I work for a Fortune 50 company. I have an Empire Blue PPO.
It is completely inadequate. Premiums for my wife and I are $400 or so per month, plus a required contribution to our HSA.
Our deductible is $5,000. The insurance kicks in for almost nothing at all until that deductible is reached.
The last round of my wife’s prescriptions cost $300. On the Rite Aid savings plan for people with no insurance whatsoever, the same prescription would have cost $315.
We have no copays when we visit doctors. We just get massive bills afterwards.
While I’m in favor of any kind of reform, my insurance hasn’t really let me down (yet).
I’m a poor youngster, still on my mother’s plan. It’s an HMO, which is supposed to mean it sucks, but for me it’s been pretty great.
The key difference between HMO and PPO is that with PPO you can do whatever you want, but you have to pay a percentage on everything (usually 20%), whereas with HMO you pay a flat co-pay on almost everything, but you have to run everything past your primary first.
I prefer the HMO route, because the copays are usually lower than the 20% deductible. A visit to my GP is technically $120; so 20% of that would be $24, but my copay is $20. Or, more significantly, when I went to the ER for kidney stones the first time, the total charge was over $3,000; 20% of that would be $600, but my ER copay is only $75.
Needing a referral for specialists doesn’t inhibit me in any way. I really like my primary doctor and trust his opinions and his knowledge of other doctors, so when I need a specialist I’d want to ask him to refer one anyway. If I had a PPO and didn’t need a referral, would I be picking my specialists out of a phone book instead? No, I’d get my doctor’s advice. The referral requirement just means I’m “forced” to be responsible instead of merely preferring to be.
If I didn’t have a good primary doc, things might be different. I think the idea behind HMO’s referral requirement is that it means you wont go for frivolous procedures because your primary is supposed to talk you out of things or only let you do XYZ, but in my experience, everything’s been just peachy.
Since I’m on my mom’s plan, though, and technically I’m not supposed to be, it would be easy for them to deny me coverage if I needed a really expensive procedure that required personal review/authorization. So I have that worry that I might get in a helicopter accident or something and need a new spleen/liver/brain/body and end up uninsured. This is why I like the reform bill, because it would require coverage up to age 25 on parents’ plans, and removes yearly payout limits.
I am happy with mine except it is not valid in the USA so I can’t live in the country I was born in and where all my family is. I pay $200/mo for my wife and I together for $7 million in coverage and a $1500 deductible.
In the US I was declined by every insurer in my state (more than a dozen companies) due to a pre-existing condition which requires no ongoing treatment.
So my insurance is fine, except I have to keep moving countries every 90 days to 6 months to stay within the limits of most tourist visas. Been doing that for more than 7 years.
One thing that really fogs up this discussion is when people mention the price they are paying. It really doesn’t matter if you’re paying $0, $100, $200 per month etc if your employer is picking up the rest. Any sort of good group policy is going to run $800-1200/month per family. So you really need to think if you’re happy with your family policy that’s costing ~$12000/year.
Even if your employer is picking up the whole tab, it is coming out of your pocket in some sense. If your employer could pay less in health insurance, that revenue would be spent on other parts of the business like paying higher wages, hiring more people, buying more equipment, etc.
I can afford it… I earn roughly $250K/yr, but a pre-existing condition means an auto-decline from every insurer in my state. What good is a system like that?
Fortunately my work allows me to live anywhere, so i have just been on the road traveling for 7 years (not as much fun as it sounds). I am in Korea today and will be in Japan tomorrow… all with great UK based insurance, as long as I do not set foot in the USA (where I was born and all my family live).
I like my plan. It’s a middle of the road to better BCBS PPO. The majority of the docs in the area take it, the one drug I take is covered (20 a month) and when I need appointments, I get em. On the other hand, I took a job-related head-to-toe physical and stress test this spring. The quack that (I think) had a hard time reading the 12-lead EKG thought she saw something on the strip, slapped me in the urgent aid ER for three hours with an IV and a case of the holy craps. Turns out according to the cardiologist and the 1/2 gallon of blood they took, I’m dandy, but stuck with almost $400 in bills now that the insurance didn’t cover. Though it makes me all filled with gr, I’ll pay up, so yes, I’m happy with my insurance overall.
That said, I think the way that the current ‘public option’ spends money is as dangerous as it is bloated. I think there are far better ways to deal with it that will cost all of us less money
I’ve had three different insurance plans: BCBS PPO, United Health PPO, and BCBS HMO. I thought I had broken my ankle or hand (from basketball) exactly once under each plan. Every time I paid my $10 co-pay (I think the BCBS might have been $20), and that was it, everything else was covered. I actually pay more out of pocket with my dental insurance (possibly vision, but I haven’t had the need to see an eye doctor since forever). Under United Health, I once had the flu or something where I literally could not even check email for 24 hrs (I was sick for a week, but that day I literally couldn’t do anything). I paid an additional $10 for the prescription they gave me for antibiotics.
So yes, I like my health insurance. Total cost to me was, at the most, $100 per month. Now, it’s $25/month because I switched to HMO. I’m not sure what the limits or deductibles are, because I never hit them. If I actually broke a bone or something or needed a cast or some surgery, I’m sure I would’ve needed to pay a deductible. But thank God, I’ve been healthy. My current plan used to be free, but because of the downturn in the economy, we were mandated to pay for it. I think high ranking VPs and above still get it for free, but my level and below now has to (before, it was a certain employee level below me that had to pay).
If I could opt out of my health insurance, I would. Even in college, I was rarely sick similar to what I am now in the working world. However, I don’t opt out because my company has repeatedly told me that they would not give me the cash equivalent (and, among the other things we provide, one sector is even in the business of health insurance).
It doesn’t bother me that others are uninsured. I’m sure that there are others like me (and at least one poster in these health care threads) that would rather manager their money in a HSA, than pay health insurance. For every time I got sick, I could have gone to a public clinic. When I rolled my ankles, I’m sure as hell not waiting to see my personal physician. I went to a public clinic/urgent care each time. I want to make sure as soon as possible that it’s not broken and if I can get any pain medication (I got some for the last one, that really hurt).
The one area that I do have a concern, though, however, is where people have chronic illness. I think, I’m not sure though, that clinics can probably treat every thing from bronchitis, asthma, and allergies to diabetes and dialysis. I think we as a society can pay for those treatments of the latter two, but let doctors and big pharma compete for the former.
In addition to market based reforms, I would also offer scholarships to potential doctors and nurses. The government will pay for your tuition if you promise to work at various clinics in addition to wherever else they work. They won’t get paid at these clinics, but they can work off their student loan debt to the government. Fannie/Freddie can manage the loans. Medicare/caid can manage the clinics in conjunction with the local county services.
Not to pick on you, but you’re expressing a fallacy people have about health insurance. They think they only need it if they get sick a lot. If you opted out, what would you do if you got cancer? Got in a car accident? Had a stroke? etc. Any of those things could cost $100,000 or more to treat. You’re not immune from illnesses. Even babies get brain tumors.
And if you did get a serious illness when you didn’t have insurance, you would likely not be able to get insurance for a long time, if ever. No insurance carrier would take you. At a minimum, everyone should have some amount of health insurance even if it is a high deductible plan.
I like my insurance for the most part. I’m a Federal Employee and they pay for a good part of the premiums. I have Blue Cross/Blue Shield and it’s pretty good. It sucks on dental and eye checkups though, so I have a supplement for dental. I used to have an HMO that was pretty good, but I didn’t like to have to do referrals for specialists and not having them pay for medical visits out of town, so I switched to what I have now.
I love my insurance coverage. It is 100% paid by my employer for me and my partner. (I have to pay taxes on the market value of his coverage, but that would be true with any company since it’s an IRS rule) No lifetime max on benefits, very cheap copays and no copay for hospital stays. I’m sure there are improvements possible in the delivery system, but it’s already ranked as one of the top systems in the country.
Sorry, I didn’t mention that I would forgo regular insurance (or opt out as it were) and use a HSA. I do suppose that healthy people like me not in regular insurance pools would overall drive up the cost of insurance, but hopefully that can be eased by creating larger pools of insured across state lines in the general public.
I pay them every month then have to pay 100% out of pocket anyway due to my deductible being so high. No dental, no vision, no prescription. Even if I stepped up to a better policy it still wouldn’t matter unless it included dental since that is 80% of my medical expenses, at which point it’s cheaper to pay out of pocket anyway.
There are so many things in my life that could be better, but my health care/insurance is not one of them. Every time I go to my doctor or emergency I’m left with that satisfied feeling of being looked after above and beyond the service I would get in any other facet of my procurements. This goes for not only myself, but my family members as well, who are of of various degrees of financial well being.
I’m Canadian, from BC, pay just over $100 per month for my health insurance premium covering my family.
Listening to you Americans debating universal health care just makes me want to pull my hair out.
Our current health insurance is OK, although we’ve had the usual “oops, we rejected that claim by mistake; so glad that you called in to correct that for us” problems from time to time. But I don’t trust insurance companies and I never will again, after our experience with my son in 2002. I’ve posted about it here before, but a brief summary is that I had excellent health insurance for myself and my child, provided by my employer. Never had a single problem with them whatsoever. Then Whatsit Jr. got RSV, and was admitted to Children’s Hospital, where it turned out that he also had MRSA pneumonia. He wound up breathing with a ventilator for about a week, in the NICU for a total of three weeks, and had to have two surgeries to insert chest tubes. It was hell. But anyway, early on in this hospital stay, we called the insurance company to make sure we were covered. They said yes, absolutely, you are covered 100% after the $1500 deductible. Fine. $1500 was a lot for us, but we could shoulder that, just barely.
Then, a few weeks after we brought Whatsit Jr. home, we were informed by our insurance company that actually, one of the neonatologists practicing in the NICU at Children’s Hospital was an out-of-network provider. That’s right: At an in-network hospital where we took our son for lifesaving services, one of the doctors was out of network. Apparently the hospital contracted with third-party providers to bring in additional staff because there was a shortage of NICU doctors at the time. So. We got charged the out-of-network rate for this doctor’s services for one day. $7,000.
We tried to fight them, but after a few months of not getting anywhere, we gave up and put it on a credit card. It screwed us up financially for a really, really long time.
And that was my experience with an insurance company that, prior to that incident, I would have cheerfully described as excellent, no problems, professional and helpful, etc. The metaphor that someone posted up-thread about umbrellas made out of toilet paper seems particularly apt to me.
Possibly, but not necessarily. If for example he was on as a minor but aged off of the policy and wasn’t removed (as should have been caught by the company) then he has not commited fraud.
I hadn’t read his post, just yours. Being on the plan is not necessarily fraud.
Since he is aware that he is uneligible and is using it anyway, then it most likely is. HIPAA made health insurance fraud a federal crime and the penalty can be up to 10 years in prison. Though the most likely scenario is that they would just remove him from the plan if discovered.
Yeah - this is the kind of thing that drives me crazy. Just a couple of the many examples come readily to mind:
-My primary recommended an endoscopy. Referred me to an in-service GI who wanted to do the procedure in the office, but the HMO required that it be done in the hospital. In the end they paid all of the claim - except the room in which the procedure was performed. Took a year to straighten that one out.
-My wife was having foot surgery. They granted the claim, except for the anesthesia. Said she chose one that is not covered. It isn’t as tho she was ordering a la carte off the menu. She was having an authorized procedure performed by authorized personnel in an authorized location.
-The day before my torn medial meniscus was to be scoped, I was within 1 phone call of calling it off, because I was going through phone hell and could not get a clear answer as to whether all aspects of the procedure would be covered.
And I am fortunate that I make decent coin and my family’s medical needs are relatively minor. I truly feel for those who are not so situated.