I buy insurance in the retail market. I am trying to optimize my insurance $ by avoiding getting overcharged by providers. This is the goal of my post - figure out how to avoid this. I figure the only reason I need insurance is for catastrophic illness or accidents. I am quote content paying doctors & labs for infrequent visits & tests, and am happy to pay reasonable rates. I do not need insurance for that. Let me give you a few examples. My last annual preventive checkup - doc. ordered routine blood tests. Quest Diagnostics billed $120 to the insurance. Insurance paid them $16. Yes, $16. That was the total of all payment received by them. Another family member needed blood tests this year. Quest billed $256. Insurance paid $64. Some years ago I visited a oral surgeon (who was listed in my list of dental insurance providers) for a checkup. His fees would have been a payment of $64 as opposed to list price of $150. It turned out this wasn't covered under dental insurance, but by medical insurance instead. And the SOB wasn't listed under medical provider - he was "out of network". He was obviously content to get $64 for his services, but when he saw this opening, the SOB won't accept a dime less than $150. I had no choice but to pay up. My ideal situation would be insurance coverage with no payment for the first $5k to $10k per year with full coverage after that reasonable charges from all providers. I define reasonable as "what private insurance like Aetna or BCBS pays". I expect to pay $16, $64, $64 at the time of service in the above examples, and be done with this. Any groups etc. that I can join for getting this? This will not be insurance - just ensuring I am not one of those suckers paying list price. Also, my understanding is that just being part of the insurance plan where the insurance doesn't cover me for doctor visits won't make the providers accept "negotiated" fair price - instead charging full price.
It sounds like catastrophic insurance is what you are after. Depending on where you reside, you can get different types that may be beneficial to you. Here in NY, I will recommend 2 types for you: 1) With Emblem/GHI you can get a high-deductible HSA plan. This will allow you to choose the deductible (they have 3-4 of them); the higher the deductible, the lower the premium. With this type of coverage, you will pay the contracted rate for routine visits, as you alluded to, and once your deductible is met, you pay $ 0. This is good to guard against big hospital expenses and such, and will minimize your costs along the way. This costs about $ 1,100 per month for a family plan here in NY. 2) Empire BCBS offers a $ 400 Hospitalization-only plan which covers hospital costs and doctor costs (in hospital only), but you pay everything else (doctor visits, for example) out-of-pocket, at full-expense. HSA plans and hospital-only plans are becoming more fashionable, with healthcare costs getting totally out-of-hand (thank you Bush and Obama !).
I am in IL. It seems rates here are cheaper than NY. I think I should call up a few insurance brokers to ask them this question of paying "contracted rates" before my deductible is met. But if anyone has figured this out - like some group "discount plan" - I would like to hear that. It's perplexing that those kind of group deals are not common - after all, the business would have zero risks - just contract with all providers and charge membership fees - foolproof plan with no risk at all.
$1,100 per month is outrageous. In many countries around the world, $1,100 is enough to pay your rent, food, and utilities for the month. Don't you think you are better off going without the health insurance and just take your chances? Pay cash for annual check-ups. It won't cost you $13,000 per year just for annual check-ups. Don't emergency rooms have to treat you even if you don't have health insurance?
Yes, they will treat you. Then come after you with "list price", and you would either file for bankruptcy or be their indentured servant for life on a lifetime "payment plan". Fun, isn't it?
Yes, it is a total joke. Every year I raise my deductible as high as possible, just to keep my premiums to the lowest levels possible. NY and CA are the worst states in the nation, by far. And current law does not permit you to shop for insurance across state lines.....the recent health care legislation that passed will not allow for it either. Healthcare is a total joke in the U.S., no doubt. I largely blame Bush for this, as he is the one responsible for engineering the middle-tier "managed care" layer, in our current system. Unfortunately, Obama is doing absolutely nothing to help out the hard-working middle class, that is saddled with this ridiculous cost, with little benefit. In our country, we don't need health reform, we need Insurance reform.
Yes they do. However, if you have any assets at all, they can go after them legally. If you don't have health insurance, and incur large hospitalization costs (e.g.), then they can go after all of your assets, including your house. So, either you have the insurance (if you have assets), or you pay nothing and free-load the system, if you have no tangible assets that they can go after. Great system - only in America !
But they don't have to give you follow up care or pay for medicine. Example you break your arm, they do a temporary set, it heals crooked. Result your arm is fucked up and they ruin your credit and/or seize your assets.
I wasn't aware that they can go after your house. I assume the hospital would have to take you to court first and win before they can collect from you? Can they also garnish your wages or seize assets from your bank and brokerage accounts?