I am self employed so I buy my own insurance

[Lorien]

Over the past 12 years or so I have paid my insurance (United American Healthcare) over $78,000.00 in premiums. I have also paid tens of thousands out in deductible costs since my deductible has been 10-12k. It's hardly "Cadillac insurance", but it's the best that I could afford.

Over the past 12 years I have submitted roughly $45,000 worth of claims. The insurance company has paid out $200.00 of the claims submitted. The rest came out of pocket and was put toward the deductible, or the claim was denied.

So, for the price of a decent home I have received exactly $200.00 worth of services in 12 years. How is that "reasonable"? I'll tell you one thing; it's no longer sustainable. Most of the doctors I see now don't accept insurance because they can't afford to battle with them over paperwork. In fact, the office manager at my GP's office refuses to carry insurance because, she says, after spending all day on the phone fighting over claims that generally never get paid she sees absolutely no benefit to it. And now the health insurance reform fans want us to cheer because an additional 32 million will now be forced to pay out several grand a year for "insurance" which will likely never pay a claim. Meanwhile that money could put food on the table or keep the lights on instead on lining a CEOs pocket.

Paying a few grand a year for health CARE is quite reasonable. Paying $133,000 for $200.00 worth of health services is NOT. The American people deserve far better. Let's push for "far better" in the final version of this bill!

[ixion]

1. Indeed. Insurance is not health care. Not even close.

And to conflate the two as equal and call it reform is madness.

[Leopolds Ghost]

95. Per Harpers and WaMonthly, years ago, the current plan is predicated on the notion that deadbeats

Are what drives up the cost of premiums.

I.e. that the uninsured ARE the problem for "the rest of us".

[grantcart]

2. Three points

1) There are going to be no more changes in the bill this time around as it is now in reconciliaton

2) As a self employed person paying for individual plans you are in one of the groups that will get the biggest benefit when the full effect of the bill is implemented.

You will be able to join in the Health Exchanges and move from high premium for individual plans to competitive premiums in a huge pool.

3) If your incorporated as a small business there may also be tax subsidy as a small business.

[Lorien]

7. Again I ask: how is paying out over 133k for two hundred dollars worth of services

reasonable or sustainable? They can make premium costs $100.00 per month, but if the deductible is entirely unaffordable and they deny all claims, then how does that help anyone?

[Inuca]

44. AFAIK the deductibles will also be more manageable

ANybody who knows better, am I right or wrong?

[Xithras]

51. There are deductible caps, but they're very high.

If I remember correctly, the deductible cap for the average American family of three making just over #30,000 a year was somewhere around $4,000 a year. The Senate bill also went right down to poverty level, so even the poorest Americans could still face deductibles of a couple thousand a year (on top of their pseudo-subsidized premiums).

Deductibles weren't well-addressed at all.

[jeff47]

94. You are assuming that there will be no changes.

Basic economics says that joining the pool of people in the exchanges should lower your costs.

[Jackpine Radical]

101. Unfortunately, insurance companies don't operate on the principles of

"basic economics." If the marketplace were competitive, prices would already be lower. That's why the public option makes sense. Remember that insurance companies are excluded from antitrust legislation, and that the people who buy it (e.g. employers) are mostly driven by price, while the people who use it are interested in quality, but have no say in what insurance they get to have. This creates an environment in which price always drives out quality.

[jeff47]

129. It's about the pool size, not the competition

The exchanges create a larger risk pool, which drives down the cost.

Yes, the PO would help to keep the insurance companies 'honest', but there are other cost containment measures.

[liberation]

126. Yeah, because supply side economists have been so right about so many things

how is that "trickle down" working out for you?

Common sense says, that when corporations have a natural monopoly, and the government forces its citizens to buy their product, there is no reason for them to lower prices. You know since lowering prices would imply lowering profits. And that goes counter nature for a publicly traded corporation.

[jeff47]

130. Except they don't have a monopoly

"Common sense says, that when corporations have a natural monopoly, and the government forces its citizens to buy their product, there is no reason for them to lower prices."

Except they don't have a monopoly, and the exchanges boost both competition and increases pool size.

Yes, there are still plenty of improvements to be made. This bill was never going to be the end of the line. But this bill gives us a framework in which to make those improvements as small, easy-to-pass, "common sense" bills. Bills we can beat the Blue Dogs into voting for.

[wolfgangmo]

134. Ah but they do have a monopoly.

Didn't you know that insurance companies are exempted from the anti-trust laws. They can collude their little asses off (and do) setting prices and reimbursement rates and no one can touch them.

[jeff47]

138. The exemption is going away

(Well, it's waiting for the Senate)

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.4626:

[WI agent]

102. The principle of insurance

I am also self employed and purchased my own coverage. I have "paid in" a little over $20,000 over the years but my company has paid claims of over $1.5M. Do you understand the principle of insurance?

[Hamlette]

115. didn't you really receive $45K in care? Aren't your numbers dishonest?

I think your figures are dishonest but maybe you can explain them to me.

You paid out $78K in premiums and submitted $45K in bills of which the company on paid $200. You paid $78K for $200 in coverage. Didn't you receive $45K in care, not $200 in care?

It appears to be a huge exaggeration to me and when you do that, you lose me.

[AllyCat]

118. Not sure where the disconnect is here for you:

$78K in premiums
$45K in submitted claims for care

Total: $133K that Lorien has paid OUT OF POCKET except the $200 offering the insurance company paid.

That's dishonest? On the insurance company's part, I'd say they are dishonest. You believe they are without reproach, but Lorien has exaggerated hugely by not subtracted the $200 "grocery store discount coupon" the insurance company actually paid?

[Hamlette]

139. here's the dishonesty

the op said she paid, PAID, $133K FOR $200 in care.

I thought I was completely clear in saying: didn't she receive $45K in care?

What she should have said is she paid out $133K (really $123K as $78K plus $45K is $123K but who's counting) and she only received $45K in care of which the insurance company only paid $200.

[AllyCat]

117. And is that in 2013 or 2014 now?

So another $60K for premiums and out of pocket expenses assuming no rate increases (hah!) while we wait for that. The exchange still does nothing to make them pay the claims.

[wolfgangmo]

123. All good points about paying for a getting an insurance policy.

But as the owner and general manager of a family medical practice that no longer bills insurance for patients I can tell you from hard experience that the insurance companies don't pay patients who submit claims and the don't pay the doctors either. Not without a hell of a fight and both the patients, doctors and staff have better things to do.

And I can tell you that general and family practice docs are moving more in the direction of opting out of the "system" because it is impossible to treat patients, pay our staff and take home any money at all. Let me give you an example. At our practice we used to spend about 50% of all staff time resubmitting forms to insurance companies, or waiting on the phone to argue with some divot head who was only reading what his/her computer told him/her to say, i.e. claim denied, often for the flimsiest of excuses.

I hope for the best with the passage of this bill, but forcing everyone to pay private companies for services that they clearly do not want to and often will not deliver is not good business.

[Cal Carpenter]

3. Thanks for telling your story

(again!) It must get frustrating for you to have to tell it, but honestly I think there are a lot of people here who have no frame of reference for the real-world consequences of this bill. The whole argument FOR this bill is predicated on the notion that health insurance = health care, or at least that health insurance makes health care possible, when really insurance is and obstacle to care for many people.

As someone who has played the role of advocate for low-income and destitute people both in my personal and professional life, I am hard-pressed to let people get away with saying shit like 'if you're poor it will be free' or 'it will be affordable for everyone' because it is NEVER that simple with federal social services. The reality is even if you aren't particularly poor it's STILL not going to be affordable, even after this bill goes into effect.

You know they've lost the argument, though, if they start telling you that 'you've' made poor choices (and I really hope they don't but it won't surprise me if they do). Because while your personal example is admittedly anecdotal, it makes a point. But the importance of this bill is on a macro level so nitpicking about one person's situation is a fail from the get-go.

[CountAllVotes]

4. my insurance just paid out $200,000. in claims

from Nov. of last year through Feb. of this year. No complaints here but the cost is $1200.00 a month!

If I didn't have the insurance I would have have gone bankrupt by now.

Best of luck finding something better is my wish for you.

[Lorien]

10. Sure, but what you pay in premiums is more than I'm bringing home most of the

time. That's the problem; the 32 million won't be able to afford much more than I could. Neither could that office manager or most of my GP's patients. The "comfortable" are OK, but most Americans aren't all that comfortable these days.

[CountAllVotes]

12. it is a burden believe me

It is the most expensive thing I have. I've managed to keep it luckily. It has not been easy - annual income is very low >$30,000.

[Lorien]

17. I know others in your situation. It's sickening that in a "civilized" nation

that it's come to this. But at least, as you say, they've paid your claims. I'm deeply in debt because mine did not, and I'm still very sick and in need of surgery. Not much that I can do about it, though.

[CountAllVotes]

50. I am not really "fixed" yet

I doubt I ever will be. I was told I am lucky to be alive and that I should shut up.

However, I really am disgusted with the results of this last surgery.

The scars are horrific and ugly.

I'm sure my insurance would never pay for cosmetic surgery. I never in my life thought I'd ever have or want such a thing but when I look at my abdomen ... OMG ... :puke: What a butcher job! :(

[Lorien]

56. That's horrifying! For what you are paying out every month you deserve far better

(though I still hate the fact that only those who pay through the nose "deserve" anything at all). I have a friend in AZ who pays $1,900.00 per month and she still has to battle the insurance industry over the services that she needs for her MS because they call them all "experimental". It's just not right. No one should suffer with hatchet jobs or substandard care in the Nation with "The best health care on Earth."

[CountAllVotes]

64. there is only one surgeon where I live

and he happened to be around when I fell sick. He operated on me at 3:00 a.m.

When I mentioned I was distressed with the care I was told to shut up being he is the only surgeon where I live.

"Don't cross him" I was advised.

People say go elsewhere. How can I? I can barely drive the car to the store and back. I was told it would take me one year to recover from this mess. :(

And yes, you'd think I'd get more for all of that money. I could go on and on but I won't. I really feel like filing complaints but I realize it won't go anywhere.

You sign too many releases when you are hospitalized in an emergency situation. They were busy shooting me up with Dilaudid and morphine as I signed my rights away!

[bvar22]

65. So you monthly premium is almost 1/2 of your income?

The rest of your year, you survive on $15,600 for everything else.
Were there any co-pays or deductibles?

This doesn't seem workable to me.

[CountAllVotes]

72. no co-pays nor deductibles

and yes it is workable. I never go anywhere for one thing.

I own one car and I have my house paid for fortunately. Being the house was a low price when I bought it 10 years ago, the taxes are low on it.

It is barely workable but I've been living this way most of my life so you get used to it.

You don't qualify for any "assistance" when you are in this boat.

In any event, I am glad I didn't change to the cheaper plan as it seems the last operation I had likely would not have been covered as it would have been considered a "pre-existing" condition.

Can't win it seems!

[SheilaT]

98. self deleted.

my comment was already answered.

[FDR_Democrat]

100. So half your net income to an insurance company is a good deal

It must be nice working for your insurance company. Let me tell you about my deal, I'm a veteran, so my health care costs are about $100.00 a year. With suckers like you, the CEO's of America should continue to do nicely.

[theFrankFactor]

121. When COBRA expires I'm Lookin' at $2000.00 a month.

I mean, really! All these fucking insureres do is risk pool! And it appears they fucking SUCK AT IT!

[SharonAnn]

124. Actually, they're very good at creating risk pools advantageous to them.

They're very, very good at it.

That's why they have so much of our money.

[dkf]

16. That was the actual cash that was paid or the inflated price?

[CountAllVotes]

30. I got two bills from the hospital

one was for $76,000. the other for $78,000. I received separate bills from the surgeon, etc. :(

[dkf]

88. What did your insurance co actually pay?

It seems to me that hospital bills are like car sticker prices with everyone bargaining them down randomly.

[paulsby]

31. i'm in a similar boat

my employer pays about 1k a month for my insurance

it is phenomenal coverage and has covered everything i have had done and i have had two surgeries in two years, and lots of other stuff

it also has benefits like full coverage for massage, acupuncture, chiro, etc.

but i support universal healthcare. i got mine. i don't think for a second that any single payer plan would get me better coverage

it's not about me.

i'm LUCKY

[CountAllVotes]

33. that is how I feel too

I am glad this bill passed for people that do not have any coverage. It is not about "me" - it is about others that don't have!

:dem:

[Lorien]

39. I'm concerned about those not getting health CARE, and insurance doesn't guarantee

care. That's the whole point. Insurance-especially for the less-than-well-heeled -stands between the patient and the care that they need.

[CountAllVotes]

47. I am quite aware of that

many doctors do not take Medicare, Medicaid, Medi-Cal, etc.

It sucks for those that are locked into these programs (and other forms of "insurance") and have no alternatives.

[CountAllVotes]

40. sounds like similar coverage to what I have

I could have changed to something that costs less but I feared that something could go wrong given my circumstances.

Luckily, I stuck with my instincts and did not change coverage last year.

I got very sick in Nov. of last year and almost died, hence the two surgeries in 3 months.

The ER visit and the ambulance(s) alone were over $10,000.00. *eek*

That said, I must add that I am not impressed with the care I received. I was discharged from the hospital and they failed to give me the RX's for antibiotics! I could have died!

Greedy IDIOTS.

[paulsby]

43. my coverage is simply phenomenal

but that's not surprising because i have a large union protecting my interests.

most people don't

[CountAllVotes]

46. same here

a very large union and yes I pay dues happily! :D :D :D

I figure let the Union goons fight with the insurance company goons! It leaves me out of the picture! :D

[flyarm]

112. but it won't be once this bill is instituted..with the 40% tax going to be levied on your union .

you will see a drastic reduction in your coverage and policy...it is policies like the unions that the insurance industry wants to eliminate...you of all people will be most hurt by this bill! But many of us warned about that..we were simply over shouted by the health industry propagandists here and in the media..why do you think they paid so many trolls to over work the internet pushing their agenda and propaganda?? why do you think all their stock went up yesterday and will continue to do so..sure they may have a slight blip..but the stock will go up..

and stay up.

[paulsby]

137. i don't support this bill because i think it will help me. it will more likely than not HURT me

i support it because i think it;'s better for society in general, because too many people fall through the health care cracks.

i often support legislation that harms me, or oppose legislation that helps me.

for example, i strongly oppose the ban on smoking in private establishments such as bars. the legislation HELPS me (i can't stand cigarette smoke), but i think the liberty interests trump my desires

[wolfgangmo]

125. I didn't know Blackwater had a union.

Bwahahahahahaha.

[FSogol]

5. True, but this bill...

"Creates a health care exchange, a marketplace where uninsured individuals and small businesses can comparison shop for insurance policies." This competition alone should allow you to buy affordable insurance. Car insurance is reasonable thanks to competition and this competition will have govt oversight.

[Taitertots]

34. I bought a car for $200 in 2000

I had to pay more than the cost of my car to get it insured.

[Lorien]

36. THAT"S your argument? Seriously?

you can do better than that.

[Taitertots]

71. Well I've had to pay close to 100 times the value of my cars over their lifespan

and I've never had a single accident and no traffic violations.

Why should I believe the same lies about this scam that they told about the last scam?

[truedelphi]

91. Thank you for bravely setting forth someof the truths about the system

That this HC "reform" bill will prop up.

It is sad to see the occasional person rather beating up on you. I have come to the conclusion that some people are really making themselves feel safer, by coming up with arguments about how much someone else handled a predicament in an unwise manner.

So if someone says, "Well gee, Lorien, why didn't you do the sensible thing, such as Action X, like I did, and then you wouldn't be in this fix," what they are really trying to do is to convince themselves that as long as things are handled in a precise manner, then everything will always be okay for them, and they could never end up in a similar jam.

So they are not even being critical with you. They are just trying to comfort themselves that by being practical and going the extra mile their lives will remain calamity-free.

And of course, one of the best things one could do regarding avoiding the health care crisis pickle is to LIVE IN SOME OTHER DAMN COUNTRY THAT DOESN"T HAVE A FOR PROFIT HEALTH CARE SYSTEM! WITH POLITICIANS THAT ARE MORE CONCERNED about People than lobbyists..

[bvar22]

69. Don't need an "Exchange" to comparison shop.

If you have access to the Internet, you can already compare prices and planns.
Its easy.
Just Google "Buy Health Insurance" and see what happens.

As far as the BIG 5 "competing" with each other in the "Exchange"....
They won't undercut each other.
They know how this game works.

They will simply divide up the 40 Million herded into the "Exchange Pens", and go about the shearing.
The plans and prices offered will be "miraculously" similar.
This IS America, fer gawds sake.

[unc70]

78. No, car insurance is reasonable because of State regulations

NC has very reasonable auto insurance rates, but they are regulated by the insurance commission. Health insurance is not, so I was paying over $2k/month until they "found" a way to cancel entire group.

All the things like tax credits for small business make little or no difference in most cases. The business must be doing well to ever be able to use the credits. My company has losts of tax credits already; what we need is more sales.

[stray cat]

6. health care savings accounts might have worked better for you

but they are crap if you ever really get sick

[Lorien]

20. That's what I'm trying for now. I've been "underemployed" for the past six months

and finally stopped paying the premiums because the phones and internet (which I depend on for my job) were shut off for non payment. I had to make a choice. After doing the above calculations the insurance was cut instead. I hope to pay down my debts and start a health savings account instead. It should be a better deal as long as nothing too serious happens. As I said, most of my doctors don't even take insurance.

[Abq_Sarah]

90. Not really

Unless you get ill before you're able to save the pre-tax deductible. Once you meet the deductible, it's no different than any other insurance.

[napi21]

8. Have you checked with other ins. companies? Your exoerience

is NOT the norm. I lived in 5 different States & had 5 diff. insurers. Although I never owned my own co., in 3 of them I was responsible for getting bids from various insurers & choosing the best one. One co. was relatively small with only 26 employees. You didnt say how many employees you have so I have no idea if your premiums are inline or not, but if you get that poor of service you should drop them like a hot brick!

[Lorien]

13. Oh yeah. My previous insurance with the National Association of the Self

Employed (NASE) was more expensive but far worse. PBS' NOW even did an expose on it: http://www.pbs.org/now/transcript/transcriptNOW218_full.html

I'm a sole proprietor. Most of my freelancing friends have similar plans.

[Warpy]

9. Your premiums will now be limited to a percentage of your income

and the care should be comprehensive with a much more reasonable deductible.

That's the last plan I was ever offered, BC/BS 12 years ago at over what I was paying for my mortgage and with a $7500 deductible. I wisely decided that shelter was more important than "insurance" that would only pay 80% of the bill after I'd already gone through much of my savings and decided to bag the idea. No one will write me a policy now, no matter the deductible or cost.

Clearly, this reform will help me. It will probably help you by cutting your costs and getting rid of that insane deductible.

Anyone who tries to get private insurance has been left running some pretty unattractive numbers. 70% of people who look for private insurance come up empty because those numbers are just too bad.

This bill attempts to fix that. Let's hope it does in the short term and that Medicare rules are loosened in the long term.

[Lorien]

14. The premiums don't worrry me as much as the deductibles and unpaid claims do

if I had had cancer I would have both lost my home and probably died because of the policies of United American Wealthcare.

[mzmolly]

11. Do you realize that the bill addresses situations like yours?

There are maximum out of pocket expenses for starters. :hi:

[Lorien]

15. Um, yeah. Specifics on DEDUCTIBLES and CLAIMS?

If one is sky high and the other goes unpaid it won't help in the least.

[mzmolly]

18. Here you go.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=239442&mesg_id=239442

[Lorien]

24. That says that deductibles are limited to 2k for small group plans

it doesn't say anything about individual plans or claims.

[mzmolly]

38. "maximum cost-sharing will be limited to the current law HSA limit"

"Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage..."

Not to mention the actuarial values have to meet minimum standards.

Have you used the KFF calculator?

http://www.kff.org/healthreform/sidebyside.cfm

[Lorien]

42. Lots of hand waving. Just give me a few straight pieces of information:

In the State of Florida how much will an individual making 24k per year be

1). Paying in premiums

2). Paying as a deductible

3). be guaranteed in claims

What services will automatically be covered or denied?

Paying a middle man is a very inefficient way of delivering health care, no matter how it's spun.

[mzmolly]

59. Assuming you're 30 and single ...

1. You'd get $982 in annual subsidies or $82 monthly (for a mid-level plan) and pay about $140 monthly for premiums.

2. This depends upon the plan you choose. Catastrophic coverage would mean greater deductibles and lower premiums.

3. No lifetime claim limits or ability to drop or deny coverage, due to the new legislation.

If you have more questions I suggest contacting your local congress person. Or, see the KFF website and use the search tool.

:hi:

[treestar]

IMO the point was to state that insurance companies are evil

and they steal your money; they are still involved, so we are still screwed. Facts can be damned. Why deal in them when emotional blackmail is so much more fun?

[mzmolly]

61. The point of the legislation is to prevent evil from

dictating company policy going forward. "Why deal in facts" alright.

[prolesunited]

19. OMG! I've been paying homeowners insurance for years

I've paid out thousands over the years and haven't collected a dime.

I feel so ripped off that my house hasn't burned down.

[Marr]

21. You'd feel ripped off if your house burned down and they wouldn't pay.

Or if your house burned down and then they dropped your coverage for having failed to disclose that you owned a candle.

[flyarm]

116. +1 million! been there done that! the ingorance around here is astounding! utterly astounding!

either some of these people are young and clueless ..or they have to be paid propagandists ..or they are people who never paid for or needed insurance or ever had a claim..

but the ignorance is astounding!

[Lorien]

22. How many claims have you filed on that policy? nt

[Cal Carpenter]

23. Did you miss this part?

from the OP: "...$45,000 worth of claims. The insurance company has paid out $200.00 ..."

[treestar]

55. So true

and the peace of mind is worthless. That evil insurance company! Stealing your money!

:sarcasm:

And if your house burns down, they won't pay! They'd rather you file a lawsuit.

:sarcasm:

They still won't pay the judgment! The courts are in on the conspiracy!

[girl gone mad]

76. read fail. n/t

[flyarm]

114. I lost a home in an earthquake ..it is not a funny matter ,when you see all the deductables

and see how little you get for what you have paid for..and how hard the insurance boys fight to keep from paying you ...you think it is funny..I THINK NOT..AFTER LOSING EVERYTHING >AND HAVING TO FIGHT FOR EVERY DAMN RED CENT I COULD GET ..AND THAT IS WITH "HEAVY" STATE AND FEDERAL REGULATIONS..that are supposed to protect the consumer.

The only thing that did not have a deductible was the fucking paint bucket we used as a toilet for 3 months..but if the insurance boys had had their way..that would have had a deductible as well! You think it is funny..it is not.

You are either young and have never dealt with an insurance claim..or ignorant.

Then you get the added benefits of having a large claim..

Just try to get insurance after a full home loss!..almost impossible...and very very expensive. In fact because of our claim..and not being able to get other insurance it held up for 6 months our being to close on a new home ..and virtually left my family homeless..and i couldn't get my son into school in his junior year of high school..after relocating to another state..because my house was 100% destroyed after an earthquake..

You live on fools gold..it is no fucking laughing matter!

It's not so " fucking funny " when you have gone through it.


And i assure you, no one, NO ONE understands their full policy until they lose it all..then you get a real good understanding of all the little words and nuances in that fucking policy!

And it sure as fuck is not a joke.

[wolfgangmo]

127. I too pay for homeowners insurance. .

The difference is that when I had a claim (legitimate - all my neighbors got covered by their companies) they did pay. My aluminum siding was damaged and they only paid for it to be repaired from massive hail damage. My house looks like it has been beaten with a hammer. And they paid me 1/5th of the replacement cost claiming that I could hire a contractor to remove the siding, bang out the dents, and then reinstall it for that cost.

If you ever want to hear a contractor laugh until they fall over I suggest you tell them this story.

Insurance companies make the mob look like little orphan annie.

[Warren Stupidity]

25. I bought my own insurance for ten years and they paid as required.

Sorry you bought such shitty insurance. This bill will help reduce the insurance company bullshit that allows your experience. My plan cost, in he last year I did this, well over 16,000/yr for a family plan, but it covered me when I was sick, and paid as per their obligations.

I also respectfuly disbelieve your assertion that doctors are no longer accepting insurance. Perhaps they are only rejecting your shitty insurance? Everywhere my family goes for health care or insurance is accepted and our claims are paid.

[Marr]

26. I find it almost funny to find people here so happily defending the insurance industry

and putting the blame on the consumer. Really-- this is usually the argument you hear from the other side.

I'm in the same situation as the OP, though my problems only started recently. A year's worth of bills and insurance hasn't paid a cent of it.

[Warren Stupidity]

28. And this bill helps.

Particiapting plans have to pay out at 80-85%. They can't take your money and not pay.

I am not defending the insurance industry - I am relating the facts about different insurance programs. I am indeed doubting the op's wisdom in continuing to purchase an insurance plan that routinely denied all his claims. I think I would put up with that for exactly one year.

[Lorien]

35. I compared many plans. It was the best I could afford.

and since hitting a period of unemployment I've allowed it to lapse. It was more affordable than the plan I had with N.A.S.E who was equally as "generous" with their payouts. Some of us are barely making 16k a year because of the recession, so don't scream about "shitty insurance" because that's all that many Americans can afford. The problem is with the insurance industry, not workers.

[wolfgangmo]

135. I can think of at least 1 way they can take the money and run.

And if an amateur like me can figure out a dodge to scam the money then how many scams do you think they have ready?

[Lorien]

27. Here's my doctor's contact info:

Robinson Family Clinic
[phone]

Feel free to call them and ask them if they accept insurance.

[Warren Stupidity]

29. Change doctors.

At least where I live doctors routinely accept insurance. You must live somewhere outside of my experience.

[Lorien]

32. This is the most highly rated doctor in my area treating Addison's disease

and hypothyroid. His prices are far more reasonable than the other three that I've seen. Since I can't afford the 12k deductible what would be the point of switching to a costly doctor who doesn't treat me effectively?

Why are you taking the whole "I've got mine, fuck you" position on this issue?

[wolfgangmo]

131. So your argument is ...

That if a doctor doesn't toe the insurance line (and follow all their rules on how to practice medicine) and actually delivers that care you need, that you should drop that doctor because that doctor doesn't bill insurance companies.

Let me be clear about a gross euphamism from the insurance companies, that doctors "take" insurance. No doctor "takes" insurance. They may have a contract to be part of the "network" but, to be clear, DOCTORS BILL INSURANCE, and they do it as a courtesy for patients. But the system has become so hard to deal with from that end that a growing number of medical practices are no longer billing insurance as a courtesy.

In my clinics case we provide our patients with bills that include the diagnostic (ICD-9) and procedure (AMA) codes so they can submit their claim for payment. The patient pays us at the time of service. We do this because it has allowed us to; focus on patient care rather than insurance rules and oversight, lower our overhead costs by letting our medical billing service go which lead to us lowering our patient's out of pocket costs by 50%, which in tern has allowed us to see a wider range of people who don't have insurance or who have lost insurance or who just are tired of being seen by a doctor for 30 seconds as they rush to their next patient in an attempt to see enough patients to support all their billing specialists that they hired to fight with the insurance companies full time.

You may not have experienced it yourself but trust me when I say that it is a growing trend in general and family practices and it is being talked about at medical conferences a lot. Expect to see more and more doctors go this way.

[Warren Stupidity]

143. The OP is spending huge amounts on health insurance

for which he receives nothing in exchange because 1) his insurance company sucks; 2) his doctor won't even try. I suggested the OP change insurers and change doctors. Do you have a better, more practical suggestion?

Yes, if your doctor won't even try to help with your access to health care, get another doctor.

[ecstatic]

67. Was he out of your insurance company's network?

:shrug: Sadly, some doctors are very selective in who they accept insurance from. Many don't even take the public programs anymore.

[mzmolly]

73. So you paid the above amounts for health care because you have a Dr.

that doesn't accept insurance? :shrug:

[wolfgangmo]

132. Molly, Molly, Molly

Practices that don't bill insurance are usually much cheaper than ones who do because they are much more efficient, have no staff to fight insurance companies (national average is 3 billing people per doctor), and the doctors are able to spend more time with the patients because a doctor is lucky to see 50 cents per dollar billed to an insurance company and the insurance companies can delay payment for years or even retroactively bill doctors for procedures that they have suddenly decided they didn't want to cover.

If you think insurance companies will start playing fair just because of this bill ...

[mzmolly]

133. I'll await an answer to my question.

:hi:

[Stinky The Clown]

37. I can't speak about doctors no longer accepting insurance, but I can say this with certainty .....

.... my dentist has stopped accepting insurance.

I have no dental insurance and haven't for a very long time. Last time I was there I was lamenting the whole shitty world of insurance. My dentist told me that she hasn't accepted any insurance for a few years now. Her insured patients are welcome to file their own claims and she will help them to some degree. but she has stopped dealing with insurance companies.

Her practice has not suffered as a result.

Yes, dentists and doctors are different. I know that.

[wolfgangmo]

128. Disbeleive all you want.

Our practice no longer bills insurance for patients and a growing number of colleagues are joining us in a effort to stay open. The only exceptions are the larger corporate clinics where the doctors are not the owners but rather just disposable employees who are forced by contract to practice insurance based medicine.

It's called boutique medicine in some circles - we call it economic survival. http://en.wikipedia.org/wiki/Concierge_medicine#References

[pitohui]

41. yeah well i'm self employed so i was not allowed to buy health insurance

i'm not disputing that united health care doesn't pay claims -- everyone knows they don't, which is why my hubby's boss's co. got a diff. health insurer years ago -- but, as a self employed person, most years i was not allowed to buy insurance at all

if what YOU described was the norm, they would be happy to sell me insurance, because they would be picking up thousands of dollars a year in pure profit

YOU were the one who made a choice not to dispute united health care's bullshit, at one point my hubby, his boss, and i all filed a complaint w. our state's insurance commissioner, and eventually we DID get the claims paid, meanwhile, we could go ahead and get treatment

as a self employed individual, with pre-conditions, so that no one would sell me insurance, i couldn't get care at all because the assumption is that i wouldn't (couldn't) pay

insurers that commit fraud need to go to jail, they need to go to jail REAL BAD, but if you didn't fight it when you were ripped off...you were part of the problem, not part of the solution

i don't know where you live but your claim that most docs don't accept insurance is pure dee bullshit, unless you're talking about for cosmetic/elective procedures

[truedelphi]

89. It's not all that easy to fight these guys.

It also sounds like when you were in crisis you had a helpful spouse and an employer - three of you backing each other up.

When you go through a major crisis and you are the only one healthy enough to deal with this S___, you often end up being told the wrong information. In our case, by the time I understood what I was supposed to do in terms of the state commission, it was too late as the time limit had expired.

However I did manage to keep my spouse alive, a daily task that involved continual fighting/advocating with doctors, and the insurance people, the pharmacists, etc and his former employer, for about six straight months. That was three and a half years ago, and only now am I starting to feel like I am recovering from stress and becoming a human being.

[Xithras]

45. Insurance, by its nature, must pay out less than it takes in for most customers.

That's what insurance is. 10 people in a group pay $100 a year for insurance. 8 of them get $30 worth of services. 1 of them gets $400 worth of services. 1 of them gets $200 worth of services. The remainder goes to bonuses and overhead.

Even if you cut the overhead, insurance still requires that the majority of customers get LESS in services than they pay in. That's how it works, and it must be averaged that way over a lifetime. If even half of the customers on any insurance plan require more in payouts than they pay in over the course of their life, the entire plan will become financially unstable.

[Lorien]

49. $200.00 for 45k in submitted claims and 78k in premiums seems a bit extreme

and unreasonable, don't you think? Programs like the NSA manage to get the people the care they need for far less because the cut out the middleman and negotiate drug prices. That's a system that works for the people while ours only works for investors and CEOs. Why DOES the CEO of United Healthcare "need" to make $120,000.00 PER HOUR? How does that fit into your plan?

[cbdo2007]

48. Sounds like you should have canceled your insurance years ago.

Would have saved you a bunch of money.

If anything catastrophic had happened you could always go to an ER for care which would have been a good deal as long as it was under $78,000 and all of their bills are negotiable anyways.

Also, your explanation here is a little off as you are claiming the $45,000 you spent for services as wasted. It wasn't wasted because you got health care for it. So you didn't "pay $133,000 for $200.00 worth of health services". You paid $133,000 for $45,000 worth of health services. Still isn't reasonable, just correcting where you seem to think you didn't get anything for the health care you actually did receive.

It sounds like you could definitely benefit from finding a better plan out there and look at what your state has available to you and tax breaks you can get for health care claims paid. Good luck to you.

[Lorien]

52. Um, no. that 45k came out of my pocket, not through the insurance company

The only check I ever received from them was for $200.00. I would have filed far more in claims had I had the vascular surgery I need and the heart stress tests, but I can't afford them since I can't afford the deductible. Individual plans are expensive, and if you only make $24,000 per year your choices are very, very limited.

[cbdo2007]

57. Wait....so you only make $24,000 per year yet you spent $10,000 per year on health ins.

and health care?

[treestar]

53. You could have done way better

Lower deductible and much lower premiums. How many people does this cover? Why did they not pay, was it psychiatric?

The market out there for the past 12 years does not sustain this story. You didn't shop around.

[Lorien]

60. I shopped around quite a bit. Go online and try it for youself. Just Google

"individual insurance plans". United was better than my previous plan with NASE. You can read all about that gem here: http://www.pbs.org/now/transcript/transcriptNOW218_full.html and, if you take the time to read, watch, or listen to the story you'll see that it does "sustain this story" very well. In fact, I've been fortunate by comparison to many others out there. Did you miss SoCalDem's story of the seven year old with cancer who had insurance but died because the insurance refused the family's claims? Not so unusual.

[Marr]

77. And no response.

Just a casual "blame the consumer", a tip of the hat to the status-quo, and he'll never think about it again.

I don't see much difference between our party loyalists and their party loyalists anymore, I've got to tell you.

[defendandprotect]

54. Wow!! Last biggest figure I heard here at DU was $29,000 for a husband and wife---

I can see where you would have been better off putting this money in a savings

acount!

This is a victory for the corporations/lobbyists -- and DLC/Corporate Democrats!!

[ecstatic]

58. Why would you stay with a company that didn't pay any of your claims?

That's ridiculous.

[Lorien]

62. Why? Because if I had gotten in a car accident or had cancer they MAY have paid

for enough of it that I could survive. That's the game, or haven't you noticed?

[cbdo2007]

63. That's kind of like buying a brand new Mercedes on your $24,000 salary....

and owning it for 10 years but then taking the bus to work and the train to visit relatives out of town and only once during that 10 years you drove it up to the post office to mail a letter.

Why buy a car if you're not going to use it?

[ecstatic]

66. Actually, it's not the game. You were paying scam artists

I hate paying for insurance as much as the next person, but every claim I submitted to BCBS was paid according to our agreed upon terms.

[cbdo2007]

70. This person's was "paid" according to the terms....but they have a deductible

and they never met the deductible.

Problem is that this person has a $10,000 deductible with an income of only $24,000 per year. Personally I don't think we're getting the whole story here but if so then this person should have a family member in charge of their finances.

[Statistical]

68. Have you looked into a HDHP plan and putting the rest into an HSA..

Rather than pay $7,000 a year in preimums you could pay a fraction of that ($2,000) and put the other $5,000 into a HSA.

Now I am not saying it is great and we should do better but in long run you would have paid $20K to insurance companies and $50,000 to your Health Savings Account which you could have used to pay for medical costs.

Anything beyond $5,000 a year for premiums seems insane. It is unlikely anyone will get an ROI for that kind of up front payment.

Make no mistakes an HDHP/HSA is essentially self insurance each year you will pay 90% of your medical costs however it is better than just having no insurance/paying cash because
a) you get reduced rates
b) you have catastrophic coverage in terms of annual out of pocket max.

You might want to consider looking at an HDHP/HSA plan. Let's face it. It can't get any worse.

Sorry for your horrible experience. We should be able to do better.

[hunter]

96. My wife and I have an HDHP/HSA and prexisting conditions.

It's really quite worthless. We max out the high deductible around November every year. So basically we pay for 90% of our medical expenses out of pocket, and get a small fraction of our premiums back in November & December, which just about covers the property taxes on our house.

For the huge amounts we pay in premiums every year, we get very little back. We pay much more in medical expenses and "insurance" than we do on our mortgage.

Our current insurance is a small group plan. My wife and I can't purchase individual insurance for preexisting conditions and have had the frustrating experiences of running out COBRAS, being uninsured, and fighting to be accepted into our state's "high risk" pool.

In retrospect we shouldn't have played the game and just paid all our medical expenses out of pocket. But then the very real threat of "losing everything" would have been hanging over our head. But I'm now beginning to think we would have lost everything anyways had some further major medical misfortune or accident befallen us. When one is too sick or injured to work one can't pay the health insurance premiums for long. Paying for this ridiculous insurance gave us a false sense of "security."

Essentially all the insurance money we've paid out over the years might well have been flushed down the toilet or spent frivolously on trips to Europe or something. We received no benefit from our medical insurance, and had that unforeseeable "something bad" happened, the reason we were supposedly paying for this "health insurance," we'd still have been up shit creek anyways.

It will be interesting to see how this new legislation plays out. I personally believe it's simply an emergency bailout of a major U.S. industry that was on the verge of collapse.

[xultar]

74. Basically you nor anyone else has health coverage. What a shame.

[Uncle Joe]

75. Kicked and recommended.

Thanks for the thread, Lorien.

[waiting for hope]

79. K&R

It's a sham, and unfortunately, the worst of it won't be seen until 2014, long after the blood suckers have moved on to cushy lobbyist jobs.

[Lorien]

80. My point is simple: "affordable insurance" does not equal "access to health care"

I don't have group insurance that is provided by an employer

I don't belong to an HMO

I paid what I could afford for individual insurance, which is less than $300.00 a month. I have a prescription card but my out of pocket costs for medications come to about $350 a month, even with the discounts. That's still a lot less than many people pay for medications.

If you're saying "you didn't shop around." you are wrong. I went to several websites to compare plans and interviewed a number of sales people from each suggested insurance provider. This was the best I could afford. Understand: the self employed, non-wealthy among you simply can't afford plans that don't have high deductibles. Most insurance companies DO automatically reject CLAIMS. that's the whole problem with the for profit insurance system. If you still refuse to believe me or are hellbent on being willfully obtuse on this topic, then I strongly suggest that you rent the film "SiCKO".

The "it's all your fault. You're stupid for having crap insurance" people sound exactly like the hard core Republicans that we all were debating back in the days when DU was pro Single Payer. Now that the path has been chosen, suddenly those who are pissed with the injustice of the for profit insurance system are "enemy #1". Insurance companies are suddenly seen as just, honest and reasonable, and it's all the consumers fault if the system doesn't work for them? Really?

If you are honestly sitting at your keyboards defending the insurance industry and their methods, then perhaps it's time to do a little soul searching to think about whose side you're really on.

[anigbrowl]

82. Wait, what?

You say just above that you pay 'less than $300 a month', and then discuss your out of pocket costs of about $350/mo.

Now, the first line of your OP is 'Over the past 12 years or so I have paid my insurance (United American Healthcare) over $78,000.00 in premiums.'

Now, if that were the case you would be paying $541.66 per month, or more.

I am not giving your insurance company a pass, and clearly if you need to spend so much on medication you have some kind of serious medical condition you need to deal with, but it seems I'm not the only person on this thread who is hopelessly confused by your explanation.

I know it is a major pain in the ass to get health insurance if you're self-employed, because I am too and don't have any insurance, so I've just tried to stay generally healthy and eat my occasional out-of-pocket medical costs.

But whatever the situation, you are doing a really really terrible job of explaining it. And if you have only gotten $200 back on almost $80,000 in premiums, maybe you are doing something wrong, or maybe you should contact the office of your state's insurance commissioner. Or an attorney. Or do something different, since what you are doing at the moment is obviously Not working.

[wiggs]

83. This goes to the point about the need to REGULATE insurance services. Approximately

70% of medical bankruptcies happened to people WHO WERE INSURED. This is widespread....and wrong on many levels.

The basic problem is that we distribute medical care based on ability to pay...for profit. For-profit insurance companies are a big problem and even though it is a historic step it is a small step that congress is taking right now. The insurance company problem has been lessened but not solved. Hopefully it gets solved in the near future.

Next problem is the high cost of medical care.

[pundaint]

107. No we need to separate insurance companies from our medical payments. And your next problem is the

insurance companies source of revenue growth. They wont go down, they'll go up faster, because now the for-profit insurers take their skim as a percentage of the cost whatever it is.

So our President thinks Public Option and Single Payer aren't even worth discussing, but he thinks that insurance companies will not be able to figure out how to raise the costs of services and hospitalization. I do not believe he is that stupid. He, on the other hand, believes a lot of Democrats are.

The problem is for-profit insurance involvement, Reform is not more for-profit insurance involvement.

[gmoney]

81. Did the insurance not reprice a lot of your $45,000 in claims?

That's been the biggest benefit for me. Had my gall bladder out about 3 years back, and they "repriced" about $15,000 "worth" of surgery expenses down to about $3000, much of which I had to pay due to my deductible, but they did actually pay a little something that time. Only time in about 17 years. A month or so back, I had $5000 "worth" of blood tests that the insurance "repriced" down to about $300.

And it's easy to look back now and say it was a waste of money. What if you'd not had the insurance, but developed some serious medical condition, or got in a serious accident, and ran up huge bills? Theoretically, the system works by diversifying risk, and those who DON'T have to file big claims should consider themselves fortunate to be in good health. Are you going to start sniffing asbestos or drive your car off a bridge just so you can "collect" on your health insurance? I don't think so.

If we could just set reasonable prices for services across the board, instead of the providers jacking things up astronomically because they know the insurance co's are going to beat them down by 60 to 75%, we could probably save the system. I think single payer with price controls is the only way to make this happen. Doctors and other providers might not make as much, but they'd have a lot less paperwork to deal with, and would probably come out ahead in the long run.

[JoeyT]

87. Of course charging different prices for different people

is yet another thing that should be illegal.

If we both go to a hospital and have a surgery and I'm charged $20k for a surgery while you're charged $3k for the same surgery because you pay a corporation every month, it's not insurance, it's a protection racket.

"Nice assets you got there. We'd hate to see anything bad happen to them."

[pundaint]

108. Why don't other countries allow for-profit insurance for basic health needs? Hint: it's not because

we're number 1.

[wolfgangmo]

136. Insurance companies only reprise if they decide to pay.

If they deny the claim then you are ON YOUR OWN.

[juno jones]

84. K&R! n/t

[autorank]

85. k*r I totally agree

I'm self employed. My rates went up, nearly doubled, in the past two years, most of which was as this "reform" emerged.

We're screwed, totally. There's nothing in her for solo/family plans for self employed.

I wrote about it and will after the stew is fully cooked on Capitol Hill.

15 million of us - what a movement that could have been. Instead, we're totally left out, completely.

Screwing the Self Employed out of Health Insurance by Michael Collins

[New Dawn]

86. K&R - single-payer is the solution!

http://www.singlepayeraction.org/

[xchrom]

92. Recommend

[Vinca]

93. We're also self-employed and had paid for our own insurance -

with virtually no claims - from about 1975 to 1995 when it went to about $1,000 a month with a giant deductible and we couldn't afford it. I recall one claim for minor surgery being paid for about 1980. It was an outpatient procedure and cost about $1,200. That's it. If we had used up the equity in our house to buy insurance since 1995, they still wouldn't have paid a dime and we'd be down well over $100,000. I remember when life and death wasn't a "for profit" business and you didn't even think about your health insurance. It was affordable, always there and reliable. Now it's a shake down. Somehow, we've got to get a public option weaseled into the current reform that will morph over time into single payer.

[Aleric]

97. What state do you live in?

You haven't mentioned any health problems so I'm assuming you aren't paying inflated prices for that reason. Over the same period of time, I've paid half what you paid for a $750 annual deductible and had two surgeries covered. What state are you in that that is the best insurance you can afford? I want to make sure I don't move there.

[NorthCarolina]

99. Insurance is not a Charity, it is an Income Generating Business with stock holders

If they paid out $200 to you, they will have to find a way to earn that back...with interest. Of course the hundreds of millions spent fighting Health (care) tweeks over this past year will also need to be recouped, with interest, so things should become quite interesting between now and Jan 01, 2011. I predict that the profit cap set to begin on the first of next year will be eliminated between now and the effective date, or will be postponed indefinitely before ever taking effect.

[catrose]

103. Amen!

from another formerly self-employed person. I had to become an employee when my husband became uninsurable.

[pundaint]

104. It's amazing how many just refuse to believe stories like this. This is for-profit-insurance, or as

the President calls it "historic reform."

[icee]

105. Again, an excellent post, Lorien. I have been seeing the same thing. Now, my

wife and I have insurance through her employer. We are registered with a doctor for prescriptions or in case something catastrophic happens. But the doctors--I've gone through five--horrible. So for specific care, despite having insurance, we pay for doctors, labs,etc that are not included with the insurance. And the doctors we see are anonymous, which I won't elaborate further on, so there are no medical records damage prospects for other types of insurance, jobs, etc. We live in a shadow world. And what that thing was that got passed the other day will do is push many people further into that shadow world. I have heard there is a site that keeps track of doctors resigning. Of my last five over eight years, four have resigned or sold their practices. Soon, we'll be seeing Millie down the street who tosses bones in a salad bowl while mumbling a few words.

[Captain Hilts]

106. Health insurance discourages people from working for themselves. nt

[flyarm]

109. anyone who calls this A HEALTH "CARE" REFORM BILL ..is a damn dope! eom

[ingac70]

110. You woulda been better off putting that money in the bank. n/t

[WeekendWarrior]

111. Wow -- as much as I hate insurance companies

My own insurance company has paid all of my claims, and they've been pretty substantial. For many years I had dual coverage and all of my medical costs were paid -- 100%, including two very expensive surgeries.

I realize that a lot of people aren't as fortunate as me, but $200 worth of services in 12 years seems a bit unbelievable to me. That's one TRULY shitty insurance plan you have.

[Hamlette]

113. How did you pay $133,000 for $200? Didn't you really receive $45,000?

From another perspective, I have health insurance provided by my employer. I pay about $600 per year to insure my entire family. I LOVE my health insurance company. They pay claims promptly. I've never had one dispute with them overpayment in fact, in the 22 years with this insurer I've only talked to them once and that was because I needed a new card for my son.

I also have a birth defect so I have consumed many dollars in health care costs with very little out of pocket expense. I have consumed more than I've paid for by far. What outrages me is not the cost of my insurance but the cost of my care. My last surgery was over 40K for 2 days in the hospital. My surgery in 1972 was 3K (yes, three) for 3 weeks in the hospital. And, since 95% of everyone's health care costs will occur in the last 2 years of life, neither of us have seen the bottom line.

While the health care system is broken and insurance is not serving everyone, the op could be snatched from the pages of free republic IF the government paid the bill. Say, for instance, that we pay for it like FICA or Medicare is paid now. Someone could make the argument that they pay far more in taxes for what they consume. Without defending insurance companies, the issue is it we are spreading the risk. You paid for my costs (thank you) and in the end I may well have paid out more than I consumed and the opposite for you.

Luckily some of your concerns are addressed in the new legislation which caps insurance company costs (just as government costs are capped).

If however you really did spend $133K (I honestly don't see how you did the math except dishonestly) for $200 in care, you are paying more than most.

[Lars39]

120. If she has a $5,000 deductible per year she might never reach it.

Not everyone is so fortunate to have premiums for a year equal to what many are paying per month.

[Hamlette]

140. yes, but isn't she receiving $5,000 worth of care for that $5,000?

my objection was to the op saying she paid $133K and received only $200 in care. I thought she said she submitted $45K in bills and the insurance company only paid out $200. If she had $45K in bills, didn't she receive $45K in care?

She said she only got $200 in care.

Anyway, my point is that's how insurance is supposed to work. Some pay more than they receive back in care, some pay less and get more care. If not, none of us would buy insurance.

[Lars39]

141. That's 5000 in addition to her insurance premiums. Hardly a bargain.

Your employer buys the bulk of your insurance if you're only paying 600/year. And you've hit the lottery if the insurance company is paying whatever bills you rack up.

[Hamlette]

142. I'm not debating the COST of her care, only the dishonesty of her argument

lying to make a point only invites ppl to point out the lie instead of listening to the argument.

That's all I said. She should not pay $5K or $133K for nothing. Duh.

But the reason we buy insurance is to pay for the expense of the unexpected. I pay an outrageous amount for car insurance and "knock on wood" I have NEVER been in an accident. 44 years of premiums and no claims. I'm not complaining. I'd delighted I've never been in an accident and glad I had insurance in case I did. But I didn't pay for MY car accidents, I paid for "yours". For ppl who have suffered the bad luck of an accident.

[Lars39]

144. But that's just it....she's wound up paying her own way, even with insurance.

[Hamlette]

145. we are in agreement, I'm taking about the lie in the op

just trying to keep us honest here

(I'm also skeptical about the whole story. Seems wildly off. There is usually another side to the story. I've worked in related areas and the stories people told others did not even resemble the evidence. I'm too old not to be skeptical.)

[Lars39]

146. Her deductible has been between 10-12 thousand per year, per the OP.

[Hamlette]

147. now I'm completely lost

The op said she paid "$133,000 for $200.00 worth of health services".

She said she PAID out of pocket $45K in addition to what she paid for her health insuracne.

The way I read it, she PAID $45K to HEALTH CARE PROVIDERS. That means, she received $45K IN HEALTH SERVICES, not $200.

I most certainly understand what she meant to say is she paid $78K for insurance and insurance only paid $200 of her health care costs But that is NOT what she said. She said she got $200 WORTH OF HEALTH SERVICES. When she really got $45K of health services.

Right?

I feel like I'm beating a dead horse. I was just pointing out that it was dishonest to say she paid $133K for $200 worth of services. If I'm wrong, what did she pay her $45 for? What did she get for the $45? She got health services.

The proper equation is she paid $123K for $45K in services. Or, she paid out $78K for insurance and insurance only paid for $200 in services.

If she really only got $200 of health services she must never go to the doctor.

[AngryOldDem]

119. Thanks for the preview of coming attractions.

Like you, I also pay for my own insurance, $250 a month. That is according to the plan I chose, which probably won't cover anything should something catastrophic happen. I have filed one claim on it so far -- for a test procedure done in January -- and I have yet to hear either from the company or the hospital if I'm square on it. This policy renews in July, and I am fully expecting my premiums to jump. If it's between $300-$350, I'll consider myself as getting off light.

[matt819]

122. I hate to rain on your rant

Especially since any one at any time could be screwed by an insurance company.

But something doesn't ring true here. $45,000 in claims and payment of only $200? I'm sorry, but that just doesn't sound right. I won't raise the question of why you haven't changed carriers, since I do realize that can be problematical.

I have to say that in only a few instances, my insurance providers (mainly Blue Cross) have done just what I signed up for. I have a high deductible, and that sucks, but they've paid just about everything they've been required to. Nothing has jumped out as being ridiculous in terms of denial of claims. Maybe it's because all claims are submitted by my provider (a large hospital group), and they have streamlined this process and have their agreements of what is acceptable, etc. But, again, nothing has jumped out as inappropriate (so far). Don't get me wrong, I'm still seriously out of pocket, and that sucks. And having the public option and/or medicare buy-in could change that. But maybe not, and even if it does, at what cost? On Medicare buy-in, I'd still pay premiums, and we'd probably see more and more providers opt out of the medicare system due to low reimbursements. On public option, someone has to pay for it, so we'd likely see a rise in taxes.

Yes, I do realize that I'm referring to objectionable issues that we have all taken for granted. It is a crime that the amount charged for a procedure bears no relation to the amount that is actually paid (unless you have no insurance, in which case you're paying the full amount. It is bizarre that here's this medical charge, and then you deduct the amount the insurance company says is higher than the amount they're willing reimburse, and then there are further deductions that seem to have no relation to anything - just adjustments.

So, no, this bill isn't perfect, but it applies protections that should offset the kind of abuse you seem to have been subject to. Yes, it does compel us to take responsibility for our care - in the form of purchasing insurance - but it ensures that we won't be further abused by the insurance system. Will it work? I don't know. But I sure hope so, and it's a far sight better that what was in place previously or what would have been in place (that is, nothing) had the republicans had their way.