Guaranteed Healthcare

My husband and I have been self-insured for over 2 years now. The premiums have gone up about 90% in 2 years. I am 45 and he is 55. I am paying over $1000 PER MONTH for a policy that has a $3000 PER PERSON deductible. The coverage is only 70/30% after that. The out of pocket maximum is an additional $3000. So this basically means that I have to fork out over $12,000 a year in premiums alone, PLUS an additional $3000 for each of us before the first red cent is covered by Blue Cross and Blue Shield of Texas. This is basically just "catastrophic" insurance. But with this economy and our income situation, I cannot afford to go in for a stress test or a colonoscopy or a mammogram.

My husband had tendonitis in his elbow. We called the doctor's office AND Blue Cross to make sure that any x-rays and treatment in the doctor's office would be covered under the office visit co-pay. So he received a cortisone shot in his elbow to relieve the pain. Then BC/BS decided to classify that as "surgery" and apply the entire cost of this towards the deductible calling it a surgical procedure. Now everyone knows that a shot is not "surgery". They don't call flu shots "surgery". They said, well, the cortisone shot has to go into a very specific place. Yeah, and flu shots must not go into an artery either! This is absurd!

Then the insurance company likes to say that it is because of the way the doctor's office "coded" the procedure and to discuss it with the doctor's office. The doctor's office says that's the only code they know of for that procedure and to talk to the insurance company. So we, the consumers are caught in them middle. We thought we did appropriate due-diligence to make sure our insurance would cover something in a doctor's office and still got screwed. It's like the medical offices and the insurance companies are in collusion against the insured.

I have been using emergency funds to keep us in insurance. We are both desperately seeking employment that could provide us with lower cost insurance, but have not had any luck in more than a year. We will eventually be uninsured and it's the saddest thing I've ever had to consider. I'm beginning to hate this country for not doing more to make health care more accessible and more affordable. The gap between the "haves" and the "have-nots" is widening at an alarming pace.

Linda