$450 co-pay?!?!?

[busymama7]

My husband had to go to ER via ambulance tonight. He is ok.

 

But when they came to discharge us they informed us that our ER co-pay is now $450!!!! Last year it was $100. What?!?!

 

I am so sick of insurance. This is through work and we pay $600 a month. It's HMO so we have little choice in doctors etc. we hardly use it anyways though. We are more alternative (chiropractor, midwives etc)

 

I want out. Besides the share plans what options do we have? I'd like a castrophic plan and a health savings account I think

 

We have 8 kids but really use the doctors very rarely. Things like stitches. And obviously the ER.

 

Thanks.

[Melissa in Australia]

:grouphug:

[Lanny]

The most important thing is that your DH is OK...

 

Probably the company your DH works for notified him of the increase in the co-pay, or, the HMO did, but if not, you have a valid reason to complain, about the lack of notification, if you can do that, without risking his job...

 

My guess is that the company your DH works for is paying far more than you are, each month, to maintain the medical insurance for your family. Depending upon the state you live in, they are probably paying far more than you are paying each month.

 

When I lived in Texas, I had an individual medical insurance policy. Every few years, I would have them increase the deductible I paid, to reduce the increase in premiums that I paid.

 

Now, with ObamaCare, the problem is greatly exacerbated.

 

There have already been some threads here on WTM, written by people whose employers notified them that their hours will be reduced to 28 or 29 each week, or, that they will lose their company sponsored medical insurance, if he works for a company with more than 50 employees.

 

It could be, that in the near future (2014), the company your DH works for will decide to pay the Fine to the U.S. Government, for not providing medical insurance that complies with ObamaCare, or they will reduce the hours he works to 28 or 29.

 

They may, at that time, offer you some alternatives, but it may be that you will need to look into one of the plans offered, by the new system in your state, if your state is participating. I believe that will begin in October 2013, in the states that are able to begin operation.

 

GL and I hope your DH continues to be OK.

[DawnM]

We pay $650/mo. Dh's employer pays $1,000 more for us to actually have insurance.

 

Our co-pays have gone up considerably as well. I am paying a LOT more out of pocket than I was.

 

I miss working. When I worked I carried all the health insurance for the entire family and we paid no monthly amount. We did have co-pays but they were minimal.

 

I don't know how much an ambulance would be for us, ER is almost $200 now. I would imagine an ambulance would be close to what you paid.

 

Dawn

[QueenCat]

Did they include both the ambulance and er co-pays? If so, those are normally two separate things so it's possible they combined them for you. Your insurance paperwork should tell you what your co-pays are for each service. There are so many different policies, even from the same insurer, so it is hard to compare. For example, mine is a straight deductible, no co-pays.

 

It would be nice if people wouldn't put the politics into it the responses... sure to get the thread closed.

[plansrme]

Could that have partly been a deductible, rather than a co-pay?

 

Frankly, $600 a month for the number of people in your family is a steal. A single ER visit can be thousands of dollars, and your year's worth of premiums might well have been recouped in that one visit.

[Jennifer3141]

Could that have partly been a deductible, rather than a co-pay?

 

Frankly, $600 a month for the number of people in your family is a steal. A single ER visit can be thousands of dollars, and your year's worth of premiums might well have been recouped in that one visit.

 

 

No kidding! The OP mentioned EIGHT kids. So that's 10 people for $600 a month. That is a huge benefit!!!

 

And yes, the politics will get the thread shut down - particularly when they are also incorrect. ;)

[Lanny]

Did they include both the ambulance and er co-pays? If so, those are normally two separate things so it's possible they combined them for you. Your insurance paperwork should tell you what your co-pays are for each service. There are so many different policies, even from the same insurer, so it is hard to compare. For example, mine is a straight deductible, no co-pays.

 

It would be nice if people wouldn't put the politics into it the responses... sure to get the thread closed.

 

 

@CathieC I "Liked" your response, because of the first part of it.

 

Regarding the 2nd part of your response, I assume you refer to my post (#3 in this thread) and if there are Politics in that, it was not intentional.

 

I tried to state what I believe is true. There are MASSIVE changes to the health/medical insurance system in the USA, that have begun. Some changes are already in place. Some changes will be in place in 2014. The impact that will have on American workers and their families is MASSIVE. That is fact, not politics...

[Word Nerd]

Our copay for ER went up this year as well, though it isn't that high. It's the deductible plus a $150 copay. Since we have a pretty high deductible, I'd likely be paying for the whole visit out of pocket unless the ER visit ended in the person being admitted to the hospital, in which case the copay would be waived. If you go to the ER and it is not an emergency, they won't cover the ER visit at all. I know they want to discourage people from using the ER when they should be going to a doctor's office. However, I do have concerns about how the insurance company determines what is an actual emergency, especially if you visit the ER on a weekend or after hours.

[Crimson Wife]

Catastrophic plans are not permitted under the ACA. My brother used to have one, but it didn't meet the new requirements. My brother is in his 20's and healthy, and all he really needs is catastrophic coverage. However, in order to make Obamacare work, young, healthy people like my brother need to pay more and subsidize older, sicker folks.

[Jeannie in NJ]

a friend of ours owns his own business, no employees, just him and his partner. They have insurance but he had to go to er last month. His co-pay or deductible was $3,000.

[m0mmaBuck]

$600/month for a family of 10 is crazy cheap insurance! That said...

 

Around here, an ambulance transport costs $1000 PLUS about $20/mile. And, according to the recent Time article Re: health care costs, the average ER visit costs around $1200-1300 (more or less depending on the insurance company's contract with the hospital as well as tests and treatments during your stay). Many insurance companies try to discourage people from using the ER (where the cost is astronomically higher than with a regular office visit) by making the co-pays higher. Our insurance has a higher co-pay for ER than office UNLESS you are admitted to the hospital from the ER as a way to discourage people from going to the ER for non-emergency issues.

 

I am sorry you weren't aware that the co-pay had been increased. The insurance company should have informed you in writing when that change was made.

[Pawz4me]

$600/month for eight kids and two adults sounds like a very good deal to me.

 

Our ER co-pay is $150 (unless the patient is admitted, in which case the ER co-pay is waived). But the bill would reflect any deductible we were responsible for, too. Is it possible that's the case with your DH's bill?

[Momof3littles]

Catastrophic plans are not permitted under the ACA. My brother used to have one, but it didn't meet the new requirements. My brother is in his 20's and healthy, and all he really needs is catastrophic coverage. However, in order to make Obamacare work, young, healthy people like my brother need to pay more and subsidize older, sicker folks.

Very young people can have a sort of catastrophic plan as part of ACA, but after a certain age, that isn't permitted.

In the exchanges there are plans that don't meet the bronze, silver, gold, or plantinum levels and are considered catastrophic. Here is a link including info on the catastrophic plan coverage in CA.

 

http://www.cahba.com...erage-tiers.htm

 

Also, from the actual ACA:

 

ACA Provision The ACA stipulates in §1302(d) that health plans covering the essential health benefits (which qualified health plans must do) may offer plans in the Bronze, Silver, Gold, and Platinum levels of coverage. In addition to these four levels of coverage, the law indicates in §1302(e) that a Catastrophic Health Plan, “a health plan not providing a bronze, silver, gold, or platinum level of coverage shall be treated as meeting the requirements of subsection (d), ifâ€

1. Eligibility is restricted to either (1) young adults under age 30 prior to the start of the plan year or (2) individuals who have been deemed exempt from the individual mandate;1

2. The plan provides the essential health benefits defined under §1302(a) after the insured has met a deductible which must be equal to the maximum annual out-of-pocket limit for High-Deductible Health Plans (HDHP) as defined by the IRS for the given plan year;

 

3. The deductible does not apply to at least three primary care visits.

 

Subsection (d) in the excerpted text above refers back to the levels of coverage in which plans offering the essential health benefits will be offered.

 

In terms of the cost of ER visits, copays, deductibles, etc. those were all on the rise pre ACA over the last decade+.

 

Right now my family has a higher deductible plan (6K for our family per year) with all well visits covered. We have a maternity exclusion. It is a private plan, as DH's employer sponsored plan is expensive (and has been, predating ACA by a lot). In a worst case scenario year, we are still only out about the same after deductible that we would be to add on to DH's employer plan (10-11K/yr). We signed up for our individual plan two months after ACA passed, so we cannot be grandfathered in. I expect our plan cost to increase or be dropped entirely as I don't think they'll be able to include things like the maternity coverage exclusion on there any longer. As a result, we are waiting to see what the cost is when it renews this fall, and depending on the price, we may move to the employer sponsored plan.

 

My daughter had an ER visit last year because she nearly bit through her tongue and it required stitches. She saw an MD for about 20 seconds, and then had a NP irrigate and suture. The bill for that event was like 4K (and as I said, we have a 6K/yr/family deductible). Overall, we are still happy having a higher deductible plan with a maternity exclusion, but I think that will be out the window this year.

 

I absolutely think the increase in copays, deductibles, employee contribution toward premiums, etc. was on the rise (and sharply) way before ACA. We previously had a near Cadillac type of plan, and our friends who still work at that particular company have seen a huge increase over the last 5-10 years in their employee contribution to premiums, copays, etc.

[Element]

I can sympathize with the OP. When you're expecting to pay x amount for something, having to pay >4x that amount would be really frustrating. I'm glad your dh is okay.

 

(That said, $600/mo for a family of 10 and $450 OOP for ambulance/ER is an incredible deal! I wish we had access to something that affordable, even for just the four of us.)

[GoVanGogh]

Re: Health savings account

I don't know about all of them, but ours is overseen by a third party that verfies (in reality: denies...) all claims on behalf of the insurance company.

Our HSA has been a royal pain and I don't know that I would ever go with one again. Our son was diagnosed with a life-long physical condition recently and he will need therapy for years to come. The HSA, in our doctors' and therapists' opinion, is acting illegally or, at the least, unethically. It has truly been a nightmare - added in on top of the dx.

Two examples:

After a few months of therapy, they told us that we needed to stop all therapy to see what his rate of regression was. No way in h-e-double-hockey-sticks can anyone with this condition stop therapy.

Then they approved a few more therapy sessions, then told us they couldn't approve any more as they "needed to save some sessions, in case of an injury down the road that might need services."

[Um_2_4]

Look back through the paper work you got towards the end of last year. You should have gotten notification about the increase. We always do. (I think in CA it has to be 90 days before it goes into effect.) Your DH may have gotten it at work in a memo or email also.

 

Here we tack on $6/mo to our city water bill and any ambulance rides needed by the service here (in our city) are covered. Might want to look into that if you have that big of a co-pay/deductible.

[plansrme]

Re: Health savings account

I don't know about all of them, but ours is overseen by a third party that verfies (in reality: denies...) all claims on behalf of the insurance company.

Our HSA has been a royal pain and I don't know that I would ever go with one again. Our son was diagnosed with a life-long physical condition recently and he will need therapy for years to come. The HSA, in our doctors' and therapists' opinion, is acting illegally or, at the least, unethically. It has truly been a nightmare - added in on top of the dx.

Two examples:

After a few months of therapy, they told us that we needed to stop all therapy to see what his rate of regression was. No way in h-e-double-hockey-sticks can anyone with this condition stop therapy.

Then they approved a few more therapy sessions, then told us they couldn't approve any more as they "needed to save some sessions, in case of an injury down the road that might need services."

 

I don't think you're talking about an HSA here. Perhaps this is the high-deductible health plan that makes you eligible for an HSA, but HSAs do not make benefit decisions. The HSA is your money, and you use it to reimburse yourself for amounts you have paid for healthcare. You could spend $1,000 on diamond-studded eyeglasses, and the HSA would pay.

[nmoira]

Around here, an ambulance transport costs $1000 PLUS about $20/mile.

 

Same rates here. Our co-pay on ambulance charges is 20%. I'd be surprised if it's part of the ER co-pay, most (all?) aren't affiliated directly with hospitals.

 

I'd never dealt with ER charges in the US until last year. Because DD was admitted, our ER co-pay was only $100, but that was only the facilities charge. Every doctor and PA billed separately from the hospital charges. Ditto for the ambulance. Coming from Canadian health care, it seems insane to me.

[melmichigan]

My husband had to go to ER via ambulance tonight. He is ok.

 

But when they came to discharge us they informed us that our ER co-pay is now $450!!!! Last year it was $100. What?!?!

 

I am so sick of insurance. This is through work and we pay $600 a month. It's HMO so we have little choice in doctors etc. we hardly use it anyways though. We are more alternative (chiropractor, midwives etc)

 

I want out. Besides the share plans what options do we have? I'd like a castrophic plan and a health savings account I think

 

We have 8 kids but really use the doctors very rarely. Things like stitches. And obviously the ER.

 

Thanks.

 

Have you looked at any deductible along with your co-pay especially if you haven't used services this year? Our deductible is $300 per person (with a family max.) and $100 ER co-pay. Tack on an ambulance charge and we could easily be at $450, the hospital is allowed to collect these charges up front. Because of co-insurance we would also be billed for another 15% in the following week, then any additional physician charges for the ER doctor and any x-ray fees if applicable. Heck, we just paid $380 for DH's C-PAP machine because of deductibles not being met, and co-pays, and co-insurance. I don't want to know what the total would be for an ER visit. :auto:

 

I don't think there are many other options, unless there is something else through the employer?

[GoVanGogh]

I don't think you're talking about an HSA here. Perhaps this is the high-deductible health plan that makes you eligible for an HSA, but HSAs do not make benefit decisions. The HSA is your money, and you use it to reimburse yourself for amounts you have paid for healthcare. You could spend $1,000 on diamond-studded eyeglasses, and the HSA would pay.

We have an HSA through a major insurance company. We use a 'credit card' which states this third party's name and "health savings account" across the top.

Our insurance company (a big company) has hired this third party for verifician of all claims. It is not this company's standard policy, though I don't know why our policy is wrtten as such. (It is through husband's employer.) Yes, it is our money, but they don't let us use it for anything we want. We have limits on what it will cover - example: it won't cover my compounded hormone replacement meds. It also doesn't like to cover therapy, though our insurance policy is plainly worded as covering "100% of therapy for developmental delays," which is what our child's dx should fall under. It only covers x-number of sessions for injuries. They are saying this is an injury, when it is a life-long neuromuscular/physical issue that is causing developental delays. Our doctors and therapists have written letters of appeal, but so far haven't gotten us coverage.

The place we go to for therapy said they have only dealt with this type of HSA/3rd party a few times - never with good results. But I really don't know why our policy is this way and why others are not. I just know that it has been a royal pain.

[vonfirmath]

They have really increased the co-pay on ER visits on our plan as well.

 

The stated reason is to encourage you to use Urgent Care and NOT er. Evidently ER was being overused (to the administrator's way of thinking) and is a LOT more expensive and they are trying to control costs.

[busymama7]

I didn't mean this thread to take a life of its own. I haven't read most of the replies as we have been busy taking care if my husband.

 

I couldn't sleep last night and was just shocked and floored that they would call $450 a co pay. And no it wasnt deductible or ambulance or anything. Just the ER co pay. She showed me the paperwork because I was so shocked.

 

And sure it might be a "good deal" compared to what others have to pay etc. but his company pays a big portion too so its not just the $600 we pay. And it doesn't feel like a good value to me and I was wondering what else we could do. I would seriously be happier to be cash pay then to feel like I pay a bunch for crappy insurance that doesn't even benefit us much.

 

It's been a long two days. My husband had a very close call and another man is dead. It's dumb that I am even worried about this but like I said I was keyed up and couldn't sleep. I saw mention that this went political but I haven't even read the posts so feel free to just end it right here. I will read them after I get some sleep. But have no desire to get into a political fight. I just wanted suggestions on other ways to handle medical care.

[Mommyof4ks]

OP, catastrophic plans, or high deductible plans are great, but they are going away next year. We have one now, and it kept us from going bankrupt when my son had cancer. The PPO had high premiums, copays never ended even after the out of pocket max was met, and the out of pocket max was crazy high. Insurance and the price of health care is going to rise a great deal for most of us in the next few years, and we will be remembering when an ambulance ride was only $450, sigh. I guess it is a good thing my family lives close to Mexico. ;) Cheap health care down there, and many docs get their training in the states.

[QueenCat]

We have an HSA through a major insurance company. We use a 'credit card' which states this third party's name and "health savings account" across the top.

Our insurance company (a big company) has hired this third party for verifician of all claims. It is not this company's standard policy, though I don't know why our policy is wrtten as such. (It is through husband's employer.) Yes, it is our money, but they don't let us use it for anything we want. We have limits on what it will cover - example: it won't cover my compounded hormone replacement meds. It also doesn't like to cover therapy, though our insurance policy is plainly worded as covering "100% of therapy for developmental delays," which is what our child's dx should fall under. It only covers x-number of sessions for injuries. They are saying this is an injury, when it is a life-long neuromuscular/physical issue that is causing developental delays. Our doctors and therapists have written letters of appeal, but so far haven't gotten us coverage.

The place we go to for therapy said they have only dealt with this type of HSA/3rd party a few times - never with good results. But I really don't know why our policy is this way and why others are not. I just know that it has been a royal pain.

 

Typically, an HSA is only for covered items. If it's covered, you can use the HSA. If it's not, then no. FSA's typically allow more than just what is covered. For example, my HSA is only for items that would meet the deductible so our HSA card has the exact amount of our deductible on it. When we've had an FSA, it could be used for deductibles, non covered but medical items, dental, vision, and other similar things. Sounds like an issue between your insurance company and the HSA "enforcer". Your insurance company should be able to verify to them that the charges are eligible per your policy.

[plansrme]

 

We have an HSA through a major insurance company. We use a 'credit card' which states this third party's name and "health savings account" across the top.

Our insurance company (a big company) has hired this third party for verifician of all claims. It is not this company's standard policy, though I don't know why our policy is wrtten as such. (It is through husband's employer.) Yes, it is our money, but they don't let us use it for anything we want. We have limits on what it will cover - example: it won't cover my compounded hormone replacement meds. It also doesn't like to cover therapy, though our insurance policy is plainly worded as covering "100% of therapy for developmental delays," which is what our child's dx should fall under. It only covers x-number of sessions for injuries. They are saying this is an injury, when it is a life-long neuromuscular/physical issue that is causing developental delays. Our doctors and therapists have written letters of appeal, but so far haven't gotten us coverage.

The place we go to for therapy said they have only dealt with this type of HSA/3rd party a few times - never with good results. But I really don't know why our policy is this way and why others are not. I just know that it has been a royal pain.

 

You can move your HSA, even if it is employer-sponsored. Our custodian pays what we tell it to pay.

[Joanne]

I would use a catastrophic is I needed to. However, having spent the better part of 3 years dealing with what happens when a chronic, slow terminal illness reveals, I would KEEP insurance if I could.

 

You never know; my dd's juvenile rheumtoid arthritis developed seemingly out of nowhere and just ONE of her meds is $1500 a month.

[melmichigan]

They have really increased the co-pay on ER visits on our plan as well.

 

The stated reason is to encourage you to use Urgent Care and NOT er. Evidently ER was being overused (to the administrator's way of thinking) and is a LOT more expensive and they are trying to control costs.

 

Ours too, you only want to go to the ER if you are relatively sure you will be admitted.

[G5052]

Virtually everyone's out-of-pocket went up this year. I always "reshop" health plans in the fall, and there truly were not any super deals out there.

 

And hang on to what you have. You truly don't know what is ahead, and the share programs aren't for chronic issues that may suddenly become an issue. If you are on a share program and have multiple cancers over several years, or needed repeated treatments, you may not be covered.

[mommybee]

Ours just changed and its the opposite........copay of around $150 if you go to the ER but if your admitted $1000 deductible. So now I'm worried about that. And we have good coverage.....but its coverage has been declining each year. An example just four years ago an insulin pump was covered at 80% and now its 50%.

[StephanieZ]

Before you drop your health insurance over your $450 share of tonight's bill . . . I'd suggest waiting 60 -120 days to get all those EOBs, etc from the visit. If your dh was sick/injured sufficiently to require an ambulance ride, I suspect his total bills will add up to at least a year's family premiums for you. I had a 4 hour ER visit that ran at least $2k in January. The 24 hour in patient hospitalization a week later (same issue) was surely well over $2-4k. I didn't look at the bills. ;)

 

For a serious 6-12 hr ER visit + ambulance ride, I would guesstimate bill totalling 3k-15k depending on where you live and what was going on. I surely wouldn't be choosing to DROP health insurance after that!

 

FWIW, unless the case is life threatening, I, too, advise you to avoid the ER if at all possible. Urgent cares are definitely the way to go unless life or limb is in jeopardy. (And, if an ambulance was required, then I am sure the visit was warranted!)

 

Anyway, employer based health insurance plans generally change yearly. So, ask your dh's HR dept (or office mgr if it is too small for an HR dept) for details on your current policy, and ask what month/day it renews next. Then put that date on your calendar, and ask for details on the new policy a couple weeks before the effective date of the policy.

 

Also, FYI, Obamacare DOES allow catastrophic plans for people under 30ish. I haven't paid too close attention to that aspect, but I am 99% sure I've read that recently.

 

Also, (((Hugs))) on the huge ER bill, and I'm glad your dh is doing well!

[TranquilMind]

This, totally this. It is happening all over the country.

 

Glad your husband is ok.

 

The most important thing is that your DH is OK...

 

Probably the company your DH works for notified him of the increase in the co-pay, or, the HMO did, but if not, you have a valid reason to complain, about the lack of notification, if you can do that, without risking his job...

 

My guess is that the company your DH works for is paying far more than you are, each month, to maintain the medical insurance for your family. Depending upon the state you live in, they are probably paying far more than you are paying each month.

 

When I lived in Texas, I had an individual medical insurance policy. Every few years, I would have them increase the deductible I paid, to reduce the increase in premiums that I paid.

 

Now, with ObamaCare, the problem is greatly exacerbated.

 

There have already been some threads here on WTM, written by people whose employers notified them that their hours will be reduced to 28 or 29 each week, or, that they will lose their company sponsored medical insurance, if he works for a company with more than 50 employees.

 

It could be, that in the near future (2014), the company your DH works for will decide to pay the Fine to the U.S. Government, for not providing medical insurance that complies with ObamaCare, or they will reduce the hours he works to 28 or 29.

 

They may, at that time, offer you some alternatives, but it may be that you will need to look into one of the plans offered, by the new system in your state, if your state is participating. I believe that will begin in October 2013, in the states that are able to begin operation.

 

GL and I hope your DH continues to be OK.

[TranquilMind]

I would use a catastrophic is I needed to. However, having spent the better part of 3 years dealing with what happens when a chronic, slow terminal illness reveals, I would KEEP insurance if I could.

 

You never know; my dd's juvenile rheumtoid arthritis developed seemingly out of nowhere and just ONE of her meds is $1500 a month.

 

Yikes! How are you handling that?

 

I feel for you. 35 years ago, one of my sister's meds was $400 a month, and I don't know how my Mom did it, even with the excellent federal insurance of those bygone days.

[TranquilMind]

Truth be told, no matter what type of plan, they all get you. We have had every plan out there and with all of them the ER bill would have been that or more. In fact, I've had ER bills like that and worse. We have really good insurance now, but there is still a copay, coinsurance, deductibles, etc. Is the $450 just a copay, or does that include other thing such as coinsurance/deductible? Is that with the ambulance? Considering what the overall bill will probably be, this truly is not that bad. I once broke my foot. I only had one x-ray. They gave me a pair of crutches, an ace bandage, and a walking boot. That came to $4000. That wasn't my portion, but just saying I had this piddly little thing and it cost that much. There was no ambulance. No cast. No surgery. There was barely anything.

 

We had an HSA once. I was not impressed. For one thing, with these "consumer driven" high deductible plans they act like you can shop around for a deal. Or be sure to only select in network doctors. Guess what? You can't. A lot of places won't even tell you their rates up front. And even in an emergency, if a doctor is not contracted you pay whatever they want to bill. And the part that counts towards your deductible is what your insurance says counts to your deductible. If the out of network doc charges three times more than what your company says counts, tough luck. In other words, if the out of network doc says he charges $15,000 and your insurance says they consider $5000 reasonable, you pay $15,000 and $5000 is credited to your out of pocket. These are the things people are not emphasizing (or they simply don't realize how this works). So these plans where you are paying more per month, but don't have those worries, might be more worth it than you realize.

 

It's worse and worse everytime the details start coming out. It has all been lies.

 

The only way you win is if you stay well and never need it at all. And even then, you are out tens of thousands of dollars per year (we are), on the off chance that you might need it!

 

Just this year, I flew across the country and paid for a surgery out of pocket, rather than deal with the games. It also saved me approximately 75%. We really, really, REALLY need to eliminate the insurance company profits.

[TranquilMind]

Same rates here. Our co-pay on ambulance charges is 20%. I'd be surprised if it's part of the ER co-pay, most (all?) aren't affiliated directly with hospitals.

 

I'd never dealt with ER charges in the US until last year. Because DD was admitted, our ER co-pay was only $100, but that was only the facilities charge. Every doctor and PA billed separately from the hospital charges. Ditto for the ambulance. Coming from Canadian health care, it seems insane to me.

 

Yeah, I bet it was eye-opening for you!

 

I went to the ER for only the second time in my life a year ago (first time was a burst appendix, after I stayed home three days, and I was admitted), because I had a hernia, and my friend insisted that my bluish belly button meant that it could be incarcerated (even though I felt fine). So I went. They did absolutely NOTHING. Not a test, not anything at all. I even had to show the ER doc where the (then-small) hernia was. HE couldn't find it.

 

They sent me out, noting that I had a hernia and should see my doctor, on the paperwork (ha ha, since he couldn't even find it).

 

Bill? $2000.

[Lisbeth]

 

 

@CathieC I "Liked" your response, because of the first part of it.

 

Regarding the 2nd part of your response, I assume you refer to my post (#3 in this thread) and if there are Politics in that, it was not intentional.

 

I tried to state what I believe is true. There are MASSIVE changes to the health/medical insurance system in the USA, that have begun. Some changes are already in place. Some changes will be in place in 2014. The impact that will have on American workers and their families is MASSIVE. That is fact, not politics...

 

 

Yes, indeed. Too bad we are wrecking our healthcare system. :(

[ChocolateReignRemix]

Yes, indeed. Too bad we are wrecking our healthcare system. :(

 

 

 

How do you wreck a wreck?

Health insurance premiums have been increasing at 12-20% per year for years, and that employers have been reducing benefits to employees over the same time period.

Edited June 10, 2013 by ChocolateReignRemix
Edited to remove completely uncalled for personal snark.

[Hen]

(((hugs))) OP, praying for you dh.

 

yeah, we had to change insurance last year because everything in our plan went up, and the services we got in return were getting smaller...the last straw was when the medication benefits changed and I had to pay over 100$ for an asthma inhaler...which I didn't. I found an old one and had my kids share it and then borrowed my MIL's really old nebulizer until we could get a new one. We finally switched to kaiser because of this, we loved our local hospital and our dr.s so we kept paying more to keep that option, but finally gave up. Yeah, the whole spiel about how we'd be able to "keep your Dr." maybe if you parse the sentence, true -but we were forced out by rising costs. :( I am very unhappy with what is happenning, but it's not political for me, I wouldn't care who was in charge if this was happening, for me, it's the result of a large population that doesn't understand that there is no such thing as a free lunch.

[Lanny]

How do you wreck a wreck?

Health insurance premiums have been increasing at 12-20% per year for years, and that employers have been reducing benefits to employees over the same time period.

 

Along with everyone else, I am very well aware of the annual increases in the costs of Major Medical and other types of Health Insurance in the USA. I lived in the USA most of my life and I experienced that. As I wrote, every few years, I would have the insurance company that wrote my Major Medical insurance policy increase the deductible (which was per cause, not per year) and try to keep the monthly premium at about the same level.

 

The problem of increasing medical/health insurance premiums isn't new, it has existed for many years.

 

Totally OT here is the fact that many doctors will now retire very early. About 6 or 7 years ago, I spoke with a man in Illinois, across from St. Louis. I believe he is an Orthopedic Surgeon. He'd never had a malpractice complaint or lawsuit against him. He'd just received notification from his malpractice insurance carrier that they were raising his annual premium, from $100K to $200K... He was going to retire early.

 

There are no simple solutions to complex problems...

[kewb]

How do you wreck a wreck?

Health insurance premiums have been increasing at 12-20% per year for years, and that employers have been reducing benefits to employees over the same time period.

 

 

So true. The minute health care became a for profit industry instead of what it was supposed to be the system was doomed. Insurance is about profit not about helping you if you have a health issue.

 

To the original poster, I am glad your dh is doing well.

[Lisbeth]

How do you wreck a wreck?

Health insurance premiums have been increasing at 12-20% per year for years, and that employers have been reducing benefits to employees over the same time period.

 

 

We have been very happy with our care. I would prefer paying for our OWN out of pocket, honestly, each time, rather than subsidizing everyone else. Personal responsibilty. The changes coming go in the exact wrong direction. I don't think it is the employer's, or the government's job to provide healthcare. I would rather a free market of healthcare services WE pay for. Red tape always lowers quality and raises prices. I would remove all of the middle men.

[QueenCat]

We have been very happy with our care. I would prefer paying for our OWN out of pocket, honestly, each time, rather than subsidizing everyone else. Personal responsibilty. The changes coming go in the exact wrong direction. I don't think it is the employer's, or the government's job to provide healthcare. I would rather a free market of healthcare services WE pay for. Red tape always lowers quality and raises prices. I would remove all of the middle men.

 

 

So then what happens to the person who works at McDonalds? And that is the best they could do, job wise? Are they to not get health care because they aren't responsible enough to make the same money has someone else, say an engineer? An everyone pays their own way system means the poor (which does not mean lazy and not working) do not get those most basic of needs met.

[QueenCat]

How do you wreck a wreck?

Health insurance premiums have been increasing at 12-20% per year for years, and that employers have been reducing benefits to employees over the same time period.

 

 

Increased for years is exactly right......... and then stabilized for many people. I know few in real life who are still seeing major increases. Most have seen stabilization in the past couple of years. Our total annual out of pocket (premiums, deductibles, copays, etc) has gone down, as have many I've known.

[Lisbeth]

nm

Edited June 10, 2013 by Moderator
That's potstirring (and off topic)

[NoPlaceLikeHome]

I didn't mean this thread to take a life of its own. I haven't read most of the replies as we have been busy taking care if my husband.

 

I couldn't sleep last night and was just shocked and floored that they would call $450 a co pay. And no it wasnt deductible or ambulance or anything. Just the ER co pay. She showed me the paperwork because I was so shocked.

 

And sure it might be a "good deal" compared to what others have to pay etc. but his company pays a big portion too so its not just the $600 we pay. And it doesn't feel like a good value to me and I was wondering what else we could do. I would seriously be happier to be cash pay then to feel like I pay a bunch for crappy insurance that doesn't even benefit us much.

 

It's been a long two days. My husband had a very close call and another man is dead. It's dumb that I am even worried about this but like I said I was keyed up and couldn't sleep. I saw mention that this went political but I haven't even read the posts so feel free to just end it right here. I will read them after I get some sleep. But have no desire to get into a political fight. I just wanted suggestions on other ways to handle medical care.

 

 

Having taken care of hundreds of previously healthy people who racked up hospital bills of hundreds of thousands of dollars, I would not risk going without real health insurance. Also, those plans like Good Samaritan are not health insurance and there is no guarantee of coverage for any illnesses you develop.

[ChocolateReignRemix]

 

 

Increased for years is exactly right......... and then stabilized for many people. I know few in real life who are still seeing major increases. Most have seen stabilization in the past couple of years. Our total annual out of pocket (premiums, deductibles, copays, etc) has gone down, as have many I've known.

 

I posted recently some data that showed the increases in 2011 and 2012 were in average lower than most (all?) years since 2000. Hopefully the stabilization will continue, but I have no difficulty believing that some will use the ACA as an excuse to cut benefits or increase prices when they likely would have been doing the same anyway.

[ChocolateReignRemix]

 

 

We have been very happy with our care. I would prefer paying for our OWN out of pocket, honestly, each time, rather than subsidizing everyone else. Personal responsibilty. The changes coming go in the exact wrong direction. I don't think it is the employer's, or the government's job to provide healthcare. I would rather a free market of healthcare services WE pay for. Red tape always lowers quality and raises prices. I would remove all of the middle men.

 

If you are content with a "Little House on the Prairie" model of healthcare I guess your plan could work. Realistically, state of the art healthcare is only affordable for the vast majority (99%+) thanks to a risk sharing model. I do agree with removing the employer role from the healthcare model, but likely not for the same reasons.

[Melissa in Australia]

every single time I see a thread like this I am so glad I live in Australia

[Splash]

I know how frustrating it is. I used to get upset too, thinking we are paying so much each month then to be hit with large copays and deductibles. Seemed like an awful lot of the expenses were our responsibility. Now though I'm so thankful for our insurance. What we've paid in premiums along with employers contributions can't even begin to cover all my daughters ongoing medical expenses. Last year at this time we were a family of seven who rarely went to doctors, never had someone in the hospital and only one prescription medication.

 

This year my daughter has been diagnosed with an ultra rare disease, spent 35 days in the PICU and will spend the rest of her life on medication that currently is $64,000.00 every time she gets an infusion which happens every two weeks. If she doesn't have medication she will die. We are so thankful we have insurance. We do not qualify for Medicaid. We make "too much". There is no way we could pay her bills out of pocket. Just the copays and all the deductibles add up to about $1000 per month and we paid out of pocket close to $20,000 last year (hospital stay was in September) I'm a big believer in always having some type of insurance. You never know what the future holds for you.

 

[Debbi in Texas]

We got our bill recently from a major cancer center for one doctor visit that included labs. After insurance paid we owe over $2800. It is totally unreasonable.

 

I sent them a check for $25 and I know they will turn us over to Collections