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My Affordable Healthcare plan that covered my cancer!

I've been meaning to tell you about my health insurance plan for a while now, but was more focused on dealing with my cancer. So, as the healthcare debate continues I would like to explain the little understood affordable heath insurance plan known as HSA - high deductible plans. About 4 years ago my monthly premiums had risen to almost $500/month for the privilege of having a $20 copay for visits, prescriptions and most tests. $500 month x 12 months =$6,000 in premiums before I even made a single doctor visit. During the Bush years, the Republican Congress passed a terrific new healthcare law that has been horribly promoted. Basically it allows individuals to purchase a high-deductible insurance plan which comes with a low monthly premium and allows you to open at a bank, a Health Savings Account. This HSA account is your money that you can contribute to and use for a rainy day. The HSA account allows you to contribute $3,000 a year that you can spend as you wish or not, for medical expenses (from surgeries to saline eye solution) and the great thing is, it’s tax-deductible just like an IRA contribution. So your income is reduced by $3,000 if you contribute. There are different levels of ‘high deductible’ The higher the deductible the lower the premium. I chose a $5,000 deductible and my premium was about $150/mo. My wife chose a $2,800 deductible with a $220/month premium. In my plan, I am responsible for the first $5,000 of medical expenses. After that the insurance company picks up 100% of everything. Hospital, drugs, surgeries, tests etc.. So if compared to my other plan, my annual premium was now $150x 12 months =$1,800. Plus if I want to, I can contribute $3,000 in a year in to my HSA bank account which is also tax deductible. That’s what I did. So before going to the first doctor visit I was in for $4,800. But $3,000 is still in a bank account in my name. It’s a safety account I can use at any time to spend for doctors and other medical treatment no permission or explanation required. It builds interest (big deal) tax free as well. If I never went to the doctor all, I would spend $1,800 in premiums and still have my $3,000 in the bank. The next year I could contribute another $3,000 on top of the first $3,000, etc... At first, the thought of paying for my own doctor and prescriptions was frightening, but I soon understood another advantage of the plan that had escaped me. When I would go to a see my primary doctor for example, his office visit would have normally cost me $75. But since he participates and accepts my insurance plan the ‘negotiated rate’ the doctor agrees to charge and collect is not $75 but $47. Therefore I go to the doctor and I end up with a bill for $47.00 which is then applied towards my $5,000 deductible. I also discovered that most of my old $20 prescription co-pays from the other plan (MDNY now defunct) for generic drugs were now cheaper as well. Most of my generic scripts today are $4.00 to $12.00. Go to Walmart and see all the $4 generic scripts. For the first two years I saved a lot of money by only paying for what I used and paid for it at the pre-negotiated reduced rate. An ENT specialist visit was regularly $220, but my out of pocket cash price was $110.00 2008 The year I got cancer.. And had only a $150/mo insurance policy.

In 2008 as you may have seen on this blog I was diagnosed and treated for “Metastatic Squamous Cell Carcinoma with unknown primary” The cancer was in my lymph nodes of my neck. I had two surgeries, including a 5 1/2 hours radical neck dissection surgery where the surgeon removed 5 lymph nodes, 4 having cancer and removal of my tonsils. Although they believe the primary cancer was in my tonsils or throat they were never able to locate it. They said the primary cancer could be as small as 5 or 10 cells big and would never show up on a test! I went on to a second surgery, a series of tests, consultations with doctors, etc. I consulted with 3 radiologists, one being a throat and neck cancer specialist at Sloan Kettering in New York City, but chose to go to have my treatment at Stony Brook University Hospital under the care of the chief of radiation Dr. Alan Meek. The care of the doctors and staff was first rate. I owe them my life and eternal gratitude. The first worry I had when I came down with cancer was, would the insurance pay for it? Well it did. No questions, no problems. I paid for the first $5,000 which was easy to do and met my deductible in February of 2008. For the rest of the year I did not lay out a red penny. Drugs, radiation, tests were all covered 100%. Even treatment at Sloan Kettering and Stony Brook were all ‘in plan’. Today my premium is $155 and is going up to $177 in March of 2010. Meanwhile I have friends who are paying $800 to $1,800 for their insurance plans with $20 and $30 copays. My insurance plan is through GHI which is now part of Emblem. There are numerous other companies that offer this type of insurance of high deductible with low premium and HSA account options. Have I had any problems? Until now no. Currently I am fighting with them for an approval on my semi annual PET scan which they have denied 3 times in a row. I am appealing it, playing hardball with them and will get the test. The PET scan which normally costs $7,700 will cost me out of pocket $2,400 because of the insurance. So i can't understand why they are objecting to it, but every company has it's stupid bureaucracies none of which will ever compare to the nightmare of any government run program. I highly recommend taking control of your own health insurance and your own life. It is not the responsibility of your employer to cover you and certainly not the government. It is your life and you are the only one who has a vested interested in protecting it and caring for it. You don’t file an insurance claim for a $20 oil change but you do for a major car accident. Same thing applies to your health. An occasional $50 doctor visit is something most of us should be willing to pay for. But when we hit the lotto, and the card says “you’ve got cancer!” you’d better be covered. Love to all, Jacques Ditte

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Hi Jacques, Thanks for sharing the info about your plan, that's encouraging to hear. I'm glad its worked out for you - so nice to hear a good story about health insurance these days. I hope you're doing well. Take care, Melissa
I think it's a terrific option and smart way to go. You have a lot more control over your costs and your doctors.
Dear Jacques; I posted your note on another blog and they have been thanking me profusely for that very well explained healthcare option. You are a dear. I am Canadian and believe me, it is always hard to understand the fine print. I can see you are determined to look between the lines for the truth. Thanks from my American friends.
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Vital Info

Posts

March 23, 2008

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Hampton Bays, New York 11946

June 11, 1959

Cancer Fighter

Cancer Info

Throat Cancer

Metastatic Squamous Cell Carcinoma with Occult Primary.

February 8, 2008

5.1 - 6.0 cm

Yes

Lymph nodes on neck.

Stony Brook University Hospital. Department of Radiology

You never know how strong you are, until strong is the only choice you have left.

June 4, 2008

Swollen lymph node on the right side of my neck. Post surgery, official classification TX, N2b, M0

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