Currently we are insured through my hubby's job, but it costs us nearly $500 month, however that includes medical. mental, short term and long term disability and vision and dental and extra life insurance. Does not sound too bad? Well, we each pay $250 deductible at the beginning of year for IN NETWORK docs and $500 for OUT OF NETWORK docs. The Dr visit is $15 and the docs will not see u unless u pay it. Lab and x-rays and all other things are paid at 90% until a max is met then it is 100%. Many drugs are not on their formulary and to get what u need often requires filing grievances and complaints with the state insurance dept.(things I have to do frequently) . I have several chronic, severe illness and we spend a great deal on co-pays and prescriptions and are constantly being dunned by the medical offices. I just tell them the truth when they call, I can pay u or I can buy groceries, or pay the heating bill, which do u think I should do? They are stunned b/c many are young people (healthy) who do not know this can happen to them. I have had 3 surgeries in 2 years and it has left us with enormous bills- the amounts the insurance will not pay. I have to see two out of net work docs b/c they have been treating me for 16 years and I am not about to turn my care over to someone else. Out of net work care is paid at 70% of the allowed amount (note the words allowed) My hubby has twice recently had to have X-rays at the hospital and they cohersed him into putting the amount they thought the insurance would not pay on a credit card. My hubby said they refused to see him unless he did this. When he returned home I called the credit card company and had the money removed due to duress being placed on him. the credit card company did it and we won.My hubby had a recent surgery and the day of the surgery , right before they were to sedate him, they were trying to force us to pay the money the insurance would not pay. I said we could not and we had to sign a IOU sort of to get his surgery done. It was very upsetting.
We can barely afford this insurance and sometimes it is even hard to come up with the $15 co pay to see the doc. We would almost be better off without insurance, but then we would have to seek care at the county clinics and then they decide what is necessary, not always in your best interest.Currently I saw in the news some major insurance providers are giving docs extra money for "good care". Note, this translates in they give docs money that order fewer tests , which saves them money. I have known this for years, my mothers doc explained it all to me. He gets X amount of money for each patient from the insurance co. If he orders too many test etc, the insurance company will send him a letter warning him and if he persists , they will drop him.
When i was growing up my father seldom had insurance and insurance was not the same as it is today. Most people had major medical polices and u just paid your own docs visits and scripts. I can remember my mom and dad having to beg the docs to see us children. It was humiliating and we felt like paupers. We weren't, we were just working class people with not enough to pay medical bills. My dad went bankrupt once due to family illness. We have not filed bankruptcy yet but it looks like it is on the horizon. I do not know what the solution is, but I would not want to go back to the system my father had to deal with, fee for service, upfront.
I make it my business to stay informed and know my rights. I use my state dept of insurance and fight for my rights. One of my docs recently said (grinning) that he felt a little sorry for the insurance co. I was their worst nightmare-an informed consumer.
