ER doctor confronts Pence on Medicaid cuts

[Steeleballz 7,550]

 

   Relatively speaking, I have more issues with health insurance than dental insurance. My dental insurance is predictable, and for 2 preventative visits a year for the whole family, I actually come out ahead vs what I pay for premiums. Basic treatment is 80/20 IIRC, and major procedures are 50:50. I had a crown once and my dentist was able to tell me before hand exactly what he charged for the procedure, and my basic math skills allowed me to come up with what my 50% would be. No guesswork needed.

 

  On the other hand, with health insurance, last year  my employer paid ~$12000 in premiums, I paid ~$6000 in premiums, and ~$1000 in deductibles. What I got in return was 1 physical exam and 1 XRAY series for a hip injury. Total cash price ~$400. When I actually had to use it for anything major, my cost has a relatively good chance of being somewhere between $2500 and infinity, but good luck trying to figure out what the ballpark range is for that ahead of time. If I am like most people, 90% of my lifetime health care will be spent in the last 6 months of my life.

 

 Obviously I don't think insurance is a great model for either health care or dental, but I can actually at least see the cost/risk/benefit model fitting a bit with dentistry. 

[Nature Boy 2.0 8,370]

1 hour ago, Steeleballz said:

 

   Relatively speaking, I have more issues with health insurance than dental insurance. My dental insurance is predictable, and for 2 preventative visits a year for the whole family, I actually come out ahead vs what I pay for premiums. Basic treatment is 80/20 IIRC, and major procedures are 50:50. I had a crown once and my dentist was able to tell me before hand exactly what he charged for the procedure, and my basic math skills allowed me to come up with what my 50% would be. No guesswork needed.

 

  On the other hand, with health insurance, last year  my employer paid ~$12000 in premiums, I paid ~$6000 in premiums, and ~$1000 in deductibles. What I got in return was 1 physical exam and 1 XRAY series for a hip injury. Total cash price ~$400. When I actually had to use it for anything major, my cost has a relatively good chance of being somewhere between $2500 and infinity, but good luck trying to figure out what the ballpark range is for that ahead of time. If I am like most people, 90% of my lifetime health care will be spent in the last 6 months of my life.

 

 Obviously I don't think insurance is a great model for either health care or dental, but I can actually at least see the cost/risk/benefit model fitting a bit with dentistry. 

My part of my health insurance is about 275 per month. Once I hit my 3K max out of pocket last year it paid 100% of everything including prescriptions. My neck surgery was very expensive  and since I hit my max I also had a colonoscopy and had all the vein  problems in my legs fixed.  I came out way ahead . However with having dental problems, my dental insurance is insufficient. I still dont understand why they will not pay any part of an implant..  I do have a AFLAC supplmental I have had for years. It helps somewhat  

[Steeleballz 7,550]

28 minutes ago, Nature Boy 2.0 said:

My part of my health insurance is about 275 per month. Once I hit my 3K max out of pocket last year it paid 100% of everything including prescriptions. My neck surgery was very expensive  and since I hit my max I also had a colonoscopy and had all the vein  problems in my legs fixed.  I came out way ahead . However with having dental problems, my dental insurance is insufficient. I still dont understand why they will not pay any part of an implant..  I do have a AFLAC supplmental I have had for years. It helps somewhat  

 

   I imagine if they increased the premiums, they would cover a lot more. However dental insurance is something people would probably opt out of if the price was too high. I think that's the way the insurance companies have it balanced to make money. I don't think there is an insurance model where they can charge $10 a month for premiums and cover implants. My mom had one done in the UK years ago with no out of pocket cost, so they can come up with a model of doing that. May not be sustainable though.

[Cyberfx1024 7,980]

2 hours ago, Steeleballz said:

 

   Relatively speaking, I have more issues with health insurance than dental insurance. My dental insurance is predictable, and for 2 preventative visits a year for the whole family, I actually come out ahead vs what I pay for premiums. Basic treatment is 80/20 IIRC, and major procedures are 50:50. I had a crown once and my dentist was able to tell me before hand exactly what he charged for the procedure, and my basic math skills allowed me to come up with what my 50% would be. No guesswork needed.

 

  On the other hand, with health insurance, last year  my employer paid ~$12000 in premiums, I paid ~$6000 in premiums, and ~$1000 in deductibles. What I got in return was 1 physical exam and 1 XRAY series for a hip injury. Total cash price ~$400. When I actually had to use it for anything major, my cost has a relatively good chance of being somewhere between $2500 and infinity, but good luck trying to figure out what the ballpark range is for that ahead of time. If I am like most people, 90% of my lifetime health care will be spent in the last 6 months of my life.

 

 Obviously I don't think insurance is a great model for either health care or dental, but I can actually at least see the cost/risk/benefit model fitting a bit with dentistry. 

The only complaint I have had about my health insurance is that this time last year the local hospital suddenly was out of network for about a month. It just so happened that my wife fell one Sunday morning when she was feeding the dog early so we could go to mass that morning. She ended up with a very bad sprain luckily and not a break. But I still had to take her to the ER to make sure nothing was broke. I ended up with a $2500 ER bill that I had to pay because It was out of network during that time.

 

Other than that I like my insurance because I am able to self refer which is strange for most specialists to hear.

Edited February 3, 2020 by Cyberfx1024

[Nature Boy 2.0 8,370]

11 minutes ago, Cyberfx1024 said:

The only complaint I have had about my health insurance is that this time last year the local hospital suddenly was out of network for about a month. It just so happened that my wife fell one Sunday morning when she was feeding the dog early so we could go to mass that morning. She ended up with a very bad sprain luckily and not a break. But I still had to take her to the ER to make sure nothing was broke. I ended up with a $2500 ER bill that I had to pay because It was out of network during that time.

 

Other than that I like my insurance because I am able to self refer which is strange for most specialists to hear.

One thing they need to do. If a facility is in network, then everyone who provides services for that facility needs to be in network.  You think you have everything covered, then you get a bill out of deep space from some company you have no idea who it is. It may case it turned out to be the hospitalist, who was a contractor, and out of network 

 

Wouldn't it be great if they could stop investigating Trump long enough to take care of America 

[TBoneTX 45,273]

I have dental to cover Mrs. T-B. & Mini-B.

They both need it and have frequently used it.

 

For myself, I go to Mexico twice yearly and get deep cleanings there.

The most for that has been $65, and it's usually less.

The Zoom laser whitening is $200.

Haven't had any cavities for years.

Occasional oddball stuff (nightguard, sealant for crown) is quite reasonable.

[yuna628 9,676]

Our dental is great, and that's the first time I've ever said that about any dental insurance. I've lost count of how many fillings and work he's had to do on my mouth and he's had to also correct bad UK dental work on my husband. We don't have to pay for cleanings, and if fillings or xrays needed there is only a small copay. Yes it's a little bit more extra out of his pay, but it's certainly been worth it. Before I had dental insurance I'd expect to spend somewhere around $280 for a normal visit and much much more for work done...and if I needed an xray too you were looking at $500. When my mom had a bad tooth with infection and failing old root canal and he needed to save teeth my sister spent about $1200 on her + multiple followup charges.

 

The insurance has also been great, with them paying out well over $40k last year and we only had to spend a couple hundred in copays. This year hopefully won't be so much, but just from Nov to now I've reached a couple hundred in copays again, so I know they'll be shelling out many thousands before the doctors make up their mind what is wrong with me. Blessedly all my medications have been at zero cost to me. Insurance never seems worth it until you really need to use it.

13 hours ago, Nature Boy 2.0 said:

One thing they need to do. If a facility is in network, then everyone who provides services for that facility needs to be in network.  You think you have everything covered, then you get a bill out of deep space from some company you have no idea who it is. It may case it turned out to be the hospitalist, who was a contractor, and out of network 

 

Wouldn't it be great if they could stop investigating Trump long enough to take care of America 

That is fairly normal though. Doctors aren't always under obligation to take insurances if they work at a hospital for a number of reasons. My sister had this spinal operation once, and the surgeon wanted someone very particular to assist him so hired someone to fly out from another state - that guy ended up sending her a huge bill. No way was she going to pay that and called the office to complain - the surgeon said he had no idea and took care of the bill himself. Sometimes you can get away with that, but not usually with a hospital. I've had it happen with hospitalists, PAs, and anesthesiologists. Our big hospital's main GI doctor sent me a letter stating he wasn't participating with my insurance last year (so I guess everyone that needed emergency scopes at the hospital would be in for a surprise), but now he's participating again.