U.S. health insurance

• U.S. health insurance by NWTRNR on 29 Oct, 2008 16:17
• Man oh man. I just need to rant a little bit about the state of our U.S. health system -- especially health insurance.
  
  Being a family who has been lucky to have been on group plans for the past many years, I wasn't as familiar as some on the whole f****d up state our system is really in until having to shop for some coverage for my kids the past couple of months.
  
  It's a big f'n mess! Coverage stinks, the cost is horribly exorbitant, and there's all these sneaky little outs for these companies hidden in the plans. My kids are healthy too. And the whole process of getting individual coverage has been a big huge headache.
  
  First off, the fine print is ridiculous. Really a lot of bait and switch. Plans sound OK on the front end, until you start pouring over the details in the policies. One example -- prescription drug coverage. Most every plan I looked at, or was available had either super low coverage -- for example they might only cover prescriptions up to $2500 in a calendar year, and/or it might only cover "generic" drugs.
  
  Well... for relatively healthy people who don't need to use their coverage much, that's no big deal. Antibiotics usually aren't all that much. But, I was talking to a sister of mine who is in the medical world, and she told me that -- God forbid -- you come down with something like MS then you could easily be facing monthly prescription charges that exceed $2k -- and that's for non-generic drugs. So, you can see how little your policy would help if you had one like this.
  
  The policy we ended up applying for, at least had a stop-loss amount -- or so I thought. Basically it was advertised as the most out of pocket per year was $7500. After that, it would cover 100% of all costs. That gave me some peace of mind knowing that if again -- God forbid -- something awful happened (accident, bad illness, you-name-it) at least I knew that once I hit the $7500 amount, I wouldn't be worrying further. Well -- this was all fine, until I got the policy and figured out that this limit didn't apply to prescription drugs -- I'd have to keep paying 50% for those indefinitely.
  
  Anyway, I could keep going on, but I'll stop. I'm just sick of this whole broken down system. We've got to do something different here. Too many people don't have any insurance, and many of those that do -- probably don't have very good coverage, and won't find/figure out until they really need it.
  
  
• #1 by Brkeatr on 29 Oct, 2008 17:12
• Big sore spot with me also and I think all the American people except the ones who are employed in the Health Insurance Industry and I am not referring to the Drs and Nurses etc, who put in long hard hours.
  
  My wife worked for the Health Insurance Industry for many years and nothing is going to change until a law is passed that prevents the lobbyists from lining the pockets of our politicans.
  
  Enough said on this end......
• #2 by Medic aka Rocko on 29 Oct, 2008 17:31
• I agree completely, its a big sham.  I'm paying almost $500 a month for the wife and 3 kids, with a big deductible.  I'd cancel it outright, we could save that money and use it to pay for the average doctor visits and have plently left over.  Then she counters, what if something really bad happens.  Like you said, your probably screwed anyhow because they'll get out of paying for the majority of it.
  
  On top of that, they raise the cost every year, and you've either got to pay it or raise your deductible to keep up with the cost.  My salary doesn't go up every year either, so what do you do.  At some point it will become un-affordable, in fact it already has.
  
  My rant is over now also!
• #3 by PigPen on 29 Oct, 2008 18:14
• I'm with yas, currently spending $430 a month for just the wife and I. Then there are deductibles, and we just got a letter that MRI's and CTScan's have to approved before they can be done.
  
  I have had it up to here, but with the wife's health problems we can't afford not to have it.
• #4 by Alexander215 on 29 Oct, 2008 20:26
• "Waves a little Canadian flag"
  
• #5 by andrew on 29 Oct, 2008 21:30
• I feel your pain,  NWTRNR ...
  
  We've seen our level of coverage decrease annually, while our premiums have gone up.  Many health insurance companies are pushing the "consumer-driven" plans now, which are called HRA and HSA plans.  The HRA plans typically involve the employer funding the first $1500 or so, and 100% of the expenses are paid from this until it's exhausted.  Then the employee pays the next $1500 or so 100%.  Then beyond that, they pay 80% - 90%.   We have such a plan and one problem is that the paperwork involved is extensive, as they tell you not to pay any care-giver until you recieve their "explanation of benefits".  Constant reconciling, as they love to make partial payments and not tell us why.
  
  The HSA plans are interesting, in theory, but not very practicle when analyzed closely. These plans involve higher-deductibles than the HRA plans, but unused money in the fund (if anything is left) is carried over to the next year (and beyond), with investment options for those funds, and the gains are not taxed as the fund it intended for health care expenses.  Their theory is that the money won't be used while a person is younger and healthy, and will build up over time to fund the issues that arise as the person ages.  Sounds good, but the few HSA plans I've evaluated have crazy high deductibles, making them unusable for my family.   
  
  I sent a letter to one of the bigger insurance companies asking for a hybrid that includes the characteristics of HRA, but having the ability to carry-over and invest unused money in in the fund, like an HRA.
  
  I never heard back and we're still in search of better coverage.
  
  Andrew
  
• #6 by buuckkweet on 29 Oct, 2008 21:41
• I received an offer from my former employer to continue my health insurance for myself and Mrs. BW.  Under the COBRA plan, we would be paying $968 a month for 80/20 coverage.  We were paying $368.
• #7 by Timmay on 29 Oct, 2008 22:30
• Cobra sucks as well.  We have insurance but it doesnt pay crap.  Its a BIG problem...do not understand why the gov't cant control that.  But then again look at what the hospitals charge...OUTRAGEOUS!  Got an itemized bill from an emergency visit for my daughter a few months ago...Bandage..1 bandage..box at walmart of 100 cost $2.98....Daviess Comm. Hospital...$10 bucks.  Get real.  Justify the cost for me please..someone..
• #8 by buddha on 30 Oct, 2008 03:00
• Quote from: TimmJ on 29 Oct, 2008 22:30

  Justify the cost for me please..someone..
  

  
  Simple answer, you pay more with insurance to help defray the costs of treating people with no insurance/no ability to pay. Hospital ERs are required to treat people even without insurance in "emergency" cases but, with laws written as they are, who is to say that a common cold isn't an emergency, and failure to treat it leading to a multi-million dollar lawsuit. Some states have a government office that reimburses 10-15% of uncollectable fees and the rest gets passed along in the form of $10 band aids to paying customers.
  I have heard that sometimes you can appeal to the billing dept of some hospitals and ask them to re-bill at the Un-insured rate because many times people with insurance can't afford the co-pays.