Need Health Insurance Advice

[a la izquierda]

Hi everyone: I have what seems to me like a very dumb question, but there's a reason for said dumb question. First the reason, then the question. Since I've been a kid, my insurance has been more or less taken care of for me. I've either been a dependent of my parents, a student, or a very fortunate employee with bosses who really cared about us and gave us great health and dental insurance. So, I've never really had to worry about my health insurance, aside from occasionally arguing with the insurance company over a claim. My husband had great insurance when he worked a full time job with a good company in L.A. Then, when he was self-employed, before we were married, he went uninsured. We picked out the first company with a reputable name that we could afford--Blue Cross--to make sure if he got into a van accident on tour, he'd be covered and we wouldn't be financially ruined. Well, things have unraveled to the point that Blue Cross is pissing us off and becoming financially not worth it. Last year, for instance, they would not cover vaccinations he needed to travel out of the country, unless we got them from the pharmacy and I gave them to him myself. WTF? I wondered what the hell are we paying THEM for? Then, the minute he turned 35, in January, the rates skyrocketed--this is a man who has no health issues, has never smoked or used drugs and hasn't so much as made one single claim. So, needless to say, we're shopping for new insurance. But I want the best deal I can get. He *might* be eligible for low cost insurance through his work, but it would only be a band-aid, as one must reapply each year, and next year, we'll make too much money.
So, my question: when an insurance company, such as Aetna, has $3000 deductible, but they don't cover office visits. Now, apparently, it's a $35 charge for preventative care...so I guess if my husband wants a physical, it's $35? The man doesn't get sick much-the first time he was at a doctor's office in 4 years was last June, because of a dog bite. Prior to that, it was because he got a piece of wood stuck in his eye and food poisoning (in the same night-bad luck...) This insurance policy starts at $68. I know a $3000 deductible is high, but it's less than what we have now. But I'm worried about office visits not being covered--and I'm guessing I should be, correct? The other policies that have covered office visits have very high deductibles, which I really doubt we'll ever reach-so what's the point.

Thanks for any suggestions and sorry for the rambler.

[ayeshahaqqiqa]

1. I work in a doctor's office

(actually it's a non-profit foundation), and I file insurance claims. Blue Cross Blue Shield sucks, and I wouldn't recommend it to my worst enemy. We have patients with high deductibles, but the companies do have office visits count towards the deductible. To my mind, and insurance policy should cover two things: office visits and lab work. If the policy doesn't, I'd wonder if it was worth it. BTW, from my personal experience, Cigna is one of the easier companies to work with, but we've also gotten checks from Aetna (think it was a group policy,though).

[a la izquierda]

3. We're trying to get this handled before the 15th

of next month. I don't want to give them another dime. I can get him insurance through my university, since I'm a graduate student teaching assistant---but we can't do that now until August.
I'll have to see if perhaps a short term policy might make sense. The policy through school is $115 per month, but it comes out of my loans and then we don't think about it (well, until the future when I have to pay of $90K in loans for three degrees...but that's the LEAST of my worries). And it's a decent policy, because he's covered through our Auto insurance, plus he has insurance through USA Cycling for any serious biking accidents.

This is ridiculous. I'm in Mexico right now and when this subject comes up, Mexicans laugh at me about it--not out of malice, but out of the ridiculousness of the situation that is US healthcare.
Thanks for your input!

[Fire_Medic_Dave]

7. Those must be the same people that demanded $20k...

before they would med-evac my friend with 3rd degree burns covering 60 percent of his body out of their fair country.

David

[yellowdogintexas]

2. a plan which does not cover office visits is basically a catastrophic plan

it covers the big stuff and usually is 100% coverage after ded is met. I mainly want insurance for hospitalizations, Emergency room needs, big tests and such. $68 a month is a very reasonable premium if the plan does pick up at 100% after deductible is met. You can expect a much higher premium if all medical services are included.

Does this plan cover xrays, labs, big diagnostic tests? Prescriptions? Also, is Emergency Room covered for injuries, etc.

I used to process claims on this type of coverage. If you have something that is expensive enough that your deductible is met and it starts to pay out it is very good coverage for what it covers.

When shopping for insurance, review the exclusions and limitations carefully. That way you know ahead of time what is never covered.

In some states certain types of preventative care is mandated. Examples are mammograms, paps (aka the Well Woman exams) You pay $35 and the rest is covered usually up to a certain maximum per person.
Immunizations also come under preventative..if you are under 18 and they are required for school admission.

Truthfully, immunizations for travel needs are seldom covered by any insurance. However a tetanus shot is covered if you are injured and have not had one in at least 7 years, because it is no longer preventative if you have been injured.

Age 35 for some reason is a great turning point in premiums both for medical and life insurance. A key thing here is to try to stay continually covered, especially after 40. It keeps the insurance company from being able to claim pre existing if you come up with a serious condition.

[a la izquierda]

4. We'll keep him insured, regardless.

I'm a worry wart and even though he's healthy, his brother had TIA (I think that's what it's called) a few years ago. It scared the crap out of me. I explained a bit more upthread, but thanks a bunch for your input...

[flyingobject]

5. Check with your state insurance commission

to find out which insurance companies are rated highly and which
ones get alot of complaints.

[flyingobject]

6. PS, with the high deductables today, you should pay cash -not bill to ins

it is alot cheaper.

With a 1,500 deductable, or a 3,000 deductable, you will end up paying for office visits
anyway. You will pay out of your pocket, but if you tell Dr. to file it against insurance,
you will pay alot more for the visit.

Example:

Billing high deductable ins for a office visit - $120.00
Pay same Doctor cash, keep a receipt (in case you have 3,000 in expenses that year) visit $50-$80

Same insurance often will cover much of the cost of your prescriptions, luckily, but
for all other purposes you are up shit creak unless you have a catastrophe.