next »

[aandsdean]

I pay $300/mo for health for my family and an additional $30 for dental. It is horrible coverage. We have a $350 deductible, but the insurance company only pays allowable expenses. I went to the doctor and paid $105. The allowable expense was $74, then they subtracted $15 for a copay. All told, only $59 went toward my deductible. After the deductible is paid, the insurance will pay 80% of allowable expenses. What a joke.

I thought that one benefit of academia was a great health plan, obviously this is not the case for many of us.

If you're in network, the Dr. is only supposed to charge you the "allowable expense."  That's part of the cost-containment strategy of PPOs.

Doesn't help much with the rest of it, however.

[wareagle]

Our premiums are paid entirely by the state.  For the entire family.  You have to pay extra for dental or vision, however.

A maximum of $750 in co-insurance, and $600 in deductibles.  ($250 and $200 apiece respectively.)

SO recently spent a week in the hospital.  Nine grand, of which I paid $125 out-of-pocket.

It is a major reason I stay put.  If I took a job elsewhere, I'd need an extra five thousand a year just to make up for the difference in health plans.

[rekishi]

I pay $300/mo for health for my family and an additional $30 for dental. It is horrible coverage. We have a $350 deductible, but the insurance company only pays allowable expenses. I went to the doctor and paid $105. The allowable expense was $74, then they subtracted $15 for a copay. All told, only $59 went toward my deductible. After the deductible is paid, the insurance will pay 80% of allowable expenses. What a joke.

I thought that one benefit of academia was a great health plan, obviously this is not the case for many of us.

If you're in network, the Dr. is only supposed to charge you the "allowable expense."  That's part of the cost-containment strategy of PPOs.

That is what I thought (and common sense dictate), but I have yet to find a doctor that charges the allowable expense. Most doctors around here want the money up front and then file some paperwork. It is up to the patient to fight the insurance company for reimbursement.

This is a state plan for heaven's sake.

[aandsdean]

I pay $300/mo for health for my family and an additional $30 for dental. It is horrible coverage. We have a $350 deductible, but the insurance company only pays allowable expenses. I went to the doctor and paid $105. The allowable expense was $74, then they subtracted $15 for a copay. All told, only $59 went toward my deductible. After the deductible is paid, the insurance will pay 80% of allowable expenses. What a joke.

I thought that one benefit of academia was a great health plan, obviously this is not the case for many of us.

If you're in network, the Dr. is only supposed to charge you the "allowable expense."  That's part of the cost-containment strategy of PPOs.

That is what I thought (and common sense dictate), but I have yet to find a doctor that charges the allowable expense. Most doctors around here want the money up front and then file some paperwork. It is up to the patient to fight the insurance company for reimbursement.

This is a state plan for heaven's sake.

It sounds as though your state's plan administrator needs to do some pushing and shoving; I can't believe this kind of behavior is part of the contracted deal, and very few physicians can afford to spurn what is very probably the largest employer in your state....

Urgh.