markk wrote:
The use of insurance as the first dollar payer is the single largest cause of medical services price inflation, and runaway costs. The provider merely has to treat you. The financial transaction is of no interest to you, since you're not paying, and so, there are only two parties... the insurance and the provider, and this gives the provider every financial incentive to inflate the treatments, the cost, etc. The reason the store doesn't charge 27 dollars per gallon of milk, is that you won't pay it. But if you had insurance to provide you milk to drink, it wouldn't matter what the store charged. You'd have your milk.
Thus, the effort to tie medical funding to someone other than the patient is the very cause of all the bad things about our medical system. Obamacare, incidently, seeks to make this disconnect between paying the bill and the customer as complete as possible, thus exacerbating all the bad things even more. And then it imposes a bunch of unaccountable bureaucrats in boards, commissions, and agencies, whose job it is to decide what you can't have, in order to bring the overall price tag back down.
I think my insurance has a good way of doing it. Years ago, we had no deductible and just paid a low copay for each thing. Obviously, we did not like it when it changed to include a deductible and make us pay more. But at the same time, I can tell I am more thoughtful about going to the doctor. Not that I liked going. I prefer to avoid doctors. But I know I was thinking about the money.
My current insurance plan has a a weekly premium of $9 which works out to $468. I know, not bad at all. My deductible is $50o, and I also get $500 into my HRA account. So, in effect, the deductible doesn't exist if I never go over $500 for the year. And for a few years, I barely touched that account. It rolled over, and I had about $1400 in it. That was our money, so we were encouraged to not spend it.
Once we exhaust the HRA account, then the deductible starts. So, if we have $500 in the account to start with, we have to spend our share of the money that is held, then we have to spend our own money, and then the insurance kicks in with 85% coverage. So, we still have good insurance, and if we are pretty healthy, we may spend nothing all year. If we have problems, it does help us.
Last year, I had the $1400 in my account, and I ended yp in the ER twice in one week. I had severe vertigo. I also took an ambulance ride. I had no idea how expensive that would be. But walking wasn't working for me. The second time wasn't as bad, so i staggered in, and they put me in a wheelchair.
I used up the whole HRA account, then got the deductible, and still have some bills to pay off. I was also having high blood pressure problems with lots of visits to check the blood pressure and adjust medications as it was not improving.
This year, I got a new $500, in my account, and that was used up with more followup appointments. The deductible started before the sleep study and was finished off with the sleep study. I am actually glad that I did not know the cost of the sleep study as I might have cancelled it, and I really did need it, as well as the great start that the sleep tech gave me. But it was $6,000, and my share was $883. I haven't even started on that bill yet. I still have more follows up with the regular doctor as I my blood pressure is better, but not consistent since my sleep is not consistent yet. AND I have been having coughing problems (3 weeks and 4 weeks plus) plus two rounds of rash. So, that means extra appointments.
My xpap equipment is paid for 85% by the insurance so I think the first round of equipment is going to end up about $300-400. Not too bad, and it is working for me, so I know it is well worth it. I am past compliance, and it is a sale, so it is MINE.
Dental is 85% at most places and 100% covered at a few places. Basically the insurance still pays 85%, but those places have a deal to consider it 100 % covered. I went there last year when my second wisdom tooth broke. A piece of it completely broke off, but was still attached to the gums. I was really impressed with the dentist. It took longer to numb the area than it did to remove the whole tooth. I thought she was just going to remove the broken piece. But the whole thing was out in less than 5 minutes and never hurt afterward. I still need to go back and get the other 3 wisdom teeth out. I am a chicken with dentists, and I went back for a regular appointment and cleaning, but they wanted to do a more detailed cleaning since I had gone many years without dental work. They were also very concerned about my high blood pressure which was untreated at that time. I was normally in the 160s above 100-106. At the dentist, I was even worse. I didn't go back for more after that. But I know I need to do it, and I liked their plan. And my blood pressure is much better now.
During the exam, they noted the various things that needed to be done. I have some small cavities that need to be filled. They took photos and showed me on the screen, so I could see that everything they mentioned truly existed. And they worked out groupings of what could be done at an appointment. They recommended a deep cleaning, then an appointment to fix the small caveties. And then wait until December for another appointment. That way, if I had an emergency before then, I would still be under my annual limit. If I hadn't used it by then, I could use before it expired. And then do the rest the following year. They could get it all done in less than 6 months at no charge to me. So, I need to get brave and set u p that deep cleaning appointment, so that i can get as much as I can done with this year's available amount, and then get the rest done next year. My original broken wisdom tooth broke probably 8 years ago or so, and it starting to bother me a little. I am really good at avoiding the dentist, so I can tolerate a lot, such as not chewing some things on that side. For awhile, I had a hole in that tooth that I had to pick food out of it. But eventually, my gums filled in the hole. It didn't hurt unless I got stuff stuck in there, so it stopped hurting when the gums filled it in. It is sensitive with pressure now. Not bad, but a reminder that it needs to be removed.
Who would have thought it would be this challenging to sleep and breathe at the same time?
