Deductible

Hopefully, if Chef or I have any accidents, we’ll have them before December 31, 2010.  That’s because we’ve met our deductible for the year!

Our insurance deductible is $1500.00.  Our responsibility for the surgeon’s bill was $858.87, all of which went toward the deductible.  For the surgery center, $641.13 went toward our deductible, which brought us up to $1500.00.  After we’ve met the deductible, insurance pays 80% and we pay 20%.  We had an additional $240.25 that we needed to pay the surgery center for our co-insurance, which brought that bill to $881.38.  We’ve already paid those two bills.

Based on our Explanation of Benefits (EOB) from the insurance, we also expect a bill from the anesthesiologist in the amount of $274.56, and a bill for radiology and the post-op shoe in the amount of $12.00.

We also paid about $12.50 for the pain meds I was prescribed after surgery.

Therefore, the total cost for this surgery, assuming there are no other bills that I’m missing, is $2039.31.

Since the other surgery will be done in December, before a new deductible period starts, our costs should be less next time.  If I’m doing the math right, we should have to pay only $814.81.  First, we’ll need to pay only 20% of what we paid in deductible this time.  Also, I won’t need to purchase the post-op shoe because the one I have can be used on either foot, so I’ll just use the same one.  Also, I won’t need to get new prescriptions because I didn’t take all the medication last time, and I intend to hang onto what I’ve got in order to avoid paying another co-pay.

One of my co-workers often complains that we don’t have very good insurance.  I’m not sure if she’s dissatisfied with the amount of the deductible, or the items that the insurance chooses to cover.  But I’m just thankful we’ve got insurance.  We went a number of years without it, and while we managed okay, it sure is nice to have reduced out of pocket costs.  My employer pays my entire premium (up to $500/month per employee is paid, and my premium is lower than that), so all I have to pay is the deductible and co-insurance.

Someday, I won’t be working full time anymore, and we’ll have to say goodbye to company-paid health insurance.  At that time, Chef and I will probably need to look into other options.  Unfortunately, since he is self-employed, it’s harder to find affordable insurance.  Several years ago we had looked into it and couldn’t find a plan that was worth the cost, especially since we’re both relatively healthy people who don’t use the insurance that often.  (This year has been an exception with all my chiropractor appointments and this surgery.  But we decided to do the surgery now specifically because we do have insurance.)

I’m not sure how the new Health Care Bill will affect us, because I don’t really understand what’s in the bill.  (Does anyone??)  And we’ve got at least another year to see what happens (what changes are made, and whether the bill even stays in effect what with talk of repealing it).  But as my time as an insurance-covered employee comes to a close, I’ll start doing research on other plans to see what’s available and affordable.

Are there any self-employed Americans reading?  What do you do for health insurance?

Any readers with company-paid insurance?  What’s your deductible?  Also, would you ever decide to stay in a job just for the insurance coverage?

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10 Comments (+add yours?)

  1. Ninja
    Oct 05, 2010 @ 10:23:57

    Oh man, this insurance thing is always so scary to me. We pay a lot of money each month for our premium and then depending on what issue comes up we could be forking out hundreds or thousands more. Insurance scares the bajeezes out of me , but commend you for figuring stuff out!

    • Karen, the Small Town Runner
      Oct 05, 2010 @ 11:23:21

      Because I work in a doctor’s office, I think I understand more about insurance policies and deductibles than a lot of people. But it is still confusing, and I don’t relish the thought of going out on our own in a year or so. But I’m not willing to stay in a job I don’t love simply for the health insurance… especially since we are relatively healthy people.

  2. Amy
    Oct 05, 2010 @ 11:14:24

    Have you heard of Samaritan Ministries? It’s a group of Christians across the country that help pay one another’s medical bills. It was being discussed just this morning on one of the yahoo groups I belong to. I didn’t pay much attention since we have pretty good insurance. I don’t really know anything about it, but you might want to check it out (apparently it’s important to know that it’s not Samaritan’s Purse when you are googling it.)

    • Karen, the Small Town Runner
      Oct 05, 2010 @ 11:21:26

      I’m not sure if we looked into that one specifically, but we had looked into programs like it when we did not have company-paid insurance. On some of them, you have to sign statements of faith and conduct, some of which we weren’t comfortable with. (I think not drinking alcohol was on one of them. We tossed that one!) Also, my pastor and his wife have something like that, and they just found out that they aren’t covered for motor vehicle accidents, which really stinks because he was just badly injured in a car-motorcycle wreck. (Granted, they should have known ahead of time what their coverage was, but still.) I know there was another policy we looked at (not sure if it was faith-based or not) where we would have had to sign that we would not participate in “dangerous activities” like riding motorcycles. We couldn’t sign that one, either.

      I’m sure when the time comes, we’ll look into programs like Samaritan, but we haven’t been impressed with them in the past.

  3. Dawn
    Oct 05, 2010 @ 18:41:26

    My husband’s considered self employed as a pastor. I always say that’s silly, because he works for GOD! 😛 Anyway, we have insurance through BCBS and it’s approximately $600 a month. Ouch. That’s just for us two. We are always getting bills from our doctor for things that aren’t covered by our insurance. How irritating. A few years ago, we had the same company in another state, and I had a lap and paid zero dollars out of pocket. Nothing at all. I don’t know what has changed, or if things change depending on the state, but it’s sure expensive!

    I also would never stay in a job for the insurance. We have the option to get insurance at a greatly discounted rate through my job, but I’m only planning to be there for another year, tops, so it’s not worth it to me.

    • Karen, the Small Town Runner
      Oct 06, 2010 @ 09:02:03

      Yowza! Six hundred bucks is a LOT. I just did some searching yesterday for individual/family plans, and for the two of us, the cheapest I could find was about $111.oo/month, and the deductible was around 10 grand, and there was no Rx coverage and office visits were not covered. So basically, it was just major medical, which I guess is better than nothing. But even though I generally don’t like the idea of government-sponsored programs, the costs of private health insurance make me think more about whether we would qualify for a government program…

  4. megan @ whatmegansmaking
    Oct 06, 2010 @ 09:10:43

    insurance can be so confusing! I ‘m thankful that my husband takes care of it and I don’t have to deal with it. 🙂 Neither of us is self-employed though…but hopefully eventually we will be!

  5. Blythe
    Oct 06, 2010 @ 12:24:24

    Don’t even get me started on this whole insurance thing! I can honestly say that this is the ONLY bad thing about being self-employed. When our monthly payment was increased to something like $600 for a $2500 deductible (for 2 healthy young people), we decided to do the HSA plan which was cheaper. This means that we pay more out of pocket when we go to the doctor and for prescriptions…but instead of paying the insurance company so much every month, we can put non-taxed money into a health savings account that we use to pay medical bills. (I never realized how much drugs and doc visits were until we got on this plan.) And, on another bad note, our insurance company (Blue Cross of California) had promised us a fixed rate for one year but has now decided to raise our rates after 6 months. We sent a letter telling them this, but they ignored it… Joy and rapture! This makes my blood boil.

    • Karen, the Small Town Runner
      Oct 06, 2010 @ 12:32:44

      Ugh! What a pain. I was thinking the HSA might be the way to go, but I don’t understand it well enough yet.

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