Health insurance sucks. Just when you think you’ve got everything covered, you get dinged for something else that you didn’t budget for. It’s one of the most annoying things about being an American (especially now that it’s illegal to not have health insurance).

Here are six of the worst things you’ll have to deal with if you have health insurance. Hold onto your butts; this is a long one.


6. Crappy Optical Insurance — It looks so great in the welcome packet, right? Adding optical insurance is only $5/month for an individual, or $10/month for an entire family, and that gets you a free yearly checkup and a pair of glasses or order of contacts along with it. You might even get a discount on LASIK, if you want it. I mean, who’s not going to shell out the additional small amount of money just for that?

Not so fast… I am very nearsighted. I don’t like putting things in my eyes (I can, but I don’t like to), so I wear glasses. Have done for years. Well, recently I went to the eye doctor because my glasses were getting a bit blurry and she updated my prescription for me. That was all free, but as it turns out my optical insurance only covers a certain cost of frames (none of the ones that looked nice were cheap enough) and basic lenses. That means coke-bottles. They also didn’t cover the anti-glare anti-reflective coating. In the end, I had to pay $180 on top of what the insurance “covered”. Realistically speaking, who’s going to buy unstylish coke-bottle glasses that reflect everything back at the people standing in front of them? No one, that’s who.


5. Crappy Dental Insurance — Dental insurance isn’t quite as cheap as optical, but it’s not as expensive as health insurance, and it does cover quite a bit — two exams per year, one set of x-rays per year, and a lot of procedures are either free or heavily reduced. My daughter had to have some teeth pulled and I think it came out to only about $20 per tooth for the actual procedure. Not bad.

Not so fast… I’ve had dental insurance with every job since 2001, and none of them have covered anaethesia. Neither gas nor sedation. Thankfully they cover local anaesthetics, but given how freaked out most people get when they go to the dentist, a little gas helps. But worse than that: they’ve all had a lifetime orthodontia maximum. Braces cost a minimum of $3000 per treatment (where a treatment is “from when you get them put on until you get them taken off), and some people have to have more than one treatment. Plus, if you have multiple people who need them, you’ll hit your lifetime maximum — which, by the way, has never been more than $2500 on any plan I’ve ever been on. That’s some crap right there.


4. Grandfathered Plans — You may have heard about these during the battles over President Obama’s plan for universal healthcare. What they basically mean is that if your plan was in existence prior to a certain date, it doesn’t have to abide by certain aspects of the healthcare law. I happen to be on a grandfathered plan right now, and honestly it’s about the same as any other plan I’ve been on (except for one). I’m mostly pleased with my insurance.

Not so fast… Companies hang onto grandfathered plans for various reasons — I’m pretty sure that I have one because it costs my company less for good coverage — but there are all these little hiccups that can bite you in the ass. For example, my plan doesn’t cover birth control at 100 percent. It’s pretty inexpensive — $25 for three months if you get it through mail-order — but the law says it should be free. There are also other loopholes I’ve encountered around step therapy and only giving the lowest price if you order through the mail (which isn’t always convenient). I don’t think my company is doing this on purpose — I think they’re trying to give their employees the best value for their money — but it’s crappy on the part of the insurance companies to exploit their customers this way.


3. CDHP — A CDHP, or consumer-driven health plan (more like “consumer”-driven, because the real consumer here is the insurance company, who consumes your money), is one that allows you to pay lower monthly premiums but higher deductibles. On paper they look great, especially if you’re generally a healthy person. At my last job, I got one of these because I wanted to save money (and because the HR department didn’t make it clear exactly what I was signing up for), and for a while I did.

Not so fast… Where CDHPs get you is when you have to go to the doctor. See, your deductible might be $2500 or $5000, and you have to pay all of that money out of your pocket until you start getting coverage. The plans do often include yearly checkups and medication discounts, but those can’t be counted on. In the time I had the CDHP, I ended up paying over $100 for a few doctor’s visits. I could absorb that cost. But what I couldn’t absorb was the $1600 I had to pay for neurological testing when I discovered I was having memory problems. The appointment was in January, so my deductible had just reset. I had a FSA, but it didn’t roll over (my current HSA, thankfully, does) so I didn’t have extra money saved up. I still haven’t recovered from that financial hit. It was so bad that when I told the doctor why I didn’t want to come in for a follow-up she checked with the office, confirmed I would have to pay her hourly fee, and gave me a free phone follow-up instead. Avoid these plans.


2. Deductibles, in General — Here’s the tradeoff: if you pay a higher premium, you get a lower deductible, but if you pay a lower premium, you get a higher deductible. You’re basically deciding how much money you want to wager on your health being good, and if you lose the game, you have to pay for it. It’s all a matter of how much. If you’re generally healthy, you can gamble by paying lower premiums, but if you get sick it costs a lot more out of pocket.

Not so fast… There’s not just one deductible. You have one for dental, one for optical, one for medical care, one for emergency services, one for hospital services, one for prescriptions, one for maternity care, and they all add up. If you have a catastrophic injury and have to spend a month in the hospital, then the deductible makes more sense… but if you’re only in for three days, you’ll likely just miss your deductible and end up paying for the whole thing. This has happened to me before.


1. Lab Fees — So here’s the thing: doctors, while being pretty great, can’t diagnose everything with just the tools on hand. Sometimes they have to test your blood, pee, bone marrow, or various other things, and to do that efficiently, they set up labs. To do it even more efficiently, they send out the specimens to labs that do nothing but analysis. It usually works out.

Not so fast… Insurance companies have stopped covering lab fees — or, at least, mine has. I’ve been to the doctor for treatment of a chronic condition seven times in the past year and a half, and had lab work done three of those times. It always ends up costing me over $100, and I never have the extra budget for it. Hell, I can barely squeeze in the co-pay half the time. Getting a lab bill a month later is a super big treat, and it’s even more fun when it’s after a hospital stay because everything there costs more anyway.


Bonus Content!

I find it utterly ridiculous that insurance customers have to do as much work as they do to make sure they get the best value. It shouldn’t be incumbent upon us to find the cheapest option for an MRI or outpatient procedure, and it sure as hell shouldn’t be incumbent upon us to make sure that, if we’re having surgery, that every service provider is covered under our insurance. If it’s emergency surgery (ie: a car crash), that’s impossible to do because we’re probably unconscious at the time.

But that’s exactly what happened seven years ago, when I had spinal surgery. My surgeon was covered, my hospital was covered, and the vascular surgeon on standby was covered. As I was in the waiting area, though, I was visited by the anaesthesiologist, who gave me a paper saying that he may not be covered and I may receive a bill. And several others came in with the same pieces of paper. Most of them were covered, and I only ended up paying $200 out of pocket to service providers, but that was just luck. It could’ve been much worse.

Actually, it was. See, my insurance at the time only covered a shared hospital room. I was fine with that, and the notation was made in my file. But after surgery, my doctor made the decision — while I was unconscious — to put me in a single room. A month later, I got a bill from the hospital for $2600. Given that the surgery itself, plus hospital stay, cost $65,000, the $2600 bill wasn’t so bad. Except that I couldn’t afford to pay it and neither the hospital nor the insurance company was willing to negotiate it down. The hospital offered me a six-month payment plan, the only one they had, and I told them “screw you guys, I’ll pay you $100-$200 per month until it’s paid off. Put me in collections if you want.” They didn’t.

Oh, and by the way: after the surgery, I had to have eight weeks of physical therapy at $40 per visit, as well as several follow-up visits with the specialist (and the specialist co-pay was double the regular doctor co-pay).

The hits just keep on coming.

This, by the way, is what the Republicans were fighting for when they were trying to block parts of Obamacare. Must be nice to be a lawmaker who can afford all of these co-pays, because their constituents sure as hell can’t.


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