Health Insurance

[northshore]

Does anyone other than me consistently run into problems with health insurance? Honestly, I've had nothing but issues with doctors and especially billing disputes even if they are IN the damn network. I'll spare the details because you will be reading for hours. Don't even get me started on folks that waltz right into the E.R. and get treatment for FREE on my tax dollars. This country is going to hell. I'm off my soap box now.

[el_d00der1n0]

the hospital where our daughter was born has re-billed us several times.

[foofighter]

who's your provider? i'm on united healthcare PPO and it rocks no issues at all. our baby's delivery and pregnancy will cost us just $250

[Pato]

Yup! That's why I still haven't had my knee fixed yet. This is the first time I've had issues though.

[northshore]

Originally Posted by foofighter

who's your provider? i'm on united healthcare PPO and it rocks no issues at all. our baby's delivery and pregnancy will cost us just $250

Previous employer: Blue Shield
Current: Aetna

[foofighter]

are u HMO? or PPO

[Trizz]

Luckily for me i just go to the VA hospital in Long Beach. but i had to work pretty damm hard to have that privilege

sorry kinda off topic, but i know people that use my work insurance which is blu cross have mulitple problems.

[kamaekia]

As an employee in the evil health insurance empire (employer to rename nameless), I will say this. If you think you are not responsible for the bills, direct the various doctors, hospital, etc, to call Aetna directly. When my first child was born, we kept getting bills from various people, including some bills 9 months after the fact. I just told them to call Blue Cross and they stopped sending me the bills. Now, if Aetna says it is your responsibility, then ask them to look at the claim and try and re-adjust the claim. Sometimes, that could result in a lower payment you have to make. Often times, bills are incorrectly sent, intentional or unintentional.

Although, I have never dealt with Aetna, just Blue Cross, Health Net and Kaiser.

If you would like more info, you can PM me as I can try and help you through this maze. If you have a copy of your explanation of benefits, that will be helpful in understanding your benefits better.

[northshore]

Originally Posted by foofighter

are u HMO? or PPO

HMO

[denmother]

Originally Posted by northshore

HMO

That's the problem!!! I switched to a PPO (Blue Cross) so I could pick my own doctors and not have to go through the ridiculous "referral" process. Oh, and there were no Doctors in my HMO network that I would ever consider trusting to operate on me.

[boludo]

I've only heard good things about Aetna HMO plans. I wish I had some advice/help for you.

You could always switch to an HSA. Then you'll be able to pay for everything until you meet the high deductable then, for Aetna, pay 20% of everything else.

If you can send me the plan name for aetna I can pull up the specifics for it and have the lady in my office check it out.

[92se-r]

Now just imagine if the DMV ran your health care provider.

I have Kaiser PPO. Haven't had problems yet, but I'm 26 and don't ever get anything done so I'm not a good data point.

[northshore]

Originally Posted by boludo

I've only heard good things about Aetna HMO plans. I wish I had some advice/help for you.

You could always switch to an HSA. Then you'll be able to pay for everything until you meet the high deductable then, for Aetna, pay 20% of everything else.

If you can send me the plan name for aetna I can pull up the specifics for it and have the lady in my office check it out.

All the problems are currently with BlueShield. I have yet to use Aetna for anything since I just recently received it from my employer.

[JoeTruth]

I've been spoiled over the years through my ex's Blue Shield POS family plan with dental, eye care and prescription coverage for all very low co-pays. Since our divorce is about to be legally finalized, I need to get off her insurance and get my own. By law, I can kick in COBRA and maintain the same coverage but when I called her district office to inquire at how much it would cost me a month, I was floored to hear how expensive it is. $500 plus a month for something she pays $42.00 month for FIVE people. Some thing's wrong with that picture and hence why our health care in this country is so jacked-up and needs a serious face lift. Hard working tax paying citizens are paying for the majority of people who don't have health care and we're paying up the arss!

I don't have to maintain her exact same coverage and could drop some features (i.e. eye care, dental, etc.) and bring it down to $200 something a month. Since I'm self employed, I would need to get my own insurance. Does anyone else here have experience with this and has some suggestions on who, what and where? Thanks!

[schleppp]

My wife and I are double covered. Aetna and blueshield. They have both been very good for us. Similiar to what Foo said, our son's birth and my coming up daughter's birth will be FREE baby!!!

[el_d00der1n0]

Originally Posted by schleppp

My wife and I are double covered. Aetna and blueshield. They have both been very good for us. Similiar to what Foo said, our son's birth and my coming up daughter's birth will be FREE baby!!!

we were double covered, but my wife's ins. cost a monthly fee. we decided not to include the baby on there, but at the hospital, the wife was double covered. they have some thing that at the hospital, the baby's supposed to be covered under the mother's ins. since we didn't put her on the other ins. after she was born, the baby wasn't covered at the hospital. what a freaking mess. then, my ins. complained they were being charged 2x and refused to pay the hospital. then the hospital keeps billing us. i had to re-claim with my ins. to get them to deal with the hospital. i'm in hell!!! oh!!! ohhh!!!!

i *think* it's ok now.

[ODB]

I've been on the Aetna Premium Plus HMO plan for going on my fourth year now and was very happy with it for a while. Would pay my co-pays, and that was that. A five-day hospital stay for surgery to fix my busted femur cost me $250. Lately, however, it seems like they're lowballing providers on reimbursements or are refusing to pay for certain tests or treatment items, and we get a sh!tload of bills now. We've managed to get some of these resolved (a huge pain in the a$$), but on others we've just had to bite the bullet. Maddening. I guess this is not a phenomenon unique to Aetna, however. I hear of others on different insurers going through the same thing. I wish I had access to Kaiser, cuz everything's self-contained there and you don't have to worry about getting expensive surprises in the mail.

[kamaekia]

Originally Posted by JoeTruth

I've been spoiled over the years through my ex's Blue Shield POS family plan with dental, eye care and prescription coverage for all very low co-pays. Since our divorce is about to be legally finalized, I need to get off her insurance and get my own. By law, I can kick in COBRA and maintain the same coverage but when I called her district office to inquire at how much it would cost me a month, I was floored to hear how expensive it is. $500 plus a month for something she pays $42.00 month for FIVE people. Some thing's wrong with that picture and hence why our health care in this country is so jacked-up and needs a serious face lift. Hard working tax paying citizens are paying for the majority of people who don't have health care and we're paying up the arss!

I don't have to maintain her exact same coverage and could drop some features (i.e. eye care, dental, etc.) and bring it down to $200 something a month. Since I'm self employed, I would need to get my own insurance. Does anyone else here have experience with this and has some suggestions on who, what and where? Thanks!

I can make a few suggestions. First off, most people don't realize how expensive medical care really. $500 a month is actually not that expensive for a POS plan that covers 5 people. Think about, you could potentially have a claim for several million dollars and you insurer would be obligated to pay it on your behalf. If you had a claim using your auto or homeowner's insurance for that amount, the company would almost always cancel your coverage.

Your ex-wife's employer subsidizes the coverage, which is the most common form of coverage in America. So people don't see what it truly costs to have monthly coverage.

In regard to your situation as a self-employed individual. Are you incorporated? If you are, you might be able to get coverage through Kaiser as their small group limit used to be just one employee. If you are not incorporated, then you second option is to get an individual policy, but you will have to pass underwriting, essentially they ask you a bunch of questions about your health status. They are tons of individual policies from $50 a month up to however much you want to pay. In California, Blue Cross and Kaiser are the two biggest insurers in the individual market and hence have the best value for you money. They may not be the cheapest plans, but when it comes to actually using the plans, your cost sharing will be lower compared to other carriers. And since you are self-employed, the premiums would be a tax deductible expense, which helps some.

[JoeTruth]

Originally Posted by kamaekia

I can make a few suggestions. First off, most people don't realize how expensive medical care really. $500 a month is actually not that expensive for a POS plan that covers 5 people. Think about, you could potentially have a claim for several million dollars and you insurer would be obligated to pay it on your behalf. If you had a claim using your auto or home owner's insurance for that amount, the company would almost always cancel your coverage.

Your ex-wife's employer subsidizes the coverage, which is the most common form of coverage in America. So people don't see what it truly costs to have monthly coverage.

In regard to your situation as a self-employed individual. Are you incorporated? If you are, you might be able to get coverage through Kaiser as their small group limit used to be just one employee. If you are not incorporated, then you second option is to get an individual policy, but you will have to pass underwriting, essentially they ask you a bunch of questions about your health status. They are tons of individual policies from $50 a month up to however much you want to pay. In California, Blue Cross and Kaiser are the two biggest insurers in the individual market and hence have the best value for you money. They may not be the cheapest plans, but when it comes to actually using the plans, your cost sharing will be lower compared to other carriers. And since you are self-employed, the premiums would be a tax deductible expense, which helps some.

Great information, thank you! I guess I need to debate between sticking with blue shield but having less coverage or switching to Kaiser, which I've never used or had so it will be different. I'm a sole proprietorship, not incorporated. Any benefit of exercising COBRA through her employer and keeping Blue Shield vs. getting it on my own?

BTW, it's $500.00 plus just for me. My kids are covered under my ex's policy and will continue to be covered under her policy.

Thanks again!