Health insurance woes.

Messages
2,804
Location
NJ
Every year our company does a comparison of Health Insurance Providers and made the switch from Horizon BC&Blue Shield to Aetna. We had Aetna before and it was HORRIBLE. Doctors that were listed as in-network, weren't in network, didn't want to deal with Aetna or didn't want to see anyone enrolled with Aetna. When we switched to Horizon I was ecstatic, it was really good and literally all doors were open. To save 16% on rates they switched back and now I'm boned again. The Doctor I have been seeing under Horizon was pretty good, had a good relationship with him. Wife went yesterday and their office stated I am on a Capitated plan, and they will not accept Aetna. Yet Aetna states they are in-network, have to see me, and I am not Capitated. Doctor won't accept the insurance and I'm getting the run around. I had to cancel my physical for 11/8/11 as well due to to this and now have to find another Doctor that does accept it and hope the stupid Aetna Navigator website is correct. Had this problem with our newborn baby trying to find a Pediatrician that takes Aetna as well :|
 
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Messages
932
Location
USA
It's that time of year again! I can relate to your frustration. My firm was notified that our rates are going up significantly and are now shopping around for the cheapest provider. My rates will probably go up from $1,000/month to $1,200/month. If you truly aren't happy with your employer's plan, you can always shop around for an individual policy. That's what we're currently doing and will hopefully be picking up a bare bones policy (no maternity, no prescriptions, etc.) for half the premium we were paying. Between work and my own broker, I feel like all I do is fill out applications, document a decade of doctor's appointments, gather medical records, and photocopy physician statements.
 
Messages
2,820
Location
Southeast Alabama
I am now retired but during my 40+ years of working worked both in Asia and Europe. National health care in many countries is wonderful............ As long as you don't get sick. Problem here is we ask the medical folks if it is covered by insurance go ahead and do it even if the tests or procedure is not necessary. Some caps on on unreasonable malpractice lawsuits, insurance for major stuff and a savings plan making people more responsible. Simply put in can't keep going like it is now.
 
Messages
932
Location
USA
Originally Posted By: SrDriver
. Problem here is we ask the medical folks if it is covered by insurance go ahead and do it not is it necessary..
Why do you do that? I have a $5,000 and always ask questions about necessity and cost. I can't afford to do otherwise.
 
Messages
5,153
Location
MW
We use my wife's coverage and our rates remained the same this year. At my work, the rates remained the same as well. In Indiana, the biggest player is Wellpoint. They are proactively doing a few really exciting things to improve the health of covered souls and lower costs.
 

Anies

Thread starter
Messages
2,804
Location
NJ
I was actually looking into that and it seems its fairly more expensive. I pay out roughly 500 a month(250 bi-weekly) and our company covers the rest. If I have another kid that number will explode to over 1k a month(1st one is always free!!). You would think Dr's being Dr's they would want to retain patients and I myself don't understand what happens in the background in terms of Provider/insurance contracts relations etc. They get paid either way, or does it cost them more money?
 
Messages
932
Location
USA
Are the total premiums staying the same or just the employee's part of it? I don't think I've ever had a year where rates didn't go up but in the past, had generous employers who would absorb a disproportionate part of the increase.
 
Messages
5,153
Location
MW
Originally Posted By: kb01
Are the total premiums staying the same or just the employee's part of it? I don't think I've ever had a year where rates didn't go up but in the past, had generous employers who would absorb a disproportionate part of the increase.
For our personal coverage, the employee portion has remained the same (through my wife's employer). We are on the high deductible plan, $500 deductible for each person covered. The other plan they offer had a $200 deductible which has now become $0 deductible for the same payroll deduction amount. So my guess is that the entire coverage either became cheaper or remained the same for her employer. In my company, the entire coverage cost remained the same (the benefit cost). I have not looked into the details of what the HR has come up with... but haven't heard anything negative by the employees so things probably did not change.
 
Messages
932
Location
USA
Wow, it's kind of funny seeing $500 referred to as a "high deductible" policy. The low deductible policy at my work is $1,500 and comes with the price tag of something like $1,500/month in premiums for a family policy. Technically, I believe to even be considered a "high deductible" policy, the deductible needs to be at least $1,200 for an individual and $2,500 for a family.
 
Messages
22,187
Location
Colorado Springs
I was about to say! 500 low deductible plan? My deductible is $5,000!!! My policy has saved my butt twice and it's basically the only thing I can afford. I can't imagine how some of you guys are making it with $1,200/month high deductible family premiums.
 
Messages
932
Location
USA
Originally Posted By: Drew99GT
I can't imagine how some of you guys are making it with $1,200/month high deductible family premiums.
In my case, I can't afford to maintain our $1,000/month coverage. We're either going to get an individual policy or go without. The worst part of it all is, that there are no longer any child-only plans sold in my state. If my wife and I can't find a policy for ourselves, it will mean our kids are uninsurable too.
 
Messages
22,187
Location
Colorado Springs
Anies, I feel your pain regarding Aetna. Had it at one of my last employers and it sucked, and the medical community knows it. They generally cater to the mini-med type policies that don't cover high impact medical events, which is dumb IMO. My policy has $150/month premiums (up from $90, thanks big O) and includes 4 doctor visits per year with a $20 copay, it's a private policy, and it costs less than Aetna's group mini-med policy at that time.
 
Messages
22,187
Location
Colorado Springs
Originally Posted By: kb01
Originally Posted By: Drew99GT
I can't imagine how some of you guys are making it with $1,200/month high deductible family premiums.
In my case, I can't afford to maintain our $1,000/month coverage. We're either going to get an individual policy or go without. The worst part of it all is, that there are no longer any child-only plans sold in my state. If my wife and I can't find a policy for ourselves, it will mean our kids are uninsurable too.
Look into some of the private high deductible plans that have a limited benefit as far as Dr. visits, but still include major medical benefits like cancer and ER/hospital extended stay. That's what I have and it's a decent plan. It's called Tonik through BCBS. Then again, I'm one of those people that will only seek medical help if a bone is broken or I have pain that feels life threatening, so I don't need all the family Dr. visits.
 
Messages
932
Location
USA
That's exactly what we're doing. Even with a $6,000 deductible and no maternity and no prescriptions, the premiums will run in the $600-$800/month ballpark, if we can get coverage at all. Our broker is working very hard to find us a policy. Oddly enough, on the subject of Aetna, they denied us outright because they consider my wife's C-Section a pre-existing condition, even for a policy that doesn't cover maternity. Even through work, our current policy is a HDHP/HSA with a $5k deductible and it's still insanely expensive. The guaranteed issue policies in my state are a complete no-go, with premiums in the $1,000/month ballpark per person. At a certain point, it would just be cheaper to go without insurance and if the need arises, fly to Poland, stay with family, and see the doctors there. I really don't see an alternative. Though, we have thrown around the idea of getting a divorce, so only my wife's income is considered for SCHIP, so we can get the kids covered.
 
Messages
22,187
Location
Colorado Springs
What a sad state this country is in, especially the political debate about what to do with healthcare. The fact you're even considering having to get a divorce to get health insurance for your kids is abominable.
 
Messages
932
Location
USA
Yeah, we're definitely not happy about it. My wife's employer dumped their plan last year because so few people signed up for it (the premiums were crazy). However, she did just have her second interview for a state job, which has absolutely amazing insurance. We're crossing our fingers.
 

Anies

Thread starter
Messages
2,804
Location
NJ
I can say that some of the bills are outrageous. When Horizon sent the invoice for the baby($200 out of pocket) it was a ball park for $35k for delivery, and another invoice for $20k for the Hospital stay. Wife and Baby were in hospital for several days, kid was catching rays under the blue light for Jaundice. Not to mention that they charge you for parking, I was getting hit for $12 a day, every time I left or came back was another charge (food, clothes ect) since the stay was longer than expected and the Hospital food was horrible. 45k to deliver a baby. And you know physicians bill high and get paid low(reviewing the invoice). My friend who owns his own shop doesn't have health insurance, and he ends up paying cash (lots of it) and can't afford to get his knee worked on.
 

JHZR2

Staff member
Messages
46,286
Location
New Jersey
Originally Posted By: Anies
Doctor won't accept the insurance and I'm getting the run around. I had to cancel my physical for 11/8/11 as well due to to this and now have to find another Doctor that does accept it and hope the stupid Aetna Navigator website is correct. Had this problem with our newborn baby trying to find a Pediatrician that takes Aetna as well :|
Im in NJ too and have no such issues. I use an Aetna HDHP because costs are low and we do well with it. Ask the doctor for a cash rate. He may cut you a break. They build a few boat payments into each charge they send out.
 

Anies

Thread starter
Messages
2,804
Location
NJ
I checked my Old Doctor out and they take Aetna nothing. But his old Protege' now has his own office and does take Aetna per the navigator page. I called them to confirm and they do so i set my physical/consult up for 11/10/11. And given I know him I'm ok with it. My wife on the other hand isn't, as she had an appointment yesterday and another one for Thursday with the Dr we are having problems with for School (which starts in 2 weeks, blood work etc). So now she is trying to find a doctor for the interum since my new/old one is on vacation.
 
Messages
2,352
Location
Southwest Virginia
My private health insurance policy (Oxford) for only my wife and I (we're retired) just went up by 15% to $1,637/month. That's on top of a 13% increase last year. Coverage sucks - $2,500 hospital deductable EACH, then 30% copay up until $5,000 max-out-of-pocket EACH. Doctor office visits are $30 copay and drugs are 50% copay. Fortunately my wife went on Medicare in July, so now I pay $787/month for just me and only $300/month for her (Part B, Part D, and Medigap). Her cost includes a private Medigap policy which pays what Medicare doesn't, so we pay ZERO for just about everything for her, and a small copay for drugs. In late July she had a pacemaker put in, a simple one hour outpatient procedure at the hospital. The total billed cost was over $61,000!!! Medicare reduced those charges by 80% and paid the remaining 20%. If I didn't have insurance I'd be on the hook for the full amount. Medical costs are totally out of control. A bit of TORT reform, policy portability, and interstate competiton would be helpful.
 
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