Tuesday, November 2, 2010

Pay, Pay, and Pay Some More

That is the motto of our new health insurance.

Late last month, we finally got all the benefit information for 2011 from our employer.

Oh. My. Goodness.

Does anyone else spend hours on insurance stuff this time of year?

Or is it just us?

My head hurts.

Now we have exactly 5 days to figure out which end is up.

Yesterday we spent about an hour doing some virtually guided benefits adviser thing.

Trying to figure out the best plan for when you have a tumor in your lung that is probably NOT cancer but it COULD be cancer and what if you need a lung removed next year?

We picked this new plan, the one our employer is heavily pushing, where we open a flexible spending account with an investment company. We contribute and then pay out of that account for about $6000 annually until the insurance kicks in.

The idea is, if you don't have any major health issues, you can sock away money year after year and build a medical investment account. Like I told the hubby, it's really a 401k for your health.

But it only really works if you don't use it.

Hahahahahaha. That's a great punchline, isn't it? Here's health insurance that is only affordable if you don't use it.

Oh man, I'm going to hurt myself snorting in derision over here.

So the thing was, the employer sent us a brochure with all these 'real life' case studies where every. single. family. was better off with the new 401k-like health plan. There was not one example where a family should pick another plan. The brochure also stated that the health plan was ideal for healthy people.

Anyone here think I am a healthy person?

More like health impaired if you ask me.

So I wrote to the benefits department and was kind of snide because I was pissed that the brochure was a heavy sell marketing campaign not a tool to actually help people make a decision.

I wrote: It's great to see so many case studies and how every single time the best option is The Health Plan You Want Us To Buy. Are there case studies that show when other options are a better choice?

To which they responded by directing us to the virtual benefits advisor.

We estimated our needs based on this past year, which is the worst medical year we've had in a while. 1 short hospital stay. 2 ER visits. 10 specialist appointments a year. About 5 primary care visits a year.

The virtual benefits advisor smarmily told us, based on all our information, The Health Plan They Want Us To Buy is the best choice for our situation.

So the big question is, am I in good health and just don't know it? Do healthy people commonly end up in the hospital and ER? Is that the definition of healthy? Please enlighten me.

Granted, this plan is likely the cheapest in terms of day-to-day costs. Most of my medications will be free, which saves about $1,000, but all doc visits and labs will be out-of-pocket. The big question mark is how that trade off works. Will I spend less or more on labs and doctor visits than medication? Can we actually save some of the money we contribute or will it all be spent on medical care?

We have not been given the information to calculate projected answers to these questions--just that heavy handed, rub our noses in it, marketing brochure. I have asked for price lists so I have some idea of how much the CT scans I'll need will cost. It seems unethical and almost criminal to burden people with such a large out-of-pocket deductible and not give them the price list.

I am sure the Benefits Dept. loooooooves me, but it galls me that I have to ask, even beg for this info. Makes ya really feel like a "valued employee" don't it?

The other thing that bothers me is that side by side financial comparisons do not tell the whole story. They also need to factor in when benefits kick in and how much. A lower deductible plan may have a higher total pay out, but barring a health disaster, it may provide more benefits for run-of-the-mill health stuff. This is the math that the employer is not doing or providing to its employees and I don't feel like I have enough information to run those numbers by myself.

I continue to be 'for' health care reform, but they need to work harder on not just access, but affordability. I do not have major health issues, just chronic ones, and it is killing us. How do people on dialysis or with diabetic complications or those in need of heart surgery survive?

There also ought to be a law on how large employers 'pitch' health care. Since,apparently, they aren't going to be ethical about it on their own.

*I say 'our employer' because I have my pension and what not there still even though I'm not currently employed there.

1 comment:

  1. I know I'm reading this LONG after you were forced to make a choice, but I still can't help but feel outraged on your behalf! My husband's employer gives us an entire two weeks to make the decision each year, and I thought that was bad! We tend to default to the most expensive (from our pockets) plan available because it offers the most coverage, and goodness knows I need to max the coverage.

    His HR department (probably with help from the insurance companies) puts together a chart that you can see all the various options (I think we had three plans to choose from) and what coverage they each offer. It's still overwhelming, and there's still plenty of detail that people like us need to get additional answers about, but at least there's no heavy push like you got towards the one that saves the company the most $$$. (His company actually offers a cash incentive to choose to be covered by a spouse's policy through another employer, which feels a little fishy. But at least they require people choosing that option to show proof that they are covered elsewhere, so they're not leaving anyone uninsured.)

    I'll have to go do some catch up and see what option you ended up with. Personally, I would run away from those types of plans. My husband, who barely sees a doctor once a year, would be fine with one of those. But for my relatively healthy kid and for my lousy health, we spend way more than $6k per year, and my basic understanding is those types of insurance plans really only pay off for those basically healthy people who simply need catastrophic coverage. I'm not an expert by any means, but that's what I've read.

    More soon ...


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