health insurance rate jump

[Ann.without.an.e]

Ok so we aren't alone.  The deductible keeps climbing too :(  It just seems like a crazy amount. 

 

As far as bad lifestyles ....  I remember when we never went to the doctor.  I have always been extremely careful about my family's food choices (all natural, healthy, real foods) and we always got plenty of sunshine and exercise.  I thought that this lifestyle was the magic ticket to health.  In the last 4 years not 1, not 2, not 3, but 4 of us have been diagnosed with tough autoimmune diseases that involve specialists, etc.  Cherish your health.  I did all imaginable to make sure we kept ours but unfortunately good choices aren't always a guarantee.   

Edited January 15, 2016 by Charleigh

[umsami]

The company providing our insurance left our state, so we went with another company (United Healthcare).  Cost for a comparable plan (slightly lower co-pays, but the need to go through a PCP for referrals) is <$100 more.  

[Word Nerd]

Diabetes is a choice for many.

That's absurd.

[In2why]

Our health insurance has always increased. Even before there was a government exchange. We are also blessed with excellent insurance. Thank goodness because stuff happens. My husband never smoked, isn't overweight, and rarely drinks more than an occasional beer every now and then and is quite active. He contracted a virus that attacked his heart and his ejection fraction which should normally be around 50% in healthy people was 8%. A dead man walking basically. He went directly to cardiac ICU in a wheelchair because they didn't want him walking. (He planned on going to work that day) We were told 30% of people get worse which equals death, 30% of people stay the same, both which meant death or heart transplant and about 30% of people get better. Hospice met with us and he began medications, had to wear an external defibrillator to shock his heart into rhythm, and rehabilitation. He was lucky that he kept getting better and now, three years later is in the low normal range, although he will need medicine for the rest of his life and gets an echocardiogram every six months. My biggest point is we had to fight the insurance company every single month for continuous coverage, even with a "Cadillac" healthcare plan and if we didn't have insurance he would absolutely be dead. Hospitals are only required to stabilize a person, not treat them if they can't afford healthcare. Nothing makes us more deserving of healthcare and life than anyone else. Healthcare should be a basic human right, not how lucky you are to have a well paying job with a company who has enough employees to get discounted health insurance and provide it.

[KrissiK]

Did anyone else's rates increase dramatically this year? It looks like we will now be paying about $450 more a month for less coverage :/

Oh yeah. It almost tripled. Still high deductible and co-pays. That was when we decided to go with Medi-Share. We absolutely could not afford to pay that high of health insurance premiums. Edited January 15, 2016 by KrissiK

[heartlikealion]

Thank you for starting this thread. We were freaking out about it tonight. I am not on the same ins. as dh because it didn't make sense at the time, but now we have to re-evaluate our options.

[creekland]

Thank you for starting this thread. We were freaking out about it tonight. I am not on the same ins. as dh because it didn't make sense at the time, but now we have to re-evaluate our options.

 

Not sure if it would work for you or not, but if so, be sure to check out the health sharing groups.  I can personally vouch that Samaritan Ministries has worked well for us for over a decade including some significant issues and perhaps another on the way.  If we'd still been with the insurance we had prior to switching, we'd have been out multiple thousands of dollars (literally) due to the deductible, their only paying 80% up to an OOP max, and higher monthly premiums (approx $500/month more) to start with.

 

I shudder when I think about it - which is pretty much whenever someone starts a thread like this and I see what the alternative is like (or something similar happens at school).

 

BUT, health share groups only work for active Christians, plus one has to consider carefully if there are pre-existing conditions, or expensive prescriptions are needed.  It works better for us.  It's not necessarily going to work better (or even be an option) for others.

 

I'll also fully admit I enjoy sending my monthly share to another person/family instead of a nameless corp with overpaid executives.

 

And I still say I wish our country had a system that worked at least basically for everyone.  We don't have anything close to that now, nor did we before ACA.

[Scarlett]

Not if it's qualified as too expensive. Our premiums would be over $2,000 and the deductible was something like $11,000. I don't remember the OOP max, but the co-insurance was 20 or 30%.

 

Many people assume you can only purchase on the exchange if you're low income. We're not. We're just not $35k-for-insurance income!

Right. If your employer cost is more than a certain percentage of income you can use the exchange.

 

With dhs last job the amount fir him was not expensive but for me it was. I finally figured out I could apply through the exchange for just myself ( still listing dhs income though) and it let me get a small subsidy.

[MSNative]

Our insurance costs were increasing some before ACA and are now increasing much more.

 

Our system was and continues to be inefficient and costly both before and after ACA. I feel like the ACA is almost the worst of all options. We could have studied other countries' socialized healthcare systems and crafted one that tried to take the best bits of them and avoid some of the major pitfalls. Or we could have tried reducing regulation and making health insurance more like auto insurance. Or we could have allowed states to try their own options. Instead we got this confusing and divisive system foisted on us. Some people were helped but some people were hurt by it so we didn't even get health care for all but we are sure paying enough to provide health care for all (and I think we probably were before the ACA too.)

And I blame both parties and the media and us, the voters and buyers who respond to this. We seem to be governed by sound bites and anger. It's all about the "gotcha" moment and painting the opposition as enemies rather than sitting down and rationally discussing the issue and trying to come up with solutions and recognizing that your side isn't always right and your way isn't always what is going to prevail.

Sorry. Rant over. This is just such an important issue and it drives me nuts that our politicians seem more interested in demagoguing rather than working together to find solutions.

[heartlikealion]

Not sure if it would work for you or not, but if so, be sure to check out the health sharing groups.  I can personally vouch that Samaritan Ministries has worked well for us for over a decade including some significant issues and perhaps another on the way.  If we'd still been with the insurance we had prior to switching, we'd have been out multiple thousands of dollars (literally) due to the deductible, their only paying 80% up to an OOP max, and higher monthly premiums (approx $500/month more) to start with.

 

I shudder when I think about it - which is pretty much whenever someone starts a thread like this and I see what the alternative is like (or something similar happens at school).

 

BUT, health share groups only work for active Christians, plus one has to consider carefully if there are pre-existing conditions, or expensive prescriptions are needed.  It works better for us.  It's not necessarily going to work better (or even be an option) for others.

 

I'll also fully admit I enjoy sending my monthly share to another person/family instead of a nameless corp with overpaid executives.

 

And I still say I wish our country had a system that worked at least basically for everyone.  We don't have anything close to that now, nor did we before ACA.

 

I have to look into it. I don't know what this means exactly. Like attend church regularly? Only one of us does.

 

[creekland]

I have to look into it. I don't know what this means exactly. Like attend church regularly? Only one of us does.

 

 

Yes, in general, that is what it means, so it's not likely to work for y'all.

 

I wish more of these could be set up surrounding different central foundations (occupations, cat lovers, etc, etc, etc) as I'm fully convinced that non-profit is the way to go, but Congress, in their wisdom, said it can't happen.  (sigh)  All groups allowed had to have been in existence at a set period of time.

 

Of course it can't happen... get a working model and try to make it work for more by making some basic modifications?  Such foolishness!   :glare:

[ChocolateReignRemix]

Yes, in general, that is what it means, so it's not likely to work for y'all.

 

I wish more of these could be set up surrounding different central foundations (occupations, cat lovers, etc, etc, etc) as I'm fully convinced that non-profit is the way to go, but Congress, in their wisdom, said it can't happen. (sigh) All groups allowed had to have been in existence at a set period of time.

 

Of course it can't happen... get a working model and try to make it work for more by making some basic modifications? Such foolishness! :glare:

It isn't the way to go as those models only work as a low cost option when they can restrict access and coverage.

[heartlikealion]

Yes, in general, that is what it means, so it's not likely to work for y'all.

 

I wish more of these could be set up surrounding different central foundations (occupations, cat lovers, etc, etc, etc) as I'm fully convinced that non-profit is the way to go, but Congress, in their wisdom, said it can't happen.  (sigh)  All groups allowed had to have been in existence at a set period of time.

 

Of course it can't happen... get a working model and try to make it work for more by making some basic modifications?  Such foolishness!   :glare:

 

Maybe he could stay on his own insurance like now and since I have an individual plan, maybe I can apply for it on my own? I have to read more about it. I currently have a plan with BCBS and it just jumped up a lot.

 

[creekland]

It isn't the way to go as those models only work as a low cost option when they can restrict access and coverage.

 

That's where I would tweak these types of systems and have the federal gov't (aka all of us) take over paying for all of those with medical needs exceeding a million dollars per situation and just let groups handle those with normal costs.  They do extremely well - far better than insurance (even when insurance could reject certain individuals) with all things normal.

 

But one would need enough groups for all to fit in with one or another.  Obviously not all fit in with Christianity as the center.

 

Maybe he could stay on his own insurance like now and since I have an individual plan, maybe I can apply for it on my own? I have to read more about it. I currently have a plan with BCBS and it just jumped up a lot.

 

 

Yes, you can certainly apply as an individual.  Several folks opt for this in situations where it fits one better.

[ChocolateReignRemix]

That's where I would tweak these types of systems and have the federal gov't (aka all of us) take over paying for all of those with medical needs exceeding a million dollars per situation and just let groups handle those with normal costs.  They do extremely well - far better than insurance (even when insurance could reject certain individuals) with all things normal.

 

That isn't a tweak - it is a substantial change to how healthcare sharing services currently operate.

[creekland]

That isn't a tweak - it is a substantial change to how healthcare sharing services currently operate.

 

The one I belong to, with the option we've chosen has no max.  I'm very thankful!  They're improving acceptance of pre-existing deals too.

 

But yes, there are major changes I would make to "better" our health care system as I'm not convinced the gov't is the best option for all.  That's really for a different thread though, since folks on here are contemplating real options they can make now.  It's just part of the "I wish" rabbit trail.

 

With that, I wish all had access to good health care in an affordable way.

[amyx4]

Well as of this week, I've "used up" all my dental benefits for the year 2016. I was in tears this week.  The benefit is $1500 per year. Minus the Jan. cleaning/xrays of a painful tooth. 1500-250=1250. Then I get a root canal  1250-760=510 left in my benefits for the year. So then I need a cap which is costs 1690. So 1690 minus rest of my benefits 510 is a $1180 balance. And the office asks if I want that appointment in two weeks? Heck ya, I can come up with 1180 in two weeks. Oh and BTW you'r next 6mos cleaning won't be covered or anything else that could happen in 2016!

I grew up with lousy dental care, so much of what is being done now is directly related to that. We've always paid in full at each medical visit for us or the kiddos but in the last year we've just been shocked at the bills. BTW  We're a healthy family with no Rx.

The amount we spent OOP in 2015 is the most we've ever paid. I'm struggling to figure out how to budget for 2016. In reality, I'm trying to figure out what to cut out of the 2016 budget. I always think we live frugally but I just don't know anymore.

 

Edited January 15, 2016 by amyx4

[kewb]

These threads make me laugh to myself. Maybe it is because I am old and have been through so many health care changes. From only having major medical and you didn't go to the doctor until you were truly ill. To go to the doctor for every little sniffle. To HMOs to health spending accounts. To the Aca. From getting a job that provided health benefits was a big deal to employees now having to chip in for this benefit. Throughout all of it my premiums went up and my benefits went down. It is not because I am paying to take care of someone who made poor life choices. It is because healthcare is a for profit industry. Every decision the insurance company makes is to increase profits for their shareholders. It has nothing to do with your health or lack of it. I know someone whose insurance company told them they were no longer going to pay for a specific medicine because it would be less expensive for then to pay for the hospital stay if he got an infection then to prevent the infection. The amount in lawyers fees to fight it were extensive. It boggles my mind that so many people do not see this as the problem.

Edited January 15, 2016 by kewb

[KrissiK]

Yes, in general, that is what it means, so it's not likely to work for y'all.

 

I wish more of these could be set up surrounding different central foundations (occupations, cat lovers, etc, etc, etc) as I'm fully convinced that non-profit is the way to go, but Congress, in their wisdom, said it can't happen. (sigh) All groups allowed had to have been in existence at a set period of time.

 

Of course it can't happen... get a working model and try to make it work for more by making some basic modifications? Such foolishness! :glare:

Well, one of the reasons these groups work is because they can pick and choose people who are generally more healthy or more likely to be healthy. And generic common interests do not always mean healthy life style choices. Though of course nobody likes to talk about the generalizations these companies make, because we all feel like we are the exception to the generalization. "I am not a church member, but I have an extremely healthy lifestyle". But, the generalization must be true enough or these companies wouldn't have the rule and wouldn't be able to make a go of it. Edited January 15, 2016 by KrissiK

[heartlikealion]

Well, one of the reasons these groups work is because they can pick and choose people who are generally more healthy or more likely to be healthy. And generic common interests do not always mean healthy life style choices. Though of course nobody likes to talk about the generalizations these companies make, because we all feel like we are the exception to the generalization. "I am not a church member, but I have an extremely healthy lifestyle". But, the generalization must be true enough or these companies wouldn't have the rule and wouldn't be able to make a go of it.

 

I read through the statement of faith and the requirements. Examples of requirements were non smoking and moderate (I think?) drinking allowed. That caught me off guard at first because you could be Christian and smoke.

 

[creekland]

Well, one of the reasons these groups work is because they can pick and choose people who are generally more healthy or more likely to be healthy. And generic common interests do not always mean healthy life style choices. Though of course nobody likes to talk about the generalizations these companies make, because we all feel like we are the exception to the generalization. "I am not a church member, but I have an extremely healthy lifestyle". But, the generalization must be true enough or these companies wouldn't have the rule and wouldn't be able to make a go of it.

 

Perhaps you're right, but in the circles I'm in (only one of which is church based - another is neighbors and a third comes from work friends) I can't really see a difference in health issues, but then again, no one in any of my circles smokes, so who knows?  I know I feel I've had my share of claims - and there are probably more on the way.  I'm not quite sure what I did wrong...

 

But even so, any of these groups - to get their member monthly share amount - just needs to get a feel for how much is submitted monthly and share it.  I suspect a big part of it is purely statistical studies.  People would be able to choose what group they wanted to belong to based upon what is covered/not and what one needs to do to belong (like not smoking or whatever).  

 

Enough groups would provide enough options and by taking the "for profit" part out plus letting us all chip in for major cases (via taxes), all would still save in the long run.

[leeannpal]

Look up the cost of diabetic care and the % of the population that does not have the genetic version. Relate that back to what you are paying in taxes and premiums. Diabetes is a choice for many. Ignoring the doctor and the nutritionist is a choice. It adds up over the years, in terms of pounds. Then you, the taxpayer, start paying for complications such as knee and hip surgeries, transportation, specialists, extra help at the hospital, the rehab center, and the nursing home since the excess weight has to be accomodated.

Same exercise for tobacco users, alcoholics, etc. Choice matters. That money could be spent finding out how to prevent or cure genetic diseases.

 

As a person with Type II Diabetes, I get really tired of hearing that my Diabetes is all my fault. I was diagnosed with PCOS and a wonky metabolic system in my 20s when I was young, fit and slim. I lived overseas and walked everywhere. I knew from early on that my chances of eventually developing Diabetes were higher than average. During my pregnancy, I developed Gestational Diabetes which upped my risk even more. Fast forward 8 years, and my pre-diabetes went to full-blown Diabetes AFTER I lost 20 pounds while once again living overseas where I did not own a car. We walked everywhere, and I was certainly in better shape than I had been for years.

 

Some people erroneously believe that Type II Diabetes does not have a genetic component. I believe fully that it does, as I have a grandparent, an uncle and a cousin who have also developed Type II Diabetes later in life.

[freesia]

As a person with Type II Diabetes, I get really tired of hearing that my Diabetes is all my fault. I was diagnosed with PCOS and a wonky metabolic system in my 20s when I was young, fit and slim. I lived overseas and walked everywhere. I knew from early on that my chances of eventually developing Diabetes were higher than average. During my pregnancy, I developed Gestational Diabetes which upped my risk even more. Fast forward 8 years, and my pre-diabetes went to full-blown Diabetes AFTER I lost 20 pounds while once again living overseas where I did not own a car. We walked everywhere, and I was certainly in better shape than I had been for years.

 

Some people erroneously believe that Type II Diabetes does not have a genetic component. I believe fully that it does, as I have a grandparent, an uncle and a cousin who have also developed Type II Diabetes later in life.

This completely--but I don't have PCOS. I exercise regularly, an normal weight, eat very low carb but struggle with insulin resistance which is slowly getting worse. I have a parent, grandparent, and at least one great grandparent who had type 2. Meanwhile I have morbidly obese friends who also have terrible diets ( not meaning all morbidly obese folks have horrible diets-but these do) and who have fantastic blood sugar numbers.

[Spryte]

As a person with Type II Diabetes, I get really tired of hearing that my Diabetes is all my fault. I was diagnosed with PCOS and a wonky metabolic system in my 20s when I was young, fit and slim. I lived overseas and walked everywhere. I knew from early on that my chances of eventually developing Diabetes were higher than average. During my pregnancy, I developed Gestational Diabetes which upped my risk even more. Fast forward 8 years, and my pre-diabetes went to full-blown Diabetes AFTER I lost 20 pounds while once again living overseas where I did not own a car. We walked everywhere, and I was certainly in better shape than I had been for years.

 

Some people erroneously believe that Type II Diabetes does not have a genetic component. I believe fully that it does, as I have a grandparent, an uncle and a cousin who have also developed Type II Diabetes later in life.

 

Yep.  Another one diagnosed with PCOS, Hashimoto's, Adisson's Disease and more - all interconnected and according to my doc are likely the result of long-term undiagnosed infections from ... ticks.  The ticks were the result of a healthy lifestyle.I was ultra healthy.  All through my twenties - backpacking, trekking, major outdoors sports, vegetarian, diet was organic, sugar-free.  Very fit.  Guess what that exposed me to?  Ticks.  Lots of them.  By the time the docs figured out what was wrong I had been misdiagnosed with MS and more diseases for years.  The damage was done.  I'll never be the same.  And I am pre diabetic now, to boot, because diabetes is connected to all of these issues, or souvenirs, from long-term infection.  

 

People who talk about eating right and making healthy choices forget that there are other components to health, many of which are out of our control.  It's like saying that if you wear your seatbelt, you won't be hurt in an accident.  Accidents and injuries still happen, but the seatbelt increases your chances of a better outcome.  It's not a guarantee.

[PrairieSong]

I read through the statement of faith and the requirements. Examples of requirements were non smoking and moderate (I think?) drinking allowed. That caught me off guard at first because you could be Christian and smoke.

 

I don't think they are saying you aren't a Christian if you smoke. They don't allow smokers because smoking increases your risk for cancer, heart disease, high blood pressure, all kinds of things. It would greatly increase the cost of the health sharing for everyone and smoking is a choice. No one has to smoke.

[RebeccaS]

Ok so we aren't alone.  The deductible keeps climbing too :(  It just seems like a crazy amount. 

 

As far as bad lifestyles ....  I remember when we never went to the doctor.  I have always been extremely careful about my family's food choices (all natural, healthy, real foods) and we always got plenty of sunshine and exercise.  I thought that this lifestyle was the magic ticket to health.  In the last 4 years not 1, not 2, not 3, but 4 of us have been diagnosed with tough autoimmune diseases that involve specialists, etc.  Cherish your health.  I did all imaginable to make sure we kept ours but unfortunately good choices aren't always a guarantee.   

 

:grouphug:  :grouphug:   I joked about my unhealthy family.  I understand.  My oldest dd was diagnosed with Type 1 diabetes almost 4 years ago.  Dh was diagnosed with Parkinson's this past November.  Two chronic conditions that require lots of monthly meds and supplies.  I have kids with other issues that I won't get into here, but I know that my family costs the health insurance companies a lot.  Of my 7 family members, 6 of us are on some kind on ongoing monthly med and regular specialist visits.  I did not imagine I'd need an app to keep all our meds straight.  This wasn't what I envisioned when I dreamed of my future family when I was kid.  lol  "I wanna have 5 kids and I want at least 4 of them to have chronic health issues..."  :lol:

[heartlikealion]

I don't think they are saying you aren't a Christian if you smoke. They don't allow smokers because smoking increases your risk for cancer, heart disease, high blood pressure, all kinds of things. It would greatly increase the cost of the health sharing for everyone and smoking is a choice. No one has to smoke.

 

Oh I didn't mean to imply that! I just meant that it caught me off guard like I could see that being really disappointing to someone ready to sign up and then saying, "crap, I can't get this insurance because I smoke? I meet the other requirements!"

 

Edited January 15, 2016 by heartlikealion

[EMS83]

We lived in Canada for 8 years and I agree with you. It was such a blessing when we had any health issues-or a child in NICU--to not have to worry about asking every doctor if they were on our plan, or worrying about extra fees or hospital use fees ($300 extra b/c the doctor's office was IN the hospital) etc. The US system drives me nuts. And for the record, our insurance hasn't changed that much in the last 8 years. We are a 'small group" and it has always been around $18,000 a year. We get less in some areas now and more in other areas. What is driving me more crazy is the constant cancelling and reworking of plans.

 

The amount that the CEOs make is also driving me crazy. Things can/should be much more straight forward than this.

 

How much access did you have in Canada?  Could the patient request tests, treatments, etc.?  Did it cover dental, vision, and chiropractic?  Naturopaths and nutritionists?  I'm not trying to grill you; I've always been curious what all one has access to in exchange for the single payer system.  

 

As for our system, my in-laws' insurance was going to go up $500/month to a whopping $1600/month.  They got on the exchange and are now paying $500 or $600/month.  Our insurance didn't go up at all because we aren't insured.  It costs us less each year to just pay them directly than it would to pay a premium and whatever the insurance company's negotiated rate is until we meet our deductible (which we likely never would).  If anything changes, perhaps we'll take another look at the exchange.  But for now, we file our tax return, and pay our bills ourselves.  The one recurring expense we have did go up last year by 5% (it's a low dollar amount, though).  And I noticed our local Minor Med stopped offering a discount for established patients, but it was recently bought out by a bigger medical establishment.

 

I have to point out that people being subsidized on Medicaid have severely limited access and cannot incur personal expense (ex.: you want to visit a doctor that doesn't accept Medicaid--too bad).  Some urgent care places will look the other way, but most "out of network" doctors will not even accept a Medicaid patient wanting to pay cash.  They could be sued.  Doctors who think outside the box and might possibly have a more holistic view of things don't generally accept these programs.  The whole thing is depressing.  It's hard to naturally want to make "the right" choices when you feel bad about yourself.  The drive has to come from somewhere else--faith, love, rebellion, whatever.

[Guest]

I read through the statement of faith and the requirements. Examples of requirements were non smoking and moderate (I think?) drinking allowed. That caught me off guard at first because you could be Christian and smoke.

 

Also, only certain types of Christians are welcome. Catholics and Mormons need not apply, iirc.

[freesia]

How much access did you have in Canada?  Could the patient request tests, treatments, etc.?  

 

We had great access. We had a doctor and there were clinics all over that we could go to (like urgent care) if the doctor's office was closed. There was no extra fee for this--just show your card. We had no trouble finding doctors--but I had heard on the news that some folks had to use the clinics b/c the doctors weren't taking new patients. I could, and did, request a sleep study when I was pregnant and got one. I got to go to a breastfeeding clinic when ds was tongue tied, had weekly doctors visits at a gestational diabetes clinic, midwives were covered, ds's nicu stay. I think we payed ambulance and a larger ER fee if no admitted.

 

 

Did it cover dental, vision, and chiropractic?

Vision was originally covered, but dropped. Dh's employer had an add on policy that covered dental and chiropractic.

 

 Naturopaths and nutritionists?  

 

I can't remember the answer to this. I did see a naturopath,but may have self paid. It covered the nutritionist I needed to see with GD.

 

We did have drugs covered, but I know the coverage was less and less over the years. The supplemental may have helped with this.

 

 

I'm not trying to grill you; I've always been curious what all one has access to in exchange for the single payer system.

 

I totally understand. I know the biggest problem people around me had was long waits for some procedures. That did not effect us. For what we needed as a regular family who had some extraordinary needs (I had high blood pressure my first pregnancy and was on bedrest with visiting nurses and extra tests, hemorraged with my second, third had a Nicu stay, ds had an anaphylactic allergic reaction that landed him in the hospital) it was more than fine. Oh, and I had to have tests for my heart at one point. Everything was covered under our monthly (maybe 120 dollar) fee. Every hospital took our card, every doctor, every x-ray place, every lab --everywhere with NO hidden fees.

 

Seriously, coming home was a bit of a nightmare learning curve. I still can't BELIEVE that things like your doctor poking his head in to your hospital room while dd was admitted (not by him) is charged. I didn't ASK him to come, he didn't ASK if I wanted him. And the extra fees for where the offices are, and the doctors that help your doctor but aren't under your insurance, but no one told you they would be there. They should have to ASK to serve you,not you have to guess at who might show up.

 

And don't even get me STARTED on the hours on the phone making sure that the insurance companies actually pay what they say they will (some reject all high charges and wait for you to fight them).

Edited January 16, 2016 by freesia

[PrairieSong]

Also, only certain types of Christians are welcome. Catholics and Mormons need not apply, iirc.

I don't know about Mormons, but Catholics can be members of Samaritan Ministries. There is also a Catholic arm of SM called CURO. If you are a CURO member you are automatically a member of Samaritan, or you can just join Samaritan.

 

I'm not sure about Medi-Share.

[PrairieSong]

Well, our issue of being overcharged $250/month was resolved after our rep spent THREE HOURS on the phone. She finally figured out the issue by talking to an insurance rep friend of hers in another city. When we filled out the paperwork for the new plan, we had to write in the name of the plan, which had the city name on the end of it!!! I don't even remember seeing that. So, since I did not write Whoville on the end, we were in a different plan.

 

Sheesh. I called the insurance company several times. Even a supervisor in the billing dept. could not tell me what was wrong. He just said we were paying the correct amount for the plan we had. I had offered to forward him the proposal my rep emailed me, but he said no, that's not necessary. Maybe if I had he would have noticed the problem. But maybe not.

 

Bad news is we don't get our extra $250 back for January. Good news is our premium for February should be the correct amount. We still might go with the health sharing option.

[ChocolateReignRemix]

 

I have to point out that people being subsidized on Medicaid have severely limited access and cannot incur personal expense (ex.: you want to visit a doctor that doesn't accept Medicaid--too bad).  Some urgent care places will look the other way, but most "out of network" doctors will not even accept a Medicaid patient wanting to pay cash.  They could be sued.  Doctors who think outside the box and might possibly have a more holistic view of things don't generally accept these programs.  The whole thing is depressing.  It's hard to naturally want to make "the right" choices when you feel bad about yourself.  The drive has to come from somewhere else--faith, love, rebellion, whatever.

 

Source for the bolded? 

 

The actual rule is that a doctor who accepts Medicaid cannot accept cash from a patient for a service covered by Medicaid (excluding co-pays obviously).  Why?  This helps prevent Medicaid fraud as doctors could charge the patient and also run the charge through Medicaid.

 

If a doctor does not accept Medicaid, or a patient wants/needs a service not covered by Medicaid, the patient has the same right to purchase that service as anyone else would have.

 

I don't have time to search all of the rules, but New Jersey has a handy chart for NJ Medicaid recipients that explains how pays for what. 

http://www.nj.gov/humanservices/dmahs/home/Medicaid_TPL_Coverage_Guide.pdf

[ChocolateReignRemix]

Well, our issue of being overcharged $250/month was resolved after our rep spent THREE HOURS on the phone. She finally figured out the issue by talking to an insurance rep friend of hers in another city. When we filled out the paperwork for the new plan, we had to write in the name of the plan, which had the city name on the end of it!!! I don't even remember seeing that. So, since I did not write Whoville on the end, we were in a different plan.

 

Sheesh. I called the insurance company several times. Even a supervisor in the billing dept. could not tell me what was wrong. He just said we were paying the correct amount for the plan we had. I had offered to forward him the proposal my rep emailed me, but he said no, that's not necessary. Maybe if I had he would have noticed the problem. But maybe not.

 

Bad news is we don't get our extra $250 back for January. Good news is our premium for February should be the correct amount. We still might go with the health sharing option.

 

Wait...they acknowledged they over charged you but are not refunding the amount you overpaid?

 

[freesia]

Wait...they acknowledged they over charged you but are not refunding the amount you overpaid?

 

Echoing this---what?!?!?

 

If they had undercharged you they sure would bill you. If it was there mistake and not yours they refund you.

[PrairieSong]

Wait...they acknowledged they over charged you but are not refunding the amount you overpaid?

 

Echoing this---what?!?!?

If they had undercharged you they sure would bill you. If it was there mistake and not yours they refund you.

That's what my insurance rep told me. She works for the small business organization we belong to, not for the insurance company. They told her that since we were enrolled in the more expensive plan since we left out ONE WORD on our form, we will not be refunded. In other words, it was our fault, not theirs.

 

ETA: You're right. If they had undercharged us, even if it was THEIR mistake, they'd be billing us. So since it was our mistake, I should just send a letter of explanation and deduct the $250 from next month's premium payment. I'm sure that'd fly. :::eye roll:::

Edited January 16, 2016 by PrairieSong

[ChocolateReignRemix]

That's what my insurance rep told me. She works for the small business organization we belong to, not for the insurance company. They told her that since we were enrolled in the more expensive plan since we left out ONE WORD on our form, we will not be refunded. In other words, it was our fault, not theirs.

 

ETA: You're right. If they had undercharged us, even if it was THEIR mistake, they'd be billing us. So since it was our mistake, I should just send a letter of explanation and deduct the $250 from next month's premium payment. I'm sure that'd fly. :::eye roll:::

 

Okay, that is actually a bit different.

 

What they are claiming is that you were actually enrolled in the more expensive plan, and they are moving you into the cheaper option.  That is technically different than actually overcharging you as from their position you were purchasing the benefits of that plan.

 

I would pursue it further if you can prove you did try to inform them of the mistake before January, which it looks like you did.

 

[PrairieSong]

Okay, that is actually a bit different.

 

What they are claiming is that you were actually enrolled in the more expensive plan, and they are moving you into the cheaper option. That is technically different than actually overcharging you as from their position you were purchasing the benefits of that plan.

 

I would pursue it further if you can prove you did try to inform them of the mistake before January, which it looks like you did.

 

No, I didn't. I only knew about the mistake in January when I saw the amount they deducted from our bank account.

 

Yeah, I can sort of see their point but it is still frustrating. I did exactly what the insurance rep told me. She was on the phone with me telling me exactly what to write. She didn't catch it either. So, it is sort of her mistake, but I don't think the insurance company will refund me based on that.

[Soror]

We did have ridiculously cheap insurance, like $30 a month family plan and no deductible back when my 11yo was born. Rates have been increasing yearly for the last several years with a high deductible as well, this year we finally got a break with no increases or changes in coverage. When they started these increases they also opened a clinic on-site which charges just $5 a visit with free lab work, irregardless of who orders it. ACA has further helped with the inclusion of routine procedures. I know we are lucky, dh's insurance coverage, even now at the much higher rates than before is still fabulous compared to so many places.

 

I'm for universal coverage. I think health insurance should be a right, not a privilege. I do think it is disingenious to act like lifestyle choices make no great difference to health and medical costs. Of course there are medical issues without cause (I have auto-immune diseases myself and my husband has had 2 major surgeries due to complications from him being born with 1 kidney) but there is no denying various lifestyle choices are responsible for many health problems. Yes, some people are diabetic or have lung cancer due to genetics or bad luck but  we know that morbid obesity, smoking, excessive drinking, etc etc increase health costs. No, that doesn't mean we leave smokers high and dry if and when they get lung cancer. This is one of the big questions to solve, how can we use what we know about decreasing med costs through lifestyle changes without impinging on personal freedoms?

[ChocolateReignRemix]

No, I didn't. I only knew about the mistake in January when I saw the amount they deducted from our bank account.

 

Yeah, I can sort of see their point but it is still frustrating. I did exactly what the insurance rep told me. She was on the phone with me telling me exactly what to write. She didn't catch it either. So, it is sort of her mistake, but I don't think the insurance company will refund me based on that.

 

I would still press it a little, but there it is probable they won't refund the money.

[creekland]

It costs us less each year to just pay them directly than it would to pay a premium and whatever the insurance company's negotiated rate is until we meet our deductible (which we likely never would). 

 

Can't help but add a word of caution to this.

 

Most years - essentially all years - before the big one hit, this was us too.  And we couldn't foresee the big one.  And it might not be the last big one.  

 

And no, hospitals do not need to do more than the basics for you if you can't pay for it.  Many treatments for big ones aren't basic.

 

Some can go the charity route - esp for kids - but honestly, those who opt for that route when they could have paid for insurance/health share but chose not to bug me far more than subsidizing Twinkie eating, beer guzzling, porch sitters who share costs in the system.

 

Both insurance and health shares work by looking at the odds and saying X number of people will have needs that will cost ____ amount total.  We'll split that up so it all gets covered.  They differ with insurance being for profit, so needing to take a percentage off the top to pay their CEOs and stockholders.  It really isn't right to say I'll wait and see if I get hit by those odds, then I'll expect others to start paying for me, but I'm too cheap to do it for them.

 

We paid less to be in the system for years - insurance, then health share once I saw the benefits of it - but I have no regrets.  Honestly?  I wish we were still paying less and subsidizing others - except for not wanting issues to happen to others either.

[DawnM]

I thought ours had jumped up and additional $150/mo but DH informed me that it has been steadily going up for the last 8 years......it gets taken out of his check before we see the $$ so I didn't know.

 

Our deductible has gone up some.  Not a huge amount, but some.

 

Specialists $35/visit vs. $20 before.  Copay at doctors' offices $20.  Was $10, then $15.

 

But what I am very happy about is that they increased the amount to pay for out of network.   That will help us a lot since my oldest sees some folks out of network.

[foxbridgeacademy]

Our premium hasn't gone up but our co-pay has a bit.  We have pretty good insurance that's less than $200 per month for everything.  Because of my illness we really can't go without it like we used to.  We'll either be sticking with DH's current company or future employers will have to match benefits or pay the difference in salary.

[EMS83]

Source for the bolded? 

 

The actual rule is that a doctor who accepts Medicaid cannot accept cash from a patient for a service covered by Medicaid (excluding co-pays obviously).  Why?  This helps prevent Medicaid fraud as doctors could charge the patient and also run the charge through Medicaid.

 

If a doctor does not accept Medicaid, or a patient wants/needs a service not covered by Medicaid, the patient has the same right to purchase that service as anyone else would have.

 

I don't have time to search all of the rules, but New Jersey has a handy chart for NJ Medicaid recipients that explains how pays for what. 

http://www.nj.gov/humanservices/dmahs/home/Medicaid_TPL_Coverage_Guide.pdf

 

Maybe on paper.  I've been told "no" more than once by more than one practice.  Maybe it varies by state, but case law, multiple "out of network" doctors, and the Medicaid program's own representative all said "you can't do that."  And yes, I offered to sign something stating my willingness to pay.  Also from the rep: "no, you can't switch to another Medicaid program that includes the doctor you want because you missed the window two months ago" (before I knew I needed that specialist); "try again in 10 months."  I wanted that specialist and I needed him right then.  My two-year-old had a fairly severe systemic reaction to 3-4 fire ant bites.  After that conversation with the program rep, we dropped.

 

The System doesn't handle unusual circumstances or requests.  There's no mechanism for handling irregular income, for example.  And the above-mentioned situation.  The people dispensing it have zero power to manipulate it.  There's no one to call favors in to.  I did run into one after-hours clinic that billed us as self-pay.  But every other practice I talked to wouldn't do that.  Either for patients or for services: I wanted to adjust our well check schedule at our pediatrician, and they said we couldn't, even at my own expense (they have to be at least 12 months apart, so if you are late one year, good luck fixing it the next).  I suppose it could be billed as a consult, if an office were willing to do that.  That's not entirely honest, though.

 

It's just...there's always more than meets the eye, nothing's ever really free, etc., etc.  Maybe I didn't argue hard enough; I have no idea.  But I shouldn't have to argue to see my preferred doctor at my own expense.  That's just wrong.