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Looking for a sanity check. Open enrollment for health insurance now here at my work. Over the years, I've primarily been on a HDHP (Bronze) plan with an HSA. The math has always been pretty easy for me to work out the best option, but this year things aren't as clear cut for me, mainly because my job stepped it up and premiums have come way down, and also deductibles/max oop. Edit: It was super close cost wise between premiums and expected expenses. Went with the PPO and will put the previous HSA contributions into 401k/IRA contribution limit increases for 2024. Loan Dusty Road fucked around with this message at 17:41 on Oct 13, 2023 |
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Oct 12, 2023 22:01
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bird with big dick posted:I basically went through exactly everything you just said and it ended up costing me my out of pocket max for the year ($4,000) plus like $2,500 in out of network ambulance rides. Half of which I just said F U and never paid. Virtue posted:Hopefully, most of the expensive stuff was done through in network providers and facilities. The horror stories you hear about usually involve out of network issues. But really there's not much to do besides wait and see what comes in. Going to keep the F U option in mind too.
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Oct 13, 2023 02:33
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Nocturtle posted:Unfortunately a family member recently had a serious medical emergency within the past few weeks involving a trip to the ER followed by a ~1 week hospital stay and a fairly delicate surgical operation. We live in the US and have relatively "good" health insurance (United Healthcare Point-of-Service Plan) but expect this to all be extremely expensive. Is there a general reference on how to get prepared for the inevitable fight with the health insurer over covered expenses and procedures? Additionally we have access to a "health advocate" service through employer benefits. Are they generally regarded as useful? First up: Stop, take a deep breath, and wait. The hospital wants money from UHC - who they know have money - more than they want it from you. You're about to get a LOT of bills from people you never even met who allegedly treated your family member. Every single one of those bills should be opened, looked at, and basic analysis applied. There is going to be a lot of expository language on these bills telling you this is your responsibility and how you need to pay them yesterday and such depending on how shady they are. Their phone trees are likely the same. The more of this style language you see, the more you can safely assume they are trying to trick you into paying more than is your actual responsibility - remember that. 1. Is the bill itemized and coded? 2. Did they bill your insurance? 3. Are they claiming they are in- or out- of network? 4. What adjustments have been made? 5. Is there an actual due date on the bill or just a payment stub with no indication of anything else on it? Get out a notebook or however you organize your life. For each bill start a page with the info on the bill - name, date received (not date printed), if the insurance was billed, whatever seems relevant. From here - start waiting for EOBs on bills that claim to have billed your insurance. If they didn't, call them up and say "it appears you were not provided my insurance information, here it is, please bill them." Collect from this person on the phone their name, date, time, and a reference number. Write it in your journal as to what you did in small concise sentences. Do this even if you leave a voicemail. "10/13/2023 1:40pm Called and left a voicemail to discuss insurance." or "Called, spoke with James ID 1234, Reference 11112AA, Gave insurance information for them to re-bill." Once the EOBs start flowing, for "in network" stuff if it matches the bills you received you can pretty safely just pay them IF they were approved. Print them out, staple them together, write "PAID - Mailed Check, 10/13/2023" or "PAID - Portal Conf# 1283971249 10/13/2023 1:04pm" right on the bill and in your notebook, file it away. Denied claims move on to the next step. Denials? Read why they were denied, if it's not listed, call UHC (Member, Claims, Date of Service, Representative) talk to them about it, record the info above. (Name, ID, Ref #, get this BEFORE being transferred if anything of substance was discussed.) Call the provider and discuss the denial. They are probably working diligently on re-billing it to get paid by UHC. Document Document Document. Denied in-network stuff is just that, request they send you an updated $0 bill for the denied stuff. Though often times this stuff will get rebilled and this is totally normal. Basically they will get something slightly wrong in the coding or documentation and UHC denies it, so they fix those problems, and rebill it. This could go on for months and is totally normal. So if they reply to your request for an updated bill with "we're working on it" you have to let it go. Out of network - This is where state/federal law comes in. Google the "No Surprises Act" (federal law) and "balance billing laws <state>". Note that ground ambulance apparently has amazing lobbyists because they are pretty universally excluded from laws. California is a noted exception there. You need to look up what they are able, by law, to bill you in excess of what your insurance covers. This can get tricky if your family member (nearly said loved one, which is a pretty good assumption if you've made it this far but...) stabilized and wasn't transferred from an out-of-network to in-network facility. From here you need to steal yourself for a fight. Make sure these providers are accurately billing all of their care as "emergency" and if your insurance says "yeah but it's not" you better pray the provider put accurate notes in there about why the patient wasn't able to be transferred etc. If you were in an "in-network" facility this is golden because you can ask everyone up and down why they were an out of network provider, and you can tell the insurance <family member> was not able to choose their providers in the emergency. This should bring it all to being treated as "in network." Any bill that's more than a co-pay you can and should request it be "fully itemized" - according to reddit this has caused some bills to be cut way down. I am somewhat driven by spite with this stuff - the medical billing industry is an insane outcome of our insane insurance system in the USA. It's slowly getting better but that is damning with faint praise and some states are WAY worse than others. Any bill that every everyone has told you "we aren't budging" on, your appeals are done, etc, ask for a reduction. "Do you have charity funds?" "Can we talk about a discount?" "Can we talk about a payment plan? Yes, I can afford $8/month in perpetuity." H110Hawk fucked around with this message at 04:31 on Oct 14, 2023 |
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Oct 14, 2023 02:27
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H110Hawk posted:First up: Stop, take a deep breath, and wait. The hospital wants money from UHC - who they know have money - more than they want it from you. You're about to get a LOT of bills from people you never even met who allegedly treated your family member. Every single one of those bills should be opened, looked at, and basic analysis applied. There is going to be a lot of expository language on these bills telling you this is your responsibility and how you need to pay them yesterday and such depending on how shady they are. Their phone trees are likely the same. The more of this style language you see, the more you can safely assume they are trying to trick you into paying more than is your actual responsibility - remember that. Thanks very much, this is appreciated. Incredibly helpful being walked through the details of the process. As it turns out the treatment was entirely at in-network facilities so at least we have that going for us. There was an ambulance ride between hospitals though so will have to see what comes of that. I saw your previous posts in this thread regarding dealing with ambulance bills and looks like lots of fun.
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Oct 15, 2023 16:07
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H110Hawk posted:First up: Stop, take a deep breath, and wait. <snip> in US politician voice: "The greatest healthcare system in the world!"
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Oct 20, 2023 20:34
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But enough about my vasectomy!
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Oct 20, 2023 20:40
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Can anyone give me a rundown on getting independent health insurance in the US, particularly for someone with an existing condition. This person's been made an offer as a contract worker, but has no idea how to get your own benefits, health especially, going Is there a preferred way to get quotes? Health insurance brokers? I'm not American but I believe Obama means the existing condition will be covered, or is that more specific/conditional than I think?
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Oct 26, 2023 02:34
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https://www.healthcare.gov/ ?
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Oct 26, 2023 02:52
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Jenkl posted:Can anyone give me a rundown on getting independent health insurance in the US, particularly for someone with an existing condition. This person's been made an offer as a contract worker, but has no idea how to get your own benefits, health especially, going They can get insurance straight from an insurance company and it will basically be exactly the same as an Obamacare policy (they have to be) but they won’t be able to qualify for a subsidy (if they make less than like ~$50-60?K they could qualify for some sort of subsidy) unless they get it through healthcare.gov. Preexisting condition doesn’t matter any more. If they are offered any sort of health insurance through their work, they may not be eligible for a health insurance marketplace (Obamacare/healthcare.gov) plan. If they can afford it, the Silver tier of Obamacare seems to me to be the best value. It’s not usually thaaat much more than the bronze tier which have super high deductibles and are basically catastrophic policies, but still quit expensive. Pay 15-20% more and get actual coverage if you can. Also look out for copay’s vs. coinsurance. With copay’s you pay $50 or w/e to go see a doctor. With coinsurance you pay 20% or something which could be a whole lot depending on how the doctors bills stuff. The healthcare.gov interface is actually not bad for helping choose a plan. I have not pursued talking to a health insurance broker. I know they exist but they’ve always seemed like maybe scams or something to me. I suspect they are basically gonna have Obamacare plans with maybe some secondary insurance to help with high deductibles/copays, but I don’t know that. Depending on their line of work they may be able to get a group plan through membership in a trade or professional organization if there are a lot of self-employed people working in that industry. I know AIA (architects) and the local home builders association both offer insurance to their members, for example. When I looked at that option, it wasn’t cheaper than Obamacare but it was better coverage with a lower deductive. However, it was only available to the business owner if they had a full time employee they could offer the plan to (tho they didn’t have to use it) so it didn’t work for me because I have no employees.
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Oct 26, 2023 04:28
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Which company to go with for a short term and long term disability insurance (preexisting condition) Early 30s. I have a preexisting condition depression and recently used the employer's plan. I want to get one on my own and not be reliant on an employer's plan just in case of other disabilities. I probably won't get covered for mental health, but at least I can start getting coverage on other stuff.
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Nov 2, 2023 03:27
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I started talking to Northwestern Mutual so if I get hit by a Tesla malfunction and inevitably become disabled, I still have money to buy chicken nugggss
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Nov 2, 2023 22:37
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Hey all, my girlfriend and I (male) thought she would be covered by her parents' health policy until the end of the year after she turned 25. Turns out the policy ended immediately and I'm left trying to get her covered on my employer provider plan for the three to six months before she graduates almost directly into a job with coverage. I put her name down on my policy, and my employer sent me paperwork for a "same-sex domestic partnership", with a warning that if she isn't an IRS tax dependent, then any money she uses will become imputed income. The tax code it refers to says dependents are either children, or related to me. https://irc.bloombergtax.com/public/uscode/doc/irc/section_152 I'm tired, stressed, and don't have a lot of time before everything shuts down for thanksgiving. Is what I'm doing workable? The language is weird. She mainly needs the dental insurance right now, for removing her wisdom teeth. Edit: for the likely short period of time, is this even worth it? Yak Shaves Dot Com fucked around with this message at 00:45 on Nov 8, 2023 |
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Nov 7, 2023 23:29
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Are you sure her parents didn't just kick her off the plan? It's 26. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/young-adult-and-aca Oh - and she should contact her school and ask about enrollment in their student plan. They have one. Otherwise hit up the marketplace. H110Hawk fucked around with this message at 02:53 on Nov 8, 2023 |
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Nov 8, 2023 02:19
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Yak Shaves Dot Com posted:Hey all, my girlfriend and I (male) thought she would be covered by her parents' health policy until the end of the year after she turned 25. Turns out the policy ended immediately and I'm left trying to get her covered on my employer provider plan for the three to six months before she graduates almost directly into a job with coverage. That's the normal way health benefits for domestic partnerships work for tax purposes, the fair market value of the coversge counts as imputed income to you. Generally the imputed income is calculated as the the difference in full premium for her coverage beyond yours (not just the paycheck deduction) and not what is actually used in benefits. Since gay marriage became legal, most companies who cover domestic partners now cover both same sex and opposite sex. It's possible they sent you the wrong form. It's also possible that their form is outdated and they don't realize the form explicitly says same sex. It's also possible that they don't cover opposite sex domestic partners and you're out of luck.
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Nov 8, 2023 03:18
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Sorry if this is a silly question, but it's based off something I heard at some point and probably heard wrong. My mother received a small bill in the mail for some lab test. Am I liable for her insurance bills further down the line if I pay this one off myself? I heard at some point in the past that if you pay for someone even once, you're now the fallback if they don't pay their bills in the future, but I could have totally misinterpreted that.
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Nov 13, 2023 02:33
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two fish posted:Sorry if this is a silly question, but it's based off something I heard at some point and probably heard wrong. As long as you aren't added as a guarantor to their file it shouldn't be possible. This could be buried in the fine print somewhere but something tells me it's required to be more prominent than that. You can also just gift your mom the $74.33 and tell her to pay the bill with it if you really want to not make a paper trail. Will your mom be mad that you paid it if she finds out? If not, just do the latter process.
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Nov 13, 2023 02:42
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She would be deeply pissed off if she saw the bill, even though it's just for $15. The lab test was something routine and it was 100% covered in the past, but it isn't under this plan. I'm just feeling like paying it off to avoid having to listen to her going nuts about "WELL I DIDN'T HAVE TO PAY THIS BEFORE" for the next few weeks, you know? Age is unfortunately making some of her personality problems worse and I'm fearing she may be gradually tipping over into something bad, but that's an entirely different subject.
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Nov 13, 2023 02:46
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TIL it’s not called an insurance binder because it is a bunch of insurance documents in a binder but because it’s a temporary insurance.
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Nov 13, 2023 22:12
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Lost my job/health insurance last week. Went to the Healthcare marketplace today and while I qualify for a subsidy for the remainder of '23, they're saying I don't for '24 because I don't have any expected income, due to being unemployed. As such any plans are now around $300/mo, which I can't afford. Did I do something wrong in filling out my application or am I basically stuck w/o health care until I find some/any employment? I was hoping to not have to rush and find the first temp job available but if it's between that and not having health insurance then bullets will have to be bitten.
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Nov 21, 2023 01:33
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C. Everett Koop posted:Lost my job/health insurance last week. Went to the Healthcare marketplace today and while I qualify for a subsidy for the remainder of '23, they're saying I don't for '24 because I don't have any expected income, due to being unemployed. As such any plans are now around $300/mo, which I can't afford. You should be able to get on Medicaid if you have no income. How difficult/possible this is is going to depend greatly on what state you live in.
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Nov 21, 2023 01:41
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Ham Equity posted:You should be able to get on Medicaid if you have no income. How difficult/possible this is is going to depend greatly on what state you live in. North Carolina, so a purple state.
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Nov 21, 2023 01:45
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I'm narrowing down Medicare Advantage plans for my mother. Right now a promising one seems to be the "AARP Medicare Advantage from UHC NJ-0004 (PPO)" plan. Couple of questions: has anyone heard of that plan, for better or for worse? Also, if a doctor/dentist is listed as network right now on their site, does that guarantee that they'll be in-network as a doctor/dentist for 2024? The plan has a 4/5 star rating, unlike her current one, which is a 3/5.
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Nov 29, 2023 14:34
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Searching for term life insurance, state farm offers a normal plan (66 per month) and another plan that returns all premiums if they don't pay out at the end of the term (230 per month). Anyone know if this is a scam or if I should start doing the math to figure out if we should do it?
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Nov 30, 2023 15:57
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It's not a scam per se but it's probably not what you want. If you took that (230 - 66) and invested it yourself you'd almost surely come out ahead. Because literally that's what they will be doing, except they keep a cut of it. These things exist to address a common complaint from insurance buyers, "paying for nothing."
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Nov 30, 2023 17:36
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Spikes32 posted:Searching for term life insurance, state farm offers a normal plan (66 per month) and another plan that returns all premiums if they don't pay out at the end of the term (230 per month). Anyone know if this is a scam or if I should start doing the math to figure out if we should do it? It's not a scam (probably), but read the fine print: some of them disqualify you from getting those premiums back if you miss payments or cancel the policy. The main problem is you're handing the insurer the difference between those two values as an interest-free loan for the length of the term. If you're lucky enough to outlive the term and get them all back, you don't get any interest on the total; you just get it back as one big lump-sum payment. That payment is tax-free, so I guess it's effectively a way to force yourself to save that amount over the term and pay no taxes on it throughout, compared to the taxes you'd pay on interest from even keeping it in a savings account or whatever. But the way to calculate the math is to compare how much you'd lose out on compounding from putting the difference between those two premiums into investments, or savings, vs. the 0% return you'd earn on it by writing State Farm a fatter check every month. So, financially speaking, it's a bad deal, unless the economy happens to go into a huge deflationary period or some other bizarre scenario. So it's really more about your psychology and peace of mind: Would you actually invest that difference? Or is the idea of that big lump sum payment waiting at the end what you need to feel better about paying for something you'll (hopefully) never need to use anyway?
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Nov 30, 2023 17:37
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I'll need to read the fine print, the agent did say something about it being equivalent to 4% interest in that final payout. Need to see if that was bullshit or not. If it does include 4%, then it might be more worth it? Edit: based on the website no additional interest is included. So this is an easy no. Thanks all! Spikes32 fucked around with this message at 17:47 on Nov 30, 2023 |
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Nov 30, 2023 17:43
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Spikes32 posted:Searching for term life insurance, state farm offers a normal plan (66 per month) and another plan that returns all premiums if they don't pay out at the end of the term (230 per month). Anyone know if this is a scam or if I should start doing the math to figure out if we should do it? ROP policies are totally standard. If you invested $163/month at 6% interest would you have more than $231 in 20 years? Generally don't do ROP. Also make everyone price things in annual premiums, many places have a surcharge on monthly billing. "66/month, $200/quarter, or $780/year." just double check that.
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Nov 30, 2023 21:51
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Switching careers completely but it means I'm gonna be out my standard work insurance coverage for about 2-3 months, I'm in Oregon. No idea if there are ways I can just personally extend existing coverage another month or two or if I need to just be extra careful for two months until my new insurance kicks in. Is that COBRA? I've heard the name but I have no idea if it's that or how that works.
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Dec 16, 2023 22:36
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Thumbtacks posted:Switching careers completely but it means I'm gonna be out my standard work insurance coverage for about 2-3 months, I'm in Oregon. No idea if there are ways I can just personally extend existing coverage another month or two or if I need to just be extra careful for two months until my new insurance kicks in. Is that COBRA? I've heard the name but I have no idea if it's that or how that works. Yes, you will get a COBRA packet as part of your separation paperwork if your company was more than 20(?) employees. This allows you to continue the same coverage plan you had through your work for a set amount of time. It can be expensive and you may be better off placing your own policy through your state marketplace depending on your circumstances. Leaving a job is considered a qualifying life event under Obamacare and would give you 60 days to place coverage from the event. Obviously it is best to be continually covered, COBRA is backdated if elected & paid within the 60 days, I don't believe a marketplace policy would be backdated but I'm not sure on that.
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Dec 16, 2023 22:57
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COBRA is up to 102% of the full premium for your company plan. This is not what you paid per paycheck, it's what your employer pays the insurance company. To give you an idea our really good work plan (health / dental / vision) is something like $25k/year for my family of 4. Teasing out the health from that is pointless. So $25k / 12 *1.02 = $2,125/month.
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Dec 17, 2023 01:22
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Well that sounds...unpleasant. I assumed most general plans through the state required you to do them for a year, can I just do it for two months?
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Dec 17, 2023 01:27
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H110Hawk posted:COBRA is up to 102% of the full premium for your company plan. This is not what you paid per paycheck, it's what your employer pays the insurance company. To give you an idea our really good work plan (health / dental / vision) is something like $25k/year for my family of 4. Teasing out the health from that is pointless. So $25k / 12 *1.02 = $2,125/month. Yeah jeeze, I remember it being rediculous the last time I saw it but that's obscene. What's the point when the only time you would get COBRA is a QLE anyway? Is it a holdover from pre-obamacare? Thumbtacks posted:Well that sounds...unpleasant. I assumed most general plans through the state required you to do them for a year, can I just do it for two months? You can cancel anytime, and IIRC I was able to set it up for cancellation to coincide with my new work plan effective date. Bondematt fucked around with this message at 03:59 on Dec 17, 2023 |
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Dec 17, 2023 03:53
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COBRA is worth it in situations where you have a major medical procedure scheduled and don't want to worry about changing insurance and jumping through all the hoops to get your new insurance to approve it.
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Dec 18, 2023 00:49
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what's a good source of information on HOA insurance? Our HOA in MN went from 36K for our policy last year to 79K! many companies wouldn't even bid, and it's a relatively recent development (everything built from 2003-2005). our company from last year dropped us after paying out a roof claim (full replacement due to damage from a hail storm a few years prior) We were told that MN used to have some of the lowest HOA insurance rates, but now it's the second highest in the country (next to CO) for some reason
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Jan 8, 2024 20:54
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actionjackson posted:what's a good source of information on HOA insurance? Our HOA in MN went from 36K for our policy last year to 79K! many companies wouldn't even bid, and it's a relatively recent development (everything built from 2003-2005). our company from last year dropped us after paying out a roof claim (full replacement due to damage from a hail storm a few years prior) Wind & Hail is a huge, huge issue in multiple states right now. CO being the main one. Such an insane increase in claims. This is on track for what we're seeing on our HOAs that have a recent wind/hail claim. Sorry you're going through that, but insurance is broken in many, many markets right now. Could be worse though, you could have a non-sprinkled frame structure HOA in SoCal built in the late 80s with no updates. It's literally uninsurable, except by FAIR plan, who won't even pick up the drat phone.
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Jan 8, 2024 21:10
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actionjackson posted:what's a good source of information on HOA insurance? Our HOA in MN went from 36K for our policy last year to 79K! many companies wouldn't even bid, and it's a relatively recent development (everything built from 2003-2005). our company from last year dropped us after paying out a roof claim (full replacement due to damage from a hail storm a few years prior) Did they increase your wind/hail deductible with that increase too? From what I've seen in non-weather states, your renewal seems pretty reasonable.
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Jan 8, 2024 21:22
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Dango Bango posted:Did they increase your wind/hail deductible with that increase too? From what I've seen in non-weather states, your renewal seems pretty reasonable. I'm not sure - but this is just such a crazy increase, about 120%! we have a total valuation of around 23.5M, bare walls, 25K deductible per building (we have seven townhomes and one condo), and a 5% wind/hail deductible per billing I am pretty sure the deductible on our roof claim was 2% of the value per building, which individual owners paid out from their H06 plans
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Jan 8, 2024 21:54
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I saw my doctor in December but didn’t get an official bill for it until 12/25. I got an explanation of benefits for this in 2023 from my insurance I believe. By the time I got around to paying it it’s January (this week). Will this amount count towards my newly refreshed 2024 deductible because I pay it in 2024? Or does it count towards 2023 because it was billed for services rendered in 2023?
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Jan 8, 2024 22:03
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actionjackson posted:I'm not sure - but this is just such a crazy increase, about 120%! Did you go through a broker? They should be explaining the reasoning behind all of this. A 34-cent rate per $100 of TIV is not great, but your HOA is high risk until that claim falls off. $25K deductible is the new amount carriers want to place at, reducing this increases premium drastically now. 5% Wind/Hail sucks, but I don't know that market enough to know if you could get better. In SoCal, wind/hail is automatically included at no additional cost, but our problems are wildfire, fire, crime, and water damage. For reference, we just bound a builders risk in SoCal for a $1 rate, due to wildfire score basically coming back as "yes". I would notnexpect insurance costs to go down or coverage to be restored anytime soon. Insurance is broken, and no one really knows how to fix it.
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Jan 8, 2024 22:08
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Boris Galerkin posted:I saw my doctor in December but didn’t get an official bill for it until 12/25. I got an explanation of benefits for this in 2023 from my insurance I believe. By the time I got around to paying it it’s January (this week). It's based on the date of service, not the bill or pay date So it goes toward 2023 deductibles, etc.
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Jan 8, 2024 22:25
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