Help me understand - high deductible health insurance vs no insurance

Parent Cafe
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<p>My daughter was hit by a car almost two years ago. (Before you panic: broken collarbone, banged-up knee, broken helmet and bicycle. She’s recovered quite nicely.) At the time, she had a nice high-deductible Blue Cross policy I’d gotten her. </p>

<p>The emergency room treated her without question, told her to see an orthopedist in a few days, and sent her home with narcotics. That and the ambulance ride cost about $2000. She still needed to get an MRI of her knee (which was NOT done in the ER, because she could walk on it and therefore it was not life-threatening).</p>

<p>Then the hunt began for an orthopedist. That took a few days. The fact that she was insured made a huge difference. Without the insurance, I don’t think her collarbone would have been set correctly–it needed to be re-aligned. </p>

<p>Bills totaled more than $11,000 in the end. Things like MRIs and x-rays add up very quickly. </p>

<p>Blue Cross denied the claim because the driver was responsible (as clearly determined by the police). My daughter began negotiating with the driver’s insurance company, which called her THE DAY AFTER THE ACCIDENT offering to settle immediately for $10,000 cash, if she’d sign off against future claims. </p>

<p>Within two months–before my daughter knew how long healing would take, with a brace still on her knee–the hospital and ambulance company were dunning her for payment. Blue Cross was not helping. Her father and I stepped in and began covering the bills.</p>

<p>In the end, ten months after the accident, my daughter settled for more than $10,000. (The details are her story, not mine.)</p>

<p>Without the Blue Cross coverage, however, even though they didn’t pay–I think the treatment she got would have been much less. </p>

<p>An appendectomy can run $25000 to $30000. A friend’s wife, who hit a curb while riding her bike (wet leaves), broke her femur and her wrist; her medical bills have been over $30,000, counting physical therapy.</p>

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<p>Shrinkrap,
I wouldn’t view this as fair. I’m just curious. How does an MD determine a fair market value for a patient visit? Do you check out other doctor’s prices?</p>

<p>Here’s my prediction: If Medicare reimbursement cuts go through in 2010, my price for a visit will go up so that my physician can recover the loss of income due to Medicare cuts. I am not sure he will survey the physicians in the neighborhood to see if his prices are competitive. He will lose income due to Medicare cuts; he may very well lose income because Blue Cross/Blue Shield/Humana/Wellpoint will demand that he accept lower reimbursement as well. (Those companies tend to set their reimbursements a few percent higher than Medicare) He may have to accept private insurers’ demands for cuts because there are not many insurers in our area. If he refuses he may lose half his patients! </p>

<p>So he will raise the price on the people who have no clout in this country: the uninsured. And if the uninsured leave his practice because they cannot afford health care-oh well, tough noogies. Physicians and other providers do not particularly want to treat uninsured anyway. They regard uninsured as poor risks so it is no great loss to their business if a patient leaves.</p>

<p>There is nothing particularly fair about this situation. And the pricing for medical services is not like the pricing for airline tickets or shoes or movie tickets. Insurance companies and Medicare are not paying for you to fly or wear Jimmy chu’s. So I think the “fair market” analogy is not correct.</p>

<p>Anyway, I hope the OP understands that experiences of the uninsured and the insured are like night and day. It is critical for everyone to have affordable health insurance.</p>

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<p>“How does an MD determine a fair market value for a patient visit? Do you check out other doctor’s prices?”</p>

<p>Yes, locally, at least in my field. Mental health providers may be different because so much of what we do is uncovered anyway, or because folks don’t went to file claims and have it “on the record”.</p>

<p>What do Y0U think is the right way to determine how physicians should be paid? Especially in the context of time rather than diagnosis or procedures? Psychiatry visits are generally paid for in 10 or is minute increments; the longer the visit I usually, the less you get paid. Folks who pay cash leave the ultimate control overtime spent, and it’s been interesting to see how the use it. Some think all “cognitive” (rather than procedural) specialties should be reimbursed this way.</p>

<p>For example; 50 minute therapy session $150.00/week, maybe 20 weeks. 10 minute “med check” $85/month.plus cost of medication, maybe for life.</p>

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<p>I think perhaps a good analogy is between an airline passenger flying solo and one who flies on the same day, same destination, same airline, very likely sitting next to the solo passenger, but as part of a charter group. The charter group member is most likely to pay far less than the solo traveler.</p>

<p>One does not need to have a health emergency to need medical insurance. When S2 was born, I received an itemized bill for information only. The birth was very easy and I stayed in hospital only one night. The bill came to around $10k. That was more than 20 years ago. </p>

<p>Dmd:
When we were in grad school, H was hit by a car in the middle of the night. He was taken to the local hospital with a concussion and a jaw broken in three places. Bright and early the following morning, an insurance agent showed up at his bedside with a sheaf of papers which he wanted H to sign. H had just undergone major surgery (the surgeon told me H could have died). H was too groggy to know what the insurance man wanted and could not talk anyway as his jaw was wired shut. I refused to engage in discussions with the insurance man on H’s behalf.</p>

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<p>Dreammom, it is possible that someone with no insurance could get away without paying for treatment. Yes, it does happen. Depends on the hospital, the situation, the state, the injury, etc. It is always better to have insurance because you do not know up front what is going to happen, and you the insurance to cover certain situations, “just in case”. That does not mean you are going to always be rewarded over the person who did not get insurance. You have just covered more bases.</p>

<p>When my middle son was dxed with leukemia some years ago, we really struggled with the hospital bills and our insurance. Would have made us crazy, except we were already there and really did not care about the insurance, payment, etc. Yes, there were kids who were on public assistance of sorts, and they seemed to get every bit of the same care as our son did, and they did not have to hassle with the danged insurance because they did not have any, and the hospital social workers dealt with Medicaid and the state children’s insurance. </p>

<p>However, we had options that those families did not have. Because most of our treatment was ultimately paid by the insurance company, we were able to investigate a number of alternatives that were not negotiable for those without insurance. The hospital had a fund raising kit that it distributed to families whose insurance did not cover bone marrow transplants. It included, and I am not kidding, tin cans to set up in shops to collect change. </p>

<p>The better the insurance you have, the more options you may have and the more bases you have covered. It does not mean that in every situation you are going to be better off than the one who is uninsured.</p>

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<p>The reason that the thought of being uninsured terrifies me is that I have a little something.</p>

<p>If you have nothing, they can pile debt on you and ruin your credit, which is very bad. But you were in a pretty bad situation to begin with if you had nothing. If you have a little something – a nest egg – and you have a health emergency, you can kiss your egg goodbye. That’s the down side of having something to lose. You can lose it.</p>

<p>As I’ve discussed here before, I have never given serious thought to building my consulting business into a full-time job. I am uninsurable on the private market, so I have to have a 9-5 job. I’m lucky to have a terrific one, but being an entrepreneur is simply unthinkable under the current system.</p>

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<p>That is one reason why we need Healthcare Reform, if not Universal Minimal Care. </p>

<p>DS gave up a FT staff position at a major university, with full benefits, to become an entrepreneur. Luckily he has a funded startup, and retains a parttime position with the university. The loss of HI meant that he increases his pay from the startup by the purchase cost. He is still behind in pay + benefits against his peers who have a job in industry.</p>

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<p>That is not what I would call a high deductible policy. It sounds pretty luxurious to me. H and I had a policy with a $15K deductible for over a decade. This ended up costing over $400 per month. We paid at least $40K into that plan over the time we had it and received no care that we did not pay for out of pocket, except in one case where I had to be treated on an emergency basis and the hospital forgave us their part of the bill. But we still had to pay the doctors. Because we would have had to pay an anesthesiologist and an additional $3000 for the OR, I had a D&C with local anesthetic only instead of general anesthesia, which is the standard of care nowadays. They said they no longer did it with a local because “the women kept screaming, but you seem pretty stoic.” :rolleyes:</p>

<p>We finally dropped it after the last price increase in the neighborhood of 20%. So I’d offer the possibility that it is the people with really high deductible policies who are subsidizing everyone else. They pay in substantial amounts, but never collect a dime.</p>

<p>My H is now facing cancer surgery. As is happens, the total cost of the cheapest method is supposed to be around $12K. Our former “insurance” would not, yet again, have paid a dime. At least we’ve saved the $5000 or so we would have poured into their coffers since we dropped it.</p>

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<p>RMGsmom-</p>

<p>We are paying for a high deductible plan for our grad school son in Connecticut.
It is UnitedHealthcareOne. Their website offers MANY configurations to choose from so I bet there is one for any situation.
We went with a $1500 deductible that pays 100% after that. We wanted to be sure of what he would be liable for…so did not consider any with copays after deductible.</p>

<p>It is about $104 per month. It won’t help much with dr visits. But he will get contracted price for lab work if he goes to correct lab to have it done…and also reduced prices on prescriptions. Really, though, we want to protect him from large inpatient bills.</p>

<p>And he called the other day, said he was ill with a bronchitis type thing. He went to on campus clinic, was seen by a nurse practioner and was GIVEN, as in free, an antibiotic.
Wonderful!</p>

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<p>This is an amazing article:</p>

<p>[Cancer</a> treatment; costs of keeping a patient alive - MSN Money](<a href=“http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/lessons-of-a-618616-dollar-death.aspx?page=4]Cancer”>http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/lessons-of-a-618616-dollar-death.aspx?page=4)</p>

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<p>I am also getting ready to investigate an individual policy with a high deductible for my graduating son, who I can see bouncing from job to job for a few years. </p>

<p>You’d think that the insurance companies would be marketing these more aggressively to parents! I wonder if I can keep him on one of these forever as some sort of “backup” even if he gets coverage through an employer? I’ll just tell him it will reduce his inheritance, but cause me to worry less! :)</p>

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<h1>46, #47</h1>

<p>The medical system as it is today is setup for big business, big pharma, HI companies, and the wage slave. Small business, entrepreneurs, independent tradesman and self employed people are discriminated against. </p>

<p>Think how dependent we are in this recovery on small businesses. For this I do not understand how some are against people seeking free enterprise.</p>

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<p>If you look at any bill for a hospital where there is insurance, you will see a price, and then what they accepted instead, based on your insurance’s pre-negotiated prices. I had surgery in the fall… hospital bill was $29,000. My insurance paid $8,000. Hospital says I have paid in full. And we wonder why bills are out of sight… The system is too messed up and the stuff congress is pushing is only going to make it worse. Who wants to research and report on the Republican medical plan that my relatives were all gung-ho for back in the Nixon administration? Oh wow, I never thought I would mention my name and Nixons in the same sentence. (Biting tongue and backing up)</p>

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<p>TRUE STORY…DD was recently seen in the ER. A check was sent to me from Anthem for the doctor. I called and asked why the check wasn’t sent directly to the doctor AND why there was an $87 balance to be paid. The nice Anthem lady told me it was because the ER doctor was NOT a participant in Anthem. HELLO…when you go to the ER…you don’t exactly get a CHOICE about the doctor they send to your little cell. The hospital particpated in Anthem but the ER doc did not. Anthem adjusted their payment and sent the whole amount to me for the bill. They agreed that a person cannot request a participating doc in the ER.</p>

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<p>OP here. Thank you all for sharing your thoughts and experiences. When my son graduated from college, I didn’t know what to do (COBRA was way too expensive). Son was thinking of moving OOS for additional schooling or a job “somewhere”. Hard to buy insurance when we didn’t know where he would end up! I looked at a few options and was overwhelmed by the insurance terminologies. That was when I asked other parents for advice and found that not everyone was buying insurance. I ended up getting my S a policy with the same insurance group simply because it had all his medical records. The policy had a deductible of $2000 and it paid 100% after that. I was gambling on his continued good health but I knew I could come up with the deductible if necessary. </p>

<p>I used to think that the high deductible rendered the policy practically pointless unless S got hit by a bus. Thanks to you all, I now know that is not the case. :)</p>

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<p>Nixon’s speech on his health plan:
[Nixon’s</a> Plan For Health Reform, In His Own Words - Kaiser Health News](<a href=“http://www.kaiserhealthnews.org/Stories/2009/September/03/nixon-proposal.aspx]Nixon’s”>Nixon's Plan For Health Reform, In His Own Words - KFF Health News)</p>

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<p>One other thing to keep in mind:</p>

<p>The major cause of personal bankruptcy filings in this country is not due to out of control consumer debt, regardless of what the credit card companies want you to think. The major cause is unpaid medical bills. (And this was true even before bankruptcy “reform”, when credit card debt was still easily dischargeable.)</p>

<p>Is that something you really want to saddle your child with? That’s the risk of going uninsured.</p>

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<p>Can anyone offer advice about how to look for one of these high-deductible type policies? DS is graduating from college in May, will be covered by my corporate policy until the end of August, and then will be at Cambridge for two years. Since he will be covered by the UK’s NHS while there, I have not thought much about getting insurance. If nothing else, this thread has brought home the importance of keeping him continually insured. I have–very luckily–been covered by some kind of group policy for my entire life. I have no idea how to begin to find an individual policy. Thanks for any and all help!</p>

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<p>Ivyalum: depending on where you live, there may or may not be a cheap policy available. Google your state and “individual health insurance” and then go from there.</p>

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<p>I started on ehealthinsurance.com and then went to individual companies’ websites to get better, more complete info.
I get no compensation from this site, just found it a useful jumping off point</p>

<p>I did learn rather quickly that policies must be purchased by state where student lives and that NJ has the highest cost for individual policies.
What a surprise, not. Highest property taxes and highest public university costs.
Nice to be consistently unaffordable.</p>

<p>My DD with significant special needs is graduating from school this June. Our school district has paid for 9 years of expensive out of district schooling for her.
Those unbelievably valuable years almost make me forget how horribly expensive it is to live here. Probably will not be able to retire here though.</p>