Another Health Insurance Thread

[cyrus buelton]

Health Insurance is so funny.

If this is a political topic, then my apologies, delete it if so, but not being posted in a political way, just posting because it is great.


So the wife and come home tonight and find each of us a letter from Anthem for some research medical claims.



Tiffany had the Mirena (IUC, we do not want children and this device is effective for 5 years) installed back in December. She had a typical co-pay of 15$ for the procedure.

I had shoulder surgery almost 4 weeks ago to fix (for the third time) chronic dislocations. No co-pay for the surgery.


We both get the dreaded letters today with what we potentially owe for these visits.


Tiffany's visit costs around 800$ and she owes 15$.

My surgery was around 6500$ and I owe..........

$0.00





How comical.

I have an "elective" procedure to fix chronic dislocations and discomfort.

Tiffany has a procedure to prevent pregnancy, which in return will save her employer (we kept insurance separate as it is not cost effective to be joint) thousands of dollars from having child birth, new dependants, etc etc.



discuss the logic here.

[swampduc]

Logic? From a med insurance company? Nonexistent. 8 1/2 yrs in medicine have taught me that.
BTW, the charges your company listed in no way reflect what they actually deigned to pay the providers. Again, experience teaches that.

[cyrus buelton]

BTW, the charges your company listed in no way reflect what they actually deigned to pay the providers. Again, experience teaches that.

Oh yeah, I know.

My Father was in private practice for 20 some years. Last I recall, for every billable dollar, they would receive about 38 cents.

That bullshit on the Anthem statement I got is a crock of shit.

[TiAvenger]

Funny, I just got a letter today from Anthem, and my policy increased 25% per month.  Due to rising cost. 

[He Man]

still wiating on approval fro my health insurance!

[cyrus buelton]

Funny, I just got a letter today from Anthem, and my policy increased 25% per month.  Due to rising cost. 

wow, that is a pretty substantial increase.

[Ducatista]

It's kind of like how insurance companies will cover new glasses or contacts each year, but the permanent fix?  Nope. 

[cyrus buelton]

It's kind of like how insurance companies will cover new glasses or contacts each year, but the permanent fix?  Nope. 

Lasik isn't necessarily a perm fix.

I know several who have had it done that still require contacts/glasses

[TiAvenger]

wow, that is a pretty substantial increase.

It's happened every year since I was 18, I keep chopping coverage so I can afford it. Started off with a ppo 1000, 50 bucks a month in 02.

My ppo 5000 just went from 90 to 115 a month.   

Obviously being 25 and healthy is a huge burden on the system    Hell I didnt visit a doctor last year.

[Sinister]

Health Insurance is so funny.

If this is a political topic, then my apologies, delete it if so, but not being posted in a political way, just posting because it is great.


So the wife and come home tonight and find each of us a letter from Anthem for some research medical claims.



Tiffany had the Mirena (IUC, we do not want children and this device is effective for 5 years) installed back in December. She had a typical co-pay of 15$ for the procedure.

I had shoulder surgery almost 4 weeks ago to fix (for the third time) chronic dislocations. No co-pay for the surgery.


We both get the dreaded letters today with what we potentially owe for these visits.


Tiffany's visit costs around 800$ and she owes 15$.

My surgery was around 6500$ and I owe..........

$0.00





How comical.

I have an "elective" procedure to fix chronic dislocations and discomfort.

Tiffany has a procedure to prevent pregnancy, which in return will save her employer (we kept insurance separate as it is not cost effective to be joint) thousands of dollars from having child birth, new dependants, etc etc.



discuss the logic here.

The way I see it, this shows that your health insurance is working correctly.  You are paying premiums, and you receive benefits when you have cover-able procedures performed.  My health insurance kicks ass.  The healthcare system isn't broken, in this country, people are just stupid.

[cyrus buelton]

The way I see it, this shows that your health insurance is working correctly.  You are paying premiums, and you receive benefits when you have cover-able procedures performed.  My health insurance kicks ass.  The healthcare system isn't broken, in this country, people are just stupid.

I don't agree.



In the long run, who will save the insurance company more money?

My shoulder procedure or the wife not having kids for 5 years?

[Sinister]

I don't agree.



In the long run, who will save the insurance company more money?

My shoulder procedure or the wife not having kids for 5 years?

You are comparing apples and oranges.  The two "visits" are classified differently; you know that.  She pays the co-pay because it is an office visit.  You pay nothing because I'm assuming that your deductable has been met.  Really, if you carry this out, Your wife's procedure actually denies them future income through premiums on little Cyruses.

[cyrus buelton]

You are comparing apples and oranges.  The two "visits" are classified differently; you know that.  She pays the co-pay because it is an office visit.  You pay nothing because I'm assuming that your deductable has been met.  Really, if you carry this out, Your wife's procedure actually denies them future income through premiums on little Cyruses.

My deductible has not been met.

I know they are classified differently, but the point is the disconnect on what is covered and what is not. It just seems silly.


It denies them premiums, but saves them on paying a shitload of claims.


How much did it cost for your daughter's birth?

How about all the care during the pregnancy?

[herm]

health insurance is BS! anyone who thinks that insurance was invented to help the insured is smokin crack.

even when it is a legitimate claim, they stall, drag their feet, mail requests for additional information.
and all this time, the doctors billing office is sending the insured person a duplicate of the same bill, just hoping someone will pay it (hint-this is why you sign that form that says you will pay your bill even if the insurance company is supposed to.)

the angle is this. the insurance company will wait until the absolute last possible moment to pay. they are betting that you will get nervous about the increasingly strong letters from the doctors billing office. both the doc's office AND the insurance company will suggest that you pay up, and then settle later with the insurance company.

if you do this, the insurance company will not send you a check for the amount you paid. they will PRO RATE it out of your monthly premiums over how ever long it takes. that sucks!

but ok,... at least your monthly premiums have gone down, even if you are out of pocket the price of a new monster.
WRONG! cause now they are going to increase your rates.

end result? you paid for your own medical whatever, not your insurance company. and they are still taking you money. 

[Sinister]

How much did it cost for your daughter's birth?

How about all the care during the pregnancy?

Hmmm...I think her delivery cost about $5,000; I paid about $500, maybe less.  My wife's care, during that same time, cost about $20,000; I paid maybe $1,000.  Pretty good deal, IMNSHO.

To Herm, don't know what to say.  I have had issues, but have always gotten them resolved.  I think it probably helps that my wife is in the medical industry; she handles all such medical/insurance issues.  That said, I've been dealing with my own insurance for about the past 15 years and haven't had major problems.