how I hate insurance

[tvguy]

But what percentage of the total cost is that? Her employer has to be paying out quite a bit for your premiums to be that low.

They don't disclose that. Nor does my employer. Some places don't charge anything still

 

[tvguy]

Very good point!

Also, @tvguy, you haven’t answered if you or your wife will be taking Social Security when you qualify for it.

Very good point!

Also, @tvguy, you haven’t answered if you or your wife will be taking Social Security when you qualify for it.

When we qualify for it next month? No. When we reach full retirement age, yes.

 

[michellev]

I'm 50 years old and have yet to know anyone personally that has gone to the US for healthcare. I'm sure it does happen probably with people living close to the border?

My experience - I had laser eye surgery done at a private clinic years ago. I was in the lobby Saturday morning waiting for the doctor to come in (it was all just post op check ups...) and it was all Americans. I stood there and listened to them discuss which hotel they stayed at and where they ate.
Guess it was cheaper in Winnipeg than Minnesota/North Dakota.

I am almost 50, live pretty close to the border and also do not know a single person who has gone to the US for healthcare. The only time I hear about this phenomenon is on the dis boards.

 

[kimblebee]

When we qualify for it next month? No. When we reach full retirement age, yes.

Hmmm

Interesting.

 

[mnrose]

I thought I did, but $5,000 is the cap

Laughable. You do appreciate that hardly ANY expenses actually qualify toward this maximum right? We have an OOP "maximum" (allegedly) of $1250 per year for our family. I flat out guarantee you that I've spent way more than than that this year OOP, but my "plan" shows so far I've met less than $100 of this. What a joke. When you actually look at the fine print, co-pays, co-insurance, etc DO NOT count toward the out of pocket max, which leaves one wondering exactly what DOES count. I learned pretty quickly when my daughter was deathly sick that my so-called "good" insurance wasn't nearly as good as I thought it was. All told, I spent close to 20K "out of pocket"....remember that 1250 cap? Yeah, THAT year, I believe I hit close to 250 by their calculation.

ETA: I see now that you have one of those plans that requires you to hit some number ($5000?) in spending before your insurance covers ANYTHING. After that, does your plan pay 100%? I doubt it. That would be most unusual. The insurance I reference above is my husbands. MY insurance requires me to spend $6500 before it covers anything (other than an annual physical and other recommended "preventative" care, like a flu shot), and after that, cover a defined portion of MOST other things (not all) at 70% of "reasonable and customary" for "in-network" care and 30% of "reasonable and customary" for "out of network care." There is an "annual" (alleged) OOP max of $12500 (the 6500 referenced above plus 6000 more dollars), but that $6000 more does not cover co-pays (the 30% not covered) and co-insurance. I totally do not know what would ACTUALLY be included in that $6000 because what else is there besides the initial spend, and then co-pays and co-insurance amounts? I dunno because I've never actually hit it. LOL

 

[ChrisFL]

Per the denial from insurance "Safety is not a covered benefit under his policy."

That's the US healthcare insurance industry it in a nutshell isn't it?

 

[Diznygrl]

*Whoops, sorry hit the wrong button and didn't mean to post, heh.

 

[Skippy918]

I wish your family would stop misinforming you. Either that, or they’re leaving parts out. I have six different doctors for one thing or another and I’ve never, like never, seen a pa, or an np.

Also, if I went to a pharmacy and asked for an rx they would laugh at me.




I’m in Canada, and when I want to see my dr, I see my dr. If it’s late and his office is closed, I can go to ANY walk in clinic, or, worst case scenario, ANY hospital without worrying if they’re in my network, or if I have to pay a co pay.

I don’t know (based on prices) what sort of situation you’d have to go through to owe hundreds of thousands of dollars (that you’re responsible for, not insurance paying for), but what’s your ballpark for this?

Four months in three different hospitals, a week in ICU hooked up to three different IV’s, two surgeries, six ambulance trips, too many doctors and specialists to list, six weeks of IV meds (times two), physical therapy, occupational therapy, three meals a day for 114 days, use of a hospital bed at home for two months, ongoing use of a wheelchair, and a toilet seat with arm rests to ease rising up afterwards.

Thats not even including all the incidentals like kleenex, and Tylenol, and painkillers, and rash cream and thermometers.

We haven’t seen one bill for any of this, and we won’t. You can’t understand the sense of relief that comes with that.

As a pp said, I have not met one Canadian who would EVER want to be subjected to your health care system. I used to feel superior, now I just feel true pity.

I would say without insurance you might be talking close to 7 figures. With insurance, it would be less but it depends on your policy and what’s covered.

My friend’s baby was born premature at 24ish weeks. He’s been in the hospital for almost 6 months. His care is probably in the million dollar range by now. Not sure what their out of pocket costs will be, but if he’s still in the hospital come January, all the deductibles and max out of pockets reset.

 

[kimblebee]

Laughable. You do appreciate that hardly ANY expenses actually qualify toward this maximum right? We have an OOP "maximum" (allegedly) of $1250 per year for our family. I flat out guarantee you that I've spent way more than than that this year OOP, but my "plan" shows so far I've met less than $100 of this. What a joke. When you actually look at the fine print, co-pays, co-insurance, etc DO NOT count toward the out of pocket max, which leaves one wondering exactly what DOES count. I learned pretty quickly when my daughter was deathly sick that my so-called "good" insurance wasn't nearly as good as I thought it was. All told, I spent close to 20K "out of pocket"....remember that 1250 cap? Yeah, THAT year, I believe I hit close to 250 by their calculation.

ETA: I see now that you have one of those plans that requires you to hit some number ($5000?) in spending before your insurance covers ANYTHING. After that, does your plan pay 100%? I doubt it. That would be most unusual. The insurance I reference above is my husbands. MY insurance requires me to spend $6500 before it covers anything (other than an annual physical and other recommended "preventative" care, like a flu shot), and after that, cover a defined portion of MOST other things (not all) at 70% of "reasonable and customary" for "in-network" care and 30% of "reasonable and customary" for "out of network care." There is an "annual" (alleged) OOP max of $12500 (the 6500 referenced above plus 6000 more dollars), but that $6000 more does not cover co-pays (the 30% not covered) and co-insurance. I totally do not know what would ACTUALLY be included in that $6000 because what else is there besides the initial spend, and then co-pays and co-insurance amounts? I dunno because I've never actually hit it. LOL

Oh, thank you for this info. I was trusting the person I asked was being sincere..guess not.

So, it sounds like $5000 isn’t actually $5000.

 

[tvguy]

Laughable. You do appreciate that hardly ANY expenses actually qualify toward this maximum right? We have an OOP "maximum" (allegedly) of $1250 per year for our family. I flat out guarantee you that I've spent way more than than that this year OOP, but my "plan" shows so far I've met less than $100 of this. What a joke. When you actually look at the fine print, co-pays, co-insurance, etc DO NOT count toward the out of pocket max, which leaves one wondering exactly what DOES count. I learned pretty quickly when my daughter was deathly sick that my so-called "good" insurance wasn't nearly as good as I thought it was. All told, I spent close to 20K "out of pocket"....remember that 1250 cap? Yeah, THAT year, I believe I hit close to 250 by their calculation.

ETA: I see now that you have one of those plans that requires you to hit some number ($5000?) in spending before your insurance covers ANYTHING. After that, does your plan pay 100%? I doubt it. That would be most unusual. The insurance I reference above is my husbands. MY insurance requires me to spend $6500 before it covers anything (other than an annual physical and other recommended "preventative" care, like a flu shot), and after that, cover a defined portion of MOST other things (not all) at 70% of "reasonable and customary" for "in-network" care and 30% of "reasonable and customary" for "out of network care." There is an "annual" (alleged) OOP max of $12500 (the 6500 referenced above plus 6000 more dollars), but that $6000 more does not cover co-pays (the 30% not covered) and co-insurance. I totally do not know what would ACTUALLY be included in that $6000 because what else is there besides the initial spend, and then co-pays and co-insurance amounts? I dunno because I've never actually hit it. LOL

I haven't found anything yet that they didn't count against the maximum.

 

[Turn the Page]

Oh, thank you for this info. I was trusting the person I asked was being sincere..guess not.

So, it sounds like $5000 isn’t actually $5000.

My current favorite is SD9 sees a psychiatrist. Now, to be fair, we do live in a rural area which exacerbates the issue. bHer pediatrician tried to refer us to community mental health who refused to see her because she had private insurance. The pediatrician then referred us to a provider 1 1/2 hours away who doesn't participate in insurance at all and we have to pay $270 cash at each appointment. That is on top of the $1500 we had to pay for the initial evaluation which we had to wait 6 months for.

 

[ReneeA]

That's the US healthcare insurance industry it in a nutshell isn't it?

Yes, for sure. I was just surprised they were bold enough to say it out loud, that then was documented in the medical record.

I can't report insurance companies to CMS for denying benefits due to conflict of interest, but if I were an outsider looking in, I'd start documenting with proof and sending it to each state's Attorney general. A slightly promising sign is that many states are beginning to hold the insurance companies responsible for denials and are starting to fine them, but it's few and far between.

 

[hereyago]

Insurance in the U.S. is laughable:Medicare needs to be revamped (for example it will pay for Mastectomy bra and prosthetic but will not help with a wheelchair ramp)
My Mom had Medicare and Tricare and 2 different times she had to shell out oop for medication that had to be compounded (for c diff because the regular medicine didn't work) and IV medicine for 21 days. They paid for hospital to put in line but would not pay for medicine and wouldn't pay for home health to come in every day to do it, so they had to teach me how to do it for her.

And then employers offering insurance, yea sometimes they go to what is going to cost THEM the lowest and the insurance is laughable.

 

[LSUmiss]

I would say without insurance you might be talking close to 7 figures. With insurance, it would be less but it depends on your policy and what’s covered.

My friend’s baby was born premature at 24ish weeks. He’s been in the hospital for almost 6 months. His care is probably in the million dollar range by now. Not sure what their out of pocket costs will be, but if he’s still in the hospital come January, all the deductibles and max out of pockets reset.

My son needed surgery at birth and was in the NICU for just 10 days. The nicu cost alone on the bill was $80,000 for just 10 days. Luckily my OoP was like $300 after the $1000 deductible.

 

[maddiel]

I am almost 50, live pretty close to the border and also do not know a single person who has gone to the US for healthcare. The only time I hear about this phenomenon is on the dis boards.

The few people I have known who traveled to the US for treatment tended to fall into one of these categories:

- they traveled for treatment that wouldn't be covered in Canada because it was considered unproven or unnecessary (for example, "liberation therapy" for MS)

- they traveled to participate in a specific medical trial that was only available in the US

- they were a politician or celebrity.

M.

 

[DopeyDame]

Oh, thank you for this info. I was trusting the person I asked was being sincere..guess not.

So, it sounds like $5000 isn’t actually $5000.

The person probably was being sincere to the best of their knowledge and based on their own insurance. Each insurance plan and company basically makes up their own rules about this stuff (within some government guidelines post Obamacare). On my insurance, the copays *do* count towards the annual OOP, so as long as I stay in network, $5000 is actually $5000. But the only out of network expenses that count are those within "reasonable and customary", so basically out of network doesn't count.
So... it depends. Which is almost always the answer to any health insurance question.

 

[RamblingMad]

I haven't found anything yet that they didn't count against the maximum.

Yet. Give it time. My insurance covers less for next year. It’s been like this since I finished university. It keeps getting way more expensive and covering far less.

 

[jaybirdsmommy]

My current favorite is SD9 sees a psychiatrist. Now, to be fair, we do live in a rural area which exacerbates the issue. bHer pediatrician tried to refer us to community mental health who refused to see her because she had private insurance. The pediatrician then referred us to a provider 1 1/2 hours away who doesn't participate in insurance at all and we have to pay $270 cash at each appointment. That is on top of the $1500 we had to pay for the initial evaluation which we had to wait 6 months for.

Mental health care is a whole other issue. I feel your pain. We are in the same boat DS16. There are exactly 0 psychiatrists in our area who are in-network for our insurance. We pay around $80 per visit then after the insurance pays whatever pittance they allow for out of network we get another bill for $150.00 per visit. Add that to the $160 per month for his prescription and it adds up quickly.

Right now our insurance is refusing to even answer the phone calls from the insurance dept at the mental health facility where he was hospitalized twice this year so I'm getting bills from them as well. He's allowed 30 days per year in-patient, we are at 20 so far for this year. Anything over that and it's out of pocket at about $1000 per day. In other words, if he needs long term care we are screwed.

This is with our GOOD insurance policy. We pay around $600 per month through my employer, $35 co-pay for all dr visits, including specialists, good prescription coverage, etc. We'd be bankrupt with some of the other policies I hear about.

Why are we so scared of universal health care in this country? It can't be cost, given my tax rate plus my insurance premium, plus all the out of pocket expenses for DS, I'm pretty sure my costs are close toCanada's tax rate if not over. I'd rather pay it in taxes and not have to worry if the insurance company is going to randomly decide to discountinue coverage for the med that my son takes (has happened to DH several times) or find some way to wiggle out of paying for his hospital stay.

 

[handinpocket]

Oh, thank you for this info. I was trusting the person I asked was being sincere..guess not.

So, it sounds like $5000 isn’t actually $5000.

Every insurance policy in America is different, no need to call someone a liar.

 

[mousefan73]

I had lengthy, candid, conversations with our German hosts (she is a pediatrician, and is well familiar with how that system works). Her view: the German system isn't perfect. No system is. However, everyone gets health care without worrying about how to pay for it. She thinks the US system is horrifying, and does not understand how people continue to tolerate the amounts of money we pay for it.

No, I don't think the Canadian system, for example, is perfect. It has shortcomings like ALL systems do. But, you bet your sweet bippy I believe it's a BETTER system than the one we currently use in the US.

Can agree as an expate living in Germany. I work and so does my husband. My husband is "private" and the kids are under him. I pay my "state" insurance. Between us we pay more than the average, because we make more.. About 500 euros a month. but no deductables. German Drs are smart but what bugs me is they do not do the basics. In the US, first thing is a nurse takes BP, fever, basics regardless of what you are in for. NEVER done here. You go in and tell them what is up. I feel that US Dr. talk and explain more.. That is my only jiff with the German system. Nurses are also less qualifed in Germany. Many things they do in the states, a Dr. has to do here, example giving shots. Even when my kids was in the hospital only DRs could draw blood, strange as this is a basic thing a nurse should be able to do.. Ask your pediatrician what is up with that.

In the end, I MUCH prefer the Germany system better than the US. There really is a safety net that makes me sleep better at night.

I also feel here they really try to treat thing before prescribing things.. ex. mental things. half of my friends in the states ( working moms) are on some type of anti-depressent/ anxiety pill. It's crazy, they just go to their GP say they have stress, cant sleep and bam get a script for pills. , even kids.. Where I live in Germany I know of no kids or moms on those drugs.. in the States, I need 2 pairs of hands to count... Here you would get sent on an impatient program a few weeks for stress etc.., Seems the US focuses more on giving pills and not looking at the underlying issues. Just my observation... Pillls cost and make money...