[tiereenny]

So, this crappy insurance cost me $3k a year out of my paycheck.

Last sunday my eye was irritated, took my contacts out think it was just a bad day, I was outside in the sun/wind all day and that usually dries my contacts out.

Well sunday night my eye was bright red, this is bad, but it doesn't hurt, and its not swollen/tearing up so I sleep on it. Next day its red. So I tried to get an appointment. Couldn't get one till today at 7AM. So as this goes on, my eye is getting better on its own.

The Dr can't find anything wrong other than to say I have conjunctivitis (irritation of the eye essentially). NO CRAP! I'm here because is red and irritated. WHY IS IT RED.

So comes time to pay the bill, nope sorry, you have to pay it all out of pocket? WTF? Why do I even have insurance if you aren't going to cover anything until $500 in.

He prescribes some anti-inflammatory and anti-biotic eye drops. BTW, he still hasn't even determined if its a bacterial, or viral infection.

So I go to pickup the prescription. $215!! For 1oz of the crap!?!?

Screw this insurance crap. If all they are going to do is take my money and never dish out then I'm not paying for it. I'll find my own insurance.

This has been a rant by some who pays $3k a year, and apparently that gets me NOTHING till I spend another $500.

And for those who wear glasses, my vision is like 20/500 or 20/600. What the average person sees at 500 or 600ft, I need to be 20ft away from to see in the same detail. This falls under the legally blind category without vision correction. In fact I cannot read a computer monitor unless I have my eyes about 6-7" away from the screen, and I'm NEAR sighted.

[cokLoolioli]

In my opinion the only reason insurance is worth the money it is if something catastrophic happens and you wind up in the hospital for days. You would probably be better off getting your own policy with a very high deductible and putting the remainder of the money you save in a bank account for minor doctor visits.

[aburva.org]

I guess that the one thing that the medical insurance industry in America makes, aside from a ton of money for a select group of people, is firm believers in universal healthcare.

[77Dinaartickire]

That's why I like my company insurance policy. There is none.

Instead, I get to choose whatever company I want for insurance and my job reimburses me up to $200 per month above my normal paycheck just for health insurance.

Also, there has been articles about this, is it's sometimes cheaper to tell the hospital you don't have insurance. Sometimes the cash discounts costs less then if you have insurance involved.

--- Post Update ---

I guess that the one thing that the medical insurance industry in America makes, aside from a ton of money for a select group of people, is firm believers in universal healthcare.

I envy the Canadian Healthcare system

[bypeTeenehalT]

A few months ago when I had emergency room visit followed by surgery that same day to remove my gull bladder, if I didn't have insurance I would be about 90yrs old by the time I could pay off the bill at $50/month.

So that one day was worth an entire lifetimes worth of insurance payments. It blows, but when something drastic happens, you'll be happy.

[P1international]

As someone works for an insurance company let me tell you, I get it. I really really do. The sad reality is, paying 250 a month isn't actually lot when it comes to the grand scheme of covering medical costs.

If insurance was based 100% on what everyone paid in, and everything was just covered with only that money, the premiums would be through the roof. Not even the roof, you'd be sitting on Jupiter.

Insurance pools are figured up on a few things and the most crucial factor before age, sex, sickness, medical history even comes into play. First, is the insurance company for profit or not-for-profit? The company I work for is not-for-profit, which means 80% of the funds we take in (among a slew of other restrictions we have to abide by) is used for paying claims. The other 20% is to run the business, pay the bills, pay the staff.

When you have a for profit company you have shareholders to deal with.

Then on top of that, the pools are based on history of claims not just from you, but from everyone in your given age range, sex, tobacco use, or if it is a policy through an your job that, they take the history from everyone and try to average it so it can cover everyone. Since it can never be 100% coverage across the board there are a few things that do accumulate to your out of pocket costs:

Premium - the amount of money everyone puts together to be able to pay for the anticipated use of the medical services for the coming year.

Deductible, higher it is, lower premiums get, because higher deductible plans are generally set up for catastrophic issues.

Coinsurance or Stop Loss or Out of Pocket (it is called a lot of things) - this is the break of % between you and your insurance, it might be 20/80, it might be 10/90 or even 50/50. Usually this has a maximum and when it is met, they cover you 100% of the allowable (contracted rate with a given provider who has signed up to be participating with your insurance)

Copays - Really good things. Most people look at them like WTF i have to pay more money? Most of the time that 20-60 copay is covering quite a bit of services, or sometimes it could just be charge drs have for even seeing them, and when I say see them I mean physically walking through their door. (think cover charge at a bar in some cases)

Pre-Existing waiting periods - These things are not here to stick to people with diabetes or tell cancer patients to **** off, these are there because NEWS FLASH medical costs are not cheap, but due to the Portability Act of 1996 with HIPAA, you can provide what is called credible coverage so you can have credit off or remove your waiting periods completely from your previous insurance.

I'd say paying 250 a month for a 500.00 deductible is very reasonable. Most people don't have to go to the doctor for nearly as many serious issues as they would think they need too, so a lot of the times your premiums are paying for the sick people of the pool. Healthcare reform (USA here), grants says most routine services have to be covered 100% of allowable, and this is to try and get people to stay in good health and not need to worry about having a low deductible plan because they plan on living at the doctor.

Trust me when I say this though, you may pay 3k every year but if you truly needed to use your insurance in the case of an accident or whatever, you can rest assured you'll be paying a lot less than the insurance company will.

As far as your prescription, that may be your plan, I don't handle RX at my work, just medical, but it does seem rather high.


In regards to your vision, most insurance carve out routine vision (plain on check eyes for new glasses stuff) and retain the medical side (I got hit in the head with a ball and now my eyes don't work).


And one last big thing, with employer policies, some of your coverage cost is based on what they can afford to pay themselves, high premiums from you can either mean great coverage picked out for you or a really tight ass employer.

[zCLadw3R]

Hooray for the NHS! Ok, you may come out of the hospital with AIDS or something, but at least it was free!

[Gymngatagaica]

Hooray for the NHS!

Agreed.

I'm not generally a fan of state owned and state run 'industries' but, despite its faults, the NHS does an incredible job.

I was quite ill at the beginning of this year. Went to my GP who diagnosed tonsillitis. Two days later I was going downhill rapidly and my wife took me back to see him. He took one look in my gob and immediately phoned the hospital to refer me there and packed me off.

(Even now I'm not sure what I had and I'm not 100% sure the Doctors did but hey ho).

Anyway, straight into the Emergency Dept. Got seen by a Dr within 30 mins who sent me straight up to the ward. I was having trouble swallowing, the pain in my throat was unbelievable and I felt genuinely crap.

Hooked up to an IV of fluids and AntiBiotics. Was there one night. Got transferred to the other Hospital in Hull to a specialist ward. Spent seven nights there on various AnitBiotics etc. whilst having cameras shoved up my nose and god knows what else.

Eventually got home with more antibiotics and was off work a further week and a bit.

Cost to me? Zero.

Now, people (especially our American friends on here) will point out that the cost wasn't zero as we pay more tax over here than they do.

Fair point. But instead of lying at home worrying how the hell I was going to pay my medical bill, or worrying what effect it would have on my insurance premiums, or worrying about getting ill again, I was able to rest and recuperate, safe in the knowledge that if I did become ill again, I would be straight back to the NHS, no up front costs, no increased premiums, no stress.

It's not perfect, but I would take it over the American system every day of the week.

[fectsnanteemy]

It doesn't matter how you pay for healthcare, whether via insurance, taxes or good hard currency. The fact is, the cost of healthcare in the US is too high, full stop. The reasons are varied and complex, but there are a lot of companies making a lot of money from it. Ultimately this isn't sustainable and eventually it'll become a very serious problem for the majority of people, not just a minority.

[Cofeeman]

Healthcare will balloon no matter what country as we get older. US is worse due to environmental factors and most people's diet and habits but Europe, US, Japan, Korea, China have serious issues for the future. Unfortunately, there are moral issues as to why this cannot be fixed easily.

[fectsnanteemy]

Healthcare will balloon no matter what country as we get older. US is worse due to environmental factors and most people's diet and habits but Europe, US, Japan, Korea, China have serious issues for the future. Unfortunately, there are moral issues as to why this cannot be fixed easily.

Not exactly, it's higher per capita than anywhere else, not just in gross terms.

[nuveem7070]

Another problem with US healthcare is that the doctors get paid "fee for service", that comes with the tags that need to be put on bills so that the doctor is paid appropriately.

Well, just because of that there is a whole industry with 200,000 people employed just to create and manage these tags and according to sources, it's very fast growing industry.

That's one of the other things which are bloating up health care cost in the US, that and the fact that "fee for service" encourages doctors to perform more operations since they would just get paid more if they perform more of them, which ends up leading to a 33% of healthcare being unneeded, which is again driving up insurance premiums.

[fectsnanteemy]

Another problem with US healthcare is that the doctors get paid "fee for service", that comes with the tags that need to be put on bills so that the doctor is paid appropriately.

Well, just because of that there is a whole industry with 200,000 people employed just to create and manage these tags and according to sources, it's very fast growing industry.

That's one of the other things which are bloating up health care cost in the US, that and the fact that "fee for service" encourages doctors to perform more operations since they would just get paid more if they perform more of them, which ends up leading to a 33% of healthcare being unneeded, which is again driving up insurance premiums.

I think Doctors are busy enough without making up procedures and needless care. Perhaps some are milking it, but I doubt it's endemic. As for 200,000 people managing bills, that's about $11bn in costs annually, or 0.37% of all spending.

[dfuzioniag]

Healthcare will balloon no matter what country as we get older. US is worse due to environmental factors and most people's diet and habits but Europe, US, Japan, Korea, China have serious issues for the future. Unfortunately, there are moral issues as to why this cannot be fixed easily.

While true, it does not mean nothing needs to be done to:

- Stop lawyers making money of healthcare related claims
- Slap the pharamceutical companies if they make up cost for no innovation
- Keep the base healthcare service at a reasonable level, some procedures/treatments covered under our base healthcare service are just luxuries driving up the premiums (and we even get to vote on these things yet it always passes because people do not pay their costs...)
- Work on efficency, if all bills are paid electronically and all policies are managed online some companies here give rebates
- have a reasonable discussion about how ethical it is to keep someone alive in a poor state and how much relatives or the people themselves can decide about death (while it has financial implications, if you ever had someone in your family being kept alive in misery you know it is not about money)

I pay about 3k with a 2.5k deductible with 2.1k of it being just for the base coverage...

[nuveem7070]

I think Doctors are busy enough without making up procedures and needless care. Perhaps some are milking it, but I doubt it's endemic. As for 200,000 people managing bills, that's about $11bn in costs annually, or 0.37% of all spending.

I'm not saying that they are all making up procedures but there is a big amount of needless care though and it is endemic, it really weird because there is also variations according to region or town, certain towns would have a lot of a certain procedure and in the next they would be having overwhelmingly another procedure.

Check Jack Wennbergs research on this stuff.

Also, those 200,000 don't manage bills, they just create the codes for the different procedures to be used on bills. It's called The American Association of Professional Coders. It's the fastest rising job market in the US, estimated to rise up to 20% more in the next decade.

In the case of billing is much worse, with certain hospitals spending 20-25 percent of revenue on just billing (some of it is due to wrong codes being used, since every health insurance company uses different codes as well).

[P1international]

It doesn't matter how you pay for healthcare, whether via insurance, taxes or good hard currency. The fact is, the cost of healthcare in the US is too high, full stop. The reasons are varied and complex, but there are a lot of companies making a lot of money from it. Ultimately this isn't sustainable and eventually it'll become a very serious problem for the majority of people, not just a minority.

Yup. Medical Costs are crazy.

[Kolokireo]

Old job medical = $1,000 in premiums $2,000 out of pocket cost. They also gave me $1,000 in an HRA so my premiums basically went to the HRA. $2,000 a year out of my pocket to max out. After that I don't pay a dime. For anything. Office visits, drugs, etc. are $0.00. $2,000/yr wasn't bad at all. Now that I've switched jobs I'm finishing the year out on COBRA at $450/mo. :\

New job is $265/mo for insurance with reasonable co-pays, unsure on the drug coverage. No deductible. As long as my meds don't cost an arm and a leg every month in copays I can deal with it.

The one thing I can say about my previous employer is that no matter how low you are on the corporate ladder you get amazing insurance that scales with your pay. The front line call center dudes pay even less than I paid and get identical coverage.

[Rnlvifov]

High deductible isn't too bad. Normal doctor visits count towards it. Once you hit that limit it goes away. Not really a bad thing unless you wanna pay a lot more for a lower deductible.

At least going to see the eye doctor counts towards your deductible. My wife is currently under a policy that doesn't cover dental, eyes, or really even much for the general doctor. I don't mind too much. Those are generally just little bills. $150 cleaning for teeth twice a year is nothing. $500 for the eye doctor is nothing that lasts as long as you can still see through your glasses and don't break/loss them. etc. What it rocks in though is in expensive care.

I just had a child, and this insurance is paying for most all of it. The insurance she was on before this new insurance would cover 100% of preventive care/services but if we still had it now we would pay 100% for this birth.

The insurance she is on now is way better for major events that get expensive. The other insurance was awesome for a lot of the basic services or services that are already pretty cheap but wouldn't cover much in terms of medical emergencies or just when stuff got expensive in general.

[cokLoolioli]

High deductible isn't too bad. Normal doctor visits count towards it. Once you hit that limit it goes away. Not really a bad thing unless you wanna pay a lot more for a lower deductible.

At least going to see the eye doctor counts towards your deductible. My wife is currently under a policy that doesn't cover dental, eyes, or really even much for the general doctor. I don't mind too much. Those are generally just little bills. $150 cleaning for teeth twice a year is nothing. $500 for the eye doctor is nothing that lasts as long as you can still see through your glasses and don't break/loss them. etc. What it rocks in though is in expensive care.

I just had a child, and this insurance is paying for most all of it. The insurance she was on before this new insurance would cover 100% of preventive care/services but if we still had it now we would pay 100% for this birth.

The insurance she is on now is way better for major events that get expensive. The other insurance was awesome for a lot of the basic services or services that are already pretty cheap but wouldn't cover much in terms of medical emergencies or just when stuff got expensive in general.

That's pretty much how I feel. Get insurance with a high deductible, and simply pay out of pocket for minor visits.

[flowersnewaho]

I feel very fortunate and blessed to have the insurance coverage that I have currently. This year has been quite an experience, and while I've had a few dollars come out of my pocket, the insurance has paid out big time. The insurance at my last job sucked big time (engineering contractor). We had three policies to choose from. $5,000 yearly benefit maximum, $15,000 maximum, or $150,000 maximum. Oh, and it only paid 70% of covered expenses after your deductible. Seeing how the smaller two policies were a joke, I took the $150,000 policy and was paying $130+ each week for my insurance (incl. dental, vision, and a small life insurance policy).

That's pretty much how I feel. Get insurance with a high deductible, and simply pay out of pocket for minor visits.

That's kinda what I've got. I have two options at work. Policy A with a $500 deductible and $500 co-insurance, or Policy B with a $750 co-insurance with no deductible. In-network coverage is identical, while Policy B pays a little better for out of network. Of course, I've not come across many (I can't remember any, quite honestly) doctors or hospitals that don't take our insurance, so I don't see the point.
The funny thing is that for Policy B, you pay quite a bit more than $250 more per year for it, so I've opted for Policy A each year. I remember doing the math, and there weren't too many scenarios that Policy B made sense for a single person such as myself.