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#31 of 56 Old 06-24-2010, 03:12 PM - Thread Starter
 
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Emma, what that agent did to you was a crime - I am not being hyperbolic, it literally was a crime. If I were you, I would want to talk to the insurance company, to the state insurance commissioner and possibly some other legal types about the fact that your family has been the victim of fraud.

I wouldn't want to keep paying your insurance company if I was in your shoes either, although I am very uncomfortable about going without insurance.

I've already filed a complaint about one of the lies (the maternity coverage...this agent went on and on about how "special" this coverage was because unlike others its basic care covered maternity!)

The company sent me a letter detailing my complaint. Then, as we were going through the literature for our coverage, we discovered that doctors visits are NOT covered the way she explained. Not at all. We were under the impression and assured by this agent that we'd only pay $50/visit, period. That the 80% coverage only applied to hospital visits and for regular visits, including visits to specialists, would cost NO MORE than 50 bucks, ordered tests included.

Looking over our plan, none of that is true except that we'll pay a $50 copay per visit...the plan then only covers $100 of the remaining bill after that...AND, each family member is permitted ONE visit per year, anything after that and we're responsible for paying for the visit in full.

I feel like I want my money back that we've paid in thus far.

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#32 of 56 Old 06-24-2010, 04:09 PM
 
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You certainly shouldn't be with a company who lied- I'm sorry that happened to you

That said, we would never be without health insurance. My dad developed (literally overnight) a rare tumor made up of blood vessels in his spinal column and had to go to another state for surgery- one of only 80 that had been performed world-wide. The total bill was $1M+ and the surgeons agreed to take what the insurance would pay- which was just over $500K. They told my parents that since they had done the responsible thing and maintainted health insurance, they (the surgeons) felt that they should do their part and signed off on the lower amount and declared themselves paid in full. My dad was making $100K+ per year, but a bill of close to $500K would have destroyed them, financially.

My pregnancies were high-risk and the perinatologist that I saw billed $750 for each visit- I was going every 2 weeks. DH has a good job and makes $100K+ per year, but we couldn't have paid OOP for those visits, no way.

It's all well and good not to see doctors routinely, but it truly is the unforseen or catastrophic events that having insurance can make or break your financial future.

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#33 of 56 Old 06-24-2010, 04:36 PM
 
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I've already filed a complaint about one of the lies (the maternity coverage...this agent went on and on about how "special" this coverage was because unlike others its basic care covered maternity!)

The company sent me a letter detailing my complaint. Then, as we were going through the literature for our coverage, we discovered that doctors visits are NOT covered the way she explained. Not at all. We were under the impression and assured by this agent that we'd only pay $50/visit, period. That the 80% coverage only applied to hospital visits and for regular visits, including visits to specialists, would cost NO MORE than 50 bucks, ordered tests included.

Looking over our plan, none of that is true except that we'll pay a $50 copay per visit...the plan then only covers $100 of the remaining bill after that...AND, each family member is permitted ONE visit per year, anything after that and we're responsible for paying for the visit in full.

I feel like I want my money back that we've paid in thus far.
You're not with MegaHealth/Health Markets by any chance, are you?
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#34 of 56 Old 06-24-2010, 04:44 PM - Thread Starter
 
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You're not with MegaHealth/Health Markets by any chance, are you?
No, Chesapeake.

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#35 of 56 Old 06-24-2010, 05:06 PM
 
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Wonder if they are subsidiaries of ea. other. The EXACT same thing happened to us. To the letter. Makes me sick just hearing you tell what you've been through. We were really sacrificing in order to have ins, and turns out they covered NOTHING...not what was represented to us AT ALL. Several irrate phone calls/letters later they finally came through for us, but it was STRESSFUL, both financially and emotionally.

Now we qualify for state health ins (we are in MA) and it's the best ins we have ever had. They cover EVERYTHING. Not that thrilled that we are making little enough to qualify, but I am thrilled by the quality of our health care now.

Edited to add: we went YEARS without ins. DH was self employed, insurance was prohibitively expensive, we are not the doctor going types either, etc etc. We got ins bcs we were planning baby #3 and moving to MA, where ins was "mandatory". While we were uninsured we paid for everything out of pocket, but were lucky that nothing big ever came up. But in our situation we would def. put off going to the doctor or filling prescriptions. I remember antibiotics costing almost $200 one time!! Enough to give me a heart attack!

Now that we have GOOD coverage, I would be very nervous about going without coverage again. I could be wrong, but I think kids always qualify for state coverage? Hmm, wait, that can't be right. Have you looked into an HSA to go along with a DIFFERENT high deductible plan?
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#36 of 56 Old 06-24-2010, 05:19 PM - Thread Starter
 
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Wonder if they are subsidiaries of ea. other. The EXACT same thing happened to us. To the letter. Makes me sick just hearing you tell what you've been through. We were really sacrificing in order to have ins, and turns out they covered NOTHING...not what was represented to us AT ALL. Several irrate phone calls/letters later they finally came through for us, but it was STRESSFUL, both financially and emotionally.

Now we qualify for state health ins (we are in MA) and it's the best ins we have ever had. They cover EVERYTHING. Not that thrilled that we are making little enough to qualify, but I am thrilled by the quality of our health care now.

Came through for you in what way exactly?

And yeah, it makes me sick to think that if my husband and I would get divorced, I and my children would be eligible for full coverage through the state.

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#37 of 56 Old 06-24-2010, 05:31 PM
 
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They rebated us for a good portion of my maternity/pregnancy bills. Before I went for my first ultrasound, I called to make sure it was covered (MA has state mandated coverage for certain things). They confirmed that it was covered. But then they didn't pay the bills associated with my ultrasounds. There were other pregnancy related things like that too (bloodwork, tests). My baby was born almost two years ago and I just received a bill for her hospital stay. We no longer have our insurance with them, but I called, they said, "we don't cover standard newborn care", I had to call the hospital and have them resubmit the bill bcs it WASN'T standard care that was on the bill (she had aspirated meconium). They ended up covering $900 of the $1100 bill.

If I hadn't been on top of it, and hadn't been paying attention, I'd be several thousand dollars poorer right now. Don't get me started on the CTScan they didn't cover! (DH & I really DON"T go to the doctor very often, but my third pregnancy and post partum period was riddled with all manner of strange things!)

Part on our biggest frustration was that things we assumed would be going toward the deductible DID NOT APPLY at all!!! Argggggh!
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#38 of 56 Old 06-24-2010, 06:10 PM
 
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With no insurance an injury could bankrupt you quickly.

My DD broke her arm a couple years ago badly which required surgery twice. The cost was over $40k. I'm sure most of us can't pay that out of pocket.

Just something to think about
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#39 of 56 Old 06-25-2010, 04:49 PM
 
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Don't do it!
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#40 of 56 Old 06-25-2010, 06:34 PM
 
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Wonder if they are subsidiaries of ea. other. The EXACT same thing happened to us. To the letter. Makes me sick just hearing you tell what you've been through. We were really sacrificing in order to have ins, and turns out they covered NOTHING...not what was represented to us AT ALL. Several irrate phone calls/letters later they finally came through for us, but it was STRESSFUL, both financially and emotionally.

Now we qualify for state health ins (we are in MA) and it's the best ins we have ever had. They cover EVERYTHING. Not that thrilled that we are making little enough to qualify, but I am thrilled by the quality of our health care now.

Edited to add: we went YEARS without ins. DH was self employed, insurance was prohibitively expensive, we are not the doctor going types either, etc etc. We got ins bcs we were planning baby #3 and moving to MA, where ins was "mandatory". While we were uninsured we paid for everything out of pocket, but were lucky that nothing big ever came up. But in our situation we would def. put off going to the doctor or filling prescriptions. I remember antibiotics costing almost $200 one time!! Enough to give me a heart attack!

Now that we have GOOD coverage, I would be very nervous about going without coverage again. I could be wrong, but I think kids always qualify for state coverage? Hmm, wait, that can't be right. Have you looked into an HSA to go along with a DIFFERENT high deductible plan?
I can't answer for any state than my own (Maine) but no kids don't always qualify for state coverage. We applied several years ago and were turned down, we applied again last year and literally got coverage for one year and effective April were discontinued because our income was too high.

So no not all states will cover kids. That said to answer the OP you never know when anything will go wrong. At 37 my father years ago was diagnosed w/throat cancer and given 6 mos to live. Thankfully he had insurance and received excellent treatmend is approaching 60 now. Just this year I had hernia repair surgery that was far more extensive and thankfully it happened when I still had coverage. Right now I am looking at high deductible policies which still offer some protective coverage.

When I was pregnant almost 5 yrs ago I planned to use a midwife and a freestanding birth center since I had a high deductible policy. Well I ended up having to transfer to the hospital and my bill was a lot cheaper than it would have been had I had no coverage at all. You actually get billed more when you have no insurance. Maybe its the fact that I am approaching 40 and dh is past 40 but for us as painful as it is to pay, I recognize anything could happen.

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#41 of 56 Old 06-25-2010, 06:38 PM
 
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I consider health insurance to be an absolute necessity, personally. Especially when you have kids. I know too many women whose kids get sick and get worse and worse because they aren't insured and the parents can't afford/don't want to pay out of pocket.

Even the healthiest people get sick and injured. I was a healthy 29-year old when I developed preeclampsia and had to have a c-section at 32 weeks. My son spent 6 weeks in the NICU. My insurance was billed $250,000 for both of us, and that was 5 years ago. My portion? $1200.

You don't know that you won't use your insurance. Medical bills bankrupt uninsured and underinsured families.
I agree completely. Luckily here in IL, we make under $100k+ so we qualify for Allkids even as adults. We don't have to use it, but it's there when we need it. Can you look into some sort of public assistance program if you can't afford it? Or can you save how much you put into insurance now and put it in a high yield account to access for medical bills?

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#42 of 56 Old 06-25-2010, 06:46 PM
 
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As another consideration, the health care "reform" bill that just passed has a forced-insurance mandate attached to it, meaning that you will incur fines as punishment for not having health insurance. This rule doesn't kick in until 2014, I believe, but it's something to think about.

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#43 of 56 Old 06-26-2010, 12:26 PM
 
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So no not all states will cover kids. That said to answer the OP you never know when anything will go wrong. At 37 my father years ago was diagnosed w/throat cancer and given 6 mos to live. Thankfully he had insurance and received excellent treatmend is approaching 60 now. Just this year I had hernia repair surgery that was far more extensive and thankfully it happened when I still had coverage. Right now I am looking at high deductible policies which still offer some protective coverage.
A couple of years ago dh came home from a business trip not feeling well. He woke up at 3am in severe pain and bleeding. It turned out that he acquired some bacteria that produced a polyp in his colon-- the total bill for hospitalization and procedures was $30,000; we paid $800 and insurance covered the rest.

"It should be a rule in all prophylactic work that no harm should ever be unnecessarily inflicted on a healthy person (Sir Graham Wilson, The Hazards of Immunization, 1967)."
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#44 of 56 Old 06-26-2010, 01:14 PM
 
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As another consideration, the health care "reform" bill that just passed has a forced-insurance mandate attached to it, meaning that you will incur fines as punishment for not having health insurance. This rule doesn't kick in until 2014, I believe, but it's something to think about.
It also will help subsidize affordable care if you can not afford it. OP-sounds like you've been ripped off by a scam company. I would shop around for other insurance policies. Is this through an employer?

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#45 of 56 Old 06-26-2010, 01:19 PM
 
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It also will help subsidize affordable care if you can not afford it. OP-sounds like you've been ripped off by a scam company.
If this is the case I'd contact the state AG or state insurance commission.

"It should be a rule in all prophylactic work that no harm should ever be unnecessarily inflicted on a healthy person (Sir Graham Wilson, The Hazards of Immunization, 1967)."
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#46 of 56 Old 06-26-2010, 10:58 PM
 
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It also will help subsidize affordable care if you can not afford it.
Not really, but I suppose that's fodder for another discussion.

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About the fine...MA has already done that, but the fine is piddly compared to what it costs to pay for insurance. If we hadn't qualified for state health care we would have had to tke the penalty. We just couldn't continue to pay almost $700/mo for insurance that didn't cover anything! I'm not saying that dropping insurance is the right decision...but in our situation (obviously, since we DID qualify for state insurance) it was not doable. Don't know why it took us so long to apply.
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#48 of 56 Old 06-29-2010, 03:04 AM - Thread Starter
 
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An update on our situation.

We're considering dropping our current policy (and seeing about getting some of our money back since we were lied to) and purchasing hospital only coverage through Blue Cross as an alternative to having no coverage.

Thanks again for the advice, everyone. And please comment further, if you'd like, on our new plan.

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#49 of 56 Old 06-29-2010, 09:41 AM
 
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An update on our situation.

We're considering dropping our current policy (and seeing about getting some of our money back since we were lied to) and purchasing hospital only coverage through Blue Cross as an alternative to having no coverage.

Thanks again for the advice, everyone. And please comment further, if you'd like, on our new plan.
I don't know the specifics of what your proposed plan covers, but for my breast cancer treatment, well over $300,000 of it was non-surgical and not delivered in a hospital setting.
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#50 of 56 Old 06-29-2010, 10:23 AM
 
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I would never drop health insurance unless paying the premiums meant not eating or something equally as necessary. Not only would I not want to risk denial of care and bankruptcy, but I also I wouldn't want to risk having to leave a huge bill for a healthcare provider to absorb thus increasing the cost of healthcare for everyone else.

If I felt a traditional plan was a waste of money, I'd do a price comparison of high deductible plans from reputable companies, read all the fine print, and go with the best fit. I'd also stash the savings and put it in an high yield account to cover the deductible.
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#51 of 56 Old 06-29-2010, 11:02 AM
 
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Thank you.

These are the EXACT things we've discussed. Our plan is so-so...and we're not convinced it's the most reliable in the event that we'd need coverage for something serious/expensive. There are many, many exclusions and specifications involved in the coverage.

AND, the agent who sold us the plan lied to us about several things regarding the coverage. She assured me that pregnancy would be covered (it's not), that we had a $50 co-pay for ANY doctor visits, and the remainder would be covered (not true) and she also said the first payment would be X amount and it ended up being X amount + $75 dollars...an amount which was very important to our monthly budget.

This agent sat face-to-face with us in Starbucks, and we very carefully listened before agreeing to buy the plan. I was shocked that pregnancy would be covered, since it was a high deductible-high co-pay plan.

Now we're wondering what else we were lied to about. Would we really be ok if one of us were injured and had to seek expensive emergency room care? Or would we be inadvertently taken to a hospital which is out-of-network and be on our own anyway?


Bottom line is, we're not confident in this insurance company AT ALL, and think we'd rather go without than continue giving them monthly payments.

But we're going to check into some other companies before making our decision.

Thank you everyone for your advice.
Do you have Golden Rule, by any chance? I am self insured with them...and they are the worst insurance I have ever had. I specifically wanted something with maternity coverage, and that's what the agent told me I was getting. Turns out it caps at 2,000. That's NOTHING. I am actually going in as a self-pay at the hospital because if they even try to use the insurance, it will end up costing me more (they use different rates). I've also had to pay the OB pretty much out of pocket. Furthermore, NOTHING for the newborn is covered. So, if he ends up in the NICU, I can't even imagine what it will cost - I assume we would go bankrupt. And this is not cheap insurance, either.
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#52 of 56 Old 06-29-2010, 03:43 PM
 
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lmk1,

Double check your policy. MegaHealth is THE WORST insurance ever (got it specifically bcs of maternity coverage and then it turns out there wasn't any - so similar complaint) but the newborn care they won't cover is "standard" newborn care, which means that anything like NICU would be covered. I contested a $2000 bill for putting a tube down my baby's throat...not "standard" care as far as I know (!), and they actually paid it (!). I'm still in shock that they didn't make it more painful to resolve! Sometimes it's just a question of staying on top of them, which is a royal PIA.
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#53 of 56 Old 06-29-2010, 07:40 PM
 
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lmk1,

Double check your policy. MegaHealth is THE WORST insurance ever (got it specifically bcs of maternity coverage and then it turns out there wasn't any - so similar complaint) but the newborn care they won't cover is "standard" newborn care, which means that anything like NICU would be covered. I contested a $2000 bill for putting a tube down my baby's throat...not "standard" care as far as I know (!), and they actually paid it (!). I'm still in shock that they didn't make it more painful to resolve! Sometimes it's just a question of staying on top of them, which is a royal PIA.
Thanks! I didn't even think of that. I'm planning on adding the new baby to my coverage as soon as he's born, but I was somewhat terrified by the possibility of something being wrong immediately before he's added. Ds #1 needed an xray when he was born and the regular (not contracted) rate would probably be about $500 just for that. Back then I had awesome insurance, and I didn't have to split hairs about what was covered or not.
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#54 of 56 Old 06-30-2010, 01:09 PM
 
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I consider health insurance to be an absolute necessity, personally. Especially when you have kids. You don't know that you won't use your insurance. Medical bills bankrupt uninsured and underinsured families.
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#55 of 56 Old 07-01-2010, 12:32 AM
 
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I haven't read all the posts yet... but I'll tell you my story. Almost 2yrs ago my very healthy 20yr old son was hit side impact by a fuel tanker and spent 5 weeks in a coma in an SICU. The total bill if there was no insurance? 390k

And that isn't even including the amazing rehab he had (the insurance insisted he go to Shepard Centre in Atlanta, one of the top brain & spinal injury rehabs in the US), and he was there for 6wks as well.

Absolutely no way would I have wanted to have him without insurance even if I paid thousands of dollars a year for it. That insurance made his remarkable recovery possible, and I do not think he'd have come back like he has if he was in a local, less progressive, centre.

disclaimer: These days this is not a concern for me, I live in Australia and we have medicare. Any serious health need we have will be taken care of.. it's not perfect but it IS great. We do however, buy 'extras' cover for dental, optical and other assorted care though.

ETA: Finished reading through the thread! OP I'm glad you found an alternative solution to going without insurance, the financial trauma and emotional heartache of dealing with catastrophic medical bills is something NOBODY should have to deal with. I mean, it just should not happen.

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#56 of 56 Old 07-01-2010, 01:47 AM
 
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Even the healthiest people get sick and injured. I was a healthy 29-year old when I developed preeclampsia and had to have a c-section at 32 weeks. My son spent 6 weeks in the NICU. My insurance was billed $250,000 for both of us, and that was 5 years ago. My portion? $1200.
Yes, that. I could have written that. No matter how bad our financial situation is, DH and I have always maintained our insurance. Some months it really seems like a huge waste, but you never, ever know when you might need it. I had a ruptured ovarian cyst recently and BOY was I glad I was insured!

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