Friday, February 03, 2012

Health Insurance Frustrations

So, last year we had to switch from group health insurance coverage to individual health insurance coverage.  I was surprised at the cost (more than $500 a month, just for Joel and I) and even more surprised when after 2 doctors visits nothing was covered.  Really?  Okay...a routine physical is covered, but nothing else.  So we paid over 6000 for insurance so that our prescriptions would be cheaper.  Makes a lot of sense, right?  When I did our taxes, I calculated that between premiums and office visits/labwork/prescriptions we paid more than 8,000 out of pocket for health care last year for 2 of us...and we are relatively healthy individuals.

In January we changed plans within the Blue Cross system.  We read, and read and RE-READ through the plan specifications and decided that we would go with a higher deductible and lower monthly costs.  Office copays were a lower percentage, too and it looked like 80% of most things were covered in network.  What we did not realize (did I tell you that we read the plan, a lot) is that NOTHING is covered (no prescriptions, no doctors visits if you're sick, none of the "covered" things) until the deductible is met.  Also, there is an integrated deductible, which means that prescriptions and office visits are combined to meet the deductible, but the combined deductible for the plan must be met before covered services are paid. That means we have to pay $10,000 out of pocket (PLUS our premiums) before they will even cover a simple prescription or office visit. The wording on these plans is so tricky and we missed this detail.


So, yesterday I went to see my endocrinologist and he changed my thyroid meds.  This morning I went to pick up the meds only to find that they aren't covered.....and my visit yesterday won't be covered.....and my blood work won't be covered.....THIS IS JUST WRONG.  We considered going without insurance, but prices are different for those with/without insurance.  The system is so messed up.

I've come to the conclusion that  unless you have group coverage you have to pay several thousand dollars a year before you can get sick or worse, need surgery.  This is ridiculous.  What's worse is that I KNOW better plans exist.  When we were at Macomb, we had great insurance with BCBS.  As individuals, we CANNOT purchase the same coverage.  It doesn't exist as an option.

Thankfully, we are being added to group coverage at Joel's work in April.  Amazingly....the coverage is much like what we had at Macomb...only even better.

I'm writing this not to assert that we need a federal health insurance program.  What I do think is that I should be able to pay for the kind of coverage that companies are offered.  As an individual, I cannot even access that kind of plan.  Even if we picked the BEST plan with the BEST coverage, it still pales in comparison to a group plan.

I can't wait til April.....

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