alumiere (alumiere) wrote,

interesting if radical health care proposal

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...

Tags: medical

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