Wednesday, December 17, 2008

What Injuries Teach You about Health Insurance

When I turned 24 last year, I had to get my own health insurance for the first time. I was definitely lucky to be able to stay on my parents' plan for so long after school, and since I pretty much never had to go to the doctor and they had a family plan it never mattered much anyway.

I decided when I got my own that picking a health insurance plan is like gambling. It's always a bit of a crap shoot. You can pay a high monthly premium and get tons of benefits that you may never use. You may have a low deductible that will be helpful if something serious were to happen. However, I'm a fairly healthy gal and I decided that I'd prefer to risk having to meet a high deductible if something serious happened and take the lower monthly premium. I figured I wouldn't be using it much anyways, so I preferred to pay less each month.

(Sidenote: I set it up so that they hit my credit card for my premium each month. I have a rewards credit card and get 3% of that back. We're talking like $3 a month, but still... I feel like I'm getting a discount. I pay the card off monthly to avoid interest charges.)

You might imagine where this is going.

I wasn't pleased when I found out that my insurance wouldn't pay for my bad news-bearing MRI. It's frustrating to be injured, but it's even more frustrating to pay hundreds of dollars to be told what's wrong. Ugh. I'm going to be paying for that baby on a monthly payment plan, and even though it goes toward my deductible, it happened in 2008... which will be over in 2 weeks and everything starts over again. Double ugh.

Today I pulled up all of my EOB's online (so cool that we can do that these days) to figure out how much I've paid to my insurance company this year verses how much they've paid on my behalf. I am feeling much better now that I've seen the numbers.

I pay approximately $1300 over the course of the year through my monthly premium (there are so many better things I could think to do with that kind of money!) I've been to get my annual exam. I had to go to the walk-in clinic twice this summer for problems with my allergies. I've been to get two of the Gardacil vaccinations. I've had the one orthopaedic visit/x-rays and then the MRI. Over the course of that, I had to pay another $225 in copays. Add in another $120 I've paid over the year for birth control and I've spent around $1645 on this stuff. (That's not counting the MRI yet).

Now, the insurance company has paid around $850 to various doctors for various things. In addition to that, they pay the difference on the birth control each month, a total of $240 for the year. So they've paid close to $1000 on my behalf.

So I've still had to spend $645 more than they have spent for me, and now I have to pay for the stupid MRI. (I've come to calling it stupid every time I speak of it... It makes me feel better.) I don't think it's fair that I still end up paying far more for things than the insurance company pays on my behalf.

However, I looked at what the doctors actually charge for all of the stuff that either myself or the insurance company has paid for and have found that if I didn't have health insurance and had to pay full price, I'd be out more like $5000 if not a bit more.

So it's definitely to my advantage to be paying the insurance company the $1300, even though I still end up having to pay more than them out of my own pocket (very annoying). But I certainly wouldn't want to have to pay the bills if I didn't have insurance. The MRI is billed at a whopping $1300. I'll be paying a little less than half due to the discount I get for having insurance.

It's still frustrating, but I think in the end I took the right risk with picking my plan. Stuff like this rarely happens. Most of the time in a year I'd only go for my annual and then if I were to get sick. I wouldn't have vaccinations. I wouldn't have MRI's. I don't like having to spend my money on medical issues, but if I've got one then I need to pay someone to make it better.

I may be spending more on health issues this year than I'd prefer, but I have to remember that more than likely I'm not going to need to use my health insurance very much anyways. So I still prefer paying the lower monthly premium and having a higher deductible. If something REALLY major happens, I've got the deductible money in my emergency fund. I might not like having to use it, but if it were a serious issue then I'd imagine I'd be glad to not have thousands and thousands of dollars in medical bills... my plan pays 100% after the deductible.

This post has been a little dry, I know. I just hadn't really figured all this stuff out before and have definitely been learning more about it the past few weeks. Part of that is also because my insurance company screwed a few things up and posted some things to my account incorrectly and I've finally gotten it all straightened out. You better believe I pay close attention to make sure things are done right so that I can make sure they pay for everything they are supposed to .

Meanwhile, I think I might be getting a cold. This is not exciting, but it's making me feel kind of yucky and that helps to keep me on the couch and resting. I know that the more I can do that, the easier it will be on my body to try to heal my fracture.

Thanks again for all the comments you guys keep leaving, including the advice on gift giving for the boy. I made a decision after some brainstorming with your comments. I'll tell you about it after Christmas!

I also went with my sister yesterday and got my mom a really awesome gift for Christmas. I don't think she even knows about this blog, but I'm still going to wait and share what we got her after she gets it. She's going to love it. I don't think we've ever gotten her something so good.

Meanwhile, all I have left is my dad. My mom usually helps us out in finding something for him, and since I'm in no condition to do much shopping I'm hoping she'll pick something up and let us pay her back for it. You do what you gotta do.

I've also mastered taking a shower. The baths weren't cutting it, so I've found a way to balance on my right leg and barely sit my left leg down. When I shampoo my hair, I lean against the wall. It seems to be working, and I haven't had any moments of feeling unsteady even though all my weight is on one leg.

I mentioned this last night, but I really can tell a difference in the size of my quads. I'll have been on the crutches for 7 full days after today. It's crazy how quickly my muscles changed. I'd take a picture and show you, but I still haven't shaved my legs. Yeah, it's gross... deal with it. :) I did make an appointment to get them waxed next week because I'd already gone long enough without shaving to do it and now it'll be one less thing to need to do while I'm on the crutches. I won't be showing off my legs again for a while, but I still always feel better when they're nice and smooth. This way I won't be grossed out every time I look at my legs. And I won't get any ideas about trying to shave in the shower. Ha.

1 comment:

*aron* said...

gah i hate dealing with insurance... but like you said imagine if you didnt have it - phew!