Quote :

"I would rather get the money (that the employer pays out for benefits) in my check. People see their per pay period premiums taken out and think hey, that's way cheaper than the premium I'd have to pay in an individual plan. Well, no, not really. The employer pays way more for benefits than the employee, you just never see that money. That's part of the reason I think employer-provided healthcare is a bad idea. It would be better for people to get the money, and they could spend the money how they want. They'd actually research insurance companies and figure out which plan is best for them, or which plan is most cost-effective."

This.


Before I got laid off, I was paying out about $125 per pay period (bi-weekly). I figured it was worth it at the time.

$250 a month. For Health Insurance for a single guy age (at the time) 27, fit and without bad medical history, from the goddamned group plan at work. What the fuck.


The plan I'm on now is $110 a month, and has a quarter of the deductible.

[Edited on July 8, 2010 at 8:43 PM. Reason : that job fucking sucked anyway]

7/8/2010 8:42:13 PM

Quote :

"That's part of the reason I think employer-provided healthcare is a bad idea. It would be better for people to get the money, and they could spend the money how they want. They'd actually research insurance companies and figure out which plan is best for them, or which plan is most cost-effective."

I agree with this. Having your healthcare tied to your employer is crap. I think situations like right now where so many people are out of work demonstrate well why it sucks.

Quote :

"comparing THAT coverage to the BCBS (my dad's employer plan) that i've been under...i've never had them call and be like "why were you getting blood work done? what do you MEAN you were anemic" and i know the SECOND i do that goldenrule will probably call me and be like "RAWRRRRR""

Cigna used to pull the same bullshit with me but they would take it one step further. Rather than calling me to ask why I was getting a test done, they would just stop payment on it, not tell me they weren't going to pay for it, and then suddenly YEARS later after I guess the doctor's office stopped fighting Cigna, I'd be getting a bill from the doctor's office or one time a fucking collection agency for something like a urine test. Absolute bullshit.


[Edited on July 8, 2010 at 9:28 PM. Reason : a]

7/8/2010 9:24:15 PM

^ that is bullshit. i've also had cigna before and it is HORRIBLE

at least golden rule/united it is possible to win the fights with. its just so annoying for them to call me every 5 seconds and be like "why are you doing this. what do you mean you felt sick."

and i still don't get why male insurance is so much lower. no female cancer shit?

7/8/2010 9:37:08 PM

Yeah I really hope whatever job I get in the (hopefully) near future doesn't use Cigna. I'd rather go with the devil I don't know than the one I do

7/8/2010 10:03:20 PM

KISS ME ONCE!

7/8/2010 11:01:57 PM

Quote :

"and i still don't get why male insurance is so much lower. no female cancer shit?"

You can emit babbys. We cannot.

We contribute to how babby is formed (i.e. we get girl pragnent), but overall there's way fewer complications for a dude until he gets older.

7/9/2010 1:09:52 AM

but that is why you can say no to maternity coverage!

7/9/2010 1:11:35 AM

Yeah exactly. So much of pregnancy is not covered by insurance companies so it's pretty ridiculous that they would use it to factor the cost of male and female insurance fees.

7/9/2010 1:25:17 AM

I don't think you can state that as a blanket statement. It's going to vary from policy to policy.

We paid about $300 out of pocket total when our kid was born, including pre-natal care, and my wife was high-risk, so we had weekly checkups.


however, when she fell and landed on a wine glass earlier this year and had to go to the ER for a 4" deep laceration, it was almost $2000 out of pocket.

[Edited on July 9, 2010 at 8:13 AM. Reason : .]

7/9/2010 8:12:20 AM

well yea it does depend on the policy but my policy covers 0 maternity stuff so i don't get why STILL it is more expensive than had i put i was a male (with all the other stuff the same - i'm not obese, i'm healthy, etc)

i mean luckily it is over $100 less than a comparable (as far as i could tell) BCBS policy

but you know what i also found that pisses me off? when looking at policy brochures (esp limitations and exclusions sections but ALSO sections about coverage) and stuff online (did anyone else sign up for plans online or is that not normal?) most plans have a partial brochure and they say you get the FULL detailed packet when you become a member. that seems kinda like bullshit to me because i want to read all about it BEFORE i purchase it, duh.

7/9/2010 11:40:14 AM

I paid $7000 in health insurance in the last two years. I went to the doctor ONE TIME, the bill was $75 AFTER paying a $20 copay. Guess what, insurance only covered $45 and I had to cover the rest. That is bullshit, I should get back everything I put in.

But I don't.

INSURANCE ISN'T IN BUSINESS TO LOSE MONEY, THEREFORE THEY WILL WIN. IF THEY RUN OUT OF MONEY, YOU LOSE ALL THE MONEY YOU PUT IN. IF THEY WIN, YOU LOSE ALL THE MONEY YOU PUT IN. How else could they afford to cover $500,000 in bills per year with you only putting in $125 a month? Not to mention you are paying their wages and advertisement costs (trillions of dollars). There will be a LOT of losers, and only a few winners.... like a slot machine.

My solution:

I canceled my policy and started paying myself $300 a month.

As far as I know, medical bills have no interest. So If I rack up $100,000 in bills, I'll just pay them $300 a month or file bankruptcy. If I'm in too bad a shape to work, my life is fucked anyways and I shouldn't give a shit what happens to me after that.

At least if I don't use the money that I save for the next 30 years, I can pass it to my kids or use it on retirement, or pay for health insurance when I'm 60 when I really need it. The most important aspect is that I'm in control of my money.

No approval waiting...
No wondering...
No reckless profiteering...


By the way... if I get hurt in a car accident, my car insurance will cover it.
if I get hurt at my job, my business insurance will cover it.

There is overlapping insurance for everything, it's a scam.

[Edited on July 9, 2010 at 12:58 PM. Reason : .]

7/9/2010 12:56:53 PM

^just curious, are you going to do that if/when you get married and/or have kids?

7/9/2010 1:01:06 PM

Quote :

"As far as I know, medical bills have no interest."

As far as you know, HVAC stands for High Voltage Air Conditioning.

7/9/2010 1:06:30 PM

I pay around $800 a month for health insurance. This covers me, my wife and my daughter

getting old sucks

7/9/2010 1:09:08 PM

Quote :

"or pay for health insurance when I'm 60 when I really need it."

If they approve you...my parents were denied coverage for acid reflux.

Acid frickin' reflux.

7/9/2010 1:13:52 PM

I have two kids.



A doctor's visit is like $250... which is less than 1 month payment.
Vaccinations are $1000... which is roughly 3 months.


The question is: If the average person racks up a bill higher than what they're putting in, how can insurance afford to cover it? It just doesn't mathematically add up.

They get to keep your money if
-someone is killed immediately and they never use their insurance
-someone cancels their policy like I did. They got my $7000. fuckers.
-someone can't afford to keep their insurance open and they cancel their policy.


According to http://www.ampminsure.org/insuranceagents/about3392.html

Quote :

" The income made by insurance agents also depends on the type of insurance they sell. There are agents who started with $50,000 and rose to $60,000/year. Insurance agents can earn more with more years of experience. Hard working agents can push up their earnings to 120,000/year too."

I certainly don't put that much money in over a lifetime to pay for JUST ONE person's salary, much less cover their advertisement costs, much much less a $500,000 policy when I need it and all my doctor's bills over the course of my lifetime. Insurance is absolutely raping us.



[Edited on July 9, 2010 at 1:17 PM. Reason : .]

7/9/2010 1:14:30 PM

Quote :

"The question is: If the average person racks up a bill higher than what they're putting in, how can insurance afford to cover it? It just doesn't mathematically add up. "

what do you mean? like if you are hospitalized or something?

my parents racked up a MUCH MUCH MUCH MUCHHHHHHHHHHHH (MILLIONS) higher bill than what they were putting in and just paid what their insurance said they needed to pay which was way less than the total bill.

i'm confused.

7/9/2010 1:20:55 PM

Which part doesn't make sense?


How insurance can afford it?

7/9/2010 1:26:55 PM

Yes, there are people that pay more in then they get out, and people that get more then they pay in. Most large insurance companys also invest the money for additional income. So yes, so far you were losing to the insurance company, but if someone in your family gets something as common as a kindey stone(up to 35k), you're gonna be fucked without the insurance.

If you are bad at the math, that's your medical budget for 9 years, 8 months and 3 weeks.

[Edited on July 9, 2010 at 5:37 PM. Reason : o]

7/9/2010 5:37:00 PM

GeniuSxBoY doesn't understand the concept of pooling risk and sharing the burden

yes the pool will lose out on average but nobody will be thrust into poverty by an illness

7/9/2010 5:50:02 PM

GeniuSxBoY doesn't understand a good many things.

7/9/2010 6:49:51 PM

lol

7/9/2010 7:44:18 PM

I was able to stay on my parent's plan until my insurance from work kicked in. Had I stayed unemployed though, I would have been allowed to stay on their plan anyway until I was 26, their insurance is through the AVMA Ghilt, not sure who the actual provider was.

7/11/2010 1:08:21 PM

Quote :

"I pay around $800 a month for health insurance. "

7/11/2010 4:30:08 PM

^ Seriously.

I pay $50/month for me and my wife. High Deductable plan ftw

7/11/2010 4:47:59 PM

Until I got a job, I never had health insurance. I just paid the money as needed. When I got a job, I paid the 10 dollars a month through work.

From the time I was 18 until 23 when I got a job, I had spent 412 on doctors. I sprained my ankle once. I had strep throat twice.

Between what my work's share and my share, they spend about 540 dollars a month on me. This is the first year where I will actually get more out then the 6000 they put in. (I am pregnant)

[Edited on July 11, 2010 at 10:11 PM. Reason : ]

7/11/2010 10:08:52 PM

In response to how insurance companies make money, just because the vaccines are 1000 for you does not mean that is what the insurance company pays.

My level II ultrasound was 1400. The negotiated rate was $300. I paid a copay. Everybody does not pay the same amount. When I had no insurance, I usually got a "cash" rate. My sister, mom and brother all paid different amounts for an MRI at the same hospital. That is the real problem with health system.......

7/11/2010 10:15:28 PM

anybody have insurance through a company OTHER THAN one of the typical big providers? i'd be interested in considering one of those new-fangled health insurance exchange type things you keep hearing about, if only i could find one. seriously, a back-to-basics, customer-owned, risk sharing health insurance plan would be just great

btw, http://healthcare.gov is a pretty decent site for information about finding health insurance in the context of the new legislation. it's new, so it doesn't have premium quotes (yet), but the presentation and content is pretty helpful

[Edited on July 12, 2010 at 11:23 PM. Reason : .]

7/12/2010 10:25:14 PM

can someone explain to me pre existing conditions?

i mean can an insurance company just decide that something you had prior to your coverage with them (even if it was covered under previous coverage with a different company) isn't going to be covered?

and if so, then what the hell is the point of insurance?

and if so, then why is my premium going UP (from what it was when i initially applied) when they are excluding things.

i'm confused. but either way i think i'm going to just cancel the policy i applied for w/ refund (i have 10 days) and get like the basic BCBS coverage or something (the like uber cheap shit that gets you nothing but if you are in a car wreck you have like a $10,000 deductible. perfect. not).

can anyone recommend a company that has waiting periods for pre existing conditions? i mean fine, if you don't want to cover the anemia i had ONCE last fall (almost 12 months ago) for like 6 months or a year or whatever, fine. but i don't want it to be indefinitely excluded. OR a company that does pre existing condition exclusions (6 months, would be ideal, so then the stupid anemia and anxiety wouldn't be excluded). both of these things i suffered from last august/september and are now excluded under my new plan. but instead of excluding anxiety, ALL mental health coverage is excluded...for any reason and of any type. that seems like kind of a broad area to be completely excluded - especially when i'm paying more NOT to have it.

and i had continuing coverage so i don't get what the deal is. they can just decide that these things are "pre existing" even if i had continual coverage???

[Edited on August 13, 2010 at 8:40 PM. Reason : .]

8/13/2010 8:28:44 PM

at least you'll only have to deal with it for a few years
http://www.whitehouse.gov/blog/2010/07/29/insurance-americans-with-pre-existing-conditions

8/13/2010 8:42:47 PM

unhelpful and unnecessary

if someone has something helpful to share i'd really appreciate it. i'm serious. i don't know what to do. i just want to pull my hair out. i guess suck it up, and fine i can do that, but not with this policy that is $$$$ and excludes stuff. like shouldn't it be cheaper if they're taking shit out?

i'll just get the really shitty incase i get in a car wreck coverage, whatever. don't mind the mass growing in my groin. i'll save that for when i get a big girl job and can afford better coverage.

but seriously, can they just decide they don't want to cover something even though it was previously/continuously covered by my former/current provider? this is so confusing. i thought if you didn't have a gap in coverage you were good?

8/13/2010 8:50:21 PM

health insurance companies can currently deny you coverage for an individual plan (as opposed to group plans through an employer) for any reason, and this is often the case for certain types of pre-existing conditions (for example, my wife is always denied b/c she has Type I diabetes)

but if you they do approve you for coverage, and have pre-existing condition exclusions or waiting periods, the waiting periods can typically be reduced by having continuous or creditable coverage through previous insurance plans. for example, if the plan you sign up for has a 6 month pre-existing condition waiting period, but before you joined that plan, had been on a previous plan for 5 years that had covered that condition, the 6 months would be reduced to 0.

pretty sure i got all that right, somebody correct me if i'm wrong



furthermore, if you are on COBRA, and use up all your eligibility, then try to buy an individual insurance policy, you are now a HIPAA Eligible Individual. which i think means an insurance company can't deny you coverage, or exclude your pre-existing condition, but they can charge you out the ass, making the HIPAA protections basically pointless

[Edited on August 13, 2010 at 8:57 PM. Reason : again, i could be mixing up some details here, so don't take this as 100%. shit's complicated]

8/13/2010 8:52:41 PM

thanks!!! ok that is what i thought. mine didn't give me an exclusion period option (when i was searching for plans). it says "indefinite" by the things excluded, which isn't cool. not that i need that coverage now but what if i have this stupid ass policy for 2 years and then i have a blood test for anemia or something??

i need to find a company that will do the waiting period ish.

so like all of the HIPPA rules about having 0 break or < like 60 something days break in coverage and not being subjected to pre existing conditions is only applicable to group/employer plans and not individual plans? just making sure i have it right.

does anyone know of any companies/plans that are known to have the waiting periods for excluded conditions? so its like if you had X then the company could deny you coverage for like 12 months or something for X but then after the period was up, you'd be good?

[Edited on August 13, 2010 at 8:59 PM. Reason : .]

8/13/2010 8:56:55 PM

After I officially left my job at the end of April, I had to get short-term coverage and did a ton of research on it.

Frankly, I was under the impression that a pre-existing condition had to be either diagnosed or treated within 6 months of the application for new insurance. If you were treated for it 12 months ago like you said I don't see why that would be allowed to be classified a pre-existing unless I'm misinterpreting what you said.

^^ that's basically right other than the one thing that I noticed.

[Edited on August 13, 2010 at 8:59 PM. Reason : x]

8/13/2010 8:59:21 PM

i think even if you get on a group plan, they can still have pre-existing condition waiting periods. again, typically your creditable coverage from previous plan would reduce that to 0

Quote :

"Frankly, I was under the impression that a pre-existing condition had to be either diagnosed or treated within 6 months of the application for new insurance. If you were treated for it 12 months ago like you said I don't see why that would be allowed to be classified a pre-existing unless I'm misinterpreting what you said. "

i don't think that's right. doesn't matter how long ago it was diagnosed, it's still going to be considered a pre-existing condition

Quote :

"so its like if you had X then the company could deny you coverage for like 12 months or something for X but then after the period was up, you'd be good"

but if you had 12 months of prior creditable coverage, you shouldn't have a waiting period with the new plan.

[Edited on August 13, 2010 at 9:02 PM. Reason : .]

8/13/2010 9:00:09 PM

^^ yea, that is what i thought. i haven't been anemic since sept/october of last year so i don't understand how/why that could be excluded especially since i didn't have a break in coverage. this is so retarded.

the last time i was out of school/work (for like 6 months in between college and law school - i worked PT but no benefits) i used this same company (golden rule, part of united health) and everything was a battle with them. i vowed not to use them again but they had the cheapest premium for what i wanted. though now that they've added all the exclusions and increased my premium, i feel like i'd be better off going with BCBS, which is who i had while in school.

^ oh ok i see. but my new plan doesn't give me a waiting period option at all. they just flat out excluded it indefinitely even though i had continual coverage. so...i mean they can just decide to do that for individual plans? i mean you already said yes, so i believe it but that is so stupid. so what the crap was i supposed to do when my other insurance plan was about to be up? i HAD to apply for a new one. and i did it BEFORE the first one expired so i wouldn't have to deal with this shit. but i still do? LAME.

[Edited on August 13, 2010 at 9:06 PM. Reason : .]

8/13/2010 9:03:45 PM

Hmmm.... This is what I found. I had no pre-existing condition so I really didn't worry about that part, but I came across this on one of my bookmarked sites from when I was looking.

Quote :

"I just changed jobs. Seven months ago, I received my last treatment for carpal tunnel syndrome. Can my new employer’s plan apply a preexisting condition exclusion? No. If your last treatment was more than 6 months before enrollment in your new employer's health plan and you have had no other advice or care relating to your carpal tunnel syndrome in the last 6 months, your condition cannot be subject to a preexisting condition exclusion. "

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

[Edited on August 13, 2010 at 9:05 PM. Reason : i had bcbs in CA and I have them now. no problems at all.]

8/13/2010 9:04:42 PM

which BCBS plan are you under now? i looked at them first because i really liked them before. but then i found this plan which was ALLEGEDLY CHEAPER (not anymore) than the comparable BCBS. but the thing is if i cancel this golden rule policy i feel like my shit is going to be even more fucked than it already is

so like my policy was going to expire in july soooo in june like a normal person i applied for a new one while i still had existing coverage. and this new one, even though it just got approved, back dated my coverage to the date i applied so there wasn't a lapse or whatever. but now i just got all my shit in the mail and have 10 days to cancel. but then i will really be screwed because then i will have a lapse won't i?

this is so stupid hate insurance. i HATE IT!

[Edited on August 13, 2010 at 9:09 PM. Reason : .]

8/13/2010 9:08:49 PM

Quote :

" unhelpful and unnecessary"

uh it has information on pre-existing conditions and links you to healthcare.gov

but fuck you then

[Edited on August 13, 2010 at 9:20 PM. Reason : i mean what the fuck was that about]

8/13/2010 9:13:17 PM

Cutoff is 63 days I think. I'm out the door but I'll check back in sometime tomorrow and tell you what plan I am on (it's pretty affordable).

8/13/2010 9:14:20 PM

^^ because i don't care what is happening in 2014, or that kids under 19 (that isn't me) cannot be exluded for pre-existing conditions now, OR that if you have cancer, diabeetus or lupus and have been uninsured and unemployed continually for like 6 months or something that you can qualify for coverage now.

i already knew all of that and none of that really applies to me. i just didn't know that insurance companies could deny individual plans for anything they wanted (or so it seems) even with previous, continual/concurrent or whatever coverage. and basically i just need help finding a plan that will let me do a waiting period. because who knows how long i'll be unemployed or need my own individual health insurance (like if i end up at some tiny firm or something), if i have this coverage for more than a year then i would like the exclusions to not be "indefinite" you knowwww?

but thanks i appreciate the effort

^ thanks!

[Edited on August 13, 2010 at 9:24 PM. Reason : .]

8/13/2010 9:23:53 PM

they talk about stuff that is directly relevant to what you are asking when you follow the link and make one click, so sorry for posting in your someone else's thread

8/13/2010 9:36:44 PM

if you're low-income, couldn't you apply for medicaid?

8/13/2010 9:42:13 PM

^^ i'm confused - not much of what i read/saw in that link or the other link included in the article applied to me besides the fact that discriminating due to pre existing conditions will be illegal in 2014.

the pre existing insurance plans that states have right NOW have requirements i don't meet.

unless i am missing something, which i probably am so can you direct me to that???

^ i have enough $$$ to make the premium payments. its just the pre existing stuff that i'm having trouble with (with this particular provider. i don't mind a slightly higher premium for pre existing coverage or a waiting period option - i just don't want indefinite exclusions. ideally i won't have this plan for long, but who really knows so i'd rather not have indefinite exclusions. 12 months, whatever i don't care as long as there is a limit)

[Edited on August 13, 2010 at 9:46 PM. Reason : .]

8/13/2010 9:44:05 PM

im not talking about pcip i'm talking about the general information about knowing your rights under existing and new laws, which i could navigate you to (but won't). good luck in your endeavors though.

[Edited on August 13, 2010 at 10:00 PM. Reason : .]

8/13/2010 9:59:06 PM

yes. your first post clearly implied that as your initial intention. especially the part about only having to deal with it for a few years.

reading the laws are one thing. got it. which is why i wanted to ask questions in here about my understanding.

[Edited on August 13, 2010 at 10:07 PM. Reason : .]

8/13/2010 10:05:56 PM

As promised, my plan is the Blue Advantage Plan B $1,000/30%.

http://www.bcbsnc.com/assets/plans/public/pdfs/BlueAdvantage.pdf

For me it's only ~ $145 a month. I'm not sure if that is a great deal because this is the first time I've had to have my own health insurance in this state (I was on my parents during college) but it seems pretty reasonable for what I get.

8/15/2010 1:05:47 PM

Quote :

"Cutoff is 63 days I think."

That is correct. A PE waiting pd looks back a full year from the time your coverage begins. If you had no lapse in coverage greater than 63 days, your PE waiting period can be removed. If you say had 6 mos of coverage and 6 mos without, they will reduce your PE waiting period by giving you a "credit" but you'll still have a few months where any condition you go to a doctor for, can and will be denied, such as Diabetes, Cancer, etc.

If you work for an employer with >100 employees, I believe, you are on a Self-Funded plan. That means your employer picks the options and coverage they want as well as pay your medical bills. The insurance company is simply the administrator in processing the claims using your employer's money. With this, your employer can also dictate whether they want a PE waiting pd or not since it's their money that the insurance company is spending.

Group plans with <100 employees are Fully Funded plans meaning the money spent on medical services is the insurance companies money. These plans are more heavily controlled by the insurance company as far as what will be covered, what needs to be Pre-Approved beforehand, etc. The employer doesn't have as much say.

Same thing mostly applies for an individual policy. The insurance company makes the rules that need to be followed.

One good thing about having insurance is that the insurance company already has a negotiated rate with various providers & hospitals as long as you're seeing one that has a contract with the insurance company (In-Network). I've seen $50,000 facility charges dropped to $21,000 based on their Usual & Customary Rates. Generally, hospitals will charge 50% more than what's in their contract to someone who doesn't have insurance and then it's the consumer's job to negotiate the rate down if they do not have insurance. Whether the provider will reduce the rate is up to them but they HAVE to if there is a contract with said insurance company.

8/16/2010 3:22:51 PM

I have USAA and they referred me to Assurant Health, I think. I have gap insurance with them now, but they had regular stuff, too. It's not really cheap or anything, but it's manageable, and I got it for my kid, mainly. I bet it would be a lot cheaper for you.

8/16/2010 5:49:02 PM

but i thought all the pre existing rules and stuff only applied to group plans. like aren't you just SOL if you are on an individual plans? regardless of no lapse in coverage and stuff? cause that seems to be what happened to me. i have 2 things listed as pre existing conditions on my new individual plan, no lapse in coverage, the "conditions" were covered before and happened last fall.

i'm so confused. i mean i'm hearing mixed things. i just don't know what to do. i guess having some insurance is better than none and hopefully the PE (anemia) won't be an issue again but my policy doesn't even state anywhere that there is a waiting period for the PE to be removed like...it just says "indefinite" on it. ????

8/16/2010 5:51:26 PM