Medical Benefits

Can someone please explain to me why I pay over $1200 a month for medical benefits just to pay a $500 deductible, then to pay for 20% of my bills after I've reached my deductible? Keep in mind that the deductible is for each member of my family. I'm so angry about the cost of medical benefits.

My son has illness-induced-asthma, which basically means that any time he gets a cold it quickly and easily turns into an infection in his lungs and can literally progress to pneumonia in a matter of 48 hours. It is a scary thing, especially before we knew why this occurred and how to help prevent it from progressing so quickly. So, he has a cold and a nasty sounding cough right now. Luckily he had a regular check up with his allergist on Friday, copay $20. He already takes 3 maintenance medications to keep his symptoms under control, those cost about $75 a month, just for our copay. Now since he has a cold, he is taking an additional steroid, $40 copay, and breathing treatments with two separate medications twice a day, each with a $25 copay. Thanks to one of my friends for letting me borrow her old nebulizer (I'm not sure how to spell that) to give him these treatments. But I really need to get my own machine, which can't even be billed to the insurance, so I have to pay for it out of pocket, then try to file a claim to be reimbursed for it. What is this out of pocket expense? A measly $130. So basically, I have just given almost my entire monthly grocery budget to the pharmacy ($75+$40+$50=$165). Now, we aren't including the medications that my husband needs to stay healthy or the medications that I take to stay healthy or the fluoride supplements that both of my children take for strong bones and teeth ($45+$10+$30=$85).

So, where is my $1200? I understand that these out-of-pocket expenses that I am paying are only a portion of the entire bill . However, the insurance company is contracted with providers with how much they "allow" the provider to bill them. After reducing their cost by about 40% (this is what I have observed on my bills), they pay their 80% of that, then the provider bills me the rest. I just don't get it. Now, this month I have used my insurance at least twice as much as on average. On average I only have about $150 in pharmaceuticals. But this month, I have $165, for Taylor's medicine +$55, for Josh's and my prescriptions +$30, for the kids fluoride +$60, doctor copays for this month =$310. So, say hypothetically, that $310 is 20% of this month's total bill, that means that the insurance company paid $1240 on behalf of my family. Like I said, this is about twice as much as we usually spend, due to illness. But, I have paid $1200 per month for 10 months this year, totalling $12,000 so far this year. Three times this year I have incurred approximately $1550 in bills, equalling $4650, plus $750 per month for the other 7 months (assuming 80%, insurance company's prescription costs), adding to $5250. So, the insurance company has paid, on behalf of my family, $9900 this year. But we have paid $12,000 is premiums this year, so as I see it, I still have $2100 that I haven't used of my premium. So why can't the stupid company pay for the nebulizer? I don't know.

I understand, given my logic above, that we are awfully close to meeting our premiums for this year. But consider that for many years, Josh and I have paid premiums of around $600 per month without incurring even $300 in costs in a year. It just doesn't balance out.

I really hope that should Obama win this election, he can follow through on his campaign promise to reform the health care system in this country. Especially when you consider that 75% of all bankruptcies filed in this country are middle class Americans with health insurance, like myself, buried with medical bills (prior to the economic crisis and mortgage crisis). It just doesn't seem right.