I want to stick my head in the oven

My afternoon went something like this:

Gabe asked for a bowl of oatmeal for a snack, oatmeal with butter, cream and brown sugar.  He ate one bite and then a second.  With the third bite, he tapped the spoon on the side of the bowl to get the drips off.  When he did that, he flipped the bowl through the air and we had a slimy lake of oatmeal all over the floor. 

While I was cleaning it up, one of the little girls ran through it and slid across the floor, banging into the leg of the table.

I listened to complaint after complaint from the big kids.  This one cried, that one fussed, another one taunted, one teased, yet another cried, the tv was turned on and off and on.  My insurance company returned my phone call with the news that my daughter's new nebulizer - previously covered at 100% - was now my responsibility. The Hubster called to ask me if I wanted to sell Mary Kay.  I was given papers to sign, STAT. Some of the grades weren't so good, but I was assured that it wasn't the student's fault - it was because the teacher hated this student. Riley cried and Emma bugged her, and both were sent to sit on chairs in opposite rooms.  One of them colored on the wall and one screamed at her not to do it.  The Hubster called and asked me if I knew we were invited to a party on Saturday - a pool party.  An indoor pool party, and I'm not going to be able to go.  My swimsuit no longer fits.  When I attempted to explain that a suit doesn't fit when the wearer is almost 50 pounds smaller, he didn't get it. 

I yelled at my kids, and was reprimanded by a kid who is old enough to know better.  My girlfriend cancelled our dinner out tomorrow night.  I realized that I've not sent out memos to the class, in order to plan the Christmas party. 

In short, it was a sucky afternoon.  One of those things, though, crystalized something for me.

and no, it wasn't the decision to run away.  But it was close.  Damn close.

It was the insurance thing.

We pay out over $1000 a month for health insurance, including dental and vision. The Hubster has aksed me before to call around and try to find a way to purchase cheaper health insurance.  For what we pay, we should have better coverage.  Riley's therapy isn't covered, flu shots are not covered, lots of testing is not covered.  Vision checkups are only every two years, and glasses and contacts aren't covered.  There is no orthodontia coverage, and the only benefit to the dental is really the cleanings, which are covered 100%.  Nothing else is covered. Apparently, as of now, durable medical equipment is now our responsibility as well.  Copayments for specialist visits are $50.  Asthma meds are either $40/$60.  ER visits are $500 each.   Hospitalization is our responsibility up to $5000.  I think, and I could be wrong, that for $1000 a month, these benefits don't add up.  What do you think?

Have any of you bought your own health care coverage?  What should I look for?  What is necessary, and what should I avoid?  Do I need to get an insurance broker, or can I just call a company and ask for help?  Are there any companies with a really stellar reputation, or some that are wise to steer away from?

When the insurance clerk was completely unhelpful and rude to boot, I decided that we need to give our money to a different company.  It KILLS me to spend this much every month and still shell out tons more.

Input?

Comments

[rachel]

gah. That is sucky sucky sucky coverage.

And the change in coverage coming at the end of a crappy day just bites.

We currently (crossing fingers) have low copays and a $1500 durable med equip/year limit (I'm looking into a scooter), and no premiums. As annoyed as my dh might get with his job, this all makes it worth it for me - I'm on 7 prescriptions at this point!

I have no advice on finding insurance - I hope you can get one that will actually help you instead of adding more stress!

[Tammy]

I am so glad that I live in Canada. Good Luck with your search.

[Gigi]

Yikes that is bad. I bought into blue cross individually before and during my pregnancy and while it wasn't great, it was better than yours. One plus if you did the Mary Kay thing (or have any kind of business) you can buy into small business co-ops. Again not great but there are so many to look at. You may get stuck with an HMO, but it might be worth it. If Health Net is in your area they were good for us.

Kaiser basically just took over our town, so we are forced to go with them after the 1st. Pray for me. The last time we had Kaiser it was awful. (So no, I don't recomend them ;-) )

[margalit]

There is a policy comparison tool at
http://www.ehealthinsurance.com/

that might be able to help you. I'm doing something similar right now with the medicare coverage and it is very discouraging. Good luck.

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[Shelly]

Sounds like my insurance. Thank goodness Sean and Daniel's state insurance for special needs children covers 100% of their costs. With my insurance we pay very similar to what you pay. Ken doesn't make enough to cover the costs. His company does not get it when we have gone over the numbers to show them it isn't helping their employees to have this insurance.

Good luck!

[Shelly]

Must have been something with the warm weather yesterday, because my kids were HORRIBLE too. it was the day that wouldn't end.

Sorry, can't help you with the insurance. Good luck in your search.

[wookie]

My suspicion is that with a large number of people to cover and a number of pre-existing conditions (athsma, allergies, IIRC sensory issues?), you're going to continue to find this challenging.

If I were in your shoes, I would start calling around, trying to get whatever a consultation would be, because your medical situation is far from ideal. It will definately take some legwork and I hope you will be treated better than you were today... generally if you can talk to someone face to face they will be more pleasant than on the phone.

I don't know how many companies do this, but some will give you a base number of "points" to put into different areas, so you might decide to get 500$ of glasses coverage a year, but 2000$ of dental, or buy into a certain level of perscription coverage.

Good luck! I have had the good fortune to wait until I could invest in an employer based plan. My teeth have suffered but sometimes that's just the way it goes.

[Emily]

Oh, I don't envy you at all. I'm due to give birth any day now, but three months ago my husband lost his job and therefore our health insurance. He hadn't been making much, but they'd paid all of his premium and 75% of mine as a negotiated raise. Now his new job only provides health insurance if you're working more hours than he can work right now. We're on student insurance and it's royally lame. No prescription coverage whatsoever. And as soon as I graduate in April, instead of my paying $80 a month, it'll cost me $1200 a month. Talk about frustration.

It sounds like your vision coverage is a waste of time--whatever you are paying certainly can't be worth what you're getting. I agree, though, that it's probably best to try and negotiate with people, although there are websites that would certainly be helpful, like the one mentioned above.

Well, good luck. Sounds like you need it.

[NYCA]

Absolutely, call an insurance broker. Let that person do the legwork for you. You have to be careful that they will give preferential treatment to the companies that give them the higher commission... but on the other hand, what with the oatmeal the grades the party the swimsuit... are you really going to have time to be put on hold by the dumbest large companies on earth?

Michelle Edelman is director of strategy at NYCA, a full-service marketing agency that grows businesses with inspired ideas. To find out how NYCA can grow your business, log on to www.nyca.com.

[NYCA]

PS, one thing to do is to analyze your behavior. Get out all the old receipts and copay bills and look at what you REALLY use. Perhaps partially covered orthadontia is critical, but vision not so much.

As well, there are some programs out there like New Dental Choice here in California (http://www.newdentalchoice.com/) that offer discount programs. They are not true insurance... they are memberships that allow you service discounts through approved providers as you need it. Depending on how much of certain services you actually use, this might be to your benefit... allow you to pay for less broad scope within your insurance and therefore pay lower premiums.

Michelle Edelman is director of strategy at NYCA, a full-service marketing agency that grows businesses with inspired ideas. To find out how NYCA can grow your business, log on to www.nyca.com.

[KatieButler]

No advice on insurance, but best of luck in finding something. My husband is employed with a major corporation and we have seen our cost/benefit ratio decrease over the ten years he has been there.
It was a "stick your head in the oven" kind of day here, too, made worse by the fact that my dh had the nerve to refuse to indulge me in my pity party. >;(
Oh, and my dh wouldn't get it about the bathing suit, either. This is the man that didn't understand why I needed new jeans when I had lost weight, until our daughter pointed out that I was holding them with up a large safety pin in the back!

[Katie]

Puts all of the complaints in Britain about our National Health Service (all health car is free, pretty much)
http://en.wikipedia.org/wiki/NHS
into perspective, while we may sometimes have to wait to see specialists and for operations at least you know taht it's all being paid for in a much fairer way.
I really hope we never get rid of the NHS because for all it's failings it's a truely wonderful system!

[Christina]

We were just discussing this last night. As my husband is self-employed we have been buying individual insurance also, we carry a $2500/year deductible with a Health Savings Account attached, which at least gives us tax breaks on all of the medical bills that we pay. He wrote it for us (he is insurance) but doesn't write very many individual policies as they are just not that competitive if there is any other choice. We don't have dental or vision coverage but I would like them as the kids get older and start needing glasses, right now we just pay for everything out of pocket and write it off our taxes. It's definately worth looking around for, but costs have gone up so much that we are paying roughly 10x what we were 5 years ago, but we've only added 3 kids. Seems very out of whack to me...

[Jess]

I would call a insurance broker. They can search around and get you the best coverage for your money. Good luck.

[Erin]

Ironically my health insurance with work kicked into today its blue cross and blue shield and only $30 a month (of course its just me on the plan). However I'm guessing that whatever your using is the best insurance that your husband's work offers.

Previously I purchased insurance from Golden Rule (http://www.goldenrule.com/). It was all right. $25 office visits including specialists but very little help with perscriptions I have an acne perscription that would be $145 without any insurance with Golden Rule it was still $135 and with Blue Cross its $15. I paid $91 a month for Golden Rule for individual coverage. You can look into Golden Rule but there were some things that I didn't like about it and definately wouldn't stay on it for the long term. Also there is zero coverage for any prenatal care.

[Tammy]

go to Dave Ramsey's website for local insurance providers he recommends. www.daveramsey.com and there is a link you can click on for health insurance.

[Anna]

Much as I hate the bureaucracy surrounding it, I love the service delivered by the NHS in the UK. We are so lucky and yet take it so much for granted. Hope you manage to find better insurance without too much stress.

(And isn't it a little bit nice to think you can't go to the pool party because of how slim and toned you are, not because you are too big for your swimming costume...!)

[carolb]

Hooray for Canada!
Have to say that we do have wonderful health coverages.
We still have to buy the extras, like dental, vision, etc... but we are so lucky to have awesome health benefits.

[Hayes]

We pay about the same as you do, but get WAY better benfits. $30 copay for office visits, $50 for ER visits. Dental is covered with 100% coverage for cleanings, every 6 mos. Cavitiy filling was partially covered as well. Vision, one visit per year, plus a pair of glasses or two boxes of contacts for each of us. Prescriptions are $10 for generics, $20 for "name brand" and $30 for some "fancy" drugs, although I Admittedly don't know how they decide which drug is what.

HOspital stuff is almost completely covered as well. We paid $150 for Isaac's birth, for random meds they didn't cover and for a private room, go figure.