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[lock] Buying health insurance as an individual
Jasconius
sword criminalmad onlineRegistered User regular
sword criminalmad onlineRegistered User regular
I need to buy health insurance, and dental insurance, as an individual. I am young, and I don't smoke. This will make it cheap. But I am looking for the least vampiric option.
I don't want an HSA. I'm figuring a PPO with a pretty low deductable and essentially full coverage, doctor visits, ER, hospital, etc.
I also need comprehensive dental insurance. I don't know if every health insurance company offers that.
Blue Cross is the hyper-obvious option, but their quoting page gives you about 90 billion plans to sort through.
I live in Florida.
I don't want an HSA. I'm figuring a PPO with a pretty low deductable and essentially full coverage, doctor visits, ER, hospital, etc.
I also need comprehensive dental insurance. I don't know if every health insurance company offers that.
Blue Cross is the hyper-obvious option, but their quoting page gives you about 90 billion plans to sort through.
I live in Florida.
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Do you have any meds you take (get a plan with a drug rider)
With Florida, they're allowed to call pretty much fucking anything "insurance" even if they're just giving you what is basically a $75 coupon per office visit and $150 per "HOLY SHIT! YOU HAVE GODDAMN FACE CANCER!!!!" (this is only marginally hyperbolic)
So read the benefits summary pretty fucking thoroughly. If you have any questions about it, post that.
Have worked for:
BCBS, Medco, with bcbs be warned that when we called to check on claims we were told that the doctors had never been able to get a bcbs rep on the phone before, may or may not be an issue for you
Have had to bill:
BCBS
Medicare/caid
a ton of other small companies that are fortunately probably not an option for you
Have had, through work:
UHC
Aetna
Aetna Dental
Delta Dental
UHC was just a giant clusterfuck, they billed me for three months without ever providing coverage, and then refused to quit billing me until my employer told them I'd been fired. Every time I called I got the runaround and was hung up on several times. Aetna health has been a pretty decent plan so far, lots of options and CSAs are polite and helpful.
For dental insurance, I've had the best luck with Delta and wish my current employers offered it; they have more dentists in network and fewer billing delays than I've had with Aetna Dental.
However all advice is super region specific, you're going to want to look up how many doctors/dentists there are in network in your area, deductibles/copays, benefit caps, and monthly premiums as well as talk to insured people in your area to see what their experiences are. UHC in Kentucky was a vastly different experience than UHC in Colorado was, and BCBS outsources the shit out of everything on a state by state basis, so bcbsfl is handled by entirely different people than bcbstn or bcbsny.
As far as Dental, yeah, I need a lot of work done.
I already spotted the stupid "here's a coupon" deals. I know to avoid them. Probably why BCBS offers 30 billion plans in Florida. Different formulation of ripoffs.
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I think right now I have co-pay only... and I like it. 20 dollars, no questions asked.
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Definitions of pre-existing conditions, this is so fucking tl;dr. Varies from company to company, from any condition within the last two years that was not previously addressed during a period where you had insurance, to any condition within the last six months (more reasonable).
You'll need pre-approval for any kind of surgery and possibly any dental work beyond a filling, how much pre-approval you'll need varies from plan to plan. If you're going to be denied for pre-existing, this is when you'll find out. VERY IMPORTANT, I'm sure you have a nearby hospital you'd go to, make sure whatever plan you're looking at is accepted by the hospital, the doctors, and the anesthesiologists. You do not want to find out after you rack up a $7000 anesthesia bill that they don't accept your insurance. When I did medical billing this came up a lot, and it always sucked to have to tell someone they owed a huge chunk of change because of it.
Short list:
Benefit caps, deductibles, copays (flat copay or 20/80 coinsurance?), do you have to choose a primary provider (unless you have a doctor you've been seeing since you were a kid, and you love them to death, and they're in your network, avoid this if at all possible), pre-existing conditions, pre-auths, basically this is a good list.
God yes this. A lot of the good parts of HIPAA re: pre-existing conditions only cover employer sponsor plans. Check Florida's State insurance site to see what bullshit WILL be pulled on you if you come down with something that you would actually like, you know, need insurance for.
This is good advice as far as the checking goes, but the anesthesiologist thing is largely the stupidest game in the industry. Most Ans are not PAR with insurers, because after all is said and done, they will be paid at the UCR by the insurer.
** all is said and done meaning endless hours of your life wasted on the phone with customer service reps, writing appeals, possibly dealing with collections people, and pulling your fucking hair out.
It is stupid as hell but it is also kinda common, tbh we could probably make a whole thread just based on stupid shit insurance companies and doctors (especially doctors) pull to fuck you over. Like double billing for a service, in most places not legal but doctors get away with it because patients don't know what to look for; non-network providers in a network hospital; etc, etc, etc.
Having to sit on the phone with patients and say, "Sorry, the anesthesiologists don't accept your insurance even though the hospital does, there's nothing we can do, you owe us $5000 for your surgery" is probably one of the most soul-sucking jobs I've ever had.
I mean, it is not something that I need to do. It is a latent condition and it's one of those things I just should get done when I have the time.
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I'll go you one better. I had to process eveything to kick a 16 year old with Leukemia out of his hospice and notify the facility to balance bill the parents for 2 months of a hospice stay because the little bugger wasn't considerate enough to die within the 180 day benefit.
That gave me nightmares and they had to move me over to the Medicare line of business because I almost had a mental breakdown. I win?
Im pretty sure Florida allows medical underwriting, so any policy that will cover this sort of thing will require disclosure. The important thing is that if they ask, you have to tell them. If you don't they can retro-actively terminate your policy for submitting a fraudulent application.
This will raise your rates.
That's fucking terrible.
I know and I'm an asshole for having worked for what apparently was the devil (and continuing to work with them for a year after because they moved me over to the area where I did the same type of shit to your grandma, but since it was old people I didn't mind as much).
Still depressing but 'happy' ending for the above:
Long and short of it, read your contract. If an insurance company isn't required to pay for something, they fucking wont. If an insruance company can weasel out of paying for something, they will.
Also I mentioned prior coverage because most policies have different terms and conditions for pre-existing depending on if you have had insurance in the last x time period and if you haven't. So if you've had insurance for the last year, it may be less likely to be denied for pre-existing, but if you haven't had insurance in the last year it would be more likely to be considered pre-existing. It is, at best, a massive clusterfuck in most cases.
So for example, I had a cyst that was discovered when I was 16. At 20, I got insurance through work. Under this particular plan, because my cyst was discovered more than two years in the past, it was not considered pre-existing.
-If it had been discovered in the two years prior to me getting coverage, and I had not had insurance, it would have been denied as a pre-existing condition.
-If it had been discovered in the two years prior to me getting coverage, but I had insurance with another company, it would not have been a pre-existing condition.
I now have a different plan with a different company and their definition of pre-existing is completely different.
Basically it's just best to ask for details about what is and isn't a reason for a pre-existing condition denial, because they can make it hinge on tiny things you would not ordinarily think to ask about.
A few examples -
Once you get a filling on a tooth - you probably won't be able to get another filling on that tooth, for 2-3 yrs
If you get a crown - you can't replace that crown, no matter what, for 5,7 or 10 yrs
White fillings on back teeth are usually paid at a lower rate (the insurance pays for metal fillings which are cheaper - so you pay more for these - which is B.S. because the white material which dentists charge so much more for, costs them pennies more per tooth.)
My advice - look into a plan with a shorter Age limitation for crowns and other "appliances"
Get the coverage that will pay for the white fillings
and try to get $1500 or more as a calender year max - A root canal and crown alone will eat right through $1500
And one last word of advice - choose your dentist carefully. The are like car mechanics - you don't know what's wrong with your mouth, and once you are in that chair, they are just going to start working on stuff, and you can wrack up thousands of dollars in work without even knowing it, in under an hour - and they don't care if your insurance pays for it or not - they will just bill you. So some are total crooks, and others are terrific. Also, I would seriously consider getting pre-approvals for any work done above and beyond a cleaning - so you know if it's going to be paid for before you have it done.
the "no true scotch man" fallacy.
SOOOO. I need to try some different carriers. I've heard many bad things about UHC, but how about Humana? Are they decently sized? I don't want to get some great in-network plan only to find out their network is like 4 doctors.
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Several times.
They politely told me to seek out one of their competitors.
I have the doesn't-eat-cheese-every-day plague.
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Seek out their competitors. Make sure you tell them you're healthy as shit. Then call them back and be like "haha fuckers, looks like you miss out on some easy money."
Seriously. Do that last part once you get coverage.
So, that's what I call a stonewall.
I filled out the prelim app at Humana and wasn't immediately rejected.. I want to know if they have a good provider network first, before I pull the trigger.
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As it was explained to me by a consultant "they don't actually weigh you", but the last thing i need it to pay 100 bucks a month only for them to say "oh yeah your medical record shows weight XYZ, REJECTED!!!11"
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Height/Weight is one stat that is super easy to use to screen for potential health problems and yes, actuaries are the fucking devil.
I do not give a motherfuck what anyone that is not an insurance company think I should weigh, at the moment.
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See if they pull anything extra up for you, in terms of companies.
e: I found the plan through ehealthinsurance as well.
So. Locked!
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