Health Insurance in Dallas (Commerce, Howe: how much, house, deductible)

[Robzherenow]

I have a friend who moved to Dallas and now has very little health insurance coverage. He had to pay a massive amount for his wife's delivery. Could this be because of the state? or his particular insurance program?

[USA_Mom]

It's probably his insurance program. I know when we moved the 1st place we had fought me tooth and nail on hospital charges for an emergency C-section...but when we changed insurance companies we didn't have any problems knock on wood.

[mckinneydeb]

There could be various reasons for the charges the family incurred. For instance, was the pregnancy pre-existing, what particular plan did they opt for, did they obtain care out of network? Was this the first actual billing submitted to the insurance company since the employee's status was confirmed? Was there a period of noncoverage even though employeed? Some companies still have a "waiting period" before coverage begins (in case the employee quits or is terminated before their probationary period ends).

I know when I moved to Texas, my husband's insurance covered the family as soon as he was a confirmed employee. However when our 8 wk old infant was admitted to the hospital a couple of weeks after we moved here, we had to fight to get the hospital and doctor bills covered because they considered his "asthma" a pre-existing condition even though he had never been diagnosised with any breathing problems before we moved here.

I worked in managed care for 7 years. One of the greatest errors made by employees is failing to fully read the descriptions of the plans offered or after the plan is chosen failing to read the actual policies. Hopefully, once the employee understands the plan chosen, they can then decide whether to choose another plan during open enrollment. Most large employers in Texas offer cafeteria style insurance, meaning there are mulitple plans to choose from and sometimes even multiple managed care companies to choose from.

[NY2DFW]

What about the self-employed? Any self-employeds out there paying for your own insurance? How much for a single, family, etc?

[momof2dfw]

Originally Posted by NY2DFW

What about the self-employed? Any self-employeds out there paying for your own insurance? How much for a single, family, etc?

If your self-employed the best thing you might be able to do is join the local Chamber of Commerce and then use their benefit plan. Being a member of the CoC puts you in a pool for a provider that they use and can give you better plans and rates. We did this for years for our small business and many others do too.

As for the OP, I'd say it was the plan and not the state. Even from state to state or region the coverage/plan can be different for the same company.

[NY2DFW]

Thanks. That's a good idea and I will look into that. I do the same thing here only it's not the coc but a private company. Still though, the rates are high and keep going up every year. I pay $400 a month for a single policy and fairly high copays. For a family it's over a $1000. Taxes and insurance are my two biggest expenses here in NY. My house is 2000 sq. ft. and the taxes are $8000. It was the highest taxed home on the block so I just won a grievance that lowered it to $7600. Woo hoo!

[dlee]

You might want to look into Aflac. I am an independent agent for them and help many self employed and small business owners. The plans are very affordable and can be payroll deducted at a discounted price if you can get your employer to deduct. They work great with other insurance or by themselves. Aflac will pay you directly and not to any doctor or hospital. You can use the money anyway you choose.

[ChristieP]

HIPAA made it illegal for insurance plans to consider pregnancy a pre-exising condition. Most likely your friend signed up for one of those "consumer-driven health plans" with the high deductible and the reimbursement account. If you have a high bill in your first year, they nail you since your reimbursement account has basically nothing in it...

[loves2read]

did he have any idea how much it would have cost where he was before--having a baby is expensive...