Submitted by nebirah t3_yp6nyh in massachusetts
I pay $150 a week for an employer-subsidized PPO plan. While it's more than twice as expensive as the HMO plan, I want to control who I see and when. I can't get that control with an HMO.
I choose to pay the rate. That's not my rant. My rant is that it's frustrating that Massachusetts is known for its healthcare institutions and distinguished doctors, but here we are paying for that reputation.
Right?
“Why does the best stuff cost so much money that I’m totally able to payyyyy?”
Hard to jump on board with this one.
Wait till you see the cost of housing!
It’s not about OP. It’s about all the other people who can’t afford health insurance
Doctors do cost way more out here than the rest of the country. I get sticker shocked everytime I go to a doctor. I had one bill I flat out refused to pay because it was damn near extortion. It was an otolaryngologist.. $1200 for an office visit. Back home in NY, I visit my cancer doctor for $75. Doctors may be good here, but they aren't $1200 a visit good.
This. It’s about people who have had a long standing rapport with their doctors, and then have to switch.
This is especially difficult for extremely ill people, people with nuanced needs, or who are in pain management.
Health insurance is a lie… all it does is ensure they will take all of your life savings away from the things you saved it for. You are literally being bleed until you are dead.
Think about the last time you had an easily defined Illness, and how long did it take for the “experts” to diagnose you
Insurance in the Northeast is super expensive. Well, the greed of the doctors and “not for profit” hospitals insurance companies are compiled together and you got this abomination. The only respect i give are to the nurses and healthcare personnels like lab technicians.
I pay 400/mo for an epo family plan…..cheaper than the ppo, but my in network is awesome, so why pay more than I need to.
Your pricing seems high, especially if it’s a single plan….I would look into the hmo network to see if you can get the same coverage….
It’s not reputation …. It’s whatever deal the employer has with the provider. Employers typically cover 80% of the cheapest option they offer and give you the same dollar amount towards tre more expensive one. Unless you have medical issues, I would strongly consider the cheaper plan
I pay $95 for my PPO, but I also only have a $500 deductible. I hit that in March.
I hate HMOs and the $95 is well worth the price.
I'll be waiting a looonnggg time
Your use of the word literally makes me figuratively insane.
I [26m, single] pay $300/mo for HMO plan. I used to have a PPO but i found I was paying extra money for basically nothing. My PCP is amazing so anytime I need a referral I can get it pretty much instantly and I just made sure all my specialized doctors were in network before switching. I’m saving about $100/mo which is a pretty big deal for me as I use my health insurance a lot.
We have a lot of teaching hospitals. Those are always more costly. Also, your employer might offer plans with crappy networks, high deductibles, or not subsidize the premium.
We should enact statewide universal healthcare and be done with it.
A week?? Is this through work or MA connector
I am 21 (my parents pay my insurance but it is expensive) I had a kidney stone and went to the ER due to the pain. When I got the bill I was glad that I had insurance because that one trip was twice what it cost to insure me.
Sounds like it was out of network. You can still get some of that covered.
It was in network. The negotiated price with MA BCBS was $850. The point isn't about the insurance coverage, it's the high rates doctors charge here, that's what makes the insurance so expensive here.
[citation needed]
Buddy it’s not the doctors, it’s the millionaire admins. Vote for single payer so we can trim the overhead.
> Well the in network doctors are probably good too, you just want to see specific doctors, it sounds like.
Not necessarily. I'm paying extra for a better class of plan, myself, because when I moved to Arlington, I discovered that there were many PCPs who took my previous HMO insurance, and probably many of them were great, but all of them belonged to one of three practices, all of which practices had bad reputations for things like billing practices and wait times, and also all of which were owned by the same hospital chain, which has some policies I can't stand. So in an important sense, no, I had no choice at all if I wanted to see a doctor in my town.
Touché, I’m not saying what you should or shouldn’t do and that you don’t have plenty well reason, I’m just saying we’re lucky because almost ALL doctors here are great- it’s a highly competitive market. As for the companies that run these things, I can relate to those gripes.
My HMO, super limited plan is $1,400/month for a family of 3. My employer pays half. It’s pretty ridiculous and, frankly, unsustainable.
We should promote preventive care and public health information. Our schools and colleges should be role models. The food is disgusting and unhealthy. Unhealthy foods are promoted at these places and develop habits that may become a costly illness wich is subsidize by insurance premiums .
Go to Mass General ER right now and you will wait 8 hrs to be seen by a doctor unless you are gravely I’ll. We have our problems too.
Join the movement for single payer healthcare in MA! https://www.wmmedicareforall.org
My son agrees with you. He's 13 and started his first website last year that's just photos of the school lunches and a simple description of what's in each. Has not yet shamed the school into action but received some traction among his classmates.
Did you pay 850 out of pocket?
Heck no, I offered them $250 and when they said "that's not how we operate" I said then either $0 or take me to court and I'll tell a judge how you tried charging me $2400 an hour for an office visit, your choice. They opted for the $0.
Through who? I’m paying over double that…
Cigna … coverage and rates is something negotiated between employer and provider
Cigna epo working for one employer could be quite different from Cigna epo through another
💯 Another difficulty is finding an appointment. You have a problem now? The next available appointment is a couple of months away. We need more doctors (caring doctors that want to help out) :(
Have to agree that OP's pricing sounds high. We pay just under $400/month for two people through Blue Cross Blue Shields PPO plan. Add in dental coverage and we are at about $430/month.
Edit: typo
If it’s in network, all doctors, not just the ones in M.A have rates that are negotiated with the payers they accept. The payers create those rates, not the doctors.
Doctors are the ones negotiating the rates with the insurers. In MA, really much of the northeast, a person is very loyal to their doctor, its why Massachusetts BCBS has close to 100% doctor participation, they want everyone, and they are willing to pay higher rates for it. Doctors have formed large bargaining groups to make sure they take advantage of that. If doctors request large contracts, and the insurer declines, the physician group threatens to pull out and send letters to their XX,XXX customers to tell them to find new insurance. (I've seen that done countless times). The insurer finally gives in and pays what the doctor wants, and raises insurance premiums.
If you look at states with lower doctor participation in their health plans, premiums are less. Florida Blue, I can't find the statistic right now, but I believe I saw it was in the mid 70%'s of doctors in the state participating. Florida prices insurance by age and smoking for the under 65 market, so I can't compare very well between them, so I'll compare the over 65 market where rates are the same regardless of age or smoking. The lowest price MA BCBS plan is $0 a month, the lowest Florida Blue is negative $75 a month, yes they put $75 a month into your social security check. Doctor copays, drug deductible, hospital copay, ambulance copay, it's all lower with the Florida Blue plan. Because if a doctor wants an excessive amount of money, Florida Blue, says no, we want to provide the best deal for our members. They still have doctors in every field and geographic region of the state, covering the vast majority of the doctors, but the ones who want payments that are well more than average, aren't helping medical costs, they are hurting them, so insurance companies pass on their participation. If we did that in MA, our insurance could be 10-15% cheaper, maybe even more.
Health connector has cheaper plans than this.
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We should do both.
The government absolutely shouldn't do anything about this. The insurance companies just need more time to work out the kinks.
Schools aren't the ones that need convincing. If you want better school lunches, you need to convince all of your local townspeople to pay more taxes so the public schools can buy better food. Best of luck...
I think most people, myself included, would rather not pay the taxes and instead brown-bag it for their kids. Still far healthier & fresher than anything you'd get in a large-scale cafeteria.
Pick your poison brother, it sucks out there.
I cover my wife and I, I’m paying $560 a month for a PPO and my employer picks up 75% of the $2500 deductible. This is all about to increase, as we’re expecting our first kid next month. Now the monthly cost here is expensive, but I have piece of mind knowing that my growing family can see anyone at anytime for anything (pretty much) without a referral.
Prior to this PPO, my old employer only had HSA options. Those absolutely infuriate me and they feel designed to de-incentivize people to visit the doctor, because the cost of care is on you. Sure, the contributions are small for the “privilege” of having coverage, but you pay for it in your HSA fund contributions. Now listen I get all the tax benefits that accompanies that fund- however I think psychologically (at least for me), I’m less likely to use my own money on my care. I’d put something off because now I need to use my own funds to see that doctor, versus having it covered already via a PPO or HMO.
The insurance system is broken as fuck in general. And while I have a ton of complaints about the state of it, I sure as hell don’t have the expertise to know how to fix it.
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Meh, go back to allowing kids to brown bag it.
Those with issues with nuts, etc make a corner of the lunch room for them.
Tax payers are not going to want to pay more in taxes to fund a lunch program with better food as they know it'll never happen for 1, and the funds just wasted. And most of the tax base don't have children in the schools. Most of the problem is forcing kids to take food and then it just hitting the trash can because the child doesn't like that meal.
The waste in lunchrooms is ASTOUNDING.
Kids might be more open to healthier options if schools teached honestly. and took that outdated for the last 50 years food triangle and trashed it. It might have been a good guild when most worked high labor jobs, but that was 50 years ago.
They don't teach balance, they teach, candy bad, fruit good. soda bad, fruit juice good. When many times this is 100% wrong.
Sure, IPAs, MSOs, ACOs and any other independent physician groups, or IDNs will have more bargaining power.
I’m lucky and have a great plan through my employer, but I know there are many who are much less fortunate.
I have a fantastic plan too, the plan isn't the point, its how much they pay physicians that dictate the cost of the plan. They agreed to pay that otolaryngologist $850, when it would have been $250 with a provider in any other state, that raises our insurance costs, which was the OP's self-described rant.
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> I can't get that control with an HMO.
Of *course* you can. You just need to a) get a referral [super simple!] and b) ensure the GP refers you within the network of doctors / specialists you wish to see. Do you have some super complex issue that only one or two specialists can treat? Doubtful.
In Mass, there's no need to be on a PPO. In junk states, such as down south and some in the mid-west, for sure..but here? Come on...
Also - you pay $150 PER WEEK? Fuck are you doing? Get back on that HMO (!)
Maybe, maybe not. I've used the NHS extensively, here's some of the differences I like here:
- don't like my GP? I can switch, easily. In the NHS - forget it. I'm stuck with a potentially lousy fucking GP.
- Referrals - done within a few minutes at my GP office. NHS - it took *30 fucking days* to get a referral from my GP to a BUPA specialist.
- Specialists - the quality of care all depends on the foundation (region). You can _not_ go outside it. Period. Here - I could go from the Lahey network, to the Emerson one if I had a PPO, and if on HMO I could change my GP to one in that network. Done.
It's all about perspectives. People in the UK think the US system is fucking horrendous, but they've *never* used it in anger. They just hear the shit stories mostly from junk states. Is private healthcare, primarily funded by employers, a good system? Fuck no - but the other alternative isn't all sea and roses.
2k deductible? That's a *lot*. Our family deductible is zero. The PPO plan is $500.
The lowest I could get was 500 and the highest was 4k so I went with a middle of the road option. I also luckily have only needed my regular checkups with no emergency services or specialists in a long time so compared with OP I'm feeling pretty lucky
Also, the administration and human resource people.
In my district, it IS the schools that need convincing. This isn't an issue of budget or taxes. During COVID, they switched to a 'no-touch' cafeteria kitchen where everything is pre-packaged centrally by an outsourced vendor instead of being prepared by the local staff. The costs are the same, but the quality has gone way down... some private company is making bank and delivering garbage.
That's wild I pay 55 a week in new hampshire for very good ppo plan with low deductible.
Ok folks. Your premium through your employer is not the cost of medical insurance. The cost all in is about 25,000 for a family plan. What else is higher in your family budget?
Health insurance for nonMedicare and nonMedicaid payers are charged at a higher rate than these two. In turn, they also pay more or less to providers, not just for the premiums. In order of lowest payouts to highest:
All the numbers in your comment added up to 69. Congrats!
25
+ 1
+ 25
+ 2
+ 3
+ 4
+ 3
+ 1
+ 2
+ 1
+ 2
= 69
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“Being Mortal” by A Gawande · 2014 · Cited by 1659 — Citation. Gawande, A. (2014). Being mortal: Medicine and what matters in the end. Metropolitan Books/Henry Holt and Company.
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OD8891 t1_ivhn3yi wrote
Well the in network doctors are probably good too, you just want to see specific doctors, it sounds like. Which is totally fair, but I can’t get on with this rant. And I could use a good rant right now 😂