Health Insurance

[merlinmagic4]

I found the health insurance talk interesting on the "economy" thread so I thought I would bring it here.

What kind of coverage do you have and how much do you pay? We have the great insurance (BCBS of Mass) and pay about 125.00 week or 6500.00 per year.

Our doctor's visits are only 5.00 although most of our prescriptions are 25.00 (some are as low as 5 but not the ones we need!). We don't have a deductible.

I also wanted to note that people with health insurance can still become overwhelmed with costs associated with medical care. Having insurance does not protect you from many other costs associated with major illness/surgery/etc. I can definitely see a family with lesser means than ours facing serious financial problems if, say, their child had to have an organ transplant or go through cancer treatments. So, it is not only the uninsured people who risk losing it all for serious health problems. You can be completely responsible (having a house you can afford, good health insurance, older cars) and STILL run into trouble with when faced with medical issues. I just had to say that.

[gauvin4]

I am one of the fortunate ones that has my health coverage for my whole family paid by my employer at a cost of $1440.00 per month. I have good insurance (Anthem/BCBS of Maine) The health insurance is the main reason I am still at this job. I have, at times, gone without insurance (when we were covered through my husbands employer) because we could only afford to get it for the kids or for a time the whole family was without insurance. So I guess for the things (and people) that drive me crazy at my job, I will put up with it if it means we have insurance.

I know that in the future I may have to start paying for the insurance. All good things do eventually come to an end.

[murphy1]

Kelly, you said so many great things. I have a medical condition ( I have thyroid disease and an autoimmune form of it called "Hashimotos thyroiditis). I see my dr. every three to six months for care. I had half of my thyroid removed for a nodule with abnormal cells and now am going through watching the other side, so we might be facing another surgery. My treatment is "cheap" compared to others. But I will always depend on medical care, medication and health insurance. I have always been a very healthy, active and athletic person, too, so it upsets me to see people abuse drugs and do bad things to their body. Our insurance is filed, but we have to meet a deductible, sometimes have to pay a copay and sometimes don't and we pay different amts for prescriptions. When I was out of school, I had no health insurance, it was too expensive, so I see why some people have to do that. I can never go without it now.

I hope your son is doing well! My neighbor had a kidney transplant about 9 years ago and is still doing well. Yes, I am an organ donor!!

[Ian]

That is a good point about the potential for catastrophic health care costs even for the insured ... I've heard of that happening before, especially in the case of transplants.

Anyway, to respond to the OP's question ... we have Blue Cross of Minnesota. I pay, for family coverage, just a shade over $400 a month. That's for health insurance, dental, and vision care. My company picks up the balance of the expenses, which are approximately $900 a month additional.

Our coverage isn't great ... probably average. We have $25 copays, $25 prescription copays (with enforced use of generics whenever possible), but no annual deductible amount.

[murphy1]

I just checked on our, it's $800 a month out of the paycheck and then we are OOP the additional co-pays, prescrips, etc.

[Jimenyfan]

We are a family of 4 and pay just over $200 a month for our health care, its also pre-tax dollars so there is a small tax savings that brings the cost down a little.

We have BCBS of SC, medical,dental,vision. $25 co-pay and our prescriptions range from $5.00-$40 depending on the generic vs. name brand.

[princessjojo]

I can so go along with working not for pay or pleasure of the job, but for health insurance alone. When our boys were hurt in late 2004/early 2005 it was completely unexpected. DH was the only one working at the time because I was intending to go back to nursing school at that time. You would not believe how quickly medical expenses can rack up. And many times no one gives a second thought to their lifetime max. We do now because of their accident. In a 12month period, our medical bills exceeded at tax time $879,000. Try paying that bill on 1 income. But thanks to our less than par insurance plan at the time, and my obsessive compulsive needs, we only were responsible for a fraction of that amount. It was still more than I would have liked, and more than our income for 1 year as a 2 income family, but it wasn't $879k.

DH's company pays his premiums 100%, but not family. We average about $350/month. With that we have $25 co-pays for routine & specialist visits, $15/$25/$50 prescription co-pay after $400 deductible, $75 ER unless admission, all covered as in-network. Out of network is a standard 80/20 or 70/30 depending on location and services. There is a family deductibe with the in-network plan as well of $3000, but not under out of network. It does cover vision, dental, orthodontia, and mental/behavioral health services with max of 30visits/yr. as well as physical & occupational therapy maxing out at 120visits/year. With us, the kicker was our hospital was in network, but many of the doctors who treated us were out of network. If you're smart, you can get it appealed and have insurance pay it as in network, because in that setting you rarely have a choice of physicians.

And yes if it were to happen today, our choices may be different because of the economy. We wouldn't drive to Chapel Hill 3-5 day/week for therapy and clinic. We possibly couldn't have kept our home if it would have been like today. But it wasn't this bad then. And things worked themselves out.

One piece of advice I will offer to anyone with lots of med. bills, don't pay until you have everything together. Keep your itemized statememt of services, your actual bill, EOB, and cancelled check or receipt all attached. And pay each bill seperately, regardless of how many you get in the mail in one day. I did this and found roughly $3800 in overbilling errors. For us, it was worth the extra paperwork and space requirements for that much paper. That one overbilling could pay for a Disney trip!!!

[BronxTigger]

I'm VERY blessed with my insurance coverage!

It's $0 deductible.
It's $0 copay at the doctor's office AND at the ER.
It's $5 for generic prescription but some prescriptions have $35 oop for me.

To go to a specialist I have to have a referral from my PCP, and and I have to stay in network, but the network is large (but local). So far, I haven't had to deal with it on vacation, so I'm not sure what the protocol is for that.

[JanetMegan]

For some reason this week people keep bringing up topics I have a lot to say about...so here goes from an employers and employee's prospective.

First off, small businesses have a very hard time with health insurance. It's obvisouly a benefit we want to offer and we need for ourselves and here's a little breakdown...

We pay as a company approx. $450 per month for our employees each, this is just for the one person. They can add family coverage for about $1000 MORE per month. This is major medical ONLY. No dental, no vision etc. This is also WITH a $1,500 deductible for anything other than routine medical expenses (ie I had to pay for even a mammogram out of my own pocket.) Perscriptions are about $20 generic and $35 name brand. Sick and Well office visits are $35.

This is with Blue Cross/Blue Shield of GA. We are only getting this "great deal' because we all had that coverage under a similar plan with our old company and were able to transfer that. When shopping for cheaper plans, we couldn't even get insurance quotes due to health conditions (pre existing) in some of our employees. It was basically this or nothing.

[Jeff G]

In case you missed this on the other thread I pay $800/mon with Anthem/Blue Cross of Wisconsin. For this I have a $1000 deductible, $35 co-pay, no vision or dental.

Being a healthy family this is basically a catastrophic plan. We have never reached the deductible which means with the kids we we end up paying several thousand additional dollars on medical items.

[Ian]

I did this and found roughly $3800 in overbilling errors.!

You know, this is really good advice. You'd be amazed at how routinely doctors and hospitals will bill patients for bills they aren't actually responsible for.

That's especially true for folks who have HMO/PPO types of coverage. I'll give you an example:

About 15 years ago I fractured my leg very badly in a rock climbing accident. I required four surgeries to fully repair the damage and the total medical bills were somewhere in the neighborhood of $100,000.

I used to get bills almost daily from the hospital and my doctors that would show my owing the difference between what they charge for their services and what the HMO paid. Luckily for me I worked for the company who provided my coverage at the time, so I knew that this was not the way it worked. When you're a provider and you sign up for an HMO or PPO, you agree to accept their payments for services rendered as full payment. The patient is NOT responsible for making up the difference.

I argued it and won and the final count showed that I had "saved" close to $10,000. Now had I been less educated about health insurance and HMO's I might have paid that money and you can bet that they would have kept it, too. They claimed at the time that those were just "statements" not bills. But of course it didn't say that anywhere ... at least not in readable size print. Now I've noticed that they print in big letters across the top of these "THIS IS NOT A BILL."

And just so you don't think this is an isolated occurance, the same thing happened to my Grandmother not once but twice, when she broke her ankle and her hip.

[princessjojo]

Ian, you are so right, and often times they count on you not knowing the difference or not being "insurance educated." Our case was due to overbilling or more specific the insurance company looking at services as duplicate entries leaving me to handle it with the hospital. In all actuality they were accurate (i.e. grafting of sites, or multiple similiar procedures performed like fluid record pressure checks) It appeared that this was entered more than once, but it was actually performed more than once.

I have probably fallen victim to the additional billing for cost not covered as a difference between cost charged and provider paid amounts.

Thanks to you I can be more careful of this in the future as well...

[LauraF]

I have Cigna for health insurance at a cost of $4 per week (as a single; if I were covering another person it jumps to $32 per week!)

The reason it's so cheap is that my company aggressively markets health care to its employees, not just because of the mandatory healthcare law in Mass, but also they figure by keeping costs low for us that we're more likely to go get preventative care instead of waiting. They do get us on prescription costs though . . . it's not unreasonable, just a few dollars more compared to other plans.

It must be working - the amount of claims from my company to Cigna actually dropped over the last three years running, so we've been getting freebies at work, like a fancy new gym, etc. They're on this big 'healthy body, mind and work' kick. I'm not complaining.

But Cigna is HORRIBLE in claims processing. I can't tell you the number of times I've had to call up and tell them they got something wrong. It's not much worse than any other company however, so I deal with it.

[DisneyDog]

I'm pretty happy with my plan. I have Aenta. My employer pays for it 100%. No deductible. I pay $10 for office visits, $15 for specialists. Prescriptions are either $10 or $15.

DH just started a new job and his insurance will be paid for as well.

DS has been on DH's insurance. If I want to add him to mine, it would cost the majority of my take home pay. At his new job, he would be paying $190 per paycheck if he puts DS on his insurance. We are currently looking at CHIP for our DS, which is Pennsylvania's health insurance for children. It is free for some families. It would not be free for us, since we earn too much. But, it would probably be around $160 per month (vs. $380 to be on DH's plan). It's good insurance, and covers everything. So, hopefully we'll be able to get him on that. He is covered on DH's old plan until the end of the month.

[poohluva]

We have Cinga POS from DH's company. We haven't had any problem with them yet, and we've had them for 16 years.

He's part of a union so he pays dues once a month, but nothing for health, vision or dental.

We pay $10 for office visits, none of us have needed prescriptions in a while, so I'm not sure how much we'd pay for them. When I had DD
(10), we didn't see a single bill. For DD (14) I think we had to pay $300.

We are eligible for one eye visit every 2 years with either glasses or contacts at no extra charge. The kids go every year with the same option. The only time I haver to pay a co-pay here is for a contact lens check.

As far as dental goes the only thing we pay for is what the insurance doesn't cover. There's 4 of us at 2x each year, but it's still not bad.

We're very lucky to have such great insurance. Our DD (22) was on our insurance until she graduated from college last May.

[Hammer]

Hey, Ian, look out your window in suburban Philadelphia as you may see a pig flying by as I am about to agree with you on something ! It is so important for people to not blindly accept charges that their insurance tries to pass on to them. I'm currently fighting my insurance company right now for an expensive blood test that my doctor ordered when they were trying to figure out what was causing some health problems I am having. They keep saying it is not covered by my PPO though it clearly states that tests ordered by doctors that are within the network (which all of my doctors are in-network) . I think most of you can tell from my posts, they are not going to get away with that with me .

My health insurance is with Blue Cross/ Blue Sheild NJ and is a PPO. I pay around $40 a paycheck(bi-weekly) for myself (not married and no dependents) and that is medical, dental and vision. I think next year, after all the issues I'm having with IBX, I will take the Aetna PPO option we have available. I had an Aetna PPO before and I never had these issues about payment.

[Ian]

Hey, Ian, look out your window in suburban Philadelphia as you may see a pig flying by as I am about to agree with you on something !

[Tinkerfreak]

My husband and I own a small construction business. We have 2 girls. We are paying $300 per month for a 15,000. deductible. They pay nothing until we have paid 15,000. We had a 5,000 ded. and it was costing us 600. We have Anthem BC/BS. We have shopped around and found nothing cheaper. It is very frustrating. We have one employee and we gave him the choice, either we covered some of his medical insurance or we covered none and paid him more per hour. He chose no coverage from us (he got his own) and more money per hour. We are not a big enough company to qualify for any kind of group rate so we are really stuck. I had thought about going back to work just for the medical coverage but I do alot of the paperwork for our business and my Dad had a stroke and I am going to have to help care for him during the day so I just don't know how I would have time to get a job. I have to admit it frustrates me sometimes when I hear people complaining about their job or how much they make when they have good insurance coverage. When someone is looking at jobs and benefits they really need to consider the insurance and realize how valuable it is. I would love to pay my employee more but because of the high cost of health insurance for my family and the unbelievably high cost of workers comp insurance for him we just can't do it.

[Ian]

We are not a big enough company to qualify for any kind of group rate so we are really stuck.

Mmmm ... the size of the company doesn't always dictate whether or not you qualify for a group rate.

Many, many industries have insurance "groups" that are comprised of multiple small business owners like yourself. They pool their risk into one large group and are then able to qualify themselves for group rates.

You should look into it ... if you haven't already, that is.

[pogo]

This is an area where I might be able to help out. I run a small insurance firm in Upstate NY.

Most small business's can not afford health insurance on their own. Some join their Chamber of Commerce or can get affordable health insurance through trade groups or unions. Another place to look is associations.

Frivolous law suits are raising your Doctors malpractice insurance. This causes all kinds of problems for the population. Another reason health insurance premiums are sky high is because of the un-insured running to the ED for things like colds and flu.

I advise my clients to do several things that can help. Here's my list;

1) Make sure you have good disability coverage that can keep you earning money while you are sick or injured.

2) If your employer is not providing your health insurance, buy a high deductible plan with a HSA (Health Savings Account) attached and use a pre-tax deduction to help lower your cost.

3) If possible, purchase supplemental insurance to help with catastrophic costs.
Example: An Aflac Cancer Policy can pay you as much as $300 per day for chemo or radiation treatments. And there are many good companies that have almost the same thing.

4) Live a healthier lifestyle. Cut down on fats, carbs, and quit smoking ! Exercise can work wonders. (I know .... I need to do this more.)

If anyone has any questions and wants specific answers, you can PM me. I'm only licensed in NY, but I might be able to advise you on where to find information in your own state.