Adding to Insurance

[The Mean Lady 604]

You don't have to get a referral if you break something

You just go to the hospital.

I happened to get lucky because my family doctor that I've had since I was 11 was part of my HMO network.

[TracyTN 237]

Ah, the US health system! My insurance through work for my family is really nothing more than a glorified discount program by the time you factor in the deductible we have to meet. I changed employers and am making more money, but the insurance SUCKS at this new employer.

[The Mean Lady 604]

My sister has an extensive history of issues so when my mom had to finally leave her cobra and join our plan, she decided on the HSA (I think that's the name for it?) basically she forks 10k out of her POCKET then the rest is paid in full. Because for a PPO plan for them, it was 1.4k per month... x12 is 16.8... so they decided to save 6k. Still... both options are RIDICULOUS.

[khwaidee1 196]

You don't have to get a referral if you break something

You just go to the hospital.

I happened to get lucky because my family doctor that I've had since I was 11 was part of my HMO network.

Except I usually wait or try and fix it myself so by then I usually need an see orthopedist to undo what I've done!

[NikLR 13,227]

My husband joined a high deductible PPO??? Heck I don't know what it means except he doesn't want to see the doctor (not that he has one here) for the next few years so that he doesn't have to fork out over a grand. I said to him, "That's f***ing ridiculous! That much just to see a doctor if you're sick? UGH! REALLY?!" How can you tell I'm from Canada!!!! LOL!!! I was grumpy after that though because it makes me worry about when I move down here. I'll need to find a doctor and I always get a yearly exam. Do I have to see a gyno to get the internal exam? What about the blood work that is normally associated with a yearly exam like checking cholesterol, glucose, iron etc? Is that blood work extra as well? So confusing!

I'm in Parker, CO right now, which is really close to Centennial and Denver and there is darn near a "medical center" on every corner. In my city, there is ONE. You have to drive to the next city over to get a new one. Only in very large cities like Calgary etc.. are there multiple hospitals. It's so odd to me. I get that some are private and some are probably just for specialty things. There are obviously a lot more people in the USA than in Canada so more hospitals are needed, but I always wonder when we drive by if you can only go to each hospital as long as you have the right insurance. He said it doesn't matter in an emergency, but somehow I wonder still about that.

Oh on the insurance note, he did get reduced car insurance because I was added onto the policy. Probably because I'm in my 30's. (Still feels odd to write that btw) He went with Allstate. My car insurance in Canada wasn't affected at all so I didn't bother.

[Marilyn. 340]

you won't have to pay $1000 to see the doctor. You just have to pay for everything out of pocket until the deductible is met..

[The Mean Lady 604]

The fact that your husband says it will cost him a grand to see a family doctor? Yeah... that's not right.

It would cost me 100 dollars to see my doctor when I didn't have insurance. A normal GP is right around that amount.

I saw a gyno w/o insurance last christmas, and the cost was $160 for a yearly pap.

I had some blood tests done w/o insurance and I believe the cost was about $60... I was actually surprised at how cheap that one was!

With my insurance, costs are as follow:

GP: $20

Gyno: $40

Blood Test: $0

ER visit: $150 (would cost thousands w/o insurance)

If you have a PPO, it doesn't matter what doctor/hospital you see just so long as they accept your insurance type.

If you have an HMO, like me, there is a special network of doctors you can see, but I pay much less.

[NikLR 13,227]

you won't have to pay $1000 to see the doctor. You just have to pay for everything out of pocket until the deductible is met..

It's quite possible I completely misunderstood what he met as well. I find the US health system infuriatingly confusing, mostly because I've never had to deal with any of it. the most I had to deal with is Dental insurance where I paid the money out, then my ex took the form to work, they send it out and we got the money back 100%.

The fact that your husband says it will cost him a grand to see a family doctor? Yeah... that's not right.

It would cost me 100 dollars to see my doctor when I didn't have insurance. A normal GP is right around that amount.

I saw a gyno w/o insurance last christmas, and the cost was $160 for a yearly pap.

I had some blood tests done w/o insurance and I believe the cost was about $60... I was actually surprised at how cheap that one was!

With my insurance, costs are as follow:

GP: $20

Gyno: $40

Blood Test: $0

ER visit: $150 (would cost thousands w/o insurance)

If you have a PPO, it doesn't matter what doctor/hospital you see just so long as they accept your insurance type.

If you have an HMO, like me, there is a special network of doctors you can see, but I pay much less.

I'll look into his insurance more. I mean we can always change it next year as well since they have a time period each year that you can change plans if you want to. He doesn't go see a doctor that often and did explain that he just needed to pay the XX amount every year as a deductible and it builds up in some kind of health savings fund he can take with him even if he changes jobs (which he won't ever do.. LOL)

I feel like doing this whenever I think about it all though. I'll admit, it's not an easy thing for a 31 year old woman to get used to when you've had it a different way your whole life. I've never had to worry about seeing the doctor or breaking something and not being able to afford care. Nothing is out of pocket for medical care. Everything you need, is given. No matter how rich or how poor, you received the best care available to you. If you had to wait, well, that means there are people ahead of you that are worse off. I'm happy to be sitting in the waiting room at the emergency room or having to wait a month to see a dermatologist. I've been rushed in, and ya know what, it sucks. It means something is REALLY wrong.

I'm sure I'll get used to it and it's probably just one of those things that for me is like a life changing thing. I don't have much choice but to read up and become educated instead of all day. LOL anyhow..

[Marilyn. 340]

we have a $200 deductible. We have to pay for blood work and tests etc out our of own pocket until we reach $200 and then the insurance we have covers 80%.

Doctor visits don't come out of the deductible, we pay a $20 copay for our regular doctor and $40 for a specialist..

[gzbabi 2]

... as all insurance companies view it as a 'life-changing event' and as such, she's eligible to be added once she's inside the USA.

I agree, I just had to do "open enrollment" again as I am waiting for my spouse and daughter to come here hopefully in a few months (waiting sniff). My health insurance defines "Family member leaving from or coming/returning to the US" as QLE, qualifying life-changing event.

That means, I can add them later and don't have to pay family insurance premium yet, can go with the cheaper single premium.

[The Mean Lady 604]

you won't have to pay $1000 to see the doctor. You just have to pay for everything out of pocket until the deductible is met..

I have never heard of insurance paying this way unless you are using the HSA plan which would not be $1000, it would be thousands of dollars.

PPOs and HMOs have deductibles as well which is where they start paying 100% of EVERYTHING including copays.

My sister reached her deductible of $5k last year so she no longer had to pay the copays to see her psychiatrists and even got all of her scripts for free too.

I agree, I just had to do "open enrollment" again as I am waiting for my spouse and daughter to come here hopefully in a few months (waiting sniff). My health insurance defines "Family member leaving from or coming/returning to the US" as QLE, qualifying life-changing event.

That means, I can add them later and don't have to pay family insurance premium yet, can go with the cheaper single premium.

I thought I would be able to add him whenever because of that, but our accountant said he could not be added until open enrollment. I do not fully trust her, however.

[Marilyn. 340]

I have never heard of insurance paying this way unless you are using the HSA plan which would not be $1000, it would be thousands of dollars.

PPOs and HMOs have deductibles as well which is where they start paying 100% of EVERYTHING including copays.

My sister reached her deductible of $5k last year so she no longer had to pay the copays to see her psychiatrists and even got all of her scripts for free too.

I thought I would be able to add him whenever because of that, but our accountant said he could not be added until open enrollment. I do not fully trust her, however.

We have a PPO and like I mentioned in my other post we have a $200 deductible and copays, once we hit that $200 our insurance pays for 80% and we pay 20% and we still have copays, (copays don't go against the deductible with our plan)..

the first few years my husband was with this company they covered everything 100% with no deductible, we just had to pay copays which were $15/$30 at the time.. I was just thinking about this. we pay more per month now but the insurance covers less

Edited October 30, 2012 by Marilyn.

[The Mean Lady 604]

We have a PPO and like I mentioned in my other post we have a $200 deductible and copays, once we hit that $200 our insurance pays for 80% and we pay 20% and we still have copays, (copays don't go against the deductible with our plan)..

the first few years my husband was with this company they covered everything 100% with no deductible, we just had to pay copays which were $15/$30 at the time.. I was just thinking about this. we pay more per month now but the insurance covers less

The only luxury of a PPO is not having a network.

I pay less and get more covered, but since I have an HMO, I have to see certain doctors and wait to see specialist after my doctor gets them approved. I've had an HMO for about 4 years now and I just don't see the negatives that so many others do. Getting to see certain specialists can be a hassle, but if I don't get to see the one I'm waiting on now, it's not like my life would be unlivable, it would just be a little uncomfortable. I guess I'm just willing to deal with things more than others because I only have to pay 100/mo for the plan and if I shattered every bone in my body and spent the next 6 months in the hospital, I'd only pay 150 for my ER visit... can't complain.

Edited October 30, 2012 by KDubovik

[Marilyn. 340]

every year we consider going to an HMO but we always stick with the same plan. We have a really great family doctor and we would hate to give him up. My SIL has a HMO and it always seems that she has a tonne of hassles..

[The Mean Lady 604]

Yeah, see that's where I got lucky, as I said earlier, my family doctor that I've had since 11 was part of the bcbs HMO plan so lucky me but that isn't normal.