[bamapsych]

I'm surprised that so many ins companies only pay for like 12 visits per year. That's awful. I have BCBS and they don't limit my visits. I go see a LPC once per week. She charges $100, but since she is a BCBS provider, she has to accept the $65 that BCBS allows her to charge. After I met my deductible, BCBS pays 80% of the $65 and I pay the other 20% which is $13. That's cheaper than the intern I was seeing that didn't/couldn't accept insurance. She was charging $20. The place I go has many therapists and many of them do the sliding scale which is a good option for people with little or no income. Also, many churches in my area give free or almost free therapy.

[beauflow]

if i may ask- how much is your deductible?

[bamapsych]

$750 but im single. Its $1500 if you have a family plan

[Perna]

Actually, you pay more than you were with the $20 therapist. If you see your therapist 50 weeks a year (2 off for "vacation" :-) then the one charging you $20 got $1,000 of your money ($20 x 50 weeks). But if you are paying $750 deductible; at $65 that is gone in 12 weeks, leaving you to pay 38 more weeks at $13 which comes to $494 so your total is $1244 under that plan ($750 + $494). And, you did not mention your premium price, what comes out of your paycheck each month; you have to add that in too.

Generally, a "middleman" cannot be cheaper than one-on-one. Insurance is "in case", so a constant use will always cost more; that's why it is rarely cost effective to buy dental, eye, or other "extra" insurance (which mental health is often too, which is why many companies don't have it or limit it) because not everyone needs it so there is not a big enough group of people paying but not using to cover those using. When we use insurance at companies, especially small companies, the next time the company goes to renegotiate their contract, the price is higher because the cost average was higher. I worked for a company with 30 or so people and the premium would often rise, per employee, a couple hundred dollars a year because someone had had a major emergency costing the "fund" a lot of money. It's based on the statistics and actual use patterns for whatever group you are in. They have to pay the employees, the paper pushers and that adds to the "actual" cost.

[beauflow]

Originally Posted by Perna

Actually, you pay more than you were with the $20 therapist. If you see your therapist 50 weeks a year (2 off for "vacation" :-) then the one charging you $20 got $1,000 of your money ($20 x 50 weeks). But if you are paying $750 deductible; at $65 that is gone in 12 weeks, leaving you to pay 38 more weeks at $13 which comes to $494 so your total is $1244 under that plan ($750 + $494). And, you did not mention your premium price, what comes out of your paycheck each month; you have to add that in too.

Generally, a "middleman" cannot be cheaper than one-on-one. Insurance is "in case", so a constant use will always cost more; that's why it is rarely cost effective to buy dental, eye, or other "extra" insurance (which mental health is often too, which is why many companies don't have it or limit it) because not everyone needs it so there is not a big enough group of people paying but not using to cover those using. When we use insurance at companies, especially small companies, the next time the company goes to renegotiate their contract, the price is higher because the cost average was higher. I worked for a company with 30 or so people and the premium would often rise, per employee, a couple hundred dollars a year because someone had had a major emergency costing the "fund" a lot of money. It's based on the statistics and actual use patterns for whatever group you are in. They have to pay the employees, the paper pushers and that adds to the "actual" cost.

thanks Perna.

It all sucks (lol?) but try to

[Perna]

I have the highest deductible I can get so the monthly premiums are less. I can afford a "broken arm" just not heart surgery Mostly all my insurance is good for is getting the insurance rate for paying doctors rather than the rate one without insurance would have to pay (and, most doctors won't see you if you don't have insurance of some sort). It's certainly important to have insurance, because big, bad things happen, but it is rarely a "benefit". It is often much more cost effective to pay out-of-pocket than to use insurance, even when you have insurance.

A lot of people don't understand what insurance is and what it is for and don't understand the arithmetic of it. I just think "life insurance" and that sort of gets me in the right frame of mind; oh, if I die, then someone can afford to bury me Health insurance isn't that much different; it's not meant for the day-to-day stuff like regular doctor visits and common prescriptions, but for the hurricanes, tsunamis, volcano eruptions, invasions from outer space, etc.

The average premium in the United States is $183 a month http://news.ehealthinsurance.com/pr/...ce-218305.aspx (mine is like twice that as I am not employed and too young for Medicare) and that comes to $2,196 a year (so even without any deductible one is already paying more than twice what a $20/session therapist costs). My deductible is $2600 a year so my premiums won't be $500+ a month, only $360 or so.

It's very important to do the premium x 12 with various deductibles to see what is less. I "usually" only see the doctor 4 times a year @ $85 a visit plus another several hundred in blood tests, etc. So, I end up paying my monthly premiums x 12 and getting no "discount" due to my deductible (in other words, the $65 is "mine", not the $13 with BCBS paying 80%). But, $85 x 4 is much less than $200 x 12 (the difference between a premium of $350 versus $550 if I elect a lower deductible).

Say I pay $350 a month in premium, that's $4,200 a year plus I'm responsible for the first $2600 of expenses, so, conceivably I could pay $6,800 a year (and then 20% of anything after that).

If I pay $550 a month in premium, that's $6600 a year, so I would want to be offered a $200 deductible or I'd be paying more with a lower deductible plan. But, deductibles with my plan start at $500. My "usual" medical expenses each year are only $85 x 4 = $340 + maybe $1,000 in testing. So, I actually pay $4,200 for premium and $1,340 to the doctor (deductible) for a total of $5,540 a year in medical. Even if I got 100% deducted with a lower deductible plan, I would still have to pay $6600 in premium so that would lose me $1060!

Many people go for the seemingly lowest cost plan but don't do the math for their particular needs and that can be costly.

[beauflow]

Thanks Perna-- for both the information and the funnys.

yeah I am one that gets some what confused with what, is what... I get why Insurance is important though- just like you say with the Uh Ohs in life... I want to renters insurance in case of uh ohs for some reason I worry more about that, but just cant right now and realistically I guess Health insurance is more important. Life insurance I should had listened to an older friend and should had started that when I was 20, I am 25 now, and just blah..

I get "low benefit insurance" through my employer which I kept this year but I really need to think if getting some where else would be better (i pay 75 a month, then like if something happens I pay thousands of dollars which I am experiencing due to I had to have back surgery due a big Uh Oh with falling multiple times on ice-- on the plus side One medical bill saw that the insurance paid them nothing and took the 4500 bill and made it 500 for me to pay; a few others took my situation in to play too a few others have not- and i am fearing they may be taking me to collections even though I have been paying something every month of what I can to them all- I have 2 of the 5 paid off and hopefully by the end of the year 3 of the 5- leaving me 2)..On the down side i am only making a few buck over minimal wage. So 350 a month is a little unreal for me to pay a month for insurance. On another down side with my current low benefit insurance is that they will only pay 250 dollars A YEAR for office visits-- So I only go in for chest colds and my birth control- after 250 has been used, I am "exhausted of my funds" and have to pay all out of pocket with also paying them the 75 per a month- That actually happened the first year that I had them due to I was also seeing back doctors and found I was paying for my office visits for regular doctor at the end of the year. They (insurance of mine) also only have a like I believe 300 limit for prescriptions (which excludes my inhaler oddly enough); which I have already exhausted with the meds that I tried through the county and some meds for a chest cold at the beginning of the year... I hope I am understanding that right as well-- I go to Target which has the 5 dollar for generics if there are those, but they still charge my insurance the difference, which one pill for thirty days was like 300 but I got generic, and I had to get a fancy inhaler in Feb that was 250 (which was not generic), but I paid my co-pay of my insurance.

Even though CO is one state that says that Mental Health should be Covered as *Good/Well/Equal* to as Physical Health, the Insurance that I have, actually the last two years they have had "graces from the government" they don't even meet the standard for Physical per their letters that they give me. The County people agreed I was reading that right, of them not covering Therapy when I went for my short term therapy with the County.. which did not go well-- and after that, Now I want a specific therapist (PTSD specialist to be honest) if I do therapy again due to I think that dx there is what causes more problems than the Bipolar2 (which I debate now but do not take it out of the equation completely; for it could be, but i have to wonder now- i could just be an emotional person that has trouble adjusting to the present due to my past). So I keep wondering, if I got other insurance in CO (one that is not trying to pull out of CO as Aetna is and SRC is part of them which is what I have) and does not get "grace periods of getting their act together to meet state standards"... perhaps maybe, I could afford a PTSD therapist...

I keep hoping by next year I will have my back surgery people paid off- If then, I could have a little more play money for insurance per a month. OR if I found a therapist that would work with me on a reasonable sliding scale that works for both of us, that would work too...

Until then, I keep my low benefit insurance that is not full insurance but it is something, and keep reading and trying to find help with articles, books, and life experiences i guess...

sorry for babbling--

[Perna]

That's hard, Beauflow, when a lot of things happen at once. That's like multiple car accidents or something, where you have extra expenses and have to get new transportation and your insurance goes up and just a mess to straighten out, all in the middle of "life" when other things are happening too.

Last year was a little like that for me; Christmas Eve 2010 I fell bad and had to go to the ER and then to the orthopedist for my knee and back to the doctor to get stitches out (broke my nose and got a bad cut needing stitches, too), but then I had a blood pressure problem/false alarm late that summer and went to the ER in an ambulance (that gets expensive; you have to pay if they don't keep you) and a couple months later, right at new years this year, had to go to the ER again in an ambulance, my asthma complicated by bronchitis so I couldn't breathe. For the first time in a really long time, we were able to have enough health expenses (from me) to put on our income taxes!

[beauflow]

that is too much Perna!! Meaning like you are saying- things toppling down one right after another- It is hard to get back up.

Originally Posted by Perna

For the first time in a really long time, we were able to have enough health expenses (from me) to put on our income taxes!

Yep yep on that- that I guess is a plus side of paying medical out of pocket.
That is one thing there that I keep track of and gather- I take all of my stuff and see what I can put on my taxes from health care to see if I can get anything back. Last year it was a little, so I just keep on with it.

[googley]

Perna,
Your math only works if an individual is not seeing a doctor or pdoc for anything else. If the person is on medication, or has chronic illness, or needs to see their Pdoc monthly these cost go into the deductible and then are cheaper with the insurance depending on what the person needs in regards to their other health care. Needing to see specialists for other conditions also has to be taken into account. When I had student insurance (that honestly isn't that expensive, and had limits) the benefit of not having to pay $300/ mo for a medication until I hit the benefit cap (don't get me started on this). So there are times where insurance is cheaper.

[Amazonmom]

You aren't supposed to come out ahead with insurance. You are supposed to be covered for the big things you can't pay for on your own. I don't understand why people with deductibles tend not to use their insurance. How are you ever going to meet that deductible if you never use the insurance? Oh and its a huge nono to buy meds for cash outside of the insurance plan if the pharmacy knows you have med coverage. If you meet a coverage limit its different.

[googley]

Originally Posted by Amazonmom

You aren't supposed to come out ahead with insurance. You are supposed to be covered for the big things you can't pay for on your own. I don't understand why people with deductibles tend not to use their insurance. How are you ever going to meet that deductible if you never use the insurance? Oh and its a huge nono to buy meds for cash outside of the insurance plan if the pharmacy knows you have med coverage. If you meet a coverage limit its different.

Oh, I was totally hitting the insurance ceiling. In undergrad was $1,000 limit for all meds. When you have one med that is $300/mo you reach that really quickly. In graduate school the limit was $500/yr for psych meds (though some really high limit for all other meds). Hit that really quickly even though my meds had gone generic.

[Perna]

I am just pointing out that insurance costs is a monthly premium x 12 + deductible, + 20% of anything after deductible. A lot of people only think about the 20% of anything after the deductible and don't see what they are really paying.

Everyone needs insurance because it is for all medical, not just mental health. But that does not make things less, because one's deductible gets used up sooner, that just means you are having a bad run and paying 20% more than your premium covers (and probably increasing your premium costs for future years, like when you use automobile insurance).

One always uses insurance with doctors (one has to, doctor's usually won't treat you without) but sometimes it is more cost effective to have a huge deductible for a smaller monthly premium and, when dealing with therapists and other behavioral health care-givers, it may not be a good idea to use insurance. Everyone's case is different, but I would not trade a good $20 out of pocket therapist for a $65 insurance therapist and think the insurance therapist was less expensive; in my case it would not be.

[bamapsych]

Originally Posted by Perna

Everyone's case is different, but I would not trade a good $20 out of pocket therapist for a $65 insurance therapist and think the insurance therapist was less expensive; in my case it would not be.

The $20 out of pocket exT was just an intern (no credentials or license). The $65 insurance current T is an LPC, and I was shocked at the difference that experience makes. To me it was well worth the extra couple hundred bucks per year to get the more experience/credentials... Just my own opinion though. And I think I may have failed to point that out in the original post

[Perna]

I assumed that was the case, bamapsych, you didn't forget to point out that he was an intern. That's why I qualified him with "good" $20 therapist might be preferable to a more expensive insurance one. I've always tried to treat my therapy as something like college and see if I could pay for it rather than use up my health care which might be more costly, later, if it gets used often.

One thing is sure, the insurance company isn't going to "lose" money, since it's a business, not a charity. If it gives me X coverage for Y amount; if I use it more, it's going to charge me more. That's why automobile insurance can go up when you get in an accident. Everyone wants their pre-existing conditions covered but the prices will have to go way up to do that; they're a business for "in case" you get sick, not for using day-to-day on chronic stuff. They can be used that way but then prices rise.

[happiedasiy]

Originally Posted by Perna

That's hard, Beauflow, when a lot of things happen at once. That's like multiple car accidents or something, where you have extra expenses and have to get new transportation and your insurance goes up and just a mess to straighten out, all in the middle of "life" when other things are happening too.

Last year was a little like that for me; Christmas Eve 2010 I fell bad and had to go to the ER and then to the orthopedist for my knee and back to the doctor to get stitches out (broke my nose and got a bad cut needing stitches, too), but then I had a blood pressure problem/false alarm late that summer and went to the ER in an ambulance (that gets expensive; you have to pay if they don't keep you) and a couple months later, right at new years this year, had to go to the ER again in an ambulance, my asthma complicated by bronchitis so I couldn't breathe. For the first time in a really long time, we were able to have enough health expenses (from me) to put on our income taxes!

Thanks for adding putting it on icome tax forms! Most people don't know what they can/ can't do.

[Perna]

Great point, Happiedasiy! I remember when I use to go to therapy from work and put the mileage on there too. http://www.irs.gov/taxtopics/tc502.html