Insurance policies

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kaitie

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Alright, I'm not quite sure where this goes, but I'm putting it in here. It's potentially an asking advice thing, but also just a mini-rant.

I've recently been looking into private health insurance. I'm not going to have a job for a couple of months, and even if I get one, I'm not holding out that I'll get one that actually offers insurance. I'm currently covered in Japan under the national health insurance, and it's a pretty darn good plan. Granted, Japan is also awesome in that certain diseases are automatically paid for by the government, so I've got a friend here with MS (one of the most expensive diseases) and as long as he's here, his treatment will be covered.

Anyway, that's not really all that important, but just setting up where I'm coming from. I'm looking for just a basic plan for when I return. Something so that if I get sick with bronchitis again like I did last time I returned for Christmas I'm not having to pay 200 dollars on the doctor's visit alone. Now, I know there's a bit of a logical fallacy there anyway considering insurance would require me to pay much more than that over the course of a year, and if that was the only thing I had to pay related to an illness I'm actually out more by paying for insurance, but I guess the way I see it is that if I'm paying for insurance, I'd like to not also have to pay full price on doctor's visits. Seems logical to me.

Well, there are a couple of things I've noticed. One is that it seems like an awful lot of private policies have simply ridiculous deductibles. Like in the thousands of dollars range, some as high as ten. Now, am I understanding right that what that means is that insurance won't pay anything until I hit that 10k mark? Because that is a hell of a lot of money. I'm also noticing that these are the more affordable plans, which basically means that the poorest people who can't afford a higher plan would be buying health insurance that only kicks in if they've had to spend thousands of dollars (that they probably don't have) first. Does that seem right to anyone? Or am I just missing the logic here?

The second thing I've noticed, and the one that really frustrates me, is that almost every single plan out there excludes maternity care. To me, it seems that this should be one of the main things on a simply human level that should be covered. A woman and her child need to receive good prenatal and maternity care in order to ensure a safe, healthy birth for both parties.

America has one of the highest rates of maternal problems and such of the developed world. And here I look at this and can't help but think, "Okay, this is partly why." A lot of studies on the topic discuss how it's the poor people who can't afford care who are suffering the consequences, but this search has proven that even if you could afford health insurance, you still aren't covered! What the frak!?

I want to have kids. Does this mean that if I get a health insurance plan on my own I'm just going to have to pay for all of that by myself? Or risk not receiving the same level of care as someone else simply because my insurance doesn't cover it? I've never heard of an employer's plan doing this. My parents have been on a couple, my current one includes everything. Is this normal? Or again, am I missing something? It seems to me that something this important should be an automatic inclusion in plans, or at the very least that it should be the norm and then women can opt out or choose a plan that doesn't offer it if they don't intend to have children. The snarky part of me also wants to say, "If you aren't going to give that coverage, you'd damn well better pay costs for birth control pills."

Rantish thing over. Anyway, feel free to offer thoughts, or disagreements or explain what I'm missing the picture on here. And if anyone has any suggestions on what to do, I'm all ears. I really want health insurance. I had pneumonia for six weeks once, and I remember being terrified of going to the emergency room because I knew they'd admit me and I didn't have insurance and couldn't afford the bills. It's bad when you're going to bed honestly not certain on whether you're going to wake up in the morning just because you know you can't afford care.
 

backslashbaby

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Unfortunately, it's just that bad. Private insurance is ridiculously expensive, and you still end up paying so much for so many things.

I finally dropped mine within the past couple of months. It had gotten so expensive just to have, I wouldn't be able to afford any co-pay. So I have many thousands clear now to pay doctors directly. Except the rates are higher without insurance.

Oh, it's a lovely system we have, it is.... :(
 

kaitie

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See, things like this make me wish even more for a single-payer system. :(

What gets me most is the sheer injustice of this. The people who's employers pay for insurance tend to be the ones who are getting paid well in their jobs in the first place. The poor people who are working on the lowest rungs, struggling to put food on the table for their families, aren't going to be as likely to receive insurance through their employers, and so they'd have no choice but to use private. It just seems so wrong to me.

The worst part is that you don't receive the same care when you don't have insurance, either. It doesn't matter if the reason you don't is because you can't afford it or because the only policy you could get is a sucky one that would put you out more money than it's worth (the majority I've seen). Once they see that you don't have insurance, you're not treated the same. My mother works at a hospital and sees it all the time, and I've been without insurance enough to know how it goes.
 

the addster

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Yep, the system sucks.

I'm losing my employer paid plan on the first of the month, so I'm looking too. It looks like I'm going to have to go with a high deductible plan, just so I have something for now. We looked at adding me to my husband's employer plan, we looked at COBRA, both were completely unaffordable.

I live in a poor rural area where there is a fairly decent government supported clinic I can go for less serious and preventative visits, they only charge $30 dollars for office visits. You see interns and residents from a nearby medical school, which is what you usually end up with anyway at the private clinics, unless you ant to wait 3 weeks to see the actual doctor. So I suppose I'll be alright there.

If something big would happen, I suppose I'll just have to make payments on my deductible and hope the plan covers enough that I don't lose my house. At least I'll have an insurance card to get me into the emergency room.

I'm old enough I don't need maternity care, but I agree, there is a reason the US has an embarrassingly high infant mortality rate. There is something wrong with a society that puts their most vulnerable at the highest risk.
 

Susan Gable

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We've been without insurance for some time now. And what's I've discovered is that most doctor's office -- in fact, ALL of the ones we've had contact with since being unable to pay for COBRA, which thenran out anyway -- is that they charge us LESS than what the "list price" is that they charge the insurance companies.

My husband recent;y went to our regular family doctor because he had a suspicious bug bite with a red-ringed rash around it.

Cost of office visit -- $25. That's affordable.

My chiropractor charges me $40 instead of the $60 he charges the insurance company. (But he probably only ends up with $35 or $40 anyway.)

So for the "little things" you can probably be fine. It's when you get something more wrong with you that you end up not being able to afford stuff. That's why you need the catostrophic care policies. (We're hoping to get something like that in place soon.)

Moral of the story -- tell medical care providers you don't have insurance. Ask them for the discounted price. Because they don't actually get what they charge the insurance companies. ANd if you're paying them directly, they don't have to pay someone to fill out all the forms and stuff.

Susan G.
 

GeorgeK

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. Now, am I understanding right that what that means is that insurance won't pay anything until I hit that 10k mark? .

No, because that would be too easy to figure out. They will deny any bill that arrives on their desk on either a friday or thursday, and shred without reading anything that arrives on a saturday. Then they will delay payments on allowed things for 6 months hoping you will pay it out of pocket without having documented the receptionist's grandmother's maiden name on the check you used to pay the bill. Then retroactively they will want you to have told them what they did pay over the two years preceding and divide that in half to say when the 10K was hit and whether or not they are going by calendar years or enrollment years.

Wait you want to have a baby? Then you should have paid for a family plan before you had a family, and families start whenever you think you might be pregnant, or 11 months before you deliver, even if your baby weighs 2 and a half pounds.

Remember insurance companies don't care about you, only your premiums.
 

GeorgeK

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Get a local insurance agent to discuss what plan you should get. Don't get the guy who smiles a lot and wears a nice suit. Look for the agent with the nervous twitch and the 36 oz mug of coffee and one eye keeps wandering around not in conjunction with the other.
 

darkprincealain

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The insurance industry in the US is extremely screwed up. You're best off trying to go Susan G's route. Unfortunately private plans are cost-prohibitive in the profoundest sense, in many cases, since you'll typically pay multiples of what the care would have cost out of pocket.
 
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