What's the point of paying for insurance when it doesn't cover anything?

Think about it...

X amount of dollars are deducted from my paycheck for health insurance but when you get to the doctor you still have to pay through the nose - wtf is that?

For example, I need a root canal and a crown on a molar, the costs without insurance are around $1,500+, with insurance I still have to pay $400-$600. So what's the point of paying for insurance, never mind that I contribute more money per year than the cost of the procedure needed. Co-pays for doctor visits and prescriptions...

Someone help me out here... what is the deal?

say a stroke later in life or is born with a birth defect that requires surgery after surgery then you can come back and answer your own question. Or maybe you'll be lucky and it will happen to you and then you can answer from a personal perspective. Don't want insurance...don't buy it...and then roll the dice...

sP

:sarcasm:

Do you work for the insurance industry? If so, thanks for nothing. Don't let that stand in your way of enjoying my money.

whether you will admit it or not. You have the peace of mind of being covered in the event of a major problem. Like I said, don't want it...don't buy it. And then see how you feel. I would guarantee that there are a few tens of millions of americans who wish they could bitch about the insurance they don't have.

sP

edited to remove my tasteless language...sorry, devilgrrl

No, I don't work for the insurance companies. I am a teacher of sorts. There is a very simple answer to your problem. Simply don't pay for the insurance. There are plenty of people who feel they get nothing out of it so they don't pay for it. Some people set up MSA's and that might be a good answer for you...you get more control of your money...but you would still likely want to carry a catastrophic illness policy. My only problem is that you act like there is nothing gained for carrying insurance...and that is merely perception and a poor one at that.

sP

Sorry for being snarky but this just slays me.

you carry a high deductible insurance policy in case of serious illness or injury. You then establish an MSA into which you deposit money, rather than paying into insurance. You can then use that money for the irritating and lower cost medical things (not that much medical is low cost). That way you have sole control over the money and 100% of it goes to actual expenses rather than having to pay some insurance company for services that you may never use. That is not the full explanation but it is a start. Most HR personnel would be able to much better explain it than I.

And please forgive MY snarkiness...bad day... but still not a good excuse.

sP

and thank you for the edmunication, I needed it. :-)

And you pay almost as much for that and the HSA as you do regular insurance. Her point might be better phrased as 'where the hell is my premium going since I have to pay so much extra and insurance companies make their money off of investment'. Or, 'what good is my insurance if I can't even afford the co-pays and deductibles'. We're being ripped off and that isn't any piece of mind at all.

Health insurance is really for a major medical..But with all the deductibles etc.. and then consider the astronomical premiums vs the actual payouts by insurance companies their profits are also astonomical.Plus on average (and I'm using my family Doctor as an example) an office call fee hasn't gone up that much over the last four years.
In conclusion.Yes insurance companies should pay more when one considers the cost of coverage.

you're the only person i know that has any kind of dental insurance. And thats all i got!!, i agree with you on the rest of your rant.

The health care system in this country sucks, but thats not a secret we've known that for sometime. And you may be right, if you don't have children and you're young and healthy you're probably spending way to much on insurance.

Peace!

for dentist work and eye care ect, its better to start some kind of investment account
but its still useful for something major like disease or a tragic accident-something that drags on and on and racks up the bills

the only downside to that is the possibility of getting dropped-and that should be illegal

Surely not $1000 per year.

Most years, I figure we break even, but the reason we pay the insane premiums is that a serious illness that would cost many 10's of thousands or even 100's of thousands is not that unlikely. The system sucks worse than any other country in the modern world because for all the talk about "Free Markets", we have virtual no choices at all.

your just supposed to have it so insurance companies can make insane amounts of money. So stop the whining and send your check in for crying out loud, daddy needs a new 80 foot yacht, he plans on spending the winter someplace warm. :sarcasm:

edited cuz i speel as well as freepers.

but wasn't quite sure.

:silly:

I mean, unless you get something dire, you're going to pay for your healthcare pretty much out of pocket...


and it is damned expensive to boot.

I needed some dental work done that was going to cost me $1,800 with insurance. That wasn't the only thing shocking. I found out from a friend that he got the same procedure done by a different dentist and it cost him $1,500. It was $300 less and that is without insurance! I called my insurance company to try to get some answers about this. I asked whether I could go to a different dentist to get a cheaper price and was told no because that was the dental office on my plan in the area I lived in, and that the price was a set charge from the insurance company regardless of which dentist I went to. That sounded like some kind of scam to me.

I don't get how health insurance works either, so I'm sorry I can't help you understand it. It couldn't be that insurance companies are just evil entities out to make a buck on people's suffering, could it? And we all know how the private sector does so much of a better job than the government could when it comes to health insurance. I know this because the republicans told me so.

(edited because I'm compulsive)

Its the god damned greed of the Doctors. Why won't anyone say it? You ever see one who was dragging down less than a hundred grand a year? Not very many. Screw 'em all is how I feel about it.

The insurance folks will tell you they are covering some percentage of the 'fair and reasonable' cost or call it something like the prevailing cost, or other meaningless shit. Whatever the number is that they set you can bet whatever procedure you were subject to cost twice as much.

Fucking thieves if you ask me, just plain old fucking thieves. And the god damned AMA. Look at them. You want to see medical costs go down in this country? How about opening up a few more medical schools? I hate to say it but anyone smart enough to get a graduate degree in anything else has the potential to make it in medicine too. But how many slots are available? Very dam few, that's how many and the AMA makes good and sure it stays that way.

Thank you for letting me rant. I feel better now and it didn't take some Lexus-driving-clown to get me that way either.

It was cheaper to pay for cleanings and maintenance out of our pockets each year (you have to do the math w/your own program).

Granted, the other procedures you mention are really pricey, I would try to hold off until the next enrollment period - not an option if you are in pain. Most dentists will work out a pymt schedule with you.

Gotta keep medical, even the sucky kinda of coverage.

but I would be so royally screwed if I hadn't kept Federal BCBS after I retired from the V.A. Having cancer twice has pretty much exhausted my little bit of proceeds from the sale of my house, but if I didn't have the insurance I would be practically indentured to the hospital or credit card company.

Dental is a whole nother ball of wax. I have extremely limited dental, like $16 per cleaning done by a preferred dentist. If I only had to pay $400-600 for a root canal and crown I'd be very happy.

In the past 6 months, I've had to go to the ER over 5 times.

I've had an MRI, CT scan, spinal tap, more IVs than I care to discuss, and I feel like I'm single-handedly supporting CVS w/prescriptions.

I'm lucky to have insurance, even if it's not the best in the world.... it takes a LOT of the burden off of my shoulders.

I was paying about 5 grand a year and visiting the doctor once every few years, so I was spending about 15K to save two hundred bucks. It wasn't worth it. Now I live in fear that I'll get sick and have to pay more than the 25K or so I've saved since I dropped it.

Problem with insurance is that medical prices are higher than market because doctors know insurance companies will have to pay their outrageous bills. People don't try to find cheaper medical care, so doctors charge very high. Then people feel they have to have insurance to afford the high cost of medical care, so insurance companies charge even higher rates because people are afraid to not have insurance.

Now, 41% of Americans don't have insurance in a medical system that expects everyone to have insurance, so rates go even higher, and employers go broke trying to cover insurance for employees, and then they gripe about the high cost of taxes and scream for tort reform and blame liberals.

There is a major emergency coming in medical care. Companies can't afford the prices and the exhorbitant rate of annual increase of insurance companies, and so they are dropping insurance coverage, and people are going without.Either medical prices or insurance prices will have to fall dramatically, or we will have to get a national healthcare plan.

Here's something neat, though. Go to a small doctor's office and tell them you don't have insurance. They'll often give you a much lower price than they'd charge the insurance companies. Larger medical centers won't, because they make more money herding the HMOs and PPO customers through, but the smaller offices who aren't constantly busy often will.

On the other side, my boss just finished cancer treatment that cost over 300K in about six months. For him it paid off. But he doesn't have to pay for it, since he's an officer of the company. It doesn't reduce his salary, and he writes off the loss in company profits at the year end. So it's worked well for him.

So, if you're wealthy, you're set, and if you're poor, you're living a gamble, and if you're somewhere in the middle, you're somewhere in the middle. Eat healthy, look both ways, and keep your fingers crossed.

I must say that my assistant's child was diagnosed with a serious
illness a few years ago. At the time, this required surgeries, and
a couple of months of intensive medical hospital care. As it happened,
I provided her insurance as part of her mother's employment benefit.
Thank god I did that.

Presently, I am in a 'group' so that I theoretically cannot be tossed.
I pay about $18,000 a year for four people.

I considered going for individual policies but my wife is on
medicines that render her so that they won't take her.

I sought to do an MSA BUT, that hurts my assistant's position.

I suppose I am slowly paying back the insurance company for the
thousands they shelled out to cover the child a few years ago.

If anyone has suggestions I would love to hear it.

I'd be pleased to have dental coverage like yours for crown work.

The copays are what really frost me.

Before * occupied the White House, we paid $5 copay for every prescription. He has lots of friends (including Rummy) in pharmaceuticals.

Now we pay $35 for many of the same medications - a 700% increase in 5 years. And they tell us we're getting a really great deal if we get a 3-month prescription and only pay $70 for it, a $35 savings. Oh goodie gumdrops!

I pay completely out of pocket to insure my two youngest kids at 85 dollars each. A month. No prescription coverage but 20 dollar office visits BUT at least they are seen. At least I can make an appt for them and even get a call back when needed. If they break something they will be taken in the back and treated.

It's very scary not to have insurance in the world. I have dental for the three of us for 90 bucks a month that I pay completely out of pocket. So far the insurance company makes out better with what I'm paying them but again, I can get my family seen, even in a emergency condition.

Damn if you do...damned if you don't.

I notice that while a medical bill may be 1000. The insurance company
shows where it is 'discounted' as a 'member' provider and they
pay ...about 40% of the actual bill.

I think (am not sure) that these kind of number get generated because
providers know they will be discounted on there billings paid by
Medicare or Medicaid. So, they inflate the bill so that when the
gov't pays...they actually get the fair amount. Problem is that
now they have set 'the price'.

When you, the consumer, go in, if uninsured, you are still billed at
the inflated price. It is a screwed up system.

Meanwhile the insurance companies bargain for discounted pay schedules
because they can see what the provider charges the government.

OUCH

Medicare pays hospitals by a system called DRGs (Diagnosis Related Groups), and hospitals often get screwed. A DRG pays a specific amount for a specific illness. For example, all patients with a Principal Diagnosis of pneumonia would generate the same payment even at different hospitals in the same area. The payment would be higher if the patient had a complication or co-morbidity. If a patient had many complications and/or co morbidities, it wouldn't matter. The payment would be the same as if the patient had just one. So if a patient's Principal Diagnosis was pneumonia, and the patient also had insulin-dependent diabetes, the payment would be the same as the payment for a patient with a Principal Diagnosis of pneumonia who also had insulin-dependent diabetes and congestive heart failure and multiple sclerosis and a urinary tract infection. The system was implemented in the '80s, and it's the screwiest system I've ever seen. Hospitals pay hundreds of thousands of dollars for consultants to come in and train the coders to find complications. If a coder has a chart that does not have a complication or co-morbidity, the coder will scour the chart looking for any indication that another condition might have been present. Then the coder will query the doctor asking if the doctor thinks the patient may have had such and such, and if so, would he/she please come to the medical record department and document it on the chart.

I think hospital bills are inflated, but mostly because hospitals often lose money on government insurance patients and because they've signed contracts with the non-government insurance companies to provide services for discounted rates. They make it up by charging uninsured people the inflated price. If a hospital won't sign a contract for the discounted prices, the insurance company may prohibit its customers from using that hospital.

Insurance companies are making out like bandits on our health care system, and it's a disgrace. They take in big bucks in premiums, often deny coverage for certain conditions, take huge discounts and dictate which doctors and hospitals we can use.

Sorry this is so long. Our health care system really touches a raw nerve in me. I worked as a coder in medical records for many years, and I just couldn't take the pressure to maximize DRG payments any longer.

... If the expectation (a mathematical term) isn't in your favor, then don't make the bet.

harder than those little tubes they put in your mouth.

at least mine does. my health insurance, thankfully, is pretty good. I am about to get my two lower wisdom teeth taken out at a cost of $1900. My insurance is paying $40. Apparently, they want me to get the teeth (which are impacted below the gum line) taken out without anesthesia. :eyes:

... because many believe that one key to fixing our health care system is for the consumer to pay more for each service out of pocket.

Whatever the premiums are for the insurance you have, they would be much greater if the root canal were 100% covered.

My own doctor believes strongly (and I agree somewhat) that medical care is abused by folks with 100% coverage. They visit the doctor for every little thing, demand all kinds of tests that are not medically indicated, why not it costs "nothing".

I'd prefer a single-payer system, but that will be a while in coming. In the meantime, expect co-pays to keep rising, because it is the only way the current system can be maintained at all.

And what I pay out is nowhere near what is paid in by the insurance companies by his condition. Plus he has a neurologist who is a patient advocate and has no problem taking on insurance companies for treatments she believes in. Even though he has secondary-progressive MS, he is still able to walk, drive and function at a fairly high level. Much higher than the brain lesions on his MRI show.

This doesn't help the healthy though. Do those that are healthy pay for those who are not? It looks like it. The insurance companies are going to make their profit somewhere. It's an ugly way to think, but I work at hospital and I know not only tax dollars, but insurance premiums and coverage can't possible equalize the cost of medical care. Especially catastrophic care.

I have decent dental now, but I've had shitty dental before and you're right, that 50% coverage for crowns and whatnot is horrible.

I wish I had a better answer.

My employer (non-profit organization!) pays 100% of my medical and dental premiums. I have a $10 co-pay at time of visit (used to be $5), and I pay about $10 for prescriptions (can't remember exactly - fortunately, I'm quite healthy). My dental plan allows me 2 cleanings per year (no co-pay), plus full x-rays once per year. I recently had to get an overnight bite-plate, but the dentist let me know well enough ahead of time so that I could enroll in my company's medical savings plan - a certain amount, which I determine, is taken out of my paycheck, pre-tax. We have no optical plan, and I am as blind as a bat.

So I have to pay for all of my extra dental work (certain percentage) and optical work (I was unhappy with the chintzy plan here in Boston, so I still go to my home town optometrist (friend of the family) when I'm home for the holidays). He only charges me his cost for exams and lenses.

But the medical insurance kicks ass. I have a 20 year history of kidney stones, and my current medical plan (for which I pay nothing) has paid for 4 Extra-Corporeal Shock Wave Lithotripsies - out-patient non-invasive surgery. (I've been clean for about 5 years).

Of course, I take a hit on my salary, but the free insurance is worth it, especially when it come to settlng bills, etc.

I am frequently horrified when I learn what others are paying for their health plans.

Medical insurance said it was dental and wouldn't cover it... Dental said it was medical and wouldn't cover it. He had to go to his company's plan administrator to get it worked out.

Another time, he had to have outpatient surgery. He kept getting the statements and the insurance company wasn't paying everything. He found out that they would only pay a third of the bill the first time they got it. a second third of the bill the second time it was submitted and finally finish paying what they had promised to pay after the bill was submitted for a third time. That sure sounds like they are drumming up administrative costs for themselves and for the provider.

My brother went for years without medical insurance. His wife got a job at the county and that was one of the benefits she picked up for them. Then, suddenly, like David Letterman, my brother had to have bypass surgery. Six bypasses. That was 12 years ago. Since then, she has left her job with the county and the Cobra ran out and they are paying 1,500 a month for insurance. She told me their insurance premiums are supposed to go up soon by $500. My brother said he doesn't believe in National Health care. !??!!!? I don't get it, why not? The bright side is that he will soon be eligible for Veterans' medical benefits.

It's a scheme, because as soon as you might need it your rates will be beyond your means and the company will figure out a way to avoid paying.

to insure a 1,500 sq ft. home. That can't last.

- so you could end up beating the system yet. Throw in a few extra fillings, a cap or two and some gum surgery and you'll come out on the sweet end of the deal.

Check with your employer and see if you can opt out of the insurance program if you don't feel you have a need for it. Most companies allow that.

You just saved $1000 on this bill. That's $83 a month. The dental portion of you insurance premium is likely around $25 a month.

but it's still a pain in the ass. Gee whiz, I'm lucky I don't have children, imagine what the average family goes through?

Insurance companies often take huge discounts on medical bills, and the difference cannot be passed on to the patient. We pay some pretty large premiums for family coverage, but one illness or injury can more than make up for it. For my husband's $5,000 hospital bill, we paid less than $700 because of the discount. For my $4,000 emergency room bill, we paid a $100 co-pay plus $14 for prescriptions. Without insurance we'd have been billed the full amounts.

In the past we had dental insurance that discounted bills, and the discount would sometimes be 25%. Our current insurance does not discount, but it pays more out than we pay in premiums. We have family coverage, and if all three of us go in for check-ups twice a year, we come out ahead. For your root canal and crown, if you're paying $400-$600, then the insurance is picking up $900-$1100. Add to that the amount the insurance pays for your regular check-ups and any work like fillings (usually covered at 80%). If you're paying more than that for just dental insurance, then you may well be better off without it. But chances are your dental insurance alone may not be that much.

I know there are many people who can't afford medical insurance or who do not have it available to them, but if you have the option, it's a big gamble not to have it. One illness or injury can throw a person into bankruptcy. Even the healthiest of people fall and break legs or develop kidney stones or appendicitis. Our $5,000 hospital bill was for an outpatient kidney stone removal. The $4,000 emergency room bill was for a 5-hour stay for muscle spasms. I hate to think how much even a few days in the hospital might cost.

I think our health care system in this country stinks, and I know it's frustrating and sometimes depressing to pay out the big bucks in premiums. But unless/until we can get some kind of universal coverage, those of us who have health insurance available to us and can afford it are fortunate.

Hang in there, and good luck with your dental work.

auto ins is one of the worst!

I watched a show a while back about babies being born all over the world. One of the couples profiled was a Chinese couple. They ended up giving birth to twins and the babies needed special care and had to be transferred to another hospital. They would not transfer them until the couple coughed up their entire savings account and then showed their pay stubs to prove that they could pay the balance. I decided after I saw that to be grateful to have insurance, even if it does suck and seem unfair sometimes.