Venting about Health Insurance

[Samurai_Writer]

OK, so I know there are lots of people who don't have health insurance and I should feel lucky that I do. But what's the point of having health insurance if the deductible is so high you can't afford to meet it, even for necessary surgery?

Here's my situation. My company is switching insurance companies on April 1st. 2 weeks ago, I started having severe pain in my abdomen, which has not gone away. Went for ultrasound and CT scan under our current HMO, so there was no out-of-pocket for me except a $20 co-pay doctor visit. The doctor diagnosed a combination paraumbilical and incisional hernia.

I went to see the surgeon for a consultation today. The earliest the surgery could be scheduled for was April 6th. Not only that, there is only ONE hospital in a 60 mile radius that is 'in network' on this new plan. NOW I come to find out that I have to pay a $1500 deductible UPFRONT before they will even schedule me for surgery!

I'm really pissed at this point. I don't have the $1500, I'm in constant pain, and this type of hernia is VERY prone to becoming strangulated and incarcerated. If that happened, it would require emergency surgery. At least if it's an emergency they wouldn't be asking me for the $1500 right away.

The company I work for told us this plan was Soooo wonderful and it was going to save us a lot of money. NOT!!!! Yes, the premiums are lower, but not by $1500 a year! And that doesn't include the 20% of the total I have to pay AFTER the deductible is met!

Call me a whiny bitch if you want, but what's the point of having an insurance plan if you can't afford to USE it when you need it????

[GOPisEvil]

1. Your company talked this plan up because it is good for them!

Saves THEM a few bucks for the bottom line. Being that * has wrecked the economy, it's not like you're going to rush right out and get another job anyway. This crap will continue until the job market gets back the way it was a few years ago when companies fought for good employees with excellent benefits packages.

I wish you the best.

[boobooday]

2. Totally Immoral

Our health care system is totally immoral. I'm sorry for your problems, believe me, I relate!

Extorting people over their illnesses! Disgusting!

Profiteering from human misery should not be allowed. It is immoral to run hospitals and prisons for profit.

http://www.wgoeshome.com

[mmm]

3. that sounds pretty damn irritating

what would happen if you went to the ER?

[Samurai_Writer]

11. ER is 'covered'

kind of. If I am admitted to ANY hospital through the ER and have surgery, it's treated as 'in network'. But of course, they aren't going to admit me or do surgery on an emergency basis unless I'm practically dying.

[FlaGranny]

4. Only ONE HOSPITAL?

That would scare me right off. It is obviously not a large plan. Almost every hospital joints every single insurance plan.

My company has a pretty decent plan that costs me nearly $300 a month for just myself, but the deductible is pretty good. I'm covered, but under a COBRA which will expire Sept 1. Then I have to make the decision to either go some months without insurance until I'm eligible for Medicare or take a policy with a humungous deductible. I guess I'll wind up paying thousands of dollars so I won't run the risk of losing my home if I get sick.

[Samurai_Writer]

12. only ONE hospital

This is a HUGE, national plan. However, this particular insurance company completely screwed over the larges medical group in this area, and they dropped their plan and will NOT go in their network. Of course, our company didn't tell us THAT when they were giving us the pep talk about the new insurance.

[curlyred]

5. My company pays $30,000-35,000

per month for health insurance for 100 employees. We are partially self insured due to the cost of insurance. I pay $195 per month for myself and two dependents for an 80/20 policy after the first $500.

I know it sucks, and you are right: it could be worse. I don't know anything about your employer, maybe they are naking money hand over fist and could afford a better plan... but I do know that insurance is costing them a LOT, too, and that we should be bitching about how much money some insurance companies are making, and the whole damn healthcare system in general.

Someone is getting rich.

[Samurai_Writer]

13. My company is a Fortune 400 company

and is VERY profitable. They could have kept the old plan with negligible cost to them. But you are right, insurance companies and for-profit medical facilities are raking it in.

[camero]

6. The whole insurance scheme is a major league ripoff

It's almost as if these companies are financing a ponzi scheme so they can play in the casinos.

It's not just health insurance. Life, auto, malpractice, fire, well every form of insurance anyway. One more reason for UHC.

[Love Bug]

7. Go to your Human Resources Dept

Explain the situation to them and ask for them to intercede on your behalf. Your company decides what your benefits are, no matter what insurance company you have. Have you already met your deductible for this plan year? Another option is to call your surgeon and explain the situation to him and ask if your procedure can be scheduled at another hospital before your plan changes on April 1. He also might be able to intercede with the hospital.

Good luck with this.

[Samurai_Writer]

14. My human resources dept...

basically told me 'too fucking bad'. Our current plan is an HMO and there is a very low deductible. I am trying to find a surgeon that can fit me in their schedule before April 1st. In this area, that's going to be tough. We have lots of senior citizens and not very many health care facilities, so they are always full.

[skippysmom]

8. Our system is pathetic

We spend all sorts of money for insurance -- yet somehow there are so many things that need to be covered.

We need universal single payer health insurance pronto.

My best to you, RadFemFL.

[madrchsod]

9. you went under your plan now-

your new plan doesn`t go into effect until April 1. can your doctor schedule you before April first? find out tomorrow. my wife usually switches insurance each year and if anything needs to be done we try to get it done under the insurance at the time. this avoids crap like you are running into.

[Samurai_Writer]

15. Trying to be scheduled earlier...

but I doubt I will be able to. Looking for another surgeon, but the medical care here is limited.

[KT2000]

10. Insurance is really extortion

They are practicing the business strategy called "push back." They will see how much they can get away with before people start to push back. They are counting on people being too sick and exasperated to do that though.

Without insurance, no one is required to assist you in becoming a well functioning person again - the only requirements now are that you be stabilized in the event of an emergency, then released to find your own medical care. In the community where I live that means seeing a volunteer nurse in a charity clinic that is open for 2 hours a week.

Insurance, except for the kind that allows Asscroft to spend a few weeks in the hospital for something the rest of us would be kicked out for in a couple days, is not really in the business of maintaining a healthy population. It is a profit driven enterprise that is increasingly spreading the financial and health risks to policy holders. I hope you tell your employer this is not acceptable.

Got a hold of a text book from a big insurance comapny that was teaching insurance people about the conversion to HMO's - pretty cynical reading.