OT: Health Insurance Woes

[Nooch]

I switched jobs last year and went from a huge, self-insured company to a small, getting as good a deal as they could in insurance company..

the plan year is set up to be september through august, so we're coming up on a renewal period. from the rumblings I've heard, the company wants to move to a calander year plan, and for sept-dec of this year, we're picking up an interim plan.

okay, cool, the january plan is supposed to be much better than the plan we have now, awesome. but i'm fearful on the interim plan, because, well, could it be that great if we're just using it as filler?

problem is, my wife is due in october. all the bills related to medical expenses will fall under the interim plan. and right now, I have no idea how good/bad that will be.

what are my options? could i just buy insurance from aetna at this point for the interim period? will they even insure my wife, because the pregnancy is a 'pre-existing condition?' i know i may be putting the cart ahead of the horse right now, but this has my head spinning!

[echelon_john]

Talk to HR, or whomever is negotiating the interim insurance. Make sure it's clear with everyone in power at your company what the situation is. They have more leverage right now, even if it's just the purchase decision around the interim plan, than you will as an individual once that plan is enacted.

[AngryScientist]

ditto talking to HR about this. My wife has excellent health coverage, and her entire pregnancy/delivery/c-section cost us exactly $10, the amount of one copay.

i did get to see a lot of the bills though, and with the hospital, c-section surgery and standby pediatrician, the full cost bill would have easily bankrupted me.

figure it all out now, it's a fun, exciting time, and you want to enjoy it, not worry about what they are going to charge you for.

[zap]

How many employees at your firm?

[tuxbailey]

Make sure you keep a record of all communication with HR.

[Nooch]

How many employees at your firm?

< 40.

Just spoke to the partner in charge of benefits, told me we're not switching for the interim, but switching as of the new year. that's a little more comforting.

however we're doing a partial year FSA in order to re-up the FSA for a calander year, so for the 4 month period (including when the baby is due) we can only put $500 into the FSA.... Not gonna cover a baby...

UGH.

[chuckred]

As long as you don't have a lapse in credible coverage, I don't think the new insurance company can not cover pre existing conditions. One of those pesky federal intrusions into our lives... (tongue in cheek). You will of course be responsible for deductibles, copays, coinsurance...

[eddief]

health insurance is delivered through employers? the dumbest system on the planet.

[zap]

health insurance is delivered through employers? the dumbest system on the planet.

Have you lived in and participated in health care plans in other countries?

[zap]

< 40.

Just spoke to the partner in charge of benefits, told me we're not switching for the interim, but switching as of the new year. that's a little more comforting.

UGH.

That's good.

[eddief]

i exaggerated. but i hate our system all the same. lose your job, burn through your Cobra, reapply for your own, individual plan with a pre-existing condition, you will hate it too.

Have you lived in and participated in health care plans in other countries?

[PQJ]

Have you lived in and participated in health care plans in other countries?

I've never lived in France and it follows that I've never participated in any French health care plan. But when I was in France once and in need of medical care, without any form of international health insurance coverage, very limited French and not knowing a soul, the experience was extremely efficient, pleasant and, most surprisingly, affordable. A very stark contrast with my healthcare experiences in the US, even with the 'excellent' health care plan I have ('excellent' only in comparison with what the alternatives are).

[echelon_john]

*most* folks who look down on single payer health care have never had a health need treated while in France, Germany, Italy, etc.

GENERALLY speaking, the care is quite efficient and comparable to what you would receive going into a clinic/practice here if not better. Are there shortcomings? Absolutely! But there are plenty of shortcomings with our existing system.

Anyone who thinks the government will mandate/exclude certain expenses more than a FOR PROFIT insurance company has never had to negotiate with an insurance company.

[rugbysecondrow]

]*most* folks who look down on single payer health care have never had a health need treated while in France, Germany, Italy, etc. [/B]GENERALLY speaking, the care is quite efficient and comparable to what you would receive going into a clinic/practice here if not better. Are there shortcomings? Absolutely! But there are plenty of shortcomings with our existing system.

Anyone who thinks the government will mandate/exclude certain expenses more than a FOR PROFIT insurance company has never had to negotiate with an insurance company.

This is reasonable. People fear what they don't understand. Benefits are part of people salary, so essentially people have to trust that this benefit that has been negotiated will be provided by, needs met by another. That is a big leap IMO. I am not arguing who is right or wrong, just furthering a perspective.

As for the Private vs Public...both will have actuaries determining rates, structures etc.

[eddief]

if given a choice, what percent of us would choose a single payer system. Then you gotta wonder, who/what is in the way of giving us a choice? Why can't those who want a private corporate run health plan stay with it, and those of us who prefer single payer be able to buy that? What is so scary about that? Who owns who?

[rugbysecondrow]

if given a choice, what percent of us would choose a single payer system. Then you gotta wonder, who/what is in the way of giving us a choice? Why can't those who want a private corporate run health plan stay with it, and those of us who prefer single payer be able to buy that? What is so scary about that? Who owns who?


Fear of the unknown is not always rational.

[echelon_john]

The insurance companies own the politicians. It's ALMOST that simple.

[eddief]

i hate being in the herd of sheep shepherded by the likes of ceo's. corporations are people too. i forgot.

The insurance companies own the politicians. It's ALMOST that simple.

[rugbysecondrow]

i hate being in the herd of sheep shepherded by the likes of ceo's. corporations are people too. i forgot.

Circle back to the fear statement.

Bad enough to complain about it, but to good a situation to risk something that might be worse.

[echelon_john]

great question. probably the same reason people vote for political parties that don't have their best interests at heart--fear of the unknown.

i think that the deck is so stacked at every level against meaningful change that it is impossible. too many wealthy and powerful people and organizations are too dependent on the status quo and have too much influence on the people who could actually enact change for anything to ever happen.

i truly don't consider myself a pessimist; just a realist. i also don't believe people are inherently good. they're not inherently anything except animals who like eating, drinking, having sex, and exerting power over those less powerful.

i need to go for a bike ride.



i hate being in the herd of sheep shepherded by the likes of ceo's. corporations are people too. i forgot.

[rugbysecondrow]

great question. probably the same reason people vote for political parties that don't have their best interests at heart--fear of the unknown.

i think that the deck is so stacked at every level against meaningful change that it is impossible. too many wealthy and powerful people and organizations are too dependent on the status quo and have too much influence on the people who could actually enact change for anything to ever happen.

i truly don't consider myself a pessimist; just a realist. i also don't believe people are inherently good. they're not inherently anything except animals who like eating, drinking, having sex, and exerting power over those less powerful.

i need to go for a bike ride.

I also think that Americans are continuing to put themselves in a physical state, due to their lack of self care, which does/will continue to require more frequent and more costly health and medical care.

As a generic statment, many Americans are concerned about their health to the degree somebody else can do something for them, but not so much when it comes to what they can do for themselves. No matter the system in place, this fundimental issue needs to be dealt with.

I agree with both you and Eddie though, we need solutions oriented people work on this, and niether Repubs or Dems seem to be those people now.

[eddief]

Athenian techniques to prevent the rise of oligarchy

Especially during the Fourth Century BC, after the restoration of democracy from oligarchical coups, the Athenians used the drawing of lots for selecting government officers in order to counteract what the Athenians acutely saw as a tendency toward oligarchy in government if a professional governing class were allowed to use their skills for their own benefit.[6] They drew lots from large groups of adult volunteers as a selection technique for civil servants performing judicial, executive, and administrative functions (archai, boulē, and hēliastai).[7] They even used lots for very important posts, such as judges and jurors in the political courts (nomothetai), which had the power to overrule the Assembly

[echelon_john]

Sure, but look what happened to Greece! ; )


Athenian techniques to prevent the rise of oligarchy

Especially during the Fourth Century BC, after the restoration of democracy from oligarchical coups, the Athenians used the drawing of lots for selecting government officers in order to counteract what the Athenians acutely saw as a tendency toward oligarchy in government if a professional governing class were allowed to use their skills for their own benefit.[6] They drew lots from large groups of adult volunteers as a selection technique for civil servants performing judicial, executive, and administrative functions (archai, boulē, and hēliastai).[7] They even used lots for very important posts, such as judges and jurors in the political courts (nomothetai), which had the power to overrule the Assembly

[559Rando]

< 40.

Just spoke to the partner in charge of benefits, told me we're not switching for the interim, but switching as of the new year. that's a little more comforting.

however we're doing a partial year FSA in order to re-up the FSA for a calander year, so for the 4 month period (including when the baby is due) we can only put $500 into the FSA.... Not gonna cover a baby...

UGH.

How's this all working out? I've worked in health care administration for about 8 years and had two babies.

The second was by far the cheaper...my wife works for the county and elected a PPO as her primary and I carried her as a secondary. That was just this year here in California.

The first baby was when we were single income, living in Dallas, Tx and had a HDHP. Bad news.

The interim plan might not be a bad thing: choose it based on the lowest out of pocket threshold possible.

Unfortunately, that $500 FSA won't do much good for you. Can you carry over your current (pre-interim) FSA? Or does it expire? Honestly, the biggest benefits of the FSA is to lower your pre-tax income and allow you to borrow from yourself (pay up front for healthcare costs and pay it back from your paycheck over the year), so at least you can lower your taxable income (if that makes a difference to you).

Bummer!