Tuesday, April 27, 2010

Well Baby gone Bad

We are healthy people. We take vitamins, we exercise a lot, we eat right. Chris just actually lowered his cholesterol over 30 points and lost 20 pounds in 3 months with diet and exercise. I think we are the kind of people that 'pay into' the insurance world. So when we got our last insurance increase and it was over $600 a month-we freaked and couldn't afford it so we did some research. Basically (here is my soap box) insurance is a rip off!!!

We ended up with a catastrophic type plan because the monthly premiums on anything else were enormous, like a house payment. Before we paid just under $600 a month for medical insurance, we had a $15 copay and were happy to go to the Dr when we needed to and feel covered with the basics. The new plan is around $300 a month but has no copay. So now when we go to the Dr I have to pay for it. 2 weeks ago it cost me over $100 to spend 1 hour and 15 minutes in the waiting room, and 7-8 minutes with the Dr. This of course did not include the 12 month immunizations so we headed down to the Utah County health clinic in Provo for the afternoon. We waited with a few questionable characters in a not too clean clinic for another 30 minutes-but immunizations only cost me $13 per shot for the wee man. Worth the money? I guess. Now we just put money in a HSA so when we need to go to the Dr we have the money. Hopefully we keep up with the only needing to go for well baby visits, like we've done for over a year now.

I've also learned in the last few months that with my $600 health insurance my birth control was $25 a month. Now with my $300 health insurance plan the same birth control is $30 a month, and they ship it to my house. Hmmmmmm doesn't add up right? Amoxicillen was $15 with my $600 plan, and it's now $4, again doesn't add up. What the crap does insurance pay for? I really think it's a bunch of paper work administrative bull.

I talked to the Dr about the H1N1 booster for Brooks. He had gotten the first shot with the $600 plan and it cost me my $15 copay. Then we switched to the $300 plan so I asked if I could just pay for the booster shot without running it through my insurance. Sure, they said it would be $14.50. WHAT???? Anyway, poor wee man went for his 12 month well baby visit-totally healthy we thought. He ended up having a little ear infection so they put him on amoxicillan. 10 days later he looked like this.....


At first I thought it was chicken pox but after 48 hours they didn't blister, they kind of turned into gross bruise looking things. He had a horrible fever, runny nose, wouldn't sleep so good, and a cough came on after a few days too. This was all AFTER the antibiotic. So here's the debate. Yes they looked like they were taking their course and clearing up BUT what if it's more than just a little rash or something? Before for $15 I'd go to the Dr for peace of mind, now it's over $100 so what do I do?

It's my baby's health so I go to the Dr. Turns out he is allergic to penicillin (or the family of those antibiotics) and all of this was an allergic reaction to the amoxicillen, not chicken pox from the immunization we had thought it was. So I got a new antibiotic that's not in the penicillin family and the pharmacists said it would be $35. Okay, they asked me if I wanted a cheaper one that wasn't penicillin so we looked into a few prices. Turns out getting a different kind, with my insurance is $31. Nice
So, my whole beef is your damned if you do, damned if you don't. There is no way to NOT have insurance, but in the mean time I'm paying hundreds of dollars for what?????? Ugh
Am I way off here or should I just move to Canada, oh wait, in a few years this will be just like Canada.

8 comments:

Jennifer Pelo Rawlings said...

That is crazy. I'm glad you've done all this research for me.

~alicia said...

Jamie,
I used to sell insurance and this is the same dilemma that everyone is faced with, unfortunately. Premiums are so high because those of us that can or do afford health insurance have to pay for all those without - stinks. NM actually has some great programs through the government to try to help everyone have insurance at an affordable rate. Poke around and see if there are any programs like that in Utah...based on income and household size.
I think you are doing the right thing with your insurance - look at how much you were spending per month for what kind of utilization? Sure you pay more upfront, but there is also a cap to what you will have to spend...once you reach that cap the insurance company does pay 100%. Right? Also, whenever you go to the pharmacy, ask if they have the $4 generic and DON'T show them your insurance card - you don't need it to get a $4 generic. The benefit to this is that it doesn't go on your "experience" (usage) and when you come up for renewal, they won't raise your rates based on prescription costs...because there won't be any. Not saying they won't raise rates, but they won't base it on Rxs...
Good luck! I am pretty sure all this will be changing thanks to our dear Pres...and things will be more expensive. BCBS here just announced a 20% increase in rates...across the board. Ugh!
Hope the baby is feeling better - poor little guy!
Hugs!

Jen said...

HOLY COW! I hope little Brooks is okay!! Damn insurance. :)

Tony and Whitney said...

Oh my! I totally agree! I keep saying it's not the healthcare industry that needs to be fixed--it's the insurance companies. There needs to be some kind of regulation. We are the same way. . .we pay more into it than we take out. Hope the little man is getting better soon.

Cathy said...

Oh I sure do hope lil wee man is healing...He is such an adorable one...Prayers are only what we have left for this country...that and HOPE.
God Bless..
Cat

dandan594 said...

My little one is a bit of a terror too.
http://urbannewsninja.blogspot.com

Schauers Hours said...

I myself am allergic to penicillin and went through the same thing at age 8, so I feel for Brooks.

The Snow Family said...

I have a picture of both Austin and Ashlyn that looks just like that. I am sorry. I wish I had been paying attention I might have saved ya a day of misery. When Ash was 5 or so one of the docs in my ped group decided she had probably outgrown her allergy and prescribed some amox. She hadn't!