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Health Insurance Advice Learned the Hard Way

I have become very familiar with health insurance over the past few years. First, we had our little Roo in February of 2010. Second, while cleaning windows at someone’s home I fell about 12 feet from a ladder and broke an assortment of bones in both feet. Lastly and most recently we had our little Moo.

These experiences gave me a crash course in how my health plan works. You would think that since I had insurance during all of these events I would have gotten off easy and not had to pay a bundle; unfortunately insurance is not what it used to be.

When we had Roo we were on a HRA (Health Reimbursement account) the basics of that plan was my employer provided $1500 as a reimbursement for any health care expenses.

When we would go to the doctor the insurance paid out of the HRA whatever we owed the doctor. All the money spent out of the HRA was applied to each individual’s deductible which was $1000 per person.

The HRA would cover at least one full deductible and then half of another person’s. Once our deductible was met for Janna during the pregnancy, then it starts what the insurance companies call “Co-insurance”.

Our co-insurance is 80-20 up to $2500. This means that for every bill we got after the deductible was met we had to pay 20% of all the doctors’ bills until the total paid equaled $2500.

After all was said and done my employer paid for the $1000 deductible then also paid $500 of our coinsurance which left us with a bill for the rest ($2000).

We ran into a pretty big problem as this all played out; since Roo was born in Feb 2010 all the appointments leading up to the birth were on the 2009 plan year then add the birth to the 2010 plan year and we maxed out 2 plan years with one condition.

Some advice for those wanting to be parents; try your best to make the 9 month pregnancy all happen before December 31st, this seems simple enough but I didn’t think about it beforehand.

This will also help you come tax time you will be able to claim him/her on your taxes for that year.

Next, I broke my feet, I don’t have much to say about it other than nobody is invincible on a ladder. I fell from about 12 feet on concrete, I’m super lucky I did not fall on my back or even worse my head. Click here to see the gross picture if you dare.

*Just FYI, if you are a nurse or doctor and you happen to be giving a patient the same drug that killed Michael Jackson… don’t tell them that. I was able to recover from the whole experience and am able to walk fine today.

Add the broken feet numbers to the mix and our 2010 health expenses were staggering. The next time open enrollment came around I decided to really buckle down and understand what was happening. I received all the information from my employer about the different plans and looked it over.

Keep in mind Janna and I decided at this point we were going to have another child in 2011. Knowing that we would max out the policy all I had to do was find out the worst possible scenario for each plan and go with the cheapest.

As it turned out that the cheapest health insurance plan was an HSA (Health Savings Account). The deductible was quite a bit more than the HRA but there was no coinsurance after the deductible was met. I think the deductible was about $2300.

For 2012 we switched back to the HRA because we don’t plan on any major hospital stays (fingers crossed) and it worked out to be a little cheaper because of that.

A few tips I’ve learned along the way…

  1. Never pay a hospital bill the first time it shows up in the mail. It’s likely the insurance company just received it as well; wait until you know insurance has paid its share.
  2. Don’t pay big lump sums. It’s like an interest free loan, just pay something towards it every month and most of the time they won’t hassle you.
  3. Know the worst case scenario with your insurance plan; find out what the total cost would be if you had something catastrophic happen.
  4. Make sure you are visiting an in network doctor. Believe it or not before I checked myself into the hospital for my broken feet, I checked on my iPhone if the closest hospital was in my network… I know I’m crazy but a lot of times using an out of network provider can double the cost of care.
Funny story as a result of breaking both feet…
  • Because I broke both of my feet I was obviously unable to walk. This created problems that I cannot count, I was not able to get back into our apartment and as a result my inlaws took us in for my recovery period. Unfortunatly I was not able to navigate my wheelchair into their bathroom… have you ever seen those stand alone adult size potty chairs? Yep I had to use one. Let me tell you how not cool it is to have to do your business  in the living room on one of those things and then letting people know when it’s safe to enter the room again. Bless Janna’s heart she was so good to me.

What are some tips you have about health insurance? Please leave a comment below and share.

Jesse

{ 10 comments… add one }
  • Derek Frei August 24, 2012, 2:45 pm

    We just got our hospital bill for Maile’s birth and the associated hospital stay. It added up to somewhere in the ballpark of $20k for a completely natural birth (the only real medical intervention performed was Ashley’s epidural). Our plan (GEHA) says it’s covered, and hopefully that’s the case!

    • Jesse August 24, 2012, 3:06 pm

      Congrats again Derek! I am pretty sure the insurance you get where you work is about as good as it gets. Hopefully you won’t owe anything. Are you with Group health? What types of plans do they offer at your work?

  • Ruth S September 11, 2012, 9:55 pm

    Hey, I have a broken foot story.
    I broke my right foot the first year we were married. Fortunately for us, I fell in my landlord’s yard and their homeowner’s insurance paid for the bills as we had zero insurance at that time, (Being very young and clueless to important matters like the need for insurance.)
    I didn’t require surgery like you did, fortunately. In “those” looonnnggggg-ago days, first I had to wear a plaster cast and used crutches. I had bend my leg at the knee to keep the castup & off the ground when I moved along. Then I progressed to a walking cast, which was a thicker plaster cast with a rubber cube attached to the sole of the cast.
    Mobility was very treacherous, considering we were living in northeast Oklahoma during an icy winter. I dreaded negotiating steps, especially outdoor steps! I slipped once on icy steps. The crutches went flying, and I went down hard. I thought I broke something else when I fell…but ended up just banged up and bruised.
    I remember when my final cast was removed, I stood up off the table and about fell on the floor. Fortunately for me, my hubby caught me before I made it all the way down. My muscle tone in that foot/leg was lousy from being immobile in the cast. I think today’s method of the walking boot is a better healing technique.

    • Jesse September 11, 2012, 10:06 pm

      Wow, it’s good that your medical bills were covered. Sometimes the medical bills end up being more messy than healing. I was surprised when they said I didn’t need a cast of some sort but I guess that’s how the do things now. The whole crutches thing took a while to get used to, they seem to slip on everything and can be a safety hazard to someone trying to recover from an injury. Good to hear everthing worked out for the better.

  • Ruth S September 11, 2012, 9:57 pm

    Do your feet ache when the weather is really cold and damp, too?

    • Jesse September 11, 2012, 10:16 pm

      You know a lot of people have asked me that same question. I don’t know that I’ve had enough experience with cold weather yet to make a call on that. I know my right foot aches often, sometimes it affects my walking and I end up limping a little. The doctor said I’m at a very high risk for arthritis in that foot. I’ll get back with you on that after this winter, I’ll pay more attention this time when the pain happens.

  • Erin October 19, 2012, 7:14 pm

    We just received our anatomy ultrasound bill for $1600. Our insurance bumped it down to $800. That’s not “covering” it, that was just the discount my company applied. I cried my eyes out. My Doctor also added a “recommended but not required” cystic fibrosis test to our blood screening on our first visit. We had no idea until we received another bill for $800, our insurance covered $500 of that.

    Now we’re at $1100 for the ultra sound and blood screening. Luckily we’ve learned to ask “Does our insurance cover that? If not, we’ll pass”. We’ll do this until the start of the new year when we’ll have to pay all of our $2500 deductible.

    Ask, ask, ask is our new motto.

  • Dyan December 27, 2012, 4:20 am

    Great post, really enjoyed it!
    — Dyan

    http://www.bigconceptdesigns.com

  • julian December 19, 2013, 1:14 pm

    I agree with number two. A big bill will, eventually, become small if you keep chipping away at it.

    • Jesse December 21, 2013, 11:49 am

      I totally agree Julian, now when I get a bill, I pay $30/mo till its paid off. Works every time!

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