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Any tricks for dealing with health insurance?

Discussion in 'Off-Topic Discussion' started by teedubbya, Feb 17, 2020.

  1. Feb 17, 2020 at 1:22 PM
    #1
    teedubbya

    teedubbya [OP] I like fat booty

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    Went to the hospital back in September for something minor. They did X-ray, labs and that was about it. Out in an hour and a half.

    my insurance is decent, but I have a 3k deductible I can’t do anything about.

    bills coming back, $700 (double that before insurance adjustment) billed by the doctor then another $5k+ billed by hospital ($800 owed on my part)

    So all in all I owe around $1500 out of my pocket. I’m pretty pissed.
     
  2. Feb 17, 2020 at 1:29 PM
    #2
    Black Wolf

    Black Wolf Bigfoot Hunter, Sasquatch too, but not Yeti

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    I always opt for the low deductible PPO plan at work since it's just me. Costs more but no BS. $300 deductible. Our company puts in $500 in HSA accounts for the folks that opt for the hi deductible plans. Monies not used roll over each year since it's effectively your money. Helps offset hi deductibles.
     
  3. Feb 17, 2020 at 1:35 PM
    #3
    teedubbya

    teedubbya [OP] I like fat booty

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    like I said, I can’t do anything about that.
    It’s just perplexing to me. Previous insurance was like a $100 copay for ER visits.
     
  4. Feb 17, 2020 at 1:43 PM
    #4
    jeffw6236

    jeffw6236 New Member

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    Its confusing. bad thing is once you get past open enrollment it's a year before you can change it. Max out your HSA if you can - I do that and usually roll over enough to help with deductibles each year. Also, urgent care clinics are usually cheaper than emergency rooms.
     
  5. Feb 17, 2020 at 1:44 PM
    #5
    Hbjeff

    Hbjeff New Member

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    Sounds like you used to have an hmo and now have a high deductible ppo.

    My work did the same thing. It’s a tough pill to swallow right now, but even with the higher out of pocket for services, we have still spent less over the last 3 years than we previously spent to buy the hmo option.

    Sorry to hear you have to pay, but if you had the hmo still, they may have been taking that 1500 out of your check slowly anyways.

    I like the ppo thing because it forces us to not go to the dr when we dont really need to
     
    jtwags likes this.
  6. Feb 17, 2020 at 2:01 PM
    #6
    Rex Kramer

    Rex Kramer Vinyl Spinner

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    I wish I could help, but I haven't had health insurance since Obamacare dropped me after raising my deductible to $12,000.
     
  7. Feb 17, 2020 at 2:26 PM
    #7
    RLHULK

    RLHULK Too many gamma rays in all that BBQ smoke.

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    I feel your pain.
    Last two years we have lost our ER deductible, now its a flat 30%, that 6 hours in 2018 I spent in the ER and cat scan for that damn kidney stone back then cost me $800 total. Now that bill would be $2000 my part.
    My PCP costs are now $45 per visit and no out of network options, go out of network you pay 100% of all bills.
     
  8. Feb 17, 2020 at 2:34 PM
    #8
    PWMDMD

    PWMDMD New Member

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    I have a $2000 individual and $4000 family max deductble so every year I make sure I have $4K in my HSA to cover my maximum OOP. Yes, I'm still paying it but having it aside seems to lessen the sting and I get a little tax relief from it. Other that that...a couple emergency surgeries in the last 3 years and two out of three of those years I've paid the maximum amount of $4K per year.
     
    Black Wolf likes this.
  9. Apr 13, 2020 at 4:27 AM
    #9
    mrmachinist

    mrmachinist New Member

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    I’m sure you have gone over your EOBs but be sure the bill amounts match up.

    I’m currently fighting an 11k charge that was for “convenience items” that insurance won’t cover while my wife was in the hospital. And I have a 500 deductible 2k out of pocket max....
     
  10. Apr 13, 2020 at 4:59 AM
    #10
    RollTide82

    RollTide82 New Member

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    And all these asshats that go to the ER and don't pay a dime......I work for a hospital and I won't go to the ER unless I am half dead cause my co-pays are so high even as an employee...I am not a freeloader but damn its crazy
     
  11. Apr 13, 2020 at 5:52 AM
    #11
    Johnsonman

    Johnsonman New Member

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    I think COVID is proving our high cost health care is no better and perhaps worse in so many ways than all other developed nations of the world, Great.
     
  12. Apr 13, 2020 at 5:55 AM
    #12
    Kung

    Kung [Insert Custom Title Here]

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    This. 100% this; additionally, make sure you read the manual that comes out every year that explains all your coverages. I'm blessed to have pretty damn good insurance ($350/month premium, $350 deductible per person, $700 per family; 15% paid out of pocket, etc.), but even still, we'll catch them several times a year 'accidentally' not covering something that it clearly says is covered in the manual. Most stuff is small but some stuff has been fairly large.
     
    mrmachinist[QUOTED] likes this.
  13. Apr 13, 2020 at 8:50 AM
    #13
    PWMDMD

    PWMDMD New Member

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    If you think insurance is bad to deal with for the consumer, try participating with them as a provider. They do everything possible to not pay legitimate claims and to try and make any issue be between you and the patient when it's not...the contract is between the patient and the insurance company. Why didn't my insurance cover whatever? I don't know dude, your guess is as good as mine but I don't decide what they do or don't pay.
     
    PermaFrostTRD likes this.
  14. Apr 15, 2020 at 7:41 AM
    #14
    mcm0455

    mcm0455 New Member

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    Health insurance premiums are difficult to deal with. We moved from Utah to rural Colorado two years ago and my premiums tripled. But my property taxes are 1/2 and my chronic bronchitis went away with the clean air. But then vehicles registration is 2x in Colorado. Someone has to pay for the Front Range projects.
    But I really cannot complain. When my son was born at 26 weeks, 15 years ago, my wife had insurance through the state of New Mexico. The first month at the NICU was over 1 million, for a total of 3 million for three months. We ended up paying $1000. It is unfortunate that medical bills are often the cause for wrecking so many peoples financial well being.
     
  15. Apr 4, 2023 at 3:13 AM
    #15
    KNABORES

    KNABORES Sarcasm incoming

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    HSA account. Still your money, but at least it’s tax free. Can be used for a wide variety of health care costs including dental.
     
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  16. Apr 4, 2023 at 3:38 AM
    #16
    Retired...finally

    Retired...finally Utilizing that doctorate of procrastinatory arts

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    I retired at 61 with a full pension but no heath bennies. Rode out the 18 month COBRA which expired just as the Covid lockdowns hit. Went to my brick and mortar insurance agent and they hooked us up with an affordable short term plan. Lots of exclusions. Didn't pay for any illness for 2 weeks, no injuries if alcohol in your system, yadda, yadda, yadda. Wife got a kidney stone and they paid but wouldn't renew her the next term. Said she had kidney disease. She had to get ACA which really sucked. Now both on Medicare with plans A,B,D and G. Total cost about $500/month for both. A&B reduce our pensions about $250 and plans D&G cost us a out $250. Best insurance I've ever had and I was management.
     
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  17. Apr 4, 2023 at 3:42 AM
    #17
    KNABORES

    KNABORES Sarcasm incoming

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    Management doesn’t get the good insurance, the union members do.
     
  18. Apr 4, 2023 at 4:08 AM
    #18
    PermaFrostTRD

    PermaFrostTRD Tumescent Member

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    This is the way.

    I’d also add care credit. And then a low premium, high deductible “catastrophic” plan. Exams/physicals are covered, hsa + care credit to take the deductible when/if you need it
     
  19. Apr 4, 2023 at 4:13 AM
    #19
    ZappBrannigan

    ZappBrannigan The mind is willing but the flesh is weak

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    Get on a payment plan. Healthcare providers are very flexible in this regard.
     
  20. Apr 4, 2023 at 5:29 AM
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    Retired...finally

    Retired...finally Utilizing that doctorate of procrastinatory arts

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  21. Apr 4, 2023 at 5:33 AM
    #21
    KNABORES

    KNABORES Sarcasm incoming

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    As we used to love to say at work, putting on the tie cuts off the blood supply to the brain.
     
  22. Apr 4, 2023 at 6:46 AM
    #22
    trucksareforgirls2

    trucksareforgirls2 New Member

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    The reason you are getting two separate bills, is that in a majority of hospitals in the USA outsource their physicians, and midlevels, in other words the doctor or other provider you see doesn't work for the hospital directly, they work for a group of doctors and providers, thus you get their separate bill. Same thing happens when you have surgery, you get a bill from the hospital to use their staff and resources, and another one from your surgeon, and another one from your anesthesia provider. It sucks, but it's the way it has been for decades. Not much you can do about it, other than maybe call and try and negotiate the bill lower.

    I don't need emergency care often, hardly ever, but if and when I do I try to go to urgent care since a lot of insurance companies will cover 100 percent of that and exclude your deductible, as opposed to the emergency department. (every insurance company is different though, so you would have to check with yours to see if this is true to your own plan). As always call 911 if you have a life or limb threatening emergency, and contact your physician if you are unsure if urgent care will be able to handle whatever your illness or injury is. Urgent care is not a good choice for certain things, and if you go there you will just end up with an urgent care bill and an emergency room bill.... I know this because we have two urgent cares in the area my ambulance services and we are there all the time for people who should have gone to the emergency room, but they were trying to circumvent the system because they didn't want to "wait" to be seen in an ER. Bottom line make use of urgent care when you can, it's often cheaper, but also use common sense and consult with your PCP if you are unsure!! Anyway, you get it. Sorry to hear about your bill!

    Not sure if clarification is needed, but here goes:

    Co-pay: Fee you pay to use particular services, usually 100-250.00 per an ER visit.

    Deductible: What you will pay for out of pocket BEFORE the insurance pays any bills, usually excluding preventative care such as a physical. So if you go for a physical, you won't pay a deductible for that generally speaking, but you will pay for some of the lab work if it's ordered. If you go to the ER, as in this case, you are paying for 100 percent of the visit up to the amount of your deductible or the amount that is owed in total, whichever is less.

    Co insurance: You will pay a percentage, you can find this information with your health insurance info, of the bill IN ADDITION to your deductible if that has not been met. So if you go to the hospital for day surgery, and your co insurance is 10 percent, plan on paying your deductible PLUS whatever 10 percent is up to the maximum out of pocket cost for the year. So most insurance carriers with say you have a ten percent co-insurance, but your maximum out of pocket for the year is 4,000. So you would potentially pay up to 4K for your surgery!!

    The health insurance in this country and what they can get away with, is in a sad state in this country. While I am against socialized medicine, insurance companies need a revamping, as does our medical system. Costs are out of control!!

    I HIGHLY recommend getting an itemized bill from the ER, or when you use other hospital services, as often times there are errors and you may be getting charged more than you should be.

    -T
     
    Last edited: Apr 4, 2023
    Hbjeff likes this.
  23. Apr 4, 2023 at 7:25 AM
    #23
    MadMaxCanon

    MadMaxCanon New Member

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    Too many, but not enough....
    I have had a similar situation in the past due to a high deductible plan through my work.

    I got some bills for the ambulance and the emergency room. I think the total out of pocket for me was almost 5 grand. I ended up paying only 1200.

    You can negotiate with medical bills. I would call the biller and just tell them straight up that you cant pay it and you will have to let it go to collections, which would be bad for you and for them. Tell them you want to do whats right and pay but you can only pay a fraction of what the bill is. For example, on my 1800 dollar ambulance bill I told them I can pay you 400 right now and if not, I will have to let it go to collections. I gave them a sad story and they bought it. Got out of that bill for only 400 bucks.

    The hospital bill was harder because they said they would not negotiate the bill, but after i pressed them, they said they have some assistance if you qualify for it. Long story short, I showed them I spent 10% of my income on medical expenses (any medical expenses, be it dentist cleanings, medicine, copays, etc) and they came back after I submitted the application and they covered all of it.

    Just call them up, be polite with the person on the phone and just appeal to them on a human level. You will be shocked what you can get away with.

    I like the high deductible plans for this reason. You get all the benefits with tax breaks and HSA and all that, and you can always negotiate on the rare occasion you get hit with something big.

    I would highly encourage you to call them, you cannot lose anything. Let me know if you have specific questions.
     
    Retired...finally likes this.

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