# Oh My word, what about health insurance?



## decoustudio (May 4, 2006)

*NOW HEAR THIS: I do not get anything from anyone for posting any names of health providers in this Forum. I do not sell insurance, nor get any commissions from any insurance companies* (but I would be open to getting paid, so call me!), *so what I have to say is a personal opinion, only provided to help open the discussion, and see what others are doing about insurance.*

So, here it goes:
I can't tell you how many times I get asked about health insurance by folks that wish they could leave their corporate jobs and do something they really enjoy. Working for the "Man" comes with some "benefits'" such as; steady pay, someone that says they will help you retire in comfort, people to fall back on in times of trouble, and the promise of low-cost health insurance to cover everything from first-aid to major medical problems, and sometimes even disability insurance. They even cover half of your costs for Social Security (ok, ok, the Feds make them do that much). But, you might wonder why all of those benefits are provided to you? Stop and think about it, if all of those benefits weren't provided, how many of you would continue to show up on Monday morning? The "Man" knows that, and so He provides the benefits.

Fear of the unknown and worries about personal bankruptcy caused by unplanned health problems, sends many of our family, friends, and neighbors to jobs they hate each Monday morning. I know this because it was true for me, and like I said, from the countless number of people that have spoken to me about it in the past.

*This is the summary of the information I always offer when people ask:*

In the past, I have considered several different options for getting health coverage:
1) have spouse get a job and provide income and insurance for me.
2) continue to work at a job I hate to keep insurance.
3) pay "Cobra" payments from past job-provided insurance.
4) go without insurance, and pray for good health.
5) buy American Medical Security health insurance plan for self employed people.
6) buy "National Association for the Self Employed" insurance through Mega Health.
7) buy health coverage through other companies, such as "Blue Cross Blue Shield." 
8) consider getting another job that pays better and provides insurance and benefits.

When I spent several years exploring the options of self-employment, counting the sacrifices required, and seeking out full-time artists to get advice from, I was told by every person I contacted for me to pick "Option 1." And for some families, this might be the best. But, for our family it wouldn't work, as my wife wanted to live out her dream of staying home to raise kids. So for us, I had to move on down the list.

I have been most happy out of all the above listed options with Number 6, insurance provided through my membership in the www.nase.org group. I found this insurance through a trade show, where we happened onto an insurance salesman. The sales person that would call on me in Kansas, will be different than anyone else would use, so if you are interested, get on their website and get someone to contact you.

We are healthy, family of four, no bad health history, no prescriptions, safe lifestyle, no dangerous hobbies, no alcohol consumption, no smoking, no drugs, no sexual promiscuity, no "nothing," (pretty un-American in a lot of ways). For our health coverage, and the group's membership, our health costs are around $400 per month. This has to do with a lot of factors, so get your own quotes. Also, in this $400, I have pay $50/month more than I could because I am heavier by 10 pounds than their height/weight chart allowed (So, the wife is riding me about the pounds, and the $600/year cost that it causes). So, the end result could be that our costs are more like $350/month if my diet works out.

Now, I don't speak "insurance-ease" language, so I don't totally understand all of the coverage that I have, or don't have, so just don't ask me. If you have questions about the coverage, ask someone that might be able to answer those questions at the website, or from a salesperson.

I do know that I have a good sized deductible, I can choose whatever doctor I want, and the less I use a doctor, the cheaper my future costs are. So far, so good. If this opinion changes, I will sure let you all know.

I'd be very pleased to hear what others have done to get insurance,
Mark DeCou


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## dennis (Aug 3, 2006)

Thanks Mark! I just talked to the fellow from nase and signed up. I had a heart attact about 5 years ago so i figured my cost would be astronomical…i was pleasantly suprized. I was fearing a $1200.00 a month as I've seen other woodworkers have to pay, so I never even got a qoute. By the way when i had my heart attact I was employed by an outfit who could not "afford" insurance. (I get to hear the coyotes at night and see them some mornings…Thanks God)


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## dennis (Aug 3, 2006)

Suprise…the rest of the story is they turned down my application due to my heart attact. Same old crap. Now we see if I get a refund for joining NASE.


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## decoustudio (May 4, 2006)

Sorry that this didn't work out for you. You may find the benefits of being a member of NASE are worth the membership costs, so I would recommend that you look through their entire benefits list before you quit it.


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## oscorner (Aug 7, 2006)

Dennis, don't feel alone. I've had two operations with three stents and have diabetes. I currently work for a utility company that has great insurance, but because I would face the same discrimination as you do because of the heart problems, I can not even think about going into another line of work to get off of these rotating shifts that throw my blood sugar for loops everytime I go from day to night shift and back again. With all the medications and check ups, I couldn't afford to be uninsured. I hope you find a compasionate insurance company that will cover your medical insurance needs. Until then, may God keep you healthy and safe.


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## bbrooks (Jan 3, 2007)

There may be other associations that offer health insurance too. Or maybe we could make lumberjocks an association that some carrier would provide coverage to? There are already over 300 members, which would qualify as a mid to large size group for most carriers. I know at least one of the "Blues" were interested in covering associations as a way to get new members.

As someone now on COBRA, I can tell you the costs are amazing. I dread when I have to change to another plan. Maybe I should get out my tin cup for donations now to beat the rush.


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## bbrooks (Jan 3, 2007)

After looking at my costs for the year, I hope I can find a more reasonable priced health insurance. It is hard to make a profit with this kind of monthly bill.


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## BassBully (Mar 8, 2007)

Mark,

Thank you for the post. I've been wanting to ask you how you provide health coverage for your family, now I don't need to. Like you said, I continue to work for the corporate world mainly for the benefits. The other main reason is college loans. It scares me to think about the costs I would face if I became self-employed.

My company benefits are about the best I've found. I have asthma so I have to pay $25/month for medicine that would otherwise cost me upwards to $100 without their insurance. Plus, we're not done having children and our first child was born three weeks early and had to stay in the hospital for a week. Compared to the total costs, my portion was very minimal. An insurance company like you have would probably discriminate against me for that reason and with more children on the way, it fears me to take that chance.

Maybe someday I will.


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## BassBully (Mar 8, 2007)

Mark,

By the way, you could save your marriage and health insurance costs if you'd quit stealing M&M's from your wife's trail mix bag!


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## Sawdust2 (Mar 18, 2007)

I know what all of you are talking about. I, too, cannot get health insurance because I have had 2 (or 3) heart attacks and have 5 stents.
In case of emergency you should know that all hospitals are required to have a charity policy. They must excuse 5% of their "profit" for charity. My bill was over $70K and they wrote it all off because that year the hospital had not met it's charitable obligation and the cutoff for my income for that year would have had to be in excess of $308K. While I wouldn't have made that much in a good year I surely could not make it in the year of recovery. Made my wife feel a lot better.
Another thing I have learned is to negotiate with the doctors and hospitals first. We all know that the insurance company does not pay the normal billing rate nor does Medicare or Medicaid. You can usually bargain them down to somewhat close to those rates if you do it beforehand. This could be a savings of near 50-60% off the normal rate.

BTW this is my first post but I found the topic near and dear to my heart.


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## Sawdust2 (Mar 18, 2007)

Forgot another tip.
As I don't have insurance neither does my wife.
She needed an MRI and the local purveyor quoted one exorbitant price.
I did a google search for "discount mri" got a quote that was 40% of what was originally qouted by the local and they agreed to match it.
With what we had been given as quotes for mediocre insurance was still high due to our ages and health history our medical bills are not really excessive considering what we save in premiums and copays.


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## dennis (Aug 3, 2006)

Yes my problem is when my families health is in jeopardy I don't think about the price…then I get charged 40% more than those covered by health insurance and the doctors save another 30% on administrative cost when I pay in cash. Then I can't take it off my taxes so I'm stuck again…paying taxes for prisoners and bureaucrats health insurance…and all those who just can't afford to pay. I guess I'm feeling a bit abused by our medical system. So I just have to let it go, because it is obvious to me it will not get fixed by our *government!*


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## bbrooks (Jan 3, 2007)

I am not sure if the government fix would not be worse than the system we have now Dennis. I so agree, the current system is not working.

Everyone says let the market work, but in this case it is so distorted that it does not work. There is not a true market for purchasing health insurance, since the primary customers are the companies that offer coverage to their employees, not the employees themselves.

The payment system is also distorted as well. The health insurance companies control the payments to the doctors and hospitals. They use their buying power to force down their costs. So, the doctors and hospitals raise their rates for those not covered to make up the reduction.

Having worked in the industry for many years, it is a subject that concerns me greatly. I have no problem with anyone who has coverage, I think that is great. I feel sorry for those who do not or have to pay for their own. Sorry to vent, but it does hit home to me in many ways.


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## MsDebbieP (Jan 4, 2007)

and we, in Canada, are headed towards your system.. silly us


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## Sawdust2 (Mar 18, 2007)

The complaints of Dennis and Bill are well recognized.
Another little secret:
There have been a number of lawsuits against hospitals for the inequitable billing practices, especially against those who cannot get or cannot afford medical insurance.
The result of most of them has been that the hospital has had to reduce its charges to those folks.
The "tort reform" that doctors wanted did not result in decreased premiums. In fact, they usually increased after laws limiting what could be collected in medmal suits. 
My doctors and hospitals recognize this and that's why they are willing to negotiate - just like the market says should happen. 
Dennis, talk to your doctors. They will deal. Then, you only need insurance with a $10K deductible for catastophes and you are ahead of the game.


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## Greg3G (Mar 20, 2007)

Another option is a Health Savings Account. These are fairly new. They allow you to put money into an account tax free. This money can be used to pay for any medical expence, premiums, drugs, etc. When you replentish the spent money, it goes in tax fee. There are several companies out there that will set up an insurance plan with a high deductable and a HSA to cover the detuctable. That is what I am planning to do when I make the move away from corporate life. (Just as soon as my wife and I get the kids through college, only 15 yrs : )


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## DanLyke (Feb 8, 2007)

Bill (And others who live in areas covered by Kaiser Permanente), have you looked into Kaiser?

They've been wonderfully affordable for a decent level of care for me, and the billing issues and all that seem to "just work".


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## decoustudio (May 4, 2006)

After seeing medical bills pour into the mailbox from my gall bladder issues, and now with the specialist and biopsy to diagnose my daughter's problems, I am not so thrilled about the insurance I purchased with Mega.

I was told by the salesman that it was a $5,000 family deductible. It was a high deductible, but we were healthy at the time, so we took the insurance. Now, I find out that our deductible is actually $5,000 per person, per diagnosis, per year. After the deductible has been met, we get 20% of the remaining costs.

Moral of the story:
Read the fine print, don't listen to a salesman, understand what you are signing, before you sign up with any insurance. The legal-ease language was overwhelming to me when I signed the contract, so I didn't understand that the deductible rate was so bad.

Hope nobody else is surprised, and I'm sorry if I lead anyone astray by this Forum Topic,

Sorry,
Mark


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## Chipncut (Aug 18, 2006)

Sorry to hear that Mark,
I don't know if you agree, but this country needs an equitable national health plan that, isn't controlled by these money grabbers, with their high premiums, & those high paid executives with all their perks, & bonuses.
I've been fortunate to have good coverage. I carry a supplemenal plan that is overseen by the MN state retirement system,. They kind of watch out for us. A year ago they gave me a choice of a different plan. I was with Blue Cross, & I switched to Ucare of MN. I'm saving $300/month with better coverage.


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## dennis (Aug 3, 2006)

Did I tell you I got to pay $300.00 dollars an hour just to talk to a nurse who probably made about $20.00 an hour.


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## Sawdust2 (Mar 18, 2007)

Mark:
Just out of curiosity have you done you cost breakout on this insurance?

Given the amount of deductible and the amount of premium and the amount of copay how far are you ahead of what you would have been if you had just self-insured and did some shopping around for medical services?
Oh, yes. Medical services can certainly be shopped. People just rely on the same old same old method of seeing the doctor.

If you have the time, and the inclination, I think the LJ's would appreciate your end figures.


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## decoustudio (May 4, 2006)

The insurance news just gets worse.

Now we learn that it doesn't cover any costs associated with "specialist" or "outpatient services".

What does that mean? It means that for the 5 visits to a specialist for my daughter, her outpatient biopsy surgery, and the pathology testing of the sample, the bill starts heading to $20,000 quickly.

However, a sweet daughter you love more than your own life….....priceless.

What does our Mega Health insurance cover? Still working on that.

Good news is that all of the bill senders are willing to negotiate their bills with us.

Not sure on the cost break down Sawdust2. The problem is that none of us ever need insurance for anything….....unless something happens we can't afford to pay for, or we are willing to accept the consequences of not getting services.

How do you put a price on that?

The insurance companies are counting on that motivation. Our fear of death, fear of lifestyle change, and fear of the unknown. This varies from person to person. Hear about a good friend who gets cancer, or a heart bypass, and you start looking for an insurance company.

We are looking into the health savings plans. It will be awhile before we can afford to save much for future bills, but when we can, it might be the ticket.

One of the clinic business managers said that they get beat down so bad from the insurance companies that they hardly make any money on the services they provide. I didn't buy that one, but it was interesting to hear. Too many photos of the surgeon's vacation trips and toys hung around the office to think they weren't making money. Our recent vacation photos….....the Emporia Zoo. Still a great time together, and costs nothing.

I'll keep you updated as I learn more.


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## MsDebbieP (Jan 4, 2007)

scam artists! And they get away with it-- at a family's worst times… That's horrendous.


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## MsDebbieP (Jan 4, 2007)

so now I'm thinking-ok, you have to be in the hospital for it to be covered-but wait, if you have a heart attack and they call in a heart surgeon .. bah,, specialist! 
What do plain ol' doctors do these days?? Nothing-it's all specialist.. Oh that is so bad..


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## dennis (Aug 3, 2006)

Went to my Cardiologist yesterday. $94.00 for 4 min. = $1400.00 an hour. I don't have the "heart" to not pay the poor man.


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## shangrila (Apr 5, 2007)

Don't you wish you could get away with charging just a fraction of that wage for your profession?


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## dennis (Aug 3, 2006)

amen


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## Zuki (Mar 28, 2007)

That sucks Mark.

As Debbie stated . . . there appears to be a move to a two tier health care system here in Canada. Right now health care is "free", but many people have waited 6-8 months for MRIs and other procedures.


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## bbrooks (Jan 3, 2007)

I bet there will be a lot of people finding out how much their insurance really costs, as they get laid off and have to purchase their own. It makes you wonder how much longer the system can go on like it is.


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## TreeBones (May 21, 2007)

I have the Nase / Mega Life for self employed and now wonder if the $370.00 a month (covers me only with the high deductible) would be better spent in the health savings type of insurance. Does anyone have this?


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## North40 (Oct 17, 2007)

About a year ago, one of my daughters had a serious resperatory infection and spent several days in the hospital. We had Blue Cross/Shield through my wife's employment, and paid an outrageous amount to cover the girls, but it was a $500 deductable per person per year, then 80/20 up to a maximum of $2k out of pocket. After that it was 100% coverage. Said so in the brochure. That's great coverage and almost worth the cost. But of the $12k+ of medical bills from this one hospital stay, we ended up paying over $8k. Oh, and insurance took so long (nine months) to decide what they were going to pay that several of the medical providers turned us over to collections. When we suggested that we would pay the medical providers until insurance paid (to avoid collections), and then get a refund from them after insurance paid, the insurance company said if we did that they wouldn't cover anything with that provider. Of course, they didn't cover any of the collections fees.

I did the math, and insurance paid out less towards the $12k than we paid in for insurance premiums that year. How do they get away with saying $2k max out-of-pocket in a year, and then let you pay $8k on a single illness?


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## mrtrim (Oct 11, 2007)

i wonder if we could get an insurance policy that covers our insurance policy ?


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## North40 (Oct 17, 2007)

Oh, I know the hospitals are in it too - one of my daughters was born c-section. The hospital billed us $1200 for the six pre-med students who observed the operation. We didn't pay that. They also billed us $1000 per night because I slept in the room (in a chair). We didn't pay that, either.

On the resperatory infection, we got seperate bills from each department of the hospital and each doctor - all on the hospital's letterhead. No itemization, just totals for each. I asked for itemized bills and was told "We don't do that anymore. It would be pages and pages." Oh, and they put her in the cardiology unit the first night because they weren't sure she was going to be admited into regular hospital care and they wanted to free up the emergency room in case someone else needed it, and cardiology is right next to the emergency room. Sounds reasonable, right? Except being in cardiology is more expensive than being in the emergency room, even if you aren't using cardiology services.

Oh, yes, hospitals are in it too.


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## snowdog (Jul 1, 2007)

The only reason I am still working is to cover my wifes med bills. 6 more years to go.. Sometimes the free market needs a slap on the wrist. In this case it needs a bit more than that. I wish I had an answer and I bet a lot of people do. It kills me, I have much more $$ in the bank than I need to retire if it was not for the medical community. Shoot the lawyers first, then the gas companies after that enslave the doctors


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## saddlesore (Oct 17, 2007)

More like a slap up the side fo the head, Snowdog. Don't get me started about medical insurance companies. And the way people put down the oil companies! Insurance industry is worse!


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## EGA (Dec 17, 2007)

I always tell anyone young enough, military, military etc. I have my rertired ID card, good in any free country of the world. Never have paid for any kind of insurance. Well, I could go on and on. Down side got shot at a few times in Nam. Worth it??? Dang right!! Semper Fi!


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## MsDebbieP (Jan 4, 2007)

Peter.. I wonder how many people pay the bill because they don't look at it .. or they think that it is not worth the fight.
that's horrible.


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## GaryK (Jun 25, 2007)

I have to say that I was lucky. Both with my insurance and being alive. In 2004 I had an aneurysm and almost died. Then upon news that I was going to live with my brand new heart valve, I started worring how much it was going to cost me. Well, the total bill came to over $750,000.00 US. Well, to make a long story short
my insurance paid for every penny, even my deductible. So I have nothing to complain about.

Gary


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## TreeBones (May 21, 2007)

Gary, maybe the rest of us can get the same policy as you have?


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## GaryK (Jun 25, 2007)

Company is: Blue Cross Blue Shield


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## TreeBones (May 21, 2007)

I'll be looking closer at this. Thanks.


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