To set this up, I’m a service connected disabled veteran, but since the VA Hospital botched up at couple of medical procedures for me in the late 70s, it has always been a priority to always have the best available insurance for my family, and not go to VA Hospital. In my working years before retirement, I always had good insurance. After I retired, Texas had a assigned risk pool, where individuals could pay twice the Small Business Group Rates, but it was still good insurance.
Then came Obamacare. The first year, I had to replace all of my doctors. because none accepted the best Obamacare offered. Last year the insurance was worst yet, and my family was cancelled mid year, not allowed to have insurance for the rest of year, despite three appeals. And then was fined $3000 from the IRS for not having insurance, which I wasn’t allowed to have.
So this year, I’ve had the worst insurance of my life, despite being the best offered on Obamacare. All year long its been a fight of having virtually every procedure and prescription denied. My out of pocket for insurance and premiums and co-pay/no-pay is almost $50,000 this year.
Six weeks ago my doctor ordered a CT Scan of my lungs. First it was rescheduled because the doctor didn’t submit the proper form. Then rescheduled because Insurance company was two weeks backlogged on approval. Then it was denied because I get non-smoker insurance rates (haven’t smoked in 30 years) and the CT was to see if I have lung cancer. We worked through that and I finally got approved. Then Tuesday was cancelled because the Imaging tech called in sick. So today, more than six weeks after the doctor order, I went to have the CT Scan.
Now here’s the part that defies all logic!
I go in, and at registering I’m told my co-pay is $300. I tell her that I met all of my deductible, and she says that she sees that, but my co-pay from the “negotiated rate” is still $300 for CT Scan and doctor reading. So I catch onto the key phrase of “negotiated rate”, and ask what that is. She answers $800 something for the CT Scan and $200 For doctor to read. So I ask how how much would I be paying if I self paid. She said $85 For CT Scan and $60 for the doctor to read. I thought I misheard her, and I asked “so if I go through insurance just my cost is $300, but if I pay cash its $145 total”? She answered “Yes”. So I had her take my insurance information out and I self paid.
This is how screwed up Obamacare has ruined Health Insurance. They spend so much time on hold verifying insurance and filling out so much paperwork and then waiting for payment; and it is heavily subsidizing those who don’t pay shit for insurance (and lets not forget abortions, birth control, child dentistry, drug rehab…. that I’m paying for) that most procedures are cheaper on self pay than your deductible with using your health insurance.
Start asking questions on how much self pay is compared to Insurance Co Pay and you might save a Hell of a lot of money. Share this with your family and friends.