Quiet today?

vlagrl35 · September 2016

@LillibetteV - congrats on IVF - hope it works for you

LillibetteV · September 2016

@vlagrl35 pick him up some CoQ10 too - my husband's urologist recommended it for sperm health.

vlagrl35 · September 2016

LillibetteV said:

@vlagrl35 pick him up some CoQ10 too - my husband's urologist recommended it for sperm health.

thanks! I'm going to be drugging him up in October lol. He's ok with it though. He won't remember so I will have the vitamins ready for him every morning.

vlagrl35 · October 2016

our ACA blue cross plan won't be available next year so I need to find a different one that is. Just found this out yesterday. In KC only 2 companies are on the exchanges blue cross and humana. I'm even more stressed now to find a similar plan and to conceive and deliver before the ACA implodes on itself come 2018. our current max OOP is 1k for family and we only pay $90 in premium a month. We should have had a baby this year. It is what it is.

brij2006 · October 2016

@vlagrl35 Us agents were just released all of the information about the health insurance changes this year. Only 2 companies are available on and off the exchange in Illinois as well. We were also told a minimum of 25% increase in premiums, and most are taking a 45% increase. Agents are also no longer being paid commissions from BCBS. So we now have to charge a set fee. We have a lot of people in our area that buy private insurance. We only have 2 options to offer that are insanely expensive, high deductibles/maxOOP, and we have to charge an agency fee in order to even get paid anything to help these people.

I haven't been neither pro nor against ACA. It has its strong suits. But I'll just come out and say it. "Affordable healthcare" my ass. How is this affordable? Employers can only afford to offer their employees high deductible plans. My H's family max OOP is $16,000! Insane! After taxes, 401k, insurance, and other deductions, he brings home about $32k/year net. If both him and DD were to get hurt, we would be using HALF of his annual income just to pay the max OOP. Yet our cost for him and DD is $125/week. $6,500/year for them 2, and we have a $4,500 individual deductible and $9,000 individual max OOP. That's all the employer and the employees can afford to pay for. Yet he has guys under him who make $12-15/hour, with families. How the heck are they supposed to be able to afford to even pay for the deductible or max OOP if anything happens? I foresee a lot of bankruptcy's happening because families can not afford to pay for these high max OOP's. Heck, we're trying to figure out where to put #2 for health insurance. If anything happens with the birth, we pay anywhere from $4,500-9,000 just for the child! That's not including the $5k we'll pay for my care on my plan.

I'm curious as to whether or not the background intentions were that passing ACA would end up closing down all of the health insurance companies and us turning to a government provided healthcare system. The way it's going, there are only 2 companies left for any self-employed person to choose from, and the employers can't afford the premiums, which in turn is forcing deductibles to increase that the employees can't afford to pay.

I will say that I do find it funny that with H's physical therapy appointments, we've been on the hook for $140 for each appointment (after insurance pays). He needs it 3 days/week. So we asked what their cash price was each session. $120. If we pay in cash or check on the day of his appointment they discount it to $100. So we're paying for his 16 physical therapy appointments without insurance because it's cheaper than actually using insurance. It's going to save us $640 in just 1 month. That's insane!
Same thing when we were getting started with the RE. It was $750 after insurance for his sperm analysis. If we didn't go through insurance and they pay their piddle amount toward it, we would pay $450 if we paid in cash that day.
It's making me question why the heck we even have insurance.

Okay, I'll get off my soapbox now. As someone who works in the industry, I can't help but roll my eyes at this whole thing. I'm so thankful I don't directly handle the health insurance clients or companies, and the ones who do deserve a case of wine a week.

LillibetteV · October 2016

@brij2006 that's ridiculous! I actually am seriously hating on the prescription benefits manager that my insurer outsources to. I spent all of Saturday fighting to get a medication that I needed to start on Sunday! I called to check the OOP price just in case I had to pay it and fight the insurance after and it was $485 (annoying, but not budget ruining for us thankfully). Luckily I threw a fit and kept going up the supervisor chain until I got them to sort out the mess and I could go pick up my medication. Imagine my surprise when there was $0 copay and the receipt showed that insurance only pays $5 for this particular medication. Seriously?! What a racket by the pharma companies!

jtmh2012 · October 2016

brij2006 said:

It's making me question why the heck we even have insurance.

Ditto. I mean I know we picked the high deductible over the PPO plan, but the deductible keeps going up and going from single to married sucked in terms of the deductible and OOP max. Especially since my wife runs to the doctor for everything. We have an HSA. Just now getting to the point where it covers the OOP if I understand it correctly. Not sure if I'll contribute beyond that amount or not....

smerka · October 2016

Because I have two kids in speech, OT and ABA therapy, we meet our OOP maximum every year. Usually by June. This year we switched to the HDHP with an HSA. We met the $5,200 deductible (which is the same as our OOP max now) by March. That was quite the hit, but starting next year, we will be paying that $5,200 out of the HSA (maxing out the contributions this year and going forward). So in the end, it's working out better for us. Yes paying for medical care sucks. People don't realize how much it costs because employers for so long have covered the premiums.

brij2006 · October 2016

@smerka I feel bad for one of D's co-workers. He has both a son and daughter with special needs. He makes $15/hour and his wife stays home to care for them. They easily meet their family max OOP by the middle of the year. My H is his manager and he said he was in his office crying because he knows there's no way they can afford to pay for the care their children need. Yet because of the ACA rules, he can not go get his own policy outside of his employer. He can put the wife and kids on a separate policy, but now there are only 2 companies to choose from and the premium is insane. He said half of his paycheck would go toward paying for the premium for his wife and 2 kids.
He jokingly told H that he's better off quitting his job.

I seriously wish they would offer an HSA with this high of deductibles. It would at least help a little bit.

vlagrl35 · October 2016

we always had that high max OOP until the ACA came along. We've been blessed by it for sure. Next year is the year we need a low max OOP so I'm hoping for something close or around $1500 for 2017. DH thinks they did it to fail on purpose so we could get single payer - universal coverage.

smerka · October 2016

I think it was too big of a problem to predict everything that was going to happen. There are too many moving parts. It costs a lot of money to cover all those mammograms, wellness visits, etc along with paying for all those formerly pre-existing conditions. I fully recognize that the ACA isn't perfect and needs to be changed, but I think we can all agree the old way was pretty awful.

short+sassy · October 2016

I'm on the soapbox with you all. Healthcare is an outrageous, ridiculously expensive mess. It was before the ACA and it still is.

I don't understand why there aren't better solutions. My job might be switching to part-time in the near future...or I might be losing it completely. Either way, I would need to go on one of the exchanges to buy insurance. So I was checking it out. Not counting subsidies (not sure I'd qualify), it would be around $850/month for my H and I. Though that isn't a high deductible plan. AND I'd still have my prescription copays which would be another $150+/month.

Why? Why is that monthly amount so much? I AM one of those "bad" people with an expensive, chronic medical condition that supposedly makes the rates so "high" for everyone. YET, I pay thousands out of pocket every year on my current high ded. plan for my medication/lab work/dr. visits. Other than my "free" annual check-up visit. My insurance does not pay one dime for anything because I'm always just under the high ded.

So? Where is all that money for premiums going? The vast majority of people cost far less than I do for their medical care...insurance or not. So, if even a "go die in the streets, you can't buy medical insurance (before the ACA)" person like me is not costing insurance companies any money, why such insane amounts for the monthly premium?

smerka · October 2016

I think they've been that high for a long time. When I was working full time, my boss paid 90% and I paid 10%. I paid $40 per month. But the family plan, he didn't pay for anyone but the employee and the employee would have to pay $700 per month. That was before the ACA

julieanne912 · October 2016

I am glad Colorado opted to stay off the exchanges, they have their own in-state one. Last I checked, I was able to find an OK plan for myself, with Kaiser, that was around $250/month. I can't recall the deductible but I know it was low because it was with Kaiser. Now, Kaiser has it's downfalls but there's an excellent Kaiser facility near our house. I ended up getting a job that had insurance so I didn't end up needing it.

In comparison, my pre-ACA plan with Anthem was around $175/mo and didn't include maternity coverage, and had a $5,000 deductible.

AprilZ81 · October 2016

One of the main problems with health care is there are so.many.middlemen with their fingers in the pie. It is a rare case where a patient and doctor can determine the best course of medical treatment without other parties getting involved. Everyone who is involved gets a cut of the cost to cover their expenses so of course the price goes up.

Another big problem is that doctors have to carry insane levels of malpractice insurance. Doctors can get sued millions of dollars for something that really doesn't affect the outcome of the patient and because there are no restrictions the insurance has to pay out. Tort reform will go a long way. Malpractice suits should be saved for gross negligence (cutting off the wrong leg, removing the wrong organs, not payting attention to serious drug interactions, etc.) and not some of these crazy lawsuits that are sent through the courts.

LillibetteV · October 2016

AprilZ81 said:

One of the main problems with health care is there are so.many.middlemen with their fingers in the pie. It is a rare case where a patient and doctor can determine the best course of medical treatment without other parties getting involved. Everyone who is involved gets a cut of the cost to cover their expenses so of course the price goes up.

Another big problem is that doctors have to carry insane levels of malpractice insurance. Doctors can get sued millions of dollars for something that really doesn't affect the outcome of the patient and because there are no restrictions the insurance has to pay out. Tort reform will go a long way. Malpractice suits should be saved for gross negligence (cutting off the wrong leg, removing the wrong organs, not payting attention to serious drug interactions, etc.) and not some of these crazy lawsuits that are sent through the courts.

First bolded - YES. The headaches I've had for IVF are all due to insurance making mistakes. They always get sorted out but it pisses me off that half the people I talk to at my insurer are truly incompetent.

Second bolded. Here in Massachusetts we require plaintiffs to obtain permission from a tribunal before filing in court to exclude frivolous cases. And even if your cases survives that hurdle the docs still win 95% of the time. I saw a few real, actual, gross negligence lawsuits that doctors still were able to win that made me really sad and angry.

brij2006 · October 2016

smerka said:

I think it was too big of a problem to predict everything that was going to happen. There are too many moving parts. It costs a lot of money to cover all those mammograms, wellness visits, etc along with paying for all those formerly pre-existing conditions. I fully recognize that the ACA isn't perfect and needs to be changed, but I think we can all agree the old way was pretty awful.

Oh yes, 100%. I'm even in the industry and couldn't stand how health insurance was before.

You're definitely correct that there was no way to predict everything that was going to happen. But at this point it's obvious that this isn't working either. Now it's creeping to beyond unaffordable.

brij2006 · October 2016

smerka said:

I think it was too big of a problem to predict everything that was going to happen. There are too many moving parts. It costs a lot of money to cover all those mammograms, wellness visits, etc along with paying for all those formerly pre-existing conditions. I fully recognize that the ACA isn't perfect and needs to be changed, but I think we can all agree the old way was pretty awful.

Oh yes, 100%. I'm even in the industry and couldn't stand how health insurance was before.

You're definitely correct that there was no way to predict everything that was going to happen. But at this point it's obvious that this isn't working either. Now it's creeping to beyond unaffordable.

short+sassy · October 2016

AprilZ81 said:

One of the main problems with health care is there are so.many.middlemen with their fingers in the pie. It is a rare case where a patient and doctor can determine the best course of medical treatment without other parties getting involved. Everyone who is involved gets a cut of the cost to cover their expenses so of course the price goes up.

Another big problem is that doctors have to carry insane levels of malpractice insurance. Doctors can get sued millions of dollars for something that really doesn't affect the outcome of the patient and because there are no restrictions the insurance has to pay out. Tort reform will go a long way. Malpractice suits should be saved for gross negligence (cutting off the wrong leg, removing the wrong organs, not payting attention to serious drug interactions, etc.) and not some of these crazy lawsuits that are sent through the courts.

Around the time ACA "yay and nay" discussions were going on, I read an interesting article that pointed out the biggest problem with healthcare was the skyrocketing costs of it. No matter which side of the debate you fall on.

It outlined some of the ways we, as a country, could reduce healthcare costs. Malpractice tort reform/limits on judgments was, by far, item No. 1.

Another fascinating fact I read (different article) was, over the course of a person's lifetime, there is almost no difference in medical care costs for individuals. Not just the "average" is the same. With few exceptions, every single individual costs about the same. In a nutshell, people with medium/serious medical conditions are more expensive to care for in their younger days. But then they aren't as likely to live as long as people who have no health problems. People who have no health problems, have low medical costs in their youth, but will live for 20-30 years as senior citizens and typically have increased health costs at that point in their life.

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