Can I vent about our high deductible insurance? TMI

[readyin07]

God, I just want to freaking cry.  I am glad we have insurance, I know we don't have it as bad as some people but dear Jesus we just can't get ahead. I am a SAHM and DH carries the insurance. It is about $650 / month for the four of us on our HDHP. We have a $3k deductible and then pay a 10% copay until we reach a $6k oop max. Prescriptions have a separate deductible. DH contributes another $75/month into our pre-tax HSA account. That is all we can afford right now. Our ds had to have a crapload of dental work so we had to draw about $900 from that account and it is tapped out. We are all pretty healthy people and aside from our well visits, we make maybe just a few visits per year to our pedi for sick visits (pink eye and strep throat this year).

So DH has an internal hemorrhoid. At first he thought it was a condition he had before called prostatitis so he went to his GP. $100 office visit, $60 antibiotic. He felt better but the doctor still wanted him to come back for a follow-up. Another $100 and a referral to a proctologist. $300 office visit with $10 antibiotic (what first doctor should have given him) and $50 suppositories. Nothing resolved. Return visit for $500 which please Jesus will take care of the problem (which isn't even bothering him anymore). We are at an $1100 hemorrhoid. I REALLY REALLY do not understand how HDHPs can be the wave of the future.

Can people afford to pay this for minor medical issues? My son's strep throat visit was a Saturday and I was charged about $97. I get about a $3 discount through my insurance. If I walked in off the street with no insurance then they would automatically discount that total 20% -- much more than what I got.

As it is, the doctor told DH and oh and you are 34, you should get a baseline EKG and colonoscopy and ALL THIS bloodwork.  seriously we just can't afford another $2,000+++ in expenses. I would really like to go to the dermatologist to get some moles removed that are bugging me but are not suspicious but I just don't want to spend the money. This sucks...I am just so depressed I thought the point of HDHP was to be able to get preventative care but these services are not going to be cheap with our insurance.

[SusanBAnthony]

Vent away.

We have a HDHP. It is cheap per month (around 100$ I think) so that part is good. The bad part is our OOP max is around 8K and we meet it every year.

We do contribute enough every year to our HSA to cover the OOP, but it sure would be nice to save some up and actually have a cushion. I honestly prefer the years that we hit the deductible early (3K MRI in January this year, cha-ching!) because then the bills are small for the rest of the year and I don't have to stress about it.

My SIL has a HDHP, and she can barely afford the premium, so the insruance doesn't actually heolp her at all, since she never goes to the doctor anyway. Obviously it is still good to have that backup in case she gets in a terrible accident or gets cancer though. DH had a triple bypass last year, and trust, we were glad we had the insurance!

The way they mark things down is so bizarre. Some things are a tiny discount, like you said (and for those you should totally still try to negotiate down!) but others are 90% off. I hate billing shenanigans.

[SusanBAnthony]

Oh, and DH had a hernia removed a few years ago. He tried to call and get pricing info ahead of time since we would be paying for it (hadn't hit deductible yet). Neither the doctor nor the surgery center could tell us even a ballpark estimate. They had no clue how much we would be charged. That is insane and wrong.

[Deleted]

Vent away, that's terrible.

[readyin07]

SusanBAnthony - YES! The piece of crap insurance company says that we have to price out our procedures (like a hernia operation!) and you know what, that's fine. I am used to haggling over every damn thing, but you are right the doctor's office is not at all transparent with that information. We have had the same problem as well which is why DH never got an EKG that was suggested to him a few years ago. It sucks. And they think I guess that you'll just do whatever. And you know what? We can't.

And just b/c I am letting it all hang out? NO, it does not need to be treated imo. It is not painful, but there are times when it is noticeable to him. I feel a little bit like DH is being a wimp/hypochondriac and it is a complete turn-off. Yes, I am a shrew but everyone in his family is soooo wimpy when it comes to things and I feel like he's kind of being that way too.

[pamela]

If your local "quack shack" is that much cheaper without insurance, I would consider just using that and don't have them bill your insurance for the minor things that you are almost positive just need a rx. I don't understand how your insurance is only getting you a $3 discount. Ours, through multiple companies, have always had a hefty discounted rate (we've been on HDHPs for almost 4+ years now).

[SusanBAnthony]

May 9, 2013 20:58:00 GMT -5 pamela said:

If your local "quack shack" is that much cheaper without insurance, I would consider just using that and don't have them bill your insurance for the minor things that you are almost positive just need a rx. I don't understand how your insurance is only getting you a $3 discount. Ours, through multiple companies, have always had a hefty discounted rate (we've been on HDHPs for almost 4+ years now).

But you have to, if you want it to count towards your deductible.  So you are stuck.  

[pamela]

May 9, 2013 21:02:44 GMT -5 SusanBAnthony said:

May 9, 2013 20:58:00 GMT -5 pamela said:

If your local "quack shack" is that much cheaper without insurance, I would consider just using that and don't have them bill your insurance for the minor things that you are almost positive just need a rx. I don't understand how your insurance is only getting you a $3 discount. Ours, through multiple companies, have always had a hefty discounted rate (we've been on HDHPs for almost 4+ years now).

But you have to, if you want it to count towards your deductible.  So you are stuck.  

But if you really don't think you'll hit the deductible in a year, might as well save the money.  There is some gamble there, I admit. 

[sent]

I will commiserate with you. Insurance companies suck. I am in a battle with two insurance issues, neither of them having to do with my personal health insurance. They are sucking the life out of me.

So many days I wake up and wish I had gone to work in the insurance industry because that's where I feel like the big bucks and big parties are these days.

[SusanBAnthony]

Oh! another vent!

dh had heart surgery last year, so we shot way past the OOP max. Like 200K over, this was not small change.

But, after paying that, BCBevil denied a 1000$ claim bc he had a preexisting condition. Well first of all, fuckers, he had continuous coverage, which we have already documented with you. That took 3 phone calls to resolve. They had somehow "lost" the proof of coverage, and I had to sit on the phone for an hour, refusing to hang up until they looked through his whole file and magically found it. Then, for months, they still didn't pay the claim. I called them weekly, then twice a week, and daily, escalated to a supervisor, etc. It took hours and hours of time. Every time I called, they told me in a patronizing tone that it took up to 30 days to process the claim. Well guess what, I am not stupid, you have been "processing this claim" for 6 months now! Finally, after the 3rd supervisor, they manually processed it, writing it down to 500$.

I will say it again. FUCKERS! DIAF Insurance companies!

Can you tell this gets me a little worked up? Back when I was young and healthy and had my dad's excellent insurance, I was all "we don't need socialized medicine, yay America!". Now I am "SINGLE PAYER PLEASE, NOW, YAY CANADA!".

[readyin07]

I did say to my son's doctor that I would just stop filing through insurance then (super unlikely that we will hit our deductible unless we really do have a major major health event and then we'll have to tap into savings so whatever we're screwed anyway) and they told me it is actually illegal to do that?

[SusanBAnthony]

May 9, 2013 21:15:45 GMT -5 readyin07 said:

I did say to my son's doctor that I would just stop filing through insurance then (super unlikely that we will hit our deductible unless we really do have a major major health event and then we'll have to tap into savings so whatever we're screwed anyway) and they told me it is actually illegal to do that?

I don't know.  I know we were told by a dr. to just get the 4$ generic scripts without going through insurance but 1.  That is meds, and 2.  Just bc the dr. told us to, doesn't make it legal.  

[kershnic]

Your insurance sounds like it sucks, I'm sorry. Insurance and medical billing is just one giant scam. It astounds me that it's allowed to continue.

[sjh722]

I'm sorry. I don't have much to add except I understand where you're coming from. It's hard (for us, at least) to come up with $5K every year on top of saving for retirement - our HSA is never fully funded because as soon as we get a buffer built up in there, something relatively minor happens and makes a big dent in it. We met our deductible early this year (thanks, March baby), but I'm going to have to set up a payment plan for some of the hospital bills.

I think they can be a decent deal if you have a higher income, or if your employer puts part of the deductible in your HSA and pays the bulk of the premiums. We pay around $300/month for coverage plus have to fund the entire deductible, and it sucks.

[sent]

May 9, 2013 21:14:47 GMT -5 SusanBAnthony said:

But, after paying that, BCBevil denied a 1000$ claim bc he had a preexisting condition. Well first of all, fuckers, he had continuous coverage, which we have already documented with you. That took 3 phone calls to resolve. They had somehow "lost" the proof of coverage, and I had to sit on the phone for an hour, refusing to hang up until they looked through his whole file and magically found it. Then, for months, they still didn't pay the claim. I called them weekly, then twice a week, and daily, escalated to a supervisor, etc. It took hours and hours of time. Every time I called, they told me in a patronizing tone that it took up to 30 days to process the claim. Well guess what, I am not stupid, you have been "processing this claim" for 6 months now! Finally, after the 3rd supervisor, they manually processed it, writing it down to 500$.

I will say it again. FUCKERS! DIAF Insurance companies!

Can you tell this gets me a little worked up? Back when I was young and healthy and had my dad's excellent insurance, I was all "we don't need socialized medicine, yay America!". Now I am "SINGLE PAYER PLEASE, NOW, YAY CANADA!".

The insurance company is banking on people to give up.  More money for the caviar upgrade at the company party.  You didn't, good for you.  I tell patients all the time the only way to fight their coverage is to call and complain.  Every day.  They don't believe me.  Like I can access the magic insurance company connection webpage and help them faster.  I am going to add telling patients to keep good notes and ask for supervisors at every phone call.

Canada doesn't have it any better.  When I lived in Buffalo, there were tons of Canadians that came over to pay cash for their MRIs and get their results sooner.  There weren't enough machines across the border and they didn't want to wait like 6 months for their MRI appointment.  I remember reading a few years ago about neonatal bed (NICU) shortages in Calgary and sending a mother to Montana to give birth to her quadruplets.  Calgary is supposed to be a big city!  At least the government paid for the woman's care.  Apparently Canada uses the US facilities and technologies to bail out its shortages.  

[ellipses84]

$650/mo seems like a really high payment for that type of insurance. That really sucks. I feel like the people who don't think we need a healthcare overhaul in the US must not have ever dealt with crappy insurance like we have.

If I were to consider a HDHP, I would compare it to my last job's health insurance, which I felt was high, but good coverage. COBRA cost $1200 for our family of 3 (my work did pay my $300 portion of it when I was there). That is $14,400/yr plus reasonable $10-$30 copays for visits and prescriptions and $100-$250 for major issues. I'd be really unhappy having to pay more than $15k/ yr for "insured" medical costs and would try to find cheaper private insurance or a HDHP where I pay everything OOP up until a certain number, like $10k, but not have the huge monthly fee!

ETA: $10k, not $10, but that would be nice, lol

[lilibet]

May 9, 2013 21:15:45 GMT -5 readyin07 said:

I did say to my son's doctor that I would just stop filing through insurance then (super unlikely that we will hit our deductible unless we really do have a major major health event and then we'll have to tap into savings so whatever we're screwed anyway) and they told me it is actually illegal to do that?

No, pretty sure that's wrong. Also if you do pay on your ownand then it looks like you might be close to your deductible you should be able to submit your receipt to have it processed under your plan and have any allowed amounts applied to your deductible. Just check if your plan has a filing period for claims.

eta - just wanted to mention that the people you are talking to on the phone or who get your letters have pretty much no power - like they seriously can't really do anything (I speak from experience). So always ask for a manager if you need results. If the person on the phone starts to get annoying or sounds mad or whatever just ask for a manager - it will save you so much trouble.

[vlagrl]

god that's way too much for health insurance.  you should look into buying your own thru an insurance agent.  we pay $200/month for a family plan.  we get $40 copays with the doctor, free annual check ups and well visits, and $12 generic medicine.

[Deleted]

We pay $630 a month for even worse insurance. $5,000 deductible per person per year, and $15,000 max out of pocket per person. Ouch. Oh, and our ER visit co-pay is $500. Thank God we had different insurance when DS was an infant, because we had several ER visits for breathing problems. I also have zero maternity coverage, so hopefully I won't accidentally get knocked up. It f-ing sucks. Our insurance sucks because DH and I are both self employed, so we have an individual policy. I'm actually thinking about leaving solo practice in no small part because we really need better insurance.

[Deleted]

May 10, 2013 22:40:38 GMT -5 vlagrl said:

god that's way too much for health insurance.  you should look into buying your own thru an insurance agent.  we pay $200/month for a family plan.  we get $40 copays with the doctor, free annual check ups and well visits, and $12 generic medicine.

$200 is crazy cheap.  I wonder what your maximum out of pocket is as well as your ages.  I'm also guessing that you have all always been very healthy.  My shitty policy has free preventive care (paps are free, physicals,
etc), but if I go to the doctor for an illness it's really expensive.

[SusanBAnthony]

When DH was self employed and we paid cobra for the hdhp at his old job, it was 1k a month for a family. Plus of course all the actual bills since it was high deductible.

That is why we moved x country from a city we loved and near friends and family. For health insurance. That is wrong.

[Deleted]

May 10, 2013 22:40:38 GMT -5 vlagrl said:

god that's way too much for health insurance.  you should look into buying your own thru an insurance agent.  we pay $200/month for a family plan.  we get $40 copays with the doctor, free annual check ups and well visits, and $12 generic medicine.

Those plans charge much higher rates for those with pre-existing conditions, they have a high OOP max, and they can drop you at any time (and they often do if you start submitting a lot of large claims). In the end, for someone with health issues, these plans end up costing more. The advantages of group insurance is worth the extra co-pay every month unless you're an exceptionally healthy person.

[vlagrl]

May 10, 2013 23:32:12 GMT -5 @godawgs said:

May 10, 2013 22:40:38 GMT -5 vlagrl said:

god that's way too much for health insurance.  you should look into buying your own thru an insurance agent.  we pay $200/month for a family plan.  we get $40 copays with the doctor, free annual check ups and well visits, and $12 generic medicine.

$200 is crazy cheap.  I wonder what your maximum out of pocket is as well as your ages.  I'm also guessing that you have all always been very healthy.  My shitty policy has free preventive care (paps are free, physicals,
etc), but if I go to the doctor for an illness it's really expensive.


yep we are really healthy.  I have some anxiety I take medication for but that's it.  our premium just got lowered this month to $200.  we were paying $237.  It's a really great plan our insurance agent found for us thru coventry. our family ded. is $5,000 but we never meet it anyways.  We are getting a rider put on it where if we are in an accident that costs a lot of money it will pay for our ded.  we would only be responsible for $100 of it.  The rider costs $35 a month plus we can get up to $1000/month in case either of us can't work for a little while.  we are self employed to this was important to us.  I am 33, DH is 37, and DD is 2.  I pay $6/month for my generic zoloft.  that's the only script we get out of all 3 of us.

[rubytue]

May 9, 2013 21:14:47 GMT -5 SusanBAnthony said:

Can you tell this gets me a little worked up? Back when I was young and healthy and had my dad's excellent insurance, I was all "we don't need socialized medicine, yay America!". Now I am "SINGLE PAYER PLEASE, NOW, YAY CANADA!".

I've often said that once you have a major medical issue, you will start to see why single payer (or at least something socialized) makes sense.  We ask people who are going through medical crises to fight with insurance companies to get treatment?  Its ridiculous!  And when you get down to it, we are so much close to socialized medicine that people realize.  The $700 support hose billed to insurance company A is just cost shifting to pay for the uninsured/unable to pay people.  It was like a light bulb that went off in my head when my insurance company denied a $4000 test on my cancer tumor, and the testing company said "no worries.  We write off anyone whose insurance won't pay."  Which means, some insurance paid $4000 so they could write off mine.  How does that make for a good system?!

To OP, I'm sorry.  Its the hard working folks that get caught in the crossfire of this mess with call our health insurance system.  Health care in the US?  Might be pretty good.  But the payment system SUCKS.

[vlagrl]

May 11, 2013 12:57:46 GMT -5 rubytue said:

May 9, 2013 21:14:47 GMT -5 SusanBAnthony said:

Can you tell this gets me a little worked up? Back when I was young and healthy and had my dad's excellent insurance, I was all "we don't need socialized medicine, yay America!". Now I am "SINGLE PAYER PLEASE, NOW, YAY CANADA!".

I've often said that once you have a major medical issue, you will start to see why single payer (or at least something socialized) makes sense.  We ask people who are going through medical crises to fight with insurance companies to get treatment?  Its ridiculous!  And when you get down to it, we are so much close to socialized medicine that people realize.  The $700 support hose billed to insurance company A is just cost shifting to pay for the uninsured/unable to pay people.  It was like a light bulb that went off in my head when my insurance company denied a $4000 test on my cancer tumor, and the testing company said "no worries.  We write off anyone whose insurance won't pay."  Which means, some insurance paid $4000 so they could write off mine.  How does that make for a good system?!

To OP, I'm sorry.  Its the hard working folks that get caught in the crossfire of this mess with call our health insurance system.  Health care in the US?  Might be pretty good.  But the payment system SUCKS.


Ughh. don't even get me started on how much I hate insurance.  I'm fighting with them right now to cover something I need to get taken care of.  It's such a joke.  Where if I lived in canada I could just get it taken care of no problem

[Deleted]

I just took a job where I will work twice as much for the same amount of money I make now, but will get good health insurance for the entire family. And I'm excited about it because we needed it so badly.

[audette]

DH and I toy with moving to Canada after he retires from the military. It's tempting for a collection of reasons, one of those being the health coverage. (I'm Canadian, so this is an option for us, and also would be part of the reasons for moving there... It also means I'm familiar with Canadian health care. It's not perfect, but at least when you are sick you don't have to battle the illness as well as your insurance...)

[Deleted]

My parents were self employed, had BCBS for 23 years, and when my father got cancer BCBS dropped him because they said it was a pre-existing condition. It was service related so the VA System picked up coverage, but there was a very scary period when I was paying my dad's bills out of pocket because it was that or not treat cancer, and my parents couldn't afford it (self employed also means not working when critically ill). I sometimes think about doing sole practice but I would never. DH has back problems and needs good insurance. I'll be paying for my own insurance going forward ($1200/month for DH and me), but at least it will be under a group plan.

[Deleted]

elle

I'm so sorry, that is horrible. It shouldn't even be legal for those fuckers to pull that shit.

[lilibet]

May 12, 2013 9:08:49 GMT -5 swizz said:

May 10, 2013 22:29:00 GMT -5 lilibet said:

No, pretty sure that's wrong. Also if you do pay on your ownand then it looks like you might be close to your deductible you should be able to submit your receipt to have it processed under your plan and have any allowed amounts applied to your deductible. Just check if your plan has a filing period for claims.

eta - just wanted to mention that the people you are talking to on the phone or who get your letters have pretty much no power - like they seriously can't really do anything (I speak from experience). So always ask for a manager if you need results. If the person on the phone starts to get annoying or sounds mad or whatever just ask for a manager - it will save you so much trouble.

Some doctor's offices and now pharmacies (specifically Rite-Aid in recent experience) are denying customers the ability to pay OOP.

We tried to get DH's Rxs filled there last week and just pay for them (he's on COBRA) and they said its a new policy that you have to have insurance or they won't fill it.

Bullshit.

Hadn't heard that yet, that sucks.