Originally Posted by
Sig178
There is a lot of very inaccurate info in your post. To say that it's not that bad is the understatement of the year. I'm gonna guess you weren't here before we got this new plan, but my max OOP wasn't near $13k. Delta and SWA have a plan very similar to ours, the difference? They pay about $11/mo for their premiums instead of my $304, plus they have OPTIONS to give guys a low deductible PPO that won't hurt guys who have chronic health problems in their family. I usually like your posts but this is way off mark and btw you can easily go past $10k in-network as we have done, so even with healthy rewards and seed money (that's not guaranteed) my max OOP will be about $11,000. Plus I am tired having to fight almost every medical bill I get to have insurance pay it, even stuff covered 100% like routine physicals they don't want to pay unless you jump through hoops. It wasn't like that a few years ago. There have been options presented by the PVC like a PPO, but since it was money related it was shot down. So yes it's as bad as people say, but hey it better than Pinnacle right?
I'd argue that nothing I said was inaccurate. I'm willing to put up my medical stuff to prove it, too. I've never had to fight to get our insurance to pay anything. They've always been spot on to the penny, and yes that included routine physicals for me and my wife along with all of her annual "woman" stuff. No issues whatsoever. No phone calls. I'm sorry you're having issues, but that's with the INSURANCE COMPANY. If we got better coverage, you'd still have the same fight.
Max out of pocket for a family under the Green Plan (the Blue Plan really isn't very different and depending on your situation isn't better) is $8,600. That's for both the Green and the Blue now. Not sure how you're spending more than $10k unless you're spending $2k in prescriptions or, as I said before, factoring in your premiums as well.
Also, the "you weren't here before" argument is getting almost as old as the "you're not at a regional" argument. It's not very valid, and it makes you sound condescending. Yes, I came in after the heath care switch. Yes, I was at a regional. Does that somehow make my opinion less valid? No. Does it mean you can ignore the facts and swap around the stats to make your argument? I guess.
I can tell you this, though. My max out of pocket last year after my wife having two surgeries, multiple follow up appointments and VERY expensive treatments after the surgeries was in the $5,000 range. With the seed money and Healthy Rewards, it brought it down to $3,350. We're looking at about the same this year. The only thing I've ever had to send in was a few things to get the Healthy Rewards credit and PayFlex not wanting to pay out of the seed money bank for something that was obviously health related simply based on the name of the company.
Again, I'm still not seeing solutions other than "our insurance sucks." I do appreciate the post of what United offered, and I think that's a pretty good comparison. However, the post that said a $9 premium would be good for major medical was a little off. That would be an INCREDIBLE premium since I was paying $10 a month for an HMO plan in 1997. $105/mo seems like a good thing to shoot for, though. I'd also be nice to see the seed money/healthy rewards guaranteed somewhere. That's the other meaningless complaint I always hear. "It's not guaranteed." Okay, so beyond guaranteeing that, what can we do to FIX the problem rather than just COMPLAIN about it. That's what I'm trying to figure out. Our health care is like the weather. Everyone complains, but no one has put forth a plan of what we could do to make it better. More importantly, what is management gonna want back in negotiations to get us there.....