[ECHOES]

I have worked in the insurance field for many years. I don't make policy or sell; my work is in claims processing.

I see how my own insurance has changed over the years. I'm disappointed with my current insurance coverage and I wonder if I just have a lousy policy or if this is the trend. I can't afford the MRI my doctor suggested because of the cost. This isn't even insurance, to me.

I hope that an overhaul of this industry is coming, and I would be glad to lose my job so we could all get the health care we need.

[bebop]

I have medicare but I also got one of the advantage companies as well. it pays much more than straight medicare. alot more benefits. thank goodness.

I too believe we need better insurance in this country. it really stinks.

[Brian37]

pay 882.00 out of my pocket each month to Anthem Blue Cross for wife, son , and myself

first 3000.00 is out of pocket, no matter what, pills, doctors..etc...

after 3K everything is paid (except monthly premium!)

[Monty_girl]

I'm unable to afford or get insurance. My husbands work insurance will not cover me and private insurance just for me is between $800- $1000 a month. I'm on disability but I'm not able to recieve medicaid because I'm married with a spouse that works. My husband is a delivery driver for a parts house. He doesn't make much money. So I have no insurance and because of that I've not been to the doctor to have my heart or psych meds refilled in almost 2 years. I just keep my fingers crossed and hope I dont get sick.

[bebop]

monty when will you be eligible for your medicare hon?

[jbug]

I am on medicare also because I'm on disability. But I have an HMO instead of medicare paying for my stuff because it is better insurance plus I get a bunch of other things like contacts, hearing aids should I ever need them, free medicine like cough drops and stuff like that and some other things also. I also have medicaid to pay for what the HMO doesn't pay.

I remember the days of having no insurance or having medicaid as my insurance. Here in Arkansas you can only go to the doctor 12 a year on medicaid and with my low immune system I go to the doctor a lot more than 12xs a year so ended up with a huge bill. I ended up declaring bankruptcy as soon as I got my disability.

Jan

[Junerain]

I am on medicare until I become a schoolteacher and get private insurance, then I am going to interview a lot of private psychiatrists until I find the perfect match, perfect care for me...just go to a clinic now...

[Monty_girl]

Bebop, I won't be able to get medicare until I'm 60 yrs old. Which is 24 yrs from now.

[jbug]

Monty aren't you on disability though? Isn't it SSI or SSDI? If it is then you can get Medicare.

Jan

[pachyderm]

The U.S. federal government may reduce or eliminate support for Medicare Advantage programs, since they cost the gov't more than regular Medicare.

[Perna]

Insurance is based on the cost of whatever group you are in, the bigger and less "sick" the group, the better the insurance because insurance costs are mostly "clerical"/people costs (to pay Echoes :-) for all the claims processing.

It's better to have high deductibles and pay out-of-pocket and only have good hospital insurance if you are basically healthy and in a "bad" group (I'm on State-mandated insurance; I'm obese so independent insurers won't cover me and I'm too young for Medicare but my state requires any insurers that operate in my State to have a plan for people like me/the self-employed, etc. but it's very expensive). Like my husband points out, "I can pay for a broken arm (a few thousand) but not a heart transplant" (or other major hospital stay that could be hundreds of thousands of dollars). So for me we have a huge deductible (I just paid $400 out-of-pocket for my asthma meds) but good hospitalization. I have a high copay too as that cuts down on overall costs. People who want to pay a little to their doctor ($10 or no copays) and get discounted or free prescriptions; that has to come from somewhere else in the plan, either higher premiums per month or lousier care.

It's like the cost of home/apartment; you want to pay as much as you can to get the best place you can afford. There's no one else to pay; the "Government" doesn't exist/have/make any money, that's just our taxes! If one doesn't pay taxes, someone else is paying so the "average" of that (which would be Government programs) is not going to be very good.

[ECHOES]

Perna that is the old definition of insurance. They no longer spread the risk that way, they replaced that with these high deductible plans.
My "plan" isn't even called an insurance plan, just a "plan". It is with a major insurance company.

I disagree with the high deductible idea sold to us as reasonable.
Having quality insurance gave me peace of mind.
Then with no warning, it gets changed from an HMO to a high decuctible plan. Suddenly I had the equivalent of a $3000 pay cut. I know, only if I use it.
But I have to have it on hand, so it is the same as a pay cut.
Maybe $3000 for a deductible doesn't sound like much to some, but when it's more than 10% of your income, it is a lot of money.
We were told what a great thing this is, to pay huge out of pocket expenses, to be punished if we become ill as if it is our fault. Meanwhile, the insurance companies continue to make money with this... interesting.
I would rather pay for peace of mind.

I fear this is only the beginning unless the new administration actually does something to restructure the insurance industry and turn it back into Insurance and Health Care instead of just a cold contract called a "plan" with the accompanying Health Savings Account that the insurance company has created banks for handling.

These plans, along with the frivolous lawsuits, are going to diminish our health care as fewer people being able to afford to get the services they need will create (is creating) a ripple effect. The providers of services are making cuts in personnel and services. Down the road when we need something done, those services may not be readily available.

Sorry for the rant.
I just hope they do something soon. We all need good healthcare!

[Perna]

Didn't you get a choice of which plan? My last company I worked with (3 years ago) had 3 "choices". Odd an insurance company wouldn't give their employees options!

I understand the wanting to pay more for piece of mind I'm that way too. Fortunately I have my husband for peace of mind, knowing if I get sick he'll make sure I'm taken care of/knows how to take care of me well.

Can you save a bit of extra money each month in case you do get sick (until you have at least a $3,000 cushion)? That's what I would try to do. I've only had an HMO once, back in the 1970's/1980's when they were a "new" idea and had to compete with the old plans so were really good AND cheap. But back then (before the HMO though) when I was in therapy, it was ALL covered and I was paying like $12 a session twice a week, for the entire year/as much as I needed. Those were the days! Don't think we'll see that again. I saved my budget books from then; didn't have much income and it was a struggle but looks so good now. . .

[ECHOES]

Hi Perna Thanks for your reply

No, there was no choice. Up until 2 years ago we did have a choice, then they went to the High Deductible plan. I don't have $250 a month to put away. I don't make enough to put anything away. I already pay $480 a month for my therapy out of pocket because the previous insurance covered only short term behavioral therapy. I have tried to adjut my lifestyle to be able to put away the $250 a month for a few years but there is nowhere to cut. Frustrating.

One good thing is that my T is a network provider with this 'insurance' company so we can file a few claims to have some $$ be applied to my deductible. But we can't file 2/week or the 'insurance' company will get nosy and I won't let her give them any information. I know that sounds paranoid, but to me it sounds like protecting my privacy. So she thinks maybe 10 visits can be submitted and that will help some. I really need to get an MRI on my knee that I hurt in Sept but haven't had the money for. The only thing I can cut that isn't rent/utilities/car payment/car ins is therapy and I'm not willing to do that.. I'll limp into therapy instead. lol

Ironically, I work in the insurance field, have for 25 years. I currently superve a claims department. We process claims for people with Medicare Supplement plans.

[Perna]

I was lucky because my last job I took JUST to pay for my therapy out of pocket (even though my insurance was good) and to get insurance initially for my husband who was working as an independent consultant at the time and insuring him separately was much more expensive than his being on my good plan (plus, I was only working part-time before that job so didn't have insurance either so we were buying two state-mandated plans that covered little and cost an arm and a leg).

I meant just save a little each month ($50) so when you needed something like an xray of your knee you'd be able to pay for that and/or would gradually save up some money as a health care cushion?

We also used my job/income to buy the maximum 401K investment (15% of my salary) so I didn't have much take-home pay but there was maybe $500 "extra" each month after my 2x a week therapy was paid for (to go toward my credit card expenses/books :-) After I terminated therapy in 2005, there was no need to keep my job :-) but I did for an extra month or two so we'd have all that "extra" former therapy money to pay down bills, etc. But by then they'd moved me to part-time (but let me keep my insurance) and since then, they just recently eliminated that job (and had to lay off my full-time replacement).

The insurance at that time was a life saver; when my appendix burst in 2003, the normally $3,000 or so fully paid, one-week operation/illness became a 5-month, $30,000-$40,000, several hospital stays, sepsis/infection mess that was trying to kill me but I think we only paid $2,000-$3,000 of that over that year; I had 7-8 CT scans, MRI, doctor visits, etc.

We were down in Dunedin, Florida (near you?) for a week; my father-in-law died and my husband was executor and I got appendicitis then but didn't know what it was, we get back and that night my appendix burst. My poor husband, loses his father and then his beloved :-) wife is critically ill. . .

[Perna]

A lot of the problem nowadays I think is the economy and companies that offer insurance aren't able to pay as much for the employees as they might have before.

I joined my company in 1998 and the company paid like half the premium, etc. but then lost a lot of business so when the insurance got renegotiated upping premiums/lowering what's offered because there were fewer employees so a greater chance that a greater percentage would make claims in any one year and the raised prices in addition to the company not having as much business meant they didn't pick up as large a percentage of the tab so it gets passed on to the employee as higher premiums for less coverage. The last year I was there, there were the 3 choices and they were horrible, especially for the poor lower ranking engineers who were insuring their family; one guy's family coverage was like a quarter or third of his salary and was arranged so he had to insure himself if he wanted to insure his kids, etc., couldn't get cheaper just for them since he was the employee. Was just structured at a disadvantage. I can't imagine what it is now that they've moved and downsized even more drastically. When I started there, there were like 180 employees and now I think there are probably 20-25.

I was fortunate and was working just for the $800 a month to pay my therapist out-of-pocket, the 401K plan, the best insurance they offered no matter what cost for my other possible health needs (my husband, meanwhile, had gotten a job with health insurance so I only had to insure myself) and they knew I didn't "need" to work so the owner/bosses had no hold over me. That was good for them too because I'd tell them what they didn't want to hear but needed to, had no issues/reasons to try to "get" at them since I didn't need them/had no bones to pick, and wasn't afraid of getting fired or anything, so they could trust what I had to say :-)

[LoneEagle]

Originally Posted by ECHOES

I have worked in the insurance field for many years. I don't make policy or sell; my work is in claims processing.

I see how my own insurance has changed over the years. I'm disappointed with my current insurance coverage and I wonder if I just have a lousy policy or if this is the trend. I can't afford the MRI my doctor suggested because of the cost. This isn't even insurance, to me.

I hope that an overhaul of this industry is coming, and I would be glad to lose my job so we could all get the health care we need.

I would like to know why the rates go up but the coverage goes down

[ECHOES]

Like anything, it's a way to control expenses.

What I don't like is having no choices.
My $3k deductible is too much to manage. To me, I don't have insurance.

[Lexi232]

I was recently on my parents Insurance which was PPO.
They pretty much paid for everything.. We just had to get refusals. And of course there was the copay, and the monthly charges to have the insurance.
When in the hospital I had some sort of a hospital medicaid..
Currently I'm uninsured, but I'm working on getting Medicaid.. It just kinda suxs here in this state, because to get medicaid I HAVE to have SSI. And I don't really need SSI... I just need Medicaid.
And that is on hold until I can get copies of my personal documents.

I do remember when we were on PPO they started to refuse to pay for certain medicine, and they refused to pay for things that earlier in my life they would pay for.

((A few posts back I said I was going to sleep.. lol and Yet i find myself still linger around. lol))

[Slothrop]

What results are folks having getting insurance with major pre-existing conditions?

In my family there is bipolar II and inflammatory bowel disease and possibly obesity (depends on the definition). At least we don't smoke!!

Just the maintenance of our conditions costs ~$2000 a month! Then there is the very elevated risk of hospitalization.

I am wondering if we will even be able to buy a family policy--and if so, pretty scared of what the cost would be!!