Medical insurance company RANT

[disneysteve]

I love the idea of an HSA, and in fact it is going to save me a ton of money.

Yes. HSAs need to really be encouraged, especially among younger healthier workers who might otherwise opt for no insurance due to the high premiums. By drawing more people into the insurance pool, you lessen costs for everyone.

[LivingAlmostLarge]

PP, what happens if you have a c-section or a special needs child at birth? And the bills are $100k plus? Can you afford it? You are paying out of pocket and the risk.

Would you declare bk? Would you actually pay back everything, say if something went wrong with your labor (i hope not), but what if?

I think it's fine if you have an HDHP to cover the catastrophe. But to go in completely uninsured? Who will clean up your mess if it happens?

Please explain to me why I should guarantee that nothing will go wrong?

[atomicrc11]

ds, the point I bring up, is I am healthy but I am choosing not to contribute as much to insurance premiums by not choosing a regular PPO or HMO. The HMO where I am is $67 for employee/spouse and $14.57 for the HSA employee/spouse. It would help reduce premiums by staying on a traditional plan as I am healthy, but I am taking that money away from people who need it. Yes, it does help with people who wouldn't have insurance anyway get in on the HSA plans, but for people who make a good living and even the wealthy it is probably going to hurt things unless we can get more people into HSAs.

Here in MA, we're just at the beginning of making health insurance required much like car insurance. If you don't have it, you lose your state tax exemption. I think it is doing a good job, but many people around me who are more liberal that I, claim that $300/month for a family is just too much to pay for health insurance. $300 is the Commonweath Care state plan for a family of 8 with an income of $70k. For an individual the max AGI for eligibility is $29,412 and the premium is onlt $106/month. My liberal friends say this is too much and balk when I say they should cut their cell phone, cable tv or entertain expenses. Our problems run deeper than just our system, it is the entitlement mentality our country has. And to be clear, for 2 years, I never had anything but limited basic cable that cost $12/month because I couldn't afford more. We need to learn to cut back.

[Joan.of.the.Arch]

atomicrc11, definitely it is not right when a person takes care of their luxuries before their basic needs. Sounds to me like your workplace offers an incredible deal on insurance. The plan we have costs about $1200/month and is not top of the line. We pick up about 1/3 of the cost, the employer picks up the remaining 2/3. We certainly pay a greater percent of income for insurance than your state mandates for that $29,412 earner on the state's plan. We do have our luxuries, but insurance comes before those. If we couldn't afford insurance, it would be bye-bye boat and any other non-necessaries. Maybe bye-bye car as well.

[jc3900]

What about Charities?

I have heard no one talk about charities. What is the deal here? I am pretty sure this is a big part of the solution to the government entitlements. So why aren't you guys talking about them.

[atomicrc11]

Yes, my company has excellent benefits. For a family, the HMO cost is $81.77 per paycheck, so on average $177.16 per month, with $15 copays for every doc visit including a physical. Generic drugs are dirt cheap, at $4 for some, and $10 for the rest. Name brand formularies are $25 and non-formularies are covered at 50% with a max out of pocket of $45. The most expensive things are ambulance rides ($100 copay), ER Visits ($100 copay) and Child Birth ($350 copay). Overall it is quite good. For the HSA the company puts $500 into your HSA per year, with a $2700 deductible for families with 90% coverage in network after that and a max out of pocket cost of $5300. I work for a large company, and that just shows what kind of buying power they have.

[disneysteve]

I have heard no one talk about charities. What is the deal here? I am pretty sure this is a big part of the solution to the government entitlements. So why aren't you guys talking about them.

I believe I mentioned earlier my friend who recently closed his family practice office. He would love to volunteer for a charity/shelter/free clinic and provide free medical care. He can not do that because there is no way to cover his malpractice insurance. The charity can't afford to pay it and he isn't going to pay it just to do volunteer work.

It comes back to what I said earlier about the legal system needing reform. There needs to be a way for doctors to practice without the sky high insurance costs and need to practice defensive medicine to protect themselves from frivolous litigation.

[maat55]

I think in frivolous lawsuits, the looser should have to pay all the legal fees. This would slow down the number of them. I also think that people can carry their own malpractice insurance, so doc's don't have to carry the burden. The doc's should only have to worry about criminal charges.

[jc3900]

disneysteve: wouldn't tort reform do something of what maat55 is talking about. by forcing the loser to pay the victor's fess wouldn't that help bring down the cost of malpractice insurance.

[Scanner]

I wouldn't count on HSA's for anything significant. They are offering them at the hospital I work for and a healthy 38 y.o. male said, when asked if he is signing up,

"Nah. . .I don't go to the doctor and I'd end up losing that money."

[disneysteve]

I wouldn't count on HSA's for anything significant. They are offering them at the hospital I work for and a healthy 38 y.o. male said, when asked if he is signing up,

"Nah. . .I don't go to the doctor and I'd end up losing that money."

That's just an education issue. Many people still think FSA when they hear HSA. With the FSA, the money that went into the account had to be used by year end or it was lost. That's one of the huge advantages of an HSA. That money is yours and it stays there until you either use it for healthcare costs or, after age 65, you use it for anything you wish.

I think as HSAs become more widespread, people will understand them better.

[Cashguy]

OMG. My partner and I just found out that one of the big medical insurance companies, Blue Cross Blue Shield, is waiving copays for patients when they visit a retail clinic, like the Minute Clinics in the CVS stores.

This means that if a patient is sick, rather than coming to see their family doctor where they have to pay their copay, they are being encouraged to go to a clinic instead where they see a nurse practitioner and pay nothing.

This is so short-sighted on the part of the insurance company (big surprise there). They run all these commercials saying they care about the patient and want people to get preventative care and then they go and do this nonsense. I can't tell you how many times a patient has come to see me for something acute, like strep throat, and that was the opportunity for me to remind them that they were due for bloodwork or a mammogram or a Pap smear. Or that they never followed up after the abnormal test they had a few months back. That reminder got them back on track and back under treatment. If they go to the clinic instead, that won't happen and more serious problems will be missed or allowed to worsen which will end up costing the insurance company a lot more money in the long run.

Doctors are struggling enough with higher overhead, malpractice premiums and lower insurance company reimbursement. Now, not only are the insurers paying us less, they are actually encouraging the patients to go elsewhere for their care.

I think we will be contacting our state medical society and professional board about this issue. It is actually illegal for me to waive a patient's copay. It is considered insurance fraud. But for some reason, it is perfectly okay for the insurance company to do it.

Ok. End of rant for now.

This is good for the consumer. Some doctors have the priestly attitude that only they can solve complex problems. An APN can assess and order tests for strep throat and other acute conditions just as an MD. They also can follow their patient's medical history like a doctor. Maybe this will encourage family doctors to start being more patient centered instead of running them through their clinics like cattle. IMHO

[asmom]

I think in frivolous lawsuits, the looser should have to pay all the legal fees. This would slow down the number of them. I also think that people can carry their own malpractice insurance, so doc's don't have to carry the burden. The doc's should only have to worry about criminal charges.

3 years ago, the Medical Association of Georgia used their money to bully the GA legislature into passing those laws aka "tort reform". They have to had admit that to date there has been no reduction in their malpractice insurance premiums. So that is not a solution.

And why should docs be shielded from being held civilly accountable for negligence or incompetence? I don't think there is anyone who doesn't agree that there are a multitude of frivolous lawsuits out there but you can't lump all lawsuits into the frivolous category.

[PrincessPerky]

AMA Patients' Action Network: American Medical Association

I received this link in my email today, thought it might interest some of you...

it has a link to emailing congress regarding new Medicaid cuts.

[PrincessPerky]

PP, what happens if you have a c-section or a special needs child at birth? And the bills are $100k plus? Can you afford it? You are paying out of pocket and the risk.

Would you declare bk? Would you actually pay back everything, say if something went wrong with your labor (i hope not), but what if?

I think it's fine if you have an HDHP to cover the catastrophe. But to go in completely uninsured? Who will clean up your mess if it happens?

Please explain to me why I should guarantee that nothing will go wrong?

I never asked you to guarantee anything...and I wont.

Would I actually pay everything back, yes.... I believe it is my duty and responsibility to pay for all costs I incur. Now and in the future. I have always believed that, and I always will.

Also the insurance we have for our kids will be covering our newborn as well. (with a bump in cost)