Health Insurance is Out of Control

[nightfighter]

First off, I get my bill for $150.00 co-pay for an emergency room visit in August when I got my index finger filleted by a bluefish. No problem with the amount of the co-pay, I knew what it was going to be.....But the entire billing was for $1050.00!!!! All they did was wash it with brown soap, stick some crazy glue on it and give me a script for antibiotics! How can they justify this? I was sitting in the admissions waiting area for 75% of the two hours I was there. In treatment are for less than 30 minutes. $2100.00 per hour? Ridiculous.

Then, tonight I get a call to pre-register for my twice postponed colonoscopy this Thursday. They just called back to let me know that I need to pay $500.00 at the time I arrive for the procedure.... WTF??? I have Tufts Health Plan and this is a prescribed/preventative procedure. It's not like I am having elective surgery here.... Not at all happy with having it in the first place and this is really putting me over the top...

[Goose]

need health ins?...lemme know

[spence]

Healthcare is a huge issue, perhaps larger than terrorism.

We need to provide basic government care, and modernize the rest of the system. Obviously personal responsibility needs to be factored in.

The liability here is in the 10's of trillions of dollars.

-spence

[Crafty Angler]

Spence, I think healthcare is a kind of terrorism - - inasmuch as everyone is scared witless of a health crisis.

I've just found out first-hand.

The day before Thanksgiving my wife came home from work after an hour doubled over in pain - in almost 30 years together I've never seen her so sick.

I rushed her to Newport Hospital, didn't feel she would make it to Providence or Boston in her condition. She was admitted that night, in surgery Thanksgiving morning and back home after a couple of days of observation and recuperation.

She still needs to go back to a specialist to resolve her health issues - and we're uninsured -

We had insurance when we had our business but costs made it prohibitive eventually. Every day since her hospitalization I approach the mailbox like it was full of rattlers waiting for the bill to arrive. She's coming along pretty well right now and I don't want to worry her with this - ultimately, not a great position to be in.

What do people who are self-insured do for coverage? Our last provider was expensive and terrible - I know that a higher deductible will bring down the costs somewhat - but I have to say I don't know what the answer is at this point in time -

Anyone have a solution in terms of coverage?

[Crafty Angler]

Blue Cross has an open enrollment going on now - I'm going to contact them just to see what the monthly is - I know it probably isn't going to be pretty

[cheferson]

Blue cross individual plans are actually reasonable. I had one before i switched over to my employers group plan.

[ProfessorM]

I am so glad my wife works for BCBS. It keeps our costs reasonable. I feel sorry for people struggling with this issue. Sucks.

[The Dad Fisherman]

Originally Posted by cheferson

Blue cross individual plans are actually reasonable. I had one before i switched over to my employers group plan.

Don't know about that anymore....I checked on them last month and it was cheaper for me to keep COBRA instead of going to them...

[luds]

Originally Posted by The Dad Fisherman

Don't know about that anymore....I checked on them last month and it was cheaper for me to keep COBRA instead of going to them...

I think COBRA is usually cheaper because you are getting the benefit of group rate. Take advantage of it while you can.

I know this is probably pretty obvious but take a very close look at coverage for individual services. Especially the ones that you utilize most. There are definitely alot of creative plans like the high deductible mentioned early but sometimes plans have an 80/20 payment set up and might be 50/50 for some services. People often overlook the higher costs for those certain services until the bill comes.

My first job out of school was taking calls in a health insurance call center 7 years ago. It's frightening to see how fast things have gone down hill since then. I could not do it now.

I still work for a health insurance company. Please tell me why my co-worker's girlfriend gets a better deal than me and she works for a financial institution.

[The Dad Fisherman]

COBRA might be cheaper but its still over 8 bills a month...thats a lot of cabbage. BCBS was about $30 more a month for their lowest plan.

I plan on riding out COBRA as long as I can but it will be ending soon....then

[cheferson]

I used to pay $200 a month at the old employer(health mate), then cobra for $480 a month, then when i did the idividual (bcbs)it was $140 with the discount. Now i pay $420 (pre-tax) for health, dental and vision for a family plan from bcbs, and delta.

[Plum Crazy]

As of Nov1 we have NONE.
Can't afford the $800 a month with COBRA while on unemployment.
Trying to figure this out is frustrating and confusing.
The paper work is enough to put you in the hospital.

[Plum Crazy]

Thanks Scott.
I will check it out.
This all so overwhelming. These things have always been taken care of FOR me, through work.
There are just way too many ways to go.
One thing that makes me nuts is the deductibles.
What the heck are we paying insurance for?
There have been years when I have never used my insurance once.
$800 a month for years and years and I still end up paying thousands more for one incident.
Now all I keep seeing is 6 month waiting periods.
What does that mean?
Will I be covered for 6 months after I cancel my insurance?
The whole thing is just a huge rip off.

[striperman36]

Originally Posted by ProfessorM

I am so glad my wife works for BCBS. It keeps our costs reasonable. I feel sorry for people struggling with this issue. Sucks.

Party at the Profs!!!!
I pay 500 a month and I work for somebody

[Goose]

Paradigm Benefits Group 508 991-5352 They primarly set up health ins. for small bussiness's and cooperations, they're very good.

[PaulS]

Originally Posted by nightfighter

First off, I get my bill for $150.00 co-pay for an emergency room visit in August when I got my index finger filleted by a bluefish. No problem with the amount of the co-pay, I knew what it was going to be.....But the entire billing was for $1050.00!!!! All they did was wash it with brown soap, stick some crazy glue on it and give me a script for antibiotics! How can they justify this? I was sitting in the admissions waiting area for 75% of the two hours I was there. In treatment are for less than 30 minutes. $2100.00 per hour? Ridiculous.

So rather than "health insurance" being the problem, isn't this indicative of "health care costs" being the problem? The costs of the hosp. bills is out the control of the insurance industry other than the insurance companies keep costs down by negotiating discounts from the hospital.

[PaulS]

Originally Posted by The Dad Fisherman

Don't know about that anymore....I checked on them last month and it was cheaper for me to keep COBRA instead of going to them...

Your correct, by law you can only be charged either 2 or 3% more than what the group pays. So as was pointed out your getting the benefit of the group rates. What might be chearper is a underwriten individual policy. Mass may be a guaranteed issue rate and you may have gotten quoted for that. If your healthy and they have an underwritten policy, you may be better off.

Waiting periods protect the insurance companies and thus are reflected in lower rates. They prevent someone who knows they have a medical condition from purchasing coverage to get treated specif. for that condition. Their similar to pre-existing exclusiions (which is what usually is the reason ins. companies canc. policies - people lie about their pre-existing condition.)

[PaulS]

Originally Posted by Plum Crazy

As of Nov1 we have NONE.
Can't afford the $800 a month with COBRA while on unemployment.
Trying to figure this out is frustrating and confusing.
The paper work is enough to put you in the hospital.

Call your state Dept of ins and ask what comp. are approved to sell in the state. Look at a HSA with the highest deducitbles offered. You need catostraphic coverage in the even you have an long term illness/accident. If god forbid it happens and you have no coverage, you'll have to declare bankruptcy. A high $ ded. HSA might only cost $100/month (I don't know the costs).

[redlite]

To all of you, I am an independent licensed insurance agent in Mass. If any of you have any questions, need explanations, or need help in navigating the muddy waters of Mass Health Insurance, seriously, let me know. This state is so f'd up and they all suck, but the system can be beat.

[freebie]

I'm lucky enough that my boss pays for half of mine(tufts, very basic coverage), he also did some legwork and found a state program that pays for half of my half, ends up costing me 140 a month, the program is called insurance partnership I believe, they base what they pay on how much you make, once Katie gets her new job I'll go on hers as a significant other until we are married since it will be better covereage but at least I have something for now

[Bishop169]

I work for an insurance company Aetna.

the hospitals and the doctors set these prices not the insurance company the 1050.00 is not on the insurance company

I know we have different plans and a few of the less expencive plans dont cover preventative procedures they only cover Medical necessary I dont know the plan you have but it sounds like case talk to your doc and see if he will bill it as medical necessary doesn't hurt to ask

[PaulS]

Originally Posted by Bishop169

I work for an insurance company Aetna.

I bet your insurance is worse than half the people on this site. Do you have a crappy HSA or HRA?

[JohnnyD]

Just read this thread for the first time. Working as an EMT for a while and knowing how much the rides cost was always dumbfounding. In MA, all ambulance ride prices are mandated by the state, but still: $200 just to get in the truck, $35/mile, and that's before we use any skills. Need oxygen: $150, gotta check the blood sugar level: $100. And that's for a EMT-Basic, people that need a paramedic, average price of a trip is almost $2000. Doesn't matter if the trip takes 20 minutes or 2 minutes.

I have Tufts as well, but my hospital co-pay is only $50, same for an ambulance ride regardless of the final cost.

You guys think MA and RI are bad policy wise... I worked 911 in Connecticut for a few years. If someone has CT Medicaid (or any other state assisted policy) and "needs" (4 out of 5 people on these plans didn't really need to) to go to the hospital, the state of CT *requires* they arrive by ambulance. I have literally picked someone up who lived within 100 yards from their front door to the ER entrance.

[Bishop169]

Originally Posted by PaulS

I bet your insurance is worse than half the people on this site. Do you have a crappy HSA or HRA?

Yea its bad I didn't go with HSA its kind of a nice idea since they allow for you to borrow against it for anything you want but I got kids..

Its so wierd working for a health insurace company and having cr@p insurance

[nightfighter]

I'm covered under an American Express employee plan in Mass. But the plan sucks. Only one option for a company of that stature... It's with Cigna and it Sucks. Expensive with huge deductible and higher co-pays. I was sent to have a pulmonary test, ie. breathing capacity, and my doctor wanted a baseline. The lab billed out at +$2600.00, the ins co. only accepted half that amount, (they will only agree to accept half of the billed amount to consider....wish I could do that), and then the plan has a co-pay and a 2300.00 deductible!!!! I am going to be billed for well over a thousand bucks.....So what exactly are we paying $600.00/mo for??????? Efin' system is totally screwed up.

[Slipknot]

Ross, so send them 300 a month instead of the 600

[Mike P]

Originally Posted by PaulS

So rather than "health insurance" being the problem, isn't this indicative of "health care costs" being the problem? The costs of the hosp. bills is out the control of the insurance industry other than the insurance companies keep costs down by negotiating discounts from the hospital.

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.

[Raider Ronnie]

No worries, Obama's health care plan is going to save us
:l augha:

[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.