Healthcare Confusion

Sam’s company recently switched up their health insurance offerings. Previously, we’ve stuck with the same plan or something similar for the last 5+ years. It was pretty straightforward, easy to understand. I was never happy with the insurance company itself, though. They seemed to reject claims on a regular basis without cause, you’d call them up and then they’d “realize their mistake” and pay for the claim. For the number of times this happened, I really became suspicious that they were just hoping you’d give up and pay the claim yourself rather than following up with them every single time. Sometimes it became tempting to do so, but I just couldn’t on principle – figuring that’s probably exactly what they wanted.

In any case, that plan is not even being offered anymore. The two choices we were given were another plan similar to what we had – but with a higher premium (and a smaller selection of doctors to chose from!) or one of these “Health Savings Account” (HSA). My first instinct was to turn down the HSA. I just couldn’t imagine how that could ever be better than the standard plan we were used to going with. But his company gave two key incentives: they gave you a credit in the HSA and the premium was quite a bit cheaper than the other plan. As well, the selection of doctors from the HSA was much wider.

So I figured, the best thing to do would be to run the numbers. First we calculated out how much it would cost if we went to the doctor’s 10x a year and then 20x a year. And in both cases the HSA was less expensive. So then I downloaded our actual claims for the past year. Figuring that we would probably be about the same. Meticulously combed through each claim and sorted them for how we would have been charged if we had been under each of the new plans. Again, the HSA ended up being cheaper. In truth – the difference between the two almost always equaled the delta of lower premium and that HSA credit the company gives. If it wasn’t for that – the two plans would have been almost neck in neck.

But it’s crazy how confusing this all is. I wonder how many people spend that many days agonizing over the decision, and then actually creating a spreadsheet of claims from the previous year – recalculating the charge on each one based on what would be charged under the new plans just to see what the difference would have been.

I really hate how difficult that needs to be, and even more than that, I hate that in this country employers are the ones that decide on the fate of your health care. I doubt his company has our family’s health interest in mind when they make these decisions. They’re going to do what makes the most business sense. It doesn’t belong in their hands.


  1. daisy
    Nov 18, 2009

    I’ve been telling my immediate family that…we already have a “government type” of health plan if our insurance comes from our employer. They pick what we use and we have little choice.

  2. Bridget
    Nov 21, 2009

    Unfortunately, it isn’t the employer who decides, its the insurance company. They decide the rates and we have to react to them. I select the insurance for my company and I have to say the insurance companies are the problem.

    In 2008 we were forced to move to a higher deductible plan so we could afford health insurance for our employees. (We covered 80% of the deductible in addition to to the employer contribution to the premium.) This year, the insurance company raised the premiums on that plan by 33%. I had no choice but to move to a different plan. We are hostages to the insurance companies.

  3. Jennifer
    Nov 21, 2009

    I just wish I could (more easily) buy the insurance myself. If people could pick and choose the insurance for themselves, rather than have their employer do it – I think things would be different. I know Daisy doesn’t agree – but I do think the government needs to get involved. What is happening right now is not good. I’m lucky I have insurance at all – since I’m self employed. I am covered under Sam’s plan. But if he ever lost his job, or if he decided to be self-employed as well… OUCH. Right now *IF* I could get insurance for myself, it would be ridiculously expensive. (And lucky me – I pay a “self-employment tax” for this privilege too!)

  4. Jane
    Nov 21, 2009

    We (read: the DH) make the spreadsheet and calculate it all out, too. (and then comes some clarification that changes it all)

  5. daisy
    Nov 23, 2009

    No I do think the government needs to be involved. I’ve worked in the medical field for 30 years and it has devolved every year it seems. The problem, I see, in getting this passed is that the medical lobbyists are fighting for it to not be passed. All those medical professionals that live in very nice homes, drive very nice cars (get medical care for free or almost free) don’t want to change those lifestyles. Add to that the insurance lobbyists and well…it gets messy.

    But yes…I’m for a government option. I can’t really see it being any worse than it is and it’s a chance for all (or almost all) to get decent coverage.

  6. Jennifer
    Nov 23, 2009

    AH! Ok, now I understand. Then in that case Daisy, we do agree. :) Although, the doctor’s I know aren’t actually raking in the money. From what I’ve been told, their own anti-lawsuit insurance premiums are so high there’s not a lot left over.

    It all seems to come back to the insurance companies I think…

  7. daisy
    Nov 24, 2009

    The doctors I know in this state still make a lot of money. They do have high ins premiums but either they are just overspending or they don’t want you to know they aren’t having a lot of problems (probably a bit of both). I do agree that the ins co are a lot of the problems tho.

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