Wife just learned the true meaning of "$6500 deductible"

[fishgutzy]

The wife broke down and went to the doctor today, and she texted me from their office saying "the doctor is saying there is no co-pay at all". I kept pointing out that our new insurance sucks and has a $6500 deductible and that there is no co-pay because you pay ALL of it. That's what a $6500 deductible means and why I keep saying we have essentially no insurance beyond catastrophic coverage.

Then she left and they didn't give her a bill. Right, eventually they'll figure out how much they want to charge and then mail it to her.

Sigh.

Many employers that are self insured are doing this. They pay NADA until the entire family deductible is paid.
My plan is still a little more traditional. But huge $7150 family deductible and $14,300 max out of pocket in network. A lot higher for out of network.
My wife's eye surgery last year cost us $6K out of pocket. Total for the year was over $21K. So far this year is not bad. No surgeries. Only one MRI for my son. Only $7500 out of pocket so far this year.
One employer I had an interview with sent me a copy of their benefits. Doesn't pay a dime until the full family deductible is paid. Given that the uncovered cost of medications in my house exceed $8,000, I'd have to have a credit card with $6000 available on it every January and pay it off as the HSA accumulates. And one does not start a job with this company in November because that $6K is not prorated for the calendar year.

 

[fishgutzy]

And no one has even mentioned prescriptions. I had a liver transplant in July so I have to take anti-rejection drugs for the rest of my life. Get them thru mail order but my first order was delayed and I ran out. The pharmacy sold them to me for $1/pill so it cost me $24 for two days. My month 360 pills get charged through insurance at 2800 or almost $8/ pill. It’s an absolute racket


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My wife's AsicolHD is around $1300 a monthout with insurance. BCBSNC forced her the spend 3 painful months being a guinea pig to try the cheaper meds. None of them worked. They also stopped covering Lialda for my son and forced a generic. Took over a year to find the right dose in conjunction with Humira.

 

[fishgutzy]

One point that needs to made.
The employer based plans that don't pay a thing until the deductible is met is due to the Obamacare "Cadillac" tax. Employer's must keep the cost of any health benefit below the level at which the 40% tax kicks in.
The maximum my employer could cover of my $27,000 premium is $20,000 without hurting the tax. My employer only covers $15k. That didn't change when the total insurance went up by $4800 for 2017. So I essentially got a pay cut of $4800.
I'm paying about $1000 A month in credit cards to pay off last year's out if pocket.

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[noway2]

My wife's AsicolHD is around $1300 a monthout with insurance. BCBSNC forced her the spend 3 painful months being a guinea pig to try the cheaper meds. None of them worked. They also stopped covering Lialda for my son and forced a generic. Took over a year to find the right dose in conjunction with Humira.

That is not the sort of thing an insurance company should be doing. That is practicing medicine without being the patients physician.

If we keep going down this rabbit hole, things are going to turn nasty, but that's probably what it will take in this country to fix it. Nobody wants to do the right thing until their fundamentally forced to as long as there's profit involved.

 

[fishgutzy]

That is not the sort of thing an insurance company should be doing. That is practicing medicine without being the patients physician.

If we keep going down this rabbit hole, things are going to turn nasty, but that's probably what it will take in this country to fix it. Nobody wants to do the right thing until their fundamentally forced to as long as there's profit involved.

sadly, liberals think the government would do exactly the same thing to save cost. It already does with Medicare. The generic bkood thinner almost killed my mother after being in it for nearly 5 decades. She had to use the new drug. But every month she has to go through the hassle of getting additional medical authorisation. And Medicare caps how much they will pay for that drug in one year.
Medicare wants senior to die earlier and save money.

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[noway2]

@fishgutzy honestky, I don't know what the answer is, but I look at how the US is handling healthcare by processing it through insurance and largely foisting it onto employers with a large segment on the government system and see that it is not working. The US is unique in this regard compared to just about every other place in the world. Our system is a left over from WW2 wage restrictions - yes government interference about 100 years ago, so what's our excuse for clinging to this nonfunctional system today?

 

[fishgutzy]

@fishgutzy honestky, I don't know what the answer is, but I look at how the US is handling healthcare by processing it through insurance and largely foisting it onto employers with a large segment on the government system and see that it is not working. The US is unique in this regard compared to just about every other place in the world. Our system is a left over from WW2 wage restrictions - yes government interference about 100 years ago, so what's our excuse for clinging to this nonfunctional system today?

The answer if free market medical. Transparent pricing.
Catastrophic insurance for serious injuries and chronic conditions.
Drugs are so expensive because somebody else pays.

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[tanstaafl72555]

Nope. Read the beginning of my post. I wouldn't dime someone out just for keeping more of the paycheck they earn.

He should get screwed because he helped do it to the rest of us. No other reason.

Other than because he's just a stinking hypocrite, but most of the Redistribute the Wealth types only want to redistribute your wealth, not theirs. Their motto is, "What's mine is mine. What's yours is ours."

Sometimes karma needs a little help.

I understand. I really do.

You have to realize you are dealing with a person (me) who believes taxation is theft. Therefore forcing you to drink poison because you supported others doing it is unwise imo, as giving someone the ability to force you to drink in the first place is the real problem, not your duplicity about it in the first place. (for sake of illustation only.... I don't think you advocated someone drinking poison )

 

[noway2]

I understand. I really do.

You have to realize you are dealing with a person (me) who believes taxation is theft. Therefore forcing you to drink poison because you supported others doing it is unwise imo, as giving someone the ability to force you to drink in the first place is the real problem, not your duplicity about it in the first place. (for sake of illustation only.... I don't think you advocated someone drinking poison )

Had to go back and reread some posts to follow but....

I don't see hiding income by working cash under the table or whatever as being any worse than the donor class bribing the politicians to make their non labor, i.e. investment income subject to much lower rates.

 

[Sleipnir]

I am more than willing to turn an obama lover into the IRS - any direction on how to proceeedbis appreciated.

https://law.freeadvice.com/tax_law/income_tax_law/report_filing_tax_returns.htm

 

[BigWaylon]

We have a high deductible plan (courtesy of AT&T), but preventive care is no charge (including no co-pay). The hope is to keep you healthy, not let you get in bad shape and have to fix you. So, your annual checkups are $0, including the extra stuff for women. Works out fairly decent.

I opted for the lowest cost ($50/mo) plan which gives me the highest out of pocket maximum. We get credits for answering a questionnaire ($100 for each of us) and going to have a wellness checkup ($200/ea) that's just a blood draw and BP check. Basically covers my $600 for the year. Works well as long as nobody gets sick.

 

[turkeydance]

well.
we're the opposite.
we have private insurance.
since my in-laws were in the
medical profession, they impressed
upon my wife the absolute need for
the best available coverage and they
were absolutely correct in our situation.
of course, if you and yours will always be healthy,
this is a "fail". over time, this will cost as much as a new house.
since we could not afford a house which costs $2,330,330, we paid premiums.
(that's the possible out-of-pocket figure i remember)
ECMO, reconstructive, and all the rest.
i don't sell insurance.
when you're young,
get you some.

 

[fishgutzy]

We have a high deductible plan (courtesy of AT&T), but preventive care is no charge (including no co-pay). The hope is to keep you healthy, not let you get in bad shape and have to fix you. So, your annual checkups are $0, including the extra stuff for women. Works out fairly decent.

I opted for the lowest cost ($50/mo) plan which gives me the highest out of pocket maximum. We get credits for answering a questionnaire ($100 for each of us) and going to have a wellness checkup ($200/ea) that's just a blood draw and BP check. Basically covers my $600 for the year. Works well as long as nobody gets sick.

The problem is that the rules defining a wellness check mean you can't talk about any condition that is under ongoing treatment. Nor can you tell you doctor that you have had a cough for 5 days. You have to make a separate appointment for those.
That wellness screening colonoscopy is only "free" if they don't find a single polyp. Once they find a single polyp, you are on the hook for the entire cost. So you best not have that done in a hospital because they cost twice as much as at a gastro clinic. I know from personal experience. We checked everything ahead of time just in case. I got hit with a bill for nearly $1000 for a "free" screening colonoscopy.

 

[noway2]

when you're young,
get you some.

This is one of the biggests problem with the current system: you don't pay into it while you're young for care later. Instead it's treated like term life and priced accordingly.