Health Insurance

[Bait O' Eggs]

My company only pays for my medical insurance and I have to pick up the insurance for my family. :depressed:

Just got informed of the rate increase for next year :shocked: :shocked: :shocked: :shocked: :shocked:

WOW!!!! I want a raise like that.

I will be dropping the family out of the company group plan, and going shopping on my own.

Finding it difficult to compare one plan to the next because there are so many variables to compare. This is a real pain. I would rather just pull out my fingernails. [img]graemlins/dork.gif[/img]

I have vented now, and am better.

[Joe Schwab]

If you think that's bad wait till you retire and you pick up all of it. That is bad!!

[Pete]

I self insure through ODS. It's not cheap, but it was the best I could find and if someone is moving from another plan they have some deals that will help. Drop me a line if you'd like.

[Lured In]

Does your company offer a Section 125 Plan or similar from someone like Aflac? If so, your family's premiums could be taken out pre-tax and maybe actually save you money.

[5-Cents]

I know of one Ifisher who owns one of the largest insurance agencies in the country that deals specificly in health insurance for individuals, self-employeds and small businesses... send me a PM if you want to know more!

[Hare's Ear]

Don't drop your family's current coverage until you have something else lined up. If you don't like what you find out there you may not be able to get your family covered again until the next open enrollment period.

[CATCH AND EAT]

Roy, I feel for ya bro. Last year the rates I have for employee went through the roof! I ended up telling them Sorry but you will have to pay half of your insurance plan if you wish to stay on it. :depressed: Got some negative reactions but I chalked it up to survival of my company.

My family insurance went from 348 to 780 per month for a family of 5. Big stinking rip off!!!!
Sterilize the buck knife from now on. :shocked:

$85,000+ in doctor bills pays for alot of insurance. I got off easy, so far, because I didn't have to go through chemo or radiation.

[5-Cents]

:depressed: Keta :depressed:

[Green Machine]

BOE-

Give Shane a call. He might throw in a fishing trip. :grin: :grin:

Green Machine

[Rakkasan]

I work for the state and mine is $400.00 out of pocket for me and my two boys. It covers medical, dental, vision. Is that good compared to others you folks have.

Retirement?......Long ways away, but thank god for the VA. Military was worth it in more ways than one

[Joe Schwab]

Forget the VA unless you have SCD. You may be able to get presciption drugs cheap there but that does not apply to your spouse. 8 years of Military won't even get me in the door.

[WaterDog]

Roy, This your first increase? I've been hit with 20 to 25% every year in the last 4.

[RogueFishr]

I changed insurance companies a few years ago, and got caught in a technical "loophole" with a medical emergency that resulted in a $100,000 bill for myself. While I am currently paying that off ($80k out of my pocket so far in the last 4 years ), my current health insurance costs me $350 a month with NO prescription, dental, or vision coverage. Yeh, I would like to see something done about health care costs and insurance....

RF

[kayakfisher]

Rogue...

The insurance industry is very skilled at also finding technicalities and exclusions to avoid paying off.

I know of a physician who has minimal disability insurance because he had a friend in the insurance industry who told him that although they sell it hard, the companies fight paying any disability claims tooth and nail so in reality they seldom pay more than five years on any private claim disability policy.

m.

[fishbait]

Roy,

please look at Kaiser. WIth a family it's a viabale alternative and any more you go to the same doc as most other plans. 10-20 bucks to see the doc....... Good luck

[Smily]

Hi Roy,
What fishbait said. I have been with kaiser over the years with my employer and they pay half and I pay half. It's around $600. But that also inculdes some crabby oh thats ppy dental insurance. They only picked half of the bill of my wife's crown. An if you go to kaiser make sure you tell them you are having a heartatack even if it's just for a headache or they will over look you. [img]graemlins/berry.gif[/img] I hate but got to have them.

:smile: Smily :smile:

[Smily]

[ 12-16-2003, 09:36 PM: Message edited by: Smily ]

[2LEYS]

I pay $200 a month for me my wife and 2 kids for the best insurance on the planet.

[kayakfisher]

What is the "best insurance on the planet?"

m.

[Rakkasan]

KAISER! Yep! If you have a bad cut on your finger tell them it is your Femeral Artery that has been cut. You might get the right treatment

My mom was with Kaiser for over 20 years as a patient. She died this past October under the care of Kaiser. I will not go into detail, however according to legal voices we have a huge case against them.

Put it this way. I would be spending Christmas with my mom this year.

Sorry, touchy subject with me

[ 12-17-2003, 05:56 PM: Message edited by: DSRods ]

[Thumper]

For those knocking Kaiser, please be aware that in study after study, year after year, Kaiser managed care plans have had the lowest morbidity and mortality outcomes of any HMO. They are the absolute best at what they do. And I am not a Kaiser enrollee.

[Rakkasan]

Well I use to work for them as does my S/O. I saw behind the scenes and heard the stories. They are a good provider depending on where you go. It is not the doctors for the most part. It is the management and the bosses who are lacking. My mother should ahve had a C Scan done years ago and they wait till the last minute when she is so sick it is to late. I even heard her doctor say they do not like to do scan because of the cost. Well what are we paying for?

Oh yes, they mis diagnosed her and we were all shocked at the death certificate. If you have had a good experience or heard of one great. I myself had a bad experience with an operation when I was twelve. They had to put me back under because my stitched were not in right.

I hear what you are saying. I go to the VA and yes, you have to wait for meds, but once you are in the system they are mailed to you. I have had nothing but awesome care by there staff. Some of the best doctors in the world work up there.

[2LEYS]

Cigna.

When my son was born he rang up $120,000+ in hospital bills. Cost us a whole $10.

[brshooter]

My wife used to have kaiser insurance. Used to drive her nuts trying to get anything done for minor things. It was another story when she had a major health issue. She had a sub-dural hemotoma as a result of an brain tumor. Almost lost her. I can say nothing but great things about the care and treatment she received. Two brain surgeries, 45 days in intensive care, and another 30 days in progressive care. She was treated like a queen. I think it was a $10 co-pay.

[ 12-18-2003, 12:38 PM: Message edited by: brshooter ]

[Radke]

How about a biased view of Kaiser.

I work for Kaiser here in the Northwest, have for a bit over 19 years. 15 years ago I hated to mention that I worked for Kaiser, not because I was embarassed, more because everyone seemed to have a horror story.

Okay, fast foward to the early-to-mid 1990's. Huge effort (and $$) has been put into improving access and care, reputation began to improve. In a recent edition of a consumer magazine (the one that won't take advertising or allow their name to be used in anyones advertising, but has the initials 'CR' ) took a poll of their readers asking to evaluate thier health care provider.
Kaiser Permanente Northwest was rated the NUMBER ONE HMO IN THE NATION. That's right, number 1 in the nation. Not in the region or some small market nitch. I think there were 4-6 other Kaiser regions listed in the top 20. The Federal Gov. also has several ranking systems for Health Care organizations, we rated # 8 nationwide in the last one they published.

I have my own less than ideal experiences here, but I also had them at other hospitals. Like the time I broke my rotor cuff & collar bone and the nurse asked me to hold a 1 gallon bleach bottle full of sand with that arm so the could x-ray it.

Okay, off my soap box.

I'm not here to pump up business for my employer, but I really am proud of the strides they have made and the care they give. And when I hear the down side of Kaiser, I feel compelled to offer an alternative (biased) view.

I'll go back to sleep now

[kayakfisher]

Kaiser .... a very double bladed sword.

If you have something terrible, and it is quickly recognized as such they can be very good on the pocketbook...

On the other hand, if you have subtle signs of a terrible disease about to explode into a disaster...this system is a hard one to get good care early, and early diagnosis done without a hassle. The use of paramedical people to examine and treat people that should be seen by physicians is one of kaiser's weak points. They use nurse practioners and physicians assistants in a huge way in order to keep costs down. It is not uncommon for these hard working and hopefully caring people to not always understand the implications of a physical finding or a medical history that a patient brings in...ie a headache being seen over and over again by a less trained person who didn't recognize the presentation as a classic presentation of an intracranial aneurysm, or a young child's hoarseness as a classic presentation of epiglottitis. Anyone can recognize a disaster that has already exploded...but to recognize a disaster while it is still subtle is a very different task.

The system itself at kaiser is prehaps best at taking care of heatlthy people...ie preventative medicine of one thing they are very good at. This is largely due i think to their capturing a large amount of the working place market around here...and their making a conscious effort to keep their insured patients as healthy as possilbe. This approach could be emulated by the other insurances, hmo or not, and physicians, but unless the preventative care is very cheap, which it is at kaiser, patients(people) tend to not seek out that kind of care themselves...ie they are not willing to pay fee for service to get it.

Once you have a serious illness kaiser is sometimes less expensive...but if you loose your job that doesn't do you much good because the costs of the policy will skyrocket and you may not be able to get the same coverage for your private policy. In the end, if you have a 400,000 dollar illness almost any policy will do.

If you are a busy person it is very very hard to get care for the less serious things at kaiser, because the waiting lists are very long, and you may have to go back for several appointments to convince someone you need to see a specialist...and there may be several weeks between appointments. If you start the policy Jan 1st, effectively that means that your hernia operations cannot be done until you have a couple of physician assistant visits, who at first thinks you had a pulled muscle, puts you on motrin for three weeks, sees you back in a months, then tries celebrex for a while and tells you to loose weight, and suggests you join a gym, then after three months lets you get checked by the family practice doc, at your insistance, then you finally get to see a general surgeon who thinks you have a hernia. The surgery may then be scheduled about two months later. So did you get to have your surgery scheduled in your first two months of coverage...no maybe 6 months later, so essentially you did not receive elective medical care until about six months into the policy.

In non hmo system if you can't see a doc you can at least go call someone else's office and get in if you choose to do so.

Can these same problems occur in other systems...you bet they can. You can at least go somewhere else however if that happens without having to change your insurance.

To my understanding, Kaiser knows they have had unnecessary complications by what I think is over dependence on non physicians to deliver primary care...and they will not likely take the steps needed to reduce those complications because it is "not cost effective" to do that. When this kind of care delivery is not properly administered it can be used as a way to appear to be delivering care, when it is actually only being denied and delayed by smoke and mirrors. Kaiser is not the only system in which this can happen, but they have refined this effect on a large scale, in the same way that computers can magnify errors by their "efficiency".

Disclaimer....many of these primary care givers are very good, very caring, very hard working...but I am not convinced that not being very good, not being very caring providers are adequately supervised at all times.

I had kaiser insurance for a long time...and the frustration became a little too much.

I do think however, that everyone needs to be actively involved in their own health care...ask challenging questions of everyone taking care of you and your family...and always ask why, why, why...if they can't answer your questions thoroughly, keep the pressure on until you get the answers you deserve. No matter what system you are in there are good medical people there to take care of the problems that come up...but the systems of health delivery are being demolished by the administrators and insurance companies.

Be an informed consumer...and do your part by also taking care of yourself and you families by practicing a healthy lifestyle.


m.

[kayakfisher]

To be fair to Kaiser i feel that I must mention another problem with the local HMO medicare policy in Eugene that I have had recent experience with...

My father in law had gone in to his "caretaker" and I use that term very loosely, since he appears to view his role as primarily a gatekeeper, with complaints of weight loss, not being able to eat, and after about three weeks of this also not being able to keep it down, except very small amounts of food and liquids in small amounts. After multiple visits to the docs office he was effectively almost killed by neglect...he was starving to death for about 10 weeks, and he was only hospitalized due finally to our insistance that they get to the bottom of his problems and get some specialists involved. Nothing, absolutely nothing was done to support him while he couldn't take things in...nor was anything done to look into why he could not eat...even in the hospital they attempted to discharge his after getting him rehydrated...and I directed his son and wife down there to refuse to take him home until they diagnose the cause of his not being able to eat and they either solve it or show why it is not solvable.

They are now finding things that his primary caretaker should have known about but for some reason only the most superficial of tests were done...and his primary symptoms, not being able to take in food, were not addressed.

I am afraid that some docs in some hmos are affected way too much by the fact that they are not being paid to take care of sick people as much as they are being paid to shuffle them through the office. If a physician's assistant misses something due to a lack of knowledge that is one thing, but if a physician misses something because he just doesn't care that is in my opinion criminal!!

Beware of all HMOs boys and girls...and beware of any capitated health plans where people are paid to have you on the roles, and not paid to get you back to good health when you are ill.

[img]graemlins/berry.gif[/img]

[Thumper]

Originally posted by Radke:
Kaiser Permanente Northwest was rated the NUMBER ONE HMO IN THE NATION. That's right, number 1 in the nation. Not in the region or some small market nitch.

<font size="2" face="verdana,arial,helvetica">Yep. Most recent issue of Consumer Reports.

[Bait O' Eggs]

There are quite a few insurance agents on ifish, and most of them have let me know who they are

I have shopped around on the net and found several health insurance places and it seems pretty simple, down the side column I find the age, across the top column I find the deductible I want to pay and where the columns intersect I find the monthly payment. All of this without "getting" to listen to all the other insurance plans I should be signing up for.

Can some of the insurance agents on ifish tell me what service they are going to provide me that I cant do myself? If I understand it correctly, the insurance company pays the agent, assuming that is true, would the insurance company make more money if I signed up direct and didnt use an agent, so they had no commission to pay? If the insurance company doesnt pay the agent,I surely dont want to be paying an additional monthly amount to pay for the agent.

I know at work we all had to fill out a health survey for our group plan, and based on the survey the monthly payment was calculated. One of the employees had cancer and as you might guess, the premiums were priced up, up, up. I added my wife to our company plan 6 years ago, and have added my 2 kids on the plan as they have come along and paid for it out of my pocket with pretax dollars and the monthly payment last year was about $500 for my 35 yr old wife and kids (4 & 6). It is going up to over $700 for the wife and kids next year. The company is paying over $300 a month for me, that will bring health insurance for my family of 4 to over $1000 a month. I can find several plans online that I can insure my family for almost 1/2 of that and have about the same insurance.

I am going to let the company continue to pay for my insurance, but put the wife and kids on another plan and save some money. Our group plan at work is just an expensive plan.

My best friend works at Keiser as a MRI tech, and he loves the health care he gets. I am not sure I can get past my own deep rooted thoughts of Keiser based on hearsay to sign up for their plan. Kind of like buying a Dodge, it probably just isnt going to happen even though I have never owned one. :tongue:

After all that babbling, the original question was what does an insurance agent do, that I cant get off the internet on my own? I seriously dont know and would like to find out. I have about as much interest in contacting an insurance agent as I do of spending a day with a used car salesman. Purely based on past experiences. [img]graemlins/1zhelp.gif[/img]

[5-Cents]

BOE... thats like saying you can buy the materials you need to build your own jetsled so why should you pay someone to put it together!

There are easily over 20 different health plans offered in Oregon... all of them have their advantages and disadvantages and an agent can help you figure out what one is best for you based on how you want to use your coverage without costing you a dime.

Do you want a plan that will cover you outside the PDX metro area?

How about a plan where you can choose your own docs without penalites or Usual & Customary charges?

How about plans that cover alternative medicine?

Did you know some plans only pay for one surgery per hospital stay... what if you were in a trama situation that called for several surgeons... do you want to pay for it out of pocket?

Do you want a plan that will cover you outside of Oregon?

Do you want a plan that covers transplants without limitations or waiting periods?

If a better plan is introduced to the market the agent can inform you about it.

The questions can go on and on and an agent can be used as a resource to make sure your insurance works the way you want... WHEN YOU USE IT! Let me tell you its too late when you figure out you dont have coverage for "this or that" when you are lying flat on your back in a hospital bed!

Take a look at some of the other posts on this thread with people having to pay $1000's out of pocket... maybe if they would have used an qualified agent they would not have had those type of problems.

The service is free... take advantage of it!

[kayakfisher]

Since when is Consumer Reports the authority on how to get good medical care?

Sorry, but the picture is far more complicated than buying a car or a vacum cleaner. I truly wish it were that clear cut...but it is not.

m.