We need new health insurance

[Anita123]

What really irks me is that we pay $700 per month for our portion of an employer sponsored plan, have a high deductible plan (3k pp or 6k per family and a 10k max OOP, 80/20 plan) and the insurance STILL denies claims for various reasons.

I have had to fight tooth and nail to get my son's prescriptions for insulin filled and they have denied labs that he had to have while in the hospital.

Today they literally had me in tears while I was calling them about denials.

 

[wendow]

What really irks me is that we pay $700 per month for our portion of an employer sponsored plan, have a high deductible plan (3k pp or 6k per family and a 10k max OOP, 80/20 plan) and the insurance STILL denies claims for various reasons.

I have had to fight tooth and nail to get my son's prescriptions for insulin filled and they have denied labs that he had to have while in the hospital.

Today they literally had me in tears while I was calling them about denials.

Ours is the same. I posted up thread about ours. $800 a month, dh's employer pays over $900, similar deductibles to yours and I also have to fight tooth and nail over everything. I *just* finished fighting over claims for my ds's speech therapy from last November. They preapproved it and even paid for other sessions (minus our $50 per session co-pay) but then denied paying for like 4 sessions (out of about 10). No rhyme or reason. So, we just got that settled. They try to kick back anything they can. That was the only therapy my ds had last year and we only had well check-ups outside of that so it was crazy that they didn't want to pay considering how much money they bring in from us. I get frustrated and in tears from them too. But I keep pushing and eventually, the claim always goes through so just hang in there and keep fighting

 

[tvguy]

I will warn you, we price shopped last year, and discovered that one company may operate multiple insurance companies. I called company "A" for a quote and got it, and 5 minutes company "B" called me, and then company "C" etc. And of course this is all allowed under the do call law because once you ask for information from a company, you are giving them ....and all their affiliated companies....permission to call you. I think I got 20 to 30 insurance companies calling me from 5 inquiries.
So be ready for a flood of calls and emails.

 

[EllNat11]

Just a couple things to consider. With the new marketplace exchanges going on your own coverage is still going to be more expensive for an equivalent plan than through your employer because there is no way to mitigate risk or adverse selection like there is with a medically underwritten group policy with a larger pool and risk tolerance. Also, to receive a subsidy through the exchange/marketplace you can't be considered to have "affordable coverage" available to you. Affordability for now is being determined by looking at the SINGLE premium vs the employees income. If the single (not family) premium is less than 9.5% of the income they pay the employee (not total household income) it is considered affordable. It doesn't matter whether you need a family plan or not, current provisions and guidance are determining affordability based on a single

Additionally even if your coverage isn't deemed z"affordable" you get no subsidy if your household income is 400% or more of the federal poverty level and is really phased out gradually from 250-399%. Add that to the loss of your tax deduction via section 125 that you get via payroll and it can be a substantial hit.

Lastly, for states that didn't get on board and move ahead with their own exchange who will be relying on the federal exchange-good luck. Most recent releases were saying in not so many words that it basically isn't ready. So instead of the wide choice of options there will likely be one option at each metal tier, take it or leave it. I'm not overly familiar with what those plans will look like as I am in ny and our marketplace is pretty much ready to go as our governor pushed an executive order through to get ours started early so ny would get a chunk of the federal grant money

Lastly - when seeking advice if you do go the exchange route - be careful who you ask. Brokers are required to be certified to work on the exchanges and have knowledge on the products and costs. Navigators are only required to know how to enroll someone, not how to consult on the benefits. Some of them may go above and beyond but make sure you know their experience

Sorry so long - I'm in the industry and for better or worse have been dealing with this since it started

Oh and a quick side note on "Cadillac" plans. Don't think those will just be old copay plans. The way health insurance is trending even many of today's high deductible plans will be considered Cadillac by 2018 bc of their premium.

 

[manning]

In two words...a mess

 

[rwielatz]

my company (I work in healthcare) has told us that they won't be making any changes for at least a year until some of the bugs get worked out.

Politics aside, I think any healthcare reform plan that was adopted would have a tough first year...simply because of the size and scope of what they're trying to achieve but I do think our current healthcare system is just unsustainable. it's too inefficient and wasteful and too many people falling through the cracks.

 

[mrsklamc]

my company (I work in healthcare) has told us that they won't be making any changes for at least a year until some of the bugs get worked out.

Politics aside, I think any healthcare reform plan that was adopted would have a tough first year...simply because of the size and scope of what they're trying to achieve but I do think our current healthcare system is just unsustainable. it's too inefficient and wasteful and too many people falling through the cracks.

This isn't sustainable either. I have no intention of arguing politics but just the fact that there was no overall plan- this was thrown together, I believe with great intentions, but no realization of what the impact would be, and everyone throwing in their 2 cents with no overall strategic plan, and kinda hoping it would all work out.

 

[tvguy]

my company (I work in healthcare) has told us that they won't be making any changes for at least a year until some of the bugs get worked out.

Politics aside, I think any healthcare reform plan that was adopted would have a tough first year...simply because of the size and scope of what they're trying to achieve but I do think our current healthcare system is just unsustainable. it's too inefficient and wasteful and too many people falling through the cracks.

Very well put.
My DD is a foreign exchange student in the U.K. I will be interested to see what she thinks over all about their system after her time there.
She is there on a student Visa, so she was able to buy into the system for $350 for the year. Her only experience so far is trying to get her prescriptions set up there. What she could do here with a phone call and have done in less than an hour here, is going to take her 3 or 4 weeks there.

 

[rwielatz]

that would be an interesting perspective. during the time before the healthcare bill was voted on I remember seeing an author being interviewed on TV, who had just written a book about their experience using the different healthcare systems in different countries. for some reason, I forget why, they did a lot of traveling and had the need unfortunately to see a doctor in each of those countries. I remember at the time I'd like to read the book but forgot to write the name down...

 

[Anita123]

I watched a video that stated that in the USA we already pay a larger percentage of our taxes for health care than they do in countries that have Universal Health Care for all. Remember we are already paying for medicaid and medicare.

My parents are in the UK and have no complaints about the health care there. My mom recently had surgery for hammer toe (which I'm not even sure insurance in the USA would cover, since it is considered cosmetic). Yes, my mom did have to wait about 6 weeks for her surgery but is was all covered by the national health.

It must be nice to go the hospital and never see and bill and have to fight for weeks, sometimes months, to get your insurance to cover stuff.

 

[Angrypenguin]

Is this the video you're referring to? It's an excellent and informative (not to mention funny!) explanation on health care in the US.

youtube.com/watch?v=qSjGouBmo0M

 

[rwielatz]

thanks for the link! that's not the one I was thinking of but this was very, very interesting. I think he nailed in on the head at the end when he said there are no simple solutions! thanks for sharing this. If i can find the name of that book I'll post it here.

 

[rwielatz]

actually I think I may have just found it on Amazon.

"The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" by T.R. Reid.

...getting my Kindle out right now...