Monday, June 12, 2006
And I have no faith in the medical system. I bought the least expensive medical insurance at my company. Sounds decent: I cover first $1000, the company has a pocket out of which they cover $1000, then I get the next $1000 and after that the insurance company and I go 80%/20% respectively until I am out $4000 for the year where they start covering all of it.
That was when I was still thinking I had something remotely like when I had my mom's insurance and was paying less than $20 for the doc, $50 for the ER, and almost nothing for prescriptions. I got food poisoning back in February at the Old Spaghetti Factory in Indianpolis eating the linguini with clam sauce. Turns out that in a whole bowl of dinner, one bad clam has enough of the toxin needed to get me amazingly sick. Alex and I spend some time talking to the member advocate for the insurance, the doctors office, and Prompt Medicine (local urgent care facility) and decided that since I have been unable to get down and/or keep down any fluids, I need to get an IV. Prompt Med can't do that, and of course it is 4:30 on a Saturday afternoon and I have been sick since about 1 or 2 in the morning. So we go to the ER. $500 to walk behind the counter. $180 to get 2 bags of fluids. $400 for x-rays that were most likely not medically necessary. Several more things to get the total bill up to around $1600. *My share* of this after the negotiated lower rates was close to $1100...
Lessons learned from this round: 1) ask "is this medically necessary" before agreeing to procedures. 2) suck ice cubes to try to get fluids 3)put more money into flexible benefits.
Then, in April, I went in for my yearly. Apparently my *annual preventative in-network* only covers the doctor's time, not the resulting lab work. Hello another bill for $300 after negotiated lower rates. At least now I am getting reimbursed since I have already spent over $1000 out of pocket. So results come back, and I get to go back for another procedure. great. I forget to ask question number one from above and go. Not much fun. Then I get the bill... really not much fun now. $310 for my doctor's time. $850 for the labwork, then an additional $720 for a pathologist to analyze the results from the lab. *Fortunately* my share of these are $150, $193, and $604 respectively. I am now up to $2500 out of pocket. I have been calling the doctors office, the pathologist, and the insurance, try to get some of those reduced, but since I am sure that there will be more of this with follow ups, I think I am now in a race to fulfil the secondary deductible, and I wonder if it is worth all the time. Either way, a supervisor in the claims department of the insurance company is supposed to call me back today or tomorrow, and we will see. If I hit that point, I think I will see about getting everything done for next year I can think of since I will only be paying for 20%...
Next year I am doing PPO. Costs $1200 instead of $600 per year in premiums, but it is flat fees for co-pays and ER visits, and would make me feel better. I would be way ahead this year doing that, I am sure... We get to re-elect this fall for insurance, and I will call and get a bit more help on what co-pays cost and what else there is involved in the plans. And I will put more into my flexible benefits. As much as drugs cost...
That was when I was still thinking I had something remotely like when I had my mom's insurance and was paying less than $20 for the doc, $50 for the ER, and almost nothing for prescriptions. I got food poisoning back in February at the Old Spaghetti Factory in Indianpolis eating the linguini with clam sauce. Turns out that in a whole bowl of dinner, one bad clam has enough of the toxin needed to get me amazingly sick. Alex and I spend some time talking to the member advocate for the insurance, the doctors office, and Prompt Medicine (local urgent care facility) and decided that since I have been unable to get down and/or keep down any fluids, I need to get an IV. Prompt Med can't do that, and of course it is 4:30 on a Saturday afternoon and I have been sick since about 1 or 2 in the morning. So we go to the ER. $500 to walk behind the counter. $180 to get 2 bags of fluids. $400 for x-rays that were most likely not medically necessary. Several more things to get the total bill up to around $1600. *My share* of this after the negotiated lower rates was close to $1100...
Lessons learned from this round: 1) ask "is this medically necessary" before agreeing to procedures. 2) suck ice cubes to try to get fluids 3)put more money into flexible benefits.
Then, in April, I went in for my yearly. Apparently my *annual preventative in-network* only covers the doctor's time, not the resulting lab work. Hello another bill for $300 after negotiated lower rates. At least now I am getting reimbursed since I have already spent over $1000 out of pocket. So results come back, and I get to go back for another procedure. great. I forget to ask question number one from above and go. Not much fun. Then I get the bill... really not much fun now. $310 for my doctor's time. $850 for the labwork, then an additional $720 for a pathologist to analyze the results from the lab. *Fortunately* my share of these are $150, $193, and $604 respectively. I am now up to $2500 out of pocket. I have been calling the doctors office, the pathologist, and the insurance, try to get some of those reduced, but since I am sure that there will be more of this with follow ups, I think I am now in a race to fulfil the secondary deductible, and I wonder if it is worth all the time. Either way, a supervisor in the claims department of the insurance company is supposed to call me back today or tomorrow, and we will see. If I hit that point, I think I will see about getting everything done for next year I can think of since I will only be paying for 20%...
Next year I am doing PPO. Costs $1200 instead of $600 per year in premiums, but it is flat fees for co-pays and ER visits, and would make me feel better. I would be way ahead this year doing that, I am sure... We get to re-elect this fall for insurance, and I will call and get a bit more help on what co-pays cost and what else there is involved in the plans. And I will put more into my flexible benefits. As much as drugs cost...
