Tuesday, October 13, 2009

It pays (someone) to be healthy!

My wife and I both work in jobs that are in or related to the healthcare industry. As such, we're a a little better-informed than the average Joe but not experts by any means.

For several years she's carried our medical benefits, largely because we agreed that the carrier whose coverage is offered by her employer is better than mine, or at least it was eight years ago. So we've continued with her coverage for that long, and for the most part, it's been fine. We pay only modest co-payments for office visits and prescriptions, but as with so many of us, the co-payments have increased somewhat in the past couple or three years. We also formerly paid very little in the way of "out-of-pocket" expenses, and were never in a position to have to pay any percentage a hospital stay. And we've been lucky enough to only need a couple of ER visits for a kidney stone for me (what you've heard is true, the worst pain I have ever experienced), so the hospital stay aspect of this has been irrelevant for us.

I mention all of this because the plan that her employer now provides has a mix of HMO-style coverage (co-pays for MD office visits and prescriptions) and the dreaded deductible and maximum out-of-pocket mix that causes us to dip into our own funds more frequently than before. The obvious reason for this is so that my wife's employer can offer "coverage" at rates comparable to the previous year. And the employee's option is to accept is and pay his/her share of the premium, or decline it and go without. Not much of a choice, I'd say.

We're experiencing some of this as my wife and I have both found it necessary to have some diagnostic testing. Nothing serious, mind you, but the kind of thing where the doctors are either trying to confirm a problem or rule out a problem.

Well, I just got today's mail and received an explanation of benefits from our insurer. Looks like we'll have to go "out-of-pocket" a little more to pay for some testing that already took place, and I'm having some tests later this week. Gee, I can hardly wait to see what that costs, as I would be absolutely shocked if it's determined that we don't have a substantial portion of that to pay, too.

I keep telling myself to remember that there are others who don't have ANY insurance or ANY means of paying for their treatment.....so they don't have it. Small comfort, but until something changes and health insurance is more inclusive and more competitively priced, this is how it's going to be.


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