Can someone make sense of this? (Pittsburgh, Erie: car insurance, home, bankruptcy)

[trackstar13]

Originally Posted by Hopes

That's what track2514 did. He assumed his situation applied to most people. That's why I responded. I really don't believe that's true. Unless someone can provide data and statistics from reliable sources, we'll never have an accurate answer. I acknowledged that we're both making the mistake of applying our individual experiences to the masses.

You are still utterly and completely wrong, look at the multiple examples of other out of network coverage costs that have been posted by Greg and myself (CMU). How about you demonstrate where all of us can get individual healthcare policies at affordable rates that have excellent out of network benefits in western PA? I enjoy arguing and debating various issues, but the misinformation you have posted in this thread is seriously dangerous. If people believe what you are posting and just say oh well Hopes said it will be no big deal when this contract expires so I will just deal with it and not complain to my local politicians or voice my concerns to my employer about which healthcare premiums are offered, they may suffer significant financial loss or lose the ability to see certain doctors. So my advice to anyone reading this is to not listen to me or Hopes, and if you have Highmark as your insurance look at your policy outline and see what your own personal out of network costs are and how this issue will affect you personally.

[greg42]

Originally Posted by Hopes

That's what track2514 did. He assumed his situation applied to most people. That's why I responded. I really don't believe that's true. Unless someone can provide data and statistics from reliable sources, we'll never have an accurate answer. I acknowledged that we're both making the mistake of applying our individual experiences to the masses.

I directed that at everyone, "you"=anyone reading, not just you Hopes. I can tell you there is a wide variation in what policies cover and don't cover, and at what levels. If it is employer provided, a fair amount of that is up to the employer.

[Hopes]

Originally Posted by track2514

Hopes you are just making your previous responses even worse by trying to retroactively say that you now understand this issue when you admitted previously that you do not.

I take great issue with your assuming that your situation applies to most people. It as simple as that. We both have different opinions on what is best for our region. I strongly believe UPMC needs to have healthy competition. Even if your situation did apply to the majority, it wouldn't sway me from believing it's important to eliminate the monopoly UPMC has on the region. If it had never been permitted to become the monopoly it is now, you wouldn't even have these problems you're complaining about. The monopoly is what is creating this dilemma you have. Keeping the monopoly isn't the solution to the problem.

Originally Posted by track2514

What I am experiencing does apply to the vast majority of people in western PA and to further demonstrate what I am talking about here is an example:

• CMU offers several healthcare options, which is not unusual because they have almost 5,000 employees.
• The healthcare plan with the best out of network coverage costs $3,792 for a family per year and that is only the employee portion. The employer is also subsidizing that rate to make it more affordable.
• All of the other CMU healthcare plans have pretty high deductibles for out of network coverage

I don't consider that to be expensive. I consider it the norm. We once had an employer group policy that cost $700/month for family plan, which is $8,400 per year. I was shocked by that too since the previous employer provided Highmark at $90/month. We adjusted because the salary increase was substantial enough. Ever since then, I haven't seen anything I consider to be expensive.

High deductibles doesn't mean paying all of the cost. An out of pocket limit is an out of pocket limit. There is a cap to how much people pay. If you have cancer, you're not going to be paying for most of the treatment. I took issue with you saying you have to pay for most of the cost if you go out of network. For just going to the doctor, you'll have to pay until you reach your deductible, but a doctor's visit isn't incredibly expensive IMO. We are not wealthy. We are solidly middle class.

As far as showing benefits from local employers, that still doesn't provide an accurate representation of the norm in the Pittsburgh region. If you total up all of the employees for the region's 10 largest employers, you still only have a small fraction of the region's greater population of workers. Most of the population doesn't work for the 10 largest employers. Many work for companies headquartered in other states. My husband and I both have not worked for a Pittsburgh area employer for many, many years. The same applies to most of the people we know.

[greg42]

Originally Posted by track2514

For my family I pay a little less than $1,500 per year for my health insurance premium.

You do understand how insanely cheap that is right? It is a huge benefit to get family coverage for that rate. The full premium for family coverage is something on the order of several hundred per month in most group plans. Most likely you are paying something like 20% of the actual premium, perhaps even less. It's a big deal. For example in our workplace only management gets that kind of perk; regular employees get individual insurance at a subsidized rate like that (I think we're paying as much as 25% now) and have to tack on the entire 100% difference between the full individual premium and full family premium. That difference is in the neighborhood of $300-400/month. So you'd have to pay that PLUS the subsidized individual rate, making for an annual total in premiums payable by the employee of something around $5000.

[trackstar13]

Originally Posted by greg42

I directed that at everyone, "you"=anyone reading, not just you Hopes. I can tell you there is a wide variation in what policies cover and don't cover, and at what levels. If it is employer provided, a fair amount of that is up to the employer.

Your last point about a fair amount of it being up to the employer is exactly what I was thinking also. Some small employers might offer great out of network benefits, but that is an expensive option, which is either passed on to the employee or the employer can subsidize at a higher rate. When I looked into individual policies it was very expensive to add the option of being able to see basically any doctor and not pay excessive out of network fees.

[Hopes]

Originally Posted by track2514

You are still utterly and completely wrong, look at the multiple examples of other out of network coverage costs that have been posted by Greg and myself (CMU). How about you demonstrate where all of us can get individual healthcare policies at affordable rates that have excellent out of network benefits in western PA? I enjoy arguing and debating various issues, but the misinformation you have posted in this thread is seriously dangerous. If people believe what you are posting and just say oh well Hopes said it will be no big deal when this contract expires so I will just deal with it and not complain to my local politicians or voice my concerns to my employer about which healthcare premiums are offered, they may suffer significant financial loss or lose the ability to see certain doctors. So my advice to anyone reading this is to not listen to me or Hopes, and if you have Highmark as your insurance look at your policy outline and see what your own personal out of network costs are and how this issue will affect you personally.

I'll do this out of respect for you.

I'll check the Highmark policy that was discussed in this thread earlier.

I'll look at my husband's employer plan, which is Highmark. It's the first time we've had a local insurance company plan in the past 12 years.

I know there are higher out of pocket costs for going out of network. I just don't feel that means paying for everything. If I want the best doctor and the best treatment, I'm willing to pay an extra few thousand per year if I have a major medical problem. Our disagreement might really just come down to our having a different opinion on what's affordable for out of network.

[trackstar13]

Originally Posted by greg42

You do understand how insanely cheap that is right? It is a huge benefit to get family coverage for that rate. The full premium for family coverage is something on the order of several hundred per month in most group plans. Most likely you are paying something like 20% of the actual premium, perhaps even less. It's a big deal. For example in our workplace only management gets that kind of perk; regular employees get individual insurance at a subsidized rate like that (I think we're paying as much as 25% now) and have to tack on the entire 100% difference between the full individual premium and full family premium. That difference is in the neighborhood of $300-400/month. So you'd have to pay that PLUS the subsidized individual rate, making for an annual total in premiums payable by the employee of something around $5000.

Yes I know it is very comparably cheap and I feel very lucky to have health coverage at the rate I pay now. Oddly enough my last healthcare premium was much better, but I know much of this has to do with my industry and the benefits offered by competitors. I also think we get a better deal because my employer only offers one healthcare plan from one provider for all employees. My wife's company's healthcare plan is simply that the employer will pay 50% of the individual healthcare rate for you and you have to buy healthcare on your own. They also won't even pay for a spouse or family, that is all on your own if you want to buy family coverage. So I have seen both extremes where employers can subsidize almost all of the healthcare costs or barely even offer healthcare.

[trackstar13]

Originally Posted by Hopes

I'll do this out of respect for you.

I'll check the Highmark policy that was discussed in this thread earlier.

I'll check my specific Highmark policy.

And I'll look at my husband's employer plan, which is Highmark. It's the first time we've had a local insurance company plan in the past 12 years.

I know there are higher out of pocket costs for going out of network. I just don't feel that means paying for everything. If I want the best doctor and the best treatment, I'm willing to pay an extra few thousand per year if I have a major medical problem. Our disagreement might really just come down to our having a different opinion on what's affordable for out of network.

Okay I can agree with what you are saying at the end of this post. To me paying an extra $2,000 to $5,000 out of pocket for out of network providers is costly and I believe it is for many people in western PA. I should have said in my original post that many people have a deductible or a specific amount that they have to reach before their healthcare will pay a significant portion for out of network providers. For me I try to stay in network because that $2,000 is a significant amount of money to me. I agree that some people may be willing to pay for the difference to see provider's that are deemed out of network, but I think we can both agree that if UPMC is out of network a significant amount of Highmark subscribers will have to investigate the cost of seeing a UPMC doctor.

[Hopes]

Thanks for asking me to look. The reality is that health insurance is changing to high deductible plans. That's just a fact.

I was mistaken. We don't have Highmark this year through my husband's employer. My husband's new employer provides three Cigna plans. We buy the most expensive plan. It's not as nice as our United Healthcare plan at his previous employer last year. Here are the details for our new plan. The deductible is the same for in and out of network. The out of pocket and percentages are what changes for this plan.

Deductible --- Network AND Out of Network
$750 individual
$1500 family
Out of Pocket -- Network
$2,000 individual
$4,000 family
Out of Pocket -- Out of Network
$4,000 individual
$8,000 family
100% Network/80% Out of Network

Now I'll look at my plan through Highmark.

[greg42]

Cigna means UMPC will be in network.