Despite the high cost, I’m still getting Health Insurance 2

As enrollment for next years health insurance has started for most, the saga of our medical bills continues. As I’m posting this we’ll be taking our son in for followup surgery to his elbow, for removal of pins (ICD-10 Z47.2). For those of you who follow this blog (if not, now would be good time to subscribe), some time ago our son broke his elbow (ICD-10 S52.601A) and required surgery to nail it all back in place. It was only after that, I found out what our deductible truly was. Not the individual deductible of $6,400 but instead the family deductible of $12,700. We reached that deductible in a matter of 28 hours.

Some sampling of the bills:

Drugs-General: $70.07
Drugs-General: $101.92
Drugs-General: $188.73
Drugs-General: $49.58
Drugs-General: $51.57
Drugs-General: $77.17
Drugs-General: $50.74

$589.78 worth of drugs alone. Awful lot of drugs for only 28 hours hospital stay, don’t you think? Add the hospital stay itself, surgery ($3,939.00), Anesthesiology ($2,098.00), X-rays ($130,00), emergency room ($817.00),  supplies ($1,377.25), recovery room ($1,676.00) and whatever else they can charge for and the bills ended up over $12,700.00.

What we paid for exactly, I’m not sure. Yes, there were X-rays, there was surgery, but how did it break down? Hospitals, pharmacies and insurance companies communicate with each other using codes such as the newly rolled out ICD-10 codes (for diagnosis), CPT codes (for treatments) and NDC codes for all the different drugs out there. The claims nor the hospital bill we received mentioned any ICD-10, NDC or CPT codes. “Drugs-General” and “Hospital supplies” is what we have to do with. As laymen, I guess we have to take their word for it. It’s kind of like getting a restaurant bill that says “Food and drinks- the expensive kind”.

Paying the bills hurt but thanks to our financial preparedness we were able to do so on short notice. I even managed to get over a thousand in discounts as part of a paid-in-full program.

Anyways back to the topic at hand: Why I will keep buying insurance. Are there any other options? I recently received an email from one of my readers lamenting her daughter had similar deductibles and how she’d never be able to afford them. Her reasoning was that she might be better off without the insurance and simply pay the penalty. The reader might have a point. If you get through the year unscathed you save thousands on premium. If not then your stuck with very high bills. If you can’t afford the $12,700 deductible you might as well go for broke, bankruptcy is bankruptcy, with or without insurance.

If you are like us and “fortunate” enough to be able to scrape together money for medical bills, I would beg to differ. Yes, $12,700.00 is an awful lot but without insurance it would have been much worse. After my deductible was met the insurance company did start paying bills in full. And lots of bills followed (still are). It seems we have a tendency to only look at the amounts we pay out of pocket and ignore those bills paid by others. When all is said and done, when I add up the premiums we pay for coverage and compare it to the bills paid by insurance, I’m sure we’ll come out on top. More than enough to justify insurance. And bear in mind we’re “only” dealing with a broken elbow. Imagine the cost of heart surgery, cancer treatment or some other dreadful disease.

So where do I land on this? Despite the ridiculous premiums and even more outrageous deductibles, I will still buy health insurance next year. Our $12,700 setback this year was due to a broken elbow. In the scheme of things a “cheap” diagnosis. Anything more serious than that without insurance, would have taken me out of retirement (if not worse).

One thing we must not loose sight of is this: insurance is not an investment. In fact there really shouldn’t be a return on your premiums if all goes well. Insurance is to prepare for the worst and hope nothing happens. We pay for term life insurance, I hope to never collect a dime. Those years that nothing happens to you, your premiums will be applied to someone less fortunate (ha ha, in a perfect world). If all of us were expecting the insurance companies to pay out a little more than the premium we paid to justify it, the insurance companies would have a bad business model. Now, whether the insurance companies should be making the profits they’re making is another question.

So why those convoluted codes at the start of the article? While l trying to research our son’s medical bills, I stumbled upon the ICD-10 codes below. Despite all, I still got a chuckle from that. It made me think of my old turtle bite debacle and yes, there is a IDC-10 code for that as well: W59.21XA, Bitten by turtle, initial encounter.

Click to Enlarge Image

14 Silly ICD-10 Codes Show the Crazy Ways People Injure Themselves
Learn More About ICD-10

Good luck reaching your financial goals.

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About Maarten van Lier

Maarten came to this country with a suitcase and a diploma. He created a financial plan and goal to become a millionaire in 10 years. He successfully turned his financial goals into reality, wrote a book about it and now blogs actively in hope of inspiring other to do the same.

2 thoughts on “Despite the high cost, I’m still getting Health Insurance

  • Jessica Greenhood

    Insurance is great if you can afford it. In 2012 my mom ended up in the ER. She had an unknown cancerous ulcer in her stomach burst. The total bill was $500,000! This included Chemo. Of all that, we paid the $5,000 deductible. This was prior to Obamacare (ACA). We paid $750 a month for her insurance. They covered the over $1,000 per treatment for Chemo, over $1,000 per a month for ICU hospital bed, $6,000 a month for the nursing home/rehab facility.

    Sadly, the same could not be said for the Medicare Advantage coverage my father had. They didn’t cover the $500 Ambulance rides, half of the ICU hospital bill, and only 3 months of his stay in a nursing home that cost $6,000 a month.

    In 2012 both parents became ill within weeks of each other. I busted my, but and spent over $60,000 in their medical bills. Most of this was towards my father’s medical care that wasn’t covered by Medicare. There is still $30,000 in unpaid bills from that year.

    I know that doesn’t cover all the breakdown of their bills like medicines & treatments, but I’m very aware of what I did pay vs didn’t.

    The sad thing is with the numbers I’ve seen for Insurance today, I can’t afford $200-$500 a month for insurance if I can get it for that low. With the copays and out of pocket, it’s just unaffordable for us. I find it sad that we are penalized for not being able to afford something that should be our choice, to purchase.

    Just because you don’t have healthcare and are stuck in a situation like my mom was, doesn’t mean there are not ways for you to get help with those bills.

    Love your articles! Keep it up

    • Maarten van Lier Post author

      Jessica, I’m so sorry for the loss of your parents. You are an exceptionally good person for taking care of your parents both emotionally and financially.

      I’ve seen similar issues with my friends and colleagues who had corporate insurance. Chemo would be covered but the $1000 for each anti-nausea pill wouldn’t. I always thought my corporate insurance had me covered, it didn’t.

      “Universal Healthcare” becomes very much a sad joke when the universe can’t afford it (and those in the coverage gap can’t get it). I started enrolling in next year’s ACA and learned that the same package I had this year (Bronze at $880 with $12,700 deductible) has a 30% higher price (~$1,100 and $13,100 deductible) next year. The credits I’m getting this year don’t go up a penny though. Don’t play the violin for me, I’ll figure out a way but for many there is NO WAY that kind of money can be coughed up (even with the credits they may receive). Even if you could afford the premiums, the deductible or non-covered items will put you in financial ruin.

      Good luck with the remaining fallout. I hope things get better soon.

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