Insurance companies

[mkgal1]

We had the same thing in her pregnancy.

Doctor told us due to our ages - he'd recommend getting some sort of genetic workup - and they said it was covered under our plan.

Three weeks later - we get a bill in the mail for $10k.

"Whoops"

Still fighting that one.

Maybe you should send a copy of that bill to that doctor to pay (not expecting him to, of course.....but making him aware of his flippant claims).

 

[DZoolander]

I didn't even know he was turned away? Who is treating him?

It could be that (him not having insurance). It could also be that the hospital didn't believe they were properly equipped to handle him. I'm not really buying that the CDC "has this under control" as they claim. That hospital was probably covering their whole solvency (and if I were a patient or employee there, I'd be thankful).

Guy came in from Liberia - and started showing symptoms of being sick (he's a Liberian - so I think it's fair to say he probably doesn't have insurance).

He goes to the hospital and complains (apparently does tell them that he's from Liberia). They just send him home with some anti-biotics.

A few days later - he's transported back to the hospital after he starts vomiting all over the street/etc. Hospital doesn't think to contact the CDC - it's actually his nephew that does...thinking that he might have Ebola...and frustrated at how the hospital is handling it.

Given that I believe the prime directive of any hospital when confronted with a patient w/o insurance is to "get them out of here" - I can see how that would go down.

 

[mkgal1]

So as it stands - for our top-of-the-line individual healthplan which purports to be "platinum" (no we didn't buy it through the exchange if you're looking to parlay this into an Obamacare rant - it's just a normal individual plan purchased directly from the carrier) - if they had their druthers we'd be shelling out $50,000+.

....and that is *with* paying each month for an insurance premium...right?

 

[DZoolander]

Of course. We pay close to $1000/mo for insurance.

 

[mkgal1]

Guy came in from Liberia - and started showing symptoms of being sick (he's a Liberian - so I think it's fair to say he probably doesn't have insurance).

He goes to the hospital and complains (apparently does tell them that he's from Liberia). They just send him home with some anti-biotics.

A few days later - he's transported back to the hospital after he starts vomiting all over the street/etc. Hospital doesn't think to contact the CDC - it's actually his nephew that does...thinking that he might have Ebola...and frustrated at how the hospital is handling it.

Given that I believe the prime directive of any hospital when confronted with a patient w/o insurance is to "get them out of here" - I can see how that would go down.

Wow. I've not really caught the details about him being Liberian (I thought he had only traveled there). So....did he fly *back* to Liberia....infected....or do you know where he is now?

I'd only heard that he was walking around Dallas for 10 days from the time he started showing signs of illness.

 

[DZoolander]

Wow. I've not really caught the details about him being Liberian (I thought he had only traveled there). So....did he fly *back* to Liberia....infected....or do you know where he is now?

I'd only heard that he was walking around Dallas for 10 days from the time he started showing signs of illness.

He's a Liberian national. Apparently he was in an area and helping out with people that were sick with Ebola and came in close contact with a few of them - a couple of which died within days of his contact with them.

He travels to America a few days later - and isn't showing any symptoms (as it takes a while). As a result - he's able to pass the screenings.

He gets to America - and within a few days starts becoming symptomatic...which is when the chronology I gave above begins.

 

[DZoolander]

and he's now in Texas.

Ebola becomes communicable once you're symptomatic - so there's a 2-3 day window between when the hospital sent him off with his antibiotics and when he finally got admitted/the Ebola was "discovered" where he had contact with people in the communicable stage.

...in Texas.

 

[mina]

Mina - we've considered doing cost-sharing instead of insurance as well, especially since hubby is starting his own business and will lose his insurance when he and I both eventually quit our jobs. Here's my question: does the cost-sharing pay up front for costs (like office visits, prescriptions, etc) or do you pay and then get reimbursed, or how does it work?

There are three main cost sharing ministries, and each one differs slightly in how they do things. The general idea is that it's most like catastrophic insurance. They will not help you pay for every sore throat or minor scratch, but will help you pay in full for any incident that is major and costly. They will not pay for annual physicals or minor doctor visits; although I am hoping that it will be added in the future. If something happens you go get medical care at any hospital or with any doctor. Up front, you let them know you are self pay. You are responsible for the first $500 (differs with each ministry) I had several incidents when I had regular insurance where I had to pay out of pocket so this doesn't phase me (then received reimbursement from the insurance company like 2-3 years later). Every doctor and medical office I've ever been self -pay has been willing to give me discounts (if you receive $500 in discounts it goes toward your personal responsibility). You ask to be on a payment plan and ask for an itemized bill to submit. You then receive a check or checks to pay off the bill in cash and to reimburse whatever you paid yourself (after your responsibility)within about 3 months. It's not for everyone and it's not perfect); but as we are both self employed it's really the only thing we could afford. I honestly think their maternity plan is so much better than any insurance plan. Premiums for private insurance ,here were at least $850 or more per person (depending on the level); and we just couldn't afford that each month; plus the high deductibles. My husband's regular doctor doesn't even accept insurance. We made too much to receive subsidies, but not enough to afford the insurance offered in this area. By comparison we only pay $150 per person each month. We are in great health and don't mind paying for yearly check-ups or sore through visits out of pocket b/c we aren't paying staggering premiums and can afford to now.
I strongly urge you to call the ministries to see what they offer and to ask questions if you are interested. I called all three and they were all very helpful and polite. I ended up doing a lot of research on the cost-sharing side of things, and right now it meets our needs and we are happy with it. Anytime I've had to call; they are helpful and polite and efficient. I was never made to feel like they were "pushing their product" on me.

 

[Ana the Ist]

Insurance companies are a joke...they're great as long as you're turning in your money and no one needs them, as soon as you do though....issues arise

I don't know if you ever read the thread I had regarding my wife's rather nightmarish health problems...but I didn't even go into some of the mess my insurance tried to pull. Granted, they paid for things without any big fuss as long as costs were low...as soon as they started to climb, issues arose. For example, even filling a prescription became a hassle....Insurance was paying upwards of 25-30k during the worst parts just on her meds. Then one time we go to fill a prescription and hear back from the insurance that "they won't exceed the manufacturer's recommendation for a monthly dosage without expressed consent from a doctor." As if somehow the prescription itself wasn't enough...

Then there was the time they called me at about 6am to schedule my wife's MRI (her fourth or fifth). They basically pretended to be from a Dr s office (didn't identify themselves "hey, we see you have an M R I coming up...") all so they could schedule her at a cheaper place instead of the specialists she had to go to. If anyone thinks they're insurance is "better", don't hold your breath. Mine is a particular type of government insurance that cannot drop me for any reason and pays 80-85% of all costs even for doctors outside our network.

Now to their credit, over 4 years they paid out over 250k while I paid about 25-30k out of pocket. This experience has shown me though that healthcare is messed up in this country and only the very very rich can afford being very very sick.

 

[DZoolander]

Yep, so long as you're still within the actuarial profit margin, they're cool. But once there's the risk of you becoming a liability, the issues arise.

 

[Ana the Ist]

Yep, so long as you're still within the actuarial profit margin, they're cool. But once there's the risk of you becoming a liability, the issues arise.

The two examples i gave don't even explain it all...it became a weekly battle of working around their garbage. They know you're going through something hard, they can't deny you, so it becomes a battle of attrition...they want to wear you down till some cheaper alternatives are reached. I had never experienced anything like that...I can't describe the amount of verbal abuse I heaped upon total strangers over the phone....

I can't imagine working with some of the companies you guys have. 1000+ in premiums??
That's insane. Im curious what kind of profit margins they have. Granted I'm only covering my wife and myself...but we don't even pay 40% of that, and I'm thinking of switching back to the basic plan for another 150 or so in savings.

 

[DZoolander]

Well, I can only speak for us, but, at least in the past few years...

2010 - $10k profit
2011 - $6k profit (due to the birth of our daughter)
2012 - $11(ish)k profit
2013 - $12(ish)k profit
2014 - TBD

 

[DZoolander]

Probably not any profit this year - because once we got verification that they will be covering our son's time in NICU (the $40k charge) and got it in writing - we summarily gave them the bird and cancelled the plan effective next month.

When they asked why - told them we hated them and were going elsewhere.

 

[NothingIsImpossible]

Only thing worse is bringing your wife here from overseas and she can't get any health insurance that immigrant supposedly get because her countries rules are she cannot use immigrant health care until shes working. So shes basically stuck going to free clinics that can't do much for bigger health issues. And sadly I am disabled so the healthcare I have she cannot be on anyways again because of her countries rules about coming here.

 

[Soma Seer]

...Once we got verification that they will be covering our son's time in NICU (the $40k charge) and got it in writing - we summarily gave them the bird and cancelled the plan effective next month.

When they asked why - told them we hated them and were going elsewhere.

and . That is all.

 

[A Taffer]

When me and my wife Rosah had our son this year, we had Anthem Blue Cross & Shield and they covered absolutely everything! Dunno why your local BCS is giving you such a hard time

 

[Hetta]

Probably not any profit this year - because once we got verification that they will be covering our son's time in NICU (the $40k charge) and got it in writing - we summarily gave them the bird and cancelled the plan effective next month.

When they asked why - told them we hated them and were going elsewhere.