Last straw with "self insurance" - considering catastrophic coverage. Bad idea?

In My Humble Opinion (IMHO)
#1

I’m 41 single no kids non smoker healthy (but 40 lbs overweight) and signed up for self health insurance because I’m a freelance employee. So far I’ve experienced the following:

• complete denial of one pre-existing condition
• monthly premium increased by 50% because I disclosed that I have taken anxiety meds in the past (am not anymore)
• denial of coverage for the last 2 (minor) claims submitted
• disclaimer read to me by phone agent that a list of about 12 common health issues will not be covered within the first 6 months of my coverage
• ridiculous deductible that is basically a catastrophic-type amount I’d have to pay ($16,000!!!)

All of this for the low, low price of $155/month.

EFF THAT. I’m done.

I want to cancel this insurance and sign up for catastrophic-only coverage and just start paying out of pocket. So far, I’ve paid about $400 OOP anyway for stuff I knew would never be covered (for example I got a yearly gyno exam done one month early because I hadn’t been feeling well and wanted to rule out a gynecological issue). I basically had 2 choices: get a discount from the doctor for paying OOP, or submit it to insurance, get denied, and have to pay full price. (and oh by the way, gynecological issues are one of the 12 non-covered things on that disclaimer list anyway). I have had nothing but bullshit from this insurance company, and am sick of getting these surprise charges automatically charged to my credit card for all the bullshit they end up declining. And I’ve already paid them 4 months of stupid premiums for what feels like nothing- not even peace of mind.

Anybody out there have catastrophic coverage and pay OOP for medical charges? What has your experience been?

#2

For the record, you’re not talking about self-insurance, you’re talking about an individual policy. Self-insurance is something altogether different.

Did you research the company before you bought the policy? There’s a few places out there where you can find ratings on insurance companies, I can dig them up if you’re interested.

I’m self-employed, and pay my own health insurance. It’s pricey - we pay a little over $500/month for Mr. Athena and I, with a $3850 annual deductible. That said, they’ve never once denied anything, even some very pricey stuff that I’ve heard horror stories about denials on. I’m very happy with them in every case except the price. The annual premiums go up about $1K/year. Crazy.

Once I hit the $4K deductible a year (and I do, every year), they pay 100% of everything. It’s Golden Rule insurance, if you’re interested.

And yeah, it’s crazy expensive. But it’s good for peace of mind, and I’d never go without it. I’m one of the unlucky ones who went from perfectly healthy when I first got the policy to having a chronic condition (Type 1 diabetes) that is perfectly controllable if you have enough bucks to throw at it. I’d be screwed without the insurance, so yeah, I’m glad we kept it up even when we were healthy and didn’t use it much.

#3

Nm

#4

Mine is Golden Rule Insurance too. I cannot afford the premium I would be charged to have even a $5000 deductible. I had to up it to $10000, and was informed by the phone agent that I would really have to pay $16000 first for them to start covering at 100%.

So far I’ve paid more in premiums than I have OOP and it just seems stupid to continue throwing my money down a hole for what appears to be nothing.

Somehow I missed your Type 2 Diabetes paragraph- when I’m mad I don’t pay well enough attention! Ugh- I guess that’s the part that worries me. B/c once you get denied for something, I’d bet that you always get denied for it every subsequent time you try to get an individual policy, huh?

#5

That doesn’t seem right - I’d investigate it a bit. I don’t pay a cent over my deductible unless I go to an out-of-policy doctor or lab, in which case another, separate deductible applies. I get around that by not going to out-of-policy doctors. Luckily in my area, I have yet to find a doctor that isn’t covered.

Well, that’s kind of how insurance works. If everyone gets back what they pay in, the model fails. You’re paying for the coverage in case something happens.

It’s Type 1, not Type 2. And I don’t think denials work that way - if one company doesn’t cover <condition X>, that doesn’t mean another insurance company won’t.

That said, pretty much all insurance companies in the US consider Type 1 diabetes (and some versions of Type 2) to be instant denials for new policies. That means that I effectively can’t cancel my insurance and go get another policy. But that doesn’t mean that my current insurance company doesn’t cover my treatments for it - they do, because the policy was in place when I was diagnosed.

#6

I get what you are saying, but I just want to point out to you that $155 a month is indeed a low, low price for insurance. Pretty much everyone who has a $150 policy that they get through work is having their insurance cost supplimented by their employer to some degree. My husband was shocked when he was laid off and got his COBRA paperwork and found out that his insurance cost his employer $600 a month in addition to the $100 he paid toward the premium. As an insurance agent I talk to a lot of people who have no concept of how much insurance costs for everyone, group plan or no.

Insurance varies from state to state so you will want to speak with a broker in your area but generally you have a couple of options for finding better coverage. You can join a freelancer’s union and sign up for their benefits. You can join a fraternal organization (Knights of Columbus, Lutheran Brotherhood, etc.) that offers group coverage outside of the workplace. You can get a part time job at Starbucks or someplace solely for the access to benefits. But no matter which of these (or other) options you choose you will probably find that $155 is a dang good deal for almost any kind of coverage at all. There will always be outliers and costs vary from state to state of course, but even in a small town at a young age the cheapest policy I ever found individually was $123 a month and that was for emergency catastrophic coverage only. The biggest benefit to group coverage is that most of the time you don’t have to go through a physical to get the coverage and that depending on how long you’ve had this coverage currently you may be able to have them waive pre-existing conditions or other things like that as part of the policy.

If you are interested in keeping your costs low you will probably want a high deductible cost sharing or HSA plan but you have quite a lot of options for coverage depending on where you go. Sit down with a broker (or union rep or fraternal organization Grand Poo-Ba or whoever if you end up going that route) and explain your needs, what you are looking for in a plan and your price range and see what they are able to do for you.

#7

That’s basically how my (employer-provided) insurance works. I cover the original deductible, and then the plan covers 90% until I hit the max-out-of-pocket number, and then it covers 100%.

Joe

#8

I would also investigate part time work. Some will pay insurance for part time work. It may be worth it, to work part time, at least till you get in the insurance. Then quit and take COBRA. I’ve done this before.

More employers are cutting back for part timers, insurance-wise but it may be something worth looking into.

I worked at a computer store and if you were a part timer and worked 20 hours per week you could get insurance for health and dental.

#9

Walk in clinics can be decent, and some offer cash discounts if you pay at the desk w/o using insurance.

I am lucky to have never had medical expenses that were more than $1000 at a time in my life, so I’ve never needed real insurance. So I can’t comment on it. But reading endless horror stories it seems paying tens of thousands on insurance just means you are slightly less likely to go bankrupt and still have no peace of mind.

There is the pre-existing health plans passed in the affordable care act. But those are likely $300-400/month for someone your age.

http://www.healthcare.gov/law/provisions/preexisting/states/or.html