I have never had a problem with my health insurance, never.

Over the years I've been in group plans including Blue Cross and Harvard Health and for a few years I had an individual policy. I have never had a problem getting the treatment I needed. In 2001 I had major surgery which came after a battery of tests. Nothing was ever questioned and I never had to get anything pre-authorized.

I am trying to figure out why my experience has been so different from other peoples' experience with health insurance. Is it because I happened to have good insurance carriers? Does it have something to do with being in the Boston area?

I am a strong supporter of reform and the public option but I wonder how many people are out there like me and I wonder if they can't relate to the problems in the system because they've never had them.

Use to be great until about 12 years ago and they started to question everything my doctor did. The nurse at work sent me to the ER one time when I swelled up like a balloon and was having a hard time breathing. Denied, not life threatening. The RN thought it was.

I think that part of it might have to do with where you live. I am not sure about this, but I believe some states have laws regarding insurance companies and what they must cover. I know that recently a law was passed in NY that makes insurance companies have to have the same copay for mental health appointments as they do for any other specialist. This decreased my copay to go to counseling from $20 to $10, and we had to fight with the mental health clinic to make them see that. They were still trying to charge us the $20. Though, now that we switched insurance they want me to somehow afford $50. so I haven't been going which is bad for me because I am pregnant and am not taking my meds as a result and have been more depressed.... uggh. but i digress. I think the state laws may have some effect on what is covered.

Another thing is that I think we are worse off insurance wise than we were in 2001 even. Insurance companies have been very busy raising rates and changing their rules on everything. So something that they gave you no hassle about in 2001 might be a problem today. I may be wrong, but it makes sense to me that this would be happening because of skyrocketing costs. I wonder if you would have been given a hassle about all those tests if it were today. And I cynically wonder if you would have even been told about the tests today because it seems that some of that goes on as well.

This is from doctor's offices and hospital administrators when I check in.

I have been with Blue Cross forever. Lucky me.

I would give it up for a European style system in a minute, though.

On edit: Things have gotten more expensive.

11 years ago I had an overnight hospital stay with surgery.
The bill was 25 grand. I paid $75.

Last year I had an overnight stay again, but just for tests and observation.
The bill was 12 grand. I paid $1200.

Office visits used to be free, now they start at $20.

while some may have great insurance, there is no guarantee that it will remain so. You are basically at the mercy of the insurance companies who control what they cover and can change the rules at any time. They have too much control over the system and the process and as long as they do, then none of us can truly count on having decent healthcare down the road. Something that they cover today may tomorrow be changed, but we don't really know until we need it. And most people don't end up needing it, so they don't ever know. And then, if you lose your job, you lose your insurance and then where are you. Employer based health insurance may have sounded like a great idea when everyone worked at the same place until they retired, but that is not the reality any more. and the burden on employers is breaking them.... It seems every other day we are hearing about another company giving over pensions to the government and screwing the retirees on healthcare. Imagine if we didn't at least have medicare!! where would all those people end up!!

I have had no problems on the coverage side but the cost side has grown immensely in the seven years I have been with this employer. That is an issue too, because as a part-timer I pay half of it.

yet nationwide there is a crisis in both areas.

We are lucky; that's all.

I haven't had any big issues with mine. In fact, I was recently diagnosed with sleep apnea, and they paid for all the studies and the ensuing/ongoing treatment with no issues or anything.

That said, per my boss, our premiums go up about 15% every year. And, so, none of us working here have had a raise in about 3-4 years. Basically, he had to make a choice between the good health insurance or raises. So, it's ok, but not exactly optimal.

One of the reasons many people go uninsured is because they don't get anything through work and what they can get on their own has a high premium and huge deductibles and copays.

Now, I'm a smoker so that may have been a part of it. At the time I looked into the NH Insurance Pool and that was pretty expensive too and didn't have very good coverage.

And people wonder why so many aren't insured.

burden and if you have to add drugs to it, it becomes unaffordable. However, before I qualified for Medicare, I was paying $500 a month for Blue Cross coverage that most of my doctors wouldn't take. I submitted my own bills and never got back anything because of a large deductible. So mostly I was giving them $6,000 a year for nothing. Oh, and I'm not a smoker.

let alone health insurance.

Try switching individual plans while (or after) getting treatment for a major illness. And don't miss a payment even if you are not planning on switching.

I have great insurance - always have.

But....

1) I've always been in a good sized group.

2) I've never been sick.

A public option might rock my little "perfect scenario" boat for the short term but I'm under no illusion my situation will remain the same - especially since I'm in my forties.

I have a couple friends that are out of work right now and afraid to go to the doctor. One informed me he has been light headed lately but he is afraid to go until he finds work. I don't know what to tell him.

The current system sucks.

They become more and more reliant on the personal experience.

The 50 million uninsured are not a problem to the insured individual.

When you reach 50 with a medical history, it makes no economic sense for them to insure you. Then you have a different personal experience.

:thumbsup:

:thumbsup:

One of my friends used to have excellent medical insurance through her husband's union job. Never paid a dime, even for major surgery.

That all changed about two years ago when the union contract was renegotiated. All of a sudden, there were co-pays on premiums, co-pays on care, and deductibles.

By the way, Raven, whatever care you enjoy may be because you're "grandfathered" into the system. I bet that if you tried to apply for an individual policy at your age (old enough to have a grown son), you would be discouraged and angry at the expensive yet stingy policies available to you.

Of all those I know, the ones who have the best insurance are union workers and retirees. Not so much their supervisory counterparts at middle management and below. Unless they've been effectively protected by unions, average workers' health care benefits have effectively degraded since about the early 1980s and it's getting worse.

Health insurance is kind of like bank loans: You can easily get them if you don't need one. If you have plenty of money to spend on insurance, and/or if you're young and in good health, your perception might be more positive than the average person's.

excellent. I lived in Boston for many years and remember when no one had a bad word about Harvard Health. Starting in the 1990s, that changed. I had friends in Cambridge who were expected to bring their kids to West Roxbury for weekend care in order to avoid emergency room charges. I lived near Davis Square after they opened a branch there and offered directions many times to bewildered patients who were trying to find the location on weekends because they were far from their normal stomping grounds. AFAIK none of my friends has had major care denied but they grumble about long delays in routine care and screening, especially if a specialist is needed, and the long trips to the location where that specialist practices -- it's absurd for people living a stone's through from Longwood to be asked to drive to Worcester or the South Shore because that's where the Harvard/Pilgrim sanctioned physician is.

That said, I know mostly people who have the top shelf HMO plans with large employers and these tend to be the very best plans. Those who work for smaller employers have very high deductibles, different carriers every year or so, and a morass of pre-authorizations and delays.

eta: also IIRC Massachusetts has some of the best pro-consumer regulations on health insurance coverage.

in quantity and spread risk.

Downside, of course, is that smaller companies find it harder to attract talent, and thus it's harder to be competitive.

Seems that recently many social ills can ultimately be attributed to lax enforcement of antitrust.

The cost per paycheck to me would have left me very little to live on, and the deductibles and out-of-pocket charges were sky-high for anything other than a serious illness. Granted these were both small businesses, and the first place I worked at offered me the best deal they could, and the second place had a plan where the owner limited his monthly costs by having a plan w/ high deductibles.

115% in the last 8 years. Has your deductibles, co-pays, or annual caps changed over time? Most employers and individuals can't keep up with the rising cost of the 'insurance'.

Law firms usually get what they want from service providers.

;-)

I'm glad you haven't had a problem, and I'm also appreciative of the fact that you are aware that you are among the lucky.

My sister, alas, who is of a similar age to you, doesn't see the point on HC reform. x( She has never had a problem either. She's retired from Ma Bell. So thanks to unions, her insurance has always worked just fine. Though, she's unaware of the connection. Her insurance is hunky dory so she doesn't thing "socialized medicine" is the way to go. But she told me a couple of weeks ago at the day surgery clinic that because of cost, she switched to a high deductible policy, 5K out of pocket every year. The day surgery was going to cost her about $1200.

I really hope she doesn't suffer a catastrophic illness and discovers just how inadequate her insurance now is. :-(


Me, I have a pre-existing condition, so I'm always in the "you gotta waite 18 months for your coverage to come fully online." camp. And being a contractor, I have many "new" jobs. :-(

Something must change. This is Dickensian!

and lose your job or quit, it may not be so easy to keep your present coverage? Also, if there is a pre-existing condition, you may not get covered at all. However, for a very high charge, you can keep your present insurance thru COBRA, if you can afford it. And your medicines will be extraordinarily high, if you are on medication. There are a lot of problems that need fixed.

What a catch 22 that is.

I, ironically, stated worked at one of the largest insurance companies in the country (nothing to do with health insurance, though) and my claims were summarily changed or denied outright.

I never had a major problem, but I paid my dentist and sent the bills in for reimbursement (that's the way they handled small stuff) and would then get a memo saying the dentist did not do what he did. Well, he did do it, but what to send in for proof? His notes? Pictures? Before and after X-rays? It only added up to a few hundred bucks, and I just ended up just pissed at shitty treatment by MY OWN COMPANY.

Years after getting out of the business for other reasons, I found myself in an HMO and found what was "not covered" and was amazed at how they could waste money with constant visits back and forth to the gatekeeper for things that had once been simple and inexpensive. The HMO soon went bankrupt and we all ended up in another one, with odder rules, and which went bankrupt, too.

I guess the moral of the story is that you are lucky to have good coverage, but that good coverage was once common but is now becoming the exception. I still refuse to blame it entirely on insurance companies, but the entire cost structure of medical delivery is simply insane here, and insurers, HMOs and other plans are reacting to it in whatever ways they can.

...since being dropped from my parents policy over 20 years ago.

that the day after I became uninsured I'd get sick. Just me obsessing but I do think that if you can possibly afford coverage, you should get it.

....these days...as good or better than our other three hospitals in our area....so at least here we've got that goin' for us...and the charity system has actually been improved since...drum roll...Bobby Jindal was appointed the position to oversee and make changes to it under Mike Foster back in the 90's.

Mammograms are free, as are bone density exams. But then, when they find a tiny speck and tell you that they recommend a needle biopsy...it's $650 a pop every time they suspect something that may or may not be cancer because they do the biopsy in a surgical center.

The entire procedure costs $1400 and takes about 15 minutes.

Something is wrong with this picture when the preventative part costs are so fricking expensive.

that could happen in the Doc's office.

Then there's the increased costs for prescriptions.

:popcorn:

the deductibles and copays have gone up a bunch in the last 25 years.
My wife and I have both had cancer.I've had a broken hip. Surgeries for adhesions from
my earlier cancer surgeries.
Our out of pocket for each of these major illness's has never been more than $1500. Expensive?
Well it sure didn't bankrupt us.
I'd just like to see everybody get access, with help for those who really can't afford a premium,copay or
deductible.

Is that a problem for anybody else?

of people that have--and I'm fully supportive of an overhaul.

went on and raised my children. They covered what needed doing. Until I had a problem that is considered a pre-existing condition and also as I grew older. And was in a situation where I had to change insurance. Forget it. The best premium I was offered was 2,800 per month with a 10,000 deductible and numerous copays. Luckily I was able to get into the state risk share program.

And in all those years, I probably would not have given any thought to any sort of insurance reform. Alot of people are well covered, going about their lives and have no reason for concern. Which I totally understand. So that is part of why it is tougher to get this reform going. But it is getting worse with insurance, and will continue to affect more and more people, business not being able to afford it, more people losing coverage, and if left unchecked, it would probably get to the point where the numbers of people wanting reform will grow. Course it is already at 76% of people according to polls. So maybe it will get to the point of - torches and pitchforks heading to Washington.

1. You don't have a family member with a disability denied by insurers.
2. You don't pay your full premium and/or deductable costs.

Also, age has a lot to do with cost burden and rejection of coverage.

my law firm offered top of the line health insurance with no deductables and no co-pays and no deductions from paychecks. This was from 1991 to 2003. It was killing us financially at the end. We provided that benefit because we felt it was the right thing to do but I'm not sure we could have kept it up for much longer.

I'm 63 and work for a small town in NH. We have Harvard Pilgrim with an $8.00 a month payment and fairly reasonable co-pays.

This idea that age would enter into coverage rejection amazes me. It's like a life insurer refusing to cover you because you're going to die someday.

The bottom line, I guess, is that insurance companies aren't insurance companies anymore.

so thanks for the thread.

although i have had the occasional blip, their customer service has been great. my family has had many problems, including several surgeries, several chronic illnesses, and mental health issues. they have never quibbled, and frequently pay 100%.

that said, our contribution to our premiums, which are attached to wages, has risen from $44/check to $300/bi-monthly check. we have an additional $150/check for a pretax reimbursement fund. that usually runs out between july and august, so we always have more than that in out of pocket. our co-pays for rx runs nearly $200/month. our total out of pocket per year has been as high at $8-9,000.

we are extremely lucky in this, however, DH is chained to his job by the need to keep this policy. he could make 3-4 times what he makes at his job as a consultant, but we just can't take the chance. last year i had a double disk fusion. the surgery itself was $100K. that does not include the diagnostics, the office visits, the follow up visits and tests which were another $10K. we would have had to mortgage our house. that would have kept our kids from going to college.

we are lucky. but this system is fucked.

I haven't had a problem recently as i have no insurance to have a problem with.
... I am just one of those that has a medical bill that I simply cannot afford. It is not that i do not want to pay is is I can't pay it as I haven't the dollars for it and food.

My Mom worked for years for an employee benefits firm and had top-of-the coverage for everything -- medical, dental, prescriptions -- she got the best on the market. She had the same experience as you.

The small company I work for has the cheapest Kaiser plan offered.

I have NOT had the same experience as my Mom has had.

This is probably why. Before I qualified for Medicare, I had Blue Cross and it was pretty worthless in covering my health care. Also, most doctors in my area wouldn't take it so I had to submit my own bills. The same doctors though will take Medicare.

but my family has had horrific experiences with their insurance.

How about being told that your ICU-worth pneumonia (viral) is a "pre-existing condition." Um... considering the family member had insurance with them for a few years, I highly doubt she had pneumonia for 2 years without knowing it. they ruined her life completely with that. I mean complete financial devastation.

It would take an average of 2-3 calls just to get everything straightened out (and how much time on hold).

I was persistent. The average person probably just gave up with all the hassle involved.

for your insurance to not pay when it really counts and you are in big trouble, maybe bankruptcy. It is too much power for them to hold over people when their motivation is to make money, not serve their customers.

Regardless of personal experience the current model is wrong, unjust and lethal.

we have to reach those people to make them understand.

Every single time there's been any sort of expensive test or operation, there's always a bill afterward that they won't cover and which I can usually find in the prospectus as a service they're required to cover. I don't want to even go into the problems I had in the 90s when I had to change insurances several times and none would cover my pre-existing stomach/esophagus condition. Lots of untreated suffering!

but allow those who have had problems and WILL have in the future due to job change
or failure by insurance companies to pay because of pre-existing conditions etc to
make a choice.

I'll go one step further and say, folks should not have to pay for health care and
don't get the service, if that where a small business man with no political clout
they would be arrested for fraud, just asked Bernard Madoff....

people are so quick on the trigger that they don't read the post...knee jerk I think it's called...so here's the thing...if you want to get something passed a legislative body or the public, you have to look at all sides...you have to understand how people think about something in order to address their concerns and deal with them.

Though a public restroom can be problematic, not having one is much worse.


Telling someone to go out to the curb so they can die sounds so Corporate-America :argh:

It's not really "my" insurance - I was turned down for health insurance twenty years ago. So when our business slowed down, I sent my husband out to get a job with coverage. Good choice - three weeks later, I blew out my knee and had to get surgery for it. That policy had no deductible, no co-pay of any significant amount. For an operation the next year with a three day hospital stay, the out of pocket total was $50.

But my husband changed jobs. The most cost effective (what we could afford to be taken out of his paycheck) policy was one with a $2000 deductible and 10% co-pay. Over the years, the premium has gone up 10-20% per year and the co-pay has increased to 20%, plus the prescription coverage no longer covers name brand medicines, even when there is no generic or a medical reason to not use a generic. Now our deductible and co-pays are three to four times what my husband's take home per month is - it's already hard to save up for emergencies and this guts those savings every time we need major medical care. But we cannot afford to reduce the deductible since that would increase our monthly premiums so much we'd never have any savings.

And the approval process has gotten to be a major interference between me and my doctor. With my recent should surgery, approval was not granted until a week before the surgery leaving me, the surgeon, the outpatient clinic and the anesthesiologist in limbo until the last minute. I was not informed of my portion of the payment until Monday for a surgery scheduled on Thursday, which made it hard to budget. And I did not realize until I started physical therapy that it was no longer covered in full, though I should have expected the 20% co-pay. That alone is nearly $500 out of pocket, on top of the almost $3000 already paid out for the other expenses.

And now the insurance company is trying to claim that my shoulder was an "injury" and is trying to find another party to force to pay. I've filled out form after form indicating it was just an age related problem - the damage was just from 56 years of wear and tear. But I think there have been four or five forms where I indicated that and they still keep coming!

On the other hand, from time to time paperwork arrives that shows that things were questioned and pre-authorized. Once I got an authorization letter for something that had already been done.

The doctor's office handles the insurance company rather nicely. It keeps track of referrals, produces the paperwork to assuage the insurance company's bean-counters, etc., etc. It handles problems before and as they come up.

I have developed an intense, bitter hatred for health insurance companies. I think it's the worst possible health care delivery system. We've had our rates more than doubled with benefits slashed. The last 30% hike in March almost killed me -- and the customer rep actually laughed at me, and said with a smiling voice, "well, costs are going up!". Pardon me if I'm wall-to-wall single payer.

I can't afford it anymore. I'm praying for the public option -- and I think businesses of our size will be allowed to purchase from a pool of sorts.

I can't even tell you the stories.

varies widely from state to state. Being in Mass probably helps too. I've
had mixed results from insurance plans over the years. The one I have now
doesn't seem all that great, but that's my only choice from my employer and my husband is unemployed
at the moment.

and almost no one in the town I lived in would accept the insurance! I had to go to the edge of town to a health center that was staffed by immigrant doctors before I could find someone that would see me without paying in full beforehand and then filing for reimbursement. What really puzzled me was that the other employees seemed to think that the plan was wonderful. What I didn't realize at the time was that crappy insurance coverage is MUCH better than having no health coverage at all, like probably half the local population (Pigs eat slop - but they'll eat cake, too, if you give it too them). Before Katrina there were only two public hospitals in Louisiana - now there is only one.

Fortunately the immigrant doctors I saw (Pakistani, I believe) were excellent. In fact, I have found the Asian doctors I've seen over the years to be superior doctors to the native born ones (generally).

Most people will never get expensively sick, and of those who do, 2/3 will not have their claims denied. The odds are in your favor. Your insurance company chose others to bankrupt or kill.