Any individiual health insurance payers here?

[Rangerscott]

Looking at individual health insurance and seeing whats best for me. Who do you have? Whats your plans details? How well does it do for the small stuff like going in for a.cold and about the big stuff like multiple days at tue hospital/surgery? Any problems with said company?

Blue Shield seems to be the best choice so far on balancing deductible and coinsurance. Havent looked at Aetna yet.

Got any stories you dont mind sharing about hospital visits and the bills?

[OneSickPsycho]

I have had a few different insurance companies throughout the years and only one big claim... Unless something major happens, I find them to all be pretty much the same. I don't have any experience with individual insurance, but some of this might help.

Most are set up with various co-pays for preventative care, stat care, emergency care, and prescriptions... Usually $15-25 preventative, $50-$100 stat care, $75-150 emergency, and $5-20 prescriptions... Some of these things may be covered 100%. Most I have had were 80/20 splits after your deductible and/or certain limits, meaning after your limit, they paid the remaining 80% and you pay 20%... or something along those lines.

The one claim I had was when I shattered my kneecap. The original total of all of the bills was $35,000 and change... My out of pocket expense was somewhere in the $3k range. The trick with this shit is not never pay anything, just keep resubmitting to insurance (generally the hospital will do this for you). The hospitals and insurance companies negotiate with eachother on price and what's covered... for example, I got a $6k bill for an anesthesiologist (sp?) assistant and insurance said they didn't cover that for my procedure... around the 5th time I resubmitted it (no bullshit), the hospital slashed it to $500 and insurance covered all of it. Quite a fucking rackett they have going there...

As with most places, open enrollment just ended here... Obamacare is causing most places to redo their insurance... Mine jumped almost 20% and I never go to the doctor, don't plan on drinking a bunch of gin and riding mini-bikes, so I went with an HSA. Should work out really well for me as long as I stay healthy this year. It's like 1/3 of the cost of the PPO option and I'm dumping the difference back into that account. My employer drops in $500 every year, which means my cost is only $150/yr and it's all my money. With a deductable of $2k/yr and the rest being like the PPO plan, it was a great fucking deal for me... I should have $2k in that account after one year and it will continue to build... if I don't use it, that money is tax free at age 65. If I fuck myself up somehow in this first year, meeting the $2k and 80/20 shouldn't be a big deal as long as what happens doesn't require learning to walk again or something.

[derf]

I've dealt with the same racket osp is describing, went to the hospital after I broke my hand a few years back, nothing major, but I did spend 6 hours in the er and get a bunch of xrays, and some pain needs. My insurance covers 100%'with no copay. But the hospital sent me a bill for $4k. I sent them back a letter that they need to talk to my insurance. The next bill came back at just under $2k, and the one after that at$500. I just kept sending them back to the insurance company until they paid up

[Cutty72]

Originally Posted by derf

I've dealt with the same racket osp is describing, went to the hospital after I broke my hand a few years back, nothing major, but I did spend 6 hours in the er and get a bunch of xrays, and some pain needs. My insurance covers 100%'with no copay. But the hospital sent me a bill for $4k. I sent them back a letter that they need to talk to my insurance. The next bill came back at just under $2k, and the one after that at$500. I just kept sending them back to the insurance company until they paid up

Tricare FTW. Sadly, they are going away for us...

[HokieDNA01]

I just hate how they don't seem to cover any pre existing conditions. I don't want to have to stop all my meds to get insurance.

[Rangerscott]

Originally Posted by HokieDNA01

I just hate how they don't seem to cover any pre existing conditions. I don't want to have to stop all my meds to get insurance.

Thought obama signed a law saying that they had to accept you no matter what?

[derf]

Originally Posted by Cutty72

Tricare FTW. Sadly, they are going away for us...

Please provide source. I have heard this quite a few times recently and each time I have looked into it, it turns out to be something that is either a political lie or talking about the changes that were enacted recently which only affects retirees who live farther than 50 miles from a base

Originally Posted by HokieDNA01

I just hate how they don't seem to cover any pre existing conditions. I don't want to have to stop all my meds to get insurance.

Originally Posted by Rangerscott

Thought obama signed a law saying that they had to accept you no matter what?

Yep, part of obamacare is that they cannot deny you for pre existing conditions

[HokieDNA01]

That doesn't start for adults until 2014.

[derf]

Originally Posted by HokieDNA01

That doesn't start for adults until 2014.

Then I believe you can wait until then to take your viagra pills

[Rangerscott]

Looking at BCBS and they have a PPO plan where the copay is $25. Then there is the HSA individual insurance and where it says copay, it just says, "Deductible and Coinsurance."

So if I go to the minor emergency and the visit is $100. I pay that and they goes towards my deductible? Is it worth having that $25 copay?

Was thinking either the PPO with $500 deduc - $216 premium w/ 80-20 coverage or the Individiual HSA $1200 deduc - $150 premium w/ 90-10 coverage



Plan Details
1. PPO Select Choice (I-VIII)
Best Seller!
Network: BlueChoice or BlueCard Preferred Provider Organization
Lifetime Benefit: No Limit

Office Visit Copay: $25
Out-of-pocket Limit: Deductible plus $3,000
Deductible Rx Drug Coverage Monthly Premium
80% Coverage
$250 $10 Generic, $30 Preferred, $45 Non-Preferred $253.00
$500 $10 Generic, $30 Preferred, $45 Non-Preferred $216.00
$1,000 $10 Generic, $30 Preferred, $45 Non-Preferred $178.00
$1,500 $10 Generic, $30 Preferred, $45 Non-Preferred $152.00
$2,500 $10 Generic, $30 Preferred, $45 Non-Preferred $133.00
$3,500 $10 Generic, $30 Preferred, $45 Non-Preferred $118.00
$5,000 $10 Generic, $30 Preferred, $45 Non-Preferred $108.00
$10,000 $10 Generic, $30 Preferred, $45 Non-Preferred $94.00


BlueEdge Individual HSA (I-III)
Network: BlueChoice or BlueCard Preferred Provider Organization
Lifetime Benefit: No Limit

Office Visit Copay: Deductible and Coinsurance
Out-of-pocket Limit: $3,000
Deductible Rx Drug Coverage Monthly Premium
90% Coverage
$1,200 $10 Generic, $50 Preferred, $65 Non-Preferred $150.00
$1,750 $10 Generic, $50 Preferred, $65 Non-Preferred $122.00
$2,500 $10 Generic, $50 Preferred, $65 Non-Preferred $105.00