ in a separate account to pay for preventative or routine care. Every person I have asked to date thinks it is a terrible idea and we will be in deep trouble with one hospital stay. I have looked for other coverage, but it is all even more expensive than what we now pay.

 

So if you have made the leap, I would be grateful for any tips or cautionary tales to help me make this decision.

 

I just don't know how people are supposed to maintain this anymore.:confused:

[Moxie]

We had an HSA with a high deductible policy for a year. It wasn't cheap but cheaper then regular insurance. We had to go back on DH's work insurance when I found out I was pregnant.

[stripe]

It seems strange to think that insurance covering catastrophes would wipe you out with one catastrophe, any more than crummy health insurance would. I don't know why someone would think that. Where I live, it is possible to get fairly affordable routine care (for example, appointments for $100 or less with a nurse practitioner), and I can see that, if one doesn't need constant monitoring, paying for it out of pocket would make sense. I think it is probably much better to have coverage for catastrophic situations than to forgoe insurance altogether. Aren't there a lot of those health savings accounts that couple savings with high deductable (catastrophic) policies? I do not have a very high opinion of insurance companies (of all varieties). I have no idea what the future will hold, but pretending the current system is great seems to me to be strange beyond words.

[elfgivas]

:grouphug: i'm sorry. for years i ran a health clinic for folks without insurance. its a lousy way to go. more bankruptcies come from health care costs than from housing costs. i really would investigate something other than aetna though. (we had clients who came for our help even though they had health insurance, and almost all of them were from aetna).

 

all that said, we did what you are suggesting for dd when she became 26 without health care coverage, because we could see that she would get it within 6 months. the cobra coverage would have been really expensive, and she was young and healthy. she just submitted her benefits paperwork for her job, and i am definitely sleeping better at night.

 

:grouphug:

ann

[Sharon37127]

I don't know anything about your situation or what expenses you had, but my understanding (and anyone feel free to correct me if I'm wrong) is you get the discount, too, if you used an in- network provider. Follow? If insurance (and I have Aetna too) reduces the costs from 2000$ to 426$, you don't then owe the provider 2000$- you owe them 426$. If it was some kind of purchasable expense before insurance submission (like medical supplies, equipment) then they should be able to tell you before you actually spend the money where you can get the discount. Maybe?

 

Ya, I agree insurance stinks. :ack2:

[Mom0012]

We were forced to switched to a high deductible plan this year. It costs exactly what the PPO we had the last number of years did, but now we have a much higher deductible.

 

As far as the insurance adjusting the bill to an "allowable amount", it doesn't really matter, does it? You will pay $2,000 out of pocket before you receive any coverage no matter what the expense is. At least that's how I look at it.

 

I had to make that mental adjustment when I realized we'd be paying $300+ for prescriptions we normally pay $20 for until the deductible was met.

 

Lisa

[TeenagerMom]

I would look into a private policy. I can cover myself and the kids for much cheaper than that. The plans I looked at that even had a lower deductible were running around $400 a month.

[Disney Dreaming]

I don't know anything about your situation or what expenses you had, but my understanding (and anyone feel free to correct me if I'm wrong) is you get the discount, too, if you used an in- network provider. Follow? If insurance (and I have Aetna too) reduces the costs from 2000$ to 426$, you don't then owe the provider 2000$- you owe them 426$. If it was some kind of purchasable expense before insurance submission (like medical supplies, equipment) then they should be able to tell you before you actually spend the money where you can get the discount. Maybe?

 

Ya, I agree insurance stinks. :ack2:

 

:iagree:

[xixstar]

That sounds really challenging to deal with. I wonder if there are other individual-purchased insurance plans you can get that would help. We have high deductible plans but use an HSA as well (plus usually never need medical care) and that has worked well for us (though we do have group-health coverage).

 

If you're never sick and it's temporary, maybe I'd be putting that 20,000 into savings for medical coverage. But that gambles a huge risk too because that can be wiped out really fast with one accident. Accidents aren't planned. And then there is the pre-existing condition issue that if something comes up, say cancer, then you're not going to be able to get coverage later and that will easily bankrupt your family. So I guess, no, even in your case - I wouldn't be comfortable dropping insurance completely. I would be shopping around or maybe seeing out a part-time job that offers insurance coverage.

 

And I agree on staying within network - if the insurance only allows $400 the an in-network provider must accept $400 - even if you're paying our of your pocket until the deductible is met. However, if you're out of network, then you'll be eating the extra about approved amounts.

[bzymom]

Thanks for the info. If there is a low-cost plan, I'd love to hear about it. My research so far has not found anything.

 

There is a set of doctors d/d sees who are not in-network, and do not accept insurance. We pay them, they give us a receipt. They do not have to eat the discount. I tried several in-network practices first, and they were useless.(I have also been billed by in-network doctors for this difference, and have had to remind them that they are not allowed to bill this.)

 

Something has to give. The last ER visit we had, which was for a hand that ended up NOT being broken, was billed at $3100. We had two x-rays, waited three hours, and saw a resident for about 3 minutes. We went as this was a child in pain with a black, swollen hand after an injury, but I will never go back unless I seriously expect someone to die if we don't.

[bzymom]

We were forced to switched to a high deductible plan this year. It costs exactly what the PPO we had the last number of years did, but now we have a much higher deductible.

 

As far as the insurance adjusting the bill to an "allowable amount", it doesn't really matter, does it? You will pay $2,000 out of pocket before you receive any coverage no matter what the expense is. At least that's how I look at it.

 

I had to make that mental adjustment when I realized we'd be paying $300+ for prescriptions we normally pay $20 for until the deductible was met.

 

Lisa

 

 

$2000 out of pocket, but if I have to accumulate an actual out of pocket amount of $8000 so the carrier "allows" $2000, it is ridiculous!

[xixstar]

As far as the insurance adjusting the bill to an "allowable amount", it doesn't really matter, does it? You will pay $2,000 out of pocket before you receive any coverage no matter what the expense is. At least that's how I look at it.

 

Actually there is a big difference being in network or out. If there is an allowable amount in-network then that is all that should be paid to the provider and when you reach $2,000 coverage will kick in.

 

However, if you're going to out-of-nework providers and you spend $2,000 but they only allow $500 - then you're going to keep spending until you reach $2,000 in allowable chargers, so you could be hitting $8,000 out of pocket before coverage kicks in.

 

I agree that is can be a big adjustment if you're used to always just doing co-pays for things. We've had a high deductible plan for several years now and we never meet the deductible but it's interesting how aware we are of how much everything is now as opposed to just thinking "oh, it's just a $30 copay".

[Mona]

We stopped health insurance about 8-9 years ago. Our premium at the time was about $800/month. I felt like I was just throwing it out the window. We are all generally healthy. We have no chronic conditions and none of us are on medication. And, if we needed RXs, I feel that the insurance companies compromise the physicians expertise because they only pay for this and not the medication the doc wants you to take.

So, because we don't have any pre-existing health concerns, we decided to take the plunge and set that money aside every month for when needed. We also figured what an average surgery may cost us and felt we could bank that amount of money in almost a year. If you need an elective surgery, you can try to work out a discount with the accounting department ahead of time. Insurance companies pay around 40% of the cost. That is their rate, not the hospital or doctor's rate, but so many people subscribe to insurance that the provider has to accept that which is why you may sometimes see physician or hospital insurance plans popping up in some places.

Catastrophic insurance is a good idea. You should look into that regardless, since many insurers have caps. Our local hospital has a deal that is not advertised, but you can pay them $50/mo. and this would cover any test you may need such as an MRI.

I'm pregnant with our third child and I was shocked at what blood work costs, but we've figured out that even paying for all these tests and after the hospital stay, we are still in the black on our decision. :) (big time!)

I should also mention that my dh works at the local hospital sometimes and I receive a discount on my care so far, but we have had friends who've pre-planned their "elective" surgeries and negotiated prices with the hospital even though they are not affiliated in any way.

Another thought is, how do the Amish and Mennonite population handle health care? I know that they need to calculate the entire cost of their care at once and submit a final tally to their bank? to get the funds for their care. Many physicians will offer the discounted price to them that they would have gotten from an insured client in fairness since they are paying.

You have to weigh out your own health situation. It's been a good decision for us, but I would never suggest that everyone go that route.

 

PS. Way back when we did have insurance, our vision plan was only covering us every other year and our dental plan wasn't covering everything either. It was really frustrating because we still had to pay our premium every single month, but they were covering less and less all the time. We finally had enough. I don't remember how much in medical expenses we needed to accrue before we could write them off on our taxes, but they haven't been enough to do so yet. Maybe, this year we can with the new little one coming.

[bzymom]

You are right--there is a big difference in-network or out. But I find the network generally is often really not very good. So I do accept that choosing better quality care out-of-network costs more. But if I pay nearly $20000 in premiums, I EXPECT great care.

 

I am truly not trying to be argumentative, and I do appreciate rational help when I am likely irrational!

 

I am just so angry thinking about the tuition payments we could have made with all this wasted money.

[LMA]

It only takes on small out-patient operation or hospitalization to meet that deductible. A hospitalization can be a minimal of $10,000.

 

My c-section and hospitalization from last year was $75,000 and we paid the deductible and some co-insurance and that was it. The baby was in the NICU for two weeks and the cost was $75,000. His part was covered at 100%.

 

Are your office visits part of the deductible or do you just pay the copay? Our plan covers office visits in network, but tests are part of the deductible and you pay the in-network price not the MSRP.

Edited September 6, 2012 by LMA

[frugalmama]

I would go the no-insurance route if it were costing that much, honestly. Find out your local walk-in clinics and how much they charge for a cash pay visit - there will be somewhere that is lower cost.

 

The other thing I would look into is insurance for the kids through the state. I'm not sure what it's called there {here it's CHIP} but you can make a LOT {depending on the size of your family up to 6 figure salary} and it's only $50 a month for all the kids with tiny co-pays.

[TranquilMind]

bzymom:

I just received the latest explanation of benefit forms from Aetna. We submitted over $2000 in medical receipts and will receive exactly nothing back. It is all going toward the ever-increasing deductibles, which now stand at $2000 per person, $7000 per family per year. The trick seems to be that they reduce all the bills to an "allowable amount" which is a fraction of reality so you never meet the thresholds. For example, out of a bill for $1435, they ALLOWED $426.

 

 

Health insurance companies are the greatest thieves on the planet. I can't believe these guys are still in business. You are right. This is a no-win situation. The only way you ever get anything paid now is if you are in a catastrophic situation and have met all family deductibles. No normal, healthy families - which we all pray to be - ever meet the deductibles the way it is now rigged.

 

We pay insurance premiums ourselves, without any employer contribution, under COBRA. Our monthly payment for the family is $1600. So I am looking at nearly $20,000 per year just in premiums. Add co-pays, which are at least $30 per covered visit, more commonly $50, pharmaceutical co-pays which have run as high as $140 for a single prescription, and all the things they do not cover or reduce, and my medical expenses are simply not affordable anymore. And this is without any major medical problems!

 

 

Yeah, it's crazy.

 

I am considering picking up some kind of catastrophic coverage and banking $$ in a separate account to pay for preventative or routine care. Every person I have asked to date thinks it is a terrible idea and we will be in deep trouble with one hospital stay. I have looked for other coverage, but it is all even more expensive than what we now pay.

 

 

Will be reading with interest. I hope you find an answer. I've been reading about those Christian self-funding programs. You'd have to trust everyone else to pay up though, and I have a hard time doing that sometimes.

[EKS]

The thing that worries me about a catastrophic plan is not a hospital stay, but prescription coverage.

[justasque]

I would

 

~ look around to see if you have any other in-network choices. You might also want to pick and choose in or out depending on what you need to have done, choosing out for the stuff that might be tricky/expensive, and in for anything routine.

 

~ If you're out of network, talk to the doc's office ahead of time to see what adjustments they can make. You might not talk them all the way down to the network price (after all, if they were willing to accept that, they'd be in the network), but perhaps they can meet you half-way.

 

~ If you're in network, don't pay until the insurance has paid, and keep a sharp eye on all of the bills. Call the doc and/or ins company every single time it looks like they're messing up. Also, read your policy to be sure you understand how it works.

 

~ Ask about every little thing the docs do, before they do it - what is this test/shot/drug/procedure for, will it be covered on my insurance. Get everything pre-authorized, so that if it ends up costing more, you're covered. This has saved me several times from facing huge bills.

 

~ See if you can set up a pre-tax-dollars medical spending account. This can save you quite a bit on the stuff that you do have to pay out of pocket.

 

~ See if you qualify for any kind of subsidized or less expensive health care options - government-based, trade organizations, etc.

 

~ Seriously consider whether you can find a part-time job that offers benefits. Even if the pay is lousy, if the coverage is decent you may find that when you factor in the COBRA cost plus deductibles, etc., and add in the pay, you may come out ahead.

[southcarolinamom]

Wow, I can't imagine forking over $1600 a month for health insurance premiums. That's insane. I'm so sorry!

 

I have a personal policy through BCBS in South Carolina. My 2 children and I are covered for $330 a month. (My husband has to drop another 100 pounds before he can qualify to even HAVE health insurance coverage.) However, each one of us has a $5,000 yearly deductible.

 

I hope you find a better answer soon.

[Stacy in NJ]

It depends on the state you reside in. Some states still allow insurers to offer high deductible/catastrophic policies while others (like NJ) don't.

 

Sorry to make this political, but under Obamacare ALL catastrophic plans will be disallowed. Heath savings accounts will be phased out as well.

[sbgrace]

Those are high premiums and COBRA often is. I would see if you can shop around for a cheaper individually purchased policy. If you're healthy maybe you can. The kids might qualify for a state program too if they are uninusured.

 

So I would look at options but I would be leery of dropping altogether. Insurance does downwardly adjust charges a great amount. Even if that doesn't help you with out of network doctor x it would be a huge deal for a hospital visit. We've had hospital stays here and it is just out of this world expensive even with insurance adjusting costs.

[angela in ohio]

We had catastrophic coverage for a year while dh was in school. It was cheaper than adding him to my policy at work. If we didn't have insurance through dh's employer, I would go back to one in a heartbeat. We went through our auto/home insurance agent, and he found one we were comfortable with.

 

I think the people you are asking don't understand the plan. The point of them is that they only pay for things like hospital stays.

[Dobela]

The thing that worries me about a catastrophic plan is not a hospital stay, but prescription coverage.

I no longer have insurance. After my dh's last pay cut we simply couldn't afford it. Interestingly, with the income drop everyone can qualify for government funded insurance - except me.

 

Not having insurance can be a royal pain. Most doctors in town refused to even consider having me as a patient. While I was on a drug trial study for psoraisis, blood work showed my glucose to be in dangerous levels. After days of calling clinics, only one would see me and that was because I knew someone working there and that could give a personal reference saying that I wasn't a freeloader.

 

Prescriptions are another issue. I am on 3 prescriptions and decisions are made each month simply based on price. When I had bronchitis, the doctor told me that there were meds that really worked better than what she was prescribing, but without insurance they would cost well over $250 for one round. She prescribed something possibly less effective so that I could afford the prescription. The last time I needed meds for my psoraisis, 3 prescriptions were giong to cost me $900.

 

So, if you actually have money to set aside to pay for whatever comes up, then I *might * go insurance free. First I would check with my current providers and ask if they would still allow me to visit them. I am not so concerned about hospital stays and all that as I am caring for the day to day.

[4everHis]

Wow, I can't imagine forking over $1600 a month for health insurance premiums. That's insane. I'm so sorry!

 

I have a personal policy through BCBS in South Carolina. My 2 children and I are covered for $330 a month. (My husband has to drop another 100 pounds before he can qualify to even HAVE health insurance coverage.) However, each one of us has a $5,000 yearly deductible.

 

I hope you find a better answer soon.

 

Would that not mean that in any given year, if you met your deductibles, you'd be paying $1,580 a month? The $5,000 X 3 divided by 12 + $330 a month. And this doesn't include copays.

 

Am I not seeing this right?:confused: I realize you hope to never meet the deductibles but then the insurance was a waste anyway. btw. we haven't had insurance in 3 years. I've tried signing up online for our state aid and was told we don't qualify. We, on paper, are at poverty level so I'm not sure what's up with that. We are a family of 7.

Edited September 6, 2012 by connib

[kroe1]

My DH no longer has insurance. Because of his medical conditions, a high deductible policy was $1500 per month. He would have to have over $25,000 per year in medical expenses before the insurance would be cost effective. Therefore, he just banks the cost of premiums each month and prays for the best. His prescriptions all fall under the $4 plan at WalMart. I think he spent a total of about $300 last year in medical expenses, so theoretically his plan of self-insuring is a good one. He figures one catastrophic medical expense is going to wipe him out financially whether he has insurance or not (because of having to pay such a large deductible and 20%). The way he's doing it, he at least has a chance of being able to afford a catastrophe.

 

:grouphug: to all those without insurance. The stress is awful.

[stripe]

The thing that worries me about a catastrophic plan is not a hospital stay, but prescription coverage.

 

Well, I currently have insurance through an employer. It does not include prescriptions. Since I rarely get any, it's not a big deal. There are some organizations that provide discounts, including AAA. It might be like a 25% discount, but hey, it beats full price. Together Rx Access, for example, is for people with moderate to low incomes, and is sponsored by various pharmaceutical companies. There are others you can just print a card for yourself off the web, including AAA if you're already a member. There are a couple listed here. Some states have discount programs too. I honestly have no clue which gives better discounts. There are a lot of regular pharmacies that participate, like CVS and Target, so you're not tied to something obscure. Also some stores (including national chains like Walmart and Kmart) have a lot of cheap medicine, from free antibiotics to $4 prescriptions, to low cost diabetes supplies. You should definitely investigate stores in your area. It's amazing how helpful these are -- I got some blood pressure and diabetes drugs for a family member at a really affordable price, it was truly lifesaving.

 

And then there is the pre-existing condition issue that if something comes up, say cancer, then you're not going to be able to get coverage later and that will easily bankrupt your family.

I have two things to say about that. One is that eventually adults will also not be able to be denied for pre existing conditions (currently it's only children). Secondly, before that kicks in, on Jan 1, 2014, the states have high risk pools you can join if you've been denied coverage. You can get specifics for your state at https://pcip.gov/PCIP_States.html . This is an enormous step forward as far as I am concerned.

Edited September 6, 2012 by stripe

[Rbsmrter]

We've gone insurance free for a time and it was VERY costly, even for routine visits. Our doctor's office allowed for some negotiation but the largest discount they ever gave us was a 10% cash discount. My daughter's well visit was $942. Insurance would have allowed $145 and paid accordingly (without requiring a copay on our part), while we were given a total of $848 after our discount. We are a family of five, so even routine visits add up quickly and while we are a healthy family we're guaranteed at least 2 or 3 sick visits a year and that doesnt even take into account emergencies. We found an individual policy through Humana for $350 a month (family of 5). We each get six visits a year with a copay of $35 (no copays for well visits and they dont count towards your six). After we hit the six visits we each have a $2500 deductible. We're more than halfway through the year and havent used half of our visits. The biggest downside is the lack of maternity coverage. The only way we can get it is through DHs employer and it's $1200 a month (along with a hefty deductible and copays) and we can only enroll in March.

 

I think it really depends on your situation (how often you visit the doctor, the discounts your doctors offer, etc). I'd definitely ask your doctor and your local hospital about discounts. I've yet to find anywhere that offered the kind of discounts you get with insurance coverage. Your current premiums and deductible seem really high, so there might be individual alternatives that are more affordable and offer better coverage. I've used ehealthinsurance the last few years and have been really happy. I can easily compare the choices and sort according to premiums, deductibles, etc.

[LMA]

We've gone insurance free for a time and it was VERY costly, even for routine visits. Our doctor's office allowed for some negotiation but the largest discount they ever gave us was a 10% cash discount. My daughter's well visit was $942. Insurance would have allowed $145 and paid accordingly (without requiring a copay on our part), while we were given a total of $848 after our discount. We are a family of five, so even routine visits add up quickly and while we are a healthy family we're guaranteed at least 2 or 3 sick visits a year and that doesnt even take into account emergencies. We found an individual policy through Humana for $350 a month (family of 5). We each get six visits a year with a copay of $35 (no copays for well visits and they dont count towards your six). After we hit the six visits we each have a $2500 deductible. We're more than halfway through the year and havent used half of our visits. The biggest downside is the lack of maternity coverage. The only way we can get it is through DHs employer and it's $1200 a month (along with a hefty deductible and copays) and we can only enroll in March.

 

I think it really depends on your situation (how often you visit the doctor, the discounts your doctors offer, etc). I'd definitely ask your doctor and your local hospital about discounts. I've yet to find anywhere that offered the kind of discounts you get with insurance coverage. Your current premiums and deductible seem really high, so there might be individual alternatives that are more affordable and offer better coverage. I've used ehealthinsurance the last few years and have been really happy. I can easily compare the choices and sort according to premiums, deductibles, etc.

 

Maternity is separate? Isn't that unusual? Is it just your state?

[stripe]

Maternity is separate? Isn't that unusual? Is it just your state?

 

I thought there were a lot of companies that did this. In fact, as was cited in the discussions prior to the healthcare reforms, women can be charged much more than men, and some companies have even required women to get hysterectomies in order to get coverage. By 2014, this will be illegal.

 

According to this article in Forbes

 

 

 

The National Women’s Law Center recently found that in states that haven’t banned the practice, over 90% of the best selling plans charge women more than men, even though only 3% of them cover maternity services. In fact, even when maternity care is excluded, almost a third of plans charge women at least 30% more than men for the same coverage. One plan even charges 25-year-old women 85% more than men. All told, the practice costs women about $1 billion a year.

 

[LMA]

I thought there were a lot of companies that did this. In fact, as was cited in the discussions prior to the healthcare reforms, women can be charged much more than men, and some companies have even required women to get hysterectomies in order to get coverage. By 2014, this will be illegal.

 

According to this article in Forbes

 

 

 

The National Women’s Law Center recently found that in states that haven’t banned the practice, over 90% of the best selling plans charge women more than men, even though only 3% of them cover maternity services. In fact, even when maternity care is excluded, almost a third of plans charge women at least 30% more than men for the same coverage. One plan even charges 25-year-old women 85% more than men. All told, the practice costs women about $1 billion a year.

 

 

You know, I am in MA and maternity care is required. Never thought that maternity care would be excluded.

 

Thanks for the article. It is eye-opening.

[justasque]

I've tried signing up online for our state aid and was told we don't qualify. We, on paper, are at poverty level so I'm not sure what's up with that. We are a family of 7.

 

You might want to call around and see if you can talk to a real person about this. Make sure you've investigated all the various possibilities - for example, CHIP for your kids. Even if you haven't qualified in the past, things change, so it may be worth checking again.

[bzymom]

We've gone insurance free for a time and it was VERY costly, even for routine visits. Our doctor's office allowed for some negotiation but the largest discount they ever gave us was a 10% cash discount. My daughter's well visit was $942. Insurance would have allowed $145 and paid accordingly (without requiring a copay on our part), while we were given a total of $848 after our discount. We are a family of five, so even routine visits add up quickly and while we are a healthy family we're guaranteed at least 2 or 3 sick visits a year and that doesnt even take into account emergencies. We found an individual policy through Humana for $350 a month (family of 5). We each get six visits a year with a copay of $35 (no copays for well visits and they dont count towards your six). After we hit the six visits we each have a $2500 deductible. We're more than halfway through the year and havent used half of our visits. The biggest downside is the lack of maternity coverage. The only way we can get it is through DHs employer and it's $1200 a month (along with a hefty deductible and copays) and we can only enroll in March.

 

Very good points. I need to do some thorough research and figure out if we can realistically do it. Dd's whooping cough this year was a million visits and meds. Can we manage the inevitable broken bones, illnesses and meds if we are paying rates of $848 as you did??

 

This is crazy. I think the best benefit my dad earned after 40 years with the same company was lifetime health coverage for he and my mom. At the time, it was routine, but as medical costs skyrocketed, it was a Godsend. And you will never find it now!

[4everHis]

You might want to call around and see if you can talk to a real person about this. Make sure you've investigated all the various possibilities - for example, CHIP for your kids. Even if you haven't qualified in the past, things change, so it may be worth checking again.

 

I will do this. Thanks for the reminder.

[ondreeuh]

I don't know anything about your situation or what expenses you had, but my understanding (and anyone feel free to correct me if I'm wrong) is you get the discount, too, if you used an in- network provider. Follow? If insurance (and I have Aetna too) reduces the costs from 2000$ to 426$, you don't then owe the provider 2000$- you owe them 426$. If it was some kind of purchasable expense before insurance submission (like medical supplies, equipment) then they should be able to tell you before you actually spend the money where you can get the discount. Maybe?

 

Ya, I agree insurance stinks. :ack2:

 

This what I was going to say, too. Aetna negotiates a reduced price with your provider. By accepting Aetna insurance, your provider agrees to their allowed amounts. So even though it may just apply to your deductable, that $426 you're paying for the procedure is still less than you would have been charged if you were uninsured. Some places offer a cash discount, but not that much.

[LMA]

This what I was going to say, too. Aetna negotiates a reduced price with your provider. By accepting Aetna insurance, your provider agrees to their allowed amounts. So even though it may just apply to your deductable, that $426 you're paying for the procedure is still less than you would have been charged if you were uninsured. Some places offer a cash discount, but not that much.

 

You also have to have the claim processed through insurance to have it count toward the deductible. Many insured people think if they are paying cash, they don't have to show their insurance card.

[Mommyof4ks]

Wow! We have a high ded. plan with an HSA, and I will not post premiums, because I get eggs thrown at me for how little we pay lol. Our "high" ded. is only $5000 for the family, and it is much cheaper than a traditional PPO with co-pays if you ever get sick. My son is a cancer survivor, and his treatment lasted 3 years and 3 months, so we had lots of doctor visits and many hospital stays over several years. We paid $5000 a year, period no matter how many times he was hospitalized or how many doctor visits he had or even how expensive his chemo drugs were. We never paid for anything out of pocket for the rest of us since he took care of the deductible and we had no copays. The best ing is that now that we do not spend much on health care our HSA money rolls over from year to year.

[ChristineW]

I don't know anything about your situation or what expenses you had, but my understanding (and anyone feel free to correct me if I'm wrong) is you get the discount, too, if you used an in- network provider. Follow? If insurance (and I have Aetna too) reduces the costs from 2000$ to 426$, you don't then owe the provider 2000$- you owe them 426$. If it was some kind of purchasable expense before insurance submission (like medical supplies, equipment) then they should be able to tell you before you actually spend the money where you can get the discount. Maybe?

 

Ya, I agree insurance stinks. :ack2:

 

 

Absolutely. I'd be talking to your provider and Aetna because you should only be paying the allowed amount not the balance if you are going to a preferred provider. If you are going out of network, you'd be responsible for the difference regardless of whether your plan was high deductible or not, and I could see why they wouldn't count the extra toward your deductible.

 

Hope this resolves soon. We were considering going with a high deductible plan next year but I'm due at the end of December. Our current PPO plan has awesome maternity coverage and I'm not willing to change doctors when I might be 41 weeks pregnant and overdue.

 

Christine

[Mom0012]

$2000 out of pocket, but if I have to accumulate an actual out of pocket amount of $8000 so the carrier "allows" $2000, it is ridiculous!

 

Okay, so you are paying $8,000 but only getting credit for $2,000 toward your deductible or am I misunderstanding? When my insurance company adjusts the fee to an "allowable amount", that is all I am required to pay and whatever I pay goes toward my deductible. The insurance company has contracted with the provider to only charge me the "allowable amount".

 

Oh, but if I go out-of-network, or to a doctor who does not accept my insurance then that no longer applies. I would have to pay the full amount in that case and none of it would go to my in-network deductible. I no longer see the guy who had been my doctor for 15 years because of this. I can't afford to pay a large deductible plus pay a doctor who will not accept my insurance.

 

Lisa

[southcarolinamom]

Would that not mean that in any given year, if you met your deductibles, you'd be paying $1,580 a month? The $5,000 X 3 divided by 12 + $330 a month. And this doesn't include copays.

 

Am I not seeing this right?:confused: I realize you hope to never meet the deductibles but then the insurance was a waste anyway. btw. we haven't had insurance in 3 years. I've tried signing up online for our state aid and was told we don't qualify. We, on paper, are at poverty level so I'm not sure what's up with that. We are a family of 7.

 

In the 12 years that I've had this BCBS personal coverage, we've never come close to meeting the $5,000 deductible - except the year I needed my gallbladder removed. Ugh. Our TOTAL medical bills for myself and 2 children are less than $1,000 a year - that includes my yearly mammograms, GYN check-up, the occasional doctor visit for illness, prescriptions, etc.

 

My husband is a "self-pay" patient, as he can't get coverage (he's self employed and off the charts when it comes to his weight). Thankfully he has only needed biannual MD visits for his check-ups, blood pressure checks, blood pressure meds, etc. Every year I hold my breath and pray that God keeps him healthy. We will be financially screwed if something happens to my DH requiring hospitalization. Self-pay patients are generally charged about half of what the bill says. We ask his MD for the cheapest possible blood pressure medicine - it's $4 a month from Walmart :001_smile:

[elfgivas]

have you checked out an hmo like kaiser? around here, they offer good middle of the road care, and have specialists that are "in house". they have a web site where you might be able to get an estimate..... around here, that is the best buy for the money, but i'm sure it varies by location.

 

hth,

ann

[stripe]

You might want to call around and see if you can talk to a real person about this. Make sure you've investigated all the various possibilities - for example, CHIP for your kids. Even if you haven't qualified in the past, things change, so it may be worth checking again.

Check this out, too http://www.insurekidsnow.gov/ -- it is really helpful and will link you to your state's info. CHIP is for families who make more money than qualifies for Medicaid.

 

Very good points. I need to do some thorough research and figure out if we can realistically do it. Dd's whooping cough this year was a million visits and meds. Can we manage the inevitable broken bones, illnesses and meds if we are paying rates of $848 as you did??

 

Yes, some places have plenty of lower cost options. There are tons of doctors' offices near me where they charge around $100 for an exam. Or less. That's not for trips to the ER or having bones set, but for an exam.

Edited September 6, 2012 by stripe

[scrapbabe]

Well I don't recommend it but we dropped all insurance. We pay out of pocket for everything. Ours was a need though. We couldn't afford the monthly premium and the monthly payment for medical bills we acquired when we didn't reach our deductable. My son had surgery that cost $7000 and the insurance didn't cover one dime. So in order to be able to pay monthly payments to the hospital we had to drop our expensive health insurance. But it ain't pretty on this end either. Son needs another surgery and we aren't even close to paying off the first one. Husband needs root canal. I am 4 months pregnant. I had thyroid cancer and have bi-annual visits to an endo and bloodwork and ultrasounds. Now that I'm pregnant those endo visits are monthly. So we are up to our ears in medical expenses. But we couldn't afford to pay for both. We make just a little too much for CHIP or HIP in our state. But with another child (3 instead of 4), we will fall under the income limit so when baby arrives we will apply for CHIP to get a little relief. Good luck in your decision.

[MFA323]

If you're a Christian, you should consider a faith-based health sharing program instead of insurance. I'm a member of Samaritan Ministries (http://samaritanministries.org/) and am really happy with it. You pay the first $300 of any event (illness, injury, pregnancy). It doesn't cover well child checks, which is why our kids are still on DH's work plan, but it's great for adults, especially maternity. If anyone applies, please list me (Megan Alwine) as your referral. A nice bonus is that you get a discount if you refer someone else. :001_smile:

[Shellers]

Warning: Ended up being a vent/rant as well as a question!

 

I just received the latest explanation of benefit forms from Aetna. We submitted over $2000 in medical receipts and will receive exactly nothing back. It is all going toward the ever-increasing deductibles, which now stand at $2000 per person, $7000 per family per year. The trick seems to be that they reduce all the bills to an "allowable amount" which is a fraction of reality so you never meet the thresholds. For example, out of a bill for $1435, they ALLOWED $426.

 

We pay insurance premiums ourselves, without any employer contribution, under COBRA. Our monthly payment for the family is $1600. So I am looking at nearly $20,000 per year just in premiums. Add co-pays, which are at least $30 per covered visit, more commonly $50, pharmaceutical co-pays which have run as high as $140 for a single prescription, and all the things they do not cover or reduce, and my medical expenses are simply not affordable anymore. And this is without any major medical problems!

 

I am considering picking up some kind of catastrophic coverage and banking $$ in a separate account to pay for preventative or routine care. Every person I have asked to date thinks it is a terrible idea and we will be in deep trouble with one hospital stay. I have looked for other coverage, but it is all even more expensive than what we now pay.

 

So if you have made the leap, I would be grateful for any tips or cautionary tales to help me make this decision.

 

I just don't know how people are supposed to maintain this anymore.:confused:

 

I feel your pain. You are the first person I've heard about that pays more in monthly health insurance premiums than we do! We pay $1,500 a month. We pay so much per month in premiums that we can't actually afford to go to the doctor.

 

I have dreamed out dropping our insurance and getting a policy with high deductibles. I believe our monthly premiums would go down to $600 a month. That would be a savings of $900 a month! We could use this money to pay the high deductible. I think we would SAVE money every month. Fear is the only thing holding me back. :tongue_smilie:

 

Our health insurance was only $1,200 a month in 2011. Premiums increased $300 a month in 2012. I can only wonder how much our health insurance will be in 2013. :001_huh:

 

I remember the good old days when we paid $350 a month for the whole family.

[Nestof3]

I am happy that bills are reduced to an allowable charge -- this is essentially an agreed rate between insurance company and doctors. Our deductible is $5,000 for family with o% to pay once deductible is met. Now, our premiums for five people are $600 a month.

 

We only met the deductible one year after a $30,000 surprise heart procedure for me.

 

I cannot imagine having your premium. Ours is a personal plan as we are self-employed too. Depending on how much your family earns a year, I'm not sure what I would do. If your husband makes enough to afford it, I'd keep it though.

 

Our premium did increase this year by $100 and the year before as well, so I'm sure our future doesn't look good with regard to insurance.

[Nestof3]

We have always had high-deductible plans that we consider catastrophic coverage. We figure we won't meet the deductible very many times.

 

I feel your pain. You are the first person I've heard about that pays more in monthly health insurance premiums than we do! We pay $1,500 a month. We pay so much per month in premiums that we can't actually afford to go to the doctor.

 

I have dreamed out dropping our insurance and getting a policy with high deductibles. I believe our monthly premiums would go down to $600 a month. That would be a savings of $900 a month! We could use this money to pay the high deductible. I think we would SAVE money every month. Fear is the only thing holding me back. :tongue_smilie:

 

Our health insurance was only $1,200 a month in 2011. Premiums increased $300 a month in 2012. I can only wonder how much our health insurance will be in 2013. :001_huh:

 

I remember the good old days when we paid $350 a month for the whole family.

[stripe]

We make just a little too much for CHIP or HIP in our state. But with another child (3 instead of 4), we will fall under the income limit so when baby arrives we will apply for CHIP to get a little relief. Good luck in your decision.

 

I thought a pregnant woman counts as two for family size purposes during her pregnancy, so would you be eligible now?

[happypamama]

I thought a pregnant woman counts as two for family size purposes during her pregnancy, so would you be eligible now?

 

I think it does for the pregnant mama's insurance (some states have insurance for pregnant women), but I don't think it does for the kids' insurance right now.

[stripe]

I think it does for the pregnant mama's insurance (some states have insurance for pregnant women), but I don't think it does for the kids' insurance right now.

 

I honestly don't know, I was just throwing it out there because it is not obvious that a pregnant woman counts as two. Anyway, :grouphug: . This whole situation makes me quite disturbed.