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Health insurance, what a scam

Old 09-11-2015, 05:29 PM
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Default Health insurance, what a scam

So I have Cigna, for a family of 5 is about $1000 a month, 80/20 plan with $2500 deductable, no vision or dental included.
My doc tells me last year ti get an MRI, insurance says it's not covered, not necesaary, so I don't get it done. Now doc wants me on cholesterol meds, I pushed it off for a couple years trying to get it down on my own but my bad levels haven't come down so I agree. He called the script in today and I get a call from the RX, the insurance company pay for none of it, $220 a month for 30 pills! Lucky the rx found me a coupon for a free month and the doc gave me a coupon for a discount on the first 3 months.
My regular doc visit copay is $40, my last blood and urine test the doc ordered cost me $100 out of pocket. So what am I paying premiums for??? Insurance is pretty much worthless unless there is a major hospital issue and even then it's $2500 out of pocket up front and then the insurance Co will deny half the crap the hospital charges for and then I'll get a separate bill from every "specialist" that saw me or from the "specialist" that are out of network that see me at an in network hospital.
I'm a conservative but I'm leaning more and more toward a Canadian style system. At the very least these politicians need to come up with a system where I pay my premium and that's it, no copay bs, no deductable, no denying procedures or test, nothing out of pocket except my premium.
There's no way I'm paying almost $80 a pill for cholesterol meds so I hope they have a stack of coupons.
Rant over.
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Old 09-11-2015, 05:36 PM
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We will end up with an Australian-style system. Private providers, some basic level of coverage for all, with the option to enhance that coverage privately if you or your employer so chooses.

Try to get on a group plan (company, union, guild, etc.). I had a private pay CIGNA for my family of five - $1700 a month and it excluded many things. My wife recently got an Aetna plan through her job and it has been an amazing difference.
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Old 09-11-2015, 05:40 PM
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It costs me $3800 a year for my daughter and I, and another $6300 worth of deductibles before it starts covering us. It's basically catastrophic insurance. That's my insurance through work.
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Old 09-11-2015, 05:41 PM
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I thought someone recently reformed healthcare.
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Old 09-11-2015, 05:42 PM
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Group plans aren't exactly that great anymore either. Pm me the RX your prescribed if you don't mind. Insurance will essentially go to pay as you go plans with everyone having 6600$ deductibles. And yes it will suck, until you have a million dollar claim.
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Old 09-11-2015, 05:54 PM
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Originally Posted by mikefloyd View Post
I thought someone recently reformed healthcare.
No... they just forced more people to have insurance... and more of us to pay for theirs.
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Old 09-11-2015, 05:58 PM
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I'm with ya. I've got a fracture in my lower back, FRACTURE!!! (Don't know how I did it) and the insurance has refused to pay for surgery. They keep telling me to give physical therapy a try. I have for 3 months although all 3 specialist and the surgeon have relayed to them that therapy will not help. It won't fix a fracture. But what do they know, they're just Dr's. I mean BCBS of NC knows everything right? This has gone on since last Dec. I finally got word today that they've approved the surgery, thank God. Oct. 21st can't come soon enough. It's bad when most days my 9 year old son has to help me get out of bed, get my shoes etc... I mean, wtf, who can't live with a little pain, right. They don't want to pay for the nessisary treatments, test, scans etc but I'll be damned if you're late with their monthly premiums. It's a joke. Rant over as well.
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Old 09-11-2015, 06:06 PM
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Originally Posted by mikefloyd View Post
I thought someone recently reformed healthcare.
Who says sarcasm doesn't translate through the Internet?!!
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Old 09-11-2015, 06:14 PM
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I'm in my 70s and on Medicare. This year I switched to an Aetna New Jersey Preferred Medicare Advantage Plan. The very large medical group I go to accepts Aetna. Premiums are ZERO. $20 copay for primary physician, $50 for specialists. Drugs are tiered at 12 and 24 or zero for three month supply, and now, even some of the $12 tiered drugs have fallen in price. I'm relatively healthy, so it really costs me very little. In fact, my old UHC Medigap plan was costing us 150/mo for which we got almost nothing, so I'm well ahead. I hope this plan continues into the years to come!
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Old 09-11-2015, 07:11 PM
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Over the past couple of years I've been through "the ringer" with health insurance.

1. Insurance is the transfer of risk for a payment. The risk you are insuring is a large bill. In March of 2014, my wife incurred $120K in medical expenses in 24 hours. That's the risk you are insuring.

2. Ask your doctor about taking a generic cholesterol medication. I take Atorvastatin which is the generic for Lipitor. Costs about $15 for 90 days.

3. When comparing plans during the enrollment period, you need to really take the time to figure out which benefits are most important. Some are all copay, but have crappy hospital coverage. Some make you hit a deductible before covering prescriptions, some don't. It's confusing but if you put some effort in, you can get a policy that meets your needs. It's not easy and the insurance companies don't make it easy either.

4. My prediction is that we will have a Canadian style system within 10-15 years. It's going to take a while because the insurance and medical lobbyists throw way too much money at politicians.
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Old 09-11-2015, 07:24 PM
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Originally Posted by t3rockhall View Post
I'm in my 70s and on Medicare. This year I switched to an Aetna New Jersey Preferred Medicare Advantage Plan. The very large medical group I go to accepts Aetna. Premiums are ZERO. $20 copay for primary physician, $50 for specialists. Drugs are tiered at 12 and 24 or zero for three month supply, and now, even some of the $12 tiered drugs have fallen in price. I'm relatively healthy, so it really costs me very little. In fact, my old UHC Medigap plan was costing us 150/mo for which we got almost nothing, so I'm well ahead. I hope this plan continues into the years to come!
Medicare Advantage plans are great as long as you don't get sick and go in the hospital. That's when you get what you pay for. Really, look at your benefits in detail. Your rehab days are limited, your doctor choices are limited, your home health is limited. I do home health physical therapy and I see this every damn day. Traditional medicare with a supplement is the best deal going. Stay healthy my friend
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Old 09-11-2015, 07:28 PM
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Yeah, total rip off. Only good for when you wrap your car around a tree.
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Old 09-11-2015, 07:44 PM
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Originally Posted by Jonesy23 View Post
...
I'm a conservative but I'm leaning more and more toward a Canadian style system. At the very least these politicians need to come up with a system where I pay my premium and that's it, no copay bs, no deductable, no denying procedures or test, nothing out of pocket except my premium.
There's no way I'm paying almost $80 a pill for cholesterol meds so I hope they have a stack of coupons.
Rant over.
That system where you pay premium and then get everything covered with nothing out of pocket was HMOs which got us into the mess we are in. Once we divorced the free market and having the patient pay for part of the costs, costs rise without any checks. For the Canadian system your premium would be more (or just call it a tax) and then if you want an MRI or cataracts out, wait until next year because they have already maxed out payments for the year...
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Old 09-11-2015, 07:49 PM
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A huge crock of poop. Don't mind paying my own way, but its ridiculous. Premiums are out of control and then it doesn't pay much in day to day health costs. All the money for the "just in case" tests, the "for the people" lawsuits and settlements, those who do not pay for their own, docs who pay $50,000 a pop for hunting trips, and other miscellaneous costs incurred by hospitals have to come from somewhere.
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Old 09-11-2015, 07:51 PM
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My wife and I are healthy, live out of the country most of the time, spend 7K a year on health care with a 10k deductible... thanks turd.
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Old 09-11-2015, 07:55 PM
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Originally Posted by Sprockets View Post
Insurance is the transfer of risk for a payment. .
This^
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Old 09-11-2015, 08:16 PM
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I have Cigna with the city and I think it's shit insurance also.
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Old 09-11-2015, 08:48 PM
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Originally Posted by Angler Management 2433 View Post
I'm with ya. I've got a fracture in my lower back, FRACTURE!!! (Don't know how I did it) and the insurance has refused to pay for surgery. They keep telling me to give physical therapy a try. I have for 3 months although all 3 specialist and the surgeon have relayed to them that therapy will not help. It won't fix a fracture. But what do they know, they're just Dr's. I mean BCBS of NC knows everything right? This has gone on since last Dec. I finally got word today that they've approved the surgery, thank God. Oct. 21st can't come soon enough. It's bad when most days my 9 year old son has to help me get out of bed, get my shoes etc... I mean, wtf, who can't live with a little pain, right. They don't want to pay for the nessisary treatments, test, scans etc but I'll be damned if you're late with their monthly premiums. It's a joke. Rant over as well.
Whatever the docs say it does not matter anymore... a bureaucrat behind a desk has the last saying, and he will be basically making a business decision based on the data he receive (doctor notes, Xrays, history etc...)

That bureaucrat has no incentive whatsoever to authorize your treatment, actually the other way around... they are trained to look for ways to stay in the gray areas providing you with the bare minimum and the cheapest alternative.

If you do not agree with his decision you can appeal it (very few would even understand and complete the process), now the burden is on you and your doctor to justify why certain treatment or procedure is the only option should be authorized.
Your appeal goes to a professional on the specialty that you need your procedure done. Do not kid yourself, that guy is employed by your HMO, and his work is to find holes on your physicians justification.

The better the appeal your doc would write, the more chances you have to beat the other guy. Now, bare in mind that you have to convince your doctor to take time to write a bulletproof justification, based on the data and supporting docs about your problem that he has, and all these would be for free.
He will not get paid for any of that time and he has to be very careful with what he writes and what he based his recommendation... The guy on the other side may be better or has more experience in the field, or have alternative ways (legal and contractually valid under the policy you bought) to challenge his recommendation or simple refuse it.

You may (eventually) get pissed and move to another company, but they are gambling with the chance that you may not have that option.
Also they hope that by delaying as much as they can you may give up and just go through life with your problem, or reach your deductible renewal and have to pay from your own pocket, etc.....

I see it happen every single day. and I can assure you is not going to get better at all, any time soon.

I can give you some policy coverage determinations guidelines that you could not believe are real....
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Old 09-11-2015, 09:10 PM
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20% along with co-pays is not insurance anymore. Working people are the least protected. Put your assets in somebody else's name and get subsidised if you are going to have a lot of medical bills.
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Old 09-11-2015, 09:27 PM
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Originally Posted by Jonesy23 View Post
So I have Cigna, for a family of 5 is about $1000 a month, 80/20 plan with $2500 deductable, no vision or dental included.
My doc tells me last year ti get an MRI, insurance says it's not covered, not necesaary, so I don't get it done. Now doc wants me on cholesterol meds, I pushed it off for a couple years trying to get it down on my own but my bad levels haven't come down so I agree. He called the script in today and I get a call from the RX, the insurance company pay for none of it, $220 a month for 30 pills! Lucky the rx found me a coupon for a free month and the doc gave me a coupon for a discount on the first 3 months.
My regular doc visit copay is $40, my last blood and urine test the doc ordered cost me $100 out of pocket. So what am I paying premiums for??? Insurance is pretty much worthless unless there is a major hospital issue and even then it's $2500 out of pocket up front and then the insurance Co will deny half the crap the hospital charges for and then I'll get a separate bill from every "specialist" that saw me or from the "specialist" that are out of network that see me at an in network hospital.
I'm a conservative but I'm leaning more and more toward a Canadian style system. At the very least these politicians need to come up with a system where I pay my premium and that's it, no copay bs, no deductable, no denying procedures or test, nothing out of pocket except my premium.
There's no way I'm paying almost $80 a pill for cholesterol meds so I hope they have a stack of coupons.
Rant over.
I'm gonna cut through the BS - you are getting what you paid for. I sell health insurance for a living ( along with property and casualty). The Canadian system works but the taxes are $$$. Heck go to Denmark- "free" college education and health insurance - for tax $$$$$$.

That said I am by no means defending our current flawed system, I know people at large insurance companies who got high 6 figure bonuses as a result of the ACA aka Obamacare.

What we have to consider is that a good portion of our premiums paid go to people with no coverage or who aren't supposed to be here to begin with. But that's a whole other topic.
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