As health insurance keeps changing each year, I have to keep adapting and learning and figuring out a way to plan out health care expenses so I don’t go bankrupt (sort of joking). Back when I worked for a non-profit, I had great health insurance. In fact, I think my out of pocket max was $500. I didn’t truly appreciate that then but goodness, looking back that was nice! I was able to get a nice stock pile going.
In April, it will be SIX years working for my husband’s company (I can’t believe it’s been that long!) and my stockpile is dwindling as each year my insurance gets worse and worse.
This year, I have a deductible of $6,500, which means that I have to pay 100% of expenses until I reach that deductible. I’m not sure if “healthy” people realize how much money a person with a chronic disease spends on healthcare each year, but $6,500 isn’t chump change. That’s a whole lot of money!
Since my husband and I have our own company, we go through peaks and valleys when it comes to income. Sometimes, it’s just not feasible to spend $3,000 in one month for diabetes supplies, which is when I’m thankful I was able to stock up so I can make it another month.
I’m not trying to write a woe is me post, but because I have to pay so much out of pocket, I am frustrated at how the health care system works. You never get an exact price of how much something is going to cost before it goes through insurance. But because of my insurance plan, I am on the hook for 100% of whatever they decide the cost is.
For example, back in December both my sons were sick and both got a flu test and a strep test. The doctor visit was covered with a copay but the tests weren’t covered. Neither of my boys had met their deductible so I was on the hook to pay 100%. When I was at the doctor’s office with my two really sick boys and the doctor said we need to test for strep, I didn’t ask how much it would cost. I was only focused on figuring out what was wrong so they could get better.
One strep test was $27. The flu test was $50. Oh and my youngest also got tested for RSV, another $30. And the doctor copay was $20. $127 for one visit for one kid. Both boys were positive for strep so I’m glad I got the tests done but not knowing how much these things cost make it hard to budget.
Next time I will know how much these tests cost but then there is the difference insurances. In December when I got those tests done, I was with one insurance company. They were no longer an option for individual coverage for this year, so we had to switch companies. And the different companies have different negotiated prices.
An example of this is Medtronic’s negotiated price for CGM sensors. Last year with my old insurance company, the sensors which are advertised as around $550 per month only cost me $326 because of the negotiated rate Medtronic had with my old insurance company. I had to order new sensors this year with my new insurance, and I figured I would have the same rate, $326 per month or $978 for a three-month supply. But apparently my new insurance company isn’t as good at negotiating a price because one month of sensors is $440 or $1320 for a three-month supply, an extra $350 almost! Before ordering, there was no way to know what the rate would be because it all had to get worked through the claims process. But now I know.
I was supposed to have an eye appointment last week, because of my diabetic retinopathy. But since I just spent $1320 on CGM supplies, I wanted to wait until next month to be on the hook for the eye doctor appointment. However, I did call the eye doctor beforehand to see what price I would pay, if I even needed to reschedule. The receptionist told me that for a high deductible plan they charge $150 at the appointment but then it will go through my insurance and I might be on the hook for more money. She couldn’t tell me how much more but transferred me to the billing department. The billing department also couldn’t give me a figure on how much a basic checkup would cost with my insurance. All she could tell me is that it would probably be between 150 and 400. That is a huge range! I checked my Explanation of Benefits from my appointment last year and it looks like the appointment cost $378 but with my old insurance’s negotiated rate, I only had to pay $190. But seeing as how my new insurance doesn’t get the same network savings, I have no idea how much I will pay.
A final example is with test strips. I didn’t order any last year because I had a high deductible plan (although it was way lower than this year) and I had just spent a TON of money giving birth so I wanted to stretch out my test strips so I didn’t have to pay. Since it’s the new year, I figured I would see how much the strips would cost under my new insurance and I can’t get an answer. I would need to submit the prescription and my insurance company will likely tell me they aren’t approved (I know that already) so then I’ll have to get a letter of necessity/pre-authorization from my doctor so they will be covered but I know I will likely still have to pay 100% for them, which will thankfully go towards my deductible. But how much will they cost?! Are they some inflated rate?
I’ve found you can actually get Contour test strips fairly cheap on Amazon so maybe I shouldn’t even bother with my insurance and get them that way. It’s just so much red tape to go through to keep me alive! Why can’t someone find a better way to deal with health care expenses?!
It just astounds me that I can’t get a price of a service before the service is performed. In no other industry do you have the work done first and then after find out the rate. How is this acceptable? I already have enough beef with health insurance but when you can’t even find out how much a service will cost you, it’s ridiculous.
*Edit to add that I wrote this a few days ago and today I went to the doctor THREE times (once for my 3 year old, once for my 18th month old and once for me) and had three strep tests done (all positive) so I will know shortly how much those will cost on my new insurance after the claim is done.