What is a Cadillac plan?

[Peikko 1,575]

I don't understand our insurance plan at all. I asked the last time I was in the Dr's office what it all meant, how I would know what was covered, what was not covered etc. No one knows anything

[w¡n9Nµ7 §£@¥€r 123]

No one knows anything

That's by design.

[Trumplestiltskin 5,791]

I've had 2 MRIs. We have a PPO. In both cases, we phoned before hand to find out what my 'fee' would be. I was quoted $150 in the first instance, which I paid when I had the MRI. Then, because we hadn't met both deductibles for the year, I received a bill for a further $700. The second time, I was very reluctant even to get the MRI because of getting burned by the billing the first time. Again, they called my insurer, asked about deductibles and all and we got a statement from then that the fee would be $85. So, I went ahead and had it done. The insurer completely denied the whole claim and the doctor's office sent me a bill for the whole amount (about $2,000). I called the insurance company and they said that the wouldn't cover MRIs done unless they were at hospitals or in the doctor's office. This was a doctor's office, I told them. They said 'not according to the claim that was filed - it was in a separate clinic'. So, I went to the doctor's office and had them correct their coding error on the submission and re-submitted it. It was denied again! This time when I called they said that they had already made a decision on the file and it was a double submission. I explained about the coding error, so they said to submit again and they would make a note in the file that this was a different code. So, I went back to the doctor's office, had them send out the information again and this time it was accepted. Then, I got a bill for an additional $400 that wasn't included because the deductible hadn't been met, even though we had called to confirm before hand that it was.

The most ironic part of this? The technician didn't do the MRI for the right part of my body that was to be scanned! The results were useless.

The worst part (other than the scan being useless) is how much stress it puts on people to be the middleman between the provider and the insurance company. Incredible amounts of time to jump through admin hoops that are essentially nothing at all to do with you.

[w¡n9Nµ7 §£@¥€r 123]

The worst part is lying between those massive disks and being yelled at every time you fidget. Sir, you must keep your ahead absolutely still!

[Trumplestiltskin 5,791]

I don't understand our insurance plan at all. I asked the last time I was in the Dr's office what it all meant, how I would know what was covered, what was not covered etc. No one knows anything

That's the thing - most people probably don't know much about the conditions and treatments that are covered by their health plans. You almost have to be a lawyer yourself to navigate the legalese and jargon.

The worst part is lying between those massive disks and being yelled at every time you fidget. Sir, you must keep your ahead absolutely still!

Yeah I had to do that - can't move even a fraction of an inch or they have to start the imaging all over again.

[w¡n9Nµ7 §£@¥€r 123]

I almost wish they had sedated me. It's too dark and too cramped in there to not move just to prove to myself I still can.

[Amby 490]

When I lived in CA I had to go to the ER. Even though I had insurance I was billed $7,500! It took me about 6 months to get the hospital to bill my insurance. In the end I was out $50

Edited July 29, 2009 by Amby

[NickD 203]

Any medical institution should give you a quote first to let you know what your insurance covers or not. People get quotes on practically anything except medical and dental, especially dental. You really don't know if they are out to cure you or screw you. Don't bother asking for a warranty, but never hurts to ask. Ask any service center in town, doctors are their worse customers, if you repair something and it breaks ten years later, they want it repaired for free.

My head was strapped in for an MRI, hated that, then they had computer problems, was in that coffin for an hour and forty-five minutes, was like an eternity after my accident. Then I had a bad side effect, my body would point north for a couple of days. Couldn't go south if I wanted to.

[Mr. Big Dog 10,747]

A Cadillac plan is a plan worth upwards of $25,000.00. Not sure what kind of Cadillac 25K buys these days but that's the definition that's used in Congress. Based on that, I think I have a classic Chevy plan - worth about half that and getting crappier year after year. I can hear the rattling already as the end of the year approaches and plan re-designs are almost certainly on the horizon again costing us more while delivering less.

[dalegg 143]

You might be more healthy if you'd just accept the bicycle plan.

[Nasturtium 500]

I just got a new (real?) job and looked over all the insurance.. I would think the Cadillac plan would be the most expensive option listed for us-- $27,868.00/year: PPO for family. Now keep in mind, most of us are starting out at $35k. ROFL. Contrary to what most of you have with your jobs I guess, we have HMO as being the cheapest and cheaper by far.. less than half for each option. I opted out of any kind of insurance since what I am most at risk for is accidentally getting knocked up, and that's a "life changing" event that I get to emergency-enroll for. I did opt in for 3 limited options: vision insurance for $.01 per paycheck (so $.26/annually). dental for the same (and that covers both Ammar and myself), and life insurance for $.01/check (Hi USCIS, I don't care about life insurance but I signed a neat paper that says Ammar is my beneficiary. Handoverthe10yearcardnowkthanxbai.) Every year, I spend on exactly the same things: vision and dental. Every year, I use the $1200+ I would have spent on insurance to pay on my student loans. In short, I am happy about my $.78 insurance plan. End of story.

[Marilyn. 340]

Is it just possible that regular doctors/specialist visits and the odd MRI don't count towards my deductible, that's why I don't know?

Doctors visits don't go towards the deductible. That is what your co-pay is for.

I'd be surprised if an MRI didn't count towards the deductible.

we have a PPO plan with no deductibles..

the insurance covers 100 percent of almost everything there are some things that are only 90 percent covered though, like hospital stays..

[w¡n9Nµ7 §£@¥€r 123]

A Cadillac plan is a plan worth upwards of $25,000.00 ... that's the definition that's used in Congress.

Interesting. Thanks.

Is it just possible that regular doctors/specialist visits and the odd MRI don't count towards my deductible, that's why I don't know?

Doctors visits don't go towards the deductible. That is what your co-pay is for.

I'd be surprised if an MRI didn't count towards the deductible.

we have a PPO plan with no deductibles..

the insurance covers 100 percent of almost everything there are some things that are only 90 percent covered though, like hospital stays..

If believe you have an annual out of pocket maximum though, it's only 10% until you hit your max then the carrier pays the rest.

[The_Dude 1,142]

AJ, you get the Kia plan

[Marilyn. 340]

A Cadillac plan is a plan worth upwards of $25,000.00 ... that's the definition that's used in Congress.

Interesting. Thanks.

Is it just possible that regular doctors/specialist visits and the odd MRI don't count towards my deductible, that's why I don't know?

Doctors visits don't go towards the deductible. That is what your co-pay is for.

I'd be surprised if an MRI didn't count towards the deductible.

we have a PPO plan with no deductibles..

the insurance covers 100 percent of almost everything there are some things that are only 90 percent covered though, like hospital stays..

If believe you have an annual out of pocket maximum though, it's only 10% until you hit your max then the carrier pays the rest.

yes, I think the annual out of pocket max is about $1500 a person..