Dang, I glad we have insurance

I didn't realize HOW expenses an office visit could be. Normally when I go into Kaiser, I never see the "itemized" bill for service, but they forgot to charge me a $15 co-pay for office visit, and had to generate a bill for the month. I saved it to post it up here on the blog, cause i'm that nerd.

So what am I talking about?

ALT Lab test: $31.00
HPV Detection Lab test: $139.00
Pap Lab Test: $139.00
Office Visit: $205.00

$514.00 without insurance to be told I was healthy for my every 2 year check up. Thankfully, we paid $15.00.

Then there was little dude who was "sick"

Office Visit: $323.00
Extra charge for "urgent care / non appointment" :$100.00

$423.00 without insurance before prescriptions... and we paid $15

Office visit to get ENT referral:
Office visit with Dr. & appointment: $125.00

We paid $15.00 ....

Makes me feel better about those insurance premiums, especially since I didn't get an itemized report from the ENT... who removed his tubes and some wax during his visit..... for $15.00

.... and then we had the other $15 co-pay when Eli had to go back to the urgent care after his tubes were removed... because there was some "fluids"...

yup, happy to have insurance.

Why we pay for good health insurance

There's a lot to talk about when it comes to the ACA and health insurance and i'm not going to debate it on the blog. When the law passed, our bills went up...But there is always one thing we have been glad to have as a family, and that folks is good coverage.

I've never had to deal with crappy insurance -- yes its always been expensive, but NEVER was it "I'm going to worry about my bills" crappy, which is why I won't debate the ACA.

I've never been in the position to not have insurance so I don't feel like I can weigh in on the subject. All I know is now, I feel like when I go to the doctor I get answers in that visit. Before, not so much. Tests, long lines and the run around for an HMO plan without real direction. Sure, it was labeled "great" insurance by many when I was in my 20's ---Yes, you read that correctly. At 20 I was working a full time job with benefits while I finished school. --- but I didn't feel like I got the best coverage for what my employer was paying.

(Growing up was different. As a kid, I was on Medi-cal or some state program because we were poor and I don't even remember going to the doctor for anything but vaccinations. I had to go once for a ingrown toe nail that had to be surgically removed and there was the chicken pox... Other than that it was OTC and wait it out...) 

My husband has had crap insurance and we paid our share of a couple hundred dollar doctor visits in exchange for cheaper premiums... and it's not something we will do again now that we are a "family" and I see how often hubs gets sick and needs a doctor to make him better so he's not miserable for a month. Health is health, and I don't want to have to have the "can i go to the doctor" chat. In our house, your sick and want to go, go (and hubs does.. I go for my annual visit and unless there's a chronic issue... they see me next year... but again, that's me and I come from a "power through it" mentality).

The policy we are on now feels more like a traditional HMO with the "approval" wait which we didn't really feel with our Kaiser plan... but that's because it's a different system... but even now, i'm super glad we have it. I love my doctor and little dudes doctors and nurses... and we figured out urgent care and all that.

With my city job, the premiums are steep and if we didn't have help from my employer this would be a different story all together, but oh boy does it cover things -- which is the whole point of this blog article!

Back in 2016 little dude needed to get tubes put in his ears. He was having wayyy too many ear infections and it was doctor recommended. He's been super happy since and HASN'T been sick... even with daycare germs floating, we only had one vomit virus... (Cross our fingers) and one head cold that he got over super fast because of the tubes...

But Holy Cow was that procedure expensive! Like $8,613

For a 30 minute procedure...

Our plan discounts and adjustments where $5,948.25, and our health insurance covered the $2,664.75 making our out of pocket cost, $0.00. They even paid our parking fees at the surgical center...

Yes, we had some follow up appointments and office visit Co-pays... but your talking less than $100

I might be upset at the price increases for 2017 and how they are affecting our paychecks, but boy and I glad that I don't have to pay almost $9k for my son's surgery. 

Apparently having a baby isn't a qualified status change...

for my husband...

My HR department told me I can't make my health insurance a "family" plan when the baby comes... I can add the baby... but not SCB because its not a status change for HIM.

I'm soooo P.O.'d.

If we had known we would have put him on at the beginning of the year or done our research sooner....because part of the perk of putting the baby on Kaiser was that the whole family would have awesome healthcare for the same take home pay... which would be worth paying all the extra money for piece of mind...

Instead I read, on the paperwork a list of qualified status changes where you can make changes to your health choices outside of open enrollment... and having a baby is on there... so I assume that means we can make changes and add and delete family members to have the best situation for our family.

As much as I want the baby on Kaiser, I think I might try and really look into finding a doctor I like with my husbands insurance since he apparently needs to find one anyway.

GAHHHHH

(If anyone on the internet can prove this wrong, I'd love you to pieces).  

Doctor's Bill

So last month it was very obvious that my poor husband was down for the count and ill beyond measure.

We loaded him up with antibiotics and had our second trip to the doctor's office this year...

Now, if you remember back to this post, our doctor charged us $240.00 for a visit just to get SCB's prescriptions renewed.

Since he's an "in-network" doctor, we got a discount and were left on the hook for $161.02...

Our insurance won't kick in until we reach our deductible, so for this last visit we had no idea if we would be charged more since he was actually sick or not, but we figured it would be around $160 basing it on our previous bill...

Well, we got our bill in the mail the other day and I noticed the doctor classified our visit as a "Level 3" office visit and charged us only $105.00. With out in-network discount we only owe $74.09.

How is it cheaper for us to go when he's really ill, then for 5 minutes to review prescriptions????

I really wish I would have kept our bill from last time to see what our visit was classified as. Guess i'll have to wait for the next prescription renewal visit. If its miraculously cheaper next time too, i'll be fighting with someone over the phone I'm sure. I want our old and simple plan back... and while i'm on the subject of health insurance and venting, my mom's covered California plan still can't seem to get their budgeting department figured out.

They have yet to mail her a bill before her payment is due so I've had to make online payments for her the last few months. It gets better. The one time they did send her a bill, she had to write a check because their website was down. They cashed her check and decided never to credited her account. I had to spend over an hour on the phone with them explaining that she had paid her insurance on time and that they took her money when she received a notice in the mail about missing a payment and the next month her bill was double what it should have been.

I also learned that apparently she can miss up to 6 months of payments before they cancel her insurance because of her government subsidy... which is a good thing otherwise the payment she made that they never credited would have automatically cancelled her insurance so at least I didn't have to fight them on that one too.

Doctors Visit

I mentioned earlier this month how South County Boy would finally be using his new health insurance plan. We picked him a new doctor and he went in so he can get his medications renewed (they require an in person visit every six months).

After navigating the new website and our new benefits, there are a few "silver lining moments."

Looks like his generic "Singular" is completely free to us with the mail in order pharmacy. What would have cost us $37.67 for a 90 day supply was covered by our insurance.... Our doctors visit, not so much.

The quick visit (he brought in his old bottles so the doctor knew what he was taking before and just confirmed that he needed to stay on them) drafted a bill for $240.00.

His insurance will cover $78.98 since it was an "in-network" doctor and this is our "discount" for staying "in-network" but we are on the hook for $161.02.

It's moments like this where I miss his old insurance plan through Kaiser (the one that was deleted after the ACA went into effect). We got one free visit a year and had a standard cheap office co-payment for visits before a deductible.... and everything I needed I could find on their website, which isn't the case with our new insurance.

Now i'm stuck navigating through Blue Shield Blue Cross of Texas... yes, another state! His insurance comes through Texas because that's were his companies corporate office is and they buy insurance for all their other states through Texas apparently... and to be honest, I can't find a single packet that explains his plan online at all... the last bit of information I got said:

We pay 20% after a $1,000 deductible and had $30 office visits. 

Which, since we got a bill for $161 seems a little off to me. We also never received any new information when 2014 rolled in... just a slightly higher premium that was deducted from his paycheck.

I called customer service and after waiting 30 minutes on hold I was told that they don't have an explanation of benefits packet that they mail out, nor is one posted online. I was a little shocked and asked her how I was supposed to compare insurance policies without any information? You know, knowing what to expect to pay for an office visit before making an appointment would be kind of nice to know... especially since we are in a different state and therefore we don't have a Texas zip-code so their website doesn't help us at all.

I explained that we kind of just took a leap of faith with it when we purchased it back in November because SCB's old plan was cancelled under the ACA and it was the cheaper option with the information that we had... but now we are apparently paying $160 to go and just get a prescription renewed.

Eventually she gave me a phone number for SCB to call to at least get a Summary of Benefits and Coverage, but she told me even that wouldn't provide a lot of information.... but at least its a start. Guess i'll be having SCB make some phone calls this week. I also had him ask around the office. His boss told him today that the $30 office visits only kick in after we go through the $1k deductible... but then why did they cover almost $79 of our office visit (not that i'm complaining about them covering things-- I just want to know how the thing works)....

So far the only perk looks like free prescriptions... But we won't be using that for everything. SCB wants to be able to get his antidepressants at a moments notice, so he prefers we pay $10 for a 3 month supply from Walmart since there is one on every corner practically and worst case he had to walk around the store for a few minutes while they process them. (He tends to be forgetful and doesn't want to wait up to 2 weeks for them to be mailed to him.) I'm hoping this will also include his inhalers.

Covered California Follow Up...

You may have remembered reading about my first experience with Covered California when I helped my mom fill out an application for help with premium payments...

She got a letter in the mail the other day indicating that she had in fact been approved for assistance help. The letter also said she had 30 days to choose a health insurance plan...

The problem was we were already supposed to have done that, over the phone, when we applied.

So I went over to my mom's house and we let the hold music ring for 40 minutes. Yes, 40 minutes before a person came on the line.

Once we got to the rep, she pulled up my mom's account and told us that our information was still in the computer and the letter was auto generated (what I expected) but since my mom was freaking out, it was worth the phone call to make her feel better.

I also was able to ask the lady for Health Net's contact information because we hadn't recieved the paperwork for my mom to fill out to set up payment and we were told we would get it in November... and with the holiday just a day or two away, we wanted to follow up.

She gave us the number and I dialed and listened on hold for around 10 minutes when a person picked up and she told us their offfice was behind and the paperwork would be mailed on Monday after Thanksgiving, and if we didn't recieve it by the 7th, to call their offices back.

We also took the time to get the phone number to verify that my mom's current health insurance plan would automatically expire on Dec 30th and that no action was needed on our part. That phone call only took 5 minutes.

All and all an hour spent and my mom now has piece of mind until the 7th... when i'm sure i'll have to call and figure out where her paperwork is.

At least both Covered California and her health insurance are putting in the papers my ability to call on her behalf with these matters since she really doesn't understand what's going on.

What I did learn from the letter they mailed us is that if my mom earns less money than last year, she could end up with a Tax Refund from the Affordable Care Act if she qualified for more premium assistance and didn't get it... That's going to be interesting for a lot of folks because the flip side is also true. If you take more assistance than you qualify for, Uncle Sam is going to take it from your tax refund... I wonder how many people will fudge their income lower and get shocked when the tax man comes collecting.

Also they are apparently setting up store front locations to try and sign people up at the mall. I wish I had my cell phone with me, but there was literally a covered California store location the other day.

My adventure with Covered California

My mom needs health insurance.

Her work cut insurance a while ago and at 62, it isn't cheap to have to find your own. She currently has a high deductible plan and pays northward of $300 a month for it.

Thankfully, the only good thing I will say about the Affordable care act, is that its going to make insurance a lot cheaper for my mom since she's low income.

She qualifies for a healthy subsidy because of her income, but with all the drama around the government website, I wasn't sure how I was going to get her to sign up.

I ended up having Monday off so she came over with her information and we began the process.

I tried to start out on the internet and created her an account with all the security questions and password... and then we got an error message and could not start the application. I was using Chrome, so I tried again in firefox and internet explorer 9 while waiting for the internet chat to open up to get someone who could assist me... I was originally number 21 in line... and after around 20 minutes, my screen looked like this:

Finally, after 40 minutes of waiting, I got a rep... and this was our conversation.

Apparently there wasn't anything we could do online... I called the number...

Thankfully the wait was only 5 minutes until I got someone. I read them word for word the advice the gal on the website had given me and then we spent around 30 minutes on the phone with the application... My mom didn't know she needed to actually have the form that says she's a US citizen in front of her (she was born in Canada and came here when she was 5), so she ran home to get it while i wrote our application number down so we could call back.

First problem came when we called back 10 minutes later and the guy couldn't find our application. We were about to start a new one after he kept searching for a good 5-7 minutes when it finally popped up.

We then spent another 30 minutes on the phone while he plugged in that one number, selected my mom's health plan, and waited with us while the application submitted. Most of the time we spent just waiting because their network was running so slow. While we chatted I discovered he actually grew up one city over from me and like my mom, his mom was one of the original homeowners in this area when there was just dirt and no paved roads.

On an average day he told me he signs up around 10 people for health insurance. Eventually our application went through and we decided to get my mom a gold health insurance plan with Health Net because it will cost her around $130 a month and it does not have a deductible.

So in total, it took me 40 minutes on-line and an hour on the phone, but my mom should receive papers by Nov 15th to set up payment so she can have her new insurance on January 1st.

Well, there goes affordable health insurance

This month we are paying two health insurance premiums... SCB will be going on his employer health insurance plan and they require you to pay a month in advance before coverage begins. We are so incredible grateful that he was able to find this amazing job with benefits... and he loves working there.

Why all the fan fair and love? Because his employer thankfully isn't sending employees to the exchanges.

I hate to say this because I don't talk politics on this blog, but because of the Affordable Care Act... AKA, Obama Care, his current plan with Kaiser will be eliminated... not because it doesn't meet the new standards as the booklet we got in the mail claims (which it does as you can see from below), but because they won't make enough money on my husband when they have to pay to help care for those that are not as well as he is for the same price. So they got rid of his plan.

The suggested new "KP CA Bronze" plan that is not sufficient for his needs and would cause our family a great financial mess. Plus, it's more expensive. Yup you read that right, more money for less medical care... in fact, 15% more money for less benefits.

His old plan was $178 a month. 

• $3,000 Deductible
• $6,000 out of pocket maximum
• 1 physical exam free
• Office visits $40 
• Inpatient care 20% after deductible
• Emergency room visits were $200 after deductible
• and his prescription coverage was $10 Generic, $35 for Brand after a $250 brand deductible. 

What was great about this plan was his doctors visits were affordable since he has to go in a few times a year to renew his maintenance medications... we have generic prescription coverage from day one, and worst case, we had to pay $3k from our emergency fund before insurance kicked in to help us cover bills.

What Kaiser was trying to sell him for $204.87 a month.

• $5,000 Deductible
• $6,350 out of pocket maximum
• 1 physical exam free
• First 3 office visits $60
• Inpatient care, 30% after deductible
• Emergency Room, $300 after deductible
• Prescription Coverage: $19 Generic, $50 brand.... all after deductible.

Despite the obvious other problems like a $5k deductible, on a practical day to day basis we'd have to pay 50% more to see a doctor from day one... and we wouldn't have any prescription coverage until we payed $5,000 out of pocket. Hubby needs his pills and while they are thankfully all generic now that singular is generic, that's still crazy. That gives us nothing and they would be charging him more money for it from the get go.

His new work plan is a little hard to read since I don't have the cheat sheet anymore but we pay 20% after a $1,000 deductible, $30 office visits, and more things are included like x-rays and there are standard fees for emergency rooms ($75) etc. Prescriptions only have $125 out of pocket before insurance kicks in (75% of the cost so we pay 25%)... which is way better than having to pay $5k out of pocket with no coverage help. 

Since we pay for it with pre-tax dollars and he also has dental taken out too, after taxes it only costs us $197.20 a month for both medical and dental for him.