?

Log in

No account? Create an account
asleep at mal 9/09
alumiere
interesting if radical health care proposal 
9/11/09 0:06
asleep at mal 9/09
http://www.theatlantic.com/doc/200909/health-care

it's a long article, but i think much of what is discussed is dead on...



take my situation... i have what would probably be termed catastrophic coverage - a bc/bs ppo plan with a $2000/year deductible at a rate of about $335/month (was split w/ my employer prior to losing my job, now the expense is all mine, and the work funded HSA that put $900/year toward out of pocket expenses is gone) so my out of pocket should be $1100/year max (note - i chose this plan in 2006 as it allowed me to keep my doctors while lowering my monthly cost by ~ $130 - so even with the high deductible it was cheaper - and stuck with it in as bc/bs wasn't paying for treatment anyway)

i have a $20 co-pay on routine visits and specialists in network, a prescription plan with co-pays of $10-15-25 depending on the drug, and 80% coverage if i go out of network for approved treatments - this is a good plan per most people i've talked to including a friend who sells insurance to individuals including bc/bs plans...

but you ask... how was my out of pocket cost last year $7500+ (note: that did not include my half of the health insurance premiums)?!

well, bc/bs has thus far denied all claims related to my auto-immune adrenal system failure with the exception of getting my blood work paid at their rates (~ 25% below list) and paying for the blood work once i'd reached my $2000 deductible (most of the last round of tests in 2008) and allowing me to get the pre-approved medications (ie: cheap, generic pain meds, muscle relaxers, etc which are often less than my co-pay to begin with) in plan

but since i started treatment w/ my current doctors in 2007 bc/bs have been battling with them regarding my diagnosis and treatment, and as such have not paid a cent for the thyroid meds, replacement hormones, heparin, immune system boosters, etc (most of these treatments are considered unapproved - compounded replacement hormones and/or "supplements" as the pharmaceutical companies do not make them since there's no profit in making T3, etc in a form my body can accept for big pharma and the options available at rite aid or walgreens made my condition worse when i was on them in 2006-2007), no payments for doctor visits except to my pcp who is in-plan (note: the specialists are not in-plan, but should be reimbursed at 80%), and they are only paying for routine blood tests required for all thyroid patients after i spend $2000 out of pocket for blood work myself (rather than counting all the other out of pocket expenses toward my deductible)

our system is so amazingly broken i have serious doubts about the current reform plans fixing things (or even making a significant improvement)... if this is what a good health care plan looks like (and i have what is considered a good plan even with the high deductible) i don't want to imagine what life without a "health care plan" would be like in the US...

Comments 
9/11/09 11:19 (UTC)
How is it you're uninsured but they aren't paying for your treatment as prescribed by doctors? Are you seeing people outside the plan when there are ones within the plan? On what basis are they denying your claims?

I thought the $7500 meant you didn't have insurance. Now I'm just confused.
9/12/09 2:59 (UTC)
ask me a question i can answer... docs and i are fighting bc/bs, and i hope they'll start reimbursing me but thus far, they've only opened a case a month ago for 2007/2008 (and they're dragging their feet about processing that too)

so yeah - i do have health insurance, i'm terrified to let it lapse because of my illness (if i do, in the current state of things if i can get a plan at all it'll be way out of my price range due to the pre-existing conditions)

and i'm one of multiple people with insurance i personally know with similar problems - either insurers not paying for needed treatment or cancelling insurance because they got sick

our health care system is so broken i wonder if the proposed reforms will even make a dent in the issues - and if there is no public option i highly doubt it will make a damn bit of difference to my situation as it currently stands - i will have to buy insurance, but no-one will insure me at a reasonable cost because of the pre-existing problems, or they'll insure me but exclude treatment for the adrenal system issues from my plan to keep their cost down

in either of those scenarios, me and everyone else with chronic problems will still be s.o.o.l. if the insurance industry has their way
9/12/09 13:40 (UTC)
and bcbs is supposed to be a good one. Ick.
9/12/09 4:07 (UTC)
that article was scary and sad. it does sound like a better method of payment to me, i think i have decent enough insurance but i don't understand all of it and i don't really know what would happen if i was in an accident or became so ill i had to go to the hospital. it seems like there's always fine print somewhere that cancels the agreement you thought you made and replaces it with something like 'we'll do what we want' in the event of any of a handful of unforeseen circumstances.