Health Insurance is Out of Control

[Raider Ronnie]

Originally Posted by Mike P

I'll give you an example. My wife had bilateral knee replacement surgery in July, and we just got a statement from Falmouth Hospital. She was there for the surgery on Monday, and for 4 nights. She was discharged to RHCI in Sandwich on Friday.

Total amount billed to Harvard Pilgrim--$89,000. Which doesn't include her surgeon's bill.

$45,000 for the two artificial joints alone.

$10,000 for the anesthesiologist.

$5,000 just for her stay in the recovery room.

Another $5,000 just for pre-op services.

The hospital bill for room and board wasn't too bad $500/night or $2000 in total.

The surgeon's bill will probably be around $50,000--just a guess.

And I expect that a week in RHCI will be at least as expensive as the hospital stay.

We're talking probably a quarter million billed to HP, of which they'll probably pay around 60%

Since Falmouth Hospital is "in network" and the whole thing was pre-approved, we're on the hook for the $100 we paid at admission, and another $100 they just billed us when they sent us the statement of what they billed HP.

I'll bet you our midget gov won't even have to pay that $100 amount towards his hip replacement !

[Mike P]

Originally Posted by Raider Ronnie

I'll bet you our midget gov won't even have to pay that $100 amount towards his hip replacement !

I don't know--I think that he's covered under the same GIC umbrella as every other state employee. His out of pocket will depend on which of the plans he has, and there are at least 2-3 plan levels for every provider. If he has the full Commonwealth Indemnity plan (which costs close to $600/month for a family plan) it won't be a lot.

And my out of pocket would have been a lot more if I went out of network. It's one of the reasons we switched from GIC's Community Choice to Harvard Pilgrim--Falmouth Hospital isn't part of the GIC network. We would have had to pay over a grand out of pocket. But it is in HP.

[Karl F]

Mike, when you say $600 a month, is that the Total Premium, or is that the employee's %??

Also,..Family Plan, or Individual?

[Mike P]

Originally Posted by Karl F

Mike, when you say $600 a month, is that the Total Premium, or is that the employee's %??

Also,..Family Plan, or Individual?

It's the employees' contribution, which is 25% of the total premium, for a family plan. GIC raised the employee contribution from 20% to 25% as of July 1. That's for the "gold standard" plan, GIC's "Commonwealth Indemnity", which is good for any hospital/doctor in the US. No "network" to stay in for full coverage.

The GIC "Community Choice" PPO, and the Harvard Pilgrim PPO plan that I have now are $300/month employee contribution. That also covers prescription drug insurance.

GIC also offers cheaper HMO plans.

Our vision and dental plans are free, but they're for crap. Vision covers an annual exam, and one pair of lenses and the cheapest POS frames available every two years. Dental plan covers up to $1000 per family member per year, so a root canal means you're digging into your own pocket for whatever it costs above a grand.