What does your family want/need in health insurance?

I was very interested to hear what President Obama would say about health-care last night on TV since my family has had such as close encounter with our nation’s health-care system recently. (Here is a summary the of the speech in case you missed it.)

With my brother in the hospital for more than 10 weeks this summer (he was finally released last Friday), we have had a very first-hand view of hospitals and how at least his health insurance company operates.

We were very lucky to have a fantastic hospital like Emory close by and also very lucky that Emory has a transplant coordinator team to help the patients through the entire process – including staying on top of their insurance companies.

That Emory transplant team (coordinators and doctors) worked hard to make sure all the procedures my brother needed were approved and would be covered. They were more aggressive with the insurance company than a regular person could probably be.

When my brother had to be taken in for a second heart surgery about two hours after the first the transplant coordinator cleared everything with the insurance company. She didn’t want my sister-in-law to have to even think about money or haggling with the insurance company at such a stressful time.

When my sister-in-law got some crazy bills telling her she owed far more than she did, the coordinator helped her review it and figure out exactly what she did owe.

Even with insurance, the transplant team encourages all transplant patients to fundraise to help cover medical expenses – mostly medicines. Despite comprehensive insurance, my brother is looking at $20,000 to $30,000 a year in prescriptions that he needs to keep his body from rejecting his new heart.

My brother and his wife kept joking that they were going to have to put his face on jars in gas stations to raise money. We ended up putting a link to his fund site on the private blog we used to inform friends and family of his condition. That has been very successful, so at least so far, no one is going to have to make crafts to pay for medicine (that is one of the suggestions transplant families get for paying the bills insurance doesn’t cover).

Elsewhere in my family ….

My father runs a very small business so my parents are self-insured. Their premiums were raised multiple times a year for many years. My father is finally old enough to go on Medicare and they were thrilled to stop paying his premium. I think some money does come out of his Social Security check toward the Medicare. They do have a supplemental insurance as well. They can’t wait until my mother is old enough to qualify for Medicare too!

Our insurance …

I have never had a problem getting the doctor that I wanted or the care that our family needed on our insurance. However, I do spend a lot of time double checking bills and calling the insurance company to tell them they have processed things incorrectly. My main complaint is that I feel like I have to follow them with a magnifying glass to make sure every bill is paid the way it is supposed to be! But I do feel grateful that at least we have good health insurance.

I have been aggravated that our company doesn’t pay for the children’s eye exams or hearing exams  — unless something proves out to be wrong. This makes no sense to me. You need the well visits to keep from having problems.  Oddly our dental insurance (different company) pays 100 percent for dental check-ups.

How would you rate the health insurance your family has right now? What else would you want or need from your insurance company? If you do not currently have insurance, how are you paying for medical treatment? What are you looking for in health insurance coverage? What would like to see in a healthcare reform bill?

63 comments Add your comment

Christie

September 10th, 2009
8:01 am

Overall, my insurance company is okay. I have a POS plan so I can see whomever I like, I just might have to pay a little more if they are not in network. I have had problems with them paying a bill from where my son was in the hospital, but it was easily resolved with one phone call. The only complaint I have right now is that they will not cover any percentage of my son’s hearing aids so that left us with a fairly significant medical expense this year.

Without starting any political debate, I am not in favor of a public option plan. As a healthcare professional, I can attest to the need for better coverage. However, I think a plan where the government contracted with private insurance company and paid some type of subsidy to get them coverage is a better option.

Theresa Walsh Giarrusso

September 10th, 2009
8:23 am

why on earth would they not cover a hearing aid — that seems pretty essential to your child’s health!!

Kathy

September 10th, 2009
8:25 am

We have insurance through my husband’s job which we are fairly happy with. Like Theresa, though, I have to make sure I read every EOB and all the online info they send me to make sure they handle every claim accurately. Last month I received a bill from the radiologist who read my mammogram and I was charged for a brain MRI along with my mammogram! The one change I would like to see is that the insurance company cover all well visits (physicals, mammograms, pap smears) at 100%. We are not sick very often but we religiously schedule all of our physical appointments (I have cholesterol and BP issues, hubby has family history of prostate cancer) and we are charged the copay. All preventative medicine should be covered at 100% by all insurance companies in my opinion. Also I would like to see the premiums not increase so dramatically every year. It disgusts me to pay the huge premiums and still have to pay copays and deductibles.

One thing we started utilizing this year was Flexible Spending. My husband and I have never used this before and it has been godsend. I hope that companies continue to offer that to it’s employees.

SouthFultonMom

September 10th, 2009
8:45 am

I despise most insurance companies and hope that something is done to stop them for charging more and covering less! I can’t even get a prescription filled without calling them first to determine IF they will cover it! It’s ridiculous! They suggested that I carry a piece of paper on me at all times so that when I visit a doctor I can show it to them so they can write my prescription from that sheet! I hope Obama gets this bill passed.

Geez Kathy...

September 10th, 2009
8:50 am

…why not just ask for the tooth fairy to cover all your needs! You sound just like Obama – I want, I want, I want – but I REALLY want someone else to take care of me!!!!! Hope Little E is not a sickly child.

Also, Kathy...

September 10th, 2009
8:53 am

…many insurance company plans DO cover well care visits at 100%; just because your husband’s company plan does not is not the insurance company’s fault – it is the plan that they negotiated with the carrier to make it affordable for both the company and the employees and their families.

Christina

September 10th, 2009
8:54 am

Kathy,

My new health coverage (took effect 9/1) is aimed at prevention. All our well visits are covered at 100%, but there is a catch. Sick visits have no copay–only a deductible. To the tune of $1000 for an individual plan or $2000 for a family plan (no individual deductible for the family plan). For young, healthy, single employees, it’s a great idea. For those of us with children in daycare, it’s a nightmare. Last year, my son was on my policy. He had more than 10 sick appointments, eight of which were for recurring ear infections, which led to tubes. Even with all those sick appointments (at $30 copay per visit), the ENT specialist visits (two of them), one ER visit and tube surgery . . . the total of all those treatments was just shy of $2000 (though my share was about $1000 because the deductible was lower and we operated on a copay system at the time). But under the new plan, the insurance company would have covered his four well-baby visits and would not have covered a dime of anything else, because we wouldn’t have met the $2000 deductible.

All those doctor visits sound like a lot, but they’re pretty standard. Half the toddlers in his daycare class have ear tubes, which means all of them have gone through the same series of ear infection visits, specialist visits and surgery.

My son now is covered on my husband’s insurance policy, because we couldn’t justify the $2000 deductible to put him on mine. While the 100% checkup coverage is nice (and is the selling point to employees), it wouldn’t benefit most families with young children if the plan operates the way mine does.

new mom

September 10th, 2009
8:57 am

We’ve had our share of issues in the past with various insurance companies, but like Christie, all are usually resolved in one phone call. Usually someone (typically in the doctor’s office) enters the wrong code so it gets rejected, but always gets resolved by asking the office to reenter the correct code and resubmit. However, never have I thought, ‘if only the government would be more involved in our insurance, THAT would make it better!’ I personally love Clark Howard’s proposal that health insurance should be severed from employers and allow individuals to shop for it in the free market, just as they do with auto, life, homeowners’ insurance. That would also allow individuals more freedom when finding a job, or security if they lose a job, that their health insurance isn’t tied to their employer.

One suggestion I like to make to friends is to save EVERY receipt having to do with their medical care, whether it’s an office copay, prescription copay, parking receipt, etc. Just stick them in an envelope and you don’t have to think about them until tax time. We’ve only had one year that our medical out of pocket expenses qualified as a tax deduction, but you never know. You could have a big out of pocket expense at the end of the year, and then wished you had been saving your other receipts. (Your insurance premiums count, as does mileage to every doctor, pharmacy, etc.) It is weighed as a percentage of your AGI so it also depends on how much you make.

Becky

September 10th, 2009
9:05 am

We have insurance through my job and have been very blessed that we haven’t been really sick..We have a $40 copay and a $500 deductible (per person)..We do not have any small children, so I’m sure that’s another good thing for us..

My company pays for my insurance and I have to pay for my husbands..The only downside to our ins. is that each year when its time to renew, they shop around to find the cheapest..I’m not complaining about that part of it, it’s just a pain to fill out new paper work each year, sometimes for nothing..Over the last 24 years, we have had some really great ins. to some that was so so..

MomOf2Girls

September 10th, 2009
9:30 am

When people are unhappy with the coverage their insurance provides, they need to understand that there are two main decision makers for their coverage (assuming it’s provided by an employer). First, the government mandates coverage for certain things, such as maternity, regardless of who purchases the insurance (single male, menopausal woman, doesn’t matter to them, it’s a government requirement). Second, the company then decides what to cover in the insurance option(s) they provide their employees. For example, my insurance covers wellcare at 100% – many others don’t have that. Some insurance requires you to pay a flat fee per visit, say $20 (copay), others have you pay a percentage (coinsurance). There are thousands of variables involved, and unless you build your policy from scratch, you’re never going to find one that suits your needs perfectly. Plus, what each family needs is different, depending on their circumstances (which of course can and will change through the years). What we all need are more choices, not fewer – an a la carte method of insuring perhaps.

Remember too, insurance is supposed to be for covering the unexpected. You expect to have a wellcare visit, you don’t expect to get pneumonia and wind up in hospital. Perhaps we need to readjust our thinking regarding our responsibility for paying for health care versus the insurance company’s.

Okay, I know I’m probably putting some things out there that aren’t going to be very popular, but there it is!

nurse&mother

September 10th, 2009
9:30 am

Ok, I wish I had time to blog today, but I am on my way to work. I have LOADS to say. I will check back in later tonight.

Theresa Walsh Giarrusso

September 10th, 2009
9:34 am

kathy –we have good insurance and ours does not cover well visits at 100 percent –

LM

September 10th, 2009
9:47 am

I paid for my own personal insurance. The company I worked for didn’t offer insurance, so I had to get a personal policy. I figured it was as important as my mortage and car insurance. I pay over $700 a month in premeiums for just myself and my child. Co-pays were from $30 to $60 a visit and my daughters medication was around $400 every three months. I just considered this my responsibility. So I didn’t have a new car, wear new clothes or have the newest and greatest toys. But I had peace of mind knowing we were covered.

I have always thought personal responsibility was important, not relying on others to provide for me and my family. I dislike the notion of wanting handouts and expecting others to provide when someone has the ability to provide for themself. As my Mother told me, “nothing is for free” and being beholden to another person, employer for the goverment for things I should provide for myself and my family is not free.

Lisa

September 10th, 2009
10:12 am

Both my husband and I worked for small businessess and had insurance until he was laid off and I was put on a contract labor basis which meant I lost all benefits, including insurance. I think my boss had an insight on the changes that healthcare was going to make for his business and decided that was the best route for him to take. He now shows NO empoloyees working for the company, just contract laborers which sucks for us!! With my husband being laid off, there is no way we can afford the 1,600 per month in premiums so we’re just hoping and praying at this point that nothing happens to us. I know it’s a huge gamble but what are you to do when you simply can’t afford the premiums? And preventive care, well that’s not been addressed for either of us this year. I’m worried and although I’m not sure about Obama’s plan, something has to give to make coverage affordable to persons like us.

Valstake

September 10th, 2009
10:21 am

You can expect increased deductibles next year, Theresa and I’ve heard where retirees at the AJC are no longer being offered dental insurance.

Joyce

September 10th, 2009
10:28 am

We’re like Lisa, but with a 7-year-old. We haven’t been able to afford insurance for more than two years. The only one that goes to the doctor regularly is our son. Both my husband and I need to do the regular preventive stuff, but can’t afford it. Decent insurance for us (when we could afford it) was over $1000/month. Crappy insurance (and I do mean crappy-it didn’t cover xrays when I broke my foot)was around $700/month.

My husband and I own a very small business and work very hard. We’re not looking for handouts, but the money just isn’t there without some kind of help.

New Stepmom

September 10th, 2009
10:55 am

Having been in and out of doc’s offices and the hospital all summer due to “elective” surgery, I have now been dealing with insurance far more than I would like for the past 4 months. We have good coverage, thank goodness but are still out $2500 for the procedure that was absolutely necessary. I was blacking out from excrutiating pain from endometriosis and anderomyosis.

Every healthcare professional I spoke to is 100% against any sort of public option and vehemently opposed the Obama plan that was on the table at that point. I have to agree with them. I would have had to wait to get this surgery for months most likely if we had a program similar to Great Britain or Canada and my quality of of life was awful even though I was not in danger of dying.

I think the Clark Howard plan makes the most sense. We are being told to be consumers of our healthcare needs at every turn, but we cannot be the ultimate consumer if we have to continue to purchase insurance plans only through employers.

Okay

September 10th, 2009
11:01 am

Clark Howard is not a insurance agent, he is a travel agent. Go to the insurance message board and read some comments from real agents. Please don’t let Clark Howard give you advice on this subject. Almost every point he’s made regarding insurance has been proven wrong on the board by real agents with real experience.

b

September 10th, 2009
11:06 am

For those who have insurance, be thankful. There are millions who do not have insurance and when a catastrophic event happens they can lose everything-house, cars, savings. We have been fortunate to always have insurance even if it was COBRA but co-pays and co-insurance changes with every plan. I never mind paying those costs-healthcare is not free. Someone needs to pay for the doctor, the nurse, the facility, the tests, etc and who is receiving the services? Us. We need to pay. Insurance is to help mitigate some of the cost and is especially helpful when there is an emergency and/or large cost.

I would hope that any reform allows people to shop for their own insurance so that it fits their needs. Employers are developing the plans now and trying to find the “best fit” for all its employees. If we all were able to choose our own plans then it would be exactly what we wanted-as large of co-payments/co-insurance as we want, POS, PPO or HMO, etc. But it would be our choice. Additionally, employers would not have huge chunks of money going towards insurance and could possibly raise our wages.

Another reality is rational health care, not rationing healthcare. How many tests, etc are done to protect the physician from malpractice instead of based on whether a patient truly needs the test or not. Have you ever asked a physician “Do I really need that test?” Have you ever shopped around for the best pricing?

There are a lot of other things that need to be changed-tort reform, insurance availability, etc but I do not think a government-run option is the right choice. Competition in a free market, one that requires everyone to have insurance just like car insurance is necessary. Tax-credits based on income to help those who have less available income are necessary, just like childcare credits, etc.

New Stepmom

September 10th, 2009
11:08 am

Okay-John Edwards advocated a very similar plan back when he was running. Being able to buy into a large “pool” of private insurance makes sense. I work in Healthcare and deal with insurance companies daily. They do not want this to be an option and that is why they are “poo-pooing” this idea.

Becky

September 10th, 2009
11:11 am

Wow, thank you for telling us that Clark Howard isn’t an insurance agent..Guess most of us didn’t already know that!!

Christina

September 10th, 2009
11:32 am

b – The reason car insurance is required is to protect against other people and their property, not the holder of the insurance. Drivers (at least in the state of Georgia) are not required to hold auto insurance that covers their own property. Minimum legal insurance only covers the people, cars and other objects a driver might hit. Now, if you have a loan on your car, then the loan holder requires coverage for their property, aka the car. Otherwise, a driver isn’t required to cover his or her own property. What about houses? You only have to have homeowner’s insurance if you have a loan on your house . . . to protect the lender’s property.

So to use this argument to say everyone should be required to carry medical insurance, doesn’t make sense. If we follow the precedent of auto and home insurance, we’d have to take out liability policies on the people to whom we might cause injury or illness.

Christina

September 10th, 2009
11:36 am

Has anyone ever shopped around for the best pricing on medical care? Seriously. I’ve tried to ask my doctors how much a procedure is going to cost, and they can’t give me an answer. After they file it with insurance, they can. But by then, I can’t back out. My insurance company actually has a “cost estimator tool” but it is ridiculously vague. You have to know all the costs associated with a procedure and even then, it’s only a ballpark estimate. For instance, if I select an uncomplicated childbirth, it gives me an estimate for the hotel stay. Does not include fees for any of the doctors, medicines, etc. And unless you’ve been through the procedure before, you probably have no idea which doctors and medicines will be involved. And if you have been through it before, then hopefully you already have a ballpark idea.

Okay

September 10th, 2009
11:42 am

Becky, I wasn’t attacking anyone or being the smart a@@ like you seem to be. Just go read the board for yourself and you’ll see what I mean. Too many people think Clark is king about too many topics and it’s just not so.

DB

September 10th, 2009
11:59 am

Theresa, first of all, congratulations to your brother — I’m sure he’s delighted to be home!

My husband and I have been self-employed for about 17 years, so we have been self-insured for quite a long time. We found an agent that has been pretty aggressive in finding us insurance at a reasonable cost, we have pretty high deductibles, and basically, it’s catastrophic insurance only, the ol’ “if I get hit by a bus” scenario. We pay for everything else — well visits, mammograms, etc. At that, it’s less than $600 a month to cover all four of us. We figured that what we’d pay for those visits, etc., were less than we’d pay an insurance company for higher coverage. It’s a fine line, and it’s a PITA to keep on top of, but there you go. I am just amazed at the multiple opportunities for insurance fraud in the health care industry.

When I was having our second child, the nurse had a hard time getting an IV started. She tried three times, and couldn’t get it in. Each time, she’d rip open a new needle package and absentmindedly slap the receipt on her smock sleeve. After the third one didn’t go in, I finally asked her, “You don’t think you’re going to CHARGE me for those three IV’s that you couldn’t get in, do you?!?!” She looked down, blushed and stammered, “Oh, of course . . . not . . .” I checked the bill later and sure enough, there were three charges, at $22 each. After a couple of phone calls, the charges disappeared — one clerk even said, rather snottily, “Oh, you were in labor, you probably don’t remember . . .” At which point I told her that all of this happened BEFORE I was induced, thank you very much, I could definitely remember being stabbed three times!!

And while it’s true that Clark Howard isn’t an insurance expert — it seems to me that insurance “experts” are the ones that sorta got us into this mess in the first place, so I’m a little hesitant to put a lot of faith into their spin on the matter. Insurance is insurance — whether it’s car, house, or health. It’s there to pay for the unexpected. Frankly, I don’t believe that insurance should cover well visits — the costs for those well visits have soared through the roof because of insurance, because people don’t care how much they cost if someone else is paying. Insurance doesn’t pay for oil changes. Why should it pay for a basic well check-up? It’s a chicken-or-the-egg problem — the costs are high BECAUSE of insurance, and we now need more insurance to cover those high costs, which means that the costs keep getting higher . . .

My 2 cents worth

September 10th, 2009
11:59 am

Our family (husband, wife, and 2 children) receive health insurance under my husband’s pension plan. He retired from one company in 2005 and started work for another one. We have a high deductible plan. Each year, I have to run a spread sheet to determine if the high deductible premium will save us money in the long run. The medium deductible premium is almost twice as high as the high deductible one. My husband may need a liver transplant in the future; so I am wary about changing companies. Our insurer is very reasonable; I have only had to “fight” one refusal to pay.

While listening to the President last night, I found myself saying “Yes, that seems reasonable.” Today, I am questioning whether or not what he proposed is financially feasible. We would all like health insurance with reasonable premiums, no life time caps, and guaranteed everlasting coverage. However, is that a financial possibility for a health insurance company? If a company continues to sustain high claim rates without the ability to raise more funds through premium increases, where will the money come from? Are we creating a failure plan for these companies?

DB

September 10th, 2009
12:07 pm

Christina, I disagree with your argument that you are only required to have insurance because of liability. While the MINIMUM coverage in Georgia is supposed to protect the other injured party (and if everyone is insured, why is that a problem, anyway . . . but I digress . . .) a responsible car owner is probably going to do more than the minimum in order to be able to recoup their losses in the case of an accident when the car is totaled, at least when the car is newer. As soon as the car is worth less than the collision insurance, then it makes sense to drop the collision — but that’s not usually for a few years. The same with a house — the lender may only require enough to make sure that their risk is covered. But a responsible homeowner isn’t going to just cover the lender’s mortgage — THAT won’t get the house rebuilt in case it burns down, and it sure won’t cover the loss of everything IN the house.

Canada as an Example

September 10th, 2009
12:19 pm

If you want to see how a socialized health care system works, or doesn’t work, is look to our neighbor to the north…Canada. I hear a lot of Canadians come here to the states to get procedures performed because the wait time in Canada is so long. That and they have to pay out of their @sses in taxes for poor service.

Jesse's Girl

September 10th, 2009
12:38 pm

Insurance companies are proving to be the tools of satan. I fully expect the Anti Christ to come out of their evil folds:) I feel the same way about the Pharamceutical companies. As with any less than pleasant….albeit neccessary…part of life….we deal as best we can.

Okay

September 10th, 2009
12:38 pm

DB – I agree with most of your analogy but pharmaceutical companies and doctors are the first rung of the ladder of people to blame for high cost insurance. Just like the nurse tried to charge you 3 times for one IV, and the extra tylenol they put on everyones bill, most people do not complain and just let their insurance cover it. They don’t stop to consider that by disputing charges they are actually saving them and everyone else money. Also, if every low life out there would quit suing for frivolous (sp) things, the doctors could maintain malpractice insurance at affordable rates and then be able to pass those savings onto us. It’s a viscious cycle that needs to be broken.

Christina

September 10th, 2009
12:52 pm

DB – I agree that a responsible owner carries insurance beyond the minimum. I have no loan on my four-year-old car but I definitely carry coverage far above the minimum, including collision. I don’t want to be caught accidentally causing thousands of dollars in damage to my own car, and have to pay it all out of pocket. My argument was, like you stated, that the minimum required by the government only covers the other parties. So while a responsible person should weigh their potential costs against the cost of premiums to determine if they need additional coverage, the government isn’t telling them they have to cover their own property. Likewise, a responsible person would weigh the risk of likely medical costs against the cost of premiums and determine how much coverage is right for them.

If I came across as attacking in my last post, I apologize. I just wanted to point out that the differences in the two types of insurance being compared.

Personally, I would like to see more insurance options. And maybe it would help if we all shop for medical coverage the way we shop for other types of insurance. My company employs more than 6,000 people across the U.S., ranging from healthy, unmarried recent college graduates, to middle-aged parents of five children, to nearly retired cancer patients. And they try to fit all of us into TWO very similar health plans, which they think make the most sense for our “average” employee. Well, one of those plans may be a good fit for 1,000 people and the other plan may be a good fit for another 2,000 people, but what about the other 3,000 employees who fall somewhere between never having a sick appointment and going to the doctor every week? We have to try to fit one of those molds and keep our fingers crossed that it works in our favor. At the same time, I’ve been looking into individual coverage for our family and it is ridiculous. A deductible of more than $1000/person just isn’t an option with small children, and plans with lower deductibles are few and far between. Maybe if everyone had to shop that way, there would be more options.

HB

September 10th, 2009
1:17 pm

The Washington Post had an interesting article recently about health care in other countries: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html. It points out that other countries have developed different systems, some using only private insurers and providers, others using government insurance and private providers, and some going all government (that’s the English system everyone points out as a reason not to have universal healthcare). It talks about costs, waits, amount of patient choice, etc, in several countries.

The simple fact of the matter is, though, that we have higher health care costs than everyone else. Our system is broken. Personally, I’m in favor of a public option, but only as an OPTION. No one is proposing that everyone be covered by public insurance. Doctors I’ve talked to don’t have a problem with this, as long as it’s only an option and not government care for all, but they say the insurance companies are against it because it would give them competition, especially for those customers who do not have employer insurance and currently have high premium policies. Insurance companies would prefer government subsidies for those policies go directly to them. Public competition would force them to find ways to lower the premiums.

CPT

September 10th, 2009
1:19 pm

This is what I would like to see with health care reform:

1.) One rate for everyone regardless of pre-existing conditions and nobody can be denied for any reason. No special group rates for large companies – one rate for everyone. Period.

2.) Severe the link between employment and health insurance – they don’t belong together. If I’m not happy with my insurance company, I should be free to choose another one without having to find a new job. And I should be free to get a new job without having to change insurance companies.

3.) Allow individuals to deduct individual health insurance premiums as companies do.

4.) Tort reform!! Get rid of punitive damages (compensatory fine, but punitive, no). If the doctor is bad and needs to be ‘punished’ then he should loose his license or receive other sanctions.

5.) Another good idea is health care savings accounts for routine care. (Let insurance be for the big-ticket items only.) Let the people pay doctors directly for services so they see how much things cost. This allows the patient to take control of their own health spending, and eliminate all the paperwork/overhead involved in basic care.

These things can be implemented relatively easily and with little or no federal expense.

lakerat

September 10th, 2009
1:23 pm

While it may be true that insurance companies are the bane of all evil, last year I had knee replacement surgery. I was in the hospital for barely 24 hours (went in at 7am for a 10am surgery on Wednesday and was discharged at 8am on Thursday morning). The hospital bill totalled $16,910!! And that did not include the anesthesiologist, my orthopedic surgeon or the surgical assistant.

My insurance company paid $988, and I paid a $250 co-pay for this hospital bill. The insurance paid all of the surgeons fees (approx $3000), all of the anesthesiologist’s bill (approx. $1100) and all of the surgical assistants fee (approx $180) – I still cannot figure how the hospital survives on this type payment system, as the $250 is ALL that I paid for this procedure and stay. And, I have not heard word one from the hospital regarding the other $15,672 – they just seemingly wrote that off since that is what they contracted with my insurance company for regarding this stay, and is what they received and accepted without further requests for payment from me.

Joan

September 10th, 2009
1:39 pm

Nobody here has spoken about why we have the highest costs for healthcare – obesity. Americans are just to dog gone fat, and that causes all kinds of health problems. Health care reform starts at the super market checkout line! About insurance, it is for the trauma. Get a high deductible plan, pay for your own routine office visits, and have your insurance for those traumatic events–like you do fire insurance–then its costs will be reasonable. Another thing that would make it reasonable, is increased competition, by allowing insurers to advertise and sell throughout the US rather than state by state. Finally, we are told the public option won’t be forced–it will be. Your employer will choose to pay $8K to the government per employee, rather than pay the $12K or more that it costs him now to pay for your medical insurance, forcing you to go the public option route, or buy your insurance privately otherwise (from those insurers who now can’t compete across state lines–while the government will).

Becky

September 10th, 2009
1:44 pm

You are the one that stated that “Clark Howard is not a insurance agent, he is a travel agetnt” All I pointed out is that everyone already knows that, there was no need to tell us..So just in case you haven’t noticed a lot of people in Atlanta think that yes he is the icing on the cake..Otherwise, why would so many people be hollering for him to run for Mayor?

Layla

September 10th, 2009
1:52 pm

Regarding coverage for hearing aids- I have not heard of one insurance company that covers anything to do with hearing. Believe me, I’ve asked. In my case it is a pre-existing condition (congenital) and the insurers all say that hearing is not medically necessary, we can live without it. I’m having to come up with $4-5K this year for 2. (I could get them for about $1200-1500 each, but I’m wanting the top of the line models- they are supposedly approaching normal hearing levels and I’d like to know what that’s like.)

I don’t know that hearing aids should be required to be covered by insurance, but I know I’d like it to be an option. That’s what I want in an insurance company- the ability to pick and choose my coverage options. Why would I want to pay for Viagra? However, that is covered under my current plan. But hearing is something that I would be willing to pay extra for.

The democrats will never agree to tort reform. Most of them are lawyers or have been paid for by lawyers, and the ambulance chasers make most of their money by going after those punitive damages. And ridiculous and frivolous lawsuits are now the norm.

I know of someone who sued a hospital because they had to wait several hours in an emergency room for a stomachache and a couple of people went in before her. Inconvenient, yes. Worthy of a lawsuit? NO! But, God forbid we should have any inconveniences in our lives. Everything should be perfect for us and to he** with other people.

new mom

September 10th, 2009
1:57 pm

Here’s one other thing that people don’t think about, when complaining about the cost of health care (and the ‘we should all be able to get it for free or afford anything we need’) Doctors spend hundreds of thousands of dollars at medical school, years of their lives dedicated to long hours and huge school loans….what do we tell them? That their expertise should not be worth anything, they should simply not be compensated for their time? How about the researchers who spend years coming up with new medicines that save lives? Sometimes those ‘exorbitant’ costs for medicines and treatments are due to the cost of years of research and the brains behind it. Personally, I don’t want the best doctors and researchers looking to move out of the US because they realize they won’t be compensated or will have to live their lives with massive debt because they chose the health care profession.

Joan, I totally agree with your points about allowing insurers to compete across state lines–talk about an inexpensive way to drive up competition and lower prices. Imagine pairing that with severing insurance from employers, and suddenly the consumer is in charge, premiums become affordable, etc. I also question the idea about the government “competing” with private insurance companies. How on earth is that fair competition? The government can continue to operate by just borrowing more and more money from future generations, where private companies are kind of expected to operate in the black and make money for shareholders. How could ANY private company compete with a government entity who operates in the red (and doesn’t care!)

New Stepmom

September 10th, 2009
2:26 pm

New Mom-all excellent points…

Okay

September 10th, 2009
2:34 pm

Because they’re uninformed.

motherjanegoose

September 10th, 2009
2:39 pm

Wow…good points today.

We have been blessed, in that we have had access to health, dental and vision insurance our entire married life. I am self employed and my husband’s company has always covered us. Notice I said BLESSED. I do not feel health care is a right. I also do not feel it is fair for those to suffer who have inadvertently had a run of bad luck and just die due to lack of medical options. I do not feel everyone should just HAVE healthcare. Many have not had it for years, BY THEIR CHOICE.

We have dear friends who have most everything paid for and probably could be retired. The wife works because she is offered group health care and they are on pins and needles if they had to cover themselves or pay cash. How many others out there have not worked a day in their life nor have they paid ANY taxes but feel they deserve healthcare….hello?

Regarding Clark Howard, if I had to pick 1 person in the United States with a grand pool of knowledge, who could relate to the average consumer, I would pick him! Anyone else? No, he does not know everything but he knows a lot more about everything than most folks. Insurance agents tend to be more specialized and Clark’s knowledge ( to me) is broader based.

@ Okay, I may be a smart a$$ but I have never known Becky to be one….she is just stating a point
(I believe) that many of us trust Clark Howard more than 100 insurance agents in the same room.
Maybe we are nuts but he does seem to be sensible, meticulous, and researched.

@ newmom, your point about quality is a good one and this is something our son talks about all the time. He has worked hard to get into professional school and will have loans out the wazoo.
While many are willing to work hard to get what they want and unfortunately some are the victims of horrendous circumstances, our society is running amok with: I HAVE A RIGHT TO HAVE THIS and I am so sick of it.

Christina

September 10th, 2009
2:58 pm

I do like the idea of severing ties between employers and medical insurance. Why are those two entities linked in the first place? I’ve never looked into it, but does anyone know? Take the company I work for, as an example. It employs more than 6,000 people across the US. Some are single, healthy, recent college graduates. Some are middle-aged mothers of five who carry family policies. Some are old enough to retire any day now but are keeping their jobs for insurance because of chemotherapy and other continuing health treatments. We have two health insurance plans. Two. The company tries to determine what kinds of coverage would benefit the average employee and be cost-effective for all parties involved. Sure, one plan might be what works best for 1,000 employees. The other plan might be just what’s needed for another 2,00 employees. But how can they possibly capture what’s best for all 6,000 of us? They can’t. So we make an educated guess and hope for the best . . .

Christina

September 10th, 2009
2:59 pm

Oh – DB, I agree with your point that a responsible adult carries more than the minimum. I was just pointing out that the government doesn’t mandate us to carry that coverage; we make that evaluation on our own.

MomsRule

September 10th, 2009
3:04 pm

Christina, from what I understand years back the government put a wage freeze in place that prevented employers from increasing the salary of people that were deserving. (At the time people carried their own insurance/paid their own medical.) As a way to circumvent the govenment mandate and still reward good employees employers started picking up insurance premiums. That’s what I’ve been told. I haven’t researched it though so it could be hog wash. Has anyone else heard this?

motherjanegoose

September 10th, 2009
3:09 pm

Enter your comments here

motherjanegoose

September 10th, 2009
3:10 pm

WOW…I thought I was being screened from the blog today…I posted 20 minutes ago/ 3 minute ago and nothing…Theresa am I in time out….lol?

CPT

September 10th, 2009
3:14 pm

MomsRule: I’ve heard the same thing – during WW II, I think?

Christina

September 10th, 2009
3:14 pm

MomsRule, I just found an article to support what you’ve heard. The wage freeze occurred during WWII and let to many employers offering fringe benefits like health insurance, in order to continue recruiting the top people for their jobs. There remains a benefit to employers because the premiums employers pay on those policies, are tax-deductible business expenses.
http://www.jeffjacoby.com/440/health-care-shouldnt-be-linked-to-employment

Christina

September 10th, 2009
3:15 pm

motherjanegoose, I was having that problem, too. I tried posting twice between 12:30 and 2:30, but to no avail.

MomsRule

September 10th, 2009
3:36 pm

Thank you for the link Christina.