Healthcare

[semipro]

I'm not sure that this fits in this discussion, but I had had to go the ER for chest pain, turned out to be benign. However on the CT scan, the Radiologist made note of a 5 MM nodule on my lower lung. The ER NP. recommended a follow up scan, and my primary Dr. agreed and ordered the test. Well, in steps BCBS of Michigan, and denied prior authorization, because the body part had been scanned within their 6 month window. My Dr. appealed the claim, but it was still denied. So I will wait my 6 months, and ask my Dr. for a followup CT. She wanted the CT, because original one only showed the lower lung and not the entire lung.

i've heard/read that you can sometimes deal directly with imaging centers and pay much less out of pocket for these scans. In many cases, a collective of physicians actually own the equipment and are perhaps guided by the Hippocratic oath to provide the service at a much lower price. I realize this sounds naive but I played soccer with a physician/owner that confirmed this after one of our teammates needed a scan.

 

[Sodbuster]

i've heard/read that you can sometimes deal directly with imaging centers and pay much less out of pocket for these scans. In many cases, a collective of physicians actually own the equipment and are perhaps guided by the Hippocratic oath to provide the service at a much lower price. I realize this sounds naive but I played soccer with a physician/owner that confirmed this after one of our teammates needed a scan.

Doesn't sound naive to me at all. My Dad's boss had his pilots license and he and his wife both flew down to Texas for a full body MRI every year, non Physician ordered.

 

[Ashful]

My comment had nothing at all to do with his work ethic. It has to do with our current healthcare system where heath insurance has gotten so expensive most people simply cannot afford it on their own. Which means they need to take a job that offers them benifits. And small companies don't get discounts on insurance for their employees meaning our current system discorages entrepreneurship.

This is even worse for people like me with a pre existing condition. If my wife didn't have a job that provided us with health insurance I couldn't be self employed. There is simply no way I could pay the premiums.

Amen, brother. In total agreement with you, on these points.

 

[peakbagger]

My comment had nothing at all to do with his work ethic. It has to do with our current healthcare system where heath insurance has gotten so expensive most people simply cannot afford it on their own. Which means they need to take a job that offers them benifits. And small companies don't get discounts on insurance for their employees meaning our current system discorages entrepreneurship.

This is even worse for people like me with a pre existing condition. If my wife didn't have a job that provided us with health insurance I couldn't be self employed. There is simply no way I could pay the premiums.

I am confused with your contention that you would pay more for insurance with a pre-existing condition. In the past that was true but since the ACA went on line several years ago one of the fundamental tenets of the ACA is that insurers can not charge more for pre-existing conditions. The only variable is age of insured. The reason why the ACA insurance costs more in many areas is that people with pre-existing conditions that may be un-insurable end up with an ACA policy increasing the ACA risk pool costs while many healthy people skip it and hope they dont need insurance. There was a mechanism in place to force everyone to buy insurance or pay an equivalent tax penalty but the congress gutted the teeth out of this part of the law. Ideally if the risk pool was spread out the costs would drop.

 

[bholler]

I am confused with your contention that you would pay more for insurance with a pre-existing condition. In the past that was true but since the ACA went on line several years ago one of the fundamental tenets of the ACA is that insurers can not charge more for pre-existing conditions. The only variable is age of insured. The reason why the ACA insurance costs more in many areas is that people with pre-existing conditions that may be un-insurable end up with an ACA policy increasing the ACA risk pool costs while many healthy people skip it and hope they dont need insurance. There was a mechanism in place to force everyone to buy insurance or pay an equivalent tax penalty but the congress gutted the teeth out of this part of the law. Ideally if the risk pool was spread out the costs would drop.

Someone needs to tell insurance companies that. Judging by the quotes I received a year and a half ago they don't seem to care about that

 

[SpaceBus]

Doesn't sound naive to me at all. My Dad's boss had his pilots license and he and his wife both flew down to Texas for a full body MRI every year, non Physician ordered.

There is something to be said about MRI vs CT. To be honest you might have been better off without the additional radiation exposure created by the CT.

 

[SpaceBus]

I am confused with your contention that you would pay more for insurance with a pre-existing condition. In the past that was true but since the ACA went on line several years ago one of the fundamental tenets of the ACA is that insurers can not charge more for pre-existing conditions. The only variable is age of insured. The reason why the ACA insurance costs more in many areas is that people with pre-existing conditions that may be un-insurable end up with an ACA policy increasing the ACA risk pool costs while many healthy people skip it and hope they dont need insurance. There was a mechanism in place to force everyone to buy insurance or pay an equivalent tax penalty but the congress gutted the teeth out of this part of the law. Ideally if the risk pool was spread out the costs would drop.

Indeed, the ACA insurance only works if everyone has it. Then could expand it into a TriCare style program.

 

[SpaceBus]

Amen, brother. In total agreement with you, on these points.

If I had to get insurance outside of TriCare it would be impossible.

 

[peakbagger]

My dad was a 20 year airforce active/reservist retiree, He used to have Tricare but at some point he switched over to Martins Point Healthcare that got paid by the military to take care of his healthcare needs until he passed. It was great program, He rarely if ever had to go near the VA. They had special reps for vets.

 

[SpaceBus]

My dad was a 20 year airforce active/reservist retiree, He used to have Tricare but at some point he switched over to Martins Point Healthcare that got paid by the military to take care of his healthcare needs until he passed. It was great program, He rarely if ever had to go near the VA. They had special reps for vets.

They keep sending me letters, but I really like my current plan. I could imagine in years past the Martins Point would be superior, especially since TriCare used to be limited to military treatment facilities.

 

[mcdougy]

What is the dollar amount of a healthplan that does not require more out of pocket expenses when you need care? Is there always additional expense when you need to go to the doctor? Say you feel something is wrong, it leads to the eventual diagnosis of stomach cancer....your health plan kicks in, but at the end do you end up with a bill as well?

 

[paulnlee]

Probably doesn't belong here but the corona thread is closed. It took me several attempts to apply for the PPU here, finally got some $$ plus the $600.00 extra. No wonder no one want to go back to work.

 

[paulnlee]

What is the dollar amount of a healthplan that does not require more out of pocket expenses when you need care? Is there always additional expense when you need to go to the doctor? Say you feel something is wrong, it leads to the eventual diagnosis of stomach cancer....your health plan kicks in, but at the end do you end up with a bill as well?

Don't think there is one. Saw doc yesterday THEY required to renew script. Asked the same dumbass questions, took vitals and over. $20.00 co pay but will get another bill from them for at least $140.00 to cover what insurance didn't.

 

[mcdougy]

What is the yearly cost of your policy?

 

[SpaceBus]

Probably doesn't belong here but the corona thread is closed. It took me several attempts to apply for the PPU here, finally got some $$ plus the $600.00 extra. No wonder no one want to go back to work.

My wife has been trying to get through. I think so far in Maine only non-Covid related claims are working, in other words only folks getting unemployment before this started.

 

[Ashful]

What is the dollar amount of a healthplan that does not require more out of pocket expenses when you need care? Is there always additional expense when you need to go to the doctor? Say you feel something is wrong, it leads to the eventual diagnosis of stomach cancer....your health plan kicks in, but at the end do you end up with a bill as well?

An insurance plan with zero deductible? Does your homeowners or auto insurance have zero deductible?

No, there is not always an expense when we see a doctor, once you have hit your olan year deductible. After reaching the individual or family deductible, you typically pay 0% to 20% of the bill on a good plan, depending on the type of service.

 

[mcdougy]

An insurance plan with zero deductible? Does your homeowners or auto insurance have zero deductible?

No, there is not always an expense when we see a doctor, once you have hit your olan year deductible. After reaching the individual or family deductible, you typically pay 0% to 20% of the bill on a good plan, depending on the type of service.

Ok, do you mind divulging what the cost of your plan is for your employer. And what are typical deductibles.
I'm just wondering how the stories of people owing large amounts of money for medical treatment happen?

 

[Ashful]

Ok, do you mind divulging what the cost of your plan is for your employer. And what are typical deductibles.
I'm just wondering how the stories of people owing large amounts of money for medical treatment happen?

Usually this happens when people fail to adequately protect themselves with an umbrella plan. These plans are insanely inexpensive for the amount of coverage they provide, as they are only used for those rare cases when someone exceeds their plan maximums. It doesn’t happen often, but those with an agenda love to hop all over these statistically rare examples.

But of course it’s easy for me to say how inexpensive they are, when I’m not struggling to put food on the table, I realize that. Honestly, we should have a better social system for these cases, as they’re rare, and the public burden to benefit ratio would be low.

I wouldn't mind providing the amount my employer pays for my plan, but I don’t know the number off the top of my head, I will have to look it up when I’m in my office.

 

[festerw]

Ok, do you mind divulging what the cost of your plan is for your employer. And what are typical deductibles.
I'm just wondering how the stories of people owing large amounts of money for medical treatment happen?

Mine is I pay $150/month employer pays $1400 for PPO Savings Plan which mostly means I have to pay out of pocket for everything after the insurance discount. Fortunately I also get a $1200/year stipend into an HSA which mostly covers everything but we're (family of 3) fairly healthy and don't visit the doctor often.

All that applies up to my deductible of $3200, then I pay 10% of the insurance billing cost up to the out of pocket maximum of $7200.

So let's say yearly I pay roughly $2500/year for health insurance and my employer pays $18,000.

Note that it doesn't include vision or dental coverage.

So worst case I'd be out $10,000 which isn't insurmountable but would be difficult for someone else to pay on top of normal bills. Couple that with the fact something like 40% of Americans don't have $400 in savings and you've got an issue.

 

[mcdougy]

Fester, that's alot of money imo between you and your employer...would you consider your plan as top end, above average, common or minimal?

 

[mcdougy]

Do companies typically include eye and dental care as well?
Do the healthplans include life insurance as well?

 

[bholler]

Ok, do you mind divulging what the cost of your plan is for your employer. And what are typical deductibles.
I'm just wondering how the stories of people owing large amounts of money for medical treatment happen?

Some plans also have a cap on total payout.

 

[bholler]

Fester, that's alot of money imo between you and your employer...would you consider your plan as top end, above average, common or minimal?

Paying $150 per month is cheaper than average but not by allot. My wife's plan is $180 bi weekly including vision and dental for family. But ours has no deductible and pretty low copays. Her benifits are fantastic. Far better than any we have had before

 

[mcdougy]

Life and disability too bholler? What is copay? Sharing cost of medication?

 

[bholler]

Life and disability too bholler? What is copay? Sharing cost of medication?

No life or disability included in that. She has it but honestly I don't know how much it is. Copays vary. Office visits are $10. Specialists are $20. I think ER visit is $50. Cheaper than any other plan we have had and no deductible or cap. I will have to dog out the paperwork to find out what they contribute.

This is through a huge engineering company with just over 30000 employees world wide.