Who do you have your health insurance with?
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Health Insurance
- Thread starter FriendofSpurgeon
- Start date
Bible Believing Bill
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I have a HMO form BCBS of IL, and my wife has this insurance as primary and Medicare as a secondary payer. The Blue Cross plan pays almost everything except a $20 copay for primary care visits, $30 for specialist visits, $100 for ER visits, and $500 for inpatient hospital stays.
Me and the kids pay these co-payments, but Medicare ends up paying them for my wife. The biggest hassle is that the Dr. requires she make her copay even though Medicare will end up paying it, so we end up with a credit and get a check a couple of times a year.
Bill
Me and the kids pay these co-payments, but Medicare ends up paying them for my wife. The biggest hassle is that the Dr. requires she make her copay even though Medicare will end up paying it, so we end up with a credit and get a check a couple of times a year.
Bill
BigBossman
Active Member
I have health insurance through my employer. I'm beginning to wonder if its a waste of money though. I went to the doctor's office because I had a middle ear infection. I asked the office clerk if my insurance is accepted through them. They said it was. Then they schedule my appointment.
I get seen by the doctor & treated. Almost seven months later I get a bill for the entire amount. When I called my insurance they told me that my plan has that office on it, but the doctor that treated me wasn't. That is so stupid.
If I got insurance, it shouldn't matter where I go or who I see. When the time comes to renew it, I think I am going to drop my insurance & take my chances.
I get seen by the doctor & treated. Almost seven months later I get a bill for the entire amount. When I called my insurance they told me that my plan has that office on it, but the doctor that treated me wasn't. That is so stupid.
If I got insurance, it shouldn't matter where I go or who I see. When the time comes to renew it, I think I am going to drop my insurance & take my chances.
I am self employed (being a Pastor) and a diabetic - bad combination. The only health insurance I could find wanted about half my salary!! But I have "medical coverage" through Christian Healthcare Ministries http://www.chministries.org/.
I'm real happy with them - great organization.
I'm real happy with them - great organization.
BigBossman said:
I'm going to be as blunt as possible. If you do that--you are stupid. First thing, you need to check with your INSURANCE company, not the doctor's office. Ensure that the DOCTOR is covered by your insurance.
If you don't have insurance, you'll have to pay way more than you would with insurance. My wife recently had lab tests done with a sticker price of $80. The insurance discounted the price to around $10. My son recently had surgery, and the anethesiologist's charge would have been around $900 more if we had no insurance, because of the discount. Note--this is the discount, applied before you or the plan pays anything.
I Am Blessed 24
Active Member
We have Blue Cross & Blue Shield where DH works, and we also have TriCare (military) because he is retired military.
Blue Cross Blue Shield (a "private pay" plan offered here in AL). Pretty decent stuff. The deductible is $2,000, which is kinda rough. And as with any insurance company--you have a surgery/procedure, get ready for denial...one must just be diligent and a little bit of a bulldog, and that works out OK.
Worst insurance I ever owned: Guidestone (So. Baptist). Not bad retirement...but the insurance was horrific. Their correspondence was painfully slow. They didn't return calls. They didn't cover any vaccinations, well-child checkups, and anything resembling preventive medicine. They would give you all of two weeks before raising your rates. And then they would send you slick brochures and claim they were a "ministry." Hogwash. They were a business...and not a very good one at that. And on top of all that...when I switched to a real health-insurance plan, my rates at the time went down $300/month at the time (all this, and better coverage, too!).
(I've heard they've improved...But they have miles to go before theyr'e even average, so we'll see)
Yes...I still use Guidestone for retirement, and they're doing fine there (at least, as fine as any other retirement is doing in this economic free-fall). But their insurance was an unmitigated disaster.
Worst insurance I ever owned: Guidestone (So. Baptist). Not bad retirement...but the insurance was horrific. Their correspondence was painfully slow. They didn't return calls. They didn't cover any vaccinations, well-child checkups, and anything resembling preventive medicine. They would give you all of two weeks before raising your rates. And then they would send you slick brochures and claim they were a "ministry." Hogwash. They were a business...and not a very good one at that. And on top of all that...when I switched to a real health-insurance plan, my rates at the time went down $300/month at the time (all this, and better coverage, too!).
(I've heard they've improved...But they have miles to go before theyr'e even average, so we'll see)
Yes...I still use Guidestone for retirement, and they're doing fine there (at least, as fine as any other retirement is doing in this economic free-fall). But their insurance was an unmitigated disaster.
StefanM said:
See, this ticks me off a bit. We're looking to change our insurance again (we do it yearly around here to keep costs down) and we may have a choice to either do a high deductable regular insurance or else do just major medical and they'll put the $800 a month difference into a health savings account for us to use. The issue I have with that is that the doctor can bill the insurance company $300 for a visit and only get $120. You tell them you will pay $120 right now and they don't want it - they want the full $300. Why??? It makes no sense! They should also give a discount for cash patients which we would be if we had the HSA. ARG!!!
Well, we have our insurance meeting at 2:15 so we'll see what happens then.
I have Anthen Blue Cross Blue Shield through my work. I work at a hospital so we get extra benefits from working there.
If I need anything done that the hospital can do, X-rays, CT scan, blood work, any procedure, as long as I go through my Doctor to get the appointment ($15 co pay) then I get the services for free. My insurance pays for 80% of the bill, when I get the other 20% I take the bill to my benefits manager and she will submit it and the hospital will pay for it.
Last year I was in the hospital because my left side went numb and they thought it might be cardio so they wanted to run some tests.. Two days in and it cost me a total of $268. The ER doctors and one other doctor that saw me didn't work FOR the hospital they worked WITH the hospital so the hospital couldn't cover their bill.
Not bad for a two day stay and every test known to man... I really mean every test too, it was 'fun' for a while because I work there and have seen all these people and wondered sometimes what they did.. and now I am seeing for myself, but after a day of test after test it got old quick...
If I need anything done that the hospital can do, X-rays, CT scan, blood work, any procedure, as long as I go through my Doctor to get the appointment ($15 co pay) then I get the services for free. My insurance pays for 80% of the bill, when I get the other 20% I take the bill to my benefits manager and she will submit it and the hospital will pay for it.
Last year I was in the hospital because my left side went numb and they thought it might be cardio so they wanted to run some tests.. Two days in and it cost me a total of $268. The ER doctors and one other doctor that saw me didn't work FOR the hospital they worked WITH the hospital so the hospital couldn't cover their bill.
Not bad for a two day stay and every test known to man... I really mean every test too, it was 'fun' for a while because I work there and have seen all these people and wondered sometimes what they did.. and now I am seeing for myself, but after a day of test after test it got old quick...
JamieinNH said:
Anthem is what we're looking at with the high co-pay.
But when I worked for a hospital, it was awesome. We were self-insured so anything we needed done, we did in house and we didn't pay a penny. That was one of the best insurances I had. Now it's just so costly that we need to figure out another solution. Certainly gone are the days that I could have the doctor come to the house when I was in high school and have him diagnose bronchitis - for $35.
Hey - I'm not even that old! :laugh:
Tom Bryant
Well-Known Member
I have BC/BS of FL. The church picks up staff insurance but sets an upward limit and we have to pay if it goes above. I will probably raise my deductible rather than spend more out of pocket.
We also have a Medical Spending account that takes whatever amount stipulated (like $2,500) out pre-tax of my salary. I then can use that for any out of pocket expenses for meds and stuff the insurance won't pay. The big issue is that you have to show that you have spent that amount or more. If not you had liable for all the taxes and FICA stuff. This is not something shady, it's perfectly legal for all businesses.
We also have a Medical Spending account that takes whatever amount stipulated (like $2,500) out pre-tax of my salary. I then can use that for any out of pocket expenses for meds and stuff the insurance won't pay. The big issue is that you have to show that you have spent that amount or more. If not you had liable for all the taxes and FICA stuff. This is not something shady, it's perfectly legal for all businesses.
annsni said:
Unless you are in Maryland (don't ask, it's just the way it is -- just like not being able to pump your own gas in New Jersey), medical providers have the freedom to charge different amounts for the same procedures. This differential is normally based off volume discounting. So since ABC health plan has more members in your area compared to XYZ health plan, the hospital provides a better discount to ABC health plan. [OK, that's a little over-simplified, but you get the idea.] And if you have no coverage, then you're really up the creek. At least with the HDHP, you get the benefit of Anthem's discounts -- even though a large part of the initial expenses will come from you.
annsni said:Anthem is what we're looking at with the high co-pay.
But when I worked for a hospital, it was awesome. We were self-insured so anything we needed done, we did in house and we didn't pay a penny. That was one of the best insurances I had. Now it's just so costly that we need to figure out another solution. Certainly gone are the days that I could have the doctor come to the house when I was in high school and have him diagnose bronchitis - for $35.
Yes, working at the hospital sure has it's perks.. I have often thought about going back home since I have started a new life, but this job and my church has kept me here in New England so far.
We have a pension plan that really good after 10 years of service, we have a 403b with company match, the pay isn't bad, the job isn't bad, and benefits like I spoke of earlier are great, the people are for the most part friendily and nice. I don't think I could do better right now in this time of my life.
Another thing I am very thankful to the Lord for. Providing me this opportunity that has worked out so well, but only started at a 6 hour per week job and has grown into a nice full time job.
OK - We had the meeting and now it's decision time. We have 2 choices:
Regular health insurance plan that the church will pay for. The co-pay for office visits is $40, prescriptions are $0/$30/$50, hospitalization has a $500 co-pay, and ER is $250 co-pay.
The other choice is major medical with a high deductible. The deductible for our family would be just shy of $6000 a year, but the church would give you the $6000 in a health savings account for you to use for the deductible. Not a bad deal - it would actually be cheaper than the other one since there's nothing out-of-pocket at all - you'd just get reimbursed by the HSA for any eligible costs. The HSA is like a flexible spending account where you can even deduct the cost of band-aids from it except the account doesn't expire each year - it carries over into the next year and it earns interest.
The biggest issue we have is that our orthopedist (who is a dear friend and fellow believer), DH's pulmonologist (he has severe asthma and only 70% lung capacity) and our regular general practitioner is not on the plan. We can still go to them and use the money in the HSA - but it doesn't go towards our deductible. SIGH Either choice does not include these doctors. So now what do we do? We're going to talk to our orthopedist since he's the orthopedist for just about everyone at church so he has a lot of patients who cannot go to him anymore - maybe he can get in this health plan. I guess I'm OK with the GP changing because I'm not overly excited with him but I've been going to him for 30 years, so it IS hard to change. As for the pulmonologist, Bob's been going to him for a number of years and he knows Bob's lungs really well - knowing how to treat him as he needs. I guess we'll have to find another one.
I hate health insurance. It's so annoying but so necessary.
Oh - for the difference in the billed amount and the "allowed amount" by the insurance company, it turns out the doctor bills the insurance company, they bump back that $$ is the amount allowed and it will go towards the patient's deductible - and then the patient pays the discounted amount. That makes me feel much better.
Regular health insurance plan that the church will pay for. The co-pay for office visits is $40, prescriptions are $0/$30/$50, hospitalization has a $500 co-pay, and ER is $250 co-pay.
The other choice is major medical with a high deductible. The deductible for our family would be just shy of $6000 a year, but the church would give you the $6000 in a health savings account for you to use for the deductible. Not a bad deal - it would actually be cheaper than the other one since there's nothing out-of-pocket at all - you'd just get reimbursed by the HSA for any eligible costs. The HSA is like a flexible spending account where you can even deduct the cost of band-aids from it except the account doesn't expire each year - it carries over into the next year and it earns interest.
The biggest issue we have is that our orthopedist (who is a dear friend and fellow believer), DH's pulmonologist (he has severe asthma and only 70% lung capacity) and our regular general practitioner is not on the plan. We can still go to them and use the money in the HSA - but it doesn't go towards our deductible. SIGH Either choice does not include these doctors. So now what do we do? We're going to talk to our orthopedist since he's the orthopedist for just about everyone at church so he has a lot of patients who cannot go to him anymore - maybe he can get in this health plan. I guess I'm OK with the GP changing because I'm not overly excited with him but I've been going to him for 30 years, so it IS hard to change. As for the pulmonologist, Bob's been going to him for a number of years and he knows Bob's lungs really well - knowing how to treat him as he needs. I guess we'll have to find another one.
I hate health insurance. It's so annoying but so necessary.
Oh - for the difference in the billed amount and the "allowed amount" by the insurance company, it turns out the doctor bills the insurance company, they bump back that $$ is the amount allowed and it will go towards the patient's deductible - and then the patient pays the discounted amount. That makes me feel much better.
annsni said:
This is what makes a high deductible plan worthwhile. For low premiums, you get catastrophic coverage as well as access to lower prices. If you visit the doctor only a few times, the discount may end up covering most of the cost of the premium.
annsni said:OK - We had the meeting and now it's decision time. We have 2 choices:
Regular health insurance plan that the church will pay for. The co-pay for office visits is $40, prescriptions are $0/$30/$50, hospitalization has a $500 co-pay, and ER is $250 co-pay.
The other choice is major medical with a high deductible. The deductible for our family would be just shy of $6000 a year, but the church would give you the $6000 in a health savings account for you to use for the deductible. Not a bad deal - it would actually be cheaper than the other one since there's nothing out-of-pocket at all - you'd just get reimbursed by the HSA for any eligible costs. The HSA is like a flexible spending account where you can even deduct the cost of band-aids from it except the account doesn't expire each year - it carries over into the next year and it earns interest.
The biggest issue we have is that our orthopedist (who is a dear friend and fellow believer), DH's pulmonologist (he has severe asthma and only 70% lung capacity) and our regular general practitioner is not on the plan. We can still go to them and use the money in the HSA - but it doesn't go towards our deductible. SIGH Either choice does not include these doctors. So now what do we do? We're going to talk to our orthopedist since he's the orthopedist for just about everyone at church so he has a lot of patients who cannot go to him anymore - maybe he can get in this health plan. I guess I'm OK with the GP changing because I'm not overly excited with him but I've been going to him for 30 years, so it IS hard to change. As for the pulmonologist, Bob's been going to him for a number of years and he knows Bob's lungs really well - knowing how to treat him as he needs. I guess we'll have to find another one.
I hate health insurance. It's so annoying but so necessary.
Oh - for the difference in the billed amount and the "allowed amount" by the insurance company, it turns out the doctor bills the insurance company, they bump back that $$ is the amount allowed and it will go towards the patient's deductible - and then the patient pays the discounted amount. That makes me feel much better.
At least with the HSA plan, you can use the $6000 funded by the church to pay for the OON physicians. Yes, talk to your physicians about being in this plan, so they won't have to be OON. Normally, it's not an issue of whether they can get in or not; more often, it has to do if they are willing to accept their level of reimbursement. Good luck with this.