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Insurance vent

Discussion in 'Parents of Children with Type 1' started by jbmom1b2g, Dec 6, 2011.

  1. jbmom1b2g

    jbmom1b2g Approved members

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    We did the High deductible plan this yr (2011) and was able to put in money in the HSA and my DH work also included 1k but that didnt even touch what we had to pay out of pocket when DD was dx with diabetes this yr.
     
  2. MommaKat

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    They're also not necessarily a benefit to people with chronic medical conditions or those who make low salary (and I don't just mean minimum wage). When your deductible is $10K and that's nearly half your annual income before taxes, chances are you can't afford to care for yourself even with a cheaper HSA type plan.
     
  3. Lisa P.

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    Yes, I think so.
     
  4. MommaKat

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    Guess I'm letting my true colors shine through here, but I totally agree with Michael Moore on this one. From an open letter he published today,

    So many corporations hire individuals between half and full time to avoid paying benefits (Wal-Mart, Target), public service employees often receive some of the costliest insurance plans with extremely limited choice (nursing, teaching, law enforcement, firefighters, etc.) I think it's time that our public officials had to live in the 'real world' of what we face daily. (Yes, speaking from a U.S. perspective here...)

    As for the OP, if you do not want to switch, ask your endo's insurance person to write a letter of medical necessity. I sat down with one of the gals at BDC and we got things covered that the endo didn't think was possible. I kept telling her that it seems impossible because the companies rely on it's customers not having the proper knowledge base to fight a decision. When you do, or research until you possess that knowledge, you can fight them and win - but it has to be worth the time to do so. For me it often is.
     
  5. Lisa P.

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    I sympathize with the idea. But I can remember when they said the same thing about means testing for Medicare, never going to happen, now it's just accepted as normal. When there's no money, either costs will go up or benefits down or both. They may just do it administratively so no politician takes the hit. :(

    As for getting worse, it's gotten worse for us and I think for many others in the past two years, so I believe it can get much, much worse. But maybe I'm just seeing that because I expected to see it, I'm biased. I don't think three years ago insurance companies were telling people which insulin to use, and supply companies limiting pump supplies strictly. But maybe I just didn't see it.

    I'm inclined to think this is out of the frying pan into the fire, but even if it's the other way around I sure dream about fixing the system in a way that we don't have to sit in the pan, either. :p But that's unlikely to happen, because no major parties or politicians seem to be advocating anything other than big insurance or big government solutions. :(
     
  6. Lisa P.

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    HSA doesn't help us because we don't pay federal income taxes at our income level so the tax break means nothing to us. But I'm happy it can help a lot of middle class folks, and with HSA more people see what they are paying and are more likely to call up the office and say "WTH?!" and that helps with costs, a bit, for me too.
     
  7. Lisa P.

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    It's o.k., when you say the MM word I just put my fingers in my ears and go Lalalala so I can love ya anyway.:p Unfortunately, my true colors are permanently tattooed on my forehead.

    So, nurses shouldn't make any money from nursing? Isn't that profiting from the sick? :p

    I firmly believe the problem is not that Walmart doesn't provide benefits (they do, some, by the way) -- it's that everybody else does. :D I don't want to rely on Walmart to get health care to people any more than I want the federal government to!

    My husband's job doesn't provide insurance. If it tried to, it would have to shut its doors. I guess if my only choices are a job with no benefits or no job with no benefits. . . .but I do wish a reformed system would disengage health care from employment entirely.
     
  8. Lisa P.

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    The problem with HSA, I feel, through work, is that the benefits of the lower premiums go largely to the company while the risks of higher out of pocket go to the family. If companies gave the $15,000 a year that they'd pay for a family's insurance straight to the employee on top of his regular salary, then he could choose a high deductible or not, that would work better. Even then, any one year with catastrophic costs is going to tip the scales the wrong way for the family, the hope would be that over an average of several years the costs would be much, much lower.

    We don't have Selah on a high deductible plan, but it's not about a hospitalization, it's about the ongoing costs. I can't figure a way to make test strips (which we'd have to pay retail for and insurance doesn't) not break the bank.
     
  9. KatieSue

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    Right HSA doesn't work for someone with a chronic condition or a lower income status. But the idea is that you build up the account when you're younger and presumably healthier, so that if something larger were to happen - you'd have the money in your account to cover up to the full amount of the deductible. It's not a perfect solution but I think it's a step in the right direction. If you're having to pay the full rate for the visit or the prescription you might think a little more about your choices. And that includes going to Urgent Care or and ER for things that could probably wait as well.
     
  10. MommaKat

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    And this is why I love talking with you on the forum. :D

    I don't see nurses, docs making a profit from someone being sick so much as being paid to provide a service, whereas health insurance companies, much like WallStreet, makes bets / investments / decisions that allow them to get richer the worse off their customer. That's making a profit off someone just because they're sick.

    My real life experience last year when I could not afford the insurance premium through work went like this. Company X said they'd cover both kids starting on 2/1/11. My son had a head injury in Sept, which I'd disclosed, and they said his insurance premium would be $152/mo through this HMO. A month later I received notice that with the head injury they wanted $698 / mo just for him. Niko was the same $152 / month indiv coverage, both had $1000 deductible with a $20 copay preventative services, 20% co insurance for everything else. After her appendectomy (caused by a tumor) last Dec and then diagnosis in Feb, they decided they would rewrite her premium to over $1000/ month. Going from $254 / month to cover two kids on a fair (not great) HMO plan to nearly $1800/ month because of that combination of life altering illness and injury should, IMO, not be legal. It definitely constitutes making a profit off someone who's sick, or at the very least, penalizing them for it. I'm grateful we have what we have right now, but very fearful of the future.
     
  11. Lisa P.

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    I love it, too! I'm an old 'cuss. . .

    Yes, this is what we are seeing, but here's my POV on it. Before the new law, Selah couldn't get private insurance, but she could get on Cover Colorado. So, we have $260 a month premiums for her and a ton of out of pocket. Not fun. But now that kids have to be allowed on policies even with pre-existing, but they can charge more, Cover Colorado is going away. So we have that option taken away. In theory, it's great that we can put her on a private policy now. But they can charge a lot more because of her diabetes (I just found out) so at some point it won't matter what's "allowed" if we can't pay for it. :( So great intentions aside, for our family federal involvement has made things worse. I am happy to say someone is helping us out and it might be still affordable to go private, if not we'll have to go on state aid altogether for the kids and hope we don't get hit with earning enough that we don't qualify at the same time two more get diagnosed with something and we can't qualify for public or afford private!

    I make things up out of fear, but you see where I'm coming from. It's not that I don't think our system could get better. It's that I think it isn't getting better this way, and I think the problems we're seeing with insurance cutting insulins and supplies are a direct consequence of the intended reforms, or at least a consequence of the insurance companies bucking against them!
     
  12. saxmaniac

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    Some do. Our family has quite a few chronic conditions - diabetes of course, but also rheumatoid arthritis, asthma, depression, all while require ongoing medication. With our current HSA+deductible, we blow through the deductible in about a month. This means we have a pretty predictable yearly cost, since we know it always will max out. Any tax benefits are really secondary to that.

    It's not profiting from the sick. People of course can and should earn money working for a non-profit, but those folks aren't profits, they are an expense. The difference is the investors sitting on the top getting the *real* profits.
     
  13. Lisa P.

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    I was definitely being disingenuous on the "profit" thing, certainly MK meant it in the terms of corporate profit from risk to capital, not individual earnings (which would be profit in a general sense). I do recognize there is a difference.
    I don't agree on the premise that risk to capital should not bring in reasonable gain if it's linked to an important staple product folks can't live without (hope I'm paraphrasing that properly) and I think the profiting investors are the guys with 401Ks in stocks (which is many of us), but I do realize the health care working earning a wage in exchange for a service is qualitatively different from a holder of capital earning money off risking it by letting others use it, and other forms of corporate and capitalistic profit.
    :cwds:
     
  14. jbmom1b2g

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    But for some people us blowing through the deductible in 1-3 months would kill finacially. While we dont have a huge deductible 3K I just dont have that much money sitting around. Especially at the begining of the yr.
     
  15. mmgirls

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    HOW about an FSA, this has so helped us this year.

    Last year we elected to put $1200 into the fsa, now January comes and we can used that FSA card right away and spend more than we have put in todate. So I could have spend the whole $1200 on January 1st, that more than covered my D kids deducatable which for most is the hardest to deal with.

    This year we chose to do $1500 but really probably should have done $1700.
     
  16. saxmaniac

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    We used FSAs for many years before finally moving over to a high-deductible plan. They are great, and never once have I lost money under the "use it or lose it" clauses. Expenses always go up!

    FSAs are a good choice, since you can overspend them - that means on day 1, you can spend the entire amount, and then contribute it back slowly over the year. You're getting an interest-free loan.

    However, FSAs cannot be used with high-deductible plans in this manner. Only HSAs, and those you can't spend ahead.
     
  17. jbmom1b2g

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    We are doing the fsa account but my DH only wants to spend what we put in it each month. We know you get it in a lump sum but he is hoping/trying to get a new job in Utah so we can be closer to everything. IE: family and dr's.
     

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