Tuesday, December 15, 2009

Medical Plan Complaints

And maybe some remedies.

In a thread due south of here:

I don't get "whining" about inanities being equated with being pissed off about the copay for Rxs at all.

Here's the deal: it's the thin edge of the wedge. That's why it's worth "whining" about ...

When I was a story person back at the Dawn of Time, the Motion Picture Industry and Health Plan was generous with the medical bennies.

* You didn't have co-pays for prescription drugs. Any kind of prescription drugs.

* Emergency Room visits were free of charge.

* Doctor visits were (almost) fully paid for.

* Minimal amounts were paid for hospital stays and surgeries.

But that was then and this is now.

In 2008, the Motion Picture Industry Health Plan was staring at a $528 million deficit over the next contract cycle (three years) and had to take action. Our Mother International negotiated higher contributions from the producers, but was also forced to "redesign" the Plan.

I won't beat around the bush. "Redesign" is a euphemism for "cutting expenses and shifting costs." The Motion Picture Industry Health Plan is going through the same doubling of costs every nine or ten years that all health plans now endure, so coverage ain't what it used to be. (Big surprise.)

Okay, there's your explanation about why health coverage is eroding, but what's the remedy to this problem? Below I give a few thumbnail solutions. (Feel free to click to the Health Plan's website for more detailed information.)

Prescription Drugs

Co-pays have gone up, so to maximize savings you need to go to the mail-order Pharmacy MedCo for all or most of your prescription drug needs. The Plan now pays most generously for generic versions of drugs, so that is the way to go for the most bang for your buck. (It's $25 for a three-month supply of popular generics. I've had zero problems with getting my drugs by mail. For long-term prescriptions, it's the way you will have to go, because the Plan will only pay for two prescriptions at your neighborhood pharmacy.)

Doctor Care and Services

There are three choices in this area:

Health Plan/Blue Shield: This is the choice most used by participants, and the default option. I call it the PPO-HMO Flexible Plan, because you have two choices inside it.

Choice One: Choose your own doctor and you'll pay $35+ per office visit. Go to a Blue Shield hospital, and you'll pay a maximum $1000 for surgical services and hospital stay (up from $700).

Choice Two: Go to one of the Motion Picture and Television Fund Clinics (Glendale, Burbank, Woodland Hills, Mission Hills, Valencia, Westside) and pay a $5 fee. (Elective health checkups are also $5, not covered elsewhere.)

Emergency Room visits: $100. (Waived if participants is admitted to hospital.)

Health Net: This HMO option has more extensive fertility coverage than the other two plans. $15 for most doctor visits. ($35 for Emergency Room visits.)

Kaiser-Permanente: The oldest HMO in the nation runs its own network of hospitals an clinics. $15 for most doctor visits.

Unless you're dripping with money, there is no ideal health plan. There is better and there is worse, but there is no perfect. What we've tried to do in new-member tutorials that Kevin and I give 45 weeks a year is provide advice about how to get the most bang for your health care dollar.

The reality is, it's still possible to save money if you know the right moves to make. But you've got to bone up on the different options available to you, and plan accordingly. Knowledge is power.

11 comments:

Anonymous said...

Steve,

Was there any development on DreamWorks not offering Health Savings Accounts to union employees?

Anonymous said...

__In 2008, the Motion Picture Industry Health Plan was staring at a $528 million deficit over the next contract cycle

public health and pension plans have been going south for years. obviously, the original equation is horribly flawed.

Steve Hulett said...

Costs have gone through the roof. 9.5% per year. And that's lower than the national average.

Anonymous said...

rising 'costs' are from low supply of physicians (bottoming education), AMA lobbying, plus lack of quality food and health education. plus american culture's incredible delusions about death and dying. insurance reform does not address any of these issues. insurance industries singular goal is to define and sustain the publics debt level - 'costs'. they are no different than banks. nothing will change, you will always hear about 'costs', and during the last months of your life, you will lie in the hospital bed wondering why they keep sticking $300 needles in your arms.

Anonymous said...

What do you mean by "american culture's incredible delusions about death and dying?"

(not snarking, actually curious)

Anonymous said...

culturally, dying is not confronted in the same manner in the US as it is in most of the rest of the world. the american obsession with youth and aging is a form of mass neurosis. rampant narcissism, especially with regard to the importance of the individual over the group. also, the american fascination with the lengthening of the average human life span far beyond what is beneficial to society as a whole. most americans die in hospitals, a result of the fracture of the multi-generational family structure. this is a post WWII shift that came with the rise of the 'boomer' - the 'me' generation, dressed up with Beatles Eastern mythology ( ...but only on the surface, with haircuts and sitars. the reality is quite the opposite...)

medically, death is a condition that needs to be treated. the western medical system only functions to perpetuate prolonging life rather than functioning to support quality of life. this is only possible because our own households no longer function to provide care, or know how to. when given the choice, we abdicate the responsibility to the state, both socially and financially. spiraling public costs are a reflection of that.

so americans sue when 'care' fails our family, on medical grounds, of course. because that's the only way our healthcare functions or fails to function. with pills and needles. if the needle is dirty or the pill was the wrong dosage, that's not a reflection of the failure of the family, but failure of the medical system.

wealthy nations get delusional like this. so the next time you get that bill in the mail that says a piece of gauze costed Blue Cross $100, look in the mirror and congratulate yourself. you're a member of the wealthiest nation on the planet.

Anonymous said...

ie, all boomers need to be exterminated and served as pate...

Anonymous said...

My friend, when it's you with a terminal diagnosis(as in "I give you anywhere from 1 year to 3"), THEN let's see if you eschew the western "narcissist" "delusion" about cheating death and tell the doctor "no thanks, no chemo, no treatment-I'm conscientious! No $100 gauze for me-I'd prefer to face facts and just go out as soon as possible, becaue I'm BETTER than the poor wretches who haven't evolved as I have".

Yes, let's see if that happens.
Because until it's YOU, as it was with MINE, you have no right to call 'americans' or ANYONE victims of some neurosis involving "the importance of the individual over the group".
Say what? What utter bullshit!

Guess what? Neither you nor I are ants, moonbeams or stems on the leaf of a tree. We're human beings who really, truly are the most evolved life on the planet for better or worse and we have minds and spirits and lives that matter, that some of us would like to hold onto as long as we can, whether it's for "narcississtic" reasons or just because we want as much time as possible to love and be loved, and not incidentally to get our families affairs in order before we do at last, indeed CROAK.

Yes, please come back and post when you've just had that talk with your doctor.

There really are reasons why a man or woman doesn't want to die besides being a selfish, delusional narcissist.

Anonymous said...

well, stepped into that one. no argument with that. sorry i've offended.

Steve Hulett said...

Paul Newman died of cancer last year.

According to his friend Gore Vidal, when Newman was 3/4 through the latest round of chemo therapy, he said to his wife:

"That's it. No more of this. I'm done."

And he stopped doing the chemo. And ultimately passed away.

His choice.

Anonymous said...

Okay, look, dump the sensitivity shit already with death and dying. You are killing me with this crap and killing this country with your mass denial. Are we all a bunch of children who don't want to be made uncomfortable for the sake of blind emotion? Are we all smoking too much medical mary jane?

Banks cover our overdraft and call it a 'courtesy' because they feel their customers don't want to be 'embarrassed' by having their f**ing mocha denied by Starbucks when their debit card is swiped. And you are okay with that? Courtesy overdraft protection? Non-negotiable, by the way. They are making a fortune off of you, writing the rules of the road for you so you don't have to worry about it. ?!?!

The health insurance scam feeds off of the exact same endorphin. It allows us to continue to bathe in our communal denial of this great American bubble. And you wonder why the world is just dying to pop it?

Americans apparently can't handle the truth anymore, nor do they want to see it. Ten trillion dollars in debt? Oh, well - who gives a f***. But god damn it, I WILL live another three months if it means the rest of this ward will pay through the nose.

Doctors hands are tied in giving proper diagnosis because of this childish notion that we are all made of more than just moon beams. We are not. We are molecules and saliva and dirt and nothingness, and all the memories in your tiny little brain will get sucked into a black hole and forgotten forever. The end.

Grow. Up. America.

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