In Network … Out of Network … Deductible … Co-pay

All these thoughts and decisions need to be made, even while you are seriously ill.

I’ve found it very hard to deal with the health insurance in the US, ever since we moved here 8 years ago.  It’s not that I object to paying my fair share of coverage, and insurance will help with many aspects of getting sick.  It is the way that insurance companies control people’s life – they decide who live and die!

We have to acknowledge that if you want cheaper health care, it comes with some rather significant changes to the economy and perhaps the quality of service received when needed.

Someone has to pay for the medical teams, equipment, facilities, staff etc. otherwise it simply would not work.

It works in Europe, and particularly well in Denmark my home country, but it has also a much higher tax rate and has been improving the health services for several decades.  People can invest in private/additional health insurance, but it is a choice people make.

In the US, you can hardly survive unless you have some level of health insurance, and the monthly insurance fees can be ridiculous even for entry-level insurance.  Imagine how low-income people and families manage.  They many times don’t and they rely on doctors that will help people with no insurance.

Increasing the taxes to cover the increased health costs of the nation in the US will not work.  Well, it might work but it will take decades to change the current environment.

The biggest culprit in the way of change is the health care insurance companies.  They are a necessary evil and they control most of the medical industry in partnership with the large drug companies.

If you have some pre-existing symptoms or medical issues, you simply cannot get good or affordable health care.  People will lose all their belongings just to save their lives, and health insurance companies simply do not care.  That is the perception.

It is a heated political debate and lobbyists are controlling the decision of many politicians.  Money runs the World!

Most times, when we receive bills from the various services we might use, we always have to double check and call the insurance company to challenge co-pay, deductibles etc. or call the medical facility to ask them to use the correct billing codes on invoices.

For whatever reason, we the consumers never win those arguments.  The insurance companies have phrases, clauses or calculations that will always favor the house. (betting term :-))

When you get sick and need urgent attention, you cannot be asked to asked doctor “are you in or out of network?”.  You just want to get better and life is more important.

My latest medical adventure was traumatic, to say the least.  However, the service I received from the medical team and doctors were top.  The hospital was super and all in all a positive experience … considering the circumstances.  They ensured that I got better and continue to get better.  The insurance company was awesome, providing me with excellent service and the bills were actually lower than I had anticipated.

I know, pretty shocking and amazing.  In those moments, I bless the insurance company.

When my daughter became sick mid-December, it was initially all positive and she got great treatment too.  They were quick and got her on the right path of recovery.

Unfortunately, the bills came in and we had to challenge cost, argue about the individual vs family deductibles, triple check values and invoice codes.  I was on the phone several times with insurance helpdesk, and they made it feel like it was our fault and that they were doing everything perfectly.

It came down to when the bills were posted to the insurance company, and when the deductibles were applied.  In my daughter’s case, the bill came in first, then deductible from a previous visit got posted the day after (literally) hence the high bill.  When I challenged them about invoice dates on the actual bills, they simply said that they process invoices as they come in, so tough luck!

I have not a magical answer or solution.  I’m happy I have a good medical plan through my company with acceptable monthly cost, and they provide good coverage for my family.  It is still something that I find hard to accept … it is a necessary evil to stay alive.

• How have your health insurance encounters been?
• Are you with a good insurance company?
• What are your thoughts?