Do you have health insurance?

opiate82_sl said:

No need to get angry, we can be civil. I didn't say that part specifically was bad. However, people like you are going to drive prices up. That is simply the way it is. Obamacare is suppose to offset this increase by forcing everyone to buy insurance. Healthy people will subsidize the costs for all the people with pre-existing conditions coming into the system. But as I stated, with pricing already rapidly rising thanks to the unknown cost impact all these pre-existing condition people will bring, most healthy people who already don't buy insurance because it is to expensive, will still not enter the system and instead will pay the fine.

Click to expand...

Yeah sorry about that, I guess it is a touchy subject for me.

The problem is, *in theory* if everyone is insured and hospital bills aren't going unpaid at alarming rates with paying customers(insured) making up the difference to cover for non-paying customers, medical care(especially emergency medical care) prices should go down, and as a result insurance premiums should go down.

In reality, none of that will happen. Hospitals and doctors will keep charging the same if not more as they do now, they'll just make even more profit once they don't have as many deadbeat customers that don't pay, because they know that even if they lowered their prices, insurance companies aren't going to lower their premiums, so fuck it, why lower prices?

Neither hospitals/doctors, nor insurance companies are going to do anything for the good of the common people(lowering prices), they are going to do what they can to make the most money possible, just like any other business or corporation in America would.

karma_sl said:

Eventually, something will have to be done (and by done I mean regulation wise) about premiums. Anyone who thinks the insurance companies wont continue to raise them till nobody can afford it is an optimist. Blue Cross weaseled out of the premium rebate that was supposed to help keep them affordable this past year. They will do it again next year.

At least we have the someplace to start health care wise now. Hopefully the AFA isnt the end of health care coverage change in the US, and only the beginning.

Click to expand...

Built into Obamacare is the 80/20 rule. What it means is that insurance companies must spend at least 80% of revenues received directly on medical care and can only spend up to 20% of revenues on administrative costs. That is where that "$1.5 billion in savings" came from in article above. Some companies had to pay rebates because they fell short of the 80/20 ratio. However most insurance companies, especially those that offer benefits to businesses, are already under that ratio.

Insurance companies aren't raising the rates simply because they can. Medical costs continue to rise, children are now allowed to stay on their parents plans longer, and the main factor that will drive prices up even further in '14 is that insurance companies will have to offer the same insurance rates to people with pre-existing conditions.

The insurance companies aren't COMPLETELY heartless. They are for-profit, which by definition means that they kind of have to charge more and more every year to appease shareholders. But that's not the reason for giant premium increases.

its a massive discussion which I don't mind getting into, but honestly it all goes back to the cost of education.

I'll try a cliff notes version and if anyone wants me to go into more detail from an insurance company perspective I'll gladly elaborate!

doctors are in massive amounts of debt right out of school. WAY more so (even factoring in inflation) than 10,20,30,40 etc years ago. In order to make a good wage, and afford student loan debt, they have to charge a lot. But what makes matters worse is competition.

I'll give an example, you have had a rough headache for over a week, you see your doctor and he says you should probably see a neurologist as they may want to do a mri. You look up doctors in your area and you find two, one who has a small practice, and another who works in a hospital pavilion with a MRI machine on site. Ignoring the quality of the doctor for a second, the choice is pretty clear. You're going to go to the one-stop-shop instead of being referred everywhere and making multiple appointments. Small doctor is losing a lot of business and decides he needs a MRI machine to stay competitive. That's a MASSIVE investment that is not only passed on in terms of higher costs for services, but now the doctor has a financial incentive to do as many mri's as possible to offset the cost of the loan.

I see this every day, mri's/cat scans/ct scans for bad reasons. And in the day of amazing benefits, consumers didn't give a shit on how much they cost, since insurance was footing the bill.

The cost of medical services are still skyrocketting, WAY faster than insurance premiums. Insurance had to invent the high deductible plans to start making consumers aware of the cost of the services.

that's why it looks like benefits are worse while premiums are higher. To even begin to start tackling insurance rates, we have to deal with the cost of medical services, and that is largely due to education costs and lack of affordable care. People go to ERs when they can't get regular treatment, and hospitals can charge whatever the fuck they want since they know they can pass those bills on to the government/tax payer and collections agencies when the patient can't pay

Just because you're under a magic age doesn't necessarily mean you should go for a high deductible. At 26 I was healthy, rarely sick. However, I found out that the constant stomach flu I had been having for the past 10 years (stupid doctors) was because I drastically went from a low fat, mainly vegetable diet to a high fat eat whatever I want diet when I was 16. All it took was that one gall bladder surgery to bankrupt me. I had to lie my ass off to get the surgery because being uninsured no one wanted to touch me because they felt that if I ate right I would stop having attacks. Which was wrong. I ended up getting the surgery but the $30k I was in debt meant I filed for bankruptcy at 27. Those hospital bills were 95% of my debt.

Fast forward another 10 years and I find a lump in my breast. At this point I was on my husband's insurance and if I hadn't been, I would have been screwed all over again. I don't begrudge the ~$300/mo. we pay towards health insurance/vision/dental. It has gotten us through countless diagnostic tests, a double mastectomy and a ridiculous number of breast reconstruction surgeries.

Now, I know most of the people here are guys but some things can strike regardless of age. If I had to beg or steal the money I wouldn't think of going without insurance. Yeah, it's an 'in case shit' kind of thing but many things are a gamble. In case shit happens, I'm covered. If you can find a way to afford it, you should be too.

yeah. Self employed. Can't possibly afford insurance.
Well, couldn't when I looked the last few years. did better this year.

going in next Friday for a biopsy, on a thyroid cyst.
which if even good news probably means that 200/month will be 400+/month if I try to get insurance again. which is back into can't afford range.
comics do not pay that well.

Caliane_sl said:

yeah. Self employed. Can't possibly afford insurance.
Well, couldn't when I looked the last few years. did better this year.

going in next Friday for a biopsy, on a thyroid cyst.
which if even good news probably means that 200/month will be 400+/month if I try to get insurance again. which is back into can't afford range.
comics do not pay that well.

Click to expand...

what state are you in? Have you tried ehealthinsurance.com?

I have the "in case I get shot" plan that costs me something like 40$/month and has a 2500$ yearly deductable or something insane. I considering getting a real plan, but of my options the "best" one was fucking 180$/month for just me and STILL had a 500$ yearly deductable on it for some ungodly reason. I do have full dental for 10$/month though which is nice, and it's about to cover them saving my jaw in half or some shit to fix my teeth.

walnut_sl said:

Hey all. I work in the insurance industry, if you have any questions or issues in particular, let me know, I can probably help.

And if you have Aetna, I have access to claims systems and stuff. But ask me Aetna related things in PM please. HIPAA shit obviously

Click to expand...

I've had Aetna through my employer for most of my six years there. It was awesome at first.

My plan around 2009ish covered the entirety of my son's birth/wife's cesarean to the tune of ~$20,000. Then it changed it covered most of my daughter's birth in 2011, around ~$15,000, and I paid just over a thousand out-of-pocket for various hospital expenses.

For 2013 I believe it's still 85/15, but now for the first time ever there's a $200 yearly deductible. But it's still around $80 every two weeks for coverage for my family of four, with dental and vision, salary-matched life insurance, $100k voluntary life insurance, $20k spouse, $5k children.

November_sl said:

I've had Aetna through my employer for most of my six years there. It was awesome at first.

My plan around 2009ish covered the entirety of my son's birth/wife's cesarean to the tune of ~$20,000. Then it changed it covered most of my daughter's birth in 2011, around ~$15,000, and I paid just over a thousand out-of-pocket for various hospital expenses.

For 2013 I believe it's still 85/15, but now for the first time ever there's a $200 yearly deductible. But it's still around $80 every two weeks for coverage for my family of four, with dental and vision, salary-matched life insurance, $100k voluntary life insurance, $20k spouse, $5k children.

Click to expand...

I don't know who your employer is, but let me tell you, a plan with a $200 deductible and is $80 every 2 weeks for a family of four is in the top 5% of plans available out there right now. If you ever have ANY problems with claims or anything let me know and I will fix that shit

80/20 with my 2nd kid, nearly 2 years ago. The bill was 11k. A week later he developed RSV and pneumonia, and was hospitalized for nearly 4 days. Another 20k, and it didn't count towards our out of pocket maximum for the birth since they tried the "Well, out of pocket max for your wife for the birth, but not out of pocket max for the childs coverage".

Not a huge fan of the insurance industry. But thank goodness for our health care "people". Other than one nurse, we had a fantastic experience considering we were both fairly scared he wouldn't make it.

edit: and by "fairly scared" I mean a Man of Science turning towards god, or the devil or anything to get my son better.

Big Phoenix_sl said:

I do not have health insurance. Should prolly pickup one of those just in case I slip and fall on my head plans tho.

Click to expand...

You mean some manner of accident coverage? If you do, READ THE POLICY. I can't count how many times I've had to explain to people that just because a policy is for accidents, that doesn't mean it covers everything that the insured person might consider to be an accident. They frequently have exclusionary language.

I've also seen plenty of hospital bills related to accidents, such as bad MVAs. It's not uncommon to see bills that range anywhere from 200k+ to 1.3 million depending the duration of the stay/the amount of surgeries required. Heck, some of the pills the patient gets everyday, the hospital is charging the person around $80-$150 PER PILL. You are literally charged for everything, right down to disposable wipes or adhesive tape to hold an IV line on your arm.

Unless you were insanely rich, there is literally no way you could afford these hospital bills without insurance.

$150/month for a plan from a Swiss for-profit insurer. (Sorry, limited to Swiss citizens living abroad. The US version of the plan is, of course, the most expensive at that rate.)

Spoilered since people may not care. FWIW: the Swiss system is the model for US reform. In 2014, there's going to be tremendous overlap with pretty much the only difference on the insurance side being that insurance premiums are not deductible in Switzerland (hence no employer offers it).

Now with payments... the wave of the future is to compensate hospitals for the diagnosed condition and not let them bill X-Rays, MRIs, etc individually. Hospitals that release patients early and they end up having complications will have to treat those without reimbursement. Pretty good incentive to do a good and efficient job.

BrutulTM_sl said:

For half the price. It is the same cost to your employer whether they give the money to you or to the insurance company. If you had an extra $2000 in your paycheck every month instead of that coverage, you could get more appropriate coverage and pay for your own massage and come out $1000 ahead every month. I think that unions are stupid for pushing for these Cadillac health plans instead of more pay raises.

Click to expand...

Not the only reason Unions are stupid *cough* ruined car industry and continues to destroy country from the inside in every environment in which it exists *cough*