Insurance shopping and cardio visits

[almost_hectic]

So it's time to shop for a new insurance plan because the great coverage I currently have is shooting up in cost to where I can no longer afford it. I can find a few options that sound pretty good. However insurance is of course a game, a gamble, and of course the house always wins. It seems the real way to compare plans is to know how you'll be using it and determine what you'll pay for services and only then compare it to the premium.

Anyway, what I'm getting at is now the I'm past surgery to get my on-x valve and my INR has leveled out, how often might I anticipate having to see a cardiologist? Twice a year? Once a year? Would I expect he's going to order any tests like an annual echo still now that there's no stenosis valve to keep watch on? I'm otherwise very healthy and don't foresee any complications.

I'd love to keep the great plan I have but it's gotten priced out of reach for me now. Most other plans that do t have high premiums have very high deductibles and high out of pocket costs. I want good coverage but finding that is proving to be a meter of reading between the lines to know how you'll use it so you can do the math.

 

[Superman]

Depends where you are and who did the surgery - but my surgeon wanted a CT scan every other year (which I only just graduated from after my most recent surgery six years ago). I never saw my first surgeon again after the operation 25 years ago. All follow up was with my cardiologist.

I still get annual echo's and a check-up with my cardiologist. Given my congenital defect, I stay on alert for "what's next." Could've been killed by my valve, but wasn't. Could've been killed by my aorta, but wasn't. So what's next? Better to be followed annually so we can catch it (whatever it is).

I avoid high deductible plans. We always meet our family deductible as it is, and if I combine premiums with deductibles and 20% co-insurance - the HSA's don't work out in my favor from a total out of pocket perspective. If you don't meet your deductibles on a regular plan and are relatively healthy with few dependents, a low premium / high deductible plan may be right for you.

 

[almost_hectic]

Well as far as I know I'm done with my surgeon. I'd be more than happy to follow up with him but it's my understanding I'll no longer see him unless I'm referred for another surgery and I'm not planning on that! From now on I'm in the care of my cardiologist. I'm going to check with his office and see what they have to say about care going forward but I was shopping insurance today and wondering what to anticipate. Even just going to my cardiology office for my INR, without seeing the doctor I get charged as a specialist visit. So I think I'll be switching that over to my PCP most likely. Why pay more than twice the cost every month for not even seeing the cardiologist?

Insurance has really gotten ridiculous when you look at what you pay and compare to what you get!

 

[dick0236]

.......... Even just going to my cardiology office for my INR, without seeing the doctor I get charged as a specialist visit. So I think I'll be switching that over to my PCP most likely. Why pay more than twice the cost every month for not even seeing the cardiologist?

Smart idea. There is nothing magical about doing routine INR finger sticks.....and for real convenience you might go to home testing.

 

[MrsBray]

(Get a government/school district job "for the benefits)
Works for me.

 

[almost_hectic]

Well I found what I think is a good plan, not that theres many great options. Its an HMO from Florida Blue, but does not require preauthorization to see a specialist, which I had though was the whole point of an HMO to begin with, to limit the number of people visiting expensive specialists if they dont need one. But all the plans available are either expensive and low out of pocket or inexpensive and high out of pocket. Its like they are all equal cost its just when youre gonna have to pay. I got spoiled on the plan I have now : (

 

[W. Carter]

The last job I had before I retired I decided to try Aetna insurance from their benefit package. I am a vet and have been using the V.A. for 25 years for free. So when I started using the Aetna, for a heart attack 4 days in hospital, cardiologist, cat scans, echoes, heart cath, etc. I started receiving big bills in the mail. It didn't take me long to go back to the V.A. I feel sorry for anyone that has to go that route now. The healthcare insurance in the United States is just a big rip off. They tried to refuse payment to Baylor Hospital for 29 thousand dollars saying since I had a record of high blood pressure my heart attack was caused by a prior disease. This was all after Obama signed the papers saying prior diseases were no longer a reason to deny payment from insurance companies. Anyways all of the bills that I received got filed in Mr. Dumpster. What a bunch of b.s., don't get me started.

 

[almost_hectic]

Since I've been on Florida Blue I've done really well. My current policy has paid everything leading up to and including my surgery without question. I've had some copays that added up, but by the time my surgery date came I had already met most of my out of pocket max. So essentially with what I had remaining to pay for, it came to $350 I had to pay to my hospital when I checked in the day of surgery. When the statement came, I say statement because it was not a bill, the total cost show was $187,000 and I had zero balance due. Not bad at all in my book!