Health care benefits

[SixFive]

P3uttt mentioned in another thread how his healthcare benefits kinda sucked.

I'm in the healthcare industry, so u would think mine would be great, right? Wrong! They suck.

I had 3 choices for family plan:

1)190 bucks every 2 weeks for a plan where u have a PCP, get referrals, set price for hospital admissions, 15 for doctor visit, etc.

2)160 bucks every 2 weeks for a PPO. U can go to anyone in network without a referral, 15 per doctor visit, 80/20 hospital stay. Out of network prices go thru the roof.

3)70 bucks every 2 weeks for a PPO like number 2 except u pay 25 for doctor visits and 70/30 for hospital stays.

These choices all suck, and they're all too high. People with good benefits that aren't thankful should be. I guess I'm glad I have benefits at all, but I wish they weren't such bad plans and so expensive.

 

[Penguinfan]

BOY could I tell stories about our healthcare, and I work for one of the largest employers in the world. Lets just say that the words "health care" and "benefits" don't belong in the same sentence.

penguinfan :shrug:

 

[MadJack]

health care

we can see any doctor without a referral, $25 per visit, $15 per prescription ($250 family deductable), 80/20 hospital ($1500 family deductable), $500 emergency room family deductable, and it's $575 a month for a family of three! UGH!!

 

[wondo]

I'm working part time at a million different places so I get screwed with no health insurance or bennies of any kind.

Luckily I don't have a family nor married or anything of that nature, so I just riverboat it on my own. But what a crock the insurance industry is. A buddy of mine was just jumping through hoops for house insurance. It sounded brutal.

I can live with car insurance. I pay out the yazoo but it should go down once I'm 25. Plus I drive a ton so I feel like it's worth it if I hit some jackass deer out in Accident MD or somewhere.

But the other stuff is terrible. I know nobody will have much sympathy, but the MLB health insurance is outrageous. Especially once you retire. And once you consider that most of the guys that play in the bigs do so for less than 90 days, it makes it that much worse because they don't have the big bucks. A couple friends have their wives or children with some illnesses or conditions that won't allow them to switch insurance so they're stuck paying a couple thousand each month! So much for that part of the union agreement.

It's like paying vig to a bookie, but you have no chance to ever win a play!

 

[DOGS THAT BARK]

Couldn't agree more.Being in the business 20+ years your clients become friends and there is nothing more dishearting when renewals come around and you know everyone will be getting at least 10% increase. Who would have ever thought just 10 years ago that many peoples health insurance premiums would be more than their house payments.
Personally I have $2,500 deductible then 80-20. BC-BS has never paid a dime on me in 18 years and I have to pay about $140 a month.Considering only expenses I have been out in that time(knock on wood)is physicals I have saved enough with large deductible to pay that $2500 ,if need be,several times over.
If you happen to have parent or friend covered by medicare that is getting killed on prescription drugs there is a website in Canada you can order from at about a 35% reduction of cost in US. I do not have site addy handy at this time but if anyone wants it I will look it up. Have referred several clients to it and all have been quite satisfied.

 

[djv]

I much like MJ will be paying 502 bucks starting in about 5 months. That is a 90/10 plan. I pay 96 a month now for the plan. But My retirement package ends in 5 months. Company lets you keep plan for 6 to 8 months when you retire depending on years of service. Now each year our raise was always figured in to the health care pacakge so the 96 bucks is very misleading. But I believe we all can see the system will fall on it's self in a few years. Maybe as short as 5 years. We have more and more folks going with out coverage. They can not afford it. That group is growing fast. At least according to Business Week. Those of us who can pay are paying more to off set those losses. Most majior health care providers have said a 10 percent hike this year is very possiable. the car insurance companies getting into the act also. Many saying the same thing. The thing that gets my ass is this. I here the bad news and the hospitals must rase rates and on and on. Then in just the last week both our hospitals show off all the new buldings and expansion they have planed for next 5 years. One will spend almost 100 mill and the other 55 mill. Ya there going broke allright. Just like the fat cat rich insurance companies.

 

[dawgball]

Yes, I have a bad taste for insurance and the way we are treated, but if I ever need it I'm going to be happy I have it. My partners and I are all single guys with no history and around 27-28 years old. We pay ~$500/ month for the three of us.

Our coverage is through United Healthcare. Our plan includes Vision but not dental. One of my partners has a brother who is a dentist that sees us for free for check-ups and standard services.

Co-payments:
Outpatient visit $20
ER $100
URGI $35
In-patient 10%
RX $10/$25/$50

Deductibles
In Network Deductible 500.00
In Network Out Of Pocket Max 2000.00
Out Of Network Deductible 500.00
Out Of Network Out Of Pocket Max 3000.00

We felt like this was a pretty decent plan. We shopped around to other providers, but we heard the best praise and least complaints about UHC.

I would like to hear if this is a good plan or not. We are definitely not insurance experts.

What I don't understand is that it is the law that we carry car insurance, but the two people that have wrecked into me have not had it, and there was nothing I could do. How is that fair?

 

[djv]

Dawgball, How is that fair. Your up against that saying nothing is fair. It's all about what you have and are you willing to lose it all. Some folks, make that a lot of folks, just dont give a shit. Or they cant pay for the insurance. I agree with you if you can't pay for it ride the bus. As for your health plan sounds about right. For your age and I assume very healthy. You get alittle older and have a family you may want to kick it up notch.

 

[DOGS THAT BARK]

Brother Dawg. Plan looks fine and decent price. I broker UHC and the are fine. Its a bitch being hit by uninsured motorists.All insurance is technically is transferring risk we are not willing to absorb to insurance co.Many people feel they have nothing at risk and to some degree they are correct. We pay for the freeloaders a lot more that just welfare benefits,but when it comes to health ins there are many responsible people that simply can't afford it,especially from age 50 on.

 

[wondo]

DTB --

How much of the current problem would you say is because of people abusing or defrauding the system, versus those that merely can't afford it?

It seems a lot is made of the fraudulent claims, when in my layman view would think that is just a drop in the bucket.

 

[AR182]

I was an insurance broker for 12 years & only sold 1 heath policy & that lapsed. It was just a hassle to sell it with the high premiums. The health insurance for the American people has gotten way out of hand. The companies are reducing coverage & increasing premiums. They blame the doctors & the doctors blame the health insurance companies. something must be done!

I agree with DOGS THAT BARK, that a higher deductible is the way to go. Insurance is for catastrophic loss & the higher the deductible the less the premium cost.

When someone purchases health insurance they should look to see if there is a pre-existing condition clause in it. There are some heath plans that have a waiting period before they cover a pre-existing condition clause. Had a friend who switched is coverage to a company that had such a clause so when he brought his kid to the doctor for treatment for asthma, his coverage would not pay for that illness until he had the plan for 11 months. That is the insurance company's way for keeping their costs under control.

SixFive,

I am curious as to which plan you decideed on. Don't know your age or family situation but I think # C is the plan I'd choose. But of course you can't go by my choice because the policy should be thoroughly read before making the choice.

Jack,

The premium that you are paying is outragious. Have you shopped it around? But of course provided that you are all in good heath.


DOGS THAT BARK,

If you don't mind I am interested in that Canadian phone number.BTW, what does UHC stand for?

 

[DOGS THAT BARK]

AR I will get you web address and post it here today. UHC is United Health Care. On preexisting condition: In ky and most states under federal HIPPA regs insurance pre-ex is now portable. If you had insurance previously and have not went without insurance for 62 days, new co. has to waive pre-ex.
If you did not have pre-ex this is what what occur. No one would carry insurance until they had the prob then go apply for it to cover any future expenses. This would be what the Ins Co's call Classic adverse selection.(Insuring all unhealthy people and no healthy ones to balance claims vs premium intake.

Wondo I don't think fraudulant claims is big part of health ins rates but plays huge part in P&C (homeowners and auto)especially auto. You have all the thefts plus big portion comes from staged accident where not just auto claims but personal injury protection medical portion where they max out medical limits to make claim worth more.Biggest by far is litigation. If just bumped in the rear many think it is open pocket to big check and after looking on cover of there phone book for that ("Marketing" attorney he will confirm their hope. As neither have nothing to lose. I will give you an actual flagrant example of occurance that happened when I use to write P&C. (just do group benefits and estate work now for most part).
Client was "stopped" at light pulling john boat on trailor. He did not have boat secured and wind blew boat sideways into car next to him(mind you they were stopped) Could not tell if it even did damage to car cause it was one of those that looked like it just came out of demolition derby and that side of car was beat up. However the occupant claimed(what else whiplash) and ins co paid $28,000 because it was cheaper than litigation.
There is corruption throughout from people,to medical field to insurance co AND their representatives. It is very hard time for insurance co right now as a lot of their revenue comes from investments on premiums they hold.There was a time when if what they paid in claims equaled premiums taken in they could still make tidy profit on investment of premiums in the interim.
Not so of late.
Do I have any answers to this crisis ,not really. It needs to start at curtailing fraudulant and frivolous claims and idiot jurys giving sometimes billions in judgements. What ins co need to do and did this a few years back in Alabama is pull out of states that award these absurb judgements. I'd pull completely out of Cal and let the state set up their own system (like they did their utilities) and then when rates are totally out of reach and their busted again,turn the other cheek when they beg to be bailed out again. My pet peave is liabilty fraud. A guys walks in your business,stages a fall,he and "marketing" attorney file suit. They have nothing to risk at taking fraudulant shot at you--but you my friend will lose regardless of outcome because you will pay for defense. I would like to say the answer would be if someone sues someone and loses he has to pay defendent's defense fees,however this would hurt the little guy that does have valid claim and competant attorney as big corps could throw up huge defense expenses making going against them unfeasible.
My best solution is each system work on cleaning up fraud from within. The good attorneys that merit admiration should clean out the chaff in their ranks and so on down the line in each industry.

 

[SixFive]

AR, I went with the third cheapest choice. It's the same plan I have currently, but the new pricetag is more than doubled

Something I have done is maxed out my healthcare spending account for 3K. This is a nice benefit. Pre tax dollars, I think $115 taken out of each check. They attach a check to your EOB, so u don't even have to submit most of your claims.

 

[Thegridiron]

Anyone here sell health care insurance? Question, if I take a plan out with high deductible say $2500, when I go to the doctor or get a prescription filled would I have to be over $2500 before Iwould only have to pay a $20 co pay for doctor visits or prescriptions?

 

[djv]

Folks we have a good subject going here. And its important more folks speek up. And not just here at MJ's. What are we headed for? More and More folks are going with out health care. They just can not afford it. In many cases they have littel to lose so they don't care. But in other cases there other family needs just have to come first. Those of us paying are starting to get hit harder and harder. How long before we just cant do it either. Is that 5 years 10 years. There has to be away. Im not a big supporter of national health care. But something in that area may have to happen. Just to help all of us get rates we can afford. Like I said in another thread maybe this one. In my city we have to majior hospitals. Both have released there 5 year plan for improving health care. Many were just shocked at there plans and money they are about to spend. Why I was asked. When one is about to spend 100 mill and the other 55 mill. How does that help hold down cost. It's funny the one just said in paper yeasteday there hikes for next year will be 9.5 pecent. Sooner or later the spiral has to stop. All of us togeather have to let our political folks know some new ideas are needed. I think some you younger folks here may feal this pinch even more then some of us here getting up ther in age. You young guys and gals may want to shoot someone about your health care cost by the time your 35 years old.

 

[SixFive]

I'd like to hear some personal experiences from the Canadians on their healthcare since it is a national healthcare system. I've heard some bad stuff from my Canadian friends especially why u need open heart surgery or chemotherapy, or a bone marrow transplant or etc other expensive procedures. Thanks.

 

[AR182]

SixFive,

Last year about this time my mother-in-law, who lives in Montreal,was diagnosed with pancreatic cancer. This was based on a cat-scan. The doctor refused to do other tests because of my mother-in-law's age. Needless to say the family was very upset. I asked if I could call the doctor. After waiting for 3 days for the doctor to return my call, the doctor told me that he is 97% sure that my mother-in-law had pancreatic cancer. He said that he believed that she only had a few more months to live. I asked the doctor about taking other tests, & he said that there was no need because he was sure of the diagnosis. I asked him about taking a biopsy & he answered that the tumor was too small for a biopsy test. My wife & I cancelled all our plans, including last years Madjack's Superbowl Party, & decided to wait for the eventual call. As the weeks went by my mother-in-law started losing weight, which happens with people with cancer. Pretty soon the months started going by & my mother-in-law's weight stabilized & she had no pain. I thought it was strange because pancreatic cancer is considered to be the fastest growing & most painful cancer of them all.The summer comes around & nothing has changed with her condition. Finally almost 9 months after being diagnosed my mother-in-law asked the doctor if she could take another cat-scan. She had to wait close to a month to take the test because there was a long waiting list. Two weeks after having the test she saw the doctor who told her that the tumor has not grown which means that it is benign. It is unbelievable that all during the year the doctor refused to take any other tests because he was so sure that my mother-in-law had pancreatic cancer. The weight loss was because she was so upset that she couldn't eat, no other reason. The only thing that I could say is unbelievable.

 

[TIME TO MAKE $$$]

Move up to Canada, you will never have these headaches

 

[AR182]

Time,

I don't know if you were referring to my last post, but that story is about Canadian health care. My mother-in-law lives in the Montreal area.

 

[wondo]

That's a terrible story, no question. But don't you think that most doctors get into the business because they enjoy helping people -- I think most doctors, although aware of the health insurance concerns, are more willing to cut corners or donate their services in the best interest of patients. That has been my limited experience, atleast. Obviously I have never dealt with a life threatening condition, but on the small stuff, doctors seem to be very willing to work with patients (such as myself) who are unisured or underinsured. There will always be a few bad apples.....