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View Full Version : Great News: Annual health insurance increase at an all-time low!



Jeffrey Makiel
06-02-2007, 3:13 PM
I just got my family's annual renewal notice for health insurance...and what I've read in the local paper about health care costs for this year having a lesser increase is absolutely true. It only went up 18% instead of the usual 20% to 30% per year in the last 8 years. Woopeee!

Please note that I'm being cynical. The amount of increase alone is now larger than the actual total policy premium that we paid 8 years ago. This makes the other off-topic post about increasing gasoline prices almost unimportant to me as one poster suggested there. In fact, our premium increase alone is more than what we spend on gasoline in 8 months at $2.80/gal.

My apologies for the rant. I should have invoked the 5 day waiting period before posting this. I'll try to do that when I get my annual property tax invoice.

-Jeff :)

Dennis Peacock
06-02-2007, 3:26 PM
well......don't get me started on THIS topic!!!! :mad: :rolleyes:

Rick Gibson
06-02-2007, 3:41 PM
There are times I am glad I live in Canada. But then again my son lives in Windsor Ont. and programs robots for a U.S. company. After he has paid his U.S. income tax the Canadian govt. comes along and says you still owe us XX$ usually between 30 and 50% of what he paid in the U.S. Then on the other side, my wife has had an MRI ordered for her knee that she injured in March. Still don't have a date.

Brian Elfert
06-02-2007, 6:35 PM
Our health plan at work was scheduled to double our premium for 2007.

The parent company decided to go with a national plan instead of each subsidiary having their own plan. They were going to have three levels each with varying levels of deductibles, percentages of payment, and the like. The top plan covered basically everything 100% with small copays. The premium for the top was going to double. Even the bottom tier plan was the same price as full coverage in 2006.

The company claimed that they were paying same percentage of the total cost as before. Total B.S. as the total cost certainly didn't double! If it did, someone at corporate HR screwed up royally.

Someone with family coverage for the top tier would have been paying over $200 a month more. This was more than just about anyone's puny salary increase.

In the end, our subsidiary was sold by our parent company at the end of 2006. We didn't go on the new plan. We kept the existing plan with some changes and employee premiums only increased 10% instead of 100%.

I expect major changes in health insurance for 2008 as my employer is doing poorly and just laid off 7%.

We really need nationalized health care so the insured aren't paying for the rest. I've heard economists say that if health care inflation isn't slowed down that 100% of our entire economy will go towards health care in another decade or two. Any rational person knows that would never happen, but it just illustrates how big of a problem heatlh care is.

Brian Elfert

Dennis Peacock
06-02-2007, 7:02 PM
There are times I am glad I live in Canada. But then again my son lives in Windsor Ont. and programs robots for a U.S. company. After he has paid his U.S. income tax the Canadian govt. comes along and says you still owe us XX$ usually between 30 and 50% of what he paid in the U.S. Then on the other side, my wife has had an MRI ordered for her knee that she injured in March. Still don't have a date.

Well Rick.....the only real good thing here? I can call the doctor today and see him on Monday for a regular appointment...xrays, mri or not. But that's as far as it goes....but at a premium cost out of my pocket.

Jeffrey Makiel
06-02-2007, 9:11 PM
We really need nationalized health care so the insured aren't paying for the rest. Brian Elfert

As the capitalist that I am, I agree whole heartedly now. In addition to the insured paying for the non-insured, there is also a big premium discount given to large companies (economics of scale capitalism). Some large corporate policies are as much as 50% less than private and small company policies in NJ. It's a huge shift of burden.

The way I see it, there are several things which ruin 'free-market' health care these days:

1. People don't choose to get sick;

2. It is impossible to shop for medical care (try pre-pricing the costs for appendicitis);

3. There are now too many people without health insurance or are under-insured (like my family) because the premiums are in a crazy upward spiral fueled by itself;

4. Medical service, even the simple routine stuff, is so expensive that preventive care is not being sought by folks that even medical insurance. Examples are: blood pressure screening, colonoscopy, coronary exam, mamograhm, etc.

5. Paying into the system is voluntary, but providing healthcare to non-insured, at least at a miminal or emergency level, is a mandatory requirement.

I understand that there are a lot of other factors that effect medical costs, like excessive litigation, longer lifespans, poorly regulated pharmaceuticals, illegal immigration, general decline of decent middle class jobs, etc. But something needs to be done when the system does not support the needs of the middle income, fiscally responsible class.

I better get off my soapbox before I break an ankle.

-Jeff :)

Jim O'Dell
06-02-2007, 9:14 PM
Well Rick.....the only real good thing here? I can call the doctor today and see him on Monday for a regular appointment...xrays, mri or not. But that's as far as it goes....but at a premium cost out of my pocket.

You're very lucky. Our health insurance plan changes "suppliers" every year. EVERY YEAR!. So generally you end up picking a different Dr. every time. 4 years ago, I got sick at work, thought it was a stomach ache. Went home, 4 hours later it was getting worse. Called the current plan's Dr., this was in Feb, and was told the first appointment was in mid OCTOBER!! I said that I didn't think that was going to work. She said "Sorry" So I asked her what I should do, and was told to go to one of the minor emergncy clinics. Got there about 2:00. It then took a couple hours to get in to a Dr., actually a PA. I was on the operating table at Harris Methodist at 7:00 having my appendix taken out. Guess it was good I didn't wait for the ppointment!! :D We'll discuss the side road LOML took to the hospital another time. :eek: I swear she's out to kill me some times. :D Jim.

Art Mulder
06-03-2007, 8:12 AM
There are times I am glad I live in Canada. ..... Then on the other side, my wife has had an MRI ordered for her knee that she injured in March. Still don't have a date.

I've never needed an MRI, however I've twice had a CT scan, and got in pretty quick. First time was about 4-5 years ago. Next was just a couple weeks ago. Doc warned me it'd take a month, but I was in 7 days later. Not bad for a non-urgent appointment.

At the end of April I fell victim of back pain (Sciatica). Since then I've had a back X-Ray, a CT scan, been to our family doctor about 5 times for assessments and reassessments, and around 7 visits to a physiotherapist. So far I'm out of pocket less than $100.

Yeah, at times I envy my US friends their low taxes, but every time I hear stuff about Healthcare down there...

ETA: I still remember, years ago, being shocked when i heard from my friends that they had to pay to have a baby -- something like $1200 or more in hospital costs. Errr, what? Now that was a totally foreign concept to me. We knew someone about 10 years ago, who was being offered a position in the states, but there was some concern because the healthcare provider wasn't wanting to cover his wife, who was pregnant, because it was a "pre-existing condition" !?!?! I never did hear how that got worked out.


...art
ps: but yeah, health costs are skyrocketing. At work, the benefit cost to the employer is 24-25% per year (for pensions, supplemental health, dental, vision care, etc) That's quite a chunk of change.

Jeffrey Makiel
06-03-2007, 10:11 AM
Yeah, at times I envy my US friends their low taxes, but every time I hear stuff about Healthcare down there...

Art...according to CNN many parts of the US now pay more taxes than Canadians. In NJ, we have a 7% sales (cloths and food are exempt), 3% state income tax, 15% federal tax, and huge property taxes in the northeast which is about 10% based upon the average household income of my area. There are also other taxes that I'm not including like utility and communication tax, gas tax, tolls, etc.

That roughly comes out to 35% total taxes...and does not include family medical. Currently, a BlueCross/BlueShield family medical policy with a $1,000 deductible is now $32,000 as per their website. This policy does not include significant dental or vision coverage either.

Based upon the average household income in my area, a $32,000 premium is about 40% of a family's income. This puts small business owners, or folks whose employers don't provide healthcare, at a whopping 85% equivalent tax rate. Therefore, many families assume more risk and have lesser coverge (high deductible, large copay, exempted illnesses and maximum limits). These lower end policies, which are being created by the healthcare market in response to the exceedingly high cost of healthcare, are about $12,000. This puts the total US equivalent tax rate at about 50%. However, one medical incident with this reduced coverage can financially wipe a family out, and routine preventive care is basically out of pocket.

And costs continue to get worse with no solution insight...

-Jeff :)

Bart Leetch
06-03-2007, 12:07 PM
Health care insurance. The only thing they insure is that you won't use it because the employer changes who they have the police with faster than they do their underwear's.

Every year you have to find a new doctor because the doctor you've been seeing isn't covered by the new policy.

There is no such thing as doctor patient relationship.

I FEEL LIKE THE LEFT FRONT FENDER ON A BUICK.

And they wonder why things are not Caught in the early stages. 1. The doctor doesn't really know you &. 2.You probably don't have a doctor because you haven't established yourself with one since the last police change.

And they say its better than nothing & I say Whats better then nothing. You have to wade through all the fine print to see what if anything is covered. I wish I had a business where most of what I had to pay out for was the printing of fine print that said give me your money but I'm not going to provide anything for what you've paid. But I'll have a ball running to the bank with your money & investing it so I can retire like a fat hog.

You think maybe I don't like insurance companies your right I think that they couldn't be bigger robbers if you gave them a mask & a gun.:eek: :D

Art Mulder
06-03-2007, 3:20 PM
Art...according to CNN many parts of the US now pay more taxes than Canadians. In NJ, ......
That roughly comes out to 35% total taxes...and does not include family medical. Currently, a BlueCross/BlueShield family medical policy with a $1,000 deductible is now $32,000 as per their website. This policy does not include significant dental or vision coverage either.

Based upon the average household income in my area, a $32,000 premium is about 40% of a family's income.

Geez, Jeff, that's insane. $32k a year, plus a deductible? who could afford that?

I do know that the tax systems are wildly different, so it is very hard to compare. For instance, I have heard that mortgages are deductible in the US, but not here. But, I think we can deduct more for charitable donations. And on and on... I frankly leave it to the experts to explain which system taxes more.

Pat Germain
06-03-2007, 7:07 PM
I work for a very large company: over 50,000 employees. If my company is getting a break on insurance rates for a large group, they're not passing it on to the employees. A few years ago it was obvious if the company was paying less because we got "benefit dollars". We would apply those dollars to one of several plans available and pay the difference out of our pocket.

Then, the benefit dollars kept going down as the premiums went up. After a few years of this, the benefit dollars went away. We now just see what each plan will cost us out of pocket. This way, the company can keep cutting the percentage they pay for insurance and chalk it up to "price increases".

Interestingly, I asked a visiting insurance rep many years ago if company executives had the same insurance plans. "The top 10% of the company has a separate benefits package," she answered. (I later got the impression she wasn't supposed to say that.) It sure torqued me off. No wonder those fat cats don't care. They're like Congress. They have they're own, special health plan.

Until the US gets a handle on illegal immigration, there's absolutely no way national health care could even begin to work. As a US resident, just try to walk into a Canadian hospital and try to get non-emergency care. "Whattaya mean I gotta be a citizen?" We should be saying the same thing in our hospitals.

Lee DeRaud
06-03-2007, 7:41 PM
Currently, a BlueCross/BlueShield family medical policy with a $1,000 deductible is now $32,000 as per their website. This policy does not include significant dental or vision coverage either.Huh?!? Methinks you got an extra zero in there somewhere. I just did a quick run at their website, using a hypothetical typical family: husband aged 40, wife aged 38, and two kids aged 10 and 12. The highest premium I saw on the list was $711/month or about $8500/year. That was with $0 deductable and max annual out-of-pocket of $3000 per covered person, for a absolute worst-case total of $20K/year. Plans closer to what you describe are down in the $300/month range.

I'm pretty sure I could diddle the ages and family makeup to get a larger premium, but $4000/month? Don't think so.

Jim Becker
06-03-2007, 7:44 PM
Many large companies actually self-insure these days, but have a firm like Aetna administer the plan for the group. My employer does things that way. Although my premiums remain "reasonable" (and we do use our coverage...), they do go up every year, but the health care spending of the 20K+ employees seems to be helping to keep large increases at bay.

The one thing I'm not pleased with is how certain medications have become "taboo" for coverage without a "trial" of something that's OTC. An example would be Fexofendine (Alegra) for allergies...something that actually works for me. Supposedly, when my current prescriptions run out, I have to do a "trial" with Claritin...something that is not as effective with me since I used to take it.

The one thing I hope I'm never exposed to are the so-called "consumer driven" plans...I'd have to seriously consider a change of employment (or switching to Dr. SWMBO's more expensive, but similarly featured plan) if that would ever happen. Way too much out-of-pocket expense as some here at SMC know all too well.

Pat Germain
06-03-2007, 8:28 PM
The one thing I hope I'm never exposed to are the so-called "consumer driven" plans...I'd likely change employers if that would ever happen. Way too much out-of-pocket expense as some here at SMC know all too well.

Is Luminos a "consumer driven" plan? My employer is really pushing this Luminos thing. Every year I get a separate information packet just about Luminos. I can't make heads or tails of it, but I get the impression it saves the company big bucks. Otherwise, they wouldn't waste money promoting it so much.

Jim Becker
06-03-2007, 8:52 PM
Is Luminos a "consumer driven" plan? My employer is really pushing this Luminos thing. Every year I get a separate information packet just about Luminos. I can't make heads or tails of it, but I get the impression it saves the company big bucks. Otherwise, they wouldn't waste money promoting it so much.

Yup..."buyer beware"...one of our fellow SMC-ers and his family have been suffering through Luminos...

Brian Elfert
06-03-2007, 8:52 PM
My health plan would have to get pretty bad before I would change employers. I get four weeks of vacation and two weeks sick leave after just six years at my employer. Each week of vacation is worth well over $1,000 to me.

The health plan we were scheduled to switch to was probably considered a consumer driven plan for the bottom two tiers of coverage. They still planned to offer a top tier of coverage which covers pretty much everything. A lot of companies are starting to not offer any full coverage plans at all.

Larger groups get better prices because a few major bills can be split over a lot more insured.

My brother worked for a company with 40 employees that was stupid enough to self insure. They had an employee with Cystic Fibrosis and his bills were sky high. The company had to drop their health plan because of this. No insurer would write the company health insurance for several years so the company gave employees money to buy their own health insurance.

Brian Elfert

Pat Germain
06-03-2007, 8:59 PM
Yup..."buyer beware"...one of our fellow SMC-ers and his family have been suffering through Luminos...

Thanks, Jim. I've never considered signing up for Luminos and now I'm glad I didn't. I'm sad to say the cynic in me kept saying, "Boy, the company sure is pushing this thing hard. Therefore, it must really suck somehow".

Art Mulder
06-03-2007, 9:13 PM
Until the US gets a handle on illegal immigration, there's absolutely no way national health care could even begin to work. As a US resident, just try to walk into a Canadian hospital and try to get non-emergency care. "Whattaya mean I gotta be a citizen?" We should be saying the same thing in our hospitals.


Pat, when I go to my doctor, or hospital, I need to show my OHIP (Ontario Health Insurance Plan) card. Seems pretty simple to me. You could do the same thing - you need a health card to get in, and illegal immigrants don't get one.

(Oh, I know that the larger issue of national health care is far from simple -- too bad you guys didn't do this back in the 40s/50s when we did -- , but I don't see how the citizenship requirement would be a problem.)

...art

Pat Germain
06-03-2007, 9:27 PM
^^ I agree, Art. Strangely, our laws demand hospitals treat illegals. The hospitals typically don't mind because the costs are reimbursed by the federal government. It's not the speediest of care, but illegals will eventually get free care.

Thus, in truth, illegals have national health care, but residents do not.

Even more strange is that many advocacy groups in the US think it's plain wrong to demand proof of citizenship for anything; even voting.

Art Mulder
06-04-2007, 10:06 AM
^^ I agree, Art. Strangely, our laws demand hospitals treat illegals. The hospitals typically don't mind because the costs are reimbursed by the federal government. It's not the speediest of care, but illegals will eventually get free care.

Thus, in truth, illegals have national health care, but residents do not.

Even more strange is that many advocacy groups in the US think it's plain wrong to demand proof of citizenship for anything; even voting.
'
I have no idea what our laws might be on that point. (Illegals, w'out documentation at hospitals.)

However, an OHIP card is not the same as proof of citizenship. It just means that you are either a citizen, or a legal resident, or a few other minor possibilities. I looked up the rules (http://www.health.gov.on.ca/english/public/program/ohip/ohipfaq_dt.html#Q1).

If I get sick in another province while travelling, I show my card and they bill Ontario. It can get sticky, depending on local rules and coverages. (the OHIP website warns that in Quebec, for instance, you may need to pay cash and claim receipts. But I think that is the exception, not the rule.

Many Credit cards here offer traveler's insurance for people who frequently enter the US.

ETA: I just looked further. (http://www.health.gov.on.ca/english/public/pub/ohip/amb.html) I found that visitors from other countries are fully liable for any land or air ambulance costs here in Ontario, but couldn't find anything about hospital costs.

Lee DeRaud
06-04-2007, 10:33 AM
Strangely, our laws demand hospitals treat illegals. The hospitals typically don't mind because the costs are reimbursed by the federal government. It's not the speediest of care, but illegals will eventually get free care.

Thus, in truth, illegals have national health care, but residents do not.Well, actually, what our laws demand is that hospital emergency rooms treat everybody, regardless of their immigration status or ability to pay. So in that sense we do have universal national health care...as long as you're willing to sit around in an ER waiting room all day for health issues that in no way qualify as "emergency". And people, illegal or otherwise, using the ER as their primary-care physician is a real problem.

Lee DeRaud
06-04-2007, 10:36 AM
Even more strange is that many advocacy groups in the US think it's plain wrong to demand proof of citizenship for anything; even voting.Main issue there is that a largish portion of the citizenship don't have anything that would qualify as "proof of citizenship", or at least don't carry it around with them. (In my case, we'd be talking about either birth cerificate or passport, neither of which is likely to be in my pocket at any given time.)

Further complicating the issue is the size and structure of our country: I'd hardly expect a worker-bee at a California polling place to be qualified to judge whether (for example) a birth certificate from Alaska was authentic or not.

Now if you want to discuss why a national ID card is a good/bad idea, fine...but that's a completely different issue, opposed by a (mostly) separate set of advocacy groups.

Pat Germain
06-04-2007, 3:23 PM
Well, actually, what our laws demand is that hospital emergency rooms treat everybody, regardless of their immigration status or ability to pay. So in that sense we do have universal national health care...as long as you're willing to sit around in an ER waiting room all day for health issues that in no way qualify as "emergency". And people, illegal or otherwise, using the ER as their primary-care physician is a real problem.

Lee, the primary difference is, if I go the ER, I get billed for the services. If I don't have insurance, I must pay out of pocket. However, someone who has no traceable income, like an illegal immigrant working under the table, won't have to pay anything.

Lee DeRaud
06-04-2007, 4:37 PM
Lee, the primary difference is, if I go the ER, I get billed for the services. If I don't have insurance, I must pay out of pocket. However, someone who has no traceable income, like an illegal immigrant working under the table, won't have to pay anything.They can bill you, but if you can't pay, that's as far as it goes.
Hint: it has nothing whatsoever to do with the immigration status of the patient.

Pat Germain
06-04-2007, 8:31 PM
They can bill you, but if you can't pay, that's as far as it goes.
Hint: it has nothing whatsoever to do with the immigration status of the patient.

I think you're missing my point here, Lee. I'm trying to say people who can't pay for medical care put a very large strain on the system and the government, ultimately the tax payer, ends up paying for it. A large percentage of such people are indeed illegal immigrants. I know their immigration status doesn't determine anything. The fact they can't pay and can't be forced to do so does matter.

As for folks like me, if we have a job with an income of any kind and a Social Security number, the hospital is going to shake us down. If they're not paid promptly, they'll turn the bill over to a collection agency pronto. The collection agency will hound you mercilessly. My in-laws go through this all the time. They are very low income. They'll make arrangements to make payments. Then they get a call saying their bill will be turned over to a collection agency if they don't come in and pay it immediately. :rolleyes:

Thus, if the US ever tries to bring about national healthcare, we'll first have to figure out what to do about the over 12 million illegal immigrants who are here. People won't tolerate paying extra taxes to bring them into the system. Yet, we can't expect them to just pack up and leave.

Jeffrey Makiel
06-05-2007, 12:21 AM
Huh?!? Methinks you got an extra zero in there somewhere. I just did a quick run at their website, using a hypothetical typical family: husband aged 40, wife aged 38, and two kids aged 10 and 12. The highest premium I saw on the list was $711/month or about $8500/year. That was with $0 deductable and max annual out-of-pocket of $3000 per covered person, for a absolute worst-case total of $20K/year. Plans closer to what you describe are down in the $300/month range.

I'm pretty sure I could diddle the ages and family makeup to get a larger premium, but $4000/month? Don't think so.

Lee,
I hope you're sitting down because I never open a renewal notice standing up.

Below is a screen shot of a standard comprehensive family policy (point-of-service) with a $2,500 deductible plus co-insurance from New Jersey's Bluecross Blueshield website rate calculator. It does not really cover dental (that is, it does not cover things like root canal, implants, crowns, etc.). It also does not cover vision. It's a whopping $2,900 per month (not per year)!

http://i3.photobucket.com/albums/y84/Beff2/BCBS-2.jpg

Wait...it gets better. To up the anty, below is a screen shot of a better policy that has a lesser deductible, and less coinsurance. It is also a comprehensive family policy but still similar to what folks had 10+ years ago. The rate is $6,547 per month... and I did not use photo editing software. Honestly! :)

http://i3.photobucket.com/albums/y84/Beff2/untitled-1.jpg

I did not check the rates lately for an HMO policy, but I believe they are around $2,500 to $3,000 per month too. And don't think that you will get executive care. I often wonder if there is an unwritten corporate policy to deny all initial claims.

And...to prove my point that individual policy holders get shook down on the rates versus corporate rates, consider this: The Bluecross/Blueshield rate provided to elected and civil service federal employees is very comparable to Plan D shown above at $78,500 per year. However, the federal government is given a rate of about $16,000 per year in NJ (the federal employee pays 25%). Individual policies are escalating around 20% per year, but Federal policies are only increasing 3 to 5% per year.

Why can't all American citizens share in this lower rate schedule? That is, why not a national health care system? After all, considering that Medicare (parts A, B and D) and State funded support for the uninsured and under-insured are really just national plans, we are probably 40% on the way towards a national system anyway. And the number keeps growing every year.

It's insane! But the good news is that mental health care is covered by the better plan...you just may have to appeal the denied claim a few times. :)

-Jeff :)

Lee DeRaud
06-05-2007, 12:34 AM
Lee,
I hope you're sitting down because I never open a renewal notice standing up.

Below is a screen shot of a standard comprehensive family policy (point-of-service) with a $2,500 deductible plus co-insurance from New Jersey's Bluecross Blueshield website rate calculator. It does not really cover dental (that is, it does not cover things like root canal, implants, crowns, etc.). It also does not cover vision. It's a whopping $2,900 per month (not per year)![snip]
Wait...it gets better. To up the anty, below is a screen shot of a better policy that has a lesser deductible, and less coinsurance. It is also a comprehensive family policy but still similar to what folks had 10+ years ago. The rate is $6,547 per month... and I did not use photo editing software. Honestly! :) I believe you when you say you did not use photo-editing software, but then again, I was not hallucinating when I saw the numbers on the Blue Cross website I quoted earlier. Care to share what family/age/medical-history parameters went into that quote? Because I have a lot of trouble believing it's simply a difference between Blue Cross in New Jersey and Blue Cross in California.

Jeffrey Makiel
06-05-2007, 6:59 AM
Lee,
Here's a description from their website on Plan D (the highest one)...

"Horizon Traditional Plan D provides you with the highest percentage of coverage than the other traditional fee-for-service plans. Under Plan D, you can choose from annual deductibles of $500 or $1,000 with an 80% coinsurance and use any physician you choose. Using our Horizon Traditional Network physicians always keeps your out-of-pocket expenses low"

Their website is: https://www.horizon-bcbsnj.com/members_presale.asp?urlSection=members

I cannot find the definition of "familiy", but when I re-calculated the rate for "husband/wife", the rate was $6,235 per month vs $6,547 per month for 'family'. Age is not used in the calculation. Also, NJ has a law regarding medical coverage for pre-existing conditions. Pre-existing conditons are covered unless the pre-existing condition occured within the last 6 months upon applying for coverage. If so, the pre-existing condition will not be covered for 1 year.

In response to the bizarre rates for traditional plans and HMO plans, Bluecross has introduced a new plan called "Essentials". This plan is an HMO with very low maximum caps on routine care. It does not cover casts, braces, trusses, prosthetic devices, orthopedic footwear and crutches, chemotherapy, infusion therapy, transplants, diabetes benefits, hospice care or prescription drugs. This plan is a disgrace to Americans and a cry to our Congress that capitalism in the medical industry has failed.

-Jeff :(

Dennis Peacock
06-05-2007, 10:05 AM
Yup..."buyer beware"...one of our fellow SMC-ers and his family have been suffering through Luminos...

Yup...one of them is Me. All I have to say is that it's barely better than nothing. :mad:

Lee DeRaud
06-05-2007, 10:30 AM
That's just plain bizarre. I went in through here:
http://www.bluecrossca.com/home-visitors.html
...clicked on the link for 'find an individual plan' (upper right), and entered my (California) zipcode. The next screen asks for family info: I entered a typical family (since that was what you were talking about, rather than a mid-50's single man). The next screens show a list of twenty or so different plans, none of them even remotely close in price to the ones you show above. I didn't research the details of the coverage, but the mid-range ones look very similar to the plans offered by my former employers.

The friends I've talked to that have individual policies with other companies all report monthly premiums in the $200-$1000 range, the variances mainly due to number of covered family members. I personally wouldn't even consider BC anyway: they are under investigation out here, mostly for their draconian cancellation policies.

Feel free to take a look...I'd be interested in your theory as to the discrepancies in the pricing.

Jeffrey Makiel
06-06-2007, 9:05 AM
Lee,

On last night's Republican debate, one debater pointed out that the health insurance industry is currently not a national industry but rather an individual State industry. He also pointed out that ???? State pays $73 / month for insurance, and New Jersey pay $373 / month. However, he did not elaborate why, and given the dollar values stated, he's probably not fully in touch with reality. But, none the less, there was an acknowledgement of this disparity.

I think there are a few major drivers why New Jersey is significantly more out of control on costs:

1. New Jersey was once a heavily industrialized state. It offered decent paying jobs with health care benefits to low skilled and unskilled workers. It was a magnet for legal immigrants entering the country. Well, industry has decayed in the last 15 years and replaced with service/retail jobs which cannot support families, and generally don't provide health benefits. Unfortunately, the influx of immigration has not reduced accordingly. In addition, illegal immigration has made things worse. Now, too many folks don't have insurance either by choice or just because they simply can't afford it. This shifts the cost to folks who do have insurance. It has become a deadly spiral.

2. New Jersey is an overly litigious state. Recent reforms regarding vehicular personal injury suits have made suing more difficult for non-apparent and alleged injuries. It's been two years now, and auto insurance companies are coming back strongly into NJ and are offering lower rates. However, curtailment of lawsuits within the medical industry are not following this cue. Our courts don't seem to be able to differentiate between bad outcomes and negligence. Malpractice insurance is so high, that NJ physicians protested in Trenton, our State's capital, for reform. When have you ever heard of physicians gathering in the streets to protest? The worst hit are neurological surgeons, orthopedic surgeons and pediatricians. All higher risk disciplines.

3. New Jersey is the home to the pharmaceutical industry. We have just about all the major companies here (Bristol Meyer Squibb, Johnson & Johnson, Merck, Shering Plough, Novartis, etc.) They are a strong lobby, both nationally and within our State. In fact, CNN stated that there are two lobbyists for each Congress person. With unbelievable profit margins, I can only believe they help maintain the status quo of our failing system. I can only deduce that this type of incestual relationship is also occuring within other areas of medicine with NJ. As evident by the demise of many State and local officials in NJ, corruption is an issue.

I believe there are a lot of other reasons why health care in America is decaying. But I beleive these are the primary reasons why New Jersey is on the leading edge of this decline.

Thanks for asking for my opinion. It helps to get this off my chest. :)

-Jeff

Joe Melton
06-06-2007, 1:41 PM
I have a great policy, Blue Cross, offered through my employer, who pays 80% of the premiums. Blue Cross has agreements with certain doctors and hospitals, and those are called "preferred providers". (If my wife or I go to a non-preferred provider, BC pays significantly less, and I pay significantly more.) Typically, even a preferred provider writes off a portion for BC members. For example, my wife recently had an MRI, and the cost was $7681 and change. The hospital wrote off about $6100 of the cost, leaving $1500 for BC and me to pay. My portion was just a few dollars.
Now consider what my cost would have been if I had no insurance: $7681. It is obvious that uninsured people are subsidizing insured people. Imagine a typical uninsured person being confronted with such a bill.
I once had a bill from a lab for a blood test and the cost was $170. After write off, the cost was $1.80, and I paid a few cents. Every bill we get has a write-off in it.
If uninsured people had advocacy, there should be an uproar over this. I don't recall ever seeing anything in print about this disparity.
Joe

glenn bradley
06-06-2007, 2:31 PM
I should have invoked the 5 day waiting period before posting this. I'll try to do that when I get my annual property tax invoice.

-Jeff :)

Oh, don't get me started on the latest California property tax issues. I'm still recovering and my "new jointer" piggy bank is squealing.

Jeffrey Makiel
06-06-2007, 2:32 PM
Joe,
A provider charging $7,600 and then reducing it to $1,500 because the provider has a contract agreement with an insurance company is quite common. Although, your reduction was a little more than what I've seen. What many folks don't know is that if you don't have insurance, or your insurance won't cover the service, you will most likely get the lower rates anyway. Just talk to them. Providers understand that there is room for negotiation and they want some payment.

The fact that a provider tries to charge $7,600 for a $1,500 service is morally fraudulent but probably legal. Since one is unable to "shop" for services, it seems that providers are trying to take advantage of the uninsured and under insured. However, when confronting a provider about an excessively high billings when insurance won't cover the service, I've experienced reductions between 40 to 70%. I've actually experienced some providers completely waving their fee. So, I'm not sure what is going on here.

If our country adopted standardized regional usual and customary fees, would this erratic billing go away? The auto body repair world has this. If you think of all the different ways a vehicle can be damaged, and consider all the different types of vehicles out there, why is it so difficult to standardize a nuclear stress test, a colonoscopy, or an MRI? After all, insurance companies seem to be able to do it. This would put an end to changing doctors all the time and possibly the end of HMOs.

-Jeff :)