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Watching 'Sicko,' trying to plan our health care

November 14th, 2009 at 09:46 pm

While trying to pick the health care coverage with the best pricing, I'm trying to factor in the worst-case scenario. So I'm ignoring the deductible, which only tells you the most you could pay for one medical event. Instead I'm adding the monthly premium and the out-of-pocket maximum for each option. That will tell me which plan would cost the least should I have expensive medical issues. (And judging from the past few years, and the fact I have the final trimester plus labor and delivery to get through in 2010, I should definitely plan to be reaching my out-of-pocket maximum.)

I have two options for medical, plus optional additional dental and vision plans. What I've done is tried to figure out the highest possible cost for each plan for me as an individual; for me and the baby; and for me, NT and the baby. Then when NT gets details of his job's options, I will figure out the highest possible cost for each option for just him; for him and the baby; and for him, me and the baby.

I'll then pair up the different ways that all three of us can be covered, adding together the maximum costs, for instance, of having just me on my work plan while NT and the baby are on his work plan. Then I'll compare, and the combination that results in the lowest maximum annual cost will be the option that I go with.

Sounds fail-safe, right? Although have you seen the movie or read the book Fail Safe? They think there's no way they could make a mistake, and next thing you know New York and Moscow are getting blown up. So we're watching the documentary "Sicko," and there are all these stories of people who had coverage, but when they were diagnosed with a serious condition, the insurance company found a way to disqualify treatment, such as calling a proven method "experimental," or to kick the person out of their coverage altogether, as they did with a woman by pointing out that she hadn't disclosed the "serious" condition of once having had a yeast infection on her application, so therefore she should never have been covered. I think she had cancer.

So I do realize that under the current conditions in the U.S., all this scrupulous planning to make sure I have enough money for the maximum out-of-pocket could be for naught if one of us were diagnosed with something serious, because there's a good chance the insurance company could find a way to deny payment for the treatment.

But what else can I do? I still have to make the best plans I can, and find the best deal, and try to have enough money in the bank to cover what the insurance companies say would be the most I'd have to pay.

And bide my time till we can move to England...hoping no health disaster befalls any of us between now and then.

5 Responses to “Watching 'Sicko,' trying to plan our health care”

  1. monkeymama Says:

    Agreed. I spent a long time looking up definitions and trying to feel confident that I understand our health plan. Another thing to look up is the "annual" or "lifetime" maximum benefit. I know too many people who blew their max in a year due to something like cancer. (& these were young people - the type who don't think they need medical coverage).

    Our current medical coverage is so good compared to most plans offered by the same company, that I am wary they are going to change it drastically down the road. Like they suck you in and change the rules - quite possible. Why else would anyone sign up for twice the out-of-pocket? Unless they really think they are that healthy and safe?

    Anyway, all you can do is try your best. I shop the same way. I always feel well aware that none of my insurance (home or health) is "fail safe." You hear too many stories otherwise...

  2. ceejay74 Says:

    I did glance at it--something like $1MM (don't have it in front of me right now). Sounds like so much, until you hear (this was in Sicko too) that getting two finger tips reattached would've cost some guy $75K--makes you realize that something more serious & ongoing could wipe out your benefit in no time.

  3. whitestripe Says:

    I haven't seen Sicko yet - it is hard for me to comprehend what the hospitals and health cover is like in America compared to here. Apparently our area has the highest wait time for emergency room treatment and the least amount of beds per population, but I am sure it is nothing like in the US.
    The sister of DF's brother in law lived in the US for several years and gave birth to children there - she had private health cover. So when DF's sister and brother in law told her that they were having their baby in the public hospital she flew off the handle about it and told them their baby was going to die or that the birth was going to be horrible - after it was all done and dusted they said that they couldn't have asked for anything better during the birth and that everything went smoothly. I've talked to a few people here and the difference between private and public seems to be that you get your own room, and that the doctors in private prefer to induce or C-section the baby sooner rather than leave it go naturally. Oh, and you don't have to bring your own nappies to private hospitals. Hmmmm....

  4. ceejay74 Says:

    Oh, we have good health care here--our hospitals & doctors are great. It's just that we aren't guaranteed lifesaving treatment even if we think we're covered by health insurance. You should see the film, though it will make you sick--there's footage of people without coverage being dumped outside a homeless shelter by the hospital--still in their gowns, disoriented, only half-treated for whatever emergency got them there. There's no safety net to make sure that no one dies of a treatable condition. Health care is a for-profit business, and the best way to make a profit is take people's monthly premiums but not let them actually use the insurance for anything expensive. Bonuses are given for insurance employees who "save" the company the most money by denying the most coverage to sick people.

  5. sarah Says:

    I'm in the U.S. and have been incredibly lucky with my health care insurance. I have one of those cadillac plans that President Obama keeps talking about. But the U.S. has to do something about the 46 million uninsured. I once had a held a baby who was extremely sick while her mother called every doctor in the city trying to get her help and no one would treat her because there was no insurance.

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