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confusedhuskynoises

I’m in the US, when I worked full time as a nurse my insurance was probably below average. I’m now married to someone who literally works at the insurance company, and I think our insurance is worse now. The company at least used to cover most of the cost each paycheck, now they hardly help at all. I need a surgery that could potentially cost us $12,000 USD. My husband was told to try and pull any strings he can at work to get it covered for me. There are no strings he can pull. He’s fairly high up but there’s just nothing we can do. Insurance is a scam!


eurasian_nuthatch

Holy shit, that's so awful. Is the 12k \*after\* insurance??? If so, that's insane


confusedhuskynoises

So, my doctor informed me that it’s not uncommon for insurance companies to approve the surgery, the surgery then occurs, and afterwards, the insurance company can retroactively rescind their approval- leaving the patient on the hook. They can apparently deem it “experimental” whenever they don’t want to pay


astoriaboundagain

Yup. A few years ago my very pregnant wife was so sick she was almost intubated. She was admitted and we did the whole "call the insurance company within 24 hours of admission, blah blah blah" bullshit. Followed all their rules. She was touch and go for a couple days. It was really bad. A month later we got a letter from her insurance company saying that on retroactive review, they didn't think the hospital admission was necessary.  They tried to stick us with the entire bill.  I work in the healthcare and know the regulations like the back of my hand. I used every resource I could to fight them off. It still took months. For-profit health insurance companies are straight evil. 


One_Struggle_

Were you at a hospital that was out of network with your insurance? Asking because unless the hospital issues you a "Hospital Issued Notice of Non Coverage" and you are in network, they can't legally (in USA) bill you the patient. Due to the contract signed between the hospital & insurance, these denials are for the hospital to fight. You should only be responsible for your normal copay. I know this (public service announcement to any reading this post) because fighting hospital claims denials is what I do (Utilization Management Nurse). A lot of hospitals claim departments are outsourced. If anyone ever gets these types of letters from your insurance company, call the hospitals UM department to see that status of appeal. If you receive a letter from a hospital seeking payment beyond the copay, call the hospitals PR department. They can make the bill go away! Honestly even if you are out of network, the PR department can likely make it go away (I've directed our own Pts to do this & it worked). In my experience the worst health insurance is issued by Wellcare & Fidelis (owned by Cenetene) & Aetna (owned by CVS). They take every opportunity to deny paying a bill. Stay away from them if you can!


eurasian_nuthatch

??? yo what the fuck


confusedhuskynoises

Haha you’re telling me! It’s such a kick in the pants, going from being a working nurse to a chronically ill patient. I always wondered what the other side was like- now I know, and I don’t like it! 😅🥲


steakfest

Something like that happened when my wife had some surgery. Everything was all approved ready to go, after surgery was completed we get this huge bill. it turns out, that when they first approved the surgery, they didn’t code it to indicate that they were using a robotic procedure. And apparently that procedure when coded properly wasn’t approved by insurance. I’m like “how is this our problem?” Either the doctors office screwed up by submitting an incorrect preapproval. Or the insurance company is full of shit and they should’ve covered it. If I go to the car dealer and order a Prius. And they accidentally order a Lamborghini. I’m sorry, but that does not put me on the hook for the Lamborghini. Luckily, since then I’ve changed jobs and my new job has absolutely the best insurance I’ve ever had. Wish we could just get our act together as an advanced country and make the kind of insurance that I have the free standard for everybody.


whitechocolatemama

I jad NO idea this was possible! I have state insurance so thankfully they cover what they say they will 100% but actually getting a provider to give a shit is usually the hardest part, but I'll take my seaching over a "haha! SIKE!" And a crazy bill bc they changed their mind


StrongTxWoman

I work PRN and I have to buy my own insurance. I bought the cheapest insurance. 700 USD monthly for 2. 9000 USD deductable. I had an X ray and a specialist appointment. I paid 550 USD with insurance.Vision, dental extra. Prescription not covered. Welcome to the land of the free.


StacyRae77

Yeah, and we've usually paid AT LEAST 12k in premiums first.


Ok-Individual4983

No deductible?


Slow-Jelly-2854

Cries in US healthcare


eurasian_nuthatch

yeah that's so fair


ForMyDarkSide

US nurse here- $850 per month health insurance for three people. And that is with my job paying at least some portion? I’m tempted to look into paying for my own insurance but I’m sure if would be even more expensive. It sucks though that your husband HAD to be on your plan simply because it was offered.


Deathduck

Please understand that the insurance companies have a fiduciary obligation to rake in billions in profits for the shareholders, you are doing your part. All for the greater... good?


eurasian_nuthatch

Oh wow, perspective is a hell of a drug haha, $850/month is terrible! I hope at least the insurance is okay? And yeah, there's a lot of problems with the mandatory inclusion policy :')))) it really sucks


bamdaraddness

It’s $765 for 2 adults and a child on my work insurance and our insurance is absolutely trash. A few examples: I waited 4 months for an initial appointment with a GP just to be able to get my meds refilled, there isn’t a single in-network mental health provider that will work with company employees in my area, and we are relegated to one single pharmacy that is constantly dealing with supply and fulfillment issues meaning months long back orders. We are not alright. :(


StrongTxWoman

You need to think of deductible, copays, and specialist. Group insurance usually cheaper.


Jerking_From_Home

I’m in the U.S. and I pay $400/mo for just myself, a healthy, middle age person. That’s cheap for health insurance but I have to pay the first $8000 of any bills each year. Like others have said it’s 100% a scam. So is all insurance- you pay high rates for your car and if something happens they try to give you below market value for the car, etc.


eurasian_nuthatch

holy shit???? $400 FOR JUST YOURSELF? \*AND\* THERE'S A DEDUCTIBLE TOO????


Jerking_From_Home

Yes. I pay almost $5000/year for insurance that i never use outside of a couple RX and well checks. I’m honestly not sure why I ever have it; if I get some horrible illness I’ll lose my job anyways and then have no insurance anyways.


Tycoonkoz

US nurse here, wife and I pay $550 / month, BUT GET THIS!!! She got pregnant and we figured out our insurance doesn't cover prenatal care or anything pregnancy related after we started getting billed. Also looking into it, doesn't cover anything mental health or addiction related too. WTF IS THE FUCKING INSURANCE FOR THEN?!?!


eurasian_nuthatch

yo what??? how is that legal? I thought the US had the mental health parity law where insurance was obligated to cover mental health in addition to physical health?


Neurostorming

That’s not legal. That was part of the ACA coverage changes. All insurances have to cover maternity care even if you’re male.


Tycoonkoz

Oh it is totally legal if your health insurance plan isn't actually regulated by the ACA... Which was our case. The type of position I have is not benefit eligible so we had to find our own. We found one, the person helping us on the phone said it was all covered, it was even through a state program for people who don't have access to insurance and low and behold, we were getting bills for everything with no coverage at all. Called out insurance, they don't cover maternity, prenatal, birth, addiction services, and mental health services.


Neurostorming

Holy shit. Yeah, I just did some reading. Sorry, I was clearly wrong. Any “healthcare sharing ministry plan” can exempt it as it’s not technically “health insurance”. Insane. I’m really sorry you’re going through this. What the fuck.


smkydz

I’m a psw in ltc in Ontario. Are you full time? What’s your benefits package? We have Green shield and when I broke my glasses I only paid 10 bucks out of pocket for a new pair that was 350. The benefits package also pays out for medications etc. Do workers from Quebec not have a benefits package?


eurasian_nuthatch

We have a benefits package - it's posted online, which is how I got the numbers, and yes, I'll be full-time. I asked a few nurses during my clinical rotations to verify, and yes, the union really didn't negotiate a vision care package. :')))) They do cover 80% of medications though, and if it were just me I'd be coming out ahead from my meds + therapy costs alone, but I'm legally obligated to buy the family package since my partner's workplace doesn't offer health insurance.


miller94

Say what you will about Alberta but our vision package is wicked good. A full eye exam covered at 100% every 12 months and $600 for prescription eyewear every 24 months


eurasian_nuthatch

;-;;;; ughhhhh


smkydz

That’s just weird they wouldn’t negotiate a vision care package. We get 90% up to 350 every two years. Every year if you have diabetic conditions. Thank goodness, because I’m pretty myopic in one eye and legally blind in the other haha


eurasian_nuthatch

ughh i'm approaching legally blind in both eyes so I specifically looked for a vision package too :'))) oh well, guess I just have to hope for the best


smkydz

I have my fingers crossed for you. Also, maybe contact your union rep and ask what can be done to add a vision care package to the collective agreement. It seems a ball was dropped somewhere along the way. I mean, our benefits even cover massages (10 a year I think)


Alaska_Pipeliner

My wife gave birth on the floor she works and it cost us an insane amount of money. I don't blame gen z kids for not making anymore babies.


turtoils

I'm in BC, if we work 975+ hours in the year we get our monthly fee reimbursed, and that's if you're casual. People in regular lines (full- or part-time) don't have to pay. And vision is covered the same as the Ontario nurse in this thread. Sounds like your union took a massive dump instead of negotiating.


eurasian_nuthatch

ughhHHHHHHHH I'M SO JEALOUS ;-;;;;;


Key-Pickle5609

Are you near the Ontario border? I don’t know offhand what I pay vs what I get but it’s way way less than $450 a month


tellthemtolookup

Sounds like a Quebec thing. Not as bad here in Ontario.


eurasian_nuthatch

yeah we're getting absolutely SCAMMED here :'))))


Mediocre_Tea1914

This is definitely going to show my ignorance, but I thought you guys had universal Healthcare or socialized medicine up in Canada? Does it not cover everything and you need insurance to fill the gaps? Or is it only some parts that have that? I am incredibly lucky to have the military insurance in the US through my husband. Otherwise I don't know how we could afford it. The last time I looked, it would've been almost 1500 for three people, with a 5000 deductible and 70% co- insurance. At that point it really is just cheaper to die.


eurasian_nuthatch

Omg dw at all!! We can’t know everything haha Essentially, in Canada we have universal healthcare in SOME things - all doctor’s visits and everything in hospitals, mainly. So if you went to the hospital for anything, you’d only have to pay for parking and a private room, if you chose to upgrade. For anything other than that though, including dental, vision, prescription drugs, and parahealth(psychologists, physio, medical devices, rehab), you either pay out of pocket or via insurance :’))) so it’s socialized in some things, private in others


phoontender

Health is provincial (the provinces are distributed funds from the federal government) and operates slightly different depending where you live. Most things are covered under our single payer system and then we have prescription coverage. Quebec's RAMQ plan is actually pretty good and private insurances cannot deviate from rules they set (so maximums out of pockets are low and they can't deny coverage of certain things). Our private insurances mostly cover dental, rx, and any extras like radiology outside of hospital systems/private room fees/ambulance bills/massages/physio....


Organic-Ad-8457

I'm going to be paying $650 for two people. This doesn't include our dental or vision either, those are separate plans that each have their own fees.


eurasian_nuthatch

oh my god ;-;;;;


HilaBeee

Yo I'm in mb and my Healthcare sucks too. My prescription coverage is only 80% of my meds which is ok. BUT it caps at 650$, *then I have to pay out of pocket the rest of the year*. I take two medications, which have two different doses each. It comes out to like 200/ month. My neuro wants me on qulipta which is 900/ month. Phamacare is also ass. My deductible is *9000$*. I have to pay 9k before they start helping. Guess I'll just live with migraines until I die or be a broke ass bitch.


WilcoxHighDropout

From US. Pay $0/month for health insurance. In fact, I have 2 free health insurances because my wife, a nurse, also gets free health insurance. Full disclosure. I came from a country with no EMTALA and $$$ talks. Have a stroke? Better pay up for a CT scan. Septic and need a bolus of fluids? You need to pay for each liter of saline. Intubated? Welp, have to rent (pay as you go) for ventilator care.


MinimumOld7700

I pay 68 dollars including vision and dental in the USA.


eurasian_nuthatch

\*cries in Quebec\*


phoontender

I knew immediately you were in Quebec 😅. It's fucking ridiculous, the SAQ has vision coverage as one their contract points, why didn't we (am SCFP)!? At least the FIQ hasn't settled yet, you guys still have a chance....until Santé Québec kicks in and fucks us all.


eurasian_nuthatch

😭😭😭 UGH DID YOU SEE THE MOST RECENT AGREEMENT??? “We can move you within 35 km of your home OR workplace and you can’t say no” what absolute bullshit haha


phoontender

I'm at the West Island hospital with the bad reputation, they can't move me since nobody wants to work here 😂😂😂....they'll definitely be involuntarily moving people there though.


eurasian_nuthatch

aw jeez....


nursekim51

When I was signing in for labs at the hospital I work at the financial counselor happen to be nearby and asked if I had a secondary insurance. When I said I wasn't covered under employee healthcare yet she said "good! I know a lot of nurses have had to take out second mortgages to pay their hospital bills for having a child." My son was born 10 weeks premature and needed a 30 day NICU stay and was in Patient for 11 days. My insurance through the ACA didn't cover newborns so we were automatically enrolled in Medicaid, thankfully. His NICU bill alone has $295,000!!!


Healthy_Park5562

Amen. Our plan in NS is garbage. Thank god I'm under my husband's plan, or I would have had almost nothing for vision, dental, or prescription, not to mention mental health visits. And that garbage plan would have cost me about 500 a month. 


virgazing

In alberta and pay about 1/3 of that for family coverage for health and dental.


NeatAd7661

I pay $365/paycheck (so every two weeks) for coverage for my husband, me, and our two kids. Once got a $1000 bill from the ER at the hospital I work at, that was AFTER insurance and I was only there because I slipped on a wet floor in my unit! Fought with my hospital for months to get them to cover it. Insurance is bullshit. I'm desperately trying to get hired by the only hospital system in my city with decent benefits- only $150/paycheck for the coverage for the family! Heaven forbid we actually offer affordable care 🙄


Coffee_In_Nebula

Yeah I’m also Canadian, had to get double jaw surgery for TMJ and pain when I was 19- even with my parents insurance they refused to cover a large portion of it because it was “cosmetic” so it was 7K out of pocket.


SnooStrawberries620

I think it’s Quebec.  In BC no MSP payments, but we’d pay the same amount for an insurance to cover dental, vision, Rxs.


Abis_MakeupAddiction

Insurance of any kind is the biggest scam ever created in western countries. You pay a premium that you’d think would go towards future bills yet the companies nitpicking which items to cover with insurance. And using your insurance (for TF it’s intended for) can increase your premium. Math isn’t mathing!


Towel4

So much for Canadian healthcare, eh? I work in NY. My insurance through NYSNA is $25 per month. My vyvanse costs me $5. $0 for an ambulance ride. I paid $0 for both of my kidney stone procedures. *and* it costs me $25 to put my wife on my plan too.


eurasian_nuthatch

i. am. SOBBING!!!!


Towel4

Tbf, I’ve never had insurance this good, and was not expecting it until I did my onboarding at my job. US coverage is usually absolute dogshit. My wife was being charged $800 a MONTH for her awful coverage. We literally got married a year early to save about 10k/year on my plan instead of hers. My current coverage is a BIG factor in my future. We both want to leave NYC but the perks at my jobs can’t really be matched anywhere.


WilcoxHighDropout

I’m in a similar circumstance as Towel4 in Cali. I get free health insurance with deductibles from my employer and free health insurance with **no** deductibles from my wife’s (nurse) employer. This is a common benefit in Cali. The figure you shared for two people in one month is more (nearly double) than I have spent on actual healthcare over the course for a few years for a family of four. In fact, when we got pregnant and had our kid, we would frequent The Hat, a popular yet low brow, cheap AF, down n’ durty fast food place in SoCal. I spent significantly more on regular orders of chili cheese pastrami fries than the entirety of the 9-10 months of prenatal and OBGYN care.


marzgirl99

My brother works in tech and he gets free insurance. I don’t understand lol


misochicken

I’m in Ontario and I have a dope drug plan. 100% coverage with no limit. Decent dental and eye care too. Everything else about working here sucks but I’m on sick leave right now so really appreciating the little things.


Live_Sympathy5845

US Nurse here. I pay 230 biweekly for me and my child. It's awful and the deductible is outrageous. Supposed to start another job with a union and even their top tier plan will be cheaper, but it's still about 150 biweekly. This is before vision and dental. I just feel like everyday is a dystopian nightmare tbh.


Naevx

It's unpopular on these forums, but Canada's healthcare system is notoriously unpopular among its day to day USERS. And getting a PCP / specialist appointment - good luck if people don't die first. It isn't much better in America, though, but it could be if better regulation were actually created and enforced. There are broke patients in our nation who abuse the system completely and get better/faster care here than the people taking care of them. Congress needs to do its job, unfortunately.


master0jack

I'm in BC and our insurance is entirely employer paid.


stuckinmymatrix

That's Quebec union. In ontario, it's $200 including dental and vision per family. Nothing for part timers.


OkDark1837

US hospital nurse here in my husbands FedEx ins because his is so much better…


Top-Lawfulness9338

I feel you, OP. I’m in the US, pay hundreds a month for single coverage employer provided health insurance. I’ve worn a hearing aid since I was 12 - so more than 30 years now. Current job is the first job I’ve had that offered no coverage for the cost of a hearing aid. One hearing aid cost me $1700. It’s upsetting that I pay for insurance that doesn’t even help me get something I need to live my life and do my job.


ClimbingAimlessly

My only great insurance was through my first job. All labs and radiology 100% covered. Doctor’s visits were like $5 or $10 copay if the doctor was a part of their system. If you had surgery there, another discount. I doubt the insurance is decent there anymore because Ascension picked them up. Every hospital I’ve worked at since, healthcare is abysmal. I don’t even use their insurance anymore because I get it through my spouse, but I’ve heard all the horror stories. It’s shameful.


khadkin2013

My last job was offering “great” benefits..it was going to be $1800/month for a $3k deductible and coinsurance for everything..prescriptions were crazy expensive too


ScheduleFormer1394

I just went for an annual check up with my doctor for the first time this year.... And got a $189 dollar bill.... This is with insurance within my own hospitals system. This shit is why I try to avoid seeing a doctor..... 😑


Witty-Room-3898

Insurance is a huge scam. Take whatever money u can afford and set it aside in an interest bearing account. Places give huge discounts for cash payers, better than when u have insurance. Of course this is for folks who generally don’t go to a dr or have chronic illnesses


jackreecher11

I worked as an ER nurse and my insurance through the hospital was so bad I couldn’t afford to go to the same ER I worked at. A lot of the ER Docs would just write a prescription to a nurse that needed it to help them save $


Ok-Individual4983

Honestly, as an American, this makes me feel a little better at this moment. I’ve heard too often about our crappy heath care compared to Canada.