made a big financial blunder

[FLA]

I had to have individual insurance for a month as my COBRA had ended and I start Medicare 2/1. I tend to have a lot of medical appts and am on some expensive meds. So I went with the insurance carrier I've used my entire life and picked the Gold Plan for $471. I would pay 15% of MD visits and have good prescription benefits.

I started getting EOBs in the mail saying they were paying nothing towards my MD visits. I called and I had missed the small print saying nothing is paid until you hit a 5k deductible. OMG, 5k before you get anything and this was the "best" plan?

So I will have to pony up for 3 MD visits. 2 of them are $260 each. IDK the third yet.

I feel like such a moron. I know about deductibles and co-insurance, OOP max, etc. How could I have missed something so big? And how the hell does anyone afford that individual plan? After I made that huge blunder, I went and met directly with a Medicare Advantage Plan consultant to make sure I didn't miss anything big. Arghh...

[rennigade]

Sorry to hear about that...insurance can be frustrating.

6 years ago I was fired from my job...my wife was in grad school at the time. Lucky I found another job within a month but we did not have medical insurance at the time. I never signed up for that cobra thing. Anyway...my wife tripped over our dog and smashed her face off the sidewalk. She had a gash under her eye. Had to got the ER, couple stitches..everything was fine luckily. We had to pay $900 for that episode. That stung a little.

I think we crunched the numbers and even if we signed up for cobra for a month and pay ER visit, blah blah...we wouldnt have saved that much. So either way it didnt really matter.

[FLA]

I should've gone without insurance for a month, by the time the ACA people caught on that I didn't have insurance, I would already have it. How big could the fine have been, definitely less than the 471 I paid for crap insurance?

[rennigade]

I should've gone without insurance for a month, by the time the ACA people caught on that I didn't have insurance, I would already have it. How big could the fine have been, definitely less than the 471 I paid for crap insurance?

Yeah but what if you had some major heart attack that would have required surgery during that time without insurance. Then that $5k deductible would be looking pretty good.

[FLA]

true, you're right

[disneysteve]

This is happening more and more. Our insurance has a $4,700 deductible. On top of that, my daughter's therapy isn't covered so we pay $185/week out of pocket for that.

Since January 1, a lot of patients have called saying their medicine wasn't covered and they couldn't afford it. We've had to explain that it is covered but they have to meet their deductible first. Sometimes I can help by changing to something cheaper or finding a coupon but often there's not much I can do.

[FLA]

In NY, if an insurance company pays for a primary, they have to pay for a therapist, they can't even limit visits anymore. Your co-pay is higher but at least you're covered.

One thing my doc gave me because some of my meds are going to be in tier 4 when I get Medicare, was to use the app Good Rx or she had cards for it in her office. I already got a $600 med reduced to 23 with Good Rx and another $200 one for $11. It's a pain to have to go to different pharmacies but they just announced a new deal they have with CVS (my preferred pharmacy) that should bring about even lower prices. And because it doesn't use your insurance, you won't fall into the donut hole.

[Mjenn]

This was the style of insurance my family had as small business owners growing up in the 80s-90s as there weren't many options. The deductible was lower, but still 2000 at the time. We were relatively healthy and almost never hit it while still paying almost 1000 per month.

The worst part was the two times we actually met the deductible, we ended up having to get a lawyer to fight to get the money because they fought us tooth and nail.

For example, when one family member had to go to the ICU for a week they refused to pay for any additional doctors because they would only pay for continued care by the first doctor seen -- which was an ER doctor. Eventually they paid for a large chunk but it took months and the things they fought about were absurd. This was years ago so hopefully things have gotten a bit better, but it doesn't sound like by much.

While I know there are issues with universal health care, I am grateful not to have any unexpected healthcare costs where I live.

[FLA]

that's just awful

[disneysteve]

For example, when one family member had to go to the ICU for a week they refused to pay for any additional doctors because they would only pay for continued care by the first doctor seen -- which was an ER doctor.

The challenge is finding intelligent life at the insurance company to explain the ridiculous nature of that claim.

Another thing that I've heard is happening a lot is that a patient gets hospitalized at a hospital that is participating with their insurance plan, but weeks later, gets a bill from one of the doctors who treated them while they were there because that doctor doesn't accept their insurance.

Sorry but crap like that just shouldn't happen. Once you are in the hospital, it's not like you generally have a choice of doctors. If your internist consults a pulmonologist, it doesn't occur to most patients to find out if that doctor takes their plan. The assumption is that any care given to you in the hospital will be covered.

[moneybags]

Since January 1, a lot of patients have called saying their medicine wasn't covered and they couldn't afford it. We've had to explain that it is covered but they have to meet their deductible first. Sometimes I can help by changing to something cheaper or finding a coupon but often there's not much I can do.

I have a new insurance plan this year. One of my meds, made by 3 different manufacturers had a copay of $105, $45, and $9. I was on the $105 med but switched to the $9. I only got this info after lengthy conversations and a suggestion from my pharmacist.

[disneysteve]

I have a new insurance plan this year. One of my meds, made by 3 different manufacturers had a copay of $105, $45, and $9. I was on the $105 med but switched to the $9. I only got this info after lengthy conversations and a suggestion from my pharmacist.

We just had a conversation about this last night at a hospital meeting. There is one particular generic diabetes medicine that is stupid expensive but the same drug is also available as a dirt cheap generic. There's no way for me to know which one you are going to get when you take my prescription to the pharmacy because it depends which generic they stock. It's a tough situation to correct because of that.

[FLA]

would Good Rx help in that situation? Just look up the drug and I think it tells you the manufacturer so you can price compare, at the very least it tells you the cheapest place to get the drug

[LivingAlmostLarge]

Try making the system all one. All the pharmacies are on different systems so transferrring a script is terrible