fbpx
:::: MENU ::::

Health Care Nonsense

by

I definitely do NOT want to get all political on the blog. I, personally, am pretty moderate and a swing voter so I can see both sides of most political issues. So without pointing fingers or blaming parties, I’m just going to say what anyone dealing with health care already knows….our current system sucks. Sucks bad.

I’ve got two case studies for you:

1) When my Dad had to retire early (due to being diagnosed with FTD), I took over a lot of his personal matters, including paying his bills, getting him insurance, etc. Here’s the problem:  we basically cannot get him the health coverage he needs. No matter the cost, its just not possible.

Some explanation…

When my Dad relocated from Utah to Texas he was given a referral to a neurologist who specializes in FTD. This physician only accepts certain types of insurance plans. He will not even book an appointment without one of these plans (I even tried to pay in full in cash at time of booking. Office simply wouldn’t do it). Unfortunately, the plan is really only available for group coverage. Did anyone else know that PPOs essentially no longer exist for privately-paying individuals? Because they don’t. We can buy various levels of HMO coverage (for like $1,000/month for a single individual), but none of the options available through the Marketplace (which is the government website) NOR direct through the big insurance companies (we tried 4 of them) have a PPO plan option for someone paying privately. It just doesn’t exist. Meanwhile, my Dad doesn’t qualify for Medicaid due to his asset base, and from the legal counsel we’ve received it sounds like Medicare is a long ways off before we can get him covered (pending getting all his disability stuff in order). So what’s our only option? We cannot see the specialist we were referred to. Just simply can’t do it. Between the poor options in health coverage available on the open market coupled with some ridiculous office policies at the specialists’ office (seriously – who doesn’t just accept cash?!?), we are stripped of the option of seeing the one person recommended to us. Absolutely disgusting.

2) Okay, to be totally fair, #2 has nothing to do with the government or sucky health care options…it has to do with my own naivety (heh). Apparently when I signed up for health insurance I was unaware that the plan I selected has NO (zero, zip, zilch, nada) coverage until a $500/person (or $1,000/family) deductible has been met. At that point we just pay the co-pays. But until then we owe 100% of our health bills. Only….I guess medical office staff wait to settle up their books until the end of the year? Since switching insurance in July, we’ve had several trips to the doctor (3 routine annual office visits/exams & 3 sick child visits). At each trip we paid our normal copay and thought that was it. Until…within just the past couple weeks bills have been flooding in! All of these visits (that have occurred at different places and with different family members) are just now being billed. At first I thought it was some issue with the insurance but after 3 separate calls to have all our benefits explained, I discovered – nope. It’s not a mistake. We owe this money. And it’s in the range of several hundred dollars (just under $500). We do still have about $400 in our health/dental/vision savings, but that’s going to go QUICK and we’ll still owe more. Groan! One more point for Murphy (of Murphy’s law) and yet another reason to slow our debt payment progress so we can try to recoup our EF (which I mentioned as an option here; still haven’t decided 100% for sure yet. We pay our debt at the very end of the month so I still have about a week to decide).

My Dad’s health care drama will likely be an ongoing thing we continue to deal with the entire rest of his life (as he’s always going to be privately paying; even after he gets Medicare it’s not like things will be all peachy. There are plenty of issues with that program, too).

In regard to my family unit, it’s annoying to have just discovered this information (and, of course, I learned this AFTER open-enrollment had ended so I can’t change it at this point). However, we can make changes to our budget to accommodate the issue (e.g., keep a larger amount in our health/dental/vision account in order to cover the $1,000/family deductible).

Live and learn. That’s all I can do. Live and learn.

And earn & save more money. ; )


31 Comments

  • Reply Maggie |

    Health care is seriously messed up in this country. No one has a good plan. Current situation is bad, the alternative of repealing all changes is bad. I think it needs to be de-coupled from employment.

    • Reply Jen From Boston |

      Yep. I remember a quote from a healthcare expert said something to the effect, “If you sat down and came up with a healthcare system you would never come up with what we have in the US.”

  • Reply SAK |

    Healthcare is messed up for a variety of reason but a couple of things. I was able to buy a PPO on the exchange this month for 2016 – not sure if your Dad is in AZ (where I am) or TX. There weren’t lots of choices but there were enough. In terms of the doctor – the fact that he won’t take a private pay patient – who pre-pays – means he is the reason your dad isn’t getting in – not the insurance issue. I use a private pay doctor and get reimbursed what I can under my plan – which is sometimes nothing. The fact that the Doctor won’t take payment is a real shame. You might ask the referring doctor to reach out to him and see if he won’t. Actually doesn’t make sense that he wouldn’t take a private pay patient unless he is part of some network that doesn’t allow “outside” people use his services. And ask for another recommendation. Good luck. Health care has never been simple and the more choices available make it harder still.

    • Reply Jen From Boston |

      I agree. I’ve read on Getting Rich Slowly that many doctors will work something out if you are paying out-of-pocket.

  • Reply Jen From Boston |

    About your deduction: It’s a shame they didn’t make that clearer to you, but a deduction of some sort is pretty standard, especially if you signed up for a high deductible plan that comes with the HSA. (I can’t remember if you did or not.) On the plus side, the ACA made it such that all preventive healthcare appointments are fully covered and the deductible doesn’t apply to them. Nor do the co-pays.

    • Reply Ashley |

      I don’t have an HSA, it’s just a regular PPO. Also, I still have co-pays even on preventative appointments. I, too, thought that was done away with due to ACA (and with our old insurance we had no co-pays or deductible for preventative treatment) but that’s not the case with our current health care plan. Why? I have no idea.

  • Reply Angie |

    I hate dealing with healthcare. Its like a lottery except you always lose! There’s no way to estimate how much you will pay. Stuff that should be covered ends up getting billed to a different code. Its freaking madness I tell you. How scary is it that both my doctors have signs that say “You agree to pay the insurance whatever we bill them for. No corrections will be made to original billing codes.” Ugh. SCAM if I’ve ever heard one.

    I’ve delayed going to the doctor forever. I went to both my “preventative” appointments this year. They should be free. But I got charged a $150 “new patient fee” and another $45 because they billed it as a “problem” visit rather than preventative. Neither will change the codes. I mean sure I have the $200 to pay. But it’s such nonsense that they can just bill whatever they feel like it and you’re stuck.

    • Reply Angie |

      PS… I’m praying they fix the US healthcare/health insurance problem by the time I’m old enough to start getting real health problems. Luckily I’m not getting hammered too hard because I’m young and have no conditions.

    • Reply Jen From Boston |

      UGH!!!!!

      If possible, you should find new doctors. I’ve NEVER had that issue. When something gets billed wrong my providers have fixed it, although it’s never been them that made the error – it was always the insurance company.

  • Reply Jill |

    Ashley, you should not have to pay anything for annual exams considered preventive – those should be covered at 100% by any plan! The sick visits are your responsibility but make sure you don’t pay for the others!

    • Reply Jen From Boston |

      That reminds me – if your employer is large enough you can try going to HR to address problems with health insurance claims. My manager did that once after he tried several times to get a charge paid that Cigna was being stupid about. Once the HR person spoke to Cigna the problem disappeared. They want our nice huge group insurance business.

      I also check each explanation of benefits to check what I owe and for mistakes. Recently, Cigna classified a provider as out of network when he is completely in network. So annoying.

    • Reply Ashley |

      That’s what I thought too (and that’s how it was with my old insurance), but that’s not the case with our current plan. Even the standard “explanation of benefits” page states that we still owe co-pays on preventative (and 1 trip/year, etc.) I don’t know why because I thought ACA had done away with that, but I know 100% this is the case, as I’ve talked to my insurance multiple times and can even see it in plain writing on my benefits info.

      • Reply Angie |

        Sadly, plans can be grandfathered in so they do not have to meet ACA requirements. Any plan that has not made notable changes since the ACA was introduced can be grandfathered in. Therefore they do not have to cover preventative and birth control. Its dumb especially because of non-definition of notable changes. Eventually all plans will likely require changes so they should get phased out. Maybe your University health plan falls in this category?

        • Reply Ashley |

          Maybe, though this still seems strange to me. When we had private insurance we were on an old plan grandfathered in. The big difference was that our plan did not cover any prenatal stuff (which was great for us since no plans for pregnancy and it made our premium lower). Even so, we had no expenses for preventative care and no cost for birth control, etc. So it almost seems like they pick and choose the parts they “grandfather” and the parts they leave behind. No idea. The whole health insurance system seems warped. I don’t get it.

  • Reply Mike |

    Its sad, but it seems like the only way you can get quality services at a hospital in this country is by paying out of pocket.

    • Reply Ashley |

      Or not…since the doctor won’t even accept out-of-pocket cash payments. A friend suggested (total heresy – I’m not alleging this to be true) that perhaps the specialist receives some type of kickback from the insurance company? I just don’t know why they wouldn’t accept a cash payment.

  • Reply Tammy |

    I am so sorry you have to deal with this for your dad. I agree with a commenter above. Maybe the referring doctor can reach out to the new doctor and arrange something. After he gets Medicare, I highly recommend AARP as a secondary. It is reasonably priced and picks up where Medicare leaves off for hospitalizations. My mother has it and has been very happy with it.

    My family’s health insurance increased by about 35% for this coming year. I’m not sure how we can pay that and still keep up with our other living expenses. I agree the system stinks and I’ll be shocked if the situation improves.

  • Reply Cheryl |

    Our insurance changed again this yr. Went from $2,500 deductible per person to 3,500 per person this yr. As some one who has breast cancer and chemo twice, that is nothing. Last year I paid off my deductible on the first week of the month, $14,000 for my first treatment of the year. Everything else but co-pays were then covered. I agree our healthcare sucks but wonder how people would feel paying much more in taxes to get free care like the British. Cheryl

    • Reply Jen From Boston |

      A friend of mine moved to Britain in the late 90’s/early 00’s. Granted, that was quite a while ago, but at that point in time she said the extra amount she paid in taxes was the same she was paying in insurance premiums here, so it was a wash.

  • Reply Meghan |

    Hi Ashley,

    Is it possible that you or one of your siblings can add your dad to your health insurance plans? Some employers consider parents who are unable to care for themselves/make health decisions dependents of their children (you may have to get a legal document drawn up). Then your dad could reimburse whomever for the increase in the cost of the plan.

    If you were to go that route though, you would want to be sure that legally you keep yourself free from any medical bill obligations that he may incur in the future in the case that he does go through all his retirement funds for medical care.

    Cheers,

    Meghan

    • Reply Ashley |

      We already tried to get my Dad added to our health insurance. The only way to do so is to legally become his guardian. At this point in time the elder care law attorneys we’ve consulted (we’ve seen a few) have advised AGAINST this route unless we are forced down that road in the future. So unless he’s a legal dependent we cannot add him as a dependent on our health insurance.

  • Reply Louise |

    Perhaps it’s unfair of me to write this, but your post makes me glad I Wass born in Australia. I have had a child, two surgeries, and three investigative procedures through the public health system, and I have paid either nothing or almost nothing. $17 for a procedure prep kit, $90 for a gap fee for a dating ultrasound. I hope the USA gets its healthcare sorted soon, you all deserve better than what you’re getting.

    • Reply Ashley |

      YES!!! I’ve read great things about Australia’s way of handling these things. As an aside, I’ve never been to the country but would love to travel there someday. Looks beautiful!

  • Reply susan |

    You are so lucky to have such a low deductible. We currently have 5000 deductible and then next year DH stops working and we’ll have to pay $1300/ month plus have a 9000 deductible until DH can get medicare (which will be in a few more years).

  • Reply Connie |

    Have you looked into a HSA for yourselves? The money gets deducted from your gross pay, thereby lessening your taxable wages. The only drawback is that if you don’t use it, you lose it. Also, for your dad, has your husband’s business got health insurance? Maybe you can add him to their group plan.

    • Reply Angie |

      The above comment is wrong. HSA’s (health savings accounts) are not use it or lose it. They were invented with the purpose of rolling over savings for years when you need to fulfill the high deductible in an HDHOP. FSA’s (flexible spending accounts) are in fact use it or lose it. I think they are typically only available with select corporate/group PPO’s.

      • Reply Jean |

        Not all FSAs are now use it or lose it. Last year my FSA changed to allow me to roll over unused funds. I’m not sure what the cap is (it’s at least $200 for me since that’s what I rolled over to this year), and I don’t know if it’s a company policy or a blanket policy for all FSAs now.

        • Reply Ashley |

          That’s a pretty new rule, and it’s based on whether the plan administrators want to allow it. It’s not required, but an option they can choose to allow.

  • Reply Sarah |

    I think it must be Texas that no longer has a PPO individual option as we just changed our coverage here in California and we have a Silver PPO Plan. Here is a link.

    https://www.blueshieldca.com/producer/ifp/products/covered-california-plans/silver.sp#3750

    We signed up for the Silver Seven plan at the bottom. For the past ten years, I had to pay 50% of my doctor visit charges which was about $100 each time. Now, I get to see her for $7. I feel like just going in to say hi.

    • Reply Ashley |

      Wow, I hadn’t even considered it might just be a state thing (that’s frustrating!) Glad you were able to find a good plan that works for you in California! $7 copay is amazing!

So, what do you think ?