Post actual experiences re healthcare

Jolie, BSN · Sep 8, 2008

I am sorry for this couple's experience, but at the risk of being flamed, I will ask what they expected to happen.

Insurance companies are businesses. It is a poor business practice to take on business that one knows will cost more than it will pay. It is impossible for an insurance company to recoup the cost of prenatal care and delivery from a couple by collecting a few months' worth of premiums. That would make as much sense as a home-owner's insurance company writing a policy on your home as it is burning to the ground.

I'm glad that she did not abort her baby over her inability to find private insurance. As I have posted before, I challenge anyone to find a county in this nation that does not offer pre-natal care and well-infant services regardless of ability to pay, via county health departments, free clinics, faith-based programs, or academic medical centers. I realize that that doesn't account for the cost of delivery, but plans can be worked out in advance with virtually any hospital for monthly payments.

Why did she not seek coverage before becoming pregnant?

dee78 · Sep 8, 2008

I was a 19 yr old, college student working "registry" at the hospital, slightly less than fulltime. I got pregnant at the end of my freshman year, we weren't married but we had talked about it so we got married. I was changed to fulltime status and the insurance plan did not have a pre-existing condition clause for pregnancy. It was Blue Cross Blue Shield.

A married coworker at my current job chose not to get insurance. She got pregnant without insurance. She talked to Tenncare and they said she made too much to qualify but if she accumulated $2500 in bills they would pay those and cover the rest of the pregnancy, birth, and child. She went to the ER with "cramping". Instant insurance!!!

Elvish, BSN, DNP, RN, NP · Sep 8, 2008

Blue Cross in our state does not define pregnancy as a pre-existing condition, at least not the employer-sponsored one. But employers who actually offer decent health insurance seem to be few and far between.

Why did she not seek coverage before becoming pregnant?

I couldn't find anywhere that she said this pregnancy was planned.

I did, however, have BCBS deny my pregnancy u/s. The MD's reason for the u/s was 'anatomy/dates.' My benefits included payment of radiological studies done on an outpatient basis - the u/s was just that. They still refused. I called them and had to read them their own definitions of benefits...and I never heard another word about it.

It's a heck of a lot easier to talk about having a payment plan for a $20000 hospital bill than it is to find a hospital that will actually allow you to do it in a reasonable fashion. I called the hospital to set up a payment plan for a cardiac echo I had done, and they told me I could have any payment plan I wanted as long as everything was paid within 10 months. I don't know if this is the same in every hospital, but paying off $20000 in 10 months is not a reasonable expectation of middle-income families in this neck of the woods.

Jolie, BSN · Sep 8, 2008

It's a heck of a lot easier to talk about having a payment plan for a $20000 hospital bill than it is to find a hospital that will actually allow you to do it in a reasonable fashion.

That's why it needs to be done in advance. Pregnancy is a condition that favors this type of arrangement. Unlike a cardiac echo or an ER visit, which are unanticipated, planning payment for pregnancy-related care can be done in advance.

2 of the hospitals where I've worked offered pre-planned payment options for uninsured couples. Both involved greately reduced rates, as long as payments were initiated in advance. (For example $2000 for the entire L&D, PP and newborn stay, regardless of method of delivery or complications.) 2 other hospitals did not have hard and fast programs, but would work with couples who requested payment plans, as opposed to presenting as uninsured patients at the time of delivery with no plan in place for payment.

Only one facility where I've worked offered no pre-planning option, but they did offer payment assistance after the fact, and wrote off large portions of many bills.

Elvish, BSN, DNP, RN, NP · Sep 8, 2008

Those are great ideas, and I wish more places would do that.

It looks like this couple did plan/pay ahead to the birthing center....and the hospital trip was an unexpected one.

allnurses Guide · Sep 8, 2008

I was kind of hoping for experiences as well as opinion.

I'll start -

My husband's bicycle was hit by a car. He was not wearing a helmet and hit the back of his head. The driver who hit him called 911. DH stopped breathing in the ambulance.

He was taken to the ER and received excellent care.

He was hospitalized for four days total. Came home a bit confused and forgetful. he needed surveillance. Now he is fine.

The bill was about $100,00.00. Medicare paid about $80,000.00. His AARP paid almost all the rest.

I have no complaints and profound gratitude for the nurses, doctors, paramedics, and other caregivers.

T

Chico David, BSN, RN · Sep 9, 2008

this is not a clinical experience but an insurance purchase experience.

Please excuse my being a bit long winded.

I've always been super frugal, big saver, small spender: drive old cars, don't eat out a lot, don't have a lot of luxuries other than some travel. So by the time I turned 55 I looked at the situation and figured I could afford to semi-retire - go per diem at the hospital, work just a little, buy my own insurance. I did my usual careful research and found I could buy a high deductible plan for only $235 a month, which I could afford OK and if the worst happened and I actually had to pay the $4,000 annual deductible, I could afford that too. I made sure I could qualify for the plan. No problem. Regular exerciser, low BP, low cholesterol, no regular meds. My only prescription is for Ambien I take when I travel.

So I went per diem, and kept my employer insurance under COBRA for a while so I could get a few things done: eye exam, dental check-up, annual derm visit. The last one got me. She found a basal cell carcinoma on the end of my nose. I had a semi-fancy procedure to remove it - Moh's surgery. I didn't think it would be a big deal, but I was wrong.

When I went to apply for individual plan (Blue Cross), no dice. Not only did the basal cell disqualify me, but the fact that I take an ambien a few times a year was also a disqualifier! The COBRA had a while to go, so I waited a bit, then went and talked to a local agent. He had me apply again with a different company (Blue Shield). They also rejected me, but they told the agent that if I waited a year after having that little basal cell removed they would cover me as a "tier 4" subscriber. That means only a little more than twice the normal price. That's how it ultimately ended up. A bit over $500 per month for insurance with a $4,000 annual deductible. That means that I pay $6,000 per year for just the peace of mind of being covered and if I actually got sick it would be a total of $10,000 in premium and deductible before the insurance paid the first dime. And of course that $10,000 would repeat annually.

We might also note that the McCain health plan is basically to put an end to employer sponsored insurance by taxing it and push everyone into individual plans. Based on my experience, this might work fine for the young and very healthy, but not for those of us a little bit older. Obviously, if I had something really significant, like hypertension or diabetes or high cholesterol, the insurers wouldn't even talk to me. And again, this experience is someone at the extreme high end of the health scale - At 57, a fifty mile bike ride in 3 hours is a normal event for me, no chronic meds etc.