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Archive for the ‘health insurance’ Category

Why I Despise my HSA – Part Five

Posted by eemilla on February 13, 2011

(Continued from Parts One, Two, Three, and Four)

After over eighteen hundred words complaining about my current health insurance coverage, I would like to clearly and unequivocally express my gratitude that I have an employer that pays a large portion of my premiums in addition to providing a moderate yearly contribution to my HSA; I would also like to show my gratitude that my husband’s employer provides a small reimbursement for his coverage too, and that we can still afford to pay for the remaining premiums.  I have many family members and friends that are uninsured because they either work for an employer that doesn’t provide coverage, they cannot afford coverage on the individual market, or they are looking for employment after losing the jobs which provided their coverage.

Although I haven’t read the Patient Care and Affordable Care Act, I have listened to numerous podcasts and read ample articles discussing the law.  Like most Americans, I like that health insurance companies can no longer non-renew policies after subscribers get sick.  I’ve never thought making people wait for their pre-existing conditions to have coverage is overly unfair because this is generally a twelve to eighteen month waiting period only if there was a lapse in coverage, but now this will eventually be eliminated; however, I recently discovered that even if one maintained continuous coverage with an individual policy but didn’t carry maternity coverage that the maternity coverage could neither be added nor could one purchase a new policy to provide maternity coverage without a waiting period.  I’ve always had a problem with the discrepancies between group and individual coverage, and after 2014 individual policies will be treated more like group policies in that age, gender, and location are considered when calculating the premium not whether someone has ever taken medication to treat anxiety or depression.  Another favorite provision is that all health plans will eventually pay for preventive care without any co-pay or deductible (this is already in effect for plans purchased after September 2010, but won’t begin for current plans until 2014), although whether the global billing package will come into play or not isn’t clear (in fact the section on pregnancy at sounds suspiciously like my current health insurance policy).  Finally my favorite provision is that all those elected officials who are trying to repeal healthcare reform and who proclaim that American healthcare is the best in world will no longer have government provided healthcare after 2014.

Insurance only works when the risk is spread over a large pool of people, and without a strong incentive to purchase coverage young and healthy people would continue to not carry insurance (this is why I don’t think waiting periods for pre-existing conditions is entirely wrong).  It is inappropriate to call the provision an individual mandate, as it is one’s option to either purchase insurance or pay a tax, which frankly will probably be less than obtaining insurance coverage in most instances.  Numerous studies have shown that the uninsured do not obtain preventive care, receive less treatment after diagnosis, and have a higher mortality rate than the insured.  They often receive their care at free or low cost clinics or emergency rooms or urgent care centers, and while these places provide valuable services, they are not a substitute for regular check-ups and treatment.

However, I do not like the fact that the law doesn’t firm price controls while pushing large numbers of people into the private market or even establish a state by state standard of usual and reasonable cost index for care (my greatest difficulty with my HSA has been to find out the cost of care prior to obtaining care).  In North Carolina, if you wish to obtain a driver’s license you must first obtain automobile liability insurance, and no insurance company can refuse to write a liability policy for any driver that can provide proof of North Carolina residency regardless of their driving record.  This works because the state has a reinsurance facility, which is funded by a surcharge to every single auto policy written in North Carolina; the insurance companies then send all the high risk policies to this pool.  If you are a high risk driver and need to have collision, no company is required to provide the coverage, but most companies will provide the coverage because again they can send the policy to the high risk pool.  The state sets the maximum auto rates as well as approving what discounts and rate reductions each company can provide; a high risk driver must agree to pay higher than the state rates to obtain collision coverage.

This model seems to work fairly well for all parties in the state, and I wish the healthcare law had enacted something similar.  A basic policy would be required to be issued, and a maximum rate for this coverage would be set.  The basic policy would cover preventive care along with a few sick visits and generic prescription drug coverage with some out of pocket costs, and it would be the same basic policy with every insurer (like the North Carolina auto policy).  Each company could offer enhancements and of course charge for those, but again there would be a maximum rate any company could charge for any policy.

Although the health insurance exchanges are purported to be the best way to control cost, I fear that the sick will be pushed to exchanges exclusively with the young and healthy primarily insured outside of the exchanges.  This is sure to bring about failure of the exchanges if they are heavily loaded with those that are more expensive to insure.  I also don’t like that even though the insurance companies are about to get an influx of customers the federal government is going to be subsidizing the high risk; why can’t the health insurance companies use their increased profits with their broader customer base to fund the high risk pools?

I also like that an excise tax will be levied against drug companies to help pay for the healthcare bill, but I really want to see an end to prescription drug commercials in all media.  As doctors have the power to prescribe, the advertising should be limited to that population.  If a patient wants to explore treatment options access to medical journals is open and available.  I loathe how much money is spent on those incessant commercials when public funds contributed to their research and development only to have private companies then hold patents for years to ostensibly recoup their development costs.

Even after all this thought, I am still undecided as to whether I will continue with the HSA or not;  if I move back to the traditional plan I will no longer get my little bonus from my employer, and we’ll still have some fairly large out of pocket expenses if I get sick.  I have quoted policies for the little one, and if we do an HSA with a $5,000 deductible the premiums will be less than $100 a month, but a traditional plan without huge out of pocket expenses it will be over $200 a month for a newborn that doesn’t smoke or drink or engage in other destructive behaviors.  However, if we decide on a plan for the little one and my honey we can have a $10,000 deductible with no co-insurance for about the same monthly premiums we are paying now, and as we will be purchasing this policy later this year, thanks to the Patient Protection and Affordable Care Act, preventive care is fully covered even in a traditional health policy.

I am interested to see how all of this plays out between now and 2018 when the final provisions of the bill become effective, and I will strenuously protest anyone who dares to repeal this law without codifying virtually all of its patient protections and adding a cost ceiling.  If it survives beyond 2014, I will be rather interested to see how those who praise American healthcare as the best in the world are dealing with being on the private market rather than on the free government provided care they currently have.


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Why I Despise my HSA – Part Four

Posted by eemilla on February 6, 2011

(Continued from Parts One, Two, and Three)

Dealing with the global billing package is working against us again because we decided to change providers.  I initially went to the obstetrician because when I called the midwife last year to see if they contracted with my health insurance company they didn’t, and out of network benefits have a higher deductible and coinsurance.  However after three visits with the obstetrician, I decided to at least explore the increased cost of out of network care only to find out the midwifery practice had begun working with my health insurance company.  The first visit at both the OB and the midwife left us with a payment schedule, so we have already paid the OB practice a few hundred dollars towards our estimated share of the global package, and they have yet (after about two months of being aware of our transferring our care and a phone call requesting it) sent a statement of our account.  I called back with my health insurance statement in hand, and after two more phone calls they issued a refund check, which includes treatment they billed for that I never received.

As previously stated I have a real problem with the uninsured subsidizing the health insurance companies.  I understand statistically the insured are healthier than the uninsured (due to obtaining preventative care and getting early diagnosis and treatment), and I understand the benefits of buying in bulk; in most cases I support it (we’re members of the French Broad Food Co-op, and I used to belong to Sam’s Club).  However, it is morally devoid that people trying to take care of themselves should subsidize companies that basically have monopolies; over 70% of health policies in North Carolina are with Blue Cross Blue Shield, and they even promote themselves as having the largest market share in the state.  According the NC Department of Insurance, in 2008 United Health Care ranked second for NC policies with less than 13% of the market.  In 2009, the CEO of BCBSNC earned almost $4 million all the while raising premiums for policy holders in a down economy, and BCBSNC is a non-profit (although thankfully not tax exempt).  Both my husband’s and my premiums increased from 2009 to 2010 and again in 2011 (I sincerely appreciate my employer not increasing my portion of my health insurance), and we can only expect another increase next year plus what we will have to pay for a third policy for our little one (as it is prohibitively expensive to add anyone to my plan, and we are probably not going to do an HSA with the kid).  In 2004 the Kaiser Family Foundation found that the uninsured paid about a one-third of the cost of their medical care, leaving the rest to be paid by charity, federal, state, or local governments, or the providers, and in 2008 Families USA found little had changed.  However, the uninsured is billed double (in most cases based on numerous personal experiences) what most insurance companies are billed.

Before this year,  I would have thought an HSA/HDHP would have been fine for a child too since most of the visits would be for wellness check-ups and vaccinations (although we might be struck with the new parent urge to rush to the doctor at every little “symptom”).  However, in reviewing my policy there is no mention about the global billing package so what surprise might be waiting for us for the little one’s care?  My policy does state that “all maternity-related medical services for prenatal, postnatal, delivery, and any related complications” are covered, and when I refer to the Schedule of Benefits I find that in network services are the same “as those stated under each Covered Health Service category in this Schedule of Benefits except that an Annual Deductible will not apply for a newborn child whose length of stay in the Hospital is the same as the mother’s length of stay.”  The term “global billing package” is absent from the definitions section of my policy, too.

In shopping for health insurance it is impossible to know what you are truly purchasing because even though the marketing material might imply or explicitly state one thing the policy will always supercede, and until the policy is purchase I don’t know of a single insurance company that will provide a copy of the policy for perusal.

To be continued.

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Why I Despise my HSA – Part Three

Posted by eemilla on January 30, 2011

Continued from last week’s Part Two (and Part One previously).

My second rude awakening came when I changed providers from an obstetrician to a midwife.  The OB had the ultrasound equipment in their office so I didn’t even think of going anywhere else to obtain my twenty week ultrasound, but the midwife contracts with a different OB to perform ultrasounds and to be the back-up if the delivery becomes high-risk so I had the option of using their OB’s office or Mission Hospitals Radiology.  Knowing that I would have to pay for this out of pocket, I decided to call the insurance company to find out the cost as the midwife’s office only knew the uninsured price ($300).  In my naivete, I called the insurance company expecting a simple answer; but I failed to remember what I was dealing with.  After navigating their automated service, the human operator needed the CPT code; I explained I didn’t know it or even what it was, and I asked if he could look it up by the name of the treatment.  He declined so I called the midwife’s office to obtain the requisite information, and if I had been smart, I would have put him on hold while I did so.  I obtained the CPT code along with the diagnosis code, and I called the health care company back to price shop my twenty week ultrasound.  My second health insurance employee took the CPT code after reading through her script then informed me the price isn’t guaranteed and is only an estimate.  I asked if there was anyway to obtain the actual cost to which she replied once the service had been billed, the claims department would know the actual cost of the service.  I then asked if I could speak with the claims department or if she could request the price from the claims department?  She explained that even if she could transfer me or contact the claims department, they would not know the exact cost because the doctor’s office might not use the CPT code or diagnosis code they provided me.  With a rising temper, I asked why I needed the CPT code, which I assumed would allow the operator to pull the contracted price from my specified provider, if there was no way to know how much any procedure would cost until it was billed?  She advised that without the CPT code the estimate range would be even greater like those provided on the health insurance company’s treatment cost estimator website.  As the point of the call was to compare between the midwife’s OB office and Mission Radiology ultrasound, I asked her to provide the cost for Mission.  However, she was not able to even provide an estimate as facilities don’t always publish their prices.  After this answer, I was incensed so I retorted how ridiculous this whole situation was; if the whole point of an HSA is to encourage patients/insureds/consumers to price shop why is it impossible to obtain a price for a basic service that is performed on virtually every single pregnant woman in the US, and not wanting to hear her script I hung up after thanking her for being completely unhelpful and wasting my time.  On another note, I was never able to speak with anyone at Mission Radiology to find if they could provide the cost of the twenty week ultrasound on a first pregnancy.

The cost for the ultrasound in my first OB’s office was $120 (per the billing plan provided by the obstetrician’s insurance liaison), which is the same cost the health insurance company estimated for the midwife’s OB’s office.  The actual amount billed by the midwife’s OB is $225 less a $104.35 discount for having health insurance so $120.65 is what we’ll pay.  There again, the uninsured pay $300 while the insured pay $120 for the exact same service.

To be Continued.

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Why I Despise my HSA – Part Two

Posted by eemilla on January 23, 2011

Continued from last week’s Part One.

Ha!  I did get pregnant right after signing up with my HSA, although it was another few weeks before I knew.  I then brightened at the idea that the HSA covers preventive care fully, so I just knew all of my prenatal visits would be taken care of.  Well, health insurance companies are wily so they devised a way to not pay for prenatal visits.  They still consider them preventive care in their marketing materials and other publications aside from the policy itself (keep in mind the policy will always supersede all other communications), but all pregnancy care is billed at one time in what is called a global package.  The global package isn’t billed until the baby is delivered, and because the preventive care prenatal visits are thrown in with the delivery they lose their full coverage.  It’s like Spanish grammar, a group of females uses the female pronoun, but if there is one male in the group then the male pronoun takes over.

Once I got over the injustice of my prenatal visits not being fully covered as all preventive care is supposed to be, I was hit hard with almost five hundred dollars in lab work.  Now I know lab work is expensive; in 2003 I did some basic blood work at my provider’s suggestion, and the lab billed over $275.  The insurance company paid about $63 (thanks again to the uninsured for subsidizing my health insurance company).  Although I’ve been in a sexually exclusive relationship for over a decade, and neither of us have ever tested positive for any sexually transmitted infections or diseases (we have both been tested a few years back), I had to pay over three hundred dollars to confirm that I didn’t have syphilis, HIV, or gonorrhea.  The other tests were to confirm I had sufficient levels of iron and no urinary tract infections or proteins in my urine, so even though I was shocked at the cost, it didn’t upset me like the wasteful other tests.  If I had been found to have an STI, I might be singing a different tune, but really it was my first wake up call to ask my providers why each and every test or procedure was recommended and to weigh the risks myself and provide either my informed consent or informed declination.

This is the point of the HSA; it was created in 2003 and signed into law by President George W. Bush in order to reign in ever increasing health care costs by making patients more aware of the actual cost of care and encouraging them to shop for price and quality.  With traditional health plans, a doctor visit might appear to the insured/patient/consumer to cost a mere $15-20 rather than the $180-$250 the doctor actually bills; not to say the health insurance company is actually going to pay the $180-$250, they’ll likely have negotiated a price closer to $100, which brings us back to the uninsured subsidizing the insured and insurance companies.  As I said earlier, my honey and I are blessed with good health, and we take care to eat well, relax, and exercise so we don’t generally get sick enough to go to the doctor, which makes us the prime market for an HSA/HDHP.  The fully covered preventative care and the thought of turning my husband’s HSA into an IRA in the future (once his employer provides group insurance again) were the major selling points for me.

Continued next week in Part Three.

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Why I Despise my HSA – Part One

Posted by eemilla on January 16, 2011

For the past couple of years my employer has given the option of being in a traditional health plan with co-pays, co-insurance, deductibles, and maximum annual out of pocket expenses or an HSA package, and I’ve resisted the HSA until this year.  The hesitancy hinged on the lack of significant savings to offset the greatly increased risk that having a health savings account (HSA) and a high deductible health plan (HDHP) entail, but my employer contributes a moderate sum each year so I decided to forgo my reservations and sign up.  My HSA/HDHP went into effect about four days before I conceived the baby we’re expecting this summer.

HSAs are supposed to be ideal for the young and the healthy, which thankfully we are (although now that I’m pregnant I’m really sick in the eyes of the insurance company).  Preventive care is fully covered with no co-pays (unless you are pregnant because pregnancy is an illness), but everything else, including prescriptions and lab work and sick visits, must be paid out of the HSA until the deductible is met; with our plans once we meet the annual deductible we’re covered 100% (until the year starts over that is even if the sickness/treatment straddles two years).  With the HSA, we still get the health insurance companies’ contracted price with the provider, so the uninsured still subsidize our care.  By law the deductible has to be over $1,200 (but not greater than $5,950 in 2010); frankly, many deductibles for traditional health plans are higher than or equal to HDHP then follow with 20% or more co-insurance until the even higher maximum annual out of pocket expense is met.  However, one does need to set up an HSA (which not one of the local credit unions we are eligible to be members of provide) and then contribute to that account.  The contributions are tax free, and an individual can contribute up to $3050 for 2010.  Unfortunately, this breaks down to about two extra car payments so maxing out our contributions won’t be something we will generally be able to do with the minimal premium savings between the HSA/HDHP and traditional health insurance.

My husband’s employer decided to stop providing health insurance under a group plan last year, but  they do provide a monthly healthcare reimbursement (which covers about half of the monthly premium based on 2010 premiums).  Due to the thirty dollars a month cost savings along with the hoped for tax benefits and the long term savings we decided to move to the HSA for him.  Even though his employer is still covering some of the cost, moving from group insurance to the individual market (even with the increased risk we carry with the HSA/HDHP) his premium increased by about thirty dollars a month (so if we hadn’t gone with the HSA we would be paying sixty dollars more a month, again all based on 2010 premiums).  As an aside, the 2011 HSA/HDHP premiums are about the same as the 2010 traditional health plan premium (which represents about a 20% increase in one year with no claims).  Finally, we can use the HSA to pay for his contacts and eyeglasses, which are not covered by most traditional health plans.

Since we were already dealing with one HSA, I figured it was time to jump on the bandwagon and collect my employer’s much more generous contribution; my employer pays about 90% of my health premiums (if I added my spouse it would basically cost three times as much as his current policy, which is why we have a two individual policies), so my monthly premiums are three-eights of his, plus my employer contributes an additional moderate sum each year to my health savings account.  I reasoned if I got pregnant I could always change back to the traditional health plan, because of course the timing would work for me to do that.

To be continued in Part Two.

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