mine is like this:

PCP Visit: $15
Specialist: $30 (no referrals required)
Hospital ER: $125 (*I believe the fee is waived if true emergency and admitted)
Urgent Care: $35
Wellness:$0
Rx: $7/30/50

Also hospital is $250, no matter how long, one co-worker was in the hospital for 2 weeks and the bill was only $250.

The copays were much more reasonable a few years ago, I came across the old insurance card a few days ago... if my salary would have gone up the same way, I would be filthy rich now



Edited 1 time(s). Last edit at 03/13/2012 07:30PM by space-time.

i have an HSA so no co-pay but 100% after deductible is met.

my son has kaiser.

Primary visit: $30
Mental Health: $60
Specialist: $50
Rx: $200 deductible the $15 generic/$30 brand

---

"Success isn't about how much money you make. It is about the difference you make in people's lives."--Michelle Obama

PCP visit - $20
specialist - $25 to $45 depending on which tier they fall in
ER - $100, waived if admitted or within a certain period after discharge
hospital stay - $200 to $700(?) depending on tier (there might be a higher tier than I recall)
prescription - $10 usually for 30 day supply, non-generic and some other items may be more or less than that amount

There is also a $250 annual deductible per covered person, max of $750 on a family plan



Edited 1 time(s). Last edit at 03/13/2012 07:48PM by JoeH.

"PPO HIGH DEDUCTIBLE 3000 (HSA COMPATIBLE)
PENNSYLVANIA
AETNA"

minimal emergency coverage for 2 adults & a child.
$3000 deductible.

no copays for any doctor visits.

it's all we can afford.

---

[www.giyf.com]

....time and a half....??

---

____________________________________________________

I reject your reality and substitute my own!

about 25% higher than yours and its excellent insurance. i live in new york.

Quote
space-time
mine is like this:

PCP Visit: $15
Specialist: $30 (no referrals required)
Hospital ER: $125 (*I believe the fee is waived if true emergency and admitted)
Urgent Care: $35
Wellness:$0
Rx: $7/30/50

Also hospital is $250, no matter how long, one co-worker was in the hospital for 2 weeks and the bill was only $250.

The copays were much more reasonable a few years ago, I came across the old insurance card a few days ago... if my salary would have gone up the same way, I would be filthy rich now

---

and your monthly premium is...

---

A man who is of "sound mind" is one who keeps the inner madman under lock and key.
(Paul Valery)



Edited 1 time(s). Last edit at 03/13/2012 08:44PM by Go To Top.

"""medical insurance: """
What's that . . . ?

---

“Stay Hungry Stay Foolish"
"There are only two mantras yummm and yuk "
"There is a fine line between a rut and a groove"
"The quality of Congress is not strained. It droppeth like a fetid cow patty from a bovine cloaca." cbelt
"I got to that part and I knew there was going to be some weapons grade stupid to follow"Lux Interior
"When all the trees have been cut down, when all the animals have been hunted,
when all the waters are polluted, when all the air is unsafe to breathe, only then
will you discover you cannot eat money."
~ Cree Prophecy




Edited 1 time(s). Last edit at 03/13/2012 08:54PM by haikuman.

$20 - $70 depending

---

!#$@@$#!

"Do not fear mistakes. There are none."

Miles Davis

Quote
Go To Top
and your monthly premium is...

good question. IIRC around $450/month for family (me, spouse, kids). Doesn't matter if you have 1 kid or 19

Quote

PCP Visit: $15
Specialist: $30 (no referrals required)
Hospital ER: $125 (*I believe the fee is waived if true emergency and admitted)
Urgent Care: $35
Wellness:$0
Rx: $7/30/50

Lucky you! I wouldn't complain about that at all.

PCP: $30
Specialist: $50, no referral
ER: $250
Urgent Care: $100
Rx: $15/$50ish/Forget about it if it's not in the formulary.
Maximum out of pocket is at least $12,000.
Labs and imaging are not fully covered.

I pay more than I can afford for insurance that I can't afford to use if I get sick. mattkime, what insurance do you have?

Quote
mattkime
about 25% higher than yours and its excellent insurance. i live in new york.

I believe it.

Oxford is great. I wish they had it down here.

Quote
ka jowct
mattkime, what insurance do you have?

UnitedHealth

i think it cost my employer nearly $400+ a month but i think i pay 10% of that. (yes, i appreciate it!)

Quote
mattkime

Quote
ka jowct
mattkime, what insurance do you have?

UnitedHealth

i think it cost my employer nearly $400+ a month but i think i pay 10% of that. (yes, i appreciate it!)

So it's employer-sponsored?

I'm hoping that I'll be able to take advantage of some of the lower-cost options that Freelancers Union is working on, but they won't be available before 2014, unfortunately.

Right now their second-best individual PPO plan is $462 a month.

Self employed, individual plan. $525/month includes dental with $250 deductible. $30 copay for PCP and specialist. Can't remember what my hospital/ER copay is. Pretty good prescription coverage although I am no longer taking anything on a regular basis.

DM

last copay alone was a hair more than I recently paid for a new hi res 15" MBP plus 16GB RAM for it... UHC makes it (way too) easy to reach your (our) out of pocket maximum if one requires expensive treatment. While the plan covers a lot, they hang you out to dry w/ an add'l % copay over certain thresholds for quite a bit of stuff the last few years. They cover the first $1,500, then hang you out to dry for awhile, then hit you w/ the % copay thing until you max out. If the treatment is in network, it has the potential to work out better for *most* care, but as soon as you gravitate into the "exceptions" categories, and/or venture out of network; ouch. Factoring in the initial coverage, the monthly is about $300 for the family... same deal as s-t, 1-19 kids no change, but we only have 1.


///

I don't understand where you folks get this dirt cheap coverage. We're self-employed, so we don't have access to employer group plans. For my wife, daughter and myself, we pay about $1400/month, $50 min copay, $250 ER or outpatient surgery, zero prescription drug coverage, no dental, it goes up from there. I guess it could be that we're both over 50 which is why they want to ream us on rates, but that is the cheapest coverage available to us. A couple of years ago it cost even more because they threw my wife into a high risk group for an utterly lame reason.

---

"So be proud to be a decent American instead of just a w'anker whipping up fear!" - Michael D. Higgins, President of Ireland



Edited 1 time(s). Last edit at 03/14/2012 12:08AM by davester.

Quote
davester
I don't understand where you folks get this dirt cheap coverage. We're self-employed, so we don't have access to employer group plans. For my wife, daughter and myself, we pay about $1400/month, $50 min copay, $250 ER or outpatient surgery, zero prescription drug coverage, no dental, it goes up from there. I guess it could be that we're both over 50 which is why they want to ream us on rates, but that is the cheapest coverage available to us. A couple of years ago it cost even more because they threw my wife into a high risk group for an utterly lame reason.

Lots of plans have lots of "gotchas", and if you don't get got by the gotchas, you come out OK. If they getcha with a gotcha, then life sucks, or at least gets really expensive. Remember, people/companies insure against unexpected expenses, as well as catastrophies, and depending on what those levels are, and what the client and the insurer are willing to bear, all get plugged into the actuary's spreadsheet on his 1.42GHz G4 Mac Mini in Excel from MS Office X. Everybody needs health insurance, but insurance companies only want insure healthy people, and doctors and health insurance executives want to drive expensive luxury European sedans. Go figure. Big companies tend to hire lots of healthy people. Lots of healthy people means lots of unused health insurance premiums... that explains some of the fancy cars. HTH.

///

What happened with my last insurance plan is the insurers did everything they could to deny payment.
All charges were legitimate billings.

Insurance companies primary goal is to avoid/deny and reduce payment. They represent another form
of 3 card monty and shell games. They continue to try and put responsibility on the insured even though
you have purchased insurance.

I personally have very little respect for insurance companies.

I have seen their dubious, unethical acts and behavior from both sides of the fence, as a patient
an as a health care worker/provider.
Rudie

---

“Stay Hungry Stay Foolish"
"There are only two mantras yummm and yuk "
"There is a fine line between a rut and a groove"
"The quality of Congress is not strained. It droppeth like a fetid cow patty from a bovine cloaca." cbelt
"I got to that part and I knew there was going to be some weapons grade stupid to follow"Lux Interior
"When all the trees have been cut down, when all the animals have been hunted,
when all the waters are polluted, when all the air is unsafe to breathe, only then
will you discover you cannot eat money."
~ Cree Prophecy




Edited 1 time(s). Last edit at 03/14/2012 01:17AM by haikuman.

"What happened with my last insurance plan..."

(details of an individual experience with a particular insurance company)

Followed by an indictment of all insurance companies

"insurance companies primary goal is to avoid/deny and reduce payment. They represent another form
of 3 card monty and shell games...."

That's rather like having a bad marriage and divorce, then observing:

"The female gender's primary goal is to avoid/deny affection and loyalty, and reduce marital obligation. They represent another form of 3 card monty and shell games..."

Indicting all women, not just the one woman you had a bad experience with.

I've had good and bad experiences with insurance companies. And I've had to use insurance a lot. My house burned down. I've had car accidents. I've had surgeries. I might have filled out more forms and worked with more agents and adjusters and customers service staff in a few decades than most people do in a lifetime. And over 25 years or so, I've had some very good experiences with some insurance companies, and some not-so-good experiences, and abusive experiences with some insurance companies. Personally, I'd hesitate to paint them all with the same brush. Though it's popular to do so, that doesn't make it accurate.

Also, the companies and institutions that insurance companies work with (health care providers, hospitals, construction companies, body shops, medical specialists, you name it) are just as crooked, or just as honest, just as rigged or overcharging, or ethical and fair, as any other entity.

If insurance companies alone are tagged with being rigged, dishonest, or abusive, while the health care systems (or other big institutions) they're in collusion with, or enmeshed with, are viewed as blameless and noble, then we're not seeing the big picture.

We have a High Deductible insurance plan and an HSA, so we're on the hook for the first $3000 each, $6000 total for the family. But, my monthly cost has dropped dramatically, from several hundred dollars per month to $78. We're covering 1/4 the cost and the college covers the other 3/4.

For us, the trick was staying healthy long enough to fund our HSA with the savings in monthly premiums to cover the deductible. We've done that, so our HSA now has enough for 2 years of deductibles. Each month it grows. As long as we stay healthy...

*(:>* amusing assumptions

"""If insurance companies alone are tagged with being rigged, dishonest, or abusive, while the health care systems (or other big institutions) they're in collusion with, or enmeshed with, are viewed as blameless and noble, then we're not seeing the big picture."""

Insurance companies redundantly deny, cheat and abuse patient rights. No runs, No drips, No errors.
ymmv *(:>*

---

“Stay Hungry Stay Foolish"
"There are only two mantras yummm and yuk "
"There is a fine line between a rut and a groove"
"The quality of Congress is not strained. It droppeth like a fetid cow patty from a bovine cloaca." cbelt
"I got to that part and I knew there was going to be some weapons grade stupid to follow"Lux Interior
"When all the trees have been cut down, when all the animals have been hunted,
when all the waters are polluted, when all the air is unsafe to breathe, only then
will you discover you cannot eat money."
~ Cree Prophecy

Quote
davester
I don't understand where you folks get this dirt cheap coverage. We're self-employed, so we don't have access to employer group plans. For my wife, daughter and myself, we pay about $1400/month, $50 min copay, $250 ER or outpatient surgery, zero prescription drug coverage, no dental, it goes up from there. I guess it could be that we're both over 50 which is why they want to ream us on rates, but that is the cheapest coverage available to us. A couple of years ago it cost even more because they threw my wife into a high risk group for an utterly lame reason.

I wouldn't say my coverage is "dirt cheap", but if you take what I pay ($525/month) and multiply it by 3 it comes pretty close to what you are paying for your family. I am a self employed single 42 year old female, FWIW. I have no maternity coverage and my policy is with Blue Cross Blue Shield of IL. Of course, the thing that REALLY bites is that when I first got the policy, 5 years ago, my premium was $263/month.

DM

Cripes you have awesome health insurance. We pay $600 a month for the insurance, $2,500 deductible off the top for the family, except for copay activities like doctor visits ($35), specialist ($50), ER ($100 and THEN they get ya with 'extras'), etc.... After all that's said and done they only pay 80% of reasonable and customary charges.

[www.democraticunderground.com]

Health insurance industry CEO salary survey, stay calm for this
by nyceve
Tue May 26, 2009 at 10:27:23 AM PDT

While the American people find themselves priced out of health insurance and healthcare, the CEOs of America's largest for-profit health insurers are making record salaries.

And perks . . .like private corporate aircraft, country club memberships, security services (wonder why they need this?) and a lifestyle most Americans can only dream about.

It's really long overdue that the American people hit the streets to demand guaranteed and affordable healthcare. It's also long overdue that we drive a stake through the heart of the fully parasitic Murder by Spreadsheet for-profit insurance industry.

Before you peruse the CEO salary survey, keep in mind the for-profit health industry exists for only one purpose, to generate profits for shareholders. In order to do so, this industry collects premiums and then it delays and denies medical care--think you're insured, think again. The situation is so bad that doctors are in revolt. They are sick and tired of fighting the insurers for every treatment, every medication and every test.

[www.democraticunderground.com]

[financialservices.about.com]

[blogs.wsj.com]

[finance.yahoo.com]

[hcrenewal.blogspot.com]

---

“Stay Hungry Stay Foolish"
"There are only two mantras yummm and yuk "
"There is a fine line between a rut and a groove"
"The quality of Congress is not strained. It droppeth like a fetid cow patty from a bovine cloaca." cbelt
"I got to that part and I knew there was going to be some weapons grade stupid to follow"Lux Interior
"When all the trees have been cut down, when all the animals have been hunted,
when all the waters are polluted, when all the air is unsafe to breathe, only then
will you discover you cannot eat money."
~ Cree Prophecy




Edited 1 time(s). Last edit at 03/14/2012 06:56AM by haikuman.

We're paying $400/month for my Wife and son, they wouldn't insure me. I'm paying $350/month for a
supplement through the railroad that is basically nothing unless something catastrophic happens,
$1500 deductible, then it pays 50% of Dr. visits and other stuff but no Rx, I'm spending about
$150/month on Rx. Out of pocket max. per year is $15K. It's basically crap. My wife and sons
is actually pretty good, Rx is like $10 and $25 and Dr. visits are $25 but only allows 4 visits a
year and eye exams are $25. It's a huge part of our monthly budget. You just about have to carry
something in case of catastrophic problems, we know what that's like with our son that passed
away last year.

---

Grateful11

For us, it's not the co-pay, it's the monthly premium ($1,050.00 for two) and the deductible that get's us. Self-employed, so I pay it all. Co-pay is only about $10 - 25.



Edited 1 time(s). Last edit at 03/14/2012 08:40AM by LaserKun.

What insurance?

Have a clinic in NYC (Ryan Center) that does prorated fees. Will give discounts to scripts on their list. Most lab tests free, on site. Got free colonoscopy through them. Great for preventive. Holding breathe on catastrophic.

Quote
mspace
What insurance?

Holding breathe on catastrophic.

This is the problem with the american healthcare non-system. The primary purpose of insurance is to cover catastrophic claims that would bankrupt most people. The routine stuff you're supposed to pay yourself, which is why there are copays, deductibles, etc. When somebody like you has a heart attack, gets hit by a car, or contracts cancer then I end up paying for it through increases in my rates. This is why we need everyone to be insured. Single payer would be best, which would cut out the predatory insurance industry, but ObamaRomneycare is currently the only stopgap we can get.

---

"So be proud to be a decent American instead of just a w'anker whipping up fear!" - Michael D. Higgins, President of Ireland

Quote
guitarist
If insurance companies alone are tagged with being rigged, dishonest, or abusive, while the health care systems (or other big institutions) they're in collusion with, or enmeshed with, are viewed as blameless and noble, then we're not seeing the big picture.

The fact is, that with essentially no exceptions, the insurance companies do in fact all operate the same way, because claim denial and recission is the only way for them to be profitable. They are incentivized primarily to cut benefits, create monopolies and raise rates, which is what they do. Capitalism is a great model to operate under when the goal is to produce the best widgets in a competitive market. It is a ridiculous model to operate under when the goal is to distribute funds for the welfare of everyone. This is why we no longer use the capitalist model to run fire departments, police departments, NIH, the armed forces, etc.

---

"So be proud to be a decent American instead of just a w'anker whipping up fear!" - Michael D. Higgins, President of Ireland

that is why claims adjusters have jobs.

their goal is to minimize the amount paid out by the the insurance company. a friend of mine did it for a while.

[en.wikipedia.org]

---

[www.giyf.com]

Quote
davester

Quote
guitarist
If insurance companies alone are tagged with being rigged, dishonest, or abusive, while the health care systems (or other big institutions) they're in collusion with, or enmeshed with, are viewed as blameless and noble, then we're not seeing the big picture.

The fact is, that with essentially no exceptions, the insurance companies do in fact all operate the same way, because claim denial and recission is the only way for them to be profitable. They are incentivized primarily to cut benefits, create monopolies and raise rates, which is what they do. Capitalism is a great model to operate under when the goal is to produce the best widgets in a competitive market. It is a ridiculous model to operate under when the goal is to distribute funds for the welfare of everyone. This is why we no longer use the capitalist model to run fire departments, police departments, NIH, the armed forces, etc.

bingggoooo.

now, let's return to our regularly scheduled program.

Quote
haikuman
*(:>* amusing assumptions

"""If insurance companies alone are tagged with being rigged, dishonest, or abusive, while the health care systems (or other big institutions) they're in collusion with, or enmeshed with, are viewed as blameless and noble, then we're not seeing the big picture."""

Insurance companies redundantly deny, cheat and abuse patient rights. No runs, No drips, No errors.
ymmv *(:>*

Sure, by that standard, all insurance policy holders lie, defraud, and cheat insurance companies. No runs no drips, no errors. You have a point. All customers are dishonest and cheat. Well said!

if you presume to be an expert on all insurance companies, you get what you ask for!

Clearly you know more than I do *(:>* I arrest your case Take your meds and call me in da mourning .

---

“Stay Hungry Stay Foolish"
"There are only two mantras yummm and yuk "
"There is a fine line between a rut and a groove"
"The quality of Congress is not strained. It droppeth like a fetid cow patty from a bovine cloaca." cbelt
"I got to that part and I knew there was going to be some weapons grade stupid to follow"Lux Interior
"When all the trees have been cut down, when all the animals have been hunted,
when all the waters are polluted, when all the air is unsafe to breathe, only then
will you discover you cannot eat money."
~ Cree Prophecy

Quote
davester

Quote
mspace
What insurance?

Holding breathe on catastrophic.

This is the problem with the american healthcare non-system. The primary purpose of insurance is to cover catastrophic claims that would bankrupt most people. The routine stuff you're supposed to pay yourself, which is why there are copays, deductibles, etc. When somebody like you has a heart attack, gets hit by a car, or contracts cancer then I end up paying for it through increases in my rates. This is why we need everyone to be insured. Single payer would be best, which would cut out the predatory insurance industry, but ObamaRomneycare is currently the only stopgap we can get.

I agree. If I actually could squeak out the money to afford insurance, I wouldn't have the money for the co-pay. We set a side a little bit each month to afford going to the clinic when we need to, take good care of ourselves via preventive measures, and hope for the best. Even if I had insurance, I know they would still fight tooth and nail to deny covering expenses, so right now I retain what little control I can. We're well aware of the risk, but it's the best when money is spread thin, very thin.