Insurance Story

[lholl36233]

I had to share the insurance details of my 6/9 trip to the Mass Eye and Ear with my AN friends.

MRI                         2,640.00
CT                          1,579.00
Contrast Injection        960.00

I can deal with my 65.00 portion of this Tufts is asking me to pay.

Who says you don't need health insurance?   

[leapyrtwins]

Yes, insurance is certainly wonderful - once you get through convincing them to cover your claims 

Last year for my MRI and AN surgery I only paid $400 deductible and this year for my MRI and BAHA surgery I only paid $400 deductible.  Not bad at all for about $175,000 worth of medical procedures.

I'm still waiting for my BAHA processor claim to be sent to my insurance company to see how much I owe for it, but I'm hopeful it won't be too much.

Jan

[Jim Scott]

As I've stated previously, although the U.S. healthcare system has it's shortcomings and the insurance bureaucracy can be a labyrinth to navigate, in the final analysis, health insurance companies generally pay the medical bills in this country and at a reasonable cost when compared to what you would owe a doctor or hospital if you were solely responsible for paying their bill.   

I'm no fan of insurance companies but I think they do a credible job, with some exceptions, of course.  The post from lholl36233 is yet another example of what gets paid and how little the policyholder is actual liable for - $65. on a bill of $5,179. A little over 1% of the total bill.  I think we could all deal with that. 

Jim

[Dan]

After surgery I stayed in the Hosp. 9 days then they sent me to a Rehab center for 5 weeks and I had physical therapy 3 times a week for another 1  1/2  months, I recieved 
100% monthly loan for 6 weeks and then 75% of mothly loan for the rest of the three months that I couldn't work.  For the hospital stay I payed about $200 and for the physical therapy I payed about $100 for the 5 weeks in Rehab I payed $0.  We pay 12-14.5% of monthly income for Insurance but children are free and 100% covered.

Dan in Germany

[Syl]

Hello all,

My co-pay for my surgery and 5-day hospital stay was $250.00 with my Kaiser insurance. I know I got off easy.

Syl

[CaryF]

I'm happy to hear that so many of you only had to pay 1/10 of pennies on the dollar for your care. But just to give some a reality check total gamma knife bill so far out of pocket 7500.00. and I pay 480.00 per month for my policy! And so far we're up to 2200.00 for Thyroid surgery on my wife and counting. Kind of makes me want to shut down my business and work for someone else so I can get that great coverage...

[Jim Scott]

CaryF:

I agree that when it comes to medical insurance, the small business owner gets a bad deal.  I sympathize with your frustration.  I would be frustrated too, in your situation.

Just as no two people pay the same exact price for a seat on the same airline flight, no two people usually pay the same for medical, home, auto or life insurance.  Insurance premiums are based on a million variables.  For those who obtain medical insurance through an employer a good part of the actual cost is subsidized by the employer, which is why it's called a 'benefit'.  Group policies tend to be more inclusive, the employee often has more options from which he can chose; from minimal 'catastrophic' hospital coverage that only covers dire situations such as heart attack or cancer to 'premium' coverage that insures you for almost anything with only a relatively small deductible that ends once you've paid a fixed amount 'out-of-pocket'.  At that point, the insurance company pays at 100%. 

The best advice I can offer is that you shop around and look for the beat deal you can find.  That takes time and effort and I wouldn't expect your friendly, commission-collecting local insurance rep to do it for you in a manner that will necessarily save you money.  Insurance shopping is tedious and many folks don't want to be bothered so they take what is offered and don't bother to look for a better deal.  Then they complain.  I trust this isn't true in your case but the advice remains valid: shop around for your medical insurance and if you do close your business and become an employee some day, still look at the fine print to see what your insurance premium dollar is buying and what you're going to be required to pay ('co-pay') for any particular procedure. 

Some folks are over-insured, some are way under-insured but sooner or later, we all need insurance, especially medical ('health') insurance.  It's a truism that everybody hates insurance companies.  That being the case, the best 'revenge' is to get the very best coverage for the lowest price.  I hope you do.

Jim

[CaryF]

Jim,

I'm not posting because I feel I have been "cheated" or taken advantage of. I just feel that if we are going to have a thread that basically tells all about what we paid for our treatment I think it's only fair that we look at the not so good as well as the good. And I did shop very carefully for the policy that I currently have but the fact is that when you are self employed you must always be finding a way to balance your budget. There are many policies that would have paid much better. But there cost would have been much higher per month. And when you are an independent contractor you have to consider ALL the cost, not just one. Sure I could have gotten a policy with a low deductable tiny co-pays and no co-insurance. But that would have been well over 1000.00 a month. And we still have to pay the rent and buy food and gas and such. And you have to keep in mind that not only do I have to cover my own health care I must also pay the full amount for social security and Medicare (self employment tax) which is just about twice as much as what I pay for insurance. No Jim I read my policy very closely and knew what all it entailed. I had struck out own my own with the idea of growing a business and maybe one day hiring employees, but this sort of thing makes it pretty difficult to do and of coarse I'm not to happy about that. And you must understand that I personally don't see this as an "insurance problem" they stuck to there deal, my deductable and co-pays as well as the co-insurance (the amount you pay over and above your co-pays and deductibles) was right where they said it would be. And I don't see this as a "doctor problem" my Doc was with me from the time I went in and did not leave my side until I could get up and walk out on my own, all in all about 6 hours. And for this he is only paid 1300.00! But the Gamma Knife center cleared about 50,000.00 for the use of there machine for an hour and a half. Looks to me like they got the best deal.
I will gladly write my check for the treatment and pay “my fair shareâ€?. But it does make one look hard at weather self employment and trying to build a business is really worth it any longer. And since I don’t believe in debt this will make a big hole in this years budget. But to me that just means we’ll be putting off that house, new car or bright shiny things from  Wal-Mart…

Cary…

[Dog Lover]

We have pretty good insurance coverage from my employer. From my research, my out of pocket maximum for an individual is $2000. I am about $175 away from meeting that and i haven't even had my surgery yet! But, if I understand it all, after i meet the Out of pocket max, they should cover 100% of "covered expenses". There are always surprises! Oh yes, and all this after I just got done paying for my youngest daughter's surgery. Was expecting a $750 deductible....oh no. Double that when they hit me with "co-pays", "deductibles" and "non-covered expenses". <sigh> Oh well - Still better than the last place I worked!

When my 25 yr old daughter was 10, she had 2 surgeries that totaled over $75k. I think we paid about $10. If only insurance coverage was as good these days.

Cathy

[Brendalu]

Wow, I have been fighting with my insurance company so much lately that this thread amazed me!  I just got my lymph pump.  The insurance paid $2500 and I have to pay $5300.  There is a $2500 cap on "durable" goods.  They have kicked my bandage bill ($348) four times so far for the same reason each time....coding.  It has been coded recoded and coded again.  No coverage for my stockings at $175 a pair.  My MRI's are covered at 100% IF I have them in an office where a doctor is present.  My neurosurgeon won't send me to one of those bacause he doesn't like their film.  So the insurance pays 80%.  So far this year I have paid $14,442.87 in copays and deductibles (deductible is $1500.)  Good thing my husbands company is footing the monthly bill because I wouldn't pay what they pay for this insurance!  I al;so pay $680 a month for my meds and that is with a copay of $10, 30 and $60, of course none of my meds are available in generic form and they are all tier three!  I love talking about insurance.....yuck!  Oh and my visits to the lymohedema center were between $705.00 and $850.00 a day of which I had to pay $135.00 per day for thirty eight days.  Keep your fingers crossed that none of your surgeries cause you to have lymph edema because it is lifelong and very, very expensive. No transear for me.......it is a durable good and I've already used that up!
Enjoy your day!
Brenda

[Jim Scott]

Cary:

Thanks for giving us the real crux of your problem. 

The fact that being self-employed is becoming financially difficult for you and your family is certainly unfortunate but somewhat understandable and, sadly familiar.  Although small business firms account for most of the jobs in the U.S., the failure rate is around 35% the first year and goes up to about 45% after four years.  The reasons are many; including competition, poor market analysis and of course, lack of capital.  Taxes and insurance also take their toll, as you made quite clear in your previous post. 

You also admitted that you aren't complaining about insurance companies or doctors but the cost of being self-employed as it relates to insurance costs.  That's a viable complaint but this thread is populated mostly by folks who are employees and are covered by medical insurance their employer subsidizes.  It shows that various AN patients have sometimes vastly differing coverage.  Some pay little for their radiation/surgery/doctors/hospital and others have to pay a lot more for the same basic care and incur big bills.  As the late President John F. Kennedy famously stated: "life is unfair".

Unfortunately, some folks seem to think that 'universal' or nationalized health insurance with a government bureaucracy at the helm would be a panacea for this kind of problem.  I think it would be a massive boondoggle that would quickly end up rationing health care and basically have citizens paying more (via increased taxes)and getting less as well as losing their freedom of choice in doctors, hospitals, etc.   However, thats a separate issue.

While anyone can sympathize with your plight and the fact that you can't afford deluxe medical insurance, being self-employed is a risk that almost always incurs some sacrifices.  It stinks that in your case, your medical insurance has to be one of them. Obviously, self-employment isn't for everyone and, in the final analysis, it may not be economically feasible for you.  I know the taxes, alone, are horrendous and, in my opinion, unfair.  I hope this situation is resolved and - if this is your desire - you can remain self-employed and, in the near future, be able to purchase health insurance with broader coverage so you can boast of your tiny co-pay when receiving medical services. 

Jim     

[tenai98]

wowserssssss...my MRI cost including the constract and reading  $945CND...when I checked in with the Messina NY hospital (as I have CHAMPVA) they wanted over $3000.00...ouch...and I had to pay 25%..so all around it was cheaper in Canada

[Lamsue23]

I quess I'm fortunate to have the insurance I have.  I'm with Bc/BS of Mass through my work which I've been on LTD and WC for two years but as long as I pay my employee premiums every month I'm OK.  I just had my surgery and the bills are coming in.  So far my surgery is up to $107,000.
My insurance is paying 100% with no deductibles.   I'm the lucky one!!!!!!!!!!!!!!!!!!!!! I checked before to see if I had a lifetime cap and I didn't....
I feel bad for those whose insurance don't pay much, this is a very costly surgery......