Getting injured in the states...

[Necrotica 0]

I probably cant explain it well, but Insurance companies pay LESS for a procedure than you would if you pay out of pocket. There was TV piece on how one fellow was upset that since he didnt have any health insurance, his heart operation cost him like $200,000, out of his pocket. BUT if he had insurance, the hospital would have only charged the insurance company something like $50,000. His thinking was hey, I should only have to pay $50,000!! I'm just happy that we have good health insurance coverage. My wife could go be a private contractor for what she does, they make alot more $$$, but no benefits, where as her federal job has excellent benefits. One thing one has to look for when looking for employment!

It's because the insurance companies have contracts with the doctors and hospitals that dictate how much they will pay for the services. The doctors and hospitals are inclined to accept these contracts because they know that it means more business for them. This is usually the reason why you can only go to the doctors or hospitals that an insurance plan has on their list (i.e. HMOs).

This is what I get for working in customer service and claims for Medicare. I know way more about the system than I ever really wanted to. *LoL*

[KarenCee 3]

Yep, definitely need to phone the insurance company about any upcoming scans, surgeries, etc. And definitely stay "in-network." Something that is "in-network" that costs $600 might cost $10,000 if you got it done "out-of network." Not to mention you have different deductibles for both.

My wife had an MRI done a couple years ago. It was $4,000. The insurance company paid $800 and that was it. Paid in full. She didn't even pay for anything. I thought how interesting. They can pay 20% of the bill and consider it payment in full and the hospital just accepts that. But it really screws the person who would rather just pay for the small stuff themselves and use insurance only for major operations. An $800 MRI, I could see paying myself. But $4,000? No thank you.

My wife's plan is $1100/month. To add me to her coverage, it would "only" be $800/month. LOL You can see why I went for my own coverage instead.

Why is it $1100/month? She works in a small office of about 15 people. Some of the older workers have had heart trouble, so everybody's rate goes up to compensate for it. In the year 2000 her insurance was $500 a month with a $500 deductible. So it's more than doubled in less than a decade and her deductible is $3,000 now too.

Texas allows insurance companies to give group coverage quotes to businesses. And then they can raise the price by up to 69% over the original quote (after they scan the company's medical history).

I'm just hazarding a guess here but...maybe working for a smaller employer the insurance isn't as good as it would be if one is working for a larger corporation or an employer who has a much larger staff. I agree though...that is an insane amount to pay for insurance. Private pay insurance yeah, but through an employer...wow.

Then again it could also be a state to state thing where it depends on what state you live in...that kind of thing. I dunno...just hazarding some guesses here.

I've lived here in the States all my life and I *still* don't understand our insurance ins and outs. *sigh*

[Flames9_RN 358]

My wife brought home the various insurance plans that were available to her, it was like an inch thick!!! crazy

[Fuzzness 2]

If I get insurance through my employer, but I'm paying for it, how exactly am i getting insurance through my employer when they arent paying for it? ive often wondered how that works

[MrsCat 6]

My wife's plan is $1100/month. To add me to her coverage, it would "only" be $800/month. LOL You can see why I went for my own coverage instead.

Why is it $1100/month? She works in a small office of about 15 people. Some of the older workers have had heart trouble, so everybody's rate goes up to compensate for it. In the year 2000 her insurance was $500 a month with a $500 deductible. So it's more than doubled in less than a decade and her deductible is $3,000 now too.

*choke* - holy moses. I must be living in a box - cause I had no idea insurance was that expensive.

[Marilyn. 340]

If I get insurance through my employer, but I'm paying for it, how exactly am i getting insurance through my employer when they arent paying for it? ive often wondered how that works

i am sure they pay a portion of it...

we were paying about 200 bucks a month for both of us and when hubby quit his job they sent us the Cobra package.. it would have costs us around 800 bucks a month to keep our same insurance so that means his work was covering that extra amount...

[pegbert64 0]

Well how appropriate to chime in to this thread today...... just got a statement from BCBSNC for my latest round of *stuff* (xrays and a CT Scan)...... claim total $1023. And guess how much of that is NOT covered?? $617!!!!!! Apparently it is applied to our deductible. So once I pay this, we will have paid just over $1000 toward our $3500 deductible. So if I go for more tests, I'm guessing they are going to nail us for another $2500 along the way? We're paying around $550/month for the both of us, through hubby's work. Between co-pays, deductibles, and premiums, we've paid probably close to $5000 thus far...... and still don't have an answer to this chest pain. Which seems like a whole ton of money for nothing. I'm at the point where I'm thinking "OK, apparently my heart is OK.... so I should just drop the tests, keep taking painkillers, and when/if something drastic happens, I'll just go the ER where the bill will be a gazillion dollars, but at least the insurance will actually kick in and make it worth it!! I know, I know, that is just stupid, but it's soooo hard to adjust from the Canadian system - which promotes preventative health - to this crazy "for profit" system that puts you in the poorhouse when you're just try to catch things before they progress to something serious.

I was just comparing BCBS plans online, and it seems that hubby's plan is actually not all that bad. He thinks it's cute that I fret about it ....... cuz he's used to it. I doubt I'll ever get used to it. No wonder there are so many sick and unhealthy people in this country..... it's just too darn expensive to be healthy!

Sigh....... the doctor is supposed to be calling me back with the next plan of attack..... now I just don't know what to say.... It's just CRAZY!!!