December 2005 - I purchased a health plan from Anthem for $197.00. My deductible was $500, and co-insurance was $1,000. This was one of the more expensive plans, but I knew I needed surgery. Back then, I was 33. In January 2007, it was raised to $235.00. In 2008, it was raised to $275.00. In 2009, the premium was raised to $297.00. In 2010, it seems that Anthem got carried away some, but the Department of Insurance (DOI) approved the premium rate to $405.00. And next month, the premium will be raised to $489.00. So basically in the course of just a few years, the monthly premium has more than doubled. I never really went to the doctor all that much and never worried about insurance until awhile back. I have been trying to keep up with some of the issues that were in the act - mainly doing away with the lifetime maximums. When I bought the policy, I saw the $2 million lifetime max and did not think anything of it. Now though, I look at it a lot closer and have learned quite a bit about insurance (i.e. having to call the carrier to let them know that the ambulance ride was an emergency and not just an expensive tax ride). For this past year, the carrier paid out $345,129.84 in expenses. I only paid $4,860.00 in premiums, so it looks like I got the better deal. In 2009, they paid $120,569.94, while it seems I paid $3,564.00. The medical / insurance industry though is something that needs a complete overhaul in my opinion. Luckily, I am able to get some of my medications in the generic form, usually going to Sam's Club for those. For example, if I went to the mail order pharmacy for a 90-day supply of Ambien, it would cost me $30.00 - at Sam's, I pay about $8.00. One surgery that I had billed out about $233,000.00 for the hospital, and the insurance paid the hospital about $130,000.00. I usually tend to side with people that the government has gone too far with some things and not far enough with other things. I was wondering though, what others might think about the Act and if it goes too far one some things and not enough on others? Do you think that some new President / Congress / Senate - down the road, let's say in fifteen / twenty years might change it? Are others happy that the lifetime maximums have gone away (and afraid they might come back)?
Lets try the new Congress this year, will try to rewrite the legislation beginning January 1st and try passing it on January 2nd. The caveat is, since it is now law they have no choice and in the end really have no plan of their own. Even a ruling in their favor by the Supreme Court against mandatory coverage will only embroil the gov't deeper into healthcare than allowing public mandatory coverage for the purpose of solvency and lower premiums in keeping healthcare separate from a gov't program. If they are able to change anything, lifetime maximums will be no different and probably by their logic will be restated. You seem to have done quite well with your coverage and do you believe the amount billed was appropriate?
Since this is a personal plan, Anthem has a little more control over raising the fees (compared to a business plan). I actually did have three plans for awhile (business plan) and the premium was about $100 (the company paid the other part). It was a pain though with the billing (primary / secondary), but I learned quickly how to navigate through that. I still have two plans to help with the office co-pays and prescriptions. It's still a bit difficult working through both of them, but it is far less money out of my pocket. I have to completely admit that I am getting the better deal, of course. Two of my medications cost $6,000.00 every three months (I pay a co-pay of $160.00.) So just by that alone, helps to build up to that lifetime maximum. Colorado has been doing something though for a couple of years. Added to my monthly premium is $3.76 starting in 2011- called CoverColorado. In 2010, it was (I think $2.52). I don't know if other states have this and it seems to be different from Medicaid. I wished I would have actually got Cigna though - I have a family member that works in the appeals department. Fortunately, I have only had to appeal a few things. Usually the doctor's office would do it but being new back then to insurance, I did it. I don't even think Anthem offers the plan I am on any longer. Last year, when it did go up more than expected, I checked online to see if it was the same price and it was. I was pretty sure the company could not raise the premium based a member's medical condition. I do think the government should look more at what the insurance company's contracted fees are with the physician's / hospitals. I always request a detailed report just to see what the hospital billed out. For example, the screws in my back was billed out at about $5,000 a each (I can not remember what Anthem paid). I have 24 in my spine. Actually during my second surgery, the doctor had to remove two of them and gave them to me. I wished I could e-bay them I also saw that the cardiologist who read my EKG charged $96.00, yet Anthem only paid him $3.00. That was a bit scary to think that if this cardiologist knew he was only getting $3.00 to take a look at this before surgery, how thorough would he be?