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Interpretation of health insurance benefits

Interpretation of health insurance benefits

Old Jul 8th 2012, 2:35 am
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Default Re: Interpretation of health insurance benefits

Originally Posted by fatbrit View Post
I never gamble! Well, actually, I suppose I gamble on everything.....but only when I fully understand the odds. Unless you have substantial, unprotected assets, you're throwing $9000/yr on something that's probably worth almost nothing.
I understand where you are coming from - but I had been here two years, fit as a fiddle and then had a brush with the big C and the insurance company was billed nearly 30K. OK, so they only paid about 60% of that but boy was I glad I had insurance.

I'm just low on the risk thresh-hold I guess.
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Old Jul 8th 2012, 2:47 am
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Default Re: Interpretation of health insurance benefits

Originally Posted by SanDiegogirl View Post
I understand where you are coming from - but I had been here two years, fit as a fiddle and then had a brush with the big C and the insurance company was billed nearly 30K. OK, so they only paid about 60% of that but boy was I glad I had insurance.

I'm just low on the risk thresh-hold I guess.
Unfortunately, if Geoff has a similar medical cost every 3 years, he'll still be better off without insurance given what they're charging him. Frightening thought!

I'm paying less than half his quotes for interim obamacare ($2k deductible, 80/20, $6k max oop),and I'm not convinced I'm quids in. Well I probably am, but as medical bills this year were going to cause a huge tax right-off, I've had my ingrowing toenail fixed and my moles removed. Wouldn't have bothered otherwise.

Another operation has cost me about the same it cost me with no insurance. The only advantage of the insurance was I don't have to negotiate with the retards in the billing department as the insurance company do it for me
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Old Jul 8th 2012, 4:46 pm
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Default Re: Interpretation of health insurance benefits

Originally Posted by fatbrit View Post
I never gamble! Well, actually, I suppose I gamble on everything.....but only when I fully understand the odds. Unless you have substantial, unprotected assets, you're throwing $9000/yr on something that's probably worth almost nothing.
Everything is a gamble! If you choose not to pay for insurance then your actual costs for the year can run from nothing to unlimited. With the insurance it restricts the range from $9k to $12k.

If it was just about my pre-existing conditions (recent eye surgery) then I'd be confident and say I wouldn't need insurance to cover that as I know the risks - I could jump on a plane and see my old eye doctor in the UK as I knew how much that op cost (private healthcare, not NHS).

But it's the unforeseeable - hit by a truck, cancer, or whatever.

When you say they can drop you, that would have to be after the event, right? So they'd pay the bill and then say bye-bye? I could live with that. But if they fainted at the size of the bill and refused to pay then I can see your point.

What about in Bob's case where he's getting bills from a year ago - if he was covered at the time then the insurance should pick up the bill, even if he was no longer with them when the bill came through, right?

[Arguments over bills excluded for simplicity]
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Old Jul 8th 2012, 5:41 pm
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Default Re: Interpretation of health insurance benefits

Originally Posted by GeoffM View Post
Everything is a gamble! If you choose not to pay for insurance then your actual costs for the year can run from nothing to unlimited. With the insurance it restricts the range from $9k to $12k.

If it was just about my pre-existing conditions (recent eye surgery) then I'd be confident and say I wouldn't need insurance to cover that as I know the risks - I could jump on a plane and see my old eye doctor in the UK as I knew how much that op cost (private healthcare, not NHS).

But it's the unforeseeable - hit by a truck, cancer, or whatever.

When you say they can drop you, that would have to be after the event, right? So they'd pay the bill and then say bye-bye? I could live with that. But if they fainted at the size of the bill and refused to pay then I can see your point.

What about in Bob's case where he's getting bills from a year ago - if he was covered at the time then the insurance should pick up the bill, even if he was no longer with them when the bill came through, right?

[Arguments over bills excluded for simplicity]
The point is that the cost is not unlimited since bankruptcy is not a particularly difficult option in the US.

At the moment, they'll drop you as soon as they can after the event if you're not on an employer's group plan. Either that or charge you so much you'll voluntarily leave the plan. Not sure what's happening in 2014 -- not sure anyone is!

They'll pay for any service that were delivered during the policy's validity. As a corollary, any payment you make is only tax deductible in the year when you make payment, not when the service was delivered.
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Old Jul 8th 2012, 6:05 pm
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Default Re: Interpretation of health insurance benefits

Thanks. Presumably bankruptcy would kill your credit score and show up in your credit history though?
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Old Jul 8th 2012, 6:26 pm
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Default Re: Interpretation of health insurance benefits

Originally Posted by GeoffM View Post
Thanks. Presumably bankruptcy would kill your credit score and show up in your credit history though?
Oh yeah! Although, surprisingly, some lenders are quite happy to lend to bankrupts -- they can't file again for x years. Also, your credit score is heavily weighted to the last 2 years, so you can recover quite quickly if you plan it out.
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Old Jul 8th 2012, 9:26 pm
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Default Re: Interpretation of health insurance benefits

Originally Posted by GeoffM View Post


What about in Bob's case where he's getting bills from a year ago - if he was covered at the time then the insurance should pick up the bill, even if he was no longer with them when the bill came through, right?

[Arguments over bills excluded for simplicity]
Yup, you'd be covered, but it might be more hassle as they like to play games and deny things to make you go through hoops to show you were in fact covered by them at the time of service.

It's a time sink.
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Old Jul 8th 2012, 10:04 pm
  #23  
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Default Re: Interpretation of health insurance benefits

It helps to keep every piece of paper the insurance company sends you (from renewal of membership card to notification of prescription drug list to every invoice).

..... and I always keep a record of my visits, who I saw and what tests were carried out.

Paranoid I know .........
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Old Jul 8th 2012, 10:59 pm
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Default Re: Interpretation of health insurance benefits

Originally Posted by GeoffM View Post
Thanks. Presumably bankruptcy would kill your credit score and show up in your credit history though?
A bankruptcy is better then years of fighting the hospital and then collections when they decide to give up and let a collection agency deal with it.

My credit recovered faster after the bankruptcy because I now had no debt, and I wasn't having a negative reported every month from the collection agency.

And insurance companies pay good money to lawyers who will find ways to not pay a claim.

I was getting letters from car loan companies 6 months after my bankruptcy and was approved for a loan 9 months after.
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Old Jul 8th 2012, 11:22 pm
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Default Re: Interpretation of health insurance benefits

Wow... so bankruptcy isn't so much of a stigma here as it was in the UK then.
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Old Jul 9th 2012, 12:44 am
  #26  
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Default Re: Interpretation of health insurance benefits

Originally Posted by GeoffM View Post
Wow... so bankruptcy isn't so much of a stigma here as it was in the UK then.
Bankruptcy usually means you got ill and didn't have insurance. The stigmatized group is quite large these days.
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