When checking my credit card activity online yesterday, I saw two identical charges from my doctor's office on two subsequent dates -- on neither of which was I actually SEEING my doctor. Four phone calls and much irk-ness later, it would appear that the credit card transactions for the co-pays at my doctor's office get processed in batches, and what I was seeing were in fact charges for two separate office visits in January and in May.
How in the frock is it helping the state of health care in this country when businesses are deliberately not collecting their money until six months after the fact? The mind absolutely boggles.
(Last rant of the week. I promise.)
Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts
Thursday, June 24, 2010
Wednesday, September 23, 2009
Problems That Still Need Solving
- My new progressive lenses are still killing me, 2.5 weeks later. How am I going to be able to see clearly again without wanting to claw my eyeballs out by 2pm each day?
- Neutrogena seems to have stopped making my very favorite lip product ever, and I am bitter. MoistureShine Tinted Lip Balm, I will miss you. Your MoistureShine Lip Sheers, Lipsticks, and Glosses are just not the same thing.
- Health insurance reform. Seriously. Our corporate renewals just came in with premium increases of twenty-frocking-percent. The company can't afford to absorb such a huge increase, so we will once again be shaving benefits to keep costs "contained", which really means we're passing yet more expense along to the employees (yours truly included) in the way of higher co-pays. Frack.
- How am I going to pick up 10 long folding tables from the local synagogue for our October 2 fundraising event? (Or, more precisely, how many long folding tables can I fit in my mother's Honda Civic hatchback at one time, and do I have enough bungee cords?)
- I am a 42-year-old woman and I still get pimples. Fa chrissakes.
- Polycystic Kidney Disease. We're up to $2600 raised so far this year, which is amazing, given the givens. Thank you all so much.
Thursday, August 14, 2008
Nonsensical
It's been a while since I've ranted about health insurance, and the truth is, no matter how hard one tries to quantify the real costs of healthcare in this country, the information just isn't as available and accessible as it could (or should) be. But I am not deterred!
Back in March, I estimated that premium and deductible costs for my family of four would be:
$10,744 (employers/estimated); $2,440 (us): total premiums $13,184
I have since updated this figure to:
$10,744 (employers/estimated); $2,530 (us): total premiums $13,274
We met our deductible a few months ago, and are therefore blessedly no longer paying out of pocket at full freight. God bless co-pays! I've been keeping very careful track of our expenditures, and right now the scorecard is:
Year-to-date retail costs: roughly $9,000*
Our out of pocket service costs: $3,500
Now, granted I'm tired and on prednisone, but doesn't it look as though the combined premium costs of $13,274 has only bought us a $5,500 reduction from the full retail costs? Roughly?
Health insurance what?
*It is nigh impossible to estimate true retail costs for various reasons, not the least of which being that they simply WON'T TELL YOU the true cost. Also, the health insurance company negotiates a discount for lots of services and meds. $9,000 represents a generous estimate of our full retail costs to date.
Back in March, I estimated that premium and deductible costs for my family of four would be:
$10,744 (employers/estimated); $2,440 (us): total premiums $13,184
I have since updated this figure to:
$10,744 (employers/estimated); $2,530 (us): total premiums $13,274
We met our deductible a few months ago, and are therefore blessedly no longer paying out of pocket at full freight. God bless co-pays! I've been keeping very careful track of our expenditures, and right now the scorecard is:
Year-to-date retail costs: roughly $9,000*
Our out of pocket service costs: $3,500
Now, granted I'm tired and on prednisone, but doesn't it look as though the combined premium costs of $13,274 has only bought us a $5,500 reduction from the full retail costs? Roughly?
Health insurance what?
*It is nigh impossible to estimate true retail costs for various reasons, not the least of which being that they simply WON'T TELL YOU the true cost. Also, the health insurance company negotiates a discount for lots of services and meds. $9,000 represents a generous estimate of our full retail costs to date.
Wednesday, March 26, 2008
My Health Insurance, Let Me Show You It
I've been meaning to post about health insurance for some time now. You may remember my frustration back in the fall, as I (a Finance & HR professional, fer chrissakes!) tried to suss out exactly what Michael's employers were offering us for 2008, and how much it was going to cost us, and how I failed miserably. Would it surprise you that it's taken me three months of living with this fakakta plan to understand what it actually does? And, would it surprise you that I'm keeping verrrrrrrrrrrry detailed records of all of the expenses and reimbursements and deductibles and nonsense?
Would it surprise you that I'm eager to share all of this crapola with the pretty internets?
Here's the dope: my employer covers my health insurance in full at company expense, and if I add any dependents, I pay their entire freight. Michael's Big Corporate Employer offers an array of plans from which to choose, with varying levels of employee premium responsibility. His company pays a portion of the premiums for dependents, so we have always enrolled the kids in his company's plan. Used to be they'd offer at least one straight-up, no-deductible HMO amongst the menu. No longer. Afterbeating our heads against the dining room table repeatedly careful consideration, we chose an Aetna plan which includes a $2,000 deductible, wherein Michael's employer funds a Healthcare Reimbursement Account (HRA) on our behalf up to $1,000. In other words, our net deductible (for Michael and the kids) will be $1,000. I have a straight-up PPO plan through my lovely employer, so I'm only on the hook for (hefty) co-pays. (I choose the group insurance for our staff, so I have only myself to blame.)
So what's this all costing? I don't have a firm figure for what Michael's employer is paying for him and the kids, but given my knowledge of the benefits market, I think $600/month is a good guess. Plus, of course, his employer is paying $1,000 into our HRA. We pay an additional $120/month (pre-tax, through payroll deductions). My employer pays $212 for my PPO from Health Assurance.
TOTAL ANNUAL PREMIUM & DEDUCTIBLE COSTS:
$10,744 (employers/estimated); $2,440 (us)
So far, in our little dual-career, upper-middle-class family of professionals, we're paying 18.5% of our family's health insurance costs for the year.
But the fun's just starting....
Until we reach our $2,000 deductible for Michael and the kids, we are paying full retail out-of-pocket for everything. Doctor's visit? $133. Asthma meds for 3 months (for ONE of the four asthmatics in the house)? $500. We have already chewed up the entire $1,000 HRA and are plunging head-first into the second $1,000 of the deductible. And it's only March.
But here's the tricky part. After we reach the top of the second $1,000 of the deductible, we stop paying full retail and start paying co-pays. I figure we'll reach this point around June at the rate we're going. And the truly flummoxing issue is that, in addition to the HRA, we have a Flexible Spending Account (FSA) with Michael's Big Corporate Employer, which allows us to designate an amount of money to be withheld from Michael's check each month (tax-free, of course), to be used for reimbursement of medical, prescription, OTC medical expenses for the whole family.
If you think I lost sleep trying to decide how high to fund the FSA, you'd be right.
We finally just stuck a pin in it and funded it at $3,500 -- higher than in past years, due to the $1,000 of deductible weare going to have incurred. The FSA is use-it-or-lose-it, so if we have any kind of balance left at year-end, on quiet nights you will be able to hear me weeping softly into my tequila. But honestly, I think we're pretty safe at $3,500, as the drug co-pays on Michael and kids are outlandish.
So what I think I'll do is post periodic updates. You'll hear about it when we top out the deductible, and you'll hear about how much money we're paying in co-pays. So far we're out of pocket a whopping $1,500 (including the $1,000 that gets reimbursed) for the year (including dental and vision). I'll be VERY curious to analyze our year-end numbers, comparing premium + out of pocket expenses against full retail costs for all of the services we use, but I'm not sure I'll have access to enough info to do that. I suspect that I'd find that the insurance company is making money on us.
The bottom line is: if it takes a reasonably smart Ivy-League graduate who does benefits as a (part of her) profession this much time, effort and angst to really understand this brave new insurance world, what hope is there for the not-as-educated, not-as-motivated among us? I fear that the insurance companies secretly hope that we're all going to become so annoyed and frustrated by them that we're going to stop paying attention to what our benefits are -- and then they'll really have us by the short and curlies.
Do you know how much you are paying of your health insurance burden?
Would it surprise you that I'm eager to share all of this crapola with the pretty internets?
Here's the dope: my employer covers my health insurance in full at company expense, and if I add any dependents, I pay their entire freight. Michael's Big Corporate Employer offers an array of plans from which to choose, with varying levels of employee premium responsibility. His company pays a portion of the premiums for dependents, so we have always enrolled the kids in his company's plan. Used to be they'd offer at least one straight-up, no-deductible HMO amongst the menu. No longer. After
So what's this all costing? I don't have a firm figure for what Michael's employer is paying for him and the kids, but given my knowledge of the benefits market, I think $600/month is a good guess. Plus, of course, his employer is paying $1,000 into our HRA. We pay an additional $120/month (pre-tax, through payroll deductions). My employer pays $212 for my PPO from Health Assurance.
TOTAL ANNUAL PREMIUM & DEDUCTIBLE COSTS:
$10,744 (employers/estimated); $2,440 (us)
So far, in our little dual-career, upper-middle-class family of professionals, we're paying 18.5% of our family's health insurance costs for the year.
But the fun's just starting....
Until we reach our $2,000 deductible for Michael and the kids, we are paying full retail out-of-pocket for everything. Doctor's visit? $133. Asthma meds for 3 months (for ONE of the four asthmatics in the house)? $500. We have already chewed up the entire $1,000 HRA and are plunging head-first into the second $1,000 of the deductible. And it's only March.
But here's the tricky part. After we reach the top of the second $1,000 of the deductible, we stop paying full retail and start paying co-pays. I figure we'll reach this point around June at the rate we're going. And the truly flummoxing issue is that, in addition to the HRA, we have a Flexible Spending Account (FSA) with Michael's Big Corporate Employer, which allows us to designate an amount of money to be withheld from Michael's check each month (tax-free, of course), to be used for reimbursement of medical, prescription, OTC medical expenses for the whole family.
If you think I lost sleep trying to decide how high to fund the FSA, you'd be right.
We finally just stuck a pin in it and funded it at $3,500 -- higher than in past years, due to the $1,000 of deductible we
So what I think I'll do is post periodic updates. You'll hear about it when we top out the deductible, and you'll hear about how much money we're paying in co-pays. So far we're out of pocket a whopping $1,500 (including the $1,000 that gets reimbursed) for the year (including dental and vision). I'll be VERY curious to analyze our year-end numbers, comparing premium + out of pocket expenses against full retail costs for all of the services we use, but I'm not sure I'll have access to enough info to do that. I suspect that I'd find that the insurance company is making money on us.
The bottom line is: if it takes a reasonably smart Ivy-League graduate who does benefits as a (part of her) profession this much time, effort and angst to really understand this brave new insurance world, what hope is there for the not-as-educated, not-as-motivated among us? I fear that the insurance companies secretly hope that we're all going to become so annoyed and frustrated by them that we're going to stop paying attention to what our benefits are -- and then they'll really have us by the short and curlies.
Do you know how much you are paying of your health insurance burden?
Wednesday, February 27, 2008
Did I Mention
that Quinlan needs braces? Like, yesterday? Not only braces, but first an appliance to widen his upper bite, followed by a trip to the oral surgeon who will cut a flap in the roof his mouth and attach a wire to the lost incisor that is coming in sideways and behind all of the other teeth, which the orthodontist will then spend several months dragging down into place by said wire, like an ornery salmon on a fisherman's line? After which, upper braces will be applied, and then lower braces?
And did I mention that Quin has sensory issues, and this is likely to be torturous, and also take 3 years to complete?
And did I mention that it's going to cost $6,000 uninsured dollars?
...I didn't?
Hold me.
And did I mention that Quin has sensory issues, and this is likely to be torturous, and also take 3 years to complete?
And did I mention that it's going to cost $6,000 uninsured dollars?
...I didn't?
Hold me.
Tuesday, November 27, 2007
Buckle Up.
Have I bitched to y'all yet about group health insurance?...
Though my job is primarily finance-related, human resources and employee benefits fall under my responsibility as well. Our core full time staff number around 30, and are spread between three locations (Pennsylvania, Florida and Texas). Until a few years ago, Aetna provided decent HMO/PPO coverage in all three locations under one plan, and life was hunky-dory.
Then, about three years ago, Aetna decided that they were no longer going to provide no-deductible coverage in Florida. But at renewal time, did they write me a letter that said "Hey, dude, here are your new rates and we're no longer going to provide no-deductible coverage in Florida! Instead, we're going to substitute a horrible, minimal-coverage, high-deductible plan and charge you three times what you're paying now for it! Have a nice day!"?
No, that would be too simple, wouldn't it?
Instead, they took our renewal (at a 20% rate increase, I might add), and when one of our Florida employees tried to use the insurance for an MRI a few weeks later, they pointed at her and laughed until their bellies ached and then charged her $3,000 for the exam, which would have been covered in full just a few weeks earlier.
Who do you think got to calm that employee down, investigate what happened, try and fail to straighten out the mess, bang her head against her desk, write a $3,000 company check to the hospital for the employee's MRI, and quickly try to find a carrier that would cover all three geographies that we do business in very very very quickly so as to forestall any further such outrages?
When the dust cleared, I had found a new carrier who would provide decent coverage to all three areas -- United HealthCare -- and I quickly converted all of the employees over at a very reasonable rate. The network was a little flimsy and their enrollment department was seriously understaffed, but after about 8 short months we finally had all of the enrollment bugs worked out.
I kid. It took about 10 months.
But the coverage was good and their provider network was growing by leaps and bounds, and I breathed a sigh of relief and wiped the blood off my desk and got back to my real job.
Then renewal time came, and the renewal rates were 50% higher than the initial rates.
Inconceivable!
I started searching for new carriers that would cover all three of our corporate branches. Aetna was still snubbing Florida and the Blues wanted even more money than United HealthCare. I was almost resigned to eating the increase when my boss happened to read an article in some weekly business magazine about the fastest growing insurance companies, one of which was headquartered in western Pennsylvania. A little leg work, and we've got Health Assurance ready and willing to provide decent coverage at a reasonable rate to -- wait for it -- our PENNSYLVANIA EMPLOYEES ONLY. They do not have networks in Florida or Texas, but were more than happy to cover the 18 or so people with Pennsylvania addresses.
So we did it. We bifurcated the company down geographical lines, and with guilt in my heart, I made sure that the plan we selected with Health Assurance mirrored the United HealthCare coverage as closely as humanly possible. Enrollment with Health Assurance went more smoothly than it had any right to, and I breathed another sigh of relief and went back to my real job for another 10-11 months.
Now, you don't have to hit me over the head more than four or five times before I realize that this is an issue that is not going to go away. So this year, I got a little smart. I called our broker a good two months before renewal and and started hounding him to get our renewal rates early early early so that we'd have time to react and find new options if we needed to.
The hounding was only marginally productive, but I had the renewal rates about 45 days before the effective dates, which was better than last year. Health Assurance -- looooooooove. Less than a 10% increase. Got to love them. But! Still no networks in Florida or Texas. Oh well, can't win 'em all -- let's see what United HealthCare has to say.
Would you believe a 50%+ increase? Oh yes. Because god forbid an insurance company should ACTUALLY PROVIDE INSURANCE rather than make a disgusting amount of profit from the premiums!
After I finished with the smelling salts I called the broker and said "Find me a different solution." Yada yada -- the Blues are still even more expensive, yada yada -- what about Aetna? They have a new program in Texas; looks pretty good. Let's ask about Florida. Yeah, I know, we got burned in Florida before, but let's ask. Holy hell -- they say if the primary group location is in Texas, they will cover the employees in Florida! Fantastic! The rates are exceedingly reasonable, sign us up, get me the applications, all systems go. We were now down to about 2-3 weeks before Renewal Date and scrambling to get everything in quickly so that I could get a group number for my peeps to start using the coverage on November 1.
(I'm leaving out the part where we did something a little tricky so that Aetna would cover our Florida and Texas employees but not mind NOT covering the Pennsylvania employees. Shhh! If you really want to know, email me.)
(I'm also leaving out the part where we decided to pay the HUGE November premiums to United HealthCare when I realized that there was no earthly way I was going to have an Aetna group number for my peeps in any kind of reasonable timeframe.)
(I'm also leaving out the part where, around a week ago, we learned that the coverage to the Florida employees was NOT IN FACT THE SAME as the coverage for the Texas employees. The only coverage Aetna could provide the Florida employees was -- wait for it -- a PPO with a DEDUCTIBLE! Not a huge honkin' deductible, but a deductible nonetheless. After yelling and screaming at the broker for not catching this earlier, I luckily thought to ask whether the PREMIUMS were going to be the same for Florida and for Texas. Oops! Nope! Silly girl! The Florida premium was going to be MUCH MUCH more than the Texas premium -- in fact, it was going to be juuuuuuust about the same at the renewal premium quoted by United HealthCare! Lollipops for everyone!)
We scrambled and frantically filled out paperwork and submitted everything to the broker (who submitted it to Aetna) around mid-November. The story should end right here with sweetness and light and rainbows and fuzzy puppies and new insurance cards for everyone. Hooray!
Who thinks that that's how the story actually does end?...
Sorry, that was a nasty trick question BECAUSE THE STORY HASN'T ACTUALLY ENDED YET. Guess what happened yesterday. Go on, guess!
Those of you who guessed that Aetna called the broker and told him that the reasonable rate that was quoted for Texas was NOT ACTUALLY the rate they were going to offer after all are RIGHT and get a gold star. If you guessed that Aetna told the broker that, after reviewing the applications, they would be in fact charging us 50% more than they initially quoted, you get a BIG FAT SHINY GOLD STAR and a shot of tequila.
You get no gold stars or tequila if you guess that I used very loud, unladylike language on the phone with the broker yesterday morning, for that is about the only development that was perfectly reasonable and foreseeable in this whole sorry mess.
Yes, I should fire the broker, who has not been watching my back the way he should. Yes, Aetna pulled a (legal, unfortunately) bait and switch and I do not want to send them a goddamned penny of our hard-earned money. Yes, I should start all over, after I finish weeping and rending my tunic.
But I'm really and truly out of options, I have less than a week before December 1, and I have employees who need medications and doctor visits and x-rays and lab work.
If you need me, I'll be over in the corner banging my head against the bricks. Send chocolate, and next November, for the love of all that's holy and for the sake of what remains of my sanity, vote and vote wisely.
Though my job is primarily finance-related, human resources and employee benefits fall under my responsibility as well. Our core full time staff number around 30, and are spread between three locations (Pennsylvania, Florida and Texas). Until a few years ago, Aetna provided decent HMO/PPO coverage in all three locations under one plan, and life was hunky-dory.
Then, about three years ago, Aetna decided that they were no longer going to provide no-deductible coverage in Florida. But at renewal time, did they write me a letter that said "Hey, dude, here are your new rates and we're no longer going to provide no-deductible coverage in Florida! Instead, we're going to substitute a horrible, minimal-coverage, high-deductible plan and charge you three times what you're paying now for it! Have a nice day!"?
No, that would be too simple, wouldn't it?
Instead, they took our renewal (at a 20% rate increase, I might add), and when one of our Florida employees tried to use the insurance for an MRI a few weeks later, they pointed at her and laughed until their bellies ached and then charged her $3,000 for the exam, which would have been covered in full just a few weeks earlier.
Who do you think got to calm that employee down, investigate what happened, try and fail to straighten out the mess, bang her head against her desk, write a $3,000 company check to the hospital for the employee's MRI, and quickly try to find a carrier that would cover all three geographies that we do business in very very very quickly so as to forestall any further such outrages?
When the dust cleared, I had found a new carrier who would provide decent coverage to all three areas -- United HealthCare -- and I quickly converted all of the employees over at a very reasonable rate. The network was a little flimsy and their enrollment department was seriously understaffed, but after about 8 short months we finally had all of the enrollment bugs worked out.
I kid. It took about 10 months.
But the coverage was good and their provider network was growing by leaps and bounds, and I breathed a sigh of relief and wiped the blood off my desk and got back to my real job.
Then renewal time came, and the renewal rates were 50% higher than the initial rates.
Inconceivable!
I started searching for new carriers that would cover all three of our corporate branches. Aetna was still snubbing Florida and the Blues wanted even more money than United HealthCare. I was almost resigned to eating the increase when my boss happened to read an article in some weekly business magazine about the fastest growing insurance companies, one of which was headquartered in western Pennsylvania. A little leg work, and we've got Health Assurance ready and willing to provide decent coverage at a reasonable rate to -- wait for it -- our PENNSYLVANIA EMPLOYEES ONLY. They do not have networks in Florida or Texas, but were more than happy to cover the 18 or so people with Pennsylvania addresses.
So we did it. We bifurcated the company down geographical lines, and with guilt in my heart, I made sure that the plan we selected with Health Assurance mirrored the United HealthCare coverage as closely as humanly possible. Enrollment with Health Assurance went more smoothly than it had any right to, and I breathed another sigh of relief and went back to my real job for another 10-11 months.
Now, you don't have to hit me over the head more than four or five times before I realize that this is an issue that is not going to go away. So this year, I got a little smart. I called our broker a good two months before renewal and and started hounding him to get our renewal rates early early early so that we'd have time to react and find new options if we needed to.
The hounding was only marginally productive, but I had the renewal rates about 45 days before the effective dates, which was better than last year. Health Assurance -- looooooooove. Less than a 10% increase. Got to love them. But! Still no networks in Florida or Texas. Oh well, can't win 'em all -- let's see what United HealthCare has to say.
Would you believe a 50%+ increase? Oh yes. Because god forbid an insurance company should ACTUALLY PROVIDE INSURANCE rather than make a disgusting amount of profit from the premiums!
After I finished with the smelling salts I called the broker and said "Find me a different solution." Yada yada -- the Blues are still even more expensive, yada yada -- what about Aetna? They have a new program in Texas; looks pretty good. Let's ask about Florida. Yeah, I know, we got burned in Florida before, but let's ask. Holy hell -- they say if the primary group location is in Texas, they will cover the employees in Florida! Fantastic! The rates are exceedingly reasonable, sign us up, get me the applications, all systems go. We were now down to about 2-3 weeks before Renewal Date and scrambling to get everything in quickly so that I could get a group number for my peeps to start using the coverage on November 1.
(I'm leaving out the part where we did something a little tricky so that Aetna would cover our Florida and Texas employees but not mind NOT covering the Pennsylvania employees. Shhh! If you really want to know, email me.)
(I'm also leaving out the part where we decided to pay the HUGE November premiums to United HealthCare when I realized that there was no earthly way I was going to have an Aetna group number for my peeps in any kind of reasonable timeframe.)
(I'm also leaving out the part where, around a week ago, we learned that the coverage to the Florida employees was NOT IN FACT THE SAME as the coverage for the Texas employees. The only coverage Aetna could provide the Florida employees was -- wait for it -- a PPO with a DEDUCTIBLE! Not a huge honkin' deductible, but a deductible nonetheless. After yelling and screaming at the broker for not catching this earlier, I luckily thought to ask whether the PREMIUMS were going to be the same for Florida and for Texas. Oops! Nope! Silly girl! The Florida premium was going to be MUCH MUCH more than the Texas premium -- in fact, it was going to be juuuuuuust about the same at the renewal premium quoted by United HealthCare! Lollipops for everyone!)
We scrambled and frantically filled out paperwork and submitted everything to the broker (who submitted it to Aetna) around mid-November. The story should end right here with sweetness and light and rainbows and fuzzy puppies and new insurance cards for everyone. Hooray!
Who thinks that that's how the story actually does end?...
Sorry, that was a nasty trick question BECAUSE THE STORY HASN'T ACTUALLY ENDED YET. Guess what happened yesterday. Go on, guess!
Those of you who guessed that Aetna called the broker and told him that the reasonable rate that was quoted for Texas was NOT ACTUALLY the rate they were going to offer after all are RIGHT and get a gold star. If you guessed that Aetna told the broker that, after reviewing the applications, they would be in fact charging us 50% more than they initially quoted, you get a BIG FAT SHINY GOLD STAR and a shot of tequila.
You get no gold stars or tequila if you guess that I used very loud, unladylike language on the phone with the broker yesterday morning, for that is about the only development that was perfectly reasonable and foreseeable in this whole sorry mess.
Yes, I should fire the broker, who has not been watching my back the way he should. Yes, Aetna pulled a (legal, unfortunately) bait and switch and I do not want to send them a goddamned penny of our hard-earned money. Yes, I should start all over, after I finish weeping and rending my tunic.
But I'm really and truly out of options, I have less than a week before December 1, and I have employees who need medications and doctor visits and x-rays and lab work.
If you need me, I'll be over in the corner banging my head against the bricks. Send chocolate, and next November, for the love of all that's holy and for the sake of what remains of my sanity, vote and vote wisely.
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