Rant (healthcare costs)

Discussion in 'The Tiki Bar' started by boatman37, Jan 13, 2020.

  1. Boat Guy

    Boat Guy Well-Known Member

    https://www.carefirst.com/congress/...ressional-health-insurance-plans-brochure.pdf

    This seems to be one of the congressional plan options.... FYI they get, I think, 72% paid for... They pay 28%....

    @yobub - I'm not sure what the "Summary of Benefits and Coverages" is that you're referring to, but here is the 170 page Service Benefit Plan for BCBS that would make anyone dizzy...Esp. if you're trying to thumb through it in a time of crisis
    https://media.fepblue.org/-/media/PDFs/Brochures/2020_SO_BO_SBP_Brochure.pdf

    Of course an insurance company has to mitigate and expressly define coverage and it's a cat and mouse game. It's simply another reason the system fails....My belief in this type of system is that cost containment trumps the health of the patient.

    My belief is a system where you pay into a wellness non-profit co-op, you could reduce the service benefits plan by 70%....You simply pay a percentage of cost until a cap....Further, I would add eye and dental care into the program. I have no idea how we created a system where they are separated out....Simply make a differentiation between elective and non-elective procedures.
     
  2. brewster16

    brewster16 Active Member

    456
    Aug 9, 2009
    Long Beach Island, N.J.
    '07 44 Sundancer
    Twin Cummins QSC 8.3
    Bob.....you and me both! I am so glad I'm at the end of my career and not the beginning. I am spending so many hours every day on administration and appealing insurance company denials. Oh how I would love to share with this forum the pile of Explanations of Medical Benefits (EOB's) waiting for appeals on my desk, most of which are for supposedly covered services! You'd be shocked at the reasons for "no payment" No joke... about 70% of my working hours doing this stuff and about 30% actually seeing patients! And, for those of you that made comments about doubting the debt young doctors are piling on oughta talk to the medical/surgical residents I work with every day instead of talking to your wealthy dock mates about their kids education. Don't you get boat and yacht owners in this forum are not a good sampling of the reality of what we're talking about here????

    Once again I must state: Medical education expense is only one aspect of the problem. But, if you're going to try to discuss the broken healthcare system it has to be part of the discussion.
     
  3. yobub

    yobub Active Member PLATINUM Sponsor

    402
    Jul 29, 2016
    Chicago
    1998 400 Sundancer
    Cat 3116's
    Ha, no, that's your full benefit book. It is designed to be the complete detail of your plan, in combination with the formulary that lists your drug coverage. That document is long and very detailed, and can be tough to follow, but it does form the basis of the contract between your insurance company and your employer for your coverage.

    Here is the Summary of Benefits and Coverage I was describing:
    https://media.fepblue.org/-/media/PDFs/Brochures/2020_BCBS_SBP_Standard_Option_SBC_Web.pdf
     
  4. El Capitan

    El Capitan Active Member

    536
    Jul 9, 2014
    Chicago IL./Vero Beach, Fl
    1970 SRV 180 w 2.5L Mercruiser.
    2000 Ford Expedition Eddie Bauer
    120HP Mercruiser
    If you don’t like your employer insurance benefits find a new employer.

    For the last decade my employer paid 100% of my insurance premium.

    My current employer pays 80%.

    I’m in healthcare IT. I work hospitals, payers, labs, physicians. Part of the problem is we in this country run to the doctor for common colds and minor flu. We consume far more services than in other countries.

    So insurance companies respond by increasing their premiums. Then employers share a larger portion of the premium w their employees and those plans have a greater patient pay in form of higher deductibles and copays to keep lower premiums.

    It’s the way we role in the U.S. Far better than Canada.
     
  5. brewster16

    brewster16 Active Member

    456
    Aug 9, 2009
    Long Beach Island, N.J.
    '07 44 Sundancer
    Twin Cummins QSC 8.3
    Anyone care to learn another MAJOR factor in rising premiums??? Ambulance chasing lawyers! They're so proud to tell you they are "protecting the rights of victims." What a freakin' joke!! Last week I was forced to stay home with a bad cold. Have any of you seen the parade of lawyers on TV all day long soliciting the non working public about how rich they can get by suing their doctors and healthcare providers? "1-800-UCANSUE".....Now THAT is pathetic! I drive up and down I-95 to Philadelphia passing every other billboard with huge ads for scumbag lawyers....Do you have any idea how this cottage industry is driving up the cost of medicine in THIS country? Another guy advertises that he has recovered billions and billions for "victims." Guess who pays for that? WE DO!
     
    techmitch and Windjammer like this.
  6. ENstig8or

    ENstig8or Active Member GOLD Sponsor

    140
    Jun 4, 2013
    New Jersey
    2003 Sea Ray 450 Express Bridge.....

    2016 Sea Ray 21 SPX BR
    Cummins 480CE (450)
    Mercruiser 4.3L (21 SPX)
    Absolutely! I thought there were a lot of legal billboards here in the South Jersey-Philadelphia area until I spent a winter in Florida! It's much worse down there. Every 100 yards, another billboard with some POS claiming that they'll get YOU MONEY YOU DESERVE! Makes me want to vomit.
    BTW, a huge percentage of Congress is made up of LAWYERS! It is a shame today the mentality is shifting to people who feel their job is to figure out how to legally steal from others. They would rather spend their lives suing people than working and earning that income.
     
  7. El Capitan

    El Capitan Active Member

    536
    Jul 9, 2014
    Chicago IL./Vero Beach, Fl
    1970 SRV 180 w 2.5L Mercruiser.
    2000 Ford Expedition Eddie Bauer
    120HP Mercruiser
    Hope you never become a victim of negligence and are in need of financial assistance to pay your medical bills. It’ll change your tune pretty quick.
     
  8. Boat Guy

    Boat Guy Well-Known Member

    @El Capitan - #1 reason for filing bankruptcy is healthcare expense.
     
  9. spikedaddy99

    spikedaddy99 Well-Known Member GOLD Sponsor

    Jun 11, 2008
    Prentice, Wi
    2005 500 DB
    QSM-11
    I agree with the above statement about lawsuit happiness. In Virginia, about 10 years ago, the Bar was trying to change the max payout for a malpractice case from 2 million to 20 million. (I may be off on the exact about, but it was 10X the current.) Now, in a true medical malpractice case, I get 2 mil might not (or won't) cover a lifetime of medical expenses. But, what they fail to reveal is the attorneys get 40% of the payout, and 40% of 20 mil is a lot better than 20% of 2 mil.

    If you've ever used Round-up and now have cancer, call XXXX. OK, if you are spraying something that KILLS something, don't you take precautions and cover up to avoid exposure? No, I don't want people to have cancer, but if common sense could prevail a little...
     
  10. atrick

    atrick Active Member

    309
    Mar 4, 2017
    Penna
    1995 searay 290 Sundancer
    1990 21 maxum
    Twin 4.3 mercrusers with alpha one genII drives
    305 chevy with a alpha one drive
    Do a little research on roundup! They have a bunch of generic modified plants that roundup doesn't effect ie; soybean, corn and many more, it is one of the most used pesticides on the market for the big farms so we are all exposed to it you just don't know it!!
     
    spikedaddy99 likes this.
  11. spikedaddy99

    spikedaddy99 Well-Known Member GOLD Sponsor

    Jun 11, 2008
    Prentice, Wi
    2005 500 DB
    QSM-11
    It was just an example of lawyer speak for big lawsuits.
     
  12. paulswagelock

    paulswagelock Well-Known Member

    Oct 25, 2010
    pa
    2018 SDX 270 OB 300 Verado
    Verado 300
    I have the good fortune of retiring very young. Went to the affordable healthcare act marketplace to shop coverage. My family of 4 will cost $20k per year in premiums and $15k addition out of pocket if we have claims. No way the average family of 4 could afford that.
     
  13. Golfman25

    Golfman25 Well-Known Member

    771
    Sep 12, 2009
    IL
    281
    V8
    What's "funny" about the ACA is that the average family would likely get a premium subsidy which would bring the premium costs closer to several thousand (that's the bait). But they still have to pony up $15,000 to use it (and there's the switch). Yeah right.
     
  14. paulswagelock

    paulswagelock Well-Known Member

    Oct 25, 2010
    pa
    2018 SDX 270 OB 300 Verado
    Verado 300
    For a family of 4, discount ends if adjusted income is over $80k a year. That is awful low.
     
  15. Boat Guy

    Boat Guy Well-Known Member

    @paulswagelock, When I look at the financial model of what's going on in the US, I'm getting more and more convinced they don't want people to retire. I'm highly concerned for those on fixed incomes as inflation is going to make those checks smaller and smaller. Healthcare just adds to the concerns.
     
  16. Woody

    Woody Well-Known Member PLATINUM Sponsor

    Nov 20, 2007
    N. Wisconsin/Lk Superior
    2005 420DA
    Cummins 6CTA8.3
    Assessing a persons worth and the best use of assets there are many that would adopt an Eskimo model. When you no longer can contribute you become a burden, get on the ice flow....goodbye...love you.
     
  17. Golfman25

    Golfman25 Well-Known Member

    771
    Sep 12, 2009
    IL
    281
    V8
    That's kind of my point. If you only make $80,000 per year for a family of 4, where the F is the $15,000 coming from. Only a moron could set up such a system and claim it's any good.
     
  18. boatman37

    boatman37 Well-Known Member

    Jun 6, 2015
    pittsburgh
    2006 Crownline 250CR. 5.7 Merc BIII
    Previous: 1986 Sea Ray 250 Sundancer. 260 Merc Alpha 1 Gen 1
    5.7 Merc BIII
    The $15,000? How could they come up with the $1600/month premiums?

    My company ended up going with Cigna. I opted for the lowest deductible policy. The 2 lowest cost were both HSA plans with either $3000 or $5000 deductible and nothing was covered until the deductible was met so I crossed those off. Then there was a $500, $1000, and $1500 deductible plans. There was only about $150/month difference between the 3 so I went with the $500 plan. Cost for me and my wife is about $1100/month (no kids on the plan).

    I also checked the Affordable Healthcare site and the cheapest there was about $700 for about a $10,000 deductible and the most expensive was about $950. I figured for the difference I just went with the companies. I was not eligible for any subsidies.
     
  19. Golfman25

    Golfman25 Well-Known Member

    771
    Sep 12, 2009
    IL
    281
    V8
    Just an aside, depending on what kind of medical user you are you should run numbers on the HSA plans. I have found it's basically pay now (in premiums) vs. pay later (in deductible). Net/net its a wash. So if your a light user and a smart user, you can actually save some money in your HSA (especially with no kids).
     
  20. Creekwood

    Creekwood Well-Known Member GOLD Sponsor

    Apr 26, 2009
    Oakville and Georgian Bay, Ontario
    '97 330 Sundancer, Raymarine C80 suite with radar, Mercury 310 Hypalon w/8hp Yammie 2stk
    2X 454 carbs w/ vDrives
    Its really hard to tell the Republicans from the Democrats on this thread. ;)
     

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