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What is the point of paying for health insurence when this happens? Obamacare or excuse?

Posted by on Jan. 20, 2015 at 6:32 PM
  • 6 Replies

Last Thanksgiving my 5 year old daughter was hospitalized (after being sent home by the ER and going back because the hospitals ped. unit was full we were only told that the second time we came) for sever peumonia. I was expecting a big bill, but I was expecting our insurence to pay a decent chunk of the bill like they always had I mean isn't that the reason of insurence.

So, prior to Obamacare our insurence (same company, same plan) was $45.00 a week approx. through my husbands employer. The company pays 80% of our plan, per HIS contract. He is head of sales and the owners right hand (in his own words). Last year it went up to $79.00 a week. Ok, so doesn't sound to bad although we are basic middle class for where we live (please NOTE not for what the federal governemnt considers middle class, $150,00-$250,00 is upper class here) .  This insurence is our only option.  This means between the company and us we pay $20,800 a year for health insurence. Ok, fine great. Not exactly happy about the increase (who is right?) but what about when there is an emergency. We pay $40 for office co-pays, $50 for OB GYN co-pay, and $75 for specialist after referell.

When our daughter was hospitalized I didn't care about the cost. We were flat our told there is a good chance we would be planning a funeral. We went through alot fo have a biological child, 12 miscarriages over 8 years and a still birth. She literally was our last try.

Well, yesterday I recieved the bill..... our $20,800 a year insurence covered $38.42 of the ENTIRE bill. The whole thing, all 3 bills put together. For 9 days in the hospital with life saving treatment and 2 days in Peds. ICU. Our bill as it stands is $19,495.87.

Back in July our car was hit by a guy who ran a red light, our son had to have 3 staples in his head and an ambulence ride. First off, ambulence wasnt covered, not in network. Closets in network ambulence is on the other side of the state, I mean we live by Lake Erie, its on Lake Michigan.  They paid for that whole thing $12.71  didn't even cover a staple.

The insurence company when I called gave me some Obamacare reasoning, the cost of this and that. So do you think they are blaming Obamacare as an excuse or is it at fault? We have a common plan, and what for 20 years was a great plan. We do not qualify for state help, we do not qualify for the exchange or anything else.

by on Jan. 20, 2015 at 6:32 PM
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Replies (1-6):
by Ruby Member on Jan. 20, 2015 at 6:46 PM
Sounds like there is more going on than the ACA. Was there a network issue? Did the plan require notification for inpatient stays? Unless your deductible is $19K, which it shouldn't be with the ACA, there's probably some contracting issue at play. Call and see what the hospital liability is and what your appeal rights are.
by Bronze Member on Jan. 20, 2015 at 7:02 PM

That isn't right. Please call them again. If you have an emergency room deductible you should only have to pay that. If they continue to refuse, take it up higher (contact the insurance commissioner).

by Platinum Member on Jan. 20, 2015 at 7:06 PM
What ridiculous insurance do you have and why is it your only option? I'm no fan of the ACA and think it really effed a lot up, but it really doesn't seem like your insurance issues are ACA related.
by Bronze Member on Jan. 20, 2015 at 7:10 PM
It's the insurance company.Get a lawyer
by Bronze Member on Jan. 20, 2015 at 7:11 PM
And read your policy. And you don't have to take the employer's insurance, you can buy a policy through the ACA
by Member on Jan. 21, 2015 at 11:07 AM

They are blaming the ACA.  It's an excuse.  Many of us wanted to expand Medicare to cover almost everyone but Nooooooooooooo that would be bad so instead we have the ACA.  If you have private insurance or insurance through work you get what you bought or what the company says they have to pay for. 

First, talk to them and appeal their decision.  Keep appealing and if they still refuse GET A LAWYER.  Make sure you understand what the insurance should pay.  Have you got a booklet that explains your coverage?  Keep us posted!  Your insurance should certainly have paid more.

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