I don't know about you, but I paid more in health care premiums last year than I did in Federal taxes. That being said, if you're an IRS agent and want more of my money, feel free to contact my insurance company. If it's a fight you're looking for, they will be more than happy to help you with that. Please press '1' for English. I have what's called a CDHC PPO; in human language that is a Consumer Driven Health Care plan with a Preferred Provider Organization. Try saying that twice without passing out from lack of oxygen. This is the way it works:
* I get to pay an outrageous premium every week, but on the upside it's pre-taxed (taxes are another subject-don't get me started)
* The first $1500 in medical expenses for the year is paid by my insurance company-this includes prescriptions
* The next $1500 is paid for by me-cash out of my pocket on top of the premiums
* Everything after that: insurance pays 80%, I pay 20%, with an out of pocket maximum of $4500
* My co-pays are $0 across the board-nothing for office visits, urgent care, or trips to the ER-it says so right there on the bottom of the card (unless of course your HRA account has been used up-some kind of secret they don't want you to know)
Doesn't look so bad on paper huh? In fact it looks pretty darn sweet.
My world however doesn't consist of paper. The least amount of which being the green kind that spends at the grocery store. If my world were paper, I would have a fleet of airplanes that were environmentally friendly, and I could make more in 5 minutes if I needed to.
This is how things work in my world.
My daughter wakes up one morning and comes in and taps me on the head like usual to get my attention. I look up to see my 3 year old's sad little face. "Daddy my ear hurts". I get up, my brain still on my pillow, and fumble for her pediatrician's phone number. The receptionist tells me I could bring her in that afternoon to my surprise (doctors' offices are another group that rank high on my "list"). Before I go on let me ask this: Should I be thinking about how much money is left in my insurance (HRA-the first $1500) account at a time like this? Well, I wasn't and it was a bigger problem than I thought.
We jump in the car about 2 p.m. and head out to the doctor's office. It's over 100 degrees outside and we're frying like eggs in a skillet. Good thing they're close to home. We arrive, I walk up to the counter, sign in and give the receptionist my license and insurance card. My daughter's appointment was at 2:30, and to my shock and amazement, we were called in at 2:20. Must be my lucky day.
All goes well with the appointment. My daughter hates doctors more than I do, but she's a trooper and she did great. She ended up with an ear infection. My family and I walk up to the counter to pick up her prescription, sign forms, etc. The problem comes when we try to leave.
The receptionist, who was nice as pie when we came in, has turned into a woman on a mission. This mission was to separate me from my hard earned money. "That will be $75 dollars please". I proceeded to show her my insurance card again, where at the bottom it says $0 due for copay on office visits. "Yes sir, but I called to verify your coverage, and it seems you've used up your HRA balance for the year. We're going to need a payment." Great. It's the day before I get paid and I have around $10 in my wallet and not much more in the bank. Somehow through my awesome talents of persuasion, I convince this woman that I still have money in my HRA account, and we leave without paying a dime. Thank God.
I have to hand it to those pharmacists. My daughter's anti-biotic was $260. It came right out of my HRA account like it was supposed to. The prescription was more than the doctor's visit. Ugh.
We finally make it home after our trial by fire kind of day. Immediately I go to my insurance company's website to look up my HRA balance. $350 was what I saw. More than enough for the office visit. I was just too hot and tired to even think about it any more.
Overnight, the past day's experience had really sunk in. What if my HRA balance had been zero? My daughter needed medical care. I have insurance. On top of my premiums I would have had to pay almost $400 to get treatment for an ear infection. I didn't have $400. I could have gone to the emergency room and waited 8+ hours with a 3 year old that was in pain. I would have, had it come to that point, without thinking twice. Should that have even been an option?
In all, I came to this conclusion. Health insurance companies are your best friend until you get sick. We're the consumers-the 'C' of the Consumer Driven Health Care plan. We drive it with our money. When it runs out, we're left on the side of the road.
