Health Insurance-update I am so mad! - Page 2

[transformed]

I am thinking about devising a different plan for us. We spent close to $15,000 last year between montly premiums and co-pays and deductables.

My new plan....which I am going to present to dh...

1. Keep dh's insurance because I think he needs to carry it to keep his life insurance and some other kinds of insurances at work.

2. Put the kids on "Florida Kid Care" which is kinda like medicaid but costs about $25/month.

3. There HAS to be a financial plan for "cancer" or whatever really serious stuff can happen. So I am looking for some kind of insurance similar to life insurance to that. You would pay a little each month and then if something happens, they pay out a chunk of money so we could pay cash for whatever astronomical illness strikes.

4. Gym membership

5. Healthy food

6. Chiropractor family plan $150/month for unlimited visits

7. Something for me. I have never been sick, nor do I walk around thinking about getting sick, nor do I "plan" to get sick...so I try to focus on wellness rather than "what if" I do realize its a possibility but thats why we need to have some kind of cash on hand plan for a major catastrophe.

Screw Insurance companies. They can kiss my butt.

[SleeplessMommy]

Originally Posted by transformed

2. Put the kids on "Florida Kid Care" which is kinda like medicaid but costs about $25/month.

That is what I was going to suggest...

And voting in the next election is a good idea also.

A friend is an MD. She would spend hours on the phone with insurance companies, arguing with phone reps over whether treatments she prescribed were "medically necessary". The insurance company reps have much less medical training than she does (duh!), but she would have to argue with them over what treatment plan was acceptable/safe/cost effective for her patients. There were multiple layers of decision makers, but the first few were just road blocks, where you demand to speak with the supervisor.

This is an insane way to provide medical care. 30% of medical care costs in the USA go to paperwork/insurance overhead. And people die on a regular basis due to lack of access to basic care or lack of long term care for chronic conditions.

[phatchristy]

Originally Posted by SleeplessMommy

This is an insane way to provide medical care. 30% of medical care costs in the USA go to paperwork/insurance overhead. And people die on a regular basis due to lack of access to basic care or lack of long term care for chronic conditions.

The insurance companies have $$$ for all the lobbyists here in this country. The set up is just warped.

I wrote about this is some other threads, but my cousin DIED because of refusing medical care because of the cost. He had been recently downgraded from full to part time by his employer (after working there for decades ) and lost his insurance.

His wife, right after that, had complications with diabetes and was in the hospital for a few days with bills totalling over $17,000...he was so stressed about that a few months later when he was having EVERY symptom of a heart attack he refused to go to the hospital because of how much it was going to cost. He eventually collapsed, then was unable to refuse treatment...but he died waiting for the cath lab. He had MANY hours before that if he had come in, his death would have likely been preventable. He didn't do it because of costs.

[SleeplessMommy]

Originally Posted by phatchristy

The insurance companies have $$$ for all the lobbyists here in this country. The set up is just warped.

The American medical association also has lobbyists, but I think the AMA may be opposed to UK-style universal coverage... that would give the government almost total control of salaries and working conditions for doctors.

[Laggie]

Yep, just like here in Canada - we have universal health care, but the amount that doctors get paid is WAY lower. The cost for a day in hospital here is a fraction of what it is in the USA.

Of course there's a lot of talk in the media about long wait lists and a move to privatization because of that - but I don't know anyone who has had to wait long for urgent surgery. My grandma broke her hip and the replacement was done immediately.

The other advantage of universal health care is that people don't sue each other for medical bills.

[Mama Dragon]

I refuse to pay for heath care in a system that purposely over-inflates the prices to make the largest profit for the least amount of effort. Between the medical industry and the insurance industry, they have us "poor" folk eating out of their hands.

[AEZMama]

Originally Posted by transformed

2. Put the kids on "Florida Kid Care" which is kinda like medicaid but costs about $25/month.

Just make sure that you fall within their financial guidelines before getting rid of your current plan. If you think navigating the insurance system is tough, wait til you try navigating the FL medicare/medicaid system!!! Talk about annoying-and they don't care if you make just over their limits and the insurance rates you're paying through work are astronomical...they don't care (for ds alone our rate went from $300 per mo to almost $500)! If you don't qualify for one program, they bounce you into another that bounces you back to the original that bounces you back...well, that was our experience. Since dh works, I'm SAHM and we have 1 child the limit was $32k salary and he makes more than that. It took us about 6 mos. of little to no information in our volleying back and forth from program to program before someone dh works with pointed us to the coverage we have now. And ds is special needs!

[transformed]

they told me there is no income limit. :

(I mean, there is for medicaid-the free one, but not the kidcare thing.)

[Mpenny1001]

Originally Posted by transformed

So basically I was somehow supposed to ask my doctor about the labritory he uses for testing and then do MY OWN check of whether or not my insurance would cover it, and then opt to request a different lab.

[/B]

Hmmm, my doctor's offices all have big signs up saying which labs they routinely use and that it is my responsibility to tell them if they need to send it to a different lab for insurance purposes. They even have little rooms with a phone so you can call your insurance company and check. Is that not the norm?

[transformed]

Originally Posted by Mpenny1001

Hmmm, my doctor's offices all have big signs up saying which labs they routinely use and that it is my responsibility to tell them if they need to send it to a different lab for insurance purposes. They even have little rooms with a phone so you can call your insurance company and check. Is that not the norm?

No, I have never seen a setup like that.

I had half the tests run at a local Quest Diagnostics....the others were drawn right in the dr's office and sent off without me knowing where they were going.


I didnt know I was supposed to ask.

[Mpenny1001]

Originally Posted by transformed

No, I have never seen a setup like that.

I had half the tests run at a local Quest Diagnostics....the others were drawn right in the dr's office and sent off without me knowing where they were going.


I didnt know I was supposed to ask.

I think the signs and stuff just started a few years ago. Maybe my area is actually ahead-of-the-curve in something, lol!

[AEZMama]

Originally Posted by transformed

they told me there is no income limit. :

(I mean, there is for medicaid-the free one, but not the kidcare thing.)

We applied when dh was out of work, then when he had gotten a job...denied both times for both programs. It wasn't until dh started speaking spanish we didn't get "the real" answers-like our income limit was $32K, etc. They didn't care that we couldn't afford our insurance for ds (I was uninsured since ds' was so expensive) and that he's special needs. He was still denied kidcare and medicare coverage. We were getting to the point where we were looking into how to make it look like dh made less than he does....

[Ellien C]

You DH's company might also have an advocate or "Privacy officer" for handling insurance disputes. I went round and round with a clear contact lense as treatment for a corneal abrasion - very standard tx once the eye ointment doesn't work. Eye Doc knew the insurance routinely refused to pay that due to "coding," but would never tell them the correct code. I finally wrote it all up, including pages from medical journals detailing the standard tx for recurrent corneal abrasion and my eye docs notes and sent it to our Privacy Officer who is also our insurance dispute person. Magically the claim was paid, the code was fine and it was all a mistake. The b@$&@*d$!!

[rabrog]

The individual and family deductibles are weird, but ind. is paid until that person (say you) meets the deductible and then you pay your whatever %. DH pays his until he meets his deductible and then pays his %. The % that you're then paying goes toward the family deductible together (or out of pocket maximum - I don't know if those are the same thing?). So it's not really different deductibles since the money paid by the ind. (after the ind. deductible is met) goes toward the family deductible.

Confused yet?

Jenn

[transformed]

Originally Posted by rabrog

The individual and family deductibles are weird, but ind. is paid until that person (say you) meets the deductible and then you pay your whatever %. DH pays his until he meets his deductible and then pays his %. The % that you're then paying goes toward the family deductible together (or out of pocket maximum - I don't know if those are the same thing?). So it's not really different deductibles since the money paid by the ind. (after the ind. deductible is met) goes toward the family deductible.

Confused yet?

Jenn

I think they make it confusing on purpose. :

[Equuskia]

Originally Posted by rabrog

The individual and family deductibles are weird, but ind. is paid until that person (say you) meets the deductible and then you pay your whatever %. DH pays his until he meets his deductible and then pays his %. The % that you're then paying goes toward the family deductible together (or out of pocket maximum - I don't know if those are the same thing?). So it's not really different deductibles since the money paid by the ind. (after the ind. deductible is met) goes toward the family deductible.

Confused yet?

Jenn

I think I lost about 10 neurons trying to process that. I'm going to bed now.