United States Healthcare Reform

[WarrenM]

So I sat down and read through my wife’s entire insurance plan, cover to cover. And I have absolutely no idea what it covers. It makes clear that regular doctor’s visits equals “$20 copay”, but everything beyond that I cannot fathom.

I agree, it’s worse than trying to file your own taxes. I have no idea what’s going to be paid for and what isn’t when I go to a doctor. I just go and hope for the best, really. It’s impenetrable.

We get updates from HR about changes to the health plan and each one is a wall of text that I don’t stand a chance of understanding. They’re covering this but not this but this with certain caveats and this with option A but option B will coincide with option C which … blah. Fuck it.

[Wallapuctus]

I get $350/mo taken out of my check (my company pays 60% of the premium, I pay 40%) for health insurance. I tried to get new contact lenses. Not covered. Not the exam, not the lenses themselves, nothing. That’s the only thing I’ve ever needed insurance for.

My dental is a separate thing, and that actually covers my semi-annual cleanings. So, at least I’m getting something for my money?

I’d much rather my $350/mo + the $525 my employer pays go toward Soviet Fucking Canada socialist ass insurance. But that would cause the dude who owns my health insurance company to have to sell his private island in the Bahamas or some shit, so NO WAY.

[jason]

If you are thinking the hospital would have given you those reduced rates you are probably wrong…especially in a case of emergency treatment. While some doctors, hospitals etc will negotiate prices they always want to do it in advance.

This is a game the insurers, the hospitals, doctors etc play, not the insured. Even the government (medicare) plays the game.

No, I wasn’t expecting to get reduced rates on the initial paperwork, they didn’t have her insurance info, so we were billed as uninsured. What happened is that for ever bill we got, we got a statement from Aetna saying the charges were ineligible for coverage, as follows:

Bill -> Aetna Pays -> Patient responsibility
$10,000 -> ineligible -> $10,000

The only one Aetna paid anything on was the surgeon
$2100 -> $1400 -> $700

Speaking with a person at Aetna right now I’ve learned that some, perhaps most, of the problem is going to be clerical in nature. Such as, Aetna will not pay anything for anesthesia from a contractor, only from a doctor’s office or hospital, so in order for Aetna to pay I have to tell the anesthesiologists that I refuse to pay, they will submit the bill to the hospital for services rendered to an indigent patient, then the hospital will resubmit the bill to the insurance at which point it will likely be paid.

And Aetna is refusing to pay for the hospital stay because… “No services were rendered during the stay.” Entirely because all the damn services were billed separately. If the hospital billed Aetna for everything at once, this would be done with, but since they broken it up and have everyone bill be separately, the system broke. So now I’m calling everyone and telling them I can’t pay and to send the bill to the hospital.

This. Is. Stupid.

[Mark_Asher]

I agree, it’s worse than trying to file your own taxes. I have no idea what’s going to be paid for and what isn’t when I go to a doctor. I just go and hope for the best, really. It’s impenetrable.

We get updates from HR about changes to the health plan and each one is a wall of text that I don’t stand a chance of understanding. They’re covering this but not this but this with certain caveats and this with option A but option B will coincide with option C which … blah. Fuck it.

So it makes it nearly impossible for consumers to shop intelligently, which means an important part of the whole free market equation is broken.

The free market process for choosing doctors is broken too. How do we choose a doctor? We pick a name from a list, probably based on how close the doctor’s office is to us. And why are the doctors on the list we choose from? Because they are the best doctors available in the area? No, because they agreed to the insurance company’s cost structure.

[Scuzz]

No, I wasn’t expecting to get reduced rates on the initial paperwork, they didn’t have her insurance info, so we were billed as uninsured. What happened is that for ever bill we got, we got a statement from Aetna saying the charges were ineligible for coverage, as follows:

Bill -> Aetna Pays -> Patient responsibility
$10,000 -> ineligible -> $10,000

The only one Aetna paid anything on was the surgeon
$2100 -> $1400 -> $700

Speaking with a person at Aetna right now I’ve learned that some, perhaps most, of the problem is going to be clerical in nature. Such as, Aetna will not pay anything for anesthesia from a contractor, only from a doctor’s office or hospital, so in order for Aetna to pay I have to tell the anesthesiologists that I refuse to pay, they will submit the bill to the hospital for services rendered to an indigent patient, then the hospital will resubmit the bill to the insurance at which point it will likely be paid.

And Aetna is refusing to pay for the hospital stay because… “No services were rendered during the stay.” Entirely because all the damn services were billed separately. If the hospital billed Aetna for everything at once, this would be done with, but since they broken it up and have everyone bill be separately, the system broke. So now I’m calling everyone and telling them I can’t pay and to send the bill to the hospital.

This. Is. Stupid.

Almost any surgery (medical treatment requiring anesthesia) will involve seperate billings for each person in the room not directly in the employ of the hospital. That is pretty standard I think…at least in all of my experiences.

See if your company has a broker that they deal with. Our broker has helped us in instances like this. Also it sounds like the hospital should simply re-submit everything now that they have your insurance info.

And I know it is too late now but you should have made sure the hospital had all the insurance info before you ever left the hospital. You probably could have avoided a lot of this…:).

Also, don’t be surprised if one bill seems to go unpaid forever. When my youngest was born I had one bill that for some reason went unpaid by the insurance company (even though they said they would and eventually did pay it) for nearly a year.

[Rob_Merritt]

I finally came to the conclusion that I’m just not going to get healthcare for some of my issues. As I age, my congenital heart defect is developing additional issues and I need some minor adjustments made to my valves. I’m not going to get the needed surgery for my heart since it was a birth defect so in the next 5 to 10 years I’m going to die from it.* So instead they get to pay for my therapy over this which oddly enough they do cover. I’m not sure if they are really making any profit on this deal.

• there is a small window that if I have a heart related episode that doesn’t kill me but lands me in the emergency room that the surgery might be cover if they determine that the episode, not the defect is the reason why I went to the hospital.

[Sabotai]

I get $350/mo taken out of my check (my company pays 60% of the premium, I pay 40%) for health insurance. I tried to get new contact lenses. Not covered. Not the exam, not the lenses themselves, nothing. That’s the only thing I’ve ever needed insurance for.

My dental is a separate thing, and that actually covers my semi-annual cleanings. So, at least I’m getting something for my money?

I’d much rather my $350/mo + the $525 my employer pays go toward Soviet Fucking Canada socialist ass insurance. But that would cause the dude who owns my health insurance company to have to sell his private island in the Bahamas or some shit, so NO WAY.

I’m curious: how many persons does this monthly premium of $ 875 cover?

[PapaSmurf]

Optical isn’t covered in Canada anyway.

[Timemaster_Tim]

Optical isn’t covered in Canada anyway.

No, but eye examinations

[Scuzz]

Optical isn’t covered in Canada anyway.

Optical and dental are always extras in the US.

My family of four, in the US, Blue Shield with $1k deductible (we do get to choose our own doctors for the most part), age 55, costs $1,730 a month. That is part of a group, bought through a group. Includes optical.

And I have it priced out every year and no matter how you work it somehow I (I say I, but it is the company) end up worse with other choices. 5% increase last year was lowest in a long time.

[PapaSmurf]

Oh I’m not saying the American system is in any way, shape, or form more efficient.

I’m absolutely certain that if the money that was spent on health insurance was converted into taxes, you could pay for health care and take a bite out of the enormous deficit.

[Scuzz]

Fix health care (somehow, don’t know myself) and things get better all across the board.

[Wallapuctus]

I’m curious: how many persons does this monthly premium of $ 875 cover?

2 people.

[Sabotai]

2 people.

Jeez, that 's a lot of money (and still includes a lot of co-pays if I understand correctly)

Under the Dutch system I pay €2.400 yearly for a family of 5 (3 kids under 18). My employer pays a mandatory premium of 2.300 a year.

This covers everything except a compulsary excess of € 170 for me and my wife, no co-pays. Coverage includes almost everything including free dental care for my kids up until 18. Only things that aren’t covered are fysiotherapy, alternative medicine, contraceptives and glasses (lenses). If I pay 200 per year more even those are covered. I only see insurance forms twice a year; when I apply and at year 's end when they send an overview of all costs they paid for me. Almost no administrative hassle.

It might not be the perfect system, but I’m really thankfull for a pretty effective system.

[Blackadar]

And I know it is too late now but you should have made sure the hospital had all the insurance info before you ever left the hospital. You probably could have avoided a lot of this…:).

Or not.

The system is so screwed up I’d go uninsured if not for having 2 kids.

I went to the in-plan doctor a while ago and gave them my insurance info up front. During the appointment, the doctor wanted to draw blood since there’s a whole host of medical issues in my family (heart disease, diabetes, etc.). As usual, the tests come back negative - I’m as healthy as a horse. Two months later I get a bill for the blood work. Since the lab the doctor used to send the blood work to isn’t “in plan” - even though he is - insurance refused to cover it.

Two years ago, the birth of our daughter (tough having a newborn at my age, but that’s a different story) wasn’t covered at all. The insurance company decided to trot out some sort of maternity coverage rider that was never presented to us, nor was it referred to in the documentation they sent us. Self-paying for that was an eye-opener. Hell, by contract we weren’t allowed to get the same rates as Big Insurance did from the doctors, even if we paid in advance and in cash!

It’s an entirely broken system.

[AaronSofaer]

The insurance company decided to trot out some sort of maternity coverage rider that was never presented to us, nor was it referred to in the documentation they sent us.

That’s actually illegal, unless they served formal notice. Shoulda taken the motherfuckers to court.

[Wallapuctus]

That’s actually illegal, unless they served formal notice. Shoulda taken the motherfuckers to court.

The Tea Party argument is just go give birth in a barn on some hay, you dirty socialist. It was good enough for Jesus, so it’s good enough for your baby.

[Scuzz]

Or not.

The system is so screwed up I’d go uninsured if not for having 2 kids.

I went to the in-plan doctor a while ago and gave them my insurance info up front. During the appointment, the doctor wanted to draw blood since there’s a whole host of medical issues in my family (heart disease, diabetes, etc.). As usual, the tests come back negative - I’m as healthy as a horse. Two months later I get a bill for the blood work. Since the lab the doctor used to send the blood work to isn’t “in plan” - even though he is - insurance refused to cover it.

Two years ago, the birth of our daughter (tough having a newborn at my age, but that’s a different story) wasn’t covered at all. The insurance company decided to trot out some sort of maternity coverage rider that was never presented to us, nor was it referred to in the documentation they sent us. Self-paying for that was an eye-opener. Hell, by contract we weren’t allowed to get the same rates as Big Insurance did from the doctors, even if we paid in advance and in cash!

It’s an entirely broken system.

I think maybe you just have really shitty medical…pardon my French…

[AaronSofaer]

The Tea Party argument is just go give birth in a barn on some hay, you dirty socialist. It was good enough for Jesus, so it’s good enough for your baby.

Actually, I think the Tea Party argument is that none of that would happen if we just abolished the pesky Federal regulations preventing insurance companies from really competing with each other across state lines.

[Scuzz]

Actually, I think the Tea Party argument is that none of that would happen if we just abolished the pesky Federal regulations preventing insurance companies from really competing with each other across state lines.

I don’t really know the Tea Party stance but that would be a good first step. It would also be nice if you could delete certain types of coverage. For instance I believe in California you have no choice but to have maternity coverage, even if you are old and neutered.