ChocolateBabz

You don't even have to read this if you don't want to, it's nothing new but I need to rant somewhere - and I know you lot will sympathize and make the right soothing noises.

We have BCBS, they are out third insurer (through hubby's work) in 8 years. Although premiums have stayed in the same neighbourhood our benefits have always gotten worse and our deductibles have always gone up. We now pay $400 per month for 3 of us with $3000/$5000/$10000 limits (individual/family/max ann oop).

We don't see the doctor very often, only two 'big' things in that time - hubby broken clavicle and me frozen shoulder plus a few small things, strep throat, ear infection type stuff so normally we don't get anywhere near our deductibles so the insurance never actually pays out a share - of course we get the benefit of the 'negotiated' prices 🙄

We used to see a doctor at Hermann Memorial but a couple of years ago they stopped taking BCBS and we swapped to Kelsey Seybold, last night I got an email saying they are going to stop accepting BCBS on Oct 1st.

What the heck are we paying for???? We are paying premiums for a PPO plan where we are getting a smaller and smaller pool of doctors who we can see in-network. We already use CVS minute clinic for minor things so it costs $69 for a visit instead of $100+ for our regular doctor.

One of my American friends says that next year they are signing up for the cheapest plan possible and not using it - instead they will pay cash for all services - so they have insurance for the 'just in case big expense' but they reckon they will save money paying cash for everything rather than use their insurance policy.

Which begs the question why have it - other than satisfying the aca rules?

Sorry - I don't expect you to solve any of these problems, I'm just annoyed because now I have to go find another doctor or make a snap decision when someone gets sick. How I pine for my small surgery back in the UK where I saw the same doctor for years and years 😢

Giantaxe

I think you answered your question in the first paragraph above - i.e. insuring against a catastrophic loss. That's certainly the approach I'd take if it weren't for my getting insurance through my employer.

sir_eccles

Narrow networks is one of the main ways the insurers are keeping costs down because the providers haven't really cut their rates. Between that and not being able to drop children with cancer that cost $10m a year to treat the insurance companies are between a rock and a hard place.

AlphaTangoMike

In my first few years in the US (and due to a lack of research on my part), I had a PPO plan. I then found out about HSA plans and have not looked back since. (I know that Pulaski is an advocate too). The idea being that it's a cheaper plan with a higher deductible (great if you're not seeing the Dr often / at all). Even better, you get to contribute to an HSA (health savings account) - these funds are yours for eligible medical expenses (it's like building a health insurance 401k). Most employers will contribute a set amount to your HSA and the money is yours to keep. Definitely worth looking into.

ChocolateBabz

We do have the High Deductible plan with HSA and it is also happens to be a PPO.

Our other choice is an HMO - higher premiums, lower deductible with an HRA.

We took the first choice in part because of the HSA benefit but also liked the choice that a PPO offered.

AlphaTangoMike

I see, sounds like it's just a cr*ppy plan then. /helpful

ChocolateBabz

Indeed

Pulaski

Which is what an increasing number of Americans are doing, and we started almost seven years ago (and have been banging on about on BE for four years, long before it got much traction) - and wished we had started years earlier. ....

Just salt money away in an HSA and then all your "out of pocket" medical expenses come from pre-tax income. As light users of medical services we have enough in our HSAs to pay the maximum family deductible for five straight years even if we stopped putting any money into our HSAs. So long as we keep on putting tax-deductible money into our HSAs I don't see how we could ever run them dry.

ETA I see you're already in a HD plan. Not sure what more I can say - I have never heard of anyone having issues with a HD plan. .... Though don't your $69 minute clinic fees come out of post-tax income?

ChocolateBabz

They do unless I claim it through insurance in which case it's the $59 negotiated fee (and counts towards my deductible) or I could use my HSA to pay for it.

I just wonder how practical it is to pay cash. Easy for a doctor office visit, I assume you just ask how much is my portion with insurance compared to how much I would pay cash. Not that the doctor always gets my insurance portion right, nearly every time I have underpaid or overpaid and got a bill or refund after the fact.

I can't imagine doing it for a hospital visit where you are getting separate bills from the hospital, dr, lab, aneatheseologist etc. When hubby had his surgery we could not get an up front estimate from anyone involved. Of course if it's an emergency there would be no way at all.

I could moan all day about insurance but I think I'll go make a cake and eat my feelings instead.

Pulaski

Why would you want to when you can channel your medical expenses through an HSA and pay it from pre-tax income? ..... I had assumed that is what your friend meant by "paying cash", not literally pulling out a wad of $20 bills, or even a cheque book.

Owen778

When I moved to the US in 2012, my company used Blue Cross Blue Shield. They changed to Cigna not long afterwards. I consider them to be moneygrabbing bastards, just like almost all of them, but the network is at least large.

We are on a high-premium plan, but only because of family-related financial reasons. Even considering that, a high-deductible plan may be preferable.

ChocolateBabz

She never mentioned an HSA so I assumed she meant cash/cheque but of course she could have meant from an HSA. For her it was more about getting a discount from the doctor for not filing through insurance.

Pulaski

I have heard some do, but I don't know how much. The ones I have heard of that do that are set up without all (or fewer) the billing staff and claims systems. I can't see most doctors giving a whopping discount when they still have to pay their staff and have office space and systems ready and waiting to process paperwork - it is effectively part of the fixed overhead of running a medical practice in the US. ..... And I doubt any discount would beat the 25% +/- "discount" you get by funneling money through your HSA.

The problem anyone might have who tried to truely "pay cash" for medical services is getting those cash expenses logged against the policy deductible. If you pay $1,000 in cash expenses, then later fall and break your leg and run up a $30,000 bill with a $3,000 deductible, if your $1,000 cash expenses aren't logged with the insurance company then they'll pay $27,000 and you're on the hook for $3,000. If the $1,000 is already documented you'd only have to pay another $2,000 out of pocket.

cautiousjon

Have you looked to see if it would be cheaper to buy your own private policy for you and your family? $400 /month is a pretty steep premium. You might find that you can get a plan directly with one of the healthcare providers. We have that option here in San Diego (with Sharp Healthcare), and it's what one of my friends got last year.

My company's policy is administered through United Healthcare, and United has a defined process for allowing users to retroactively log "cash receipts" against the annual deductible. Even with the "discounts" that United can obtain for us, the doctors' cash prices are often still cheaper.

Pulaski

I wonder if you can then claim reimbursement of the cash payment against an HSA or HRA?