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

History of Health Insurance

September 10th, 2009
4:31 pm

How employers and health insurance got linked:

Employee benefit plans proliferated in the 1940’s and 1950’s. Strong unions bargained for better benefit packages, including tax-free, employer-sponsored health insurance. Wartime (1939-1945) wage freezes imposed by the government actually accelerated the spread of group health care. Unable by law to attract workers by paying more, employers instead improved their benefit packages, adding health care.

Yet another great idea from WWII that should be GONE.

catlady

September 10th, 2009
6:13 pm

Oh, the stories I could tell. My family has been insured through state employee coverage for 38 years. When my son was born, the doctors were paid but the insurance said they wouldn’t pay the hospital bill–that they thought it should be paid first by my auto insurance! I let them know that NO part of my son’s birth or conception had anything to do with any part of a car! Red marker time!

When my son had his second BRAIN surgery, the hospital was paid (10 days) but the doctor bill was questioned. The company wanted to know if the BRAIN surgery took place in the hospital or doctor’s office (remember, they had already paid the hospital bill). Not only that, but it was clearly marked on the doctor’s form that it happened in the hospital. Another chance to use the red marker!

The hospital billed (and insurance paid for) a stomach drain and general anesthesia when my son had 7 stitches in his finger (”sword fighting” with baseball bats).

I could go on and on. No matter how good your insurance is, it is never as good as you think. Amen and amen.

I DO BELIEVE we need profit-making middlemen OUT of health care!

BlondeHoney

September 10th, 2009
6:44 pm

I agree in theory of severing the ties between insurance and employer, however my employer will need to up my compensation (i.e. salary) by an equal amount to compensate me and allow me to purchase insurance. My health benefits, in my company, are counted as part of my overall compensation plan so if that does happen, they will need to be held accountable for ponying up the difference. Also, that difference had better be enough to allow me to purchase insurance; right now, what my employer pays is a discounted contracted rate because of the volume of employees it must cover; an equally discounted rate must also be available for me to purchase for this to work.

FCM

September 10th, 2009
7:47 pm

Unions were key in getting health care linked to employers too. That was in the 40’s around WWII.

Theresa, glad to hear he is able to get home. I will keep y’all in the prayers, sounds like there is still some ground to cover. Thinking of your family (especially your Dad) as the Jackets take the field! Don’t let the ballgame get your brother too worked up.

;)

Judy

September 10th, 2009
10:09 pm

The bottom line is in this country you cannot afford to get sick…..or you risk losing everything
A quote from one of the politicians last night. ” everyone loves their health insurance until their child gets leukemia “…..have a serious illness in your family and you’ll see just how ‘ great ” your insurance
really is….

Wiblets

September 11th, 2009
12:36 am

When I was laid off, I was quoted a COBRA rate of just over $800 a month for myself and my spouse (both healthy 20-somethings). I declined. I can put that $800 a month into my own savings and have a nice cushion built up for the most likely scenarios/well visits. We paid high medical premiums for roughly five years and did not see a doctor once during that timeframe. Had I put that money into my own private account, I would have had almost $25,000 at my disposal. Not enough for something catastrophic of course, but enough for most things. Instead, during year 6, I got strep and was seen at urgent care…had to pay them $500 out of pocket since I had not met my deductible for the year! *sigh*

Caroline

September 11th, 2009
8:46 am

I was laid off in July…my COBRA payment was quoted at $500 a month, JUST FOR ME. I looked on-line for more reasonable insurance and the deductibles were so high (one was $10,000!), I figured, what’s the point? I’m looking for work and going back to school. In the meantime, I’m making about $800 less a month with unemployment. How can I make my mortage payment, electricity bill, water bill, etc and still be able to pay $200 a month for individual healthcare? I’m not asking for handouts, but just a little help until I get another job.

I have savings, but I’m trying to keep what I can in there in the event something bad happens or the unemployment runs out before I find another job and I need to pay my mortgage.

Any advice?

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DB

September 11th, 2009
2:54 pm

Caroline, if you have kids under 18, you might want to call the State of Georgia’s office for Medicaid for children. It’s called Peachcare for Kids: http://www.peachcare.org You are on a sliding scale, depending on your income with very reasonable rates — a friend of mine whose husband was unemployed for over a year used it for a year when they couldn’t afford their COBRA paid less than $20 a month five or six years ago — it paid for the children’s doctors visit and a visit to the emergency room when one of them had a sports injury.

It doesn’t take care of you, but at least the kids would be covered.

I’d at least consider a relatively inexpensive, very high deductible policy. If, God forbid, you were in an auto accident . . . you can be bankrupt in twelve hours flat with emergency room trauma, ICU, etc. We had to go without insurance for a short period of time due to changes in jobs, etc., and we ended up not going on a ski trip, because we had no insurance — neither my husband or I wanted to risk skiing without it! THAT’S when you fall off the mountain and bash your head on a rock!

Joyful Mom

September 12th, 2009
7:45 am

I have kids and lost my job one year close to the holidays. With the ending of my job came and end to my heath care coverage. Sure, Cobra was offered, but for me and the kids my premium would have been around 1000 per month. Ouch! That’s a big difference from the 200 a month I had been paying.
So, I looked for state health insurance for them. What I found out is that to get on Peach Care, the kids would have to have been uninsured privately for 6 months. I could not swing the COBRA payments even with unemployment, which is not a lot. So we took a chance and went without insurance. It was scary. I didn’t sleep at night. For something like a visit for a strep test, the cost of a doctor visit was just about equal to one of the unemployment checks.
For all of you who postulate that no one is entitled to healthcare, I suppose myself and kids should just skulk off somewhere and die from something simple like strep since we could not have covered the cost of a doctor visit. That’s a nice American picture for you.

Cammi317

September 14th, 2009
10:14 am

I want for my health insurance for myself and my daughter not to be almost $500/month. I would love to see that figured knocked down to around $300.

Julia

October 30th, 2009
2:18 am

I’ve read so many blogs I’ve wanted to individually reply to, but by the time I finally got to write…I’ll just give my own situation…

I’m 38, husband 43, and two daughters age 6 and 10 months. In ‘03, I paid a $35 co-pay to my OBGYN, and nothing else, except for a $500 deduct. for the hospital I gave birth in. I was paying $160/mo. for my health ins. through my “small business” employer at the time, (Veterinary Hospital). My husband and I decided to use his employer healthcare coverage for our family,…it cost $200/ mo…. Although we were lucky to be a healthy family, our daughter did have an occasional x-ray or bloodwork at her pediatricians’ office, but I never saw a bill, (and never even really heard of a deductible, though I knew it existed, non of our needs fell under it.)

In July ‘06, my husband was offered a job for a small business in Titusville, Fl., because of an increase in salary of $7000/yr. We jumped at it! (My husband had gone from an 8th gr. teacher, to a Logistics Eng. in Orlando for $53, now will make $60,000 in a small town .., which was what we wanted??!! Great!!! His first paycheck was actually less than his previous ones. And so the story begins…..

Our health insurance his 1st year was $158.00/week, (they got paid weekly.) The second year it went up to $176.00/wk. The third year, it increased to $201.00/wk, ( for most,the population that gets paid every other week, that would be $402.00 taken out of every paycheck you receive,…for insurance!!.) We had a 2nd daughter this last January, and though we pay almost $900/mo., we had to pay $1000/deduct. for my pregnancy! My husband had a vasectomy done in May, inwhich fell under his own deductible! Our 6 year old broke her collar bone last year, the walk in clinic took 2 x-rays, ….it all fell under her “OWN” deductible! After paying almost $11,000 last year in premiums ..alone!! We are still trying to pay off the almost $2800.00 in deductibles in addition!!

We cancelled my husband’s insurance, and now pay ‘out-of-pocket’ for Dr. visits. My husband and I are both college educated. His income is $70,000/yr. We have cut corners so that I can stay at home with our daughters. Might seem lazy to some of you, but our 6yr. old has had 100% on all of her spelling tests this year. We live within our means. But I can tell you neither my “Republican” husband, or I, a “non-party”, (but truthfully a hippie at heart), are willing to pay so much money for a premium, and then to be sent ..bill..after…bill…I just won’t do it!!! (Even my partisan-voting Republican husband won’t!!!)

We ask for no “freebies”. We never qualify for anything,..anyways! We always make too much, or too little. Neither of us would EVER take something from anyone! We have even turned down our parents help, after being VERY poor after having our 1st daughter and trying to purchase a house. We are not entitled, but I do have opinions on healthcare!!!!

Is healthcare a right? I feel that it is. Whether your wealthy, poor, or inbetween, (as I consider us, going from paycheck to paycheck) our children deserve to have the same opportunities throughout their childhood. I believe in public schools, mostly because I want my children and every child to have the same opportunities for an equal education…Black, White, Rich or Poor. The question should be……Do I want my child going to school amongst other chidren that may not have access to the same healthcare?? All children should have equal healthcare. Does anyone really want their child to be exposed to another child because they don’t have insurance?

Shoudn’t we all have equal access to sick/well visits to make sure our country is strong and healthly? I’ll pay a little more,(not to insurance co. that make billions in profits!)but invest in us as a “whole”.

I read a ‘blog’ inwhich someone mentioned “subsidizing” insurance companies premiums/policies. I’m assuming they are young,..or are working for the Ins. Industry! Unfortunately, subsidies, are what adds to our deficit. Being from Texas, living in Florida, and moving to Vermont at age 19 to 24, I understand subsidies possibly in a different way. Subsidies work for large farms, and allow them to be be ineffiecient. It does nothing for small, responsible, humane, and enviromentlly efficient, small farms. I’d rather my tax dollars go to the latter…

For those of you happy with your insurance. I’m glad. I hope you never have to claim Bankruptcy as we did, mostly bcause of our rising premiums and healthcare debt. And to be young and care-free, Gosh!, those were the days! But you too will find, one day as you get older, and find yorself with a person you love, and then to experience all the “greatness” of youth through your children together,..that health ins. is not so simple.

UHG! And for “GEEZ KATHY” what the hell? I happen to like Obama, but why would you harp so much on the previous blogger? I suppose some people just like to ‘bitch’ about the way things are, but will also oppose any changes, that might be better! The sooner we all become comfortable with thinking this as a “world economy, and “people as a ‘whole’ , the better off we will be. OH! And the sooner you come up with a better idea, please let me know!!!

But just remember, you may also find yourself with someone that you love comepletely, and have a child. And if you are lucky enough to still feel “crazy” in love with the father of your child and call yourself a “family”, you, too will be trying to find the best ‘policy’ that fits your family. Do you really think our country is strong, when some are sick and don’t go to the Dr. because they just can’t afford it?

Don’t be wish-washy!!! We’re either all for one!…Or one for all!! But stand for something!!@! :)

Julia

October 30th, 2009
4:38 am

And Govt. interferring with healthcare??? It’s an OPTION, what part of OPTION, do people not like??? An OPTION!!!!!???? Do you like less options??? I’m confused!!! Would you prefer no options at all?? Or maybe just the few options that made billions in profits last year. We have no ins. right now, other than the $200/wk one we can’t afford. I’ll make sure my snotty, coughing, sneezing kid goes to school next time.

Good thing YOU have affordable healthcare!!! Don’t worry yourself with the rest of us. Just hope we don’t pass along our ‘disease’. ….

And god forbid, you find yourself working for a small business where insurance costs you over $800 a month!!!!