January 28, 2012

I Hate Insurance Companies

I re-watched part of The Incredibles yesterday, which was a mistake since I needed to look over a dental plan option today. In The Incredibles, the dad of the family works for an insurance company, and legitimate claims are being denied left and right, and the boss keeps saying he doesn't care if it's a legitimate claim, DENY IT!! Make it IMPOSSIBLE for the clients to figure out how to get what they paid for!! Or else you're FIRED!! (The Incredibles dad eventually loses it and throws the boss through several walls, which is satisfying.)

Anyway, the forms. I can't tell if it's worth it. FIRST, the dental plan collects $1,700 per year from us. (There's no employer contribution, though it's "through" the employer.) THEN, if I understand the simple, easy-to-read charts correctly, they cover what they feel like covering, at the percentage they feel like covering it, up to a maximum of $1,000/year per family member. And next year, we'll get a letter from HR saying that the rates have doubled. Is that a good deal, or not?

We might have economies of scale going for us, here, since the amount per year is "per family." So, for a family of four, maybe they don't use more than $1,700 in coverage (plus the co-pays and deductibles) most years; but for a family of seven, we can use that in annual check-ups alone. BUT: although the cost is per family, the limit is still per person.

AND: it doesn't cover our dentist. Or any dentist I've ever heard of. So we'd have to switch from the dentist we like to an unknown dentist, and then we add to our lives the SHEER RAGE of finding out after every check-up that we weren't covered for what we thought we were covered for. Not to mention that I don't see how I can get two check-ups/cleanings/x-rays and maybe a filling per year and still have much left of my personal $1,000 maximum to pay for, say, a crown.

Also, if we have insurance, the dentist will switch their view of us from Poor Unfortunate Uninsured mode to Milk-Cow mode. Currently, our dentist looks at our file and says "...Oh. No insurance. Well, if you like, we can wait on those x-rays until next time." Or if I don't want a certain procedure considered essential for EVERYONE living in a country that has already greatly shifted the definition of "basic care," I can say regretfully, "No dental insurance," and they back right off: I mean, you either have that kind of money or you don't. But as soon as I have insurance, it doesn't matter if it costs $1,700/year before I get any benefit at all, and it doesn't matter that a procedure isn't covered or is only covered once every four years at 50%, suddenly we "have dental insurance!" Which sounds like "Everything's free!" to us, and like "Switch to Luxury Level dental care because everything's paid for!" to the dentist.

And it's hard to collect information from other people about whether coverage is worth it or not, because hardly anyone (including me) sits down and figures out the math. So if I asked you right now if it was worth it, you might say "OH, yes, TOTALLY!"--and yet you could be WRONG WRONG WRONG. Say for example you've for years been spending $1,700/year on coverage for $1,000/year of benefits (in other words, losing $700 a year on the deal), but then one year you needed a $4,000 procedure and 80% of it was covered so you only had to pay $800, WHEW. You no longer even notice the monthly payment taken out of your check, but you DID notice the huge relief of not having to pay the $4,000---so you might feel as if the insurance was totally worth it. And yet you wouldn't even have broken even: your costs would still have exceeded your benefits. (And now you're not eligible for that $4,000 procedure for another 6 years.)

(And also, even THIS happy story wouldn't apply to the plan I'm looking at this morning, since benefits cut off at $1,000/year/person, so that $4,000 procedure would be covered at $1,000 minus the dental care covered that year---or, about $700, say, at absolute most, with the other $3,300 due to my dentally-insured self.) (This really isn't sounding like it's worth it, as I type it out.)

It's also complicated because with health and life insurance, you may have heard the expression "a gamble you WANT to lose": that is, we don't mind if we put in more money than we get out, because the only way for the insurance to be a good deal is if we have a serious problem---and we'd rather lose money on the deal than get cancer and/or die in order to come out ahead. This is NOT the case with dental insurance: especially with a $1,000/year maximum per person (i.e., when we can't think of it as "But in a big dental crisis, we'd get a huge benefit out of it"), we DO need to come out ahead for it to be worth it.

I am going to see if I can do this math.

$1,700/year for $7,000/year maximum coverage
but the $7,000 is misleading because it's $1,000/person
and most of us won't get anywhere near $1,000 in a regular year
and remember we sometimes have to pay a percentage of a procedure
but we get our xrays/cleanings 100% covered
(as long as we don't get them done too often)
and if we needed fillings, we'd get more benefit
but sealants are already done for $20 through the school system
and we'd have to switch dentists, which I don't want to do
but soon Paul and I will be needing more serious work
but it's still only $1,000/year coverage for each of us

No wonder nobody does the math. It's not math, it's a LEAP OF FAITH. A leap of faith into the arms of companies we know make a huge profit. And that profit is COMING FROM SOMEWHERE, which is an equation I CAN do.


Sally said...

Oh, I totally do the math. I have either terrible teeth, terrible dental care habits, or both, so I often end up having to get fillings, etc. What I did was estimate what my family was most likely going to need to do at the dentist this year. (2 checkups/x-rays for each of my children and my husband, all of whom never need extra work. 2 checkups/x-rays for me plus a few fillings). I figured out, based on past experience, about how much we'd pay out of pocket for that. Then I figured out how much we'd pay for it if we had the insurance and added the cost of the insurance to it. We came out just barely ahead. Then, I factored in that if my kids needed something extra, it would likely be covered, even though I am no doubt going to hit my max, they each have some wiggle room left. So, really, I'm buying the insurance just in case my kids need extra work done.
But yes, it really does seem like a damned if you do, damned if you don't situation. I'm not sure what I would have done if it had also involved switching dentists.

Jody said...

We pay only about $1300 a year, for a family of five, and our $1000 maximum per covered member rolls over if we don't use it. So the year that the children had no cavities allowed us to bank funds, and then the year that OMG their crappy enamel collapsed and one of them had FIVE cavities because she doesn't brush worth a darn? That was all covered because we dipped into the banked/rolled-over max.

Of course, it all depends on your insurer.

Also, we will get $1000 each against the braces we're about to start bleeding money to fund, and that doesn't count toward the yearly limit.

I totally do the math on dental insurance. I'm not sure I would buy the particular plan you are being offered.

Beylit said...

This made my head hurt. Math and I aren't friends, nor am I friends with the dentist.

We've had dental insurance for years. I have no idea how much they take out of my check for it, and we never really go to the dentist, I just have it in case of an emergency. Of course that is why I spent like 6 hours in a dentist chair back in December and had multiple crowns inlays and fillings all at once, plus some extractions that were years overdue. But without insurance that bill would have been around $12,000 but with insurance was only just under $4,000.

Whatever they are taking out of my check is worth it. Plus I know with my insurance that my two cleanings per year, for me and the husband, are covered for free. So it seems like a decent deal to me.

Yo-yo Mama said...

Let's step back to the 1000 coverage. If you see a dentist that is in network, that 1000 max actually can stretch out to cover anywhere up to $1500. How? If the exam is $100 and the dentist is in network, they will have a contract that states the dentist accepts, for example, $50 from the insurance company as PIF.

Also, your teenagers will soon be getting their wisdom teeth. They are expensive mo-fos and your $1000 will cover about half if you decide to treat your kid to anesthesia. Plus, if you have medical insurance, you may find they are dual benefits for that surgery.

I see patients all day that are from both camps. Both feel they are getting the short end of the stick. You're not asking for an opinion, but I'm going to give one: $1700 for family of 7? I would take that in a heartbeat.

Sarah said...

I believe the real question is WHY ARE WE STILL USING THIS BULLSHIT FOR-PROFIT INSURANCE SYSTEM IN THIS COUNTRY?!? Oh, I know why, because have you seen how our math scores rank when compared internationally? Yeah, we're still trying to do the math. Meanwhile, the rest of the industrialized world figured out they were getting SCREWED.

Anne said...

I'm extremely confused. And just ran into a dental insurance issue myself, where my dentist only does the white fillings, but the insurance covers those at a lower level than the silver ones for back teeth. In other words, no one is giving me a choice. They are ALL out to fleece us!!

Portia said...

Dental insurance seems especially scam-y to me. I don't have it, because the plan that my university offers isn't a good deal for me, but my boyfriend had a plan through his employer where he paid a certain amount for a basic plan that covered two checkup/cleanings/x-rays a year. He and I went to the same dentist, on the same day, and had the exact same procedure done (cleaning/x-rays). When we got our bills, mine was significantly less than his. They charged me, like, $150 and him over $200, because of their "sliding scale" for insured vs. uninsured. Which in theory sounds generous, but in reality means that my boyfriend wound up paying more for the visit PLUS his insurance premiums. He would have saved a couple hundred by not having insurance at all. Scam, scam, scam.

...That being said, your plan doesn't sound like such a bad deal. But I have no idea. Sigh.

LDiggitty said...

I work for an auto insurance company, and I pay claims every day. It doesn't affect me (or my bottom line) if a claim gets paid or not. Claims only get denied if they're not covered for some reason specifically outlined in the policy.

Now, auto insurance is clearly different from medical or dental. It's heavily regulated because it's state-mandated - it's illegal to drive without auto insurance and, because the government requires it, the government has a duty to regulate it.

The government's ability to monitor misconduct is greatly reduced in the for-profit sector. The best way to protect consumers is to bring some governance into it, but for some reason people are scared of that.

It works VERY WELL in the auto insurance world. Consumers have to be treated fairly, there are strict regulations, and insurers pay heavy fines if they don't act in good faith.

My question is: Why do cars get treated better than people?

Anonymous said...

insurance, bah. i just had a horrible experience w my health insurance, where i was told, yes, you are covered for this service then, no, you are not (after I went ahead with the service), then, oh, yes you are (partially) after i complained. i think the portrayal of insurance companies in the incredibles is pretty accurate: they'll try to deny EVERYTHING they can, and then only cover if you make a GIANT and PAINFUL effort to prove that you are, in fact, covered.

regarding the dental insurance: you should look into a private plan (i.e not through your employer). my family did a private plan (only 3 of us, though) and it's $400/year. for that we get 2 cleanings and one set of xrays each. i'm sure any other coverage is paltry (maybe some discounted services?) but for the basics, we do come out ahead for $400 (i figure $120 or more per cleaning, right?). i don't know anyone who "gets" dental insurance with their regular job benefits anymore. my job doesn't offer ANY health benefits AT ALL anymore, so we pay for that privately, too.my husband gets medical through his job, but i would cost my little one and me a fortune to be added to his plan. the thing that is weird about that is our HMO that i pay for OOP is that it's CHEAPER than when i had it through work (a group plan) even with my employer contribution. our health care system is F'ed.

kate said...

I work in benefits, and the problem with an entirely employee-paid plan is that the insurance company asssumes that everyone who elects the coverage is going to use it, so its expensive. And because dental work can be planned - I'll do that crown next year - lots of people just hit the max year after year.

Your plan is probably worth it and Yo- Yo Mama makes a good point about in-network discounts, but if you need help with figuring it out, I'm happy to help.

Lest you think I'm pro-insurance companies, I'm totally a fan of national health care. But realistically speaking, dental insurance is not really "insurance", the way that healthcare is.

Marie Green said...

David just went from being self-employed to have a job, so we had the option for dental insurance for the first time, EVER. We declined it though. Luckily I am married to a human calculator that ENJOYS figuring this kind of stuff out, and he figured out that even if we had something big, it STILL wouldn't be worth it.

He also calculated that we should buy the health plan that has a HIGHER deductible b/c NO MATTER how much our medical bills for the year are, we'll STILL be ahead with the higher ded. OK. I won't argue. Especially since you have the spread sheet to prove it, sir.

Wendi said...

We have to buy our own dental insurance and for years, that's what I did. Every year the premium went up drastically, until I decided to look into switching.

For me, what affected my decision was how long certain benefits took to kick in. I've never had more than a filling -- usually just cleanings and xrays every year -- and those are covered right away. But my husband is more involved -- extractions, crowns, bridges, etc. All that stuff usually has a LONG wait before he gets benefits -- sometimes as long as 18 months.

We ended up going with a dental plan because there was no wait for services, and he needed stuff done ASAP. Premium is so cheap -- around $150 per year or less -- but you pay more for the services. However, you only pay if you actually need the services. For us, this ended up being cheaper.

I get cleanings just once a year (saves money) and Dave just pays when he needs specific services.

Snoopyfan said...

Swistle it sounds like you understand insurance perfectly. It is there if you need it and the money you pay is for the peace of mind that it is there if you need it. It does not matter if it is life insurance or auto insurance or dental insurance. If you never use it, you are out the $$, but if you need it, you are damn sure glad to have it!!

Swistle said...

Snoopyfan- I think what makes this different from other kinds of insurance is that the limit is $1,000 per person year. So if I ever DID really need it (like with major dental work), it STILL wouldn't really help!

Jessica said...

This is why we don't have a family dental plan. My husband and I each have single dental coverage through our employers and the kids don't have insurance. Currently I pay nothing for my plan and he pays $5/mo. The family plan at my work would be the cheapest ($35/mo - employer subsidized). Our kids are 2.5 and 7 months, though, so it's totally not worth an extra $30/month to get them dental coverage. I pay $80 out-of-pocket for the two-year-old's checkup (and she's too young for x-rays), then hope she doesn't fall and smash up her mouth or anything expensive!

I have kind of crappy teeth, so even if my employer didn't pay the $30 for the single person plan I would. I usually reach the $1000 maximum. (I'm getting a crown on Monday...)

I'm confused as to why your family plan costs so much anyway...the dental plan pretty much everyone has here is $30/month for individuals and $65/month for families (my employer puts $30 toward either plan). You would think since they're practially the only option in the state they could jack the prices, but maybe they use the power to screw the dentists instead:)

Carolyn said...

My husband's company doesn't offer dental insurance, but I have crappy teeth and needed SOMETHING so I could go in for a check up! I ended up getting a discount plan (so it's not insurance, you just get discounted prices on stuff) and I chose the plan that was a nice balance of being cheap for preventative care, but also cheap for the crowns and fillings I know I'll need sometime soon, too. It might not suit your needs at all (BOY did I get confused just trying to figure your insurance out!) but it certainly is more straightforward (the prices for common procedures are listed out, and everything not listed is 20% off the usual price) and depending on the plan, about $200/year for a family of any size. So, dentalplans.com, might be something to look into! Good luck figuring it all out! :)

Jessica said...

Uh, that smiley face doesn't mean I approve of them screwing the dentists - I was supposed to be a knowing look to show I'm aware the insurance is always screwing SOMEONE even if it doesn't look like it.

Aneets said...

Reading these kind of posts makes me so happy to live in Australia. I don't know how anyone affords basic health care in the USA- it is so expensive!

Swistle said...

Jessica- It sounds like part of the difference is that the ones you're familiar with are employer-subsidized, and the one we're being offered is not. Kate above had a good explanation: if it's part of the employee benefits, maybe a lot of people won't even use it; but if it's totally optional, the only people who choose it will be people who use it---so it has to cost more to adjust for that.

Magpie said...

My office offers lousy dental, so I just don't bother. I love my dentist, he's a catty poofta and very good at what he does, so I just suck it up.

Why are teeth and eyes not part of the body for the purposes of insurance? That's the part that makes NO SENSE.

Josefina said...

Magpie, that's what my father snarls about, too. Also feet, he says. I haven't run into this, but he claims feet are treated similarly to eyes and teeth if the feet in question are troubled due to diabetes, for example, and need special attention.

I love Sarah's comment about our TOTALLY LAME for-profit insurance industry and our nation's apparent inability to do math. HA.

Suzanne said...

Anne - I had the exact same thing happen! My insurance only covers white filing for "front" teeth but my dentist doesn't do silver filings so I had to pay 3x as much to get them done.

Of course the practice DID have ONE dentist who does silver filings but his next available appointment was two months later and I'd need to get a babysitter. The lady at the desk looked at me like I was crazy for even asking.

Swistle, I have GOOD dental insurance and I still end up paying hundreds of dollars a year. I don't know if there is such a thing as a good plan in this country.

Superjules said...

Insurance is such a racket.

M.Amanda said...

I'm not ashamed to admit that I've gone to my friend in HR, stood in her office explaining that our insurance plan has me all confused AGAIN, and cried a little. It's happened more than once. She never makes me feel foolish for it, either, not because we're friends or she's such a nice person, but because this is a reaction she has seen so many times that it is normal. Insurance is horribly confusing. And that is part of the healthcare reform that we really need in this country.

Megan Smith said...

I had some crap dental insurance where they wouldn't pay for ANY of the cleanings, xrays or regular dental care. They would only pay for the big procedures and only then at 50%. It does seem like a scam in that they don't want to pay for the PREVENTATIVE care so you don't have to have the awful, painful procedures like a root canal because you can't afford $250 for a simple cleaning.

nicole said...

We just added dental insurance last year. Previously we felt it was not worth the money, but our premiums are really low now. Also, we really had to start taking our kids to the dentist. They will all need orthodontic care too, eventually. Our coverage is average I think. And our dentist is not a preferred provider, but we choose to pay the difference for the care. We had gone to group practice (like the Care Now of dentistry I guess) and were unhappy with the care, especially for kids. Our dentist knows we have insurance, but also that it is crap for anything beyond basic care (like most dental insurance it seems) so they still work with us on cost. I think you should talk to your dentist's office before you decide. Ask them how costs would change with insurance and if they would still be flexible in their approach, even with insurance.

Maggie said...

Am so late to this, but I've never been able to resist any rant about insurance because IT'S ALL CRAP!

Sorry to shout, but UGH. Health insurance, dental insurance, car insurance, homeowners insurance, I swear every interaction I've ever had has been frustrating, unsatisfying, and rage inducing. I assume even writing this comment will result in an increase in my insurance rates somewhere... ARGH.

misguided mommy said...

My brain hurt so bad reading that. Seriously I have no idea what on earth you just said.