Something Doesn’t Add Up

Correct me if I’m wrong, but something about this scenario doesn’t make sense.

For a family of 3 we pay $806 a month for medical and pediatric dental insurance. We pay this because we own our own company and only having 2 employees does not qualify us for a “business” health insurance plan, therefore we have the individual (family) health insurance plan. This also does not include adult dental insurance because by law only pediatric dental insurance is mandated. So our premiums amount to $9,672 a year out of our own pocket. We have a deductible of $6,350 per person. That adds up to $19,050 a year. That is the out of pocket money we have to spend for anything other than an office visit or wellness visit. And of course for those we still have our $20 to $50 copay depending on the doctor. But for the sake of this argument I’m only basing this on the premium and deductible amounts. So the total for the year between premiums and the maximum deductible is $28,722.

Now generally we try to avoid going to the doctor as much as possible. All three of us are in good health, with a few minor issues that have been creeping up due to the aging process. There are no major conditions such as diabetes, heart disease, terminal illness, you get the idea.

This year has presented us with a few health issues that have been diagnosed and advised by the doctor to be taken care of. The total cost for one procedure was $3,188.78. Another procedure was $575.87. This all went towards the deductible for one family member. So now out of pocket we have paid $3,764.65, the insurance company has paid $0. So in keeping with the math, we have paid out of our own pocket $13,436.65 so far for the year. (This is our yearly premiums plus out of pocket expenses). Again, the insurance company still has paid $0. Yes, it’s less than the $28,722 if all three of us had met our deductibles and paid the premiums for the entire year. But even if we did that, the insurance company still would have paid $0 and I’m still out $28,722.

My question is this – why then must I have health insurance that isn’t paying for anything? I get absolutely no benefit from the insurance company. If I don’t have insurance I get fined by the federal government. If I didn’t have insurance this year I could have saved $9,672. This could have gone into an interest bearing account for say my child’s college education, or an emergency fund if something catastrophic should have happened. I could have also used that money to pay for the expenses that we did have and still have some left over. I get that there are those who didn’t have insurance, who needed insurance, who can now get supposedly affordable insurance. I also get that it’s possible tomorrow, next week, or next year one of us could be diagnosed with some awful, terrible disease. It’s also possible that I’ll live to be 100 and be perfectly healthy that entire time too. What I don’t get is why is this being forced on me, making me pay for something that is not benefiting me in any way, and based on the letter I just received getting more expensive next year? I just don’t understand.

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3 comments

  1. That is ridiculous! By my calculation, that means you have a family deductible of $19,050. Have you checked to see if you have a family deductible? Most family plans where an individual deductible applies to each person have the same amounts going against a total family deductible that is usually equal to two individual deductibles and gives you a break (albeit still not a sane amount) on the third individual deductible.

    This type of issue and the rising cost of healthcare is exactly why I created my healthcare blog. Good luck!

  2. Michelle this made me very sad to read. Then my anger and longstanding disgust of the insurance industry took over. Tell us that there must be alternative solutions to this insanity!

  3. I wish I had an easy answer. Currently there doesn’t seem to be an alternative, short of moving out of the country. I’ve written to both Senators and my Congresswoman, and as I expected received “canned” responses. So for now I either pay the insurance company or I pay the fines to the IRS.Either way, it still costs me in the end.

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