Hmmmm healthcare reform. This is something that's been brewing a blog within me for quite awhile... Keep in mind, this is my blog so it's my opinion. Like it or not, this is what this mama thinks about the whole situation! I worked in the healthcare industry for several years. My niche was geriatrics. Those of you that think the system isn't broke, it doesn't need fixed, there's nothing wrong with it, etc etc well I think you're wrong & here's a few examples why...
Part 1... In-network vs Out of network
So my dh's company merged with another one last fall. Mind you with either company there are only about 30 or so employees in the 3 state area surrounding us. Around the nation, however, the company has several more heavily "employee populated" areas. We're the forgotten few around here we say lol Things were supposed to be better with this new company. Insurance was going to be much better, afterall this company believed in taking care of their employees ha ha ha ha ha
Premiums with old co's ins were around $10,000 a yr for dh & Hurricane. $25 copay for dr, $50 for specialist, $20 for urgent care, $75 for ER. Standard everything else. Only had a few issues with them, those who know me personally know those issues. Otherwise they were really great to deal with.
Got the insurance info for the new company. What a joke is all I have to say. I spent nearly 3 weeks, DAILY, on the phone & on the net researching our options and speaking with reps both at dh's new company and the new proposed ins company.
See, in "our area" aka that little 3 state area, we were given the choice of two policies within one company. Everyone else could choose several policies within 3 companies. Their reasoning with such a limited choice: You are in such a secluded area medical wise, that we couldn't find a company with reasonable rates that could cover you guys in network so we looked at our options and chose the best two that we felt suited our employees in your area." Obviously you didn't look very far because our old ins had no problems covering us as an ungodly, yet apparently reasonable rate.
So our two choices were rediculous no matter which way you went. Premium up to around $1000 a mo for dh & Hurricane. No in network providers within 100+ miles unless you count the visiting pediatric oncologist & three geneticists from the other side of the state. Local hospital here not even covered. Insuring dh alone, however, was only around $150 a month.
So, what if dh or H becomes ill, what were our choices? Take to a preferred provider or hospital 100+ miles away in another state, or go to our regular long standing family physician here. Either way we'd have to pay $4000 per person before anything's covered, and only at 75% at that. So who's benefiting from us having dh and Hurricane insured. I'm pretty sure that it's not our bank account either way lol
Part 1... In-network vs Out of network
So my dh's company merged with another one last fall. Mind you with either company there are only about 30 or so employees in the 3 state area surrounding us. Around the nation, however, the company has several more heavily "employee populated" areas. We're the forgotten few around here we say lol Things were supposed to be better with this new company. Insurance was going to be much better, afterall this company believed in taking care of their employees ha ha ha ha ha
Premiums with old co's ins were around $10,000 a yr for dh & Hurricane. $25 copay for dr, $50 for specialist, $20 for urgent care, $75 for ER. Standard everything else. Only had a few issues with them, those who know me personally know those issues. Otherwise they were really great to deal with.
Got the insurance info for the new company. What a joke is all I have to say. I spent nearly 3 weeks, DAILY, on the phone & on the net researching our options and speaking with reps both at dh's new company and the new proposed ins company.
See, in "our area" aka that little 3 state area, we were given the choice of two policies within one company. Everyone else could choose several policies within 3 companies. Their reasoning with such a limited choice: You are in such a secluded area medical wise, that we couldn't find a company with reasonable rates that could cover you guys in network so we looked at our options and chose the best two that we felt suited our employees in your area." Obviously you didn't look very far because our old ins had no problems covering us as an ungodly, yet apparently reasonable rate.
So our two choices were rediculous no matter which way you went. Premium up to around $1000 a mo for dh & Hurricane. No in network providers within 100+ miles unless you count the visiting pediatric oncologist & three geneticists from the other side of the state. Local hospital here not even covered. Insuring dh alone, however, was only around $150 a month.
So, what if dh or H becomes ill, what were our choices? Take to a preferred provider or hospital 100+ miles away in another state, or go to our regular long standing family physician here. Either way we'd have to pay $4000 per person before anything's covered, and only at 75% at that. So who's benefiting from us having dh and Hurricane insured. I'm pretty sure that it's not our bank account either way lol
So, what are the reprocussions of going to our doc here? Well...
a) $8000 yes, $8000 in o.o.p. expenses had to be met first, PER PERSON.
b) After that $8000 was met, then ins would pay "up to %50" of incurred costs. But before that "up to %50" will be paid all claims must be paid in full by us, then will be reviewed by ins, then we will be reimbursed any amt that ins deems "true and necessary incurred cost" by the insurance company.
c) what are "true and necessary costs" I ask. Ma'am those are costs that our company deems true and necessary to the care provided at that time. Needless to say she couldnt' give me an example of something covered or not covered. AKA, we'll deny everything we can to save us money and make it like pulling teeth to get us to reverse our decision.
a) driving all that ways with a sick little one, or sick dh - no fun
b) if you had to go to the hospital in an emergency you'd be treated by a "hospitalist" and not by your regular physician anyways because it's more cost effective for the ins company.
c) having to drive all that ways for regular checkups and the weather isn't exactly friendly around here most of the year. Either we've got blizzard season or tornado season... take your pick. Most offices these days are now implimenting a fee for canceling within that golden 24 hour window.
d) also, because we're more than 100 miles away from the nearest physician, we'll have to pay the office visit fee plus our co-pay at the time of the visit. We'll be reimbursed the cost of the office visits once our deductible has been met. That reimbursement will come within 120 days.
Our only other option was to look into our state's supplemental insurance for kiddos under 18. At our old income we qualified. Were told by a tech that "yes, you guys more than qualify. come in, fill out the paperwork, and you'll be good to go." So we did, and were pre-approved for the insurance for Hurricane. So, we decided to save ourselves a ton of money and only put dh on his works policy. Ha ha ha ha ha. Well, thanks to a last minute DC deal, we had to "requalify" using our income from Jan 1-31. Well, that boosted our income quite a bit because we were no longer having to pay so much for ins. Guess what, we no longer qualified for insurance.
So we're back to step one, but not until Nov, when open enrollment for the silk lined snakes opens up again...
Pay out the @ss to insure the Hurricane, or pay out the @ss to not insure the Hurricane. Either way it's a matter of "hmmmm, do we line the pockets of the insurance company, or the CEO of the local hospital?"
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