Vent out: has your healthcare plan failed you?My grandmother is about to go into bypass surgery tomorrow at age 88. She was given a medication to try to unblock her arteries within the past 72...

Vent out: has your healthcare plan failed you?

My grandmother is about to go into bypass surgery tomorrow at age 88. She was given a medication to try to unblock her arteries within the past 72 hours. However, we had to take her home, because "her plan" doesn't cover hospitalization unless it is an extreme emergency. For all I could analyze, an 88 y/o female with massive blockage should be considered an extreme emergency. Apparently our current economy does not think the same way. Hence, we had the women in my family take upon the task to try to control and discipline an 88 y/o who does not understand what is going on. I have heard WORSE stories than my own....Care to share?

Expert Answers
Lorraine Caplan eNotes educator| Certified Educator

Oh, boy.  Where to begin?  I must carry my own health insurance and purchase it through a state program for people with pre-existing conditions.  It is quite costly, and has a deductible in the thousands, as well as all the usual co-pays.  This means I have an $8,000 investment annually before I have any real coverage.  It's the sort of situation in which I want to never reap the benefit of the coverage, but I'm hardly pleased to have this expenditure.  It is not particularly good insurance, for example, not even covering a standard vision check or glasses.  But I went for over three years with no insurance at all.  I have had breast cancer, and I'm at the age where hips break, so I walked around very carefully for those three years, but sought no medical care.  And I am grateful to have any insurance at all.   I cannot help but feel that I am subsidizing those who have no health insurance, and honestly, I don't mind doing that, but why can't we just acknowledge that is what is going on and spread it around to everyone in a straightforward way? 

catd1115 eNotes educator| Certified Educator

I have had many problems with my healthcare coverage but also had to live with severe chronic medical issues with no insurance. My personal opinon is that over time insurance companies have driven up the cost of all healthcare so that it is impossible to afford healthcare without insurance. In addition these companies are making billions of dollars at the expense of our medical care. Insurance companies (like all for profit businesses) are out to make money, not to provide excellent healthcare. The current reality is that insurance companies are now making the medical decisions that doctors should be making and they are deciding based on their bottom line, not your medical needs.

Any overhaul of the healthcare system in our country that doesn't rework and reign in medical cost and the insurance companies that are driving them up is a waste of time.

Kristen Lentz eNotes educator| Certified Educator

My best suggestion to teachers would be, if you are fairly healthy, to get a health savings account (if offered) and take a high deductable plan.  I have friends that pay $80 a month for health care and pay a $30 copay.  I put $100 a month into a HSA.  I went to the doctor twice last year and it cost me total about $225 out of pocket.  I have $975 left to cover any doctors visits next year.  My buddy who HAS to have his copay went to the doctor once.  It cost him $30, but he paid $960 in premiums he will never get back. 

Back to venting... my husband had to have the ambulance called on him while he was running.  He didn't ride in the ambulance... I took him to the hospital.  His ambulance "visit" was $800 dollars.  Insurance got ahold of them it got knocked down to $180, but still... $180 and they didn't even drive him to the hospital!

tinicraw eNotes educator| Certified Educator

Every year premiums go up. Luckily, I have a district that tries to wheel and deal as much as they can with the insurance company to keep copays down and the like. This year, we had to earn 3 health points by going to health meetings, attending a 5K run, or participating in a district-wide exercise competition. Each year, my husband and I have to check our cholesterol and BMI and send all that information into the insurance company. We also have to fill out surveys on our risk factors and lifestyle, which is a good way to keep us aware of our health more, but there are lots of hoops to jump. Their philosophy is if we are more active then we are healthier and less at risk to have to go to the hospital.

M.P. Ossa eNotes educator| Certified Educator

lentzk: Could you please send me some information on that? Just send it to my inbox if you can. And if there is a code for it that I need to check just send me all the numbers. lol!

I think that it is a great idea to be asked to monitor our health in order to save money. In my case it would be the ONLY way for me to take better care of myself. I am not necessarily the worst eating or drinking gal on earth but my worst habit is a) not taking my medications as prescribed,  b) not going to the doctor (because I hate going), c) not monitoring my blood pressure properly. I think that if I had a way to make myself do these things I wouldn't be in trouble as I am now. 

trophyhunter1 eNotes educator| Certified Educator

I have pretty decent health coverage, however, I have noticed that over the past few years, less doctors are participating in my plan. Unfortunately, my genetics has handed me dental problems and my plan does not cover dental implants at all. They are thousands of dollars and are out of pocket expenses. Why doesn't anyone recognize that without the teeth working optimally, that other health problems can occur related to nutrition, digestion, etc.? My plan has failed me in that I will have been and will eventually have to spend way more money than I 'd like to, in order to fix my dental problems.

literaturenerd eNotes educator| Certified Educator

My health-care plan failed me when I "thought" that my maximum out-of-pocket would be only $500.00. Given that I was undergoing a tumor removal, I thought that my insurance would be wonderful. I was wrong! Each different "category" was defined for its own out-of-pocket maximum. It didn't even come close to only being $500. Way more than that!

shake99 eNotes educator| Certified Educator

I wouldn't say my plan has failed me, at least not yet. So far I haven't had any major health problems, so maybe my insurance problems are yet to come.

I can say that I had a daughter for 15 years who had many serious health problems that we never would have been able to take care of without insurance. In her case, it saved her.

litteacher8 eNotes educator| Certified Educator

My copay doubled this year.  It is so high that even when I am sick, I usually do not want to go to the doctor.  The last time I went it cost over $200 just for an office visit and a few prescriptions and suggested over the counter medications.  How can we manage if the costs keep going up?

rrteacher eNotes educator| Certified Educator

I have nothing extreme like the cases mentioned here, but almost every medication my wife and I are prescribed gets rejected by the insurance company. And yes, our premiums are increasing substantially as well.

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