SOOO angry with health ins!!!

We are in the same boat - self employed and had to go through the exchange. I did get a decent plan this year though (even though we had to pick all new drs!)…we were uninsured last year and wouldn't you know, we had several situations that ended up being $2-5000 each. I am paying on them all and it's frustrating knowing that I will be penalized this year when I do my taxes for NOT having insurance last year even though by the end of the year I'd probably paid $7000 in medical bills. I don't think I should be penalized on top of that since I've been paying as much as I can, even paying a few off. It's not like I just ignore them and don't pay them. We are having to cut back to be able to afford the new insurance AND continue to pay on last year's medical expenses. And there as soooo many entities to pay for ONE incident that it's extremely difficult to keep up with!

It's really disheartening. I agree something needs to be done. I don't know that totally repealing ACA is the answer though…if I had to pay the fully billed amount for my insurance I couldn't afford to keep it without subsidies. But the insurance we had before ACA was reasonable and worked well for us…it just wasn't ACA compliant once that got started.

I don't know what the answer is…but there has to be one. 

I feel your pain...

This is exactly why I am afraid to retire. DH's medical expenses were over $900,000 last year. I have to keep my employer's insurance.

What is their reason for denying the visits?  Usually visits like that are covered, but just billed at a high rate (either higher copay or coinsurance). Keep pressing - I think they just assume people will roll over. I hope you get resolution and sorry your husband is  in pain.

How can they deny for pre-existing condition?  Sounds ridiculous. I hope you get it sorted out.

That really doesn't make sense.  You are actually paying more per month, but it just isn't coming directly out of your check so that makes it better?  Isn't the money for the insurance essentially coming out of your/his paycheck anyway?

Ugh!!   I feel your pain!  I had to switch insurance in Jan. I had to cancel an apt with my neurosurgeon in Jan because the new insurance company didn't do my paperwork until Jan 25th. I spent the entire month of Jan calling twice a week begging them to do my paperwork. Once we finally got our insurance cards I couldn't see Neurosurgeon without a referral from a primary care Dr which I don't have. I called the Drs on the list from my insurance company and they aren't accepting patients and are on a 6 month wait.  My father finally had to make some phone calls to get me in. 
All for the going rate of $700 a month.
jen

Wow - what a pain. My insurance plan some years ago required a referral from a PCP to see a specialist, which for me was ridiculous. It was wasted time (on my part and the PCP) and money to go to an office visit just to have the doctor say yes, you need a specialist. My plan now doesn't require a referral. And even if it did - I can't believe you had to wait that long for a PCP. Is it because the in network doctors on your insurance are severely limited? Seems so wrong to require PCP then not have enough PCP doctors. 

I thought the law applied to getting health insurance in the first place. I've never heard of an insurance company denying treatment once you have insurance due to pre-existing. I mean, doesn't that kind of negate all sorts of appointments? Like when my daughter broke her arm and we had follow up visits - they could've said "nope, pre-existing condition). 

Hopefully you can get some resolution.

We're self=employed and we went without insurance for a very long time. I found an agent who was able to walk us through getting affordable insurance for our company. She listed DH and I as separate employees of the company so we met the 2 person minimum required; this cost the same as listing one of us as employees and one as employee's spouse. She put the kids on individual policies so DH's pre-existing conditions wouldn't apply to them and their rates.

This worked for about 10 years, but the costs went up every year. In 2015 we were paying over $1500/month for just our insurance. When you add our costs plus DD insurance, our insurance cost more than our mortgage. DH had his stroke in early 2015 and I got a letter from KP stating that our insurance for 2016 for the 2 of us was going to be over $2500/month. This was more than I could pay. I contacted my accountant and he suggested I contact my original agent to see if we qualified for insurance thru ACA. He was pretty sure that not only would we qualify, but we would also receive a subsidy. Our agent found this to be true and she helped us select a plan with Kaiser that offered a subsidy and paid the deductible. This year's insurance is more expensive and has a deductible, but it's still a long ways off from being $2500/month.

I suggest that if you don't get any satisfactory answers from the agent you have, you look for another agent. My agent is a small business person and she was able to take that experience and figure out how to make it work for us in ways that would never have occurred to me. She is very much a think-outside-the-box person, but she knows the rules inside and out.

You didn't say how many people your DH employees. Does he run his insurance thru his business or does he have a stand alone policy? Did he have a policy in effect when he hurt his back? It's my understanding, as a complete layman, that if you have a policy in effect when the injury occurs and you later switch to a different insurance without a period where you're uninsured, then there is no pre-existing penalties. If, however, there is even one day where you have no insurance, then they can disqualify covering something as a pre-existing condition. As I understand it, insurance companies cannot refuse to insure you due to a pre-existing condition, but they can sure as hell charge you thru the nose for it.

If your DH is a solo employee, it may be worth it to hire someone or to reorganize the company so someone else is employed and he could get different insurance as a multi-employee employer. In our case, the company is a partnership, so I could be insured thru it even if I wasn't an active employee (which I am.) If he can get access to insurance that is equitable to yours, it may be worth your while to consider doing this. Perhaps your employer would be willing to pay you the cost of your insurance, if you elect to go on your DH's policy. I think reorganizing the company would also qualify as an event that would allow you to select a new insurance provider.

You have my deeps sympathy; negotiating insurance is definitely a nightmare.

Marcy

I'd seriously look into the availability of a multi-person policy. For us, the question wasn't affordability, but availability. The only way we could get insured was thru a multi-employee policy. If we had been able to get insurance on just us as individuals, DH would have been looking at a rate that was actually higher than what it cost to insure both of us thru the our company.

Just something to keep in mind.

Marcy

I feel your pain. Our premiums went from around $700 to $1100 and then to $1500. They were going to go up to $2200 so we had to switch plans and now we pay $1400. All with a 6K or more deductible until now, where we have a $5400 deductible and 40% copay and we can't have an HSA unless we want to pay $2000+. It's ridiculous.