Health Insurance

[TLO]

My company is changing up providers for the health insurance they offer this upcoming year, and the options are pretty lackluster.

I know diddly dick about trying to find private health insurance, but surely someone on here has some knowledge to share.

Where do I look? What would constitute "good coverage" in your opinion?

Any suggestions welcome.

[loochy]

Originally Posted by penguinz

I had Coventry when I had knee surgery about 20 years ago. Cost me $50 out of pocket for the surgery and PT.

First follow up with the ortho I mentioned I couldn't believe it was so cheap.

His response was the Coventy was great for patients because it was very inexpensive.

It sucked for doctors because Coventry was very bad about paying out if the did at all.

He said usually when a patient has Coventry he would be lucky to break even on his costs.

Then why would he choose to be in the Coventry network?

[penguinz]

Originally Posted by loochy

Then why would he choose to be in the Coventry network?

I thought the same as well. All I can think is that it was because he was younger his name wasn't on the building so he had less say into what networks the practice was in.

[notorious]

If people had to pay outside of work they would shit their pants.


46 non smoker married to a 42 female with great tits non-smoker. Healthy, I've been to the doctor one time in 20 years to get a thumb stitched up.

1400/month. Small business owner.

[BWillie]

Originally Posted by notorious

If people had to pay outside of work they would shit their pants.


46 non smoker married to a 42 female with great tits non-smoker. Healthy, I've been to the doctor one time in 20 years to get a thumb stitched up.

1400/month. Small business owner.

Yap I'm gonna be in same boat. Although a friend of mine who is a poker dealer says he makes less than 19k a year and it's only $280 a month for him.

[notorious]

Originally Posted by BWillie

Yap I'm gonna be in same boat. Although a friend of mine who is a poker dealer says he makes less than 19k a year and it's only $280 a month for him.

Healthcare.gov saves a lot of money with subsidies if Uncle Sam thinks that you don't make much.

I'm going to leave it at that.

[blake5676]

Originally Posted by penguinz

I had Coventry when I had knee surgery about 20 years ago. Cost me $50 out of pocket for the surgery and PT.

First follow up with the ortho I mentioned I couldn't believe it was so cheap.

His response was the Coventy was great for patients because it was very inexpensive.

It sucked for doctors because Coventry was very bad about paying out if the did at all.

He said usually when a patient has Coventry he would be lucky to break even on his costs.

That's not exactly how it works but honestly most doctors don't know a thing about health insurance. There's probably a few that are solo offices or independent from a hospital, but you ask you're average family physician or and ortho how much X company pays and they won't have a clue. But they probably do hear from management or billing that one company is better than the other for their specialty.

Coventry doesn't exist anymore, they were acquired by Aetna about a decade ago and slowly completely phased out into Aetna plans, but they were not unlike any other "big" insurance company. They each have their own fee schedule for the services provided. For example, Blue Cross may pay me $48 for doing one procedure yet United Health only pays me $31 for the exact same thing. I certainly have insurance companies I like better than others, but it mostly boils down to what they pay for services rather than ease of dealing with. Sure, some can be cumbersome at times but they all have to approve or deny claims w/in 30 days of submission and you basically know what you're getting paid before you send it.

So on that note, when people say one insurance company they had was SO MUCH BETTER than a different one they had another time, it usually actually means they had a better plan/contract and not that the insurance company was better. In your example, you didn't only pay $50 because Coventry kicked ass. You paid that amount bc you were either close to hitting your out of pocket max or you had a really good plan with killer copays or cost sharing.

Where people run into trouble with actual insurance companies is when they or their employer use one of the smaller guys that have narrower networks and more stringent pre-authorization requirements. If you have one of Aetna, UHC, Blue Cross, Medicare, Humana, etc, then your insurance company is basically as good as the plan you're signed up for. Not a ton of difference between them other than that, with some mild caveats.

[blake5676]

Originally Posted by notorious

If people had to pay outside of work they would shit their pants.


46 non smoker married to a 42 female with great tits non-smoker. Healthy, I've been to the doctor one time in 20 years to get a thumb stitched up.

1400/month. Small business owner.

Self-insuring is absolutely insane these days. If you fall in "middle class" where you make more than the level where you get a subsidy but you're not making 2 or 300k per year, it's gonna be a dagger. And unfortunately you can be as healthy as possible and you're still gonna get bent over.

I'm luckily on my wifes plan, but it would cost me $7-800/month for a plan with a high deductible and narrow network to insure just myself at 41 years old. And then I'd have to pay about $5k more before the insurance would even kick in. So you're basically looking at $15k out of pocket with the deductible and the monthly premium before actually getting any benefit.

I don't mean to make this political, but prior to the ACA (and getting married and being on my wifes plan) I used to pay about $70/month for a $2500 deductible with the largest local insurer and network in KC. Obviously I'm 10 years older now and inflation, but it would cost 10 times as much for a shittier plan if I were out there on my own again. The individual marketplace is HORRIBLE if you're not receiving subsidies for having a lower income.

[BigRedChief]

Originally Posted by Woogieman

US insurance needs to develop a "Health Care SR-22" so the rest of us don't have to sacrifice our retirement goals for the Big Gulp chugging, smoke-a-pack-just outside-the-building's-front-door, no-walking, buffet-busting, lil' Debbie crowd. It's such a scam that drivers are rated, life insurance purchasers are rated, but they don't group the healthy and the morbidly obese/high risk people in their own groups. Doing so would GREATLY enhance the habits of those that are trying to get into or maintain their membership in the "healthy pool".

This isnt a health insurance thing only. My wife got rear ended sitting still at a stop light. Totaled the car. Paid the money to us. Except.....Now we have to pay $400 more over 6 months because she had a wreck that no one thinks was her fault.

Florida is a no fault state. Two cars have a wreck. Police say and give a ticket to one driver of the car that caused the wreck. But, Both cars are flagged as if they were both at fault because there is this no fault insurance law.

They raised my house insurance rates in Lees Summit in the mid 90's because a hurricane happened in Florida.

[Woogieman]

Originally Posted by BigRedChief

This isnt a health insurance thing only. My wife got rear ended sitting still at a stop light. Totaled the car. Paid the money to us. Except.....Now we have to pay $400 more over 6 months because she had a wreck that no one thinks was her fault.

Florida is a no fault state. Two cars have a wreck. Police say and give a ticket to one driver of the car that caused the wreck. But, Both cars are flagged as if they were both at fault because there is this no fault insurance law.

They raised my house insurance rates in Lees Summit in the mid 90's because a hurricane happened in Florida.

I had not idea...that needs to be fixed asap. People think about food, gas, utilities, and property taxes going through the roof over the past three years, but insurance costs are sneaky and just as bad. There are no "no-wait" medical sharing orgs out there that may be the best deal on health for the self-employed

[KCUnited]

SOCIAL INFLATION

Issue: Social inflation is a term that describes how insurers’ claims costs are increasing above general economic inflation. This is generally thought to be due to a trend in increasing litigation costs brought by plaintiffs seeking large monetary relief for their injuries.

[Wisconsin_Chief]

Originally Posted by notorious

If people had to pay outside of work they would shit their pants.


46 non smoker married to a 42 female with great tits non-smoker. Healthy, I've been to the doctor one time in 20 years to get a thumb stitched up.

1400/month. Small business owner.

Absolutely disgusting.

[Couch-Potato]

Ugh, I work in Healthcare for a profit and even I suggest we'll move to a government supplemented program soon. Hopefully.

Before you jump down my throat, please note this is not a political perspective, its economic.

Approx 55% of hospitals in the US are failing to make a profit post covid. Reminder to everyone that they are business, for profit, and will cut services and employees if they can't continue to profit. At least 5 hospitals in FL shut down 1st qrt last year.

The trends relate to the increase in cost from vendors (medical and pharma companies), stagnant wages and decrease in headcount at hospitals due to less profit, YOY increases in cost of insurance, etc... Ultimately, run away capitalism requires some taming in key industries that act as the pillars of our society.

I'm also a lifelong sales person, but even I can see that there are industries where we allow unnecessary middle men to profit just to give useless folks a job. Specifically, car sales, mortgage sale, and insurance sales could all be easily purchased online now but we inflate the ins industry bc it's powerful in the US and many folks depend on it for jobs and it would have ramifications on our economy to evolve to a new system.

Don't let politicians feed you anti-american BS when it comes to offering citizens better value in healthcare is my .02c, they're paid to keep the status quo.

[blake5676]

Originally Posted by Couch-Potato

Ugh, I work in Healthcare for a profit and even I suggest we'll move to a government supplemented program soon. Hopefully.

Before you jump down my throat, please note this is not a political perspective, its economic.

Approx 55% of hospitals in the US are failing to make a profit post covid. Reminder to everyone that they are business, for profit, and will cut services and employees if they can't continue to profit. At least 5 hospitals in FL shut down 1st qrt last year.

The trends relate to the increase in cost from vendors (medical and pharma companies), stagnant wages and decrease in headcount at hospitals due to less profit, YOY increases in cost of insurance, etc... Ultimately, run away capitalism requires some taming in key industries that act as the pillars of our society.

I'm also a lifelong sales person, but even I can see that there are industries where we allow unnecessary middle men to profit just to give useless folks a job. Specifically, car sales, mortgage sale, and insurance sales could all be easily purchased online now but we inflate the ins industry bc it's powerful in the US and many folks depend on it for jobs and it would have ramifications on our economy to evolve to a new system.

Don't let politicians feed you anti-american BS when it comes to offering citizens better value in healthcare is my .02c, they're paid to keep the status quo.

The entire model is broken beyond repair IMO. I'm not smart enough to know the answer. And it goes against my inclination towards letting businesses and the market figure things out on their own. But I lean towards agreeing on some sort of drastic change or expansion of Medicare for All.

Costs are simply out of control. Changing the health insurance landscape with the ACA helped insure more people on net, but it skyrocketed spending and the cost of insurance.

Hospitals are a big problem. They charge 2-4x to private insurers when compared to what they get from Medicare. They get away with it bc they've gobbled up every doctor possible from primary care to specialists. And then hospitals have boards and administrators making tens of millions of dollars that aren't in any way involved in patient care.

We pay more for pharmaceuticals than any other country in the world, by multiple factors. Sometimes 10-fold for the same drugs. They always scream that if we didn't pay more and subsidize the cost for everyone, research money goes down the drain and we are no longer innovators.

And then you flip the script and wonder how getting the govt MORE involved would ever even help anything. Half the reason costs are the way they are is due to burdensome regulation, lobbied loopholes for certain industries and the list goes on.

I truly believe disassociating health insurance from employment could only be a good thing and a start to changing the landscape. But that will be a seismic change that I don't know anyone has balls to pull off.

Hell, I'm getting more depressed about the prospect of any solution just typing this out! I'm saying more govt involvement on one hand while reminding myself that scenario typically only makes things worse. I think we're all just pretty much ****ed when it comes to healthcare spending. Maybe when it hits 25% GDP something will change?

[Chief Roundup]

Originally Posted by Woogieman

US insurance needs to develop a "Health Care SR-22" so the rest of us don't have to sacrifice our retirement goals for the Big Gulp chugging, smoke-a-pack-just outside-the-building's-front-door, no-walking, buffet-busting, lil' Debbie crowd. It's such a scam that drivers are rated, life insurance purchasers are rated, but they don't group the healthy and the morbidly obese/high risk people in their own groups. Doing so would GREATLY enhance the habits of those that are trying to get into or maintain their membership in the "healthy pool".

Your Bias and ignorance of everything that comes into the situations is showing.
Most of the people you are referring to are poor. Those people have to eat cheap. Do you know what is cheap? Food that is bad for you. There are many other factors. I will stop here as they will get into an area that is political and all of that other stuff that gets people mad.

[Chief Roundup]

Originally Posted by Woogieman

I had not idea...that needs to be fixed asap. People think about food, gas, utilities, and property taxes going through the roof over the past three years, but insurance costs are sneaky and just as bad. There are no "no-wait" medical sharing orgs out there that may be the best deal on health for the self-employed

Dude, how old are you?
This will never be changed. Insurance companies have been doing this forever. It is an agreement that they all made with each other to save themselves money. Also to get coverage for all vehicles in a large accident situation, otherwise drivers and others would not have been covered.