How much gets deducted from your pay for health benefits?

[hoolahan]

Hi all. I haven't been on much lately now that I am working in the 9-5 mode in front of a computer, but I am curious and need some input, plus I thought this was a topic we haven't seen in relation to salary issues etc... Sorry if I missed a thread where it was discussed already in advance.

My husband had to re-apply for his job, his job was out-sourced, but they love him, so they insisted he be the one assigned by the new company st the old site. I was finally at a level where I was used to United Health Care, and knew how to get claims paid within the system, etc. Made a few appeals and won, etc... Now, we were forced to enroll in a new plan...and it is yanking my chain big time.

The new company is Blue Sheild on CALIF!! Yes, we live in NJ, so it is a HUGE PITA, all my calls have to be on california time, they request so much paperwork from the docs they are moaning. So, we have considered, now that I am staying in one place, happily, for a while, we should investigate my benefit options.

Here are my dilemmas, and options...

An HMO with Referrals req'd 100% Coverage in-network $50 nper pay (q 2 weeks)

A PPO with 100 % cov in network, 70/30 otherwise, $65 per pay & still need referrals

A POS where I can go anywhere in or out of network, lower office vist co-pays, etc... NO REFERRALS...........$145 per pay!!!!

So, for the first time, we are considering going to the HMO plan. Hubby's POS plan is $65 per pay, also q 2 weeks, also no referrals. BUT it's the California hassle. The paperwork dust is about settled, so cost-wise, unless I choose the HMO, we really can't afford those kinds of deductions, and maybe we should just stay w the California vs. NJ hassle.

For those of you who do the HMO Route, how much of a PITA is the getting referrals process?? All of our docs are in-network, so we figured why not try it??

And, how much, approx, are your deductions? For what kind of plan? What hassles do you have?

Isn't it a sin, that as healthcare workers we get so screwed w health benefits?? And, I am ashamed to say I work for a major health plan myself, and those are my deductions!! We get less of a break than the average employee in the workforce other than Health Care workers that is.

[traumaRUs, MSN, APRN]

I pay $80/every two weeks for hubby and me (family plan). Includes dental - and vision. Don't know about referrals but meds are $20/if they are on the forumulary.

[2ndgenerationnurse]

i beat all of you!!! i pay $804 a month! for a UPMC HMO plan, the ins. is for me, dh and kids. it has good coverage but it is sooooo high. it went up about $250 this year and now it is payed after taxes instead of before taxes like last year. :angryfire wish i could find ins. elsewhere but my dh is considered self employed and i only work prn. (as needed to pay premium, lol!!! NOT!!!)

[NRSKarenRN, BSN, RN]

To all:

See if your work offers "Medical Savings accounts". The money goes into this account BEFORE TAXES and can be used to pay your premiums. Saves you $$$.

[purplemania, BSN, RN]

our plan is PPO and I pay

[TechieNurse]

Hoolahan ~ I stongly urge to consider carefully the choices you have.

I have worked for, or had direct experience with, all of your choices: PPO, POS and HMOs.

HMOs are cheaper for a reason. The theory is, the healthier you are, the less you utilize costly services. So, rational thought is that the healthcare providers would be very interested in keeping you healthy. After all, an office visit, outpatient chest xray and prescription for bronchitis is cheaper than an inpatient admission for pneumonia, right?

But, that's not exactly what happens. Generally, care is delayed. There are incentives for the doctors to not utilize expensive tests/services. Specialists are underpaid, therefore they are rare and overworked, it can be months before you can get into to see them.

And try to get an HMO to pay for new treatments! They are not exactly on the cutting edge of new technologies, off label use of medications etc.

(consider the recent Supreme Court ruling: "Supreme Court Rules For HMOs In Fight Over Patient Suits")

I consider healthcare insurance as a spectrum with HMO at the bottom and indemnity at the top (POS and PPO in the middle).

Consider you and your husbands health care needs. You have an advantage because you are in the healthcare field and know some of the ins/outs.

Remember, you get what you pay for.

Lastly, any insurance is better than no insurance.

Back to your original question, I pay $17.15 per week for family coverage (POS plan), $3.47 per week for dental and .96 per week for vision. My copays are $15 for an office visit and $30 for an ER visit. No deductible.

I do need referrals for specialists, but PCPs are very willing to give them.

I hope this helps. Good luck with your decision.

[hoolahan, ASN, RN]

I am so happy so many of you took the time to respond, it is really interesting to see the vast differences.

I can't see page one to refer to it, but whoever used to work for BCBS and had those great bennies....I believe that is history now. My company is a subsidiary of BCBSNJ, and those were my fees!! But again, that is NJ.

After some more discussion, hubby and I have decided we will get the same service for the POS plan as we have now at half the cost, so we will stick with it. Rather than go the HMO/referrals route. I did not anticipate hassles with getting referrals, b/c my doctor KNOWS better than to mess with me, I just reamed his staff out for not filing a claim for over a year, their contract clearly states late claims won't be paid, so I paid the $70 in full, but warned him, I will NOT do that again, and if his staff is in error, he must make them pay for it!! Haha. I just prefer not to go thru the hassle of referrals, calling for it, picking it up, remembering to bring it to the visit. All our docs are in the network.

We considered trying it for now, and if it didn't work out, we would be able to switch in October during open enrollment. But, then we figured, what the heck, we are getting POS at half the cost now, and I have figured out the system, just finished supplying the "pre-existing condition" crap so my doc didn't have to bother, and I know who to ask for, etc... I know they have a process for everything, and timeframes to meet for their quality dept's, so I ask exactly what the policies are, and call back on decision day. The probably will put a big "B" next to our member number for B--ch!! LOL

Anyway, enough about me, this is interesting and just as important to nursing, so let's keep the topic going. Interesting to see how the "caregivers" (hospitals/employers) take care of their own and keep them healthy so that they can continue to stay well, and take care of patient's. Kind of hypocritical that a hospital will preach prevention, yet they don't practice what they preach when it comes to their own employees.

Also, to the person who had no insurance. Tx right? I believe there is a program, maybe a medicaid program, or a family care program you could be eligible for. Call your medicaid office. In NJ we have several levels of family care, it is for those who are working, but still can't afford insurance. It is so risky to go w/o insurance. You never know if you will need it, and I just learned if you develop a problem, and had no insurance coverage, it is considered a pre-existing condition and will not be paid. If you did have insurance for 6 months and it was paying for the treatment, and you get/have to get a new insurance, then it is covered. Weird, but that's how it works. If you can't afford the food, apply for WIC, but get some insurance please, I worry for you.

[hypnotic_nurse]

$256/month for just ME! Dental is an extra $40. Vision is $7.00. But my job reimburses me $240 -- one of those cafeteria plan things.

[CardioTrans, BSN, RN]

I pay 88/pay check for medical and 10/check for dental. This is for family coverage.

[Dixiecup]

I have blue cross blue shield which is good insurance but I pay approx. $150 a month for it. Just for myself. I am considering dropping it as I just can't afford that much out of my paycheck. I could pay my electric bill or groceries with that much money. If an astronomical event were to happen and I was in the hospital for any length of time I guess I'd just have to file bankruptcy or something. It just shouldn't be this hard to get by!:angryfire