Health insurance stuff is stupid (1 Viewer)

[ghostguy123]

So I have set up a sleep study for myself, ordered by my primary care doc.

Long story short, after making some calls, I will have absolutely no idea how much this will cost me out of pocket until AFTER the procedure.  

And this is with good health insurance.  

 

[ghostguy123]

 

[Osaurus]

 

[ghostguy123]

 

[heckmanm]

I had one back in May (home study).  I have no idea how widely the costs for these vary, but mine shows

- Provider charge of $1371

- Contracted rate (with my plan): $954

So I paid based on the lower number, with deductible and then 20% after that.

HTH

 

[Slider]

I pay $65 a week for family coverage. They threw the wife off because she can get her own. My bill dropped 0 because I have the kids on mine. She pays $35 a week for her's. So there's -$140 for the budget.

Then I figure we spent 1700 last year between the three of us (all dental).  So the company profited off what I paid. 

Scam all the way.

 

[stbugs]

I pay $65 a week for family coverage. They threw the wife off because she can get her own. My bill dropped 0 because I have the kids on mine. She pays $35 a week for her's. So there's -$140 for the budget.

Then I figure we spent 1700 last year between the three of us (all dental).  So the company profited off what I paid. 

Scam all the way.

Wow. I’ve never seen that before. My wife and I both have worked the past 5 years (she was part time/stay at home before) and we’ve only been on one plan the whole time. We switched to hers over a year ago when she switched jobs and no issues.

 

[bigmarc27]

Then I figure we spent 1700 last year between the three of us (all dental).  So the company profited off what I paid. 

You’re paying for the sick people you work with, just like they’ll be paying for you if you ever need it.  Just remember that when you see fat Wanda smoking two packs a day in between insulin shots. 

 

[Slider]

You’re paying for the sick people you work with, just like they’ll be paying for you if you ever need it.  Just remember that when you see fat Wanda smoking two packs a day in between insulin shots. 

Yeah I get how it works. I just don't care for it because I try like crazy to stay healthy.

 

[Slider]

Wow. I’ve never seen that before. My wife and I both have worked the past 5 years (she was part time/stay at home before) and we’ve only been on one plan the whole time. We switched to hers over a year ago when she switched jobs and no issues.

Yeah wife was on mine for twenty years then my company decided they could save some coin. 

 

[bigmarc27]

Yeah I get how it works. I just don't care for it because I try like crazy to stay healthy.

So do I, so we also take the HSA option. The deductible is high, but we wouldn’t hit the lower deductible regardless and we’ve accrued thousands in the HSA over the years. 

 

[matttyl]

Yeah I get how it works. I just don't care for it because I try like crazy to stay healthy.

You can try all you want, large claims still happen.  You guys have had at least 2 that I can already see, as you used the term "kids" upthread.  Each delivery was at least $10k, maybe twice that. 

 

[Brownsfan]

Wow. I’ve never seen that before. My wife and I both have worked the past 5 years (she was part time/stay at home before) and we’ve only been on one plan the whole time. We switched to hers over a year ago when she switched jobs and no issues.

Our company charges $650 per month penalty if your spouse has the ability to get coverage at their workplace but stays on our plan. Not sure how they check/verify as I moved my wife off a couple years ago when the penalty was $200 a month.

 

[stbugs]

Our company charges $650 per month penalty if your spouse has the ability to get coverage at their workplace but stays on our plan. Not sure how they check/verify as I moved my wife off a couple years ago when the penalty was $200 a month.

Geez. Must be something they can find out from other carriers. It might be honor system and most people wouldn’t risk not being covered. I’m sure for a big claim, they’d check and then you could be screwed by the fine print. My company and now my wife’s company don’t have anything like that and hopefully never do. 

 

[Slider]

I think it's a greedy business practice. You're basically rewarding a non working spouse and penalizing a working couple. We should be able to write off the wife's payments for insurance since I'm billed for "family" insurance.

 

[Pipes]

I think it's a greedy business practice. You're basically rewarding a non working spouse and penalizing a working couple. We should be able to write off the wife's payments for insurance since I'm billed for "family" insurance.

It is but it shows how desperate companies are to try to control health care costs.  This practice is increasing more and more everyday and it sucks.

 

[Slider]

  Don't most married couples go with whichever one has the best plan?

Back in the day...

 

[Ilov80s]

It's almost like there could be a better system out there...

 

[matttyl]

  Don't most married couples go with whichever one has the best plan?

not necessarily.  I'm on my plan as my employer pays the bulk of the premium for me, but nothing towards dependents.  My wife and child are on her plan, as they pay 100% of her cost (or very close to it) and a set amount towards whatever dependents she'd like to add.  So if I went on her plan, we'd be paying the full cost for me to do so - but me staying with my company is like $100 a month or so.  It all depends on the situation.

For reference, I'm a health insurance agent.  Mainly for small (under 50) employers and individuals.  Some of my small groups pay 100% of employees and their dependents.  So say you have me (a single guy) and my twin brother (married with 6 kids) working the same job for you.  If you're paying for all the coverage as an employer, you're "paying" him more than you're paying me - and maybe I get upset about that.  Maybe I want a pay raise because of that.  I see it all the time.  So many of the groups are shifting the bulk, if not all, of that cost to the employee.  If you want your dependents on the group, fine by us, you're paying for it (via payroll deductions). 

 

[belljr]

not necessarily.  I'm on my plan as my employer pays the bulk of the premium for me, but nothing towards dependents.  My wife and child are on her plan, as they pay 100% of her cost (or very close to it) and a set amount towards whatever dependents she'd like to add.  So if I went on her plan, we'd be paying the full cost for me to do so - but me staying with my company is like $100 a month or so.  It all depends on the situation.

For reference, I'm a health insurance agent.  Mainly for small (under 50) employers and individuals.  Some of my small groups pay 100% of employees and their dependents.  So say you have me (a single guy) and my twin brother (married with 6 kids) working the same job for you.  If you're paying for all the coverage as an employer, you're "paying" him more than you're paying me - and maybe I get upset about that.  Maybe I want a pay raise because of that.  I see it all the time.  So many of the groups are shifting the bulk, if not all, of that cost to the employee.  If you want your dependents on the group, fine by us, you're paying for it (via payroll deductions). 

well yeah 

thats why single plans are cheaper than single plus 1 that are cheaper than family.

I've never heard of places charging a penalty for having a spouse on a plan though

 

[matttyl]

well yeah 

thats why single plans are cheaper than single plus 1 that are cheaper than family.

I've never heard of places charging a penalty for having a spouse on a plan though

It's getting more and more common, mostly at larger companies.  Started around the time of the ACA (2014).  Even with a penalty, and paying some extra premium, may still be (much) cheaper than buying an individual plan.  Some companies have even gone so far as to not allow spouses onto a plan, which believe it or not, could be a good thing to the employees because of the ACA.

 

[Osaurus]

  Don't most married couples go with whichever one has the best plan?

Mrs. O and I didn’t.  It was considerably cheaper for us to both get individual coverage compared to combined.

 

[heckmanm]

I guess it's just different wording.  $150 per month for single coverage versus $650 for family would be a $500 "penalty".

If I can buy lunch for myself for $10, but if I take my wife and 2 kids, it costs $40, is that a $30 "penalty"?

 

[Binky The Doormat]

So I have set up a sleep study for myself, ordered by my primary care doc.

Long story short, after making some calls, I will have absolutely no idea how much this will cost me out of pocket until AFTER the procedure.  

And this is with good health insurance.  

yeah, and I love how all the medical insurance literature and propaganda is how we are supposed to manage our health costs.  

When I started questioning all that #### (blood testing - types, costs, results) my doctor got really ####ty about it.  He didn't know and didn't I trust his judgement.

I really hated that guy.  

 

[Thorpe]

There are two reasons they can't give you a price.

1)  Depending on the timing of how your claims are paid, the amount of the deductible/copay/coinsurance will change.  Let's say you have a $20,000 operation scheduled around the same time as this procedure.  If that 20,000 is paid first, then you will pay nothing for this procedure.

2)  It costs time and money to price a procedure.  The provider has to send a claim to the insurance company.  The insurance company verifies you have coverage and then sends it to a provider network.  The provider network may look up the price in their database, but it is also possible they negotiate the price with the provider.  They send the price back to the insurance company.  If the provider doesn't participate with this first network, the claims may be sent to a secondary network where the same thing happens.again.

 

[IMAX 3D]

It's getting more and more common, mostly at larger companies.  Started around the time of the ACA (2014).  Even with a penalty, and paying some extra premium, may still be (much) cheaper than buying an individual plan.  Some companies have even gone so far as to not allow spouses onto a plan, which believe it or not, could be a good thing to the employees because of the ACA.

Yeah I think my company charges an extra $100 or something like that if your spouse is elegible under other coverage

 

[heckmanm]

Yeah I think my company charges an extra $100 or something like that if your spouse is elegible under other coverage

Same for me.

 

[-OZ-]

If I can buy lunch for myself for $10, but if I take my wife and 2 kids, it costs $40, is that a $30 "penalty"?

Kids are always a penalty.

Still free for us (as I back away from the thread...)

 

[Soulfly3]

Every time I see these threads, I can't believe a first world country such as the USA makes citizens pay for their health care.

Unbelievable. 

 

[Don Quixote]

I did a home sleep study recently and had/having a similar experience.  I was told that my out of pocket would be capped at a certain amount, but I wasn't told what my actual out of pocket would be.  I just went in assuming the max, and figure anything I get back is gravy.

 

[ghostguy123]

I did a home sleep study recently and had/having a similar experience.  I was told that my out of pocket would be capped at a certain amount, but I wasn't told what my actual out of pocket would be.  I just went in assuming the max, and figure anything I get back is gravy.

Thats the dumb part.  Depending on the cost I might not even want to do it.  I also did not even get a range of min-max cost.  I dont know if it will be 50 bucks or 5,000?

 

[ghostguy123]

There are two reasons they can't give you a price.

1)  Depending on the timing of how your claims are paid, the amount of the deductible/copay/coinsurance will change.  Let's say you have a $20,000 operation scheduled around the same time as this procedure.  If that 20,000 is paid first, then you will pay nothing for this procedure.

2)  It costs time and money to price a procedure.  The provider has to send a claim to the insurance company.  The insurance company verifies you have coverage and then sends it to a provider network.  The provider network may look up the price in their database, but it is also possible they negotiate the price with the provider.  They send the price back to the insurance company.  If the provider doesn't participate with this first network, the claims may be sent to a secondary network where the same thing happens.again.

Right, dumb.

 

[Chadstroma]

I have never made a phone call about health insurance and came away understanding more than I did before the call. 

 

[D-Day]

Since last July, my wife has racked up about $2,000,000 in billed medical costs, with over $1,000,000 paid (contracted reductions).  I’m willing to discuss how insurance is a scam.

 

[Thorpe]

Every time I see these threads, I can't believe a first world country such as the USA makes citizens pay for their health care.

Unbelievable. 

Socialized medicine isn't free either.  Do you have any idea how much fraud there would be?  Private companies make their profits but at least they have an incentive to minimize fraud.

 

[Gottabesweet]

I've always wondered if two people have the same pay, but one has a family plan and the other single, and they had to let one employee go, it would for sure be the family plan guy.  They say you can't look at that but I find it hard to believe.

 

[Brownsfan]

I guess it's just different wording.  $150 per month for single coverage versus $650 for family would be a $500 "penalty".

For us the penalty is on top of the additional premium which adds a total of about $1000 per month. Our coverage is great and the premiums for single coverage are fair, but if your spouse has the option of coverage they want them to take it. We also can't do a +1 policy. It is either single or family

 

[RUSF18]

For us the penalty is on top of the additional premium which adds a total of about $1000 per month. Our coverage is great and the premiums for single coverage are fair, but if your spouse has the option of coverage they want them to take it. We also can't do a +1 policy. It is either single or family

This is where it really sucks, if you're just covering your spouse while a co-worker is paying the same premium for their spouse and 4 kids.

 

[Exit 1]

How much is health insurance, in general, for someone without a plan at work?  I have no idea.

I'm covered at work but let's say I'm not.  How much would it be for a single, 40 year old male with no kids who is in pretty good health?

Are we talking like $500/month?  $1,000/month?

 

[matttyl]

Mrs. O and I didn’t.  It was considerably cheaper for us to both get individual coverage compared to combined.

Individual coverages with each of your employers, or actual individual coverage not with your employers?

 

[Don Quixote]

Thats the dumb part.  Depending on the cost I might not even want to do it.  I also did not even get a range of min-max cost.  I dont know if it will be 50 bucks or 5,000?

That stinks.  I'm glad they were able to give me a cap, at least.  I was a bit interested in cost to compare at home versus at a sleep center.  But I tried the sleep center already and did not sleep at all the night that I was there, so decided taking it at home was worthwhile even if I had to pay a lot more for it.  But, again, at least I had the cap to give me some idea.

 

[matttyl]

There are two reasons they can't give you a price.

1)  Depending on the timing of how your claims are paid, the amount of the deductible/copay/coinsurance will change.  Let's say you have a $20,000 operation scheduled around the same time as this procedure.  If that 20,000 is paid first, then you will pay nothing for this procedure.

2)  It costs time and money to price a procedure.  The provider has to send a claim to the insurance company.  The insurance company verifies you have coverage and then sends it to a provider network.  The provider network may look up the price in their database, but it is also possible they negotiate the price with the provider.  They send the price back to the insurance company.  If the provider doesn't participate with this first network, the claims may be sent to a secondary network where the same thing happens.again.

The provider *should* at least be able to tell you the "allowable charge" for whatever procedure, though.  I think that's what the OP was getting at.  I say *should* because that's what the provider actually negotiated for when they went into my insurance network (we're assuming an in network provider here). 

I remember just over 3 years ago when my child was born here at the same hospital where I was born.  Once I got my wife all cozy in her room, I took her insurance ID card down to the billing department so they could get all of her information.  They entered her ID number into their system to verify coverage and all, which went fine.  When the billing rep handed me her card back, I asked a very simple question - but knew I wouldn't get an answer.  I simply said "assuming no complications, what is the in network charge for this delivery?"  The rep said, "huh?"  I responded, "well, you see the coverage she has [BCBS] which you contract with as an in network provider - you must deliver 3-4 babies a day on average and I'm sure they are your largest insurance carrier in this area or one of them - assuming this is a normal delivery and mom and baby both go home in 2-3 days, what will the charge be to the insurance company?"  She looked at me like I had 3 heads - "I don't know, I've never been asked that before." 

Now she could have said some ridiculous number and it wouldn't have mattered - I wasn't going to take my wife to a different hospital or anything - and we were going to hit her deductible ($3k) no matter what (so to your point 1, I wasn't looking for what it would cost me in the end, just what the allowable charge is) - but I did want to at least get an idea of what we'd be looking at.  No answer at all, which I expected.

 

[matttyl]

Since last July, my wife has racked up about $2,000,000 in billed medical costs, with over $1,000,000 paid (contracted reductions).  I’m willing to discuss how insurance is a scam.

If I'm understanding what you're saying here, that was never paid - just written off.  The provider wanted to charge $2m for all of it.  Insurance said, "no, the network pre-negotiated allowable charge is only $1m, so that's what you'll get."  Sounds like just having insurance, before any deductible or copay or OOP max and all that stuff......just cut your bills in half.  How's that a "scam"?

 

[matttyl]

This is where it really sucks, if you're just covering your spouse while a co-worker is paying the same premium for their spouse and 4 kids.

*Generally* it's either a 4 or a 5 tier structure, when dealing with large employers who have "community/composite" ratings.  It's either employee, employee plus spouse, employee plus child, and employee plus family for a 4 tier, with a 5th tier adding employee plus children.  Self insured groups (which many large employers are) can make up their own rules, like the above example. 

But your thought is correct, me and my wife and I kid would be paying the same as a co-worker with their spouse and 5 kids. 

 

[matttyl]

How much is health insurance, in general, for someone without a plan at work?  I have no idea.

I'm covered at work but let's say I'm not.  How much would it be for a single, 40 year old male with no kids who is in pretty good health?

Are we talking like $500/month?  $1,000/month?

First off, the bolded doesn't matter any more.  At all.  The ACA did away with it, so everyone is charged the same rate no matter their health.  I say "is charged" rather than "pays", as people under 400% of the poverty level are eligible for subsidies to help with the premiums.

Very, very, very much depends on where you live (and what's available there).  Where I live, we have 1 and only 1 carrier.  This is the case for about half of the counties in the country now as many larger carriers have left the individual market.  That one carrier, for their "benchmark" plan (2nd cheapest silver tier) would be $530 a month (with a $5,500 deductible).  At age 50 it would be $741/m, and at age 60 it would be $1,126/m.  I sell insurance, and have older couples paying well over $2k a month for their coverage, just counting down the days until they can go on Medicare. 

 

[heckmanm]

My company started using Castlight a couple of years ago. I don't know exactly how it works in terms of making it available; I think the company has to sign on.  But I now can log in to my Castlight account and see the cost for various procedures in the area. A lot of times, it won't affect my OOP much, but could save/cost the "plan" a significant amount, which in theory could affect future premiums.  (I work for a large company that self-insures and then uses Blue Cross to supplement.)

I don't use it as much as I should, but I did check out costs for some lab work a while back.  Huge range between going to an independent lab vs getting it done at a hospital, for example.

 

[matttyl]

I don't use it as much as I should, but I did check out costs for some lab work a while back.  Huge range between going to an independent lab vs getting it done at a hospital, for example.

Yes, huge range.  Not just for stuff like labs, but also for something like a CT scan.  Carriers are now proactively reaching out to insureds to say "we see you have an MRI or CT scan coming up.  At the hospital that charge would be $X, but at this place just down the street it would only be $half X."  A call like that came into my dad a few months back about something he had coming up - and those costs were the "allowable charge."  Of course, he choose the $0 deductible plan at work, so it didn't matter to him in terms of money - so he had it done in the hospital as that's where his Dr. practices. 

 

[eoMMan]

First off, the bolded doesn't matter any more.  At all.  The ACA did away with it, so everyone is charged the same rate no matter their health.  I say "is charged" rather than "pays", as people under 400% of the poverty level are eligible for subsidies to help with the premiums.

Very, very, very much depends on where you live (and what's available there).  Where I live, we have 1 and only 1 carrier.  This is the case for about half of the counties in the country now as many larger carriers have left the individual market.  That one carrier, for their "benchmark" plan (2nd cheapest silver tier) would be $530 a month (with a $5,500 deductible).  At age 50 it would be $741/m, and at age 60 it would be $1,126/m.  I sell insurance, and have older couples paying well over $2k a month for their coverage, just counting down the days until they can go on Medicare. 

Crazy.

 

[heckmanm]

Yes, huge range.  Not just for stuff like labs, but also for something like a CT scan.  Carriers are now proactively reaching out to insureds to say "we see you have an MRI or CT scan coming up.  At the hospital that charge would be $X, but at this place just down the street it would only be $half X."  A call like that came into my dad a few months back about something he had coming up - and those costs were the "allowable charge."  Of course, he choose the $0 deductible plan at work, so it didn't matter to him in terms of money - so he had it done in the hospital as that's where his Dr. practices. 

I probably could have saved some money on my sleep study (callback to the OP!), but I just let my GP schedule it.  A lot of doctors are part of larger "physician's groups", and they'll steer their patients to specialists within their group as the default.  It's completely rational for them to do so from a profit standpoint (and potentially simpler in terms of paperwork), but I think frequently there would be less-expensive options available for the patient.  That's were a tool like Castlight can be helpful, but it puts some responsibility on the patient to use it, even when there's minimal effect on the OOP cost.

And as I noted, if enough patients put in the effort to find a lower-cost provider, it can pay off in slower premium increases in future years.  There just may not be an immediately visible benefit.

 

[FBG26]

Since last July, my wife has racked up about $2,000,000 in billed medical costs, with over $1,000,000 paid (contracted reductions).  I’m willing to discuss how insurance is a scam.

If I'm understanding what you're saying here, that was never paid - just written off.  The provider wanted to charge $2m for all of it.  Insurance said, "no, the network pre-negotiated allowable charge is only $1m, so that's what you'll get."  Sounds like just having insurance, before any deductible or copay or OOP max and all that stuff......just cut your bills in half.  How's that a "scam"?

I could be wrong, but I think D-Day is actually saying insurance is not a scam.  I'm guessing D-Day was probably replying to Slider's comment, where Slider essentially stated that insurance is a scam because Slider paid in more in premium than he received in benefits. I interpreted D-Day's comment as basically saying "Look, that's how insurance works. You typically pay in more in premiums than you receive in benefit, because you never know when you will have that monster bill like my wife had."