Are you happy with your health care plan?!
Question: and why, and what do you think we can do to change it?
Answers: and why, and what do you think we can do to change it?
Most of my life I've been uninsured. So I'd like to point out a plan that would be better than what we're offered now.
See the PDF here:
http://www.booklocker.com/books/3068.htm...
Key points there and in the book itself:
Catastrophic care for ALL who want it. Along with one physical with follow-up per year for a reasonable co-pay so preventive care which is ALWAYS cheaper can be the norm. Also ONE ER visit per year if needed (how to prevent abuse is covered). The premiums would be AFFORDABLE (not only is catastrophic care cheaper, but this would be sliding-fee scale because it's to EVERYONE's advantage that all CAN afford health insurance. The plan is designed to move from a government offering that PAYS FOR ITSELF to private sector over 30 years. There would be limits on out of pocket expenses. NECESSARY meds would be covered--no fertility drugs or ED drugs, but people can pay for those on their own OR have another policy--no policies are abolished with that plan. No more "donut hole" idiocy in Medicare. Also no ridiculously low "caps" on NEEDED procedures.
Given that half of all bankrutpcies are for medical bills and most Americans declaring bankruptcy have medical insurance, clearly the current system fails miserably.
Now predatory lenders have leapt into the fray. We'll see a significant escalation in bankruptcies again:
http://www.businessweek.com/bwdaily/dnfl...
People do NOT have the health care coverage they THINK they do in too many cases and it's when you're at your most vulnerable that you discover that. That's simply wrong.
As quality care CAN be delivered at a reasonable price, there is no reason this plan can't work (funding is explained in the book in the PDF even).
Doubt that? What has happened with LASIK prices over the last decade? Gone DOWN. Plastic surgery--cheap or expensive?--cheap compared to things like an appendectomy and a "tummy tuck" is equally major. In fact, MORE major unless peritonitis has set in.
Some docs have rebelled against control by others:
http://www.simplecare.com/
This is fixable, but sense will have to return to people.
I'm MOSTLY content with my health care plan. Naturally, I can think of things I would like to change, but compared to most others that I've seen, I think I actually have a pretty decent deal going on.
My plan is Blue Cross Blue Shield, basic option (there is 'basic' and 'standard' offered where I work) for federal workers (so my particular plan may not be available to people who don't work for the government, I wouldn't know).
Things I like about my plan:
It's affordable (I pay about $100 out of every 2-week paycheck to have coverage for myself and my wife - we have no children).
Even though I'm forced to stick with the network (the 'standard' option doesn't have this restriction, and I could have chosen that, but I went with basic for other reasons, more on that later), the network is fairly large and I feel I have a good selection of physicians to choose from.
If I want to see a specialist, I don't need a referral from my primary physician. I can just pick one, make an appointment and go.
If I am prescribed a newer medication which is still under patent (meaning that generic is not yet available because the medication is too new), I don't have to go through any extra messy paperwork or approval junk. The co-pay for these meds is higher, but I can just go to the pharmacy, hand in my prescription, and get my meds with no hassles.
My plan does not have an annual deductible. THIS WAS THE SINGLE BIGGEST REASON THAT I SELECTED MY PARTICULAR PLAN OVER THE OTHERS THAT WERE OFFERED ME. Basically, how these annual deductibles work is that you have a set amount, say $500 for example, that you must pay during the course of a year before the insurance company will come in and say that you only need to pay your co-pay. Before you dish out this $500, the insurance company really only limits the amount the doctors can charge you for a visit.
So lets say that your plan has a $500 deductible, $15 co-pay, and the doctor normally charges $120 for your visit but has a deal with the insurance company to charge only $100 to people on your plan.
The way this would work is that if you have not yet paid $500 towards visits during that year, the insurance plan will tell the doctor your visit is worth $100, and that is what you will pay for the visit. At this point the insurance plan only helps to limit what the doctor charges.
After you have had enough doctor visits (say, 5 visits to the same doctor above for the same thing, for example) that you have shelled out $500, then your insurance plan will come in for the remainder of the year and help out. What happens at this point is that first the plan reduces the doctor's fee to $100, like it always does, then you pay your co-pay ($15) and the insurance picks up the rest of the tab ($85).
When the year is up, your deductible recycles, and you have to shell out $500 again before you get to enjoy the benefit of simply having a co-pay.
I CAN'T TELL YOU HOW PLEASED I AM THAT I DON'T HAVE TO GO THROUGH THAT JUNK!!!!
My plan doesn't have the deductible at all. The annual deductible is a big fat zero. There is a trade-off, however...
I have a higher co-pay. To compare my plan, the 'basic' option against the 'standard' option, it works like this...
The 'standard' option has a $15 co-pay for visits to a non-specialist, and a higher co-pay (I think it's like $20 or $25) for a visit to a specialist. The 'standard' option, however, has that annual deductible (I forget how much, but I think it's more than $500, it may be like $1k or $2k or something like that) that needs to be overcome before that co-pay kicks in.
My plan, the 'basic' option, has no annual deductible, but I pay a co-pay of $20 for non-specialist visits (standard pays $15) and I pay $30 co-pay for a specialist. For me, it's preferable to pay the higher co-pay in exchange for the benefit of being able to ALWAYS be in 'co-pay' status, with no deductible to worry about. I can enjoy co-pay status immediately.
So those are the biggest 'plusses' to my plan. The 'standard' option, in comparison, has the deductible, comes with a higher price out of every 2-week check, provides a lower co-pay, and does not restrict your choice of physicians to a 'provider network' (although your co-pay is higher if you go to a doctor outside the network, and the plan won't limit how much an out-of-network doctor charges you). The standard plan also forces you to get a referral before you can see a specialist.
Me, I'm fine with using the network doctors and, with only a few exceptions, I'm pleased with the doctors I've been to. Being restricted to the network is just that, a restriction. I think that the network is large enough, however, that the restriction is a minor consideration, and really doesn't matter much. With the number of doctor visits my wife and I have over the course of a year, it turns out to be less expensive for me on the 'basic' plan. Even though I have a slightly higher co-pay than the people on 'standard' plan, I actually end up paying less money in the long run. Not only that, but I get to spread out my overall medical expenses from day one; I don't need to shell out big bucks in the beginning because of some crazy deductible.
Also, it has been very nice being on a plan where I could FINALLY afford to have the sinus surgery I've needed for years and years! I still need more done, but just having my deviated septum fixed has improved my life tremendously. Adenoids next, but the only thing keeping me from doing that is free time for recovery. My plan makes surgery and stuff like allergy testing and shots VERY affordable, compared to other health plans I've seen.
So the big things I like about my plan are...
1) No annual deductible
2) No hassles with prescriptions for newer meds
3) Large provider network
4) No referrals needed for specialists
5) Affordable premiums
6) Affordable surgery
What, then, do I NOT like about my plan?
Just one thing, really. The way they handle mental health is a HUGE pain in the a*s! My wife suffers from several acute cases of a combination of emotional/mood disorders. On my plan, if you need to see a psychologist or pschiatrist (and my wife DOES need to see them), you have to first get permission from AN ENTIRELY DIFFERENT COMPANY that the insurance company has contracted to handle mental health stuff. This other company puts you through all sorts of paperwork and confusing regulations and guidelines and NIGHTMARISH, crazy stuff before you can be approved to see a mental health provider. And as if that wasn't bad enough to start with, they limit the number of visits you can have and then the provider has to periodically submit approval requests to them for another 'batch' of visits. IT'S PURE HELL. Even worse is that this is happening to mental health patients! These people really need help and all the red tape and turmoil of this system exponentially increases their anxiety and depression (if they suffer from that), thereby EXACERBATING the very conditions they need help for!!!
When it came to getting my wife's mental health providers approved, et cetera, I did everything for her. I set it up, dealt with all the red tape, and so on, so that she wouldn't have to. It was hell for me to go through and I don't suffer from her conditions! It exhausted me to go through all that junk!
I think if my wife had been forced to do it on her own, she probably would have just given up and tried to commit suicide (again, she's made four attempts throughout her life -only two since we've been together - and they were all for less stressful things than what I had to go through to get her set up with her mental health providers).
So if I could change that one thing; if my insurance company would stop doing all that crazy stuff with mental health (no pun intended) and just consider mental health providers like they do any other doctor; I would be perfectly pleased with my plan. If they could just dispose of that hassle and red tape so my wife could just choose a mental health provider from the network and go, just like she can with other doctors, and not have to worry about the bureaucracy of it all, I swear I would drive to the Blue Cross Blue Shield corporate headquarters and give either a hug or a kiss to everybody I see!
That would not only make my day, it would make my week, my year, my life!
And if anybody from Blue Cross Blue Shield ever reads this, you can hold me to what I just said. If you guys can reform the whole mental health thing. I promise I really, truly, will drive to your headquarters and either hug or kiss every single person I can get my hands on! I don't joke; I'm totally serious.
Just on the improbable, off-chance a BCBS executive actually DOES see this, my group code is 112.