I know some of you have been waiting to see what 2015 (healthcare) actually cost me.
Keep in mind that my discovery started in 2014 when I met Dr. Ruscio for the first time and had already done AIP/Low FODMAP) for almost three months on my own with only an 80% improvement.
So, In order to set myself up for maximum progress in 2015 I consulted with our insurance broker (a life saver, truly) and set up an HSA health care plan. I knew 2015 was the year of probably hitting my deductible. So, I wanted to chose the plan that would provide me the most coverage at the least expense. Since the health care plans in our budget were roughly the same premium with pretty crappy benefits, we chose an HSA plan. With an HSA you can deposit money pre-taxes to be spent on specific medical costs that may fall outside your insurance coverage. (see how an HSA works here)
Here's my breakdown by general category:
Healthcare Premiums: (this only counts mine, not Brahm's)
I have the Bronze HSA plan. Which gives you a $4,500 deductible and a $6,500 (after meeting 40% co-insurance) out of pocket limit. It does, however, actually grant you discounts on things like lab work and expensive tests, which I knew I'd be getting a lot of.
Lab Fees: (after insurance, what I paid)
This includes: Blood work, SIBO breath tests and re-tests, Stool Tests etc.
Doctor Fees: (after insurance, what I paid)
This includes: Doctor visits, fees for surgery, Chelation treatments (paid for at the Doctor's office), tox screens (paid at the Doctor's office), supplements (also ordered via their office).
Pharmacy Fees: (after insurance, what I paid)
This includes: prescribed supplements by a healthcare professional, integral to my healing process and other prescriptions.
Total: $13,209.74 (this was roughly 40% of my income)
Just for reference: According to this article in March of 2015 average healthcare costs for Americans last year were $9,596. With the average income in 2014 at $53,657, that's healthcare accounting for 6% of their income.
This number doesn't include what we spend on food, which is critical (in type, source and amount) to the healing process and also damn expensive.
I did end up hitting the deductible on my plan, but not hitting the out of pocket maximum til the very end of the year. Out of network doctors or procedures aren't covered at all and therefore don't contribute towards your deductible. (I'm looking at you Chelation.) They also don't get a discount when you hit your deductible and then pay 40% co-insurance until you hit your Out of Pocket max. The HSA came in handy up to the part where we'd spent it all ($3,350 is the individual limit you can claim in a year) by June. The rest we're figuring out as we go.
Having insurance is like buying into a discount club. You pay per month to obtain special pricing between you and the doctor/lab etc. There's no documentation from your insurance company OR doctor explaining the calculations but you end up paying less than you would if uninsured. It's one of the problems I have with the health care industry. While I love a discount, I think all the prices should be up front, explainable and reflective of actual cost to the provider. (I also don't agree with healthcare being a for profit system but that's something else.) The insurance adjustment is just the discount, not what insurance PAID the doctor for the service, it's just a special-for-them discount. It leads me to believe that the numbers are made up to either recoup cost from uninsured or non-paying customers or perhaps just to make a profit. Southern California Public Radio has been doing an on going report on costs of services.
If the entire country is required to have insurance (which I think is a great start), then it should be affordable and cover things that make us well. That last one, unfortunately, is a subjective topic. For example, Acupuncture is now covered pretty widely on most plans (with a limit, depending on your plan). Therapy, however is not universally covered, neither is chiropractic care. I could have spent another 15 years going in circles with general practitioners (who are covered by insurance) or I could have gone the natural health route (with some assistance from Western Doctors) and learned what I (finally) know today. So, what would end up to be my path towards wellness wouldn't have come from an MD (and therefore not covered by insurance) unless my body had deteriorated far past what I was already noticing as abnormal for me. But I digress, this is about finance and not about preventative care.
Here are some confusing and irritating examples of the agreements between insurance pricing and doctor pricing. Please keep in mind, if I didn't have insurance, I would have been responsible for the TOTAL amounts below.
Surgery Center Facility Fees for the Colonoscopy/Endoscopy: $15,000
- Adjustment by BS of CA (blue shield) $-14,400
- I owe: $600
My Doctor Bill for the Colonoscopy/Endoscopy on the bill was $10,370
- "insurance adjustment" was $-9609.42
- I ended up paying: $760.58
My Capsule Study (swallow the pill, it takes pics all through you) was $7,200.00,
- insurance adjustment $-6514.15,
- (as I'd hit my deductible by June of last year, they also owed co-insurance)
- Insurance Paid: $411.51 and $276.94 (Separately, as I asked them to re-run the claim. They didn't pay in full the first time.)
These are the "grandest" examples I have. With my plan, any Doctor fees are the patient's responsibility until you hit the deductible is met, so I just paid all of those. OR, if it were for Dr. Ruscio, I just paid it out of pocket because he doesn't take insurance.
Prepare if you can, and take it all with a grain of salt.
The point is, this journey can be expensive. I did my very best to prepare for what will (hopefully) be the most expensive medical year I ever experience. (Not counting the time in 2009 I didn't have insurance and was hospitalized twice but that's another story completely and I learned my lesson. ALWAYS have insurance.)
Do your own research. I've had plenty of practitioners recommend prescriptions to me that I ended up waiting on actually purchasing or taking. Those items, while prescribed with good intentions, may or may not be right for you. You hold the most information about your body and how you feel. Lab work isn't perfect. Don't be afraid to ask questions, stick up for yourself, wait to take medications or have procedures, get second opinions and ask for discounts!