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06-23-2008, 06:55 AM | #16 |
Donating YT 1000 Club Member Join Date: Jul 2005 Location: Chicago Suburbs
Posts: 3,306
| It's so complicated. Health "insurance" varies and can be anything from a high-deductible plan which means you pay everything until you hit $1000 or even $5000 and then insurance pays 100%, or a plan where they pay 90% of everything. Some people pay $5 for prescriptions (with ins.) and others pay $50 for the same drug (with a different ins.) My biggest issue with our system right now is that it is tied to your job. My husband works for a small company that does not offer insurance. I work as a secretary making very little $$ but the place I work for offers good insurance. I hate working here and we are moving soon so I put in my notice and we immediately applied for an "individual" plan (independent of our jobs) and we were denied. We are willing and able to pay for health insurance but they do not have to accept us, even for one of those "high deductible" plans where they are not likely to have to pay for any expenses. They have an "underwriter" that looks at the application and sees that my husband has high blood pressure and I had surgery last year and stamps a big fat DENIED on it. The only other option is to go get a different job that offers insurance because they have to accept us on their plan. So much for those who choose to be entrepreneurs and be self-employed, or those who wish to work part-time like moms who otherwise stay home with their kids. See, the way the laws work here, if you work at a job that offers insurance the insurance carrier is required to accept you into the insurance plan. Sometimes there is a waiting period of 1-3 months and sometimes the employer pays part of it and sometimes they don't. Sometimes they have good insurance where you can see any doctor (PPO) and some have HMO's where you can only see a certain doctor that may be 30 minutes away. However, if you do not have a job that offers insurance or if you are self-employed, etc. you have to apply for individual coverage and they are NOT required to accept you. Insurance is a FOR-profit industry and they have a responsibility to their shareholders to maximize profits as much as possible. That means denying claims and hoping that you don't fight them and denying anyone who has any sort of medical condition that might cost them $$. Part of the problem is that it is inconsistent. When you go get an MRI it's like $1000 if you don't have insurance. If you do, then the insurance pays their "agreed" price to the hospital (say $600) and then you pay 10% or 20% of that as your "co-insurance" so you pay $60 or $120. Since people don't usually pay attention to this and get a bill for $60, they don't shop around for a better deal or pay attention to how much things actually cost. SOME plans just have a $20 co-pay and then people REALLY don't pay attention to how much things cost. My mom's doctor sent her for an MRI once (she had cancer a long time ago and they were worried about something) and the insurance refused to pay for it even though the doctor ordered it and said she needed it. They can do that, and there is nothing to stop them because you are one person and they are a multi-billion-dollar company with lawyers and politicians on their side. It's true that they have to treat you at the ER, but then they send you an inflated bill. What ends up happening is people without insurance wait until it gets really bad before going, requiring twice the expense, or people who can't see a doctor (because many don't accept "self-pay" patients) will go to the ER for a sore throat. The system is really messed up and the politics of it is disgusting. The politicians are all in bed with the health insurance companies. I'm all for personal responsibility and taking care of myself, but I shouldn't be forced to work a dead-end, low paying job just to get health insurance. I think part of the solution is going back to actual INSURANCE not these 90% health care plans. I am perfectly happy to pay for my Dr. visit and antibiotic as long as I'm covered if I break my arm or I have to have surgery. However, doctors are so used to OVER-charging because their rates then get "discounted" by the insurers that everyone would have to go to this type of system before it became a competitive free market. There is a bill in the works called HR676 that would allow anyone who chooses to to buy into medicare (which is the system provided to the elderly and the disabled). This would be a great option for diabetics, people with high blood pressure, people who otherwise are denied coverage. But the politicians won't let it go through. They are scaring people by screaming "socialized medicine" All I'm asking is that I be able to buy insurance to be on the same level playing field as my neighbor who has insurance through his job. Another example of why this is unfair is that my husband is happy with his job so insurance through another job for him is not an option right now. Therefore I am the only one who can get a job that has health insurance. When we have children I would like to stay home with them, therefore loosing our health coverage at a very important time. There are no options for situations like this and it's very sad. Something needs to change and as hopeful as I am about a change in November, in order for this to change more people need to be outraged. Those who are just plugging along think things are just fine, until they lose a job, change jobs, have a baby, etc. Oh, also if you change jobs and insurance your deductible starts over. You can't take your insurance with you from job to job. The whole system stinks.
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06-23-2008, 06:55 AM | #17 | |
Donating YT 500 Club Member | Quote:
Although through DH employer we have always had insurance, it's still tough to meet the deductibles, co-pay's and now even gas to travel to Dr.'s appointments, if your income is not considerable. But still, in your case being in between is scary! Same goes for your situation Erin, I didn't see your excellent post until after.....
__________________ ~Ruby, Reno, Razz, & Jack~ Last edited by jencar98; 06-23-2008 at 06:58 AM. | |
06-23-2008, 07:05 AM | #18 | |
Donating YT 1000 Club Member Join Date: Jul 2005 Location: Chicago Suburbs
Posts: 3,306
| Quote:
You can shop around for doctors and hospitals but they insurance companies still get better rates. Sometimes you can get a "cash" discount but it means negotiating EVERY time you have any procedure done. If I go to the Dr. and have bloodwork done, they send it out to their lab - I don't get a choice or the opportunity to shop around. I just get a bill. The consumer has very little power. When I had surgery I could have called around and found the cheapest hospital, but then my Dr. only does surgery at one hospital so then I would have had to find a new Dr. (a specialist, who are not on every corner) You can possibly negotiate hospital fees but then you don't get to choose your radiologist, your pathologist, your anesthesiologist..... etc. You just get bills in the mail. Anyone who has had any procedures done knows that it turns into a part-time job trying to keep it all straight.
__________________ Last edited by Erin; 06-23-2008 at 07:07 AM. | |
06-23-2008, 06:13 PM | #19 |
Mojo, LilyGrace & Me Donating Member Moderator Join Date: Dec 2005 Location: cuddling with my babies<3
Posts: 17,329
| All insurance policies are different...ours is a good insurance...pays a lot, but we have to pay for some visits all up front...like all, dental & vision..we have to pay the whole bill at the time of our appt. Then, we get reimbursed...we have a great insurance lady w/ our turn over time being less then a week to get our money back. Other visits, we just pay our $20 copay (doctors, dermatologist, etc)....and nothing else. Medicines are $4-$20 (depending on if they are generic or name brand medicines). When I went for a CAT-scan awhile back....I had to pay a bill from my doctor, the hospital and THEN the tech who did the scan!!! I could NOT believe that! It seems they charge you for everything and everyone who walks buy charges you for seeing them too!
__________________ Hi I'm Jenn Mom to..... Mojo,LilyGrace & DD Kate RIP Mojo FOREVER in our hearts! |
06-23-2008, 06:36 PM | #20 |
No Longer a Member Join Date: Jul 2004 Location: South Florida
Posts: 8,577
| I thank God everyday we have good health insurance. The government covers retired policemen (US Park Service) we pay very small premiums for the two of us...and medication is $5..one prescription Bill takes runs $265 a month without ins...somebody has got to do something to help the uninsured, this is a crisis! I know dozens of people without health care... When my brother lost his insurance he had to start going to the Veterans hospital.. he is very grateful he can...they are wonderful in Birmingham ALA. |
06-23-2008, 06:51 PM | #21 |
Spoilin' Tilly & Jack Donating Member Join Date: Feb 2006 Location: Indiana
Posts: 2,227
| I agree that our health care situation here stinks but I don't think anyone has a good idea on what to do. Quite frankly I don't want to go on a waiting list to see a doctor because Billy Bob stubbed his big toe. Everyone that NEEDS help won't get it. My grandma has cancer and last year had to go to the Mayo clinic and there was a gentleman from Canada there that came here for help. I know it stinks for a lot of self employed families. Many of my family members are self employed, my great uncle owns a tire shop and and took up a second job to get insurance, (he drives a school bus). While hubby was in school we didn't have insurance. We just had to suck it up, which sounds mean but we knew until he had a good job we would have to tough it out.
__________________ Momma Tilly Money will buy you a pretty good dog, but it won't buy the wag of his tail. |
06-23-2008, 07:17 PM | #22 |
Donating YT 500 Club Member Join Date: Aug 2006 Location: Packer Country!!!
Posts: 666
| We are self employed and I did take on a second job and a third...I also drive school bus and I sell Avon and we still can't afford health insurance. And because I can't be at our business for more than an hour and a half, between bus routes, I had to hire another person to do my bookkeeping. It just burns me that we have to work so hard to make a decent living and we have all sorts of people coming here illegally, and getting the heathcare from the government that should be entitled to us hard working people. It is a no win situation, that will never change. JMHO...... |
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