Health Insurance What Would You Do?

Updated on April 29, 2013
A.J. asks from Norristown, PA
20 answers

We've been stalling for years on health insurance due to other debts (mostly medical!). We've finally paid off three out-of-pocket child births including whopping emergency c-section bill, a few out-of-pocket emergency room bills, some back taxes (long story-way more than we should have owed but my clueless ex had a bad accountant who SCREWED his band finances royally) other words we've been paying off BIG debts monthly for many years and we're finally debt free.

We are now able (barely) to afford a family insurance plan with a $10,000 deductible which is basically catastrophic, since our appointments and prescriptions each year do not amount to that (not even close). So we'd still be paying all of our medical costs PLUS adding on the monthly premium which is $650/month (much better rate than used to be available). We are not poor enough for any assistance, but we are not rich enough to afford that with ease either-we'll be majorly biting the bullet. Our budget is very basic and we already cut everything we could to pay off other debts barring kid's piano, violin and Tae Kwon Do lessons which run about $250 per month for two kids, so even if we cut those, it wouldn't equal the insurance, but we will cut those if we need to.

We are all healthy and need the insurance only in case of major calamity at this time. Knock on wood. I was all ready to pull the trigger and start the insurance when:

I just had my yearly gyno exam and tests where I was strongly advised being over 40 I need a mammogram and colonoscopy. Those are a few thousand dollars each. Even if I HAD the insurance, the six to $8000 would not meet the deductible, so I'd be paying for those PLUS monthly premium and all other family medical costs for duration of payment installments on those procedures. Those are preventative, nothing is wrong that I know of, so it's tempting to put them off.....

Obviously I cannot afford new monthly $650 insurance premiums PLUS $8000 in tests, PLUS all other appointments. Who can? So. Should I:

1) Get the insurance and forget the mammogram and colonoscopy? Or
2) Get the mammogram and colonoscopy and put off insurance for another year and 1/2 while paying those down?

I can't do both. I'm inclined to buy the procedures since letting time lapse won't make them more affordable, but I don't feel right leaving my entire family uninsured while I have those done so I probably won't get them. However, we have been uninsured now for so long just paying out-of-pocket for everything....what's a couple more years....?

Survey, which would you pick?

What can I do next?

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So What Happened?

Wild Woman, I'm still divorcing-but the agent I talked to was recommending family coverage anyway for now. There are some valid points here especially regarding follow up care if I do tests uninsured...I am using the best broker in area according to several people, but I guess I should keep looking for better coverage. I'm 43 and adopted so no known medical history, but on "young" side for the colonoscopy but doctors here are now recommending it at that age but maybe it can wait...thanks everyone!

Featured Answers



answers from Des Moines on

They have low tech colon screening where you put a stool sample on a test paper and they screen for blood. I'd do that and skip the colonoscopy. Besides, it's usually recommended to have a colonoscopy over age 50 not 40.

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answers from Portland on

I just learned that there are offices that will help you find the right insurance for you. They contract with numerous companies, have all the data on all of them, feed your information into a computer and out comes the best companies for your situation. Then they discuss your options.

The insurance companies pay them. It costs you nothing. Here in Portland, OR area my cousin and I went to one called Willamette Valley Benefits. They're a broker that represents dozens of different companies including all the major ones.

I found them, just now, in DEX by searching first for insurance brokers and then alphabetically by their name. I don't know an easy way to weed out the brokers with limited connections.

I also found a site that states they give quotes on line.

Finding Health Insurance 1 (888) 361 2193
America's #1 Health Insurance Site. Compare the Best Plans Instantly!

I, too, suggest that you can get better coverage for less.

BTW I've had both procedures and tho they were covered by insurance I was sent a statement telling the full cost. I don't remember the numbers but I do know that it was considerable less than what you quoted. And many offices will charge less if they know you don't have insurance.

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answers from Chicago on

I'd look for a different insurance policy, and then I'd start calling around and asking the cash price for the procedures. I do one procedure this year, and the other the next year.

from what you said, a lot of your debt was medical. Congrats on digging yourself out of that hole. If you don't get insurance, you could easily put yourself back in that hole. One hospital stay could bankrupt you......

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answers from Phoenix on

Fina a different insurance policy. My husband and I have before had to carry individual health insurance policies for ourselves and our family. Our monthly premiums were less and our coverage WAY better than what you're talking about. Not sure why you feel this is your only option, but it sounds like terrible coverage. Call a local insurance agent and ask for quotes from several different companies. The company that provides your car insurance can recommend an agent for health insurance.

6 moms found this helpful


answers from Los Angeles on

Congrats on being debt free! Sounds like it was a major undertaking and you should be proud that you've come out on top.

I always think having insurance is better than not. If something does happen, it is so much better to be covered.

While I absolutely hope this scenario doesn't come true, here is something to think about: Imagine you skip the insurance and get the mammogram and colonoscopy, and one of the tests detects cancer. Now, you've paid for the tests, but can't cover your care.

On the flip side, you can pay for the insurance and ask the doctors why they so strongly recommend the tests and assess whether you have any specific risk factors aside from your age. If age is the only reason they're recommending the tests, you can put them off for awhile. Have the doctor do as thorough a breast exam as possible and also a quick rectal (not pleasant, but only a few seconds).

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answers from Bloomington on

I do agree that ypu should keep looking for other insurance options. I assume neither you nor your husband have insurance through work?

Also be sure to read what the insurance plan covers. I believe almost all insurance plans are supposed to cover preventative now and a mammogram falls under preventative. Not sure about the colonoscopy since you are under 50.

I have a high deductible health plan (not 10,000) but it is a really good plan through my employer, I couny my blessings that I have such a good plan for such a reasonable price as I know not everyone does.

Keep looking at your insurance options. I do believe that having insurance is the responsible thing. if something were to ever happen to you or your husband you would not want your family to be responsible for catastrophic medical bills. If you plan to cover that with life insurance you would.most likely want a million plus.

good luck and I don't envy your decision.

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answers from Eugene on

I'd get the insurance. Mine costs $263 just for me with 10K out of pocket. Why bother? Because I had a friend in a car accident that cost a million dollars in medical. It wasn't her fault but the other driver's insurance wasn't enough to cover it. And a young man in our town had a snowboard accident and no insurance. He was able to get emergency care but none of the nursing homes would take him after that because he had no insurance.

My insurance covers some of those medical tests, a well woman exam every year, mammogram, bone scan, a few others. I think some of this is required of the insurance companies and may help make the premiums worth it for you and your family.

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answers from Abilene on

I am sorry you've had to dig out of debt like you have! Congrats on getting it done though. I don't know which I would do, but I'd like to make a couple of suggestions.

I was told at my annual the time frame for a colonoscopy is 50 unless you have issues or a family history of colon cancer. Since you're in your 40's you might be able to skate by for a few years on that one. As far as the mammogram, I would call and ask them what their cash price is. Most doctor offices/clinics have different fee schedules. That might also be something to consider for your docs that you see routinely. Most of the time I have found offices to be easy to work with. You might be able to negotiate a price with the colonoscopy as well if there's circumstances that warrant that test sooner than later. You can also contact the American Cancer Society to find out if there is a clinic in your area that does mammograms at a discounted price.

I tend to be over insured. I am self employed so I pay ridiculous premiums too. You have already demonstrated you can dig out of medical bills, and like you said, a $10k deductible is HUGE! I think I would continue to shop for insurance. My sister had a similar catastrophic policy through Blue Cross Blue shield and I think it ran @ $400 p/month. I know medical history can drive the costs up, sorry you're faced with such a tough decision. Another thought is splitting your family up in insurance. For example if there is one person in your family who is driving the cost up, it might be worth looking into writing the other family members separately.

Hope I've helped a little. I hope you come to a solution that isn't such a hardship. Please take good care of yourself and get your mammogram done. I've lost 2 very dear friends to breast cancer.


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answers from Dallas on

I am going with "find a different insurance plan" My husband has my children and he on a private HDHP that we pay for (not sponsored by his work). The cost is much lower and it covers preventative health costs and tests (when I was on it, it would cover mamos, etc).

Additionally, even with a high deductible, there are other benefits of carrying insurance, negotiated rates with physicians, preventative care covered at 100% and lower costs on prescription drugs - to name a few.

If the plan you are looking at doesn't offer this - keep looking.

Good luck.

Saw your SWH. Don't mess with a broker. Go online and do your own research and cut out the middle man. That is what we did and had much more success. :)

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answers from New York on

I'd say to forgo the testing. There's a history of colon cancer in my family and my pcp (who balances testing cost vs benefit) waited until I was over 50 to have my first colonoscopy. My insurance paid it 100% so cost wasn't a factor. With the mammogram they are just doing a base view so they can use it to see any changes for future mammograms.

In the meantime, look for better coverage. A lot of the insurance offers routine care paid at 100% with no deductible so that would cover your mammogram and colonoscopy in full.

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answers from Miami on

Get the insurance, now.

Then for the next few months tuck money away to pay for ONE of the procedures. Ask your doctor point blank which one he or she would recommend if only one can be done. If something runs in your family, it's an obvious answer. If your family is generally healthy, then your doctor will recommend based on your "health statistics". My guess will be the mammogram, but who knows.

The reason I say this is simple. What IF (and I mean "if") something comes up on that procedure? What IF you have to see a specialist for two or three years? If that's the case, you WILL NOT qualify for insurance with a pre-existing condition. You need to be insured before the procedure to have any follow-up treatments covered.

DO NOT leave your entire family uninsured.

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answers from Phoenix on

The whole point of having insurance is to put the financial burden on the insurance company and not yourself. You have already experienced this. What if your tests come back positive for cancer? It will cost you a LOT more than $650 per month and a 10k deductible is nothing. It likely could ruin you financially. Do not go without insurance.

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answers from Washington DC on

Read this book: Bargaining with our lives by Jennifer Heyns.
Lots of info.

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answers from Las Vegas on

We had to buy our own insurance for a long time and we found that in fact you CAN negotiate prices of things. E.g. my husband needed a CT scan last year and the hospital wanted 1,000s of dollars for it.. We found a place that IF you paid cash, we could have it done for $250 to $500.00 Additionally, this has been the case with another MRI that he needed... CASH is still king..

As for the Mammogram...... I think they do a lot of scare mongering when it comes to those (see DrMercola.Com) he writes about the Do s and Don't s of the exam and IF in fact it's truly needed every year. Personally, I don't do one a year......... and have only ever done one in my life. I am now 49... However, some will say if you have breast cancer risks in your family, then do it. BUT keep in mind.. there are LOTS of places that offer them for free or at a discount. it's the HOSPITALS that charge up the wazoo.. that is because they have HIGH admin costs.. forget the red tape and all that. ALSO, if you need a blood test.. go to one of the small clinics, I can get one for say $45. whereas the hospital was gonna charge me $600.00
As for the Colonoscopy.. More scare mongering..........

I say.. pay your debts.. SHOP around... don't go to hospitals for exams that can be done cheaper by clinics and frankly, you get the results much quicker..

Also, not sure if your kids are in private lessons and or group.. if in private, you could put them in group and it might be cheaper..

I guess I am for survey # 1 (because you can get both those exams for cheaper IF you go to clinics) Plan Parenthood who boast that that is their mainstay in mammograms and not other "services" is a possible place to get one... also, don't be afraid to ask for a discount at the doctor's.. we do it with our dentist when we need to.... especially since 4 of my family members see her... she'd rather give us the discount than lose the biz to another dentist who will..

shop around....

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answers from Washington DC on


I'm glad to hear you aren't divorcing your husband. That's nice!
Congrats on being debt free! it's a wonderful feeling!!!

Contact each office that will do the mammogram and colonoscopy. Ask what discounts they do for cash only patients. You might be surprised at what they will do for you.

As to insurance? 0bamacare isn't going to make insurance more affordable for you...prices have only gone UP since portions are being what you can afford now. Get your kids on the state medical care and figure out what you can do for you and your husband only. Shop around. There are companies out there that are NOT fly-by-night companies...some do the "pool" or "grouping" of individuals and that helps keep costs down.

What I would pick? Insurance. We chose that when my husband was unemployed for 10 months. Yes, we paid for it. $1,500 a month. But it was worth every, thank God, we did NOT have any catastrophic problems during that time - but they would have been covered.

Good luck!!

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answers from Cleveland on

Can you add how old you are? I'm mid 40's and have insurance so my doctor knows it won't cost me anything and he's never recommendeded a colonscopy. My sister is only now supposed to get one at 50. And we have a history of colon cancer in the family. Not extensive but an aunt died of it. I would hope you can skip that. The mammogram I'd worry more about so I'd get it, pay for it and then start family insurance if you can't find a better policy in the meantime.

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answers from Pittsburgh on

First off, I hope your children are enrolled in CHIP which would leave just you (?) to be covered. Then I would shop around for a better plan for myself, although I understand that that is easier said then done.

Like somebody said, colonoscopies are not standard until the age of 50 so unless you are having an issue, I don't see that as an issue.

As for the mammogram, I believe 40 is standard.

Regardless I do not see health insurance as optional so I would say go with the insurance BUT find a better plan. (and I wish you lots of luck there, Nobody should have to make such a decision and settle for a crappy plan.)

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answers from Pittsburgh on

The short answer - I would NEVER let my family go without health insurance. Period. We could easily lose our house and my son's college savings and our retirement with a single health catastrophe.

First, routine colonoscopy is generally not recommended until age 50 unless you have a family risk. The U.S. Preventive Services Task Force mammogram guidelines recommend women begin screening at age 50 and repeat the test every two years. While other guidelines are still for age 40, there is not conclusive evidence to support this. Again, if you have a family history, you should have it done earlier. So unless you have a family history of genetic breast or colon cancer, neither screen is urgent.

Next - you need to look for a better health plan. Thinking that you anticipate $8000 in expenses for you alone this year, you can reasonably look at plans that cost up to $1300/month ($8000/12 + $650). I would be fairly certain you should be able to find a decent plan for less than this. Also - what about your employer? Even if he/she will not pay the full price, if you can enroll in a group plan through work, you and your employer can share the cost and group plans are generally less expensive.

Finally, family plans are often more than individual plans on a per person basis. Insurance companies can safely assume that if you are employed you are not likely to be deathly ill. You might look into an individual plan through your employer's group at work and separate individual plans for the kids. My son has his own plan - it costs $169/month and he cannot be kicked off until he reaches 26 years of age. No deductible, low co-pays. Can't beat it.

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answers from San Francisco on

With my insurance, (Blue Shield) preventative care is covered 100% and does not apply to the deductible. So, you may be able to do both - get the insurance and still have the preventative procedures.

If not. I would get a plan that paid 100% of preventative stuff. As soon as it goes into effect, have the tests. Then, in a month or so, call the company and change the coverage to this $10,000 deductible catastrophic coverage.

May not really be the RIGHT thing to do, but we gotta do what we gotta do.

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answers from Oklahoma City on

I would not be paying this much for useless insurance. There's no bill other than a super bad issue that is going to even come close to the deductible you're talking about.

Find a different provider. Good Lord! I've never heard of such bad insurance.

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