Health Insurance

[jrnyc]

having insurance doesn't mean having good insurance...
no matter how long one has worked and paid into all the programs
that take money from a person's paycheck...the insurance offered
by employers or former employers leaves a lot to be desired...
and the choices are not always choices...but requirements...

the City of NY
(thank you Mr Bloomberg...didn't think i could like him less...
i was wrong) recently forced their retirees and employees who
are on Medicare to switch insurance (insurance obtained thru
employment by City) to a Medicare Advantage Plan...no choice...

this Advantage Plan has cheaper premiums...
BUT...i rather go back to the plan i had before, pay twice as much
in premiums (not including the money i also pay to Medicare)
and have the better coverage...but i am not allowed to do that..
i rather have the old plan...(even with double the premiums)
because now, there are doctors...including scoli specialists...
who have told me they do not take the Aetna Medicare Advantage Plan
that i had to switch to as of November 2012.

i will be investigating other options after husband can get Medicare
January 2014....but i do not expect to find great choices...

sooooo...my venting about insurance that comes thru employers
(or former employers) is over...

no answers....just venting...

jess...and Sparky ( puppy now has costly insurance that does not cover
pre existing conditions)

[tae_tap]

The Medicare advantage plans are one thing that really upsets me working in the healthcare system. I have seen many of our elderly patients be suckered into changing from straight Medicare and not explained that the advantage plan sucks! The coverage and deductible are not good and most of our patients can not afford the extra bill that is left behind. Our diabetic patients have it the worse because their coverages are sliced even further.

I encourage anyone that has Medicare and the option to pick if they want an advantage plan to stay away. Find a good secondary and stick to the old way.

My vent! (smiley)

Tamena

[Anthony's Dad]

Anthem Blue Cross

Like winning a jackpot at Vegas, insurance is amazing when it works, but it seems like the house (read: insurance company) always wins.

If we can talk specifics: Bills are still rolling in, but Anthony's growth rod surgery in May 2013 at Rady Children's Hospital San Diego has cost more than $230,000. Of course, Anthem is a monopoly and has all these hospitals and doctors under contract, so Anthem never really pays out $230,000.

Anthony is on the same Anthem Blue Cross PPO policy as my wife, my 18 year daughter and me. I have been paying $1,722 a month for that Anthem policy which is pretty much the only insurance we can get because of my health history. Prior to the current Anthem policy, I have been paying monthly premiums of approximately $2,000 a month for coverage from Anthem or Blue Shield since I went on disability in August 2008.

Except for Anthony's surgery in May, 2013, my family has hardly seen a doctor this year. Because of my disability, I was finally able to go on Medicare Part B on July 1, 2013, so I asked my insurance broker friend (who doesn't charge me) to find new coverage for Anthony, my wife and daughter or to continue with Anthem at a lesser premium. My insurance broker talked to various insurance companies and told me that no one would cover my wife, daughter and Anthony because of Anthony's recent surgery. The only way to get coverage was to continue the existing policy with Anthem and continue paying $1,722 a month - even though I am paying for separate Medicare Part B and D coverage. The only saving grace is that my broker tells me that because of new laws (the Affordable Care Act), the insurance companies are not going to be able to deny Anthony coverage effective January 1, 2014 because of his pre-existing condition. Having said this, my broker cannot tell me whether the premium for Anthony, my wife and daughter will continue at $1,722, although she expects it should be less with one of the carriers as a result of the Affordable Care Act. However, my decision about insurance carriers will depend greatly on whether Anthony's doctors have contracts with that company.

Anthony will be facing at least one more major surgery in a few years. In all likelihood, I am going to try to return to work in a few years to pay for insurance and other bills. I worry that the Affordable Care Act will force our highly skilled surgeons to go off the grid and demand private payment for services.
I sincerely hope I am wrong.

If for some reason I'm not around, I'm grateful to know that we have amazing people in this world like the Shriners and other fine organizations to help our children. I am going to send another donation now. Shriners now takes PayPal.

--Steve

[rohrer01]

I talked to my husband's insurance coordinator at work before signing on. She asked me about my health history and just cringed at the thought of adding me. I wanted to try to buy insurance in the private sector but was deemed "uninsurable" because of my back and heart issues. It's a real blow to hear that a healthy 30 something woman with two non-life threatening conditions is "uninsurable". I've had to go on my husband's plan. Now, unfortunately for all the others on the group plan, people like me drive the premiums up. We pay about $856/mo because the employer pays half for my husband. To add my kids would cost >$400/mo. My boys won't split the difference and pay us and my daughter and her son have Medicaid. So, my boys go uninsured because we can't afford even $400/mo more. On the up side for me, every year that I've had that insurance, the house loses. My health care costs exceed our premiums and deductibles. But it still costs us well over $1000.00/mo every month. At least I'm getting treatment that I wouldn't have been able to get otherwise, even on Medicaid. My Botox injections alone run about $4000.00 every three months. There's no way Medicaid would have ever considered paying for that. They'd rather see me be drug dependent for the rest of my shortened life. It's more cost-effective that way.

I don't know how I feel about the Affordable Care Act. I'll have to see how it affects people, especially my boys. I think back to the frontier days. No one in their right mind would have even thought about forcing people to carry insurance. Heck, it didn't even exist back then. Hardly anything was regulated, except murder.

[leahdragonfly]

Hi rohrer,

Our family had to buy private health insurance for a few months when we moved from CA to Oregon, until I got a job with a group plan. At that time I hadn't seen an orthopedist since 1984 so my back was a non-issue, and my kids were little with no know health problems, so we got insurance without difficulty. My husband was denied, though, at age 38 because he takes high blood pressure medicine. He is otherwise healthy and his BP is well-controlled. They denied him for that reason, which we found incredible.

Yes, insurance today is a mess. When I had my first surgery and ran out my FMLA, I had to pay full-price for one month of insurance through my employer. For our family of four it was over $2200 for one month!! Totally outrageous in my opinion.