Health Insurance - Don't get me started.
Because my husband is a doctor, he qualifies as both the employer and the employee and for the purposes of health insurance, we pay both halves of the premium. You shudder to think what that might be, and if you aren't shuddering, you should start shuddering.
It's about $1400/month.
Let me tell you what we get for that. I have in my hand an EOB from Blue Cross about my son's foot surgery. He had ingrown toenails and had 3 margins excised and cauterized, which I might mention is a permanent fix to an otherwise constant problem. All of it done on an outpatient basis, local anesthesia, no preop and no follow up.
The DPM charged $1012, (probably wishful thinking on his part, but we all have our dreams.)
The insurance company adjusted his charges, per contract, to $286.02.
Less my $25 copay, and the $224.04 they applied to my deductible.
Blue Cross paid the DPM a whopping $36.98.
I don't know about you, but I can't fill up my car for that amount.
This is about the time where I started explaining to my husband that your copay is a flat tax you pay just for utilizing "the system". The deductible, is really a misnomer, but in our case is $1500/person and $3000/family. It isn't deducted from anything, it's the amount you have to pay out of your pocket before the insurance will kick in. Which brings us to our next term, out of pocket. Stay with me here, the deductible does not go towards your out of pocket limits, even though it comes out of your pocket. Only copays and coinsurance counts towards your out of pocket.
I had Physical Therapy over the summer for my Achilles Tendon, all ordered by an orthopod, for which I received a bill of $2000, which the insurance company cut in half, literally, and then applied it towards my deductible. I called the company up on this one and said, "Aren't you supposed to pay like 80% after you cut the charges in half?" The answer is no, because they don't pay for physical therapy.
Go read your policy.
I have a couple of suggestions about what they can go do, and they can use my policy to do it - because you know what - That's about what it's good for.
V' haMaivin Yavin. (all the rest of you can use your imaginations)
It's about $1400/month.
Let me tell you what we get for that. I have in my hand an EOB from Blue Cross about my son's foot surgery. He had ingrown toenails and had 3 margins excised and cauterized, which I might mention is a permanent fix to an otherwise constant problem. All of it done on an outpatient basis, local anesthesia, no preop and no follow up.
The DPM charged $1012, (probably wishful thinking on his part, but we all have our dreams.)
The insurance company adjusted his charges, per contract, to $286.02.
Less my $25 copay, and the $224.04 they applied to my deductible.
Blue Cross paid the DPM a whopping $36.98.
I don't know about you, but I can't fill up my car for that amount.
This is about the time where I started explaining to my husband that your copay is a flat tax you pay just for utilizing "the system". The deductible, is really a misnomer, but in our case is $1500/person and $3000/family. It isn't deducted from anything, it's the amount you have to pay out of your pocket before the insurance will kick in. Which brings us to our next term, out of pocket. Stay with me here, the deductible does not go towards your out of pocket limits, even though it comes out of your pocket. Only copays and coinsurance counts towards your out of pocket.
I had Physical Therapy over the summer for my Achilles Tendon, all ordered by an orthopod, for which I received a bill of $2000, which the insurance company cut in half, literally, and then applied it towards my deductible. I called the company up on this one and said, "Aren't you supposed to pay like 80% after you cut the charges in half?" The answer is no, because they don't pay for physical therapy.
Go read your policy.
I have a couple of suggestions about what they can go do, and they can use my policy to do it - because you know what - That's about what it's good for.
V' haMaivin Yavin. (all the rest of you can use your imaginations)
posted by Mrs. Balabusta @ 9:09 PM
8 Comments:
At 9:21 AM,
tuesdaywishes said…
Okay, so i pay no copay, no deductible, physical therapy is covered (if prescribed by a doctor). Podiatry isn't covered unless you have some chronic problem like diabetes. But most doctors aren't accepting new patients, there are no medical beds available in most hospitals, and my husband made an appointment in August for a colonoscopy next April. And our taxes (on less than 100,000 CAD in income last year were 22,000+. You can't win.
At 9:18 PM,
Kiwi the Geek said…
If PT is the employer, then doesn't he get to choose the insurance plan? Sounds like he needs your input on this. I used to have a really good PPO plan through United Health Care. I have no idea what it cost, because the company paid the whole premium, but it covered practically everything.
OTOH, if I had to pay the whole premium, I'd be inclined to get insurance only for the big stuff, and use a medical savings account the rest of the time. Why pay hundreds of dollars a month to line administrators' pockets, when you could be saving it to actually *pay* for medical care? Makes sense to me.
At 11:29 PM,
Blue Cross of California said…
It is unfortunate to hear of your experience with blue cross blue shield I hope all goes well. Blue cross of California has worked out pretty well for me.
At 3:41 AM,
Eli said…
Don't even get me started on taxes in Israel.
At 9:31 AM,
Mrs. Balabusta said…
To all those of you who have socialized medicine - good night and good luck!
To Blue Cross of CA - nice of you to stop by, of course, I live in Wisconsin, so not of much help are you.
Kiwi - You are correct, but the "Group" chooses the plan, and not many of them have six kids, or reach their deductible anyway. So basically, my family's needs are the minority opinion, when the needs of the majority usually get to decide. Thanks for playing.
At 1:11 PM,
PsychoToddler said…
Hey, blue cross of california! Would you be interested in learning about road construction of pa!
At 12:09 PM,
Sweettooth120 said…
What about malpractice insurance? I never realized how big the problem was of lawsuits until it was an issue in the last election. It must be a big issue in the state I live, because one of my doctor's office always ask their patients if they would like to contibute to their fund to fight unneccessary malpractice lawsuits.
At 7:58 PM,
PsychoToddler said…
Malpractice insurance is a big issue. In some states, insurance premiums are so high that doctors are forced to either leave the state, or steer away from low paying professions (like family practice), or high risk speicalties (like obstetrics).
Malpractice rates in Illinois are much higher than in Wisconsin, so we've seen doctors migrating across state lines.
Right now there is a big to do in the WI state capitol, because the state supreme court struck down caps on punitive malpractice fines. Which means that instead of 400,000 as a top award (this is in addition to medical expenses, loss of work, etc), juries can award whatever they want. Which can be a ridiculous number, like 23 million. Somebody has to cover those settlements, and that would mean a hike in my malpractice premiums.
The lawyers like this fine, but it is very bad for doctors and patients.
For doctors because they will have to charge more or see more patients to make ends meet, and for patients because doctors may end up doing more unnecessary tests to cover their a$$es. And of course, if lawyers smell more blood in the water, there will undoubtedly be more lawsuits filed.
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