Reply to What is your out of network deductible and do you hit it for your kid's services?

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Reply to "What is your out of network deductible and do you hit it for your kid's services?"

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[quote=Anonymous]I am a lawyer and have worked for 2 different big law firms over 20 years. DH works in financial services and started at the bottom of the totem pole and is now high up, across two different large public companies.  Both of our employers have always offered two "health care" options:  One is the "gold" PPO where premiums are high ($2500/month per family - in law firms, the lawyer has the pay the whole thing, in the corporate world, they pay for a big chunk of DH's premiums, but adding the family is on us - it's around $1500/month).  Our deductible is around $7500 a year.  We no longer live in DC. In DC, there are laws that the amount you are billed for medical has to be tied to the insured amount. There are no similar laws where we live. So even when we are in network, insurance paying 80% is only 80% of the approved insured amount, and we still always get a bill for the balance. Might be $25, might be $400. You just never know.  And drugs all apply to the same deductible.  I don't even bother running therapy through insurance because it's not worth it.  We typically reach our deductible every fall, and we are a healthy family with a kid with ADHD but nothing much else going on.  More and more, we just pay for stuff out of pocket - my primary care doctor i pay $150 a year for my annual, our pediatrician went concierge and it's just easier to do that.  I consider the insurance for emergency/catastrophic things, and the rest we presume we will pay for.  As mentioned, this is the "gold" plan at both our employers, and has always been that way. And we are paying $1500 to $2500 for the pleasure of this every month.   The other option is typically some kind of health savings account racket where you don't actually have insurance; something that doesn't work for people with kids because the odds are just too great.

I think americans who work for govt or in these other unicorn jobs with true health insurance have no idea how bad insurance has been for so many people for two decades.  [/quote]

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