hospital deductibles; how to evade them

Ooof tough room.

Health insurance and deductibles are a tough nut. It really sucks when good, hard working people with full time jobs get hit with medical bills they can't pay.
We offer the best health care to our employees that we can afford. BCBS HMO Blue. And we pay 80% of the premiums. I wish we could pay more. In an effort to keep the costs reasonable, we selected a plan that has a $2000 max annual deductable for a family, but as a company we have decided to pay 80% of all deductibles as well.
In March of this year, one of my guys and his wife had their first kid. There were complication after the birth and she needed some pretty serious treatment. This kid is 24 and makes about $20 per hour.
When he came back to work, he asked if there was anyway he could work some overtime to earn the money to pay off his 2k deductible. I handed him the check for $1600 from our benefits company, then wrote him a check for $400 that I let him pay off pre-tax and interest free out of his paycheck for 8 weeks.
We try to do the best we can for our people. In return, they do the best they can for us. It may be an old fashioned idea, but it really does work for us and creates a feeling of family that you just don't get when you work for the big companies. His son's name is Declan. And he is a big, health boy that is growing like a weed.
 
My 4 day hospital stay for pancreatitis and gal bladder surgery totaled $90k!!! I was responsible for $4k of it after insurance....well.....and many phone calls to the insurance company to contest the charges. My initial responsibility was $12k....but insurance company claimed I was using out of network docs.......I had to bitch that in the hospital I didn't get to chose what doc came to "check my chart" twice a day. Insurance paid all but $4k......I wrote the check and paid my share.

Those docs that came in two times a day submitted bills for over $2k a day!!!!! I saw them for 30 seconds each time.

You also got lucky. Most of the insurances I've been saddled with in the last few years cost around $600/mo out of pocket to me and 2.5x that to my employer.

Most of our our of pocket actual costs for a 90k hospital event would be at least 20% of the total.

Out of pocket maximum is a BS number as are deductible calculations since they are all based on a magical MAC "maximum allowable charge". That charge for any given service changes without notice and is usually based on the national Medicare rate.

It however doesn't have to be. As I once found our when one of my providers decided the maximum allowable charge for anesthesia was $0.

Only owing $4k on $90k is awesome.

I have fortunately had almost no major medical issues. Only minor ones in family and still have around $13k in medical debt.

This is whole being fully insured with what my employers views as good plans!
 
You also got lucky. Most of the insurances I've been saddled with in the last few years cost around $600/mo out of pocket to me and 2.5x that to my employer.

Most of our our of pocket actual costs for a 90k hospital event would be at least 20% of the total.

Out of pocket maximum is a BS number as are deductible calculations since they are all based on a magical MAC "maximum allowable charge". That charge for any given service changes without notice and is usually based on the national Medicare rate.

It however doesn't have to be. As I once found our when one of my providers decided the maximum allowable charge for anesthesia was $0.

Only owing $4k on $90k is awesome.

I have fortunately had almost no major medical issues. Only minor ones in family and still have around $13k in medical debt.

This is whole being fully insured with what my employers views as good plans!
Understood.

I'm not complaining about the $4k final total bill. I have very good insurance at my civilian job and it only costs me $400 a month for the family plan.

My biggest complaint was how the $8k was calculated as my responsibility because the insurance company said I used out of network doctors. When I'm in a hospital bed because of pancreatitis....and the docs won't discharge me because the pancreatitis is severe......Im not in the mind of asking "hey.....are you an in network doctor"? When they randomly walk into my room with an iPad ....look at it... Look at me....ask how I feel......nod their head and say.."ahaa....ahaa....ahaa" while I answer....and leave. Those were my exact words to the insurance rep when I called and contested the charges. They sent me a letter about 2 weeks later and adjusted my responsibility down to the $4k. About a month later I got the bill from the hospital stating insurance paid the out of network doc fees in full and my adjusted total invoice.


I'm all about paying my responsibility......but fair is fair imo

From this experience I learned that insurance companies will deny claims to a point .....and will approve claims if you bitch. It's like they try to get away with denials until you bitch to see if you'll just write the check. Took me 6 months to get it all settled.
 
the point was they have been paid enough and don't need any more; why a deductible? which most likely goes to pay for welfare and illegals
It probably goes to the hospital so they can recover some of there losses from people like your self that don’t pay, Because you think you “paid enough”
 
It took OP all of 29 minutes to delete his post. All his failed attempts at humor are undeleted as are the quotes of the original post.

The internet is forever...

Well looking foward to his next post...he is fun to have around on the slow days....He is truly an Alien or a Dem. [rofl]
 
It seems to me that if you have insurance that, all the Doctors that can,
come and see you just so that they can charge the insurance company.


Malodave
 
When I'm in a hospital bed because of pancreatitis....and the docs won't discharge me because the pancreatitis is severe......Im not in the mind of asking "hey.....are you an in network doctor"? When they randomly walk into my room with an iPad ....look at it... Look at me....ask how I feel......nod their head and say.."ahaa....ahaa....ahaa" while I answer....and leave.

Is there any legitimate way to prevent this? Serious question because we have a hospital stay coming up in a few months. The hospital and the doctor's whole practice are in network. Can a patient provide written instructions to the hospital that they only want to be seen by certain doctors. Hang a sign on the door? Seems there's no good answer.
 
Is there any legitimate way to prevent this? Serious question because we have a hospital stay coming up in a few months. The hospital and the doctor's whole practice are in network. Can a patient provide written instructions to the hospital that they only want to be seen by certain doctors. Hang a sign on the door? Seems there's no good answer.
With pre scheduled surgery your probably in a better position. My surgery and subsequent stay was emergency.....so not much in the way of planning what docs saw me.

If I were you....I'd definitely be asking the billing department prior to the surgery about in network docs only being allowed to see you. That's based on my experience anyway

Also my advice to anyone going through medical bills......question any bill with the insurance company that you think may be wrong. There is no hurry to pay the invoice......call the insurance company and contest the bill......they more than likely will say the have to review it......get insilurance reps name you spoke with and record it.....call the hospital or doc that is billing you and tell them it's being reviewed by the insurance company.....they will give you time while the insurance is reviewed. Knocked $8k legitimately from my portion of the bill by doing this. It just took a few months....and nothing ever went to "collections".
 
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Interesting I had my gall bladder out last year and between Medicare and my part B plan I paid nothing out of pocket,granted when I became eligible for Medicare I picked a plan where there was no deductibles/co pays. Granted I have BC/BS cost is just under $200 a month but I'd rather pay that than get a surprise multi K bill that I'd have to sell a couple of internal organs to pay off
 
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