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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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Old 08-15-2011, 10:35 PM
cathydownunder cathydownunder is offline
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Question Compare cost of monthly insurance premiums

I see many threads on here about the coverage ( or lack of) from the USA health insurance companies.
Was just wondering what is the average monthly premium that you all pay and what do you get for your money?
For example.....here in Australia I pay $285 p/m for family cover with a $400 excess....which is payable once only per annual hospital admission. My package covers private hospital ( no out of pocket expense) for unlimited days, roughly 50% rebate on cost of dental, optical, chiro etc, but no doctor visits.
My 2 spine surgeries (1st hybrid then 2 lvl fusion) were fully covered by my health insurance and besides the $400 excess, I only paid an out of pocket fee of $6000 to my surgeon for the 1st surgery ( the 2nd he didn't charge).
Seeing the AUD and USD are pretty even at the moment...how does this compare?
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The Usual Discograms Epidural Facet Injections etc
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Old 08-16-2011, 04:24 AM
JEVE19 JEVE19 is offline
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I guess I'm moving to Australia..lol

We pay $549 a month for just me and my hubby (both under 50 yrs old and hubby has zero ailments). We have a $2,500 deductible. It doesn't cover ADR.
Mine has a rider that doesn't cover anything to do with my back.
It basically ends up getting me a discount on my prescriptions.
No dental, or vision either.
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Old 08-16-2011, 08:55 AM
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Jstuckey Jstuckey is offline
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I pay $350 a month through my employer provided insurance for myself, husband, and kids. That, I believe, is only about 1/4 of the cost though, and my employer pays the rest as a benefit of my employment. I have a $500 deductible per person, per year, and it generally pays 90% of covered services/hospitalizations, etc, if I use an approved,area hospital. 50% if it's out of network. ADR was not covered for me because my insurance company determined that in my case, the ADR with the fusion was not an FDA approved use. I assume they would have paid for a single level. This I'll never know as I needed at least 2 levels repaired for sure, with the third being optional. I'm sure they would have paid for a fusion, now and multiple times down the road in my lifetime - but I never asked. I'll pass on the block of wood for a spine. Went through 3 appeals, then was told I'd have to hire a lawyer. I gave up there. I felt more confident about leaving the US anyway.
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Joey Sue - 50 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick! Still doing great.
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
http://healthyback2011.blogspot.com/
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Old 08-16-2011, 09:08 AM
cathydownunder cathydownunder is offline
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WOW!! is that a standard price Vicki?

That is SO expensive....I don't know how anyone on an average wage could afford to have private health cover then. I know I couldn't

We have been in the same health fund for 25 years and the premiums have increased annually since joining but I would NEVER let it drop, especially after them paying out >$70k for surgery #1 and >$45k for surgery #2 plus a dozen other non spine sugeries for the family.

Joey Sue, yours sounds a little more reasonable....is it usual for employers to contribute to health insurance as part of your employment package? It's very uncommon for that to happen here.....unless you actually work for the health insurance co

I guess I"ll stop complaining about the cost of health here now.
__________________
Scoliosis 35*
DDD Everywhere!
The Usual Discograms Epidural Facet Injections etc
Maverick L4/5 Fusion L3/4
July 3 2006

Dynesys Stabilisation L4/5
Lt & Rt Facet Removal +Non-Bone Fusion L5/S1
May 26 2008
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Old 08-16-2011, 11:00 AM
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Jstuckey Jstuckey is offline
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It is pretty common for larger companies to offer partial payment into a group health insurance plan as a benefit - not so much for smaller companies though. My husband owns a restaurant, and only the managers have access to health insurance. I work for a hospital, so my benefit is probably better than most - but here I am borrowing $40K from my parents at 45 years old for health care!
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Joey Sue - 50 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick! Still doing great.
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
http://healthyback2011.blogspot.com/
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Old 08-16-2011, 05:08 PM
JEVE19 JEVE19 is offline
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I used to have Aetna which was a business group insurance.
Business insurance in Florida is better because when you sign up, they can't not cover pre existings. They can tell you that you have to wait from 30 to 365 days.
Because of this, we paid $2,400 a month which again was just for me and the hubby.
This was before I was diagnosed with DDD. I didn't show any back problems yet.
That was in 2005. The first year that ADR was "supposedly" FDA approved.
My doctor tried to get me an ADR back then, which of course was denied.
Then, they raised our rate to $3,600 a month! My doctor told me that is what they do when they want to get rid of you. We couldn't afford that so we had to get a personal policy, not run through the business so we could get something that wasn't a mortgage size payment.
Now, they could attach the pre existing crap, so now I have a back rider on my policy.
Kinda annoying looking back on it because my back doctor back then, should have gotten me into a study or just did a fusion. My insurance would have covered a fusion, but he said not to do that. Once denied, he no longer helped me. I wasn't the cash cow he was looking for and that's why he is my previous doctor!
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Old 08-17-2011, 12:30 PM
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robinj robinj is offline
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I feel sorry for all that have to loose sleep over where and how the money is coming from to pay for their health care.
In Canada we pay $ 0 per month for our medical. It’s true that there are waiting lists. It took 6 weeks for a CAT scan of my back because it was an “elective procedure” but it cost me $0. My two Prodisc cost $0. I did have to pay my own travel expenses, but I was able to claim them as a deduction on my income tax. Canada may not have a prefect system, but if your sick it won’t kill you trying to pay for it.

Your Friend in Pain!
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94 - fell off roof fracture L2
99 - L3-L4 herniated disc - in hospital 6 days
01 - start of severe leg & back pain
02 - L3-L4 herniated disc - in hospital 5 days
04 - DDD L4/L5/S1
07 - Prodisc L4/L5
08 - return of leg & back pain
09 - Prodisc L5/S1
no releif & pain increasing + other complications
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Old 08-17-2011, 10:51 PM
JEVE19 JEVE19 is offline
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Rob, just reading your post makes me sad.
Our countries health system is a disaster.
I sometimes feel like the cure is to move to another country.
Truly sad to feel that way.
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Old 08-19-2011, 06:14 AM
cathydownunder cathydownunder is offline
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Wow Rob, Canada's really got their health care system in order!

We also have free national medical for everyone, it's called Medicare. However it can take months if not years for elective surgery and I'm sure ADR's arent covered....only fusions.
Saying that......anybody can go anytime to the emergency dept of any public hospital and not be turned away.....no charge. Unfortunately too many people use them as free medical for minor ailments instead of going to see their local doctor, so waiting times can be hours if it's not an emergency.
__________________
Scoliosis 35*
DDD Everywhere!
The Usual Discograms Epidural Facet Injections etc
Maverick L4/5 Fusion L3/4
July 3 2006

Dynesys Stabilisation L4/5
Lt & Rt Facet Removal +Non-Bone Fusion L5/S1
May 26 2008
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