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O/T Health Insurance??

2K views 35 replies 22 participants last post by  BenR 
#1 ·
Well, the time has come. After living off of COBRA from my last employer and still being unemployed for over a year now, my health insurance is ending at the end of this month.

Anyone else in this shitty situation? I started "shopping" for private insurance and it is quite confusing.

Can anyone offer advice or providers that are worthy here in CO?

Thanks.
 
#2 ·
I highly reccomend kaiser or sharp. Blue shield and the like are CRAP in my experience. Go somewhere that provides the doctors, insurance and billing dept in one place. To try to make my story short, blue shield said go to this doctor for surgery he is approved in our network....but when my "approved doctor" did my surgery NEXT DOOR to his office at the surgery center who apparently wasnt approved in network, they sent me a nice bill for $10,500. I HATE BLUE SHIELD. :)
 
#3 ·
Do you go to the doctor a lot?

If not i would look for a type of accident insurance. I had this policy and blew my knee out. I had to pay 20% of medical bills and they picked up the other 80%. Once i i hit the $2500 mark they paid for everything else.

Still sucked that i had to come up with the $2500 but it sure was better than being on the hook for $40k plus worth of medical bills

jcos said:
Well, the time has come. After living off of COBRA from my last employer and still being unemployed for over a year now, my health insurance is ending at the end of this month.

Anyone else in this shitty situation? I started "shopping" for private insurance and it is quite confusing.

Can anyone offer advice or providers that are worthy here in CO?

Thanks.
 
#4 ·
cbrock450 said:
Do you go to the doctor a lot?

If not i would look for a type of accident insurance. I had this policy and blew my knee out. I had to pay 20% of medical bills and they picked up the other 80%. Once i i hit the $2500 mark they paid for everything else.

Still sucked that i had to come up with the $2500 but it sure was better than being on the hook for $40k plus worth of medical bills
That's pretty ideal if you're healthy, I'd rather keep that $2,500 sitting in my savings account than dole it out every month for a level of coverage I don't need. I get my health insurance through my employer and I don't have any options other than the same coverage that is offered to every employee, but the level of coverage that "we" pay for is a total and complete waste for me.
 
#5 ·
onemission said:
I highly recommend kaiser or sharp. Blue shield and the like are CRAP in my experience. Go somewhere that provides the doctors, insurance and billing dept in one place. To try to make my story short, blue shield said go to this doctor for surgery he is approved in our network....but when my "approved doctor" did my surgery NEXT DOOR to his office at the surgery center who apparently wasnt approved in network, they sent me a nice bill for $10,500. I HATE BLUE SHIELD. :)
I had the exact same experience with my insurance. My doctor was in network, but the surgery facility HE owned was not. It ended up costing me an extra $5000, and that was after some heavy negotiating and pleading. You have to ask the right questions. Of course, when you are facing surgery, the right questions don't come to mind immediately. Listen up people: if you are facing surgery, and your surgeon wants you to have it done at a private facility (which BTW, might be physically attached to a hospital!), you MUST ASK YOUR INSURANCE if the FACILITY is in network, not just the doctor. You must also verify that the anesthesiologist in in network, and also any doctors or PAs that might be involved. I got trapped with another gotcha when the doctor who fixed my son's shoulder had an assistant in the operating room. My insurance company refused to pay the bill for the assistant, saying the doctor didn't need one. WTF?

I don't have Kaiser, but surprisingly enough, they seem to have pretty good orthopedic surgeons. I know several people who have had knees, shoulders and backs done with Kaiser with good results.
 
#6 ·
This is an interesting and important topic - especially for Mt. bikers. I have had an individual plan through Anthem BC/BS for the last year+. I have been unemployed since the middle of June. I bought this plan in June of 09 based on affordability, a limited # of Dr's visits with co-pay and a $100 co-pay for ER visits. I felt the latter was very important, especially during DH season. the best plan that was offered by my former employer was a high deductible HSA and it was actually more per month than the individual plan. Having said that, an individual plan is based on age, pre-existing conditions, etc - so this may not be an option for everyone. I do know that as the gentleman stated above, I would be subject to 20% of the cost of surgery or specialized care up to my deductible, which is $3000.

So far it has been good, a sinus infection and away I go after a $30 co-pay. I can live with that. However, 3 weeks ago I had a nasty crash at keystone and the end of my handlebar stopped me dead in my groin. I had to go to the Frisco ER and have several tests and ultimately 20 stitches to sew up a deep laceration in my groin. I missed my femural artery by about 2cm. I was told by the ER Dr as well as my physician in Golden that I am very very lucky.

In summation, I have checked with Anthem and according to the contract, everything in the ER should be covered by the $100 co-pay. I certainly hope this is the case as I continue to pay premiums on the policy and for this very reason. I'll report back when I have more closure(ie a bill) - hopefully it will be good news.
 
#7 ·
I should say there isnt anything wrong with blue shield and the like if you do lots of research and do not rely on what the person on the phone tells you...get EVERYTHING in writing - and if you can decipher thier 5000 page lawyer written books they provide, more power to ya. I simply dont want to have to deal with all that anymore, way too confusing/frustrating for me to be dealing with that while worrying about medical issues at the same time. I pay more monthly for kaiser but I am much happier now with the service I recieve.
 
#8 ·
I've been purchasing my own health insurance for 20 years and have seen it all. I've been with Kaiser for 4 years now. I have been really impressed with the organization and the care they provide. If you do not have any major health issues, look into an "individual" insurance policy as opposed to "group". It will be much less expensive. I purchase an individual policy for my 22 year old son through Rocky Mtn. Health Plans... $2500 ded., $30 co-pay, 80/20 coverage, PPO policy and it runs around $80 a month.

If you have specific Docs you want to continue to use, find out what insurance providers they accept. That may limit your choices.

The easiest thing to do is find an independent insurance agent that sells health care insurance and have them quote you on several providers. They can also show you what the effect of higher deductibles will have on your monthly premium. Since I'm fairly healthy and don't go to the Doc very often, I prefer a plan with a higher deductible and lower premium. Avoid contacting a sales person that works directly for the insurance carrier. I wouldn't trust them.

BTW, it can take up to 60 days to be approved for new coverage so don't waste any time.
 
#9 ·
anthem/toniq or kaiser.

I have the toniq plan and I broke my back earlier this summer and I'm only into it about $1400(ER visit, doc visits, MRIs). I decided to pay out of pocket for the last MRI and I saved 50% because boulder comm hospital has a 'half off for cash' program. Otherwise it would have been almost equal to my whole deductible.
 
#10 ·
One more thing...

The new trend among GP's and Internists is to go "boutique". This means that MD's limit the number of patients they allow in their practice under the guise of providing "better" care. In return, patients pay an annual "membership" fee, for this privilege, above and beyond insurance costs. The lowest I've seen this annual fee is $1,200. With this practice becoming more and more popular, it may become increasingly difficult to find an Internist who's practice is open and will accept your insurance.

This is another reason that makes Kaiser so appealing. You can select your own Primary Care Physician (GP or Internist) and if you ever want to change, you are free to do so. Also, all your health records are computerized so any Doc you see within Kaiser has instant access to all you health records.
 
#11 ·
Kaiser. They have many individual plans at many price points, from just emergency stuff to almost complete coverage. I've been with them for 8 years. BTW, I've always paid for my own health insurance. Having it provided to me by an employer seems like a dream.
 
#13 ·
@casey

Curious whether this program covers all the other people that bill 'a la carte' when you go in for something:

IE:
radiologist
imaging center
custodian ;)

Most of these professional services are billed individually. Seeing as doctor visits are usually only a co-pay, it would be hard to rack up 1200 in GP fees.
 
#14 ·
I had a wicked snowboard injury in 06 that I had to pay out of pocket for. Needlesstosay, this ended up costing me 25k+ in surgeries,hospital stay,etc.

So, once I got back on my feet I knew I needed coverage if I was going to continue my lifestyle. That's when I went with Blue Cross since I knew I could see the doctor that did my surgery on my heel. Well,after having Blue Cross PPO plan at $210/month for 1 year I decided to switch because it sucked. They wouldn't even cover a simple annual physical under this plan!! Ridiculous. Then, after one year and not using it ONCE they send me a premium increase of $50/month saying their cost of business is going up.. YADAYADAYADA... Screw them!.

That's when I decided they are not worth my time or money and I don't like the confusion involved with what exactly was/wasn't covered! I'm with, onemission in that I don't want to have to decrypt my coverage!

ibelieveinsasquatch, I hope you have good results on your incident and would be interested in hearing how that works out.

Great ideas Casey. I'll have to look into this type of coverage in the future.

I'm now with Kaiser and already I appreciate their service much more than Blue Cross! I understand what my coverage is and I'm not worried about what I'll have to pay in the event of a catastrophe/critical injury.
 
#16 ·
nOOby said:
@casey

Curious whether this program covers all the other people that bill 'a la carte' when you go in for something:

IE:
radiologist
imaging center
custodian ;)

Most of these professional services are billed individually. Seeing as doctor visits are usually only a co-pay, it would be hard to rack up 1200 in GP fees.
Noobs, if you're referring to the privilege fee to be part of a specific Docs practice, in most cases, it's strictly a "membership" fee. Some boutique Docs are preforming basic annual tests as part of that fee and some treat it as a membership fee only. Right now, it's only GP's and Internists who are doing the boutique thing. Specialists do not have enough regular patient traffic to justify such a move, yet. And yes, you still have to pay separately for treatment by specialists, including the janitor.
 
#17 ·
nOOby said:
anthem/toniq or kaiser.

I have the toniq plan and I broke my back earlier this summer and I'm only into it about $1400(ER visit, doc visits, MRIs). I decided to pay out of pocket for the last MRI and I saved 50% because boulder comm hospital has a 'half off for cash' program. Otherwise it would have been almost equal to my whole deductible.
Hey noobs, do you have to be a Boulder resident for this half off for cash program to apply -- curious since I work up in Boulder but live in Golden....:confused:
 
#18 ·
jcos said:
Well, the time has come. After ... being unemployed for over a year now, my health insurance is ending at the end of this month.

Anyone else in this shitty situation? I started "shopping" for private insurance and it is quite confusing.
Unless you already have a sizable savings account or are in a "relationship" with somebody that can pay for it, "unemployed" people can't afford insurance unless it's something like "CoverColorado".

I've been self- employed forever, never made a claim in 25 yrs, no pre-existings and saw my insurance go out the roof once I passed 50 yrs old. Even for a $5,000 deductible, 80/20 plan with Humana One, I was paying ~$ 225/month. I had to cancel it about 6 months ago.

The mere fact that you are even thinking about paying for insurance means that you still have sizable funds backing you.

I've been "out of work" for 2 years but have had NO work since last Dec.

My wife went back to work a year ago, to help out, and is working for just above minimum wage to keep the lights on and a few groceries on the table. Our landlord has been pretty good about the whole situation since she hasn't gotten a months rent in a year, but is starting to hound us for "something/ anything" ..... that we don't have.

We "could" sign up for my wife's "company plan" insurance that is almost 0 deduct/ $20 co pay, but then she wouldn't be bringing home anything at all. What good is "Health" insurance if you can't even eat or keep a roof over your head?

Health Insurance in the US is still a "luxury item", and despite Obama's promises on National Health Care, I don't see any progress.

Sorry to take up your time, rant off.

I actually had a fantastic ride this evening. Got into a "face-off' with a huge herd of big buck Mulie's blocking the trail and not budging an inch !!

(Anyone know of anyone looking for a "real carpenter" with 30+ yrs experience ? Finish, frame, side, it's all good. )
 
#20 ·
topmounter said:
That's pretty ideal if you're healthy, I'd rather keep that $2,500 sitting in my savings account than dole it out every month for a level of coverage I don't need. I get my health insurance through my employer and I don't have any options other than the same coverage that is offered to every employee, but the level of coverage that "we" pay for is a total and complete waste for me.
No one likes paying for insurance until they need it. It will pay off, hopefully it won't..
 
#22 ·
This is a good thread. I've been employed and under my employers medical insurance since I started... I consider this a great privilege and use it when I can. You don't ever 'expect' to need it for accidents that can happen to you.

Insurance companies need to make their money to cover you. Even at a $250/mo premium, its cheap. I'm surprised at some of my friends that baulk at a 20 or even 50 dollar co-pay. Out of pocket is worse.

With my recent injury (heel break), I was expecting to pay thousands, even out of pocket. The anesthesiologist, surgery fees, radiologist, etc all got their take. I think the whole thing will end up costing around $18k out of pocket, but I paid a little over $1200.

In my opinion, you should take personal responsibility for this. Like any other profession, Dr's need to make their money too. Keeping a hospital running takes money. Where does it come from?

I'm not sure that I'd be biking as hard as I do without insurance. I realize it is expensive. But what really gets me is some people will gladly pay for auto insurance but complain about health insurance.
 
#23 ·
yep, my ER visit alone was 10K billed to the insurance company($100 billed to me) the most expensive thing was the follow up MRI.

I had just changed jobs and only paid one month of premiums to the new insurance. Not a great deal from them. Of course I had paid for years to other companies and made no claims. What comes around goes around.
 
#24 ·
nOOby said:
yep, my ER visit alone was 10K billed to the insurance company($100 billed to me) the most expensive thing was the follow up MRI.

I had just changed jobs and only paid one month of premiums to the new insurance. Not a great deal from them. Of course I had paid for years to other companies and made no claims. What comes around goes around.
ER or UC?

Emergency rooms are pricey! I have been trending towards the Urgent Care facilities. I have a frequent visitors card at the 6th & Simms one. Lots cheaper than ER!
 
#25 ·
pulser said:
Lucky for me I got a call from Vestas a few months ago. Hang in there man its going to get better.
Where are you working? I was an engineer for Nacelles, I designed most of the assembly line for mechanical components like drivetrain, yaw system, and hubs (pitch). I also designed a lot of custom equipment they are using in Brighton.

Unfortunately, the Engineering group manager, Allen Litt, is a complete ******bag and yes-man. He admitted he doesn't understand calculus and gave the engineering group a presentation that was copied directly from Wikipedia with no references at one point. I have never met a guy who is so incompetent, yet is able to hide the incompetence so well. He speaks confidently but most of the time the stuff coming out of his mouth is incorrect, or just made-up garbage.

Obviously, I couldn't give a F$%k about him or his recommendation anymore, in fact I'm probably going shopping for a lawyer to sue them here shortly.
 
#26 ·
onbelaydave said:
Unless you already have a sizable savings account or are in a "relationship" with somebody that can pay for it, "unemployed" people can't afford insurance unless it's something like "CoverColorado".

I've been self- employed forever, never made a claim in 25 yrs, no pre-existings and saw my insurance go out the roof once I passed 50 yrs old. Even for a $5,000 deductible, 80/20 plan with Humana One, I was paying ~$ 225/month. I had to cancel it about 6 months ago.

The mere fact that you are even thinking about paying for insurance means that you still have sizable funds backing you.

I've been "out of work" for 2 years but have had NO work since last Dec.

My wife went back to work a year ago, to help out, and is working for just above minimum wage to keep the lights on and a few groceries on the table. Our landlord has been pretty good about the whole situation since she hasn't gotten a months rent in a year, but is starting to hound us for "something/ anything" ..... that we don't have.

We "could" sign up for my wife's "company plan" insurance that is almost 0 deduct/ $20 co pay, but then she wouldn't be bringing home anything at all. What good is "Health" insurance if you can't even eat or keep a roof over your head?

Health Insurance in the US is still a "luxury item", and despite Obama's promises on National Health Care, I don't see any progress.

Sorry to take up your time, rant off.

I actually had a fantastic ride this evening. Got into a "face-off' with a huge herd of big buck Mulie's blocking the trail and not budging an inch !!

(Anyone know of anyone looking for a "real carpenter" with 30+ yrs experience ? Finish, frame, side, it's all good. )
Yup, there are certain age milestones that dramatically affect premium rates. Recently had it happen at 55... I can't wait to see what happens when I hit 60.

Prior to moving to Kaiser, premiums would typically jump anywhere from 20-40% a year, even without any claims. So every two to three years, I'd be out shopping for a new provider. I was fortunate that my family remained healthy during this time so that switching providers was never a problem. Premiums would be affordable again for a year or two then I'd repeat the drill all over again. Did that dance for 17 years. A good insurance agent is worth their weight in gold when it comes to shopping for health ins.

Don't get me wrong, Kaiser's rates increase every year too but it's on the order of 8-10%. Most other insurance providers have rate increases that are double and sometimes triple.

Congress allows Health insurance companies to guarantee themselves a double digit profit every year and get away with it. Until the lobbyists are muzzled and true campaign finance reform takes place, nothing will change. Sorry for the rant.

The way the system is set up, it's crazy not to have insurance, even if it's only catastrophic coverage. That's why I suggested to work with an independent insurance agent. They understand how the game is played and can offer options that the layperson may not know about.
 
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