Sunday, July 19, 2009

Health Insurance: My Story

Health Insurance: My Story

What is the most dreaded time of the year? If you ask that question most people will tell you tax time. For me however, the most dreaded time of the year is open enrollment. For those of you who work in the corporate world you know exactly what I am talking about. It’s the short little time period the insurance companies give employers to allow employees to change their benefits. Every year I have grudgingly, look through the information until my eye glaze over and then by default just accept it for what it is and sign up for the same old coverage. But every year I tell myself, there has to be a cheaper way, but the task seems so overwhelming and the system so riddled with regulations, I dismiss it as just the way it is.

This year however it was a little different. Our open enrollment was last month and last year was a pretty average year for us as far as visits to the doctor. We just barely met our deductible, so I pulled out the checkbook to find out how much we paid verse how much the insurance company paid. This task did require duct tape. Our health insurance premium is $3500/yr for a PPO, now remember we are fortunate to be an average healthy family we also paid another $1000 on top of this that included co-pays, deductible, and prescriptions. Would you like to know how much the insurance company paid, after adjusting the doctor price from the “excess of the allowed expense for a participating provider “ $498.00. This was the part where I needed the duct tape. What in the world are we paying for?? Now I know that some people have legitimate health concerns that make their premiums higher and I am not trying to belittle the fact that a health crisis can cause financial havoc for a family. My point is the average healthy family of 4 is really paying to much for health insurance.

It’s not just costing money either, it’s costing time. Just recently, my daughter smashed her finger and it swelled up and turned black and blue. So, as any good parent would, off to the urgent care to have it x-rayed. Good news it was not broken, bad news we got a bill for 389.00. WHAT?? HHHMMM. Luckily I got my “Explanation of Benefit’s” the same day, because the bill from the urgent care was not itemized (a regulation of HIPPA), but the EOB was itemized. The urgent care charged my insurance for surgery, well the insurance did not know we DID NOT have surgery. The insurance company would have paid it but we had not met our deductible. So after 30 minutes on the phone and a call back promised within two weeks, which never came, and a follow up call the bill was cleared.

I’ve had to deal with similar situation over the years, when the bill was not correct and it took me several attempts to clear it up. I wonder how often the insurance companies are over billed and it’s never corrected, or how often a bill is paid by the patient, because they don’t want to bother with the insurance company? The thought came to me, how much time and money would we (patients and the doctors) have saved if we could have just paid out right at the time of service. We don’t go to the doctor every month, the money we’ve been paying to the health insurance could be set aside in savings for when it’s needed. Sounds simple, makes sense, so why is can’t we do it that way? There are many questions I have and I am sure you have, I hope to answers some in the next couple of days.

Well, I’m sure by now your eyes have glazed over so take a break and stay tuned for part 2 ….

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