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Steve_A's avatar

Are these fair prices for health insurance and what should I do?

Asked by Steve_A (5130points) May 18th, 2010

I was told from my last question to just call and ask for quotes for health insurance. So I did…There is a bit of details but I could really use some help from people have experience with this.

I plan to call Blue Cross and Blue Shield I have been suggested to them. Any other ones I should try?
The 2 that are available at my income that I could pay monthly he told me.

United One
$146 monthly
$35 copay
$2,500 deductible

Edena
$105 monthly
$30 copay
$2,500 deductible
cheaper BUT they have this thing called 80/20 which he explained to me was basically instead of 2,500 I would end paying more but he did not go into details much of what it meant exactly so I’m thinking there is some catch or something..?

Also I have another problem you see I had a knee injury back in February I was going to the doctor for it. In fact I have the CT scan CD from the last visit but Medicaid ended my coverage at the end of February. Well I thought it was nothing serious but my knee is still giving me problems nothing major but still I don’t have the same mobility and flexibility…And plus its stopping me from my one main goal.(I think it was because I turned 19 that year but not sure why they ended it exactly.)

Is there a chance that they will say it is a pre-existing condition I asked the representative on the phone he sound the worse that is likely to happen would be higher premiums but he could not say 100% he said.

And one last question I was told I could go to my county’s health department and likely get treated that way. Would that be a good option?Or better off getting health insurance?

Ultimately I need find out if this is serious or not you know, like do I need surgery or just time and physical therapy at least.

Oh and my job has nothing benefit wise :\ .....

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6 Answers

Seaofclouds's avatar

It’s hard to say which one is the best policy without a lot more information. Do you have someone you trust locally that could look over all of the benefit information with you? You want to look at which company has more choices for doctor’s in your “network” and what the difference is for “out-of-network” in case you need medical care when you aren’t “in-network”. The deductibles are important, but you also want to look at what counts as going towards your deductible (this varies per insurance company).

I’m not sure how the county health department would work for you with your knee, so you could call them to ask them. Overall, it’s best to get insurance because you never know what could happen down the road.

Steve_A's avatar

@Seaofclouds What kind of information?

I don’t know anyone locally who would know about this. He also talked about the doctor “network” you are talking about.

Basically I figure what is going to happen is if they find nothing on the CT scan, they’ll ask for an MRI and worst case scenario they will say I need surgery. Hopefully not.

Do I just need to ask if they cover MRI’s (with contrast) and surgery..?

Seaofclouds's avatar

There are different types of coverage. Some coverages let you see any doctor you want to. Some require a referral to see specialists. Some say you have to choose your doctor of a certain list. Things like that are important to know. A plan that tells you to pick a doctor of a certain list and makes you get a referral to see a specialist is generally cheaper than a plan that lets you see any doctor you want to. The best way to compare plans to see which one is the better deal is to sit down with all the benefit information (they usually have packets that give all this information) and compare them side by side. Some insurance plans will cover prescription mediations, while some don’t. You really need to look at every detail of the plans to see which one has the better coverage.

As far as the health department, each area is different. You can call your local health department to see what services they offer for people with no insurance while you are waiting to get an insurance plan. Some areas have free clinics to help people with no insurance and low income. Most places also have walk-in clinics that will see you, but you will have to pay for the visit and any necessary testing.

perspicacious's avatar

80/20 is coinsurance. That means that when they DO cover something it’s at 80% and you pay 20%.

mikesands's avatar

No, they are not, but, in this country what you pay for is usually what you get… Medical socialism in a modern democracy works, try Italy, England, etc. lots of places. Capitalism in medicine promotes profit at the expense individual health….. unless you have lots of spare money. Profits can be shared to improve and do research on a collective basis. Now my brother calls me a communist, but I’m a Army veteran, a voter and pay insurance taxes, etc, unlike the Liberterian he is, so let’s not go there.

Dr_Dredd's avatar

@mikesands Hi, Mike. Thank you for your service. Have you used the VA system at all? Although it gets a bad rap sometimes, there are some VA hospitals that are quite good. (Disclaimer: I work for the VA.) I think the VA is a good example of a nationwide single-payer system right here in the U.S.

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