Do you have health insurance?

Falstaff

Falstaff

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My wife is a teacher and the district has open enrollment in March. No idea why, that's just when they do it. Since birth of a child is considered a qualifying life event, we may be able to switch to her insurance plan at that time if it's a better option, or have her leave my plan and go on her employer's plan for her and the baby. That should work but I don't know and our HR department is functionally retarded and someone in this thread probably knows more than they would. When my wife graduated from graduate school they treated that as a qualifying life event and added her to my insurance plan and I'm pretty sure they shouldn't have been able to do that because she didn't lose any insurance through school.

The funny thing is this isn't the first time she had blood drawn for a test. Why they waited until now to send us a brochure talking about how they have a preferred lab that will save us money is beyond me and pretty much past the point of mattering for us, so it's stupid.

This is my first time on an HMO and it's pretty funny the differing opinions you get on it. The people who have had great experience with it absolutely love it and those that have had bad experience with an HMO would almost rather not have insurance than have to deal with an HMO again.
 
Kuriin

Kuriin

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Gauss_sl said:
Currently uninsured thanks to the retarded way health insurance works at my university. I pay for insurance every semester but on long breaks, like right now, last semester's insurance expires on the 31st and I won't get coverage again until Monday at the earliest when the new semester's insurance charge gets put on my account.
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That sucks! I get charged the first of the month when the new semester starts so that I have coverage immediately after my coverage ends from the previous semester. For spring semester, it costs more because it goes through the summer.
 
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niss_sl

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Tarrant_sl said:
I choose our Health Partners plan, I have one of their main offices right next door to me so it makes it nice.

Co-Pay: It's different for different things, I have a huge list of it somewhere but I'll try to type what I remember. If you want to know more I can dig it up later. (Right now I'm about to pack the kids up and take them back to their mothers) Let me know if you want to know more, this is just what I remember off the top of my head.

Clinic: $25 (There is no in or out of network with my plan, my kids go to a totally different clinic 4 hours away and co pays remain the same)
Specialist: $40
Urgent Care: $50
Prescription: $10 Generics - $20 Name Brand
ER: $100
Ambulance Service: $100 (Unlimited usage/mileage)
Hospital Stay: $250 (This covers everything in terms of testing and however long you stay, were my wife to give birth it covers everything involving her stay and baby related as well)
Chiropractor: $20 (40 visits per year)
Acupuncture: $20 (40 visits per year)

Deductible: Zero
Max OOP: $2000

It covers counselling/rehab stuff too but I can't tell you specifics off the top of my head. It covers everything I could ever need it to.
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It's really funny that the copay for a clinic visit is 25$ when in Canada a GP generally bills the government 30-35$ for the visit. Shows how inflated healthcare costs in USA are.
 
Cutlery

Cutlery

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Etoille_sl said:
We're going to keep an excel doc to track out of pocket expenses for the year so we can see where we're at vis a vis the OOP max since we pretty much expect to hit it this year and want to keep the insurance company honest (lol). Very happy that the pregnancy for the most part wont be bifurcated over two years. Only paid 30 bucks in 2012 under BCBS; everything else will be in 2013 including baby's first 5-6 months (who will be covered under the family plan etc) so that timing worked out rather well.
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Why the hell would you hit the out of pocket max? It's a kid. We paid one co-pay for the first prenatal visit, and then that's it. There will be a hospital bill for the delivery (whatever your deductible is) and that should be the extent of the baby bills unless you're going on record now predicting some kind of bizarre complications. You don't need to pay for every checkup every 2 weeks or whatever ridiculous cycle they've got going on for pregnancy.

Also, you don't need to fuck with open enrollment. Like Eyashusa said, pretty much everything is a "qualifying life event." Get married? Qualified. Have a baby? Qualified. Lose a job? Qualified. Basically any reason other than "Nah, I don't want health insurance now, but I might for no particular reason in 3 months," is a qualifying event. You can get that shit changed any time for any of those reasons.
 
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etoille

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Cutlery_sl said:
Why the hell would you hit the out of pocket max? It's a kid. We paid one co-pay for the first prenatal visit, and then that's it. There will be a hospital bill for the delivery (whatever your deductible is) and that should be the extent of the baby bills unless you're going on record now predicting some kind of bizarre complications. You don't need to pay for every checkup every 2 weeks or whatever ridiculous cycle they've got going on for pregnancy.

Also, you don't need to fuck with open enrollment. Like Eyashusa said, pretty much everything is a "qualifying life event." Get married? Qualified. Have a baby? Qualified. Lose a job? Qualified. Basically any reason other than "Nah, I don't want health insurance now, but I might for no particular reason in 3 months," is a qualifying event. You can get that shit changed any time for any of those reasons.
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We don't need to fuck with OE (not sure where that came from?) - husband and I are on the same plan which only takes a phone call to bump up once the baby is born. I just said it was weird that hers was in the middle of march since most other employers I'm familiar with have all been end of the year. Since the 'life changing event' wouldn't happen in July if his employer was on a Jan-Jan cycle and the open enrollment in march started coverage in say april then I wasn't sure if there was a double coverage situation/they could unelect from the Jan-Jan plan. Curiousity only.

I'm expecting OOP maximum between my copays, husbands allergy shot copays, and whatever the hospital bill is. Its 2500 for the both of us for one year.

As I mentioned previously I already had 30 dollars in the first 8 weeks and the appointment last fri was another 30 dollars for the NT Scan.

But yes, we're also budgeting for hitting the OOP max. If we don't fantastic. But we budget for the worst case scenario and anything under that is a welcome surprise.
 
Xequecal

Xequecal

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BrutulTM_sl said:
I think that the people should pay for their own health insurance so they would make more rational decisions and stop volunteering to be fleeced by insurance companies. Yes your employer would pay you more if they didn't have to cover your insurance. There is no reason that they wouldn't.
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I've posted this several times before, but the profit margin in the health insurance industry averages out to about 3%. Insurance companies are not the reason things are expensive.

Who you're actually getting screwed by depends on your perspective. It's either Big Pharma's (Pharmaceutical companies and medical equipment suppliers have >20% profit margins) fault for buying lots of lobbyists/politicians, or the government's fault for letting themselves get bought. The "equal pay for equal service" Medicare regulations are the biggest problem, as they prevent the industry from giving discounts to people who have less money.
 
Eomer

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As far as I understand it, one of the biggest wastes of money in the US is unnecessary tests and procedures due to fear of lawsuits and simply how the system is set up. In a single payer or socialized system access to specialists and the like are much more limited, and that keeps costs down while hardly making a difference in outcomes.
 
Kuriin

Kuriin

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@Etoille: Just remember that there is such a thing known as "Family Deductible" and "Family OOP", as well as "Family Annual Limit". Be advised it's normally double or even triple than a single person's.

Problem with unnecessary tests and costs is because there is no universal cloud system for medical records. Hospitals and practices are finally becoming technological and so with affiliates comes cloud computing. This will allow providers to see tests done by other providers in a different facility.
 
Xequecal

Xequecal

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The biggest problem is the "equal pay for equal service" Medicare provisions, which I'm sure Big Pharma paid out billions to get passed. Basically, if you sell a specific medicine or procedure to one person for $100, you have to sell it toeveryonefor $100. Unlike basically every other industry that finds ways to charge less to people who have less money, (Why do you think stuff like senior discounts exist?) these provisions let the industry slap gigantic price tags on their products andtruthfullysay they would be making losses if they lowered the price.

Additionally, Medicare doesn't factor price into what they will and will not pay for. They instead outline ahead of time which medical conditions are covered, and which ones aren't. If you have a covered condition, they pay foranythinga doctor says is medically necessary to treat it. This is a gigantic fucking goldmine for the pharmaceutical industry. Come up with a new, slightly more effective drug for a covered condition? Slap a $100,000 price tag on it, and Medicare has to pay!
 
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niss_sl

shitlord
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It's also expensive because most people that do access medical services do so through health insurance so providers mark up things in relation to however much the insurance companies are willing to pay. We have a taste of this in Canada through dental services because those are not covered. My insurance will cover ~25$ for fluoride treatment once a year. So how much does my dentist charge? He charges 25$ for an ounce of fluoride swish solution that probably costs $0.14. It's inflated on all ends and the only way to fix it is to Canada/Europize it.
 
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etoille

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Kuriin_sl said:
@Etoille: Just remember that there is such a thing known as "Family Deductible" and "Family OOP", as well as "Family Annual Limit". Be advised it's normally double or even triple than a single person's.

Problem with unnecessary tests and costs is because there is no universal cloud system for medical records. Hospitals and practices are finally becoming technological and so with affiliates comes cloud computing. This will allow providers to see tests done by other providers in a different facility.
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I'm aware. Family max OOP is 2.5k annually. (See what I said earlier about my husbands plan being pretty good).

Family Deductible: 400 in network
Family max OOP: 2500 in network
Family Annual Limit (I'm assuming you meant coverage limits here): none

We pay ~400 a month all totaled for medical dental vision etc for a family plan (us plus dependents when they arrive - right now its less than that per month cost to us because its just the two of us but again we've budgeted according to that 400 a month figure).
 
Faltigoth

Faltigoth

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Eomer_sl said:
As far as I understand it, one of the biggest wastes of money in the US is unnecessary tests and procedures due to fear of lawsuits and simply how the system is set up. In a single payer or socialized system access to specialists and the like are much more limited, and that keeps costs down while hardly making a difference in outcomes.
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Very true. Tort reform is something that politicians won't touch but would be huge in keeping American health care costs down. Fucking doctors will test you for EVERYTHING here, racking up bills and driving up prices, because if you are that one in a million guy with something like Furor Tigole Sclerosis that he misses, you are going to sue his ass off and nobody wants that.
 
Xequecal

Xequecal

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Tort reform is not simple. The underlying problem is a jury of laypeople is totally unqualified to judge complex medical situations, but you can't change that as you have a right to a jury trial. A jury of laypeople is unlikely to find in favor of a doctor when presented with a truly suffering patient and the knowledge that the doctor is insured and will personally lose nothing, regardless of how culpable the doctor actually was.

The solution proposed all the time, capping damages, actually makes the problem worse. With damages capped, it's still worth the time to sue doctors who make small mistakes, and it's still worth the time to just try and see if you can find a sympathetic jury and get a judgment to stick despite your case having no merit. However, capped damages means it's suddenly a lot harder to sue the REAL fuckups, not to mention the malicious ones that are actively trying to cover their tracks. That discovery process costs hella money and if you just capped damages, well, it's not worth it anymore.
 
Dis

Dis

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Faltigoth_sl said:
Very true. Tort reform is something that politicians won't touch but would be huge in keeping American health care costs down. Fucking doctors will test you for EVERYTHING here, racking up bills and driving up prices, because if you are that one in a million guy with something like Furor Tigole Sclerosis that he misses, you are going to sue his ass off and nobody wants that.
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Tort Reform bringing down healthcare costs is a myth. See Texas.
 
Eomer

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To be clear, I wasn't saying in my post that tort reform would significantly alter medical costs in the US. Just that the way the US system is structured/incentivized, in everything from how insurance companies work to how the legal system targets/punishes malpractice, results in much more diagnostic work and unnecessary procedures than is seen in other systems. I'm pretty sure that if you look at the number of specialists in the US system and their pay relative to GP's they're totally out of whack as compared to other countries.
 
Dis

Dis

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Eomer_sl said:
To be clear, I wasn't saying in my post that tort reform would significantly alter medical costs in the US. Just that the way the US system is structured/incentivized, in everything from how insurance companies work to how the legal system targets/punishes malpractice, results in much more diagnostic work and unnecessary procedures than is seen in other systems. I'm pretty sure that if you look at the number of specialists in the US system and their pay relative to GP's they're totally out of whack as compared to other countries.
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I am telling you, tort reform and anything caused by the lack of or the passing of, have zero influence in how much you are charged for health insurance. If anything our rates have gone up since the passing of tort reform. The real problem is how much hospital's charge, the mind boggling amount of charges, why they charge you what they do.

My daughter went in to get her adenoids taken out, and tubes put in her ears. She was in the recovery room (which is really a big 40 person room) for 30 minutes. We got charged $1,700 dollars for this. The surgery itself was a 20 minute procedure, totally easy and simple, something they do all the time. $2,200 dollars for that. Anesthesia costs us $1,300 for basically laughing gas. Dont even get me started on the random bills I get from various doctor offices because they happen to be in on the operation and bill through their "private practice?" as opposed to billing through the hospital. I have no idea what bill is legit or not. /boggle

Anyways, Cut thinks the automotive retail industry is the most corrupt industry next to our political system. I am hear to tell you, my industry has nothing on hospitals.
 
Eomer

Eomer

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Did you not read my post? Or is there something difficult to understand about it? Let me try it shorter:

One of the biggest causes of expensive medical care in the US, amongst other things, is the much larger prevalence of specialized care and procedures, which is caused by a variety of factors inherent to the system but does not lead to better health outcomes.
 
BrutulTM

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They don't only do unnecessary tests out of fear of malpractice, it's also a moneymaker for the clinics. The numbers on your bill are also not necessarily what things really cost. Costs in medicine is extremely bizarre. Insurance companies all negotiate prices down and different companies pay different amounts. Then there's medicare, which basically pays what they want to pay whether the clinic/hospital makes money or not, and finally there are uninsured people who come to the ER, most of which will wind up paying nothing.

I just heard an ER doctor from LA talking about a guy who came into the ER with his mother because he hadn't been able to get a boner for a couple days and he wanted Viagara. They were on medi-Cal because they were poor, so he gave the kid a quick inspection and told him to see his PCP. He said because it was Medi-Cal the hospital would probably be paid $10, but if he had had private insurance, he probably would have had a $300 co-pay and then they would have tried to bill the insurance company as well. Basically hospitals have to try to get as much money as they can from anyone that's paying and how much people actually pay depends on how much juice their insurance company has and the hospital/clinic has to try to get money where they can to cover all the patients that don't pay or underpay (medicare).
 
Dis

Dis

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Eomer_sl said:
Did you not read my post? Or is there something difficult to understand about it? Let me try it shorter:

One of the biggest causes of expensive medical care in the US, amongst other things, is the much larger prevalence of specialized care and procedures, which is caused by a variety of factors inherent to the system but does not lead to better health outcomes.
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Eomer, you just made a broad generalization of our problems with the US health care system. Gratz, we could say everything and anything is wrong with the health care system as you managed to say something, without saying anything at all.

What you seem to be missing in my post is Tort Reform "HAS NOTHING TO DO WITH ANYTHING RELATED TO AN INCREASE IN HEALTHCARE COST". This is in ANY SHAPE OR FORM. Whether it be causation for more tests, higher patient costs because hospitals and/or private practices are trying to pass the cost of malpractice insurance to the customer, and whatever else cause of not having Tort Reform you can come up with. Tort Reform does not work, period end of story. It will not end anything that would bring lower costs to our health care systems. So if you want to come up with a theory, leave Tort Reform out of it. Hope you understand my point a little better now, basically stop using Tort Reform as an excuse as it relates to anything having to do with health care costs being lowered.
 
Ishad

Ishad

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Eomer_sl said:
Did you not read my post? Or is there something difficult to understand about it? Let me try it shorter:

One of the biggest causes of expensive medical care in the US, amongst other things, is the much larger prevalence of specialized care and procedures, which is caused by a variety of factors inherent to the system but does not lead to better health outcomes.
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It's really caused by the RBRVS more than anything.
 
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