Medical Insurance Rates

[DanteEXT]

I paid $2000 out of pocket for a surgery (the gallbladder surgery) that was $15,000 for the insurance company, after they negotiated the cost.

One of the big reasons medical costs, and therefore insurance costs, are so high is because of all the people who don't pay their medical bills. There are people who know that hospitals can't refuse to treat them. and know they can legally send them just $5/mo, which is less than it costs to process the payment. Eventually the hospital or doctor decides it isn't worth it and forgives the debt.

I tried that when I was younger, well not $5 but what I could realistically afford. I didn't make a lot of money at the time. They sent me to collections as it wasn't enough for them.

 

[Runwildboys]

I tried that when I was younger, well not $5 but what I could realistically afford. I didn't make a lot of money at the time. They sent me to collections as it wasn't enough for them.

All collections can do is take what you give them and destroy your credit rating, I believe. But I think anyone who's willing to try to work the system doesn't really care about their credit score.

 

[Reality]

I don't understand. The insurance policy outlines exactly what they'll pay for and what they won't.........or is that just mine? I've never had an issue with them paying, once I met my deductible.

The problems usually come from the details, not the event or overall coverage. People assume their insurance coverage is "blanket coverage" but that's not always the case. There are exceptions.

For example, you can have great health care insurance, but the underwriters may deem certain procedures optional (elective) even when the doctors are saying you need it. You can need to stay in the hospital longer than normal for a procedure but the insurance may only allow for a certain number of days. There can also be limits on a variety of charges by various doctors, clinics, hospital departments, etc. where you are responsible for anything over that amount. In many cases, those places will drop the price to the covered amount, but not always.

Not everyone goes through those headaches, and hopefully most people won't, but when it happens, it's can be very stressful especially when several medical places are demanding payments and the insurance company is taking their time reviewing your claims and subsequent arguments.

 

[Runwildboys]

The problems usually come from the details, not the event or overall coverage. People assume their insurance coverage is "blanket coverage" but that's not always the case. There are exceptions.

For example, you can have great health care insurance, but the underwriters may deem certain procedures optional (elective) even when the doctors are saying you need it. You can need to stay in the hospital longer than normal for a procedure but the insurance may only allow for a certain number of days. There can also be limits on a variety of charges by various doctors, clinics, hospital departments, etc. where you are responsible for anything over that amount. In many cases, those places will drop the price to the covered amount, but not always.

Not everyone goes through those headaches, and hopefully most people won't, but when it happens, it's can be very stressful especially when several medical places are demanding payments and the insurance company is taking their time reviewing your claims and subsequent arguments.

Maybe it helps that I go to doctors who are "in network". Surprisingly, I don't even need to get a referral to a specialist. I can make an appointment with whatever doctor I feel I need. I'm starting to think my insurance is pretty good, compared to many others'.

 

[Reality]

Maybe it helps that I go to doctors who are "in network". Surprisingly, I don't even need to get a referral to a specialist. I can make an appointment with whatever doctor I feel I need. I'm starting to think my insurance is pretty good, compared to many others'.

Network doctors are not the problem though. Most people go to network doctors unless something happens to them while on a trip.

If you have only gone to doctor offices then you are not likely to have ever dealt with the nightmare issues that other people are talking about.

Also, not every major medical event is a problem. It's not like the insurance companies are fighting every charge. The problem is that there is a constant battle between hospitals, surgical/specialist doctors, etc. and the insurance companies over what procedures and treatments are covered and/or to what extent they are covered.

Let's say you are in an accident that puts you in the ICU. Your health insurance covers it initially but while there you develop a secondary complication. Now, you need to stay in the ICU for several more days. You could easily rack up $10,000 per day in medical bills and your health insurance may say they will only cover the hospital expenses related to the accident and you will have to take up the secondary complication issues and charges with the hospital because they do not feel they were a result of the accident.

Be thankful that you have never had to deal with those kinds of stressful situations, but understand that just because you have never had any issues does not mean it cannot happen to you.

 

[Runwildboys]

Network doctors are not the problem though. Most people go to network doctors unless something happens to them while on a trip.

If you have only gone to doctor offices then you are not likely to have ever dealt with the nightmare issues that other people are talking about.

Also, not every major medical event is a problem. It's not like the insurance companies are fighting every charge. The problem is that there is a constant battle between hospitals, surgical/specialist doctors, etc. and the insurance companies over what procedures and treatments are covered and/or to what extent they are covered.

Let's say you are in an accident that puts you in the ICU. Your health insurance covers it initially but while there you develop a secondary complication. Now, you need to stay in the ICU for several more days. You could easily rack up $10,000 per day in medical bills and your health insurance may say they will only cover the hospital expenses related to the accident and you will have to take up the secondary complication issues and charges with the hospital because they do not feel they were a result of the accident.

Be thankful that you have never had to deal with those kinds of stressful situations, but understand that just because you have never had any issues does not mean it cannot happen to you.

Haha... Believe me when I tell you...I never say there's anything that can't happen to me! Lol

 

[CyberB0b]

I pay $240/mo for $1400 deductible, $3000 max out of pocket HSA plan. I max out my HSA and my company contributes $550/year towards it through incentives.

It basically covers an annual physical, and that's all. I'm healthy, so don't need a comprehensive plan. Mine just covers me in case of emergency. I can use an online doctor for $50 that covers any minor things a doc in the box would do.

I max out my HSA for retirement purposes down the line.

 

[CF74]

I pay $240/mo for $1400 deductible, $3000 max out of pocket HSA plan. I max out my HSA and my company contributes $550/year towards it through incentives.

It basically covers an annual physical, and that's all. I'm healthy, so don't need a comprehensive plan. Mine just covers me in case of emergency. I can use an online doctor for $50 that covers any minor things a doc in the box would do.

I max out my HSA for retirement purposes down the line.

Yeah to me Insurance is for real emergencies like surgery, not common colds. That’s why I chose the highest deductible. And I still got hosed....

 

[CyberB0b]

Yeah to me Insurance is for real emergencies like surgery, not common colds. That’s why I chose the highest deductible. And I still got hosed....

Ask your HR rep.

 

[lukin2006]

Must be nice.
Extremely different situations though.
And for things like surgery, way different wait times and higher end quality.
But yes, also more affordable for the healthy.

If you stay healthy, thats good
But the last study I saw had Canada as 28th out of 28 countries studied for quality

For the most part, you are correct. Elective surgery wait times can be lengthy. Getting tests like MRIs can be a lengthy wait, but if the doc suspects something heinous then you jump the queue and will get test fairly quickly. Our system will not let you die, if you have cancer, for example, you will get treated ASAP...

As for quality? I have no complaints...

 

[daschoo]

Never been able to get my head round your system. NHS over here isn't perfect but free "at point of service" is such a good thing. Terrified we're going to lose it post Brexit

 

[Runwildboys]

Never been able to get my head round your system. NHS over here isn't perfect but free "at point of service" is such a good thing. Terrified we're going to lose it post Brexit

Is health care supported by all the Brexit members?

 

[Reverend Conehead]

Just a thread to compare medical rates, coverages, and best companies out there.

Back in October I took on a new job at a fairly large company and was led to believe that they would pay half my insurance premium to the tune of $300 a month, or so it was implied. Well that was an implied lie unfortunately because they actually deduct about $332 from my pay check Bi-Weekly.

So in reality they are paying a little under a third unless there’s some type of accounting error. At this point you’re probably thinking dude it’s been three months and you just noticed this??? Yeah because for some reason I just got so caught up in work it slipped my mind. I just thought oh, they’ll only deduct it every other pay period. And to be quite honest I’m just not a numbers guy, it’s my achilles mentally.

Anyways I have Blue Cross with a $3,000 deductible. I work at a very large company so you would think we get a big group rate discount right? And yet my policy is over $900 per month for a guy that’s only 45??? It just doesn’t make sense to me. Or maybe my insurance premium is actually $1,200 month and they are paying half??? Welp..

I sent an email thru my member profile to Blue Cross for clarification before I storm into my HR’s office and accuse them of something and look dumber than I already am.

I’m so tempted to just cancel it and seek another policy elsewhere. Any suggestions before I yank the plug? I don’t remember ever paying this much for insurance in the past, like ever.
Aflac? Quack Quack...

Call your state's health insurance exchange. Some states run their own exchange while others defer to the Federal Government one. I know it's not thrilling to call a government office, but they can bring up comparisons so you can see your options.

Edit: I'm surprised your employer doesn't offer you a really good plan. If they don't, that in itself is a reason to shop your resume to the competition.

 

[HungryLion]

That’s not exactly true because when something does happen you have to fight like hell to get them to pay for it. They’ll try and Nicole and done you to death. I know I worked for a big insurance company for 6 years.

Depends on the insurance company.

It’s also one of those necessary evils though. I work for an insurance company. It is my job to assess people’s needs for long term services (home health aid, home modifications, home nursing, etc).

Som people want to max out their benefits and get as many services as possible, even though additional services won’t impact their functional independence level. So the company has to deny the patients request because it’s legit not needed.

Conversely, there are patients who don’t even want as much services as they would be eligible for.

I can recall very few instances where I thought my company denied somebody services that were legitimately needed based on their assessment.

Of course there’s also the appeals process.

a couple of years ago I was struck in a car by someone who fell asleep behind the wheel. My car was totaled. Luckily I wasn’t hurt.


I remember calling their insurance company and saying hey listen. I have missed time at work. I have had to deal with the headache of looking for a new car. Your driver almost killed me and now I get nervous at stop lights, etc.

I asked them to send me some money to cover these things. They gave me a decent pay out l that covered all my missed time at work plus money for inconvenience and overall my life being a pain in the butt for a while. no court needed. Nothing. They just cut me the check. But I was also reasonable. I didn’t ask for a huge payout.


one of my co workers around a same time. Rear ended somebody. Guy wasn’t hurt. Car wasn’t even totaled. A fender bender. The dude who she hit has been suing her insurance company for several hundred grand claiming he has permanent nerve damage and is going through pain and suffering. It’s nonsense because the dude isn’t hurt. But he is trying to retire because he got rear ended one day. So the insurance company is forced to fight him in court because of his lunatic demands.

Stuff like that raises everyone else’s rates.

 

[HungryLion]

Network doctors are not the problem though. Most people go to network doctors unless something happens to them while on a trip.

If you have only gone to doctor offices then you are not likely to have ever dealt with the nightmare issues that other people are talking about.

Also, not every major medical event is a problem. It's not like the insurance companies are fighting every charge. The problem is that there is a constant battle between hospitals, surgical/specialist doctors, etc. and the insurance companies over what procedures and treatments are covered and/or to what extent they are covered.

Let's say you are in an accident that puts you in the ICU. Your health insurance covers it initially but while there you develop a secondary complication. Now, you need to stay in the ICU for several more days. You could easily rack up $10,000 per day in medical bills and your health insurance may say they will only cover the hospital expenses related to the accident and you will have to take up the secondary complication issues and charges with the hospital because they do not feel they were a result of the accident.

Be thankful that you have never had to deal with those kinds of stressful situations, but understand that just because you have never had any issues does not mean it cannot happen to you.

people going to the hospital when they don’t need to, or when it’s totally avoidable is a problem too.

In the aging population. My company estimates that around 1/5 of hospitalizations are due to people
Not taking their medication properly. Whether it’s choosing not to, taking them improperly due to lack of knowledge or other barriers, or costs of the medications.

usually getting services in place to make sure the person takes their medication is cheaper than the person going to the hospital a couple of times a year because they’re in pain or their chest hurts or their blood sugar is out of control, etc.

 

[Rockport]

Depends on the insurance company.

It’s also one of those necessary evils though. I work for an insurance company. It is my job to assess people’s needs for long term services (home health aid, home modifications, home nursing, etc).

Som people want to max out their benefits and get as many services as possible, even though additional services won’t impact their functional independence level. So the company has to deny the patients request because it’s legit not needed.

Conversely, there are patients who don’t even want as much services as they would be eligible for.

I can recall very few instances where I thought my company denied somebody services that were legitimately needed based on their assessment.

Of course there’s also the appeals process.

a couple of years ago I was struck in a car by someone who fell asleep behind the wheel. My car was totaled. Luckily I wasn’t hurt.


I remember calling their insurance company and saying hey listen. I have missed time at work. I have had to deal with the headache of looking for a new car. Your driver almost killed me and now I get nervous at stop lights, etc.

I asked them to send me some money to cover these things. They gave me a decent pay out l that covered all my missed time at work plus money for inconvenience and overall my life being a pain in the butt for a while. no court needed. Nothing. They just cut me the check. But I was also reasonable. I didn’t ask for a huge payout.


one of my co workers around a same time. Rear ended somebody. Guy wasn’t hurt. Car wasn’t even totaled. A fender bender. The dude who she hit has been suing her insurance company for several hundred grand claiming he has permanent nerve damage and is going through pain and suffering. It’s nonsense because the dude isn’t hurt. But he is trying to retire because he got rear ended one day. So the insurance company is forced to fight him in court because of his lunatic demands.

Stuff like that raises everyone else’s rates.

Totally understand having to vett those that make claims.

 

[kskboys]

Depends on the insurance company.

It’s also one of those necessary evils though. I work for an insurance company. It is my job to assess people’s needs for long term services (home health aid, home modifications, home nursing, etc).

Som people want to max out their benefits and get as many services as possible, even though additional services won’t impact their functional independence level. So the company has to deny the patients request because it’s legit not needed.

Conversely, there are patients who don’t even want as much services as they would be eligible for.

I can recall very few instances where I thought my company denied somebody services that were legitimately needed based on their assessment.

Of course there’s also the appeals process.

a couple of years ago I was struck in a car by someone who fell asleep behind the wheel. My car was totaled. Luckily I wasn’t hurt.


I remember calling their insurance company and saying hey listen. I have missed time at work. I have had to deal with the headache of looking for a new car. Your driver almost killed me and now I get nervous at stop lights, etc.

I asked them to send me some money to cover these things. They gave me a decent pay out l that covered all my missed time at work plus money for inconvenience and overall my life being a pain in the butt for a while. no court needed. Nothing. They just cut me the check. But I was also reasonable. I didn’t ask for a huge payout.


one of my co workers around a same time. Rear ended somebody. Guy wasn’t hurt. Car wasn’t even totaled. A fender bender. The dude who she hit has been suing her insurance company for several hundred grand claiming he has permanent nerve damage and is going through pain and suffering. It’s nonsense because the dude isn’t hurt. But he is trying to retire because he got rear ended one day. So the insurance company is forced to fight him in court because of his lunatic demands.

Stuff like that raises everyone else’s rates.

And on the flip side of that, I got my truck totaled by a kid who ran a stop sign. His insurance company declared that they couldn't see that it was his fault.

 

[CF74]

Never been able to get my head round your system. NHS over here isn't perfect but free "at point of service" is such a good thing. Terrified we're going to lose it post Brexit

You’re delusional if u think it’s free. Your pay checks are sucked dry by your Govt.

 

[CF74]

Update:

I went to HR today and she said I’m supposed to be getting $300 of the $660 per month. It’s listed on the pay stub but when adding up the numbers it’s not being credited.

She said she’s going to have to look into this. I get the sense she is stalling. I asked her multiple times, what is my actual monthly premium to which she replied, it’s the $331.74 X 2.

I also emailed Blue Cross thru the member profile the same question. They replied to check with my HR dept.

I hate being forced to pay for something. It’s Un-Constitutional!!!!

I’m going to shop around like @Reverend Conehead suggested.

Healthcare.gov

 

[HungryLion]

Update:

I went to HR today and she said I’m supposed to be getting $300 of the $660 per month. It’s listed on the pay stub but when adding up the numbers it’s not being credited.

She said she’s going to have to look into this. I get the sense she is stalling. I asked her multiple times, what is my actual monthly premium to which she replied, it’s the $331.74 X 2.

I also emailed Blue Cross thru the member profile the same question. They replied to check with my HR dept.

I hate being forced to pay for something. It’s Un-Constitutional!!!!

I’m going to shop around like @Reverend Conehead suggested.

Healthcare.gov

It’s not unconstitutional. We are forced to pay for stuff all the time.


A $662 per month premium sounds much closer to what it should be for one 45 year old.