So the difference between two health insurance plans at Scott’s company is about $3900 a year. Not nothing, you know? One pays X, and the other pays less, it costs less but your deductible is higher, there’s a higher out-of-pocket. For all that I really, really care about what’s covered in the plan, it all starts to go all Charlie Brown’s teacher on me when we start crunching numbers.
We were advised to add up all of our expenses and determine which was the better plan.
No problem. I’ll just add up all of our expenses. And then calculate the percentages, and run them against the deductible and the out-of-pocket. Because you know what your expenses are, don’t you?
Don’t you?
:::
So Scott and I sat down to look at the plans and realize that we actually didn’t know what an out-of-pocket was. Turns out it’s a random amount of money that after you reach it, the insurance company pays out 100% of your claim.
Only they don’t because they don’t pay out the claim, they pay out what they think is a reasonable cost for that claim, and pay a percentage of that until you reach your out of pocket.
So, for example, a speech therapy session in Villa Park, Illinois is billed at $180, but the insurance company doesn’t think that’s reasonable. They think $50 is reasonable, and then they pay 70% of what they think is reasonable, which comes out to 35 dollars.
Because they’re jerks.
And also, I’m totally going to start doing that at the grocery store.
But no matter. Scott and I pulled out our iPhones and gamely started to add up expense: 2 OT sessions at $180 apiece, 2 speech sessions, one billed at $200 and one billed at $180. Social work with Miss Sue. Our neurologist. Our neuropsychologist. Our allergist.
X over 180 equals 80 over 100, carry the one minus deductible and the out-of-pocket. I started sweating when Scott started using the word “delta,” as in the delta between two numbers.
“None of these numbers make sense,” Scott said, finally. “This looks like they cover so much, but don’t I write checks for thousands of dollars?”
We thought about it for a while, and then remembered that we were on the hook for the $130 that the insurance company doesn’t think is reasonable. We grabbed our iPhones and started calculating new numbers.
“And how do you factor in the maxing of the out-of-pocket?” I asked, and was reminded that I barely scraped by in calculus with a D. I remember that one of the questions on the final began with the words, “A mad scientist wants to build a fence.” And I'm sorry, but a mad scientist's landscaping ideas shouldn't really be my problem
“Scott,” I said, an edge of panic in my voice, “these numbers shift and move.”
I pored over the brochure one more time, the one that HR kept referring to, the one that laid out various insurance scenarios, hoping some detail would jump out at me.
“So-and-so has three kids and expects his medical expenses to look like this,” was one example. But how did So-and-so know that all of his medical expenses would add up to $22,576? How on Earth would he know that? Was So-and-so a genius of some kind? Clairvoiant? A meticulous, savant Type-A record keeper? Were his kids robots? Were they neurotypical? I began to really hate So-and-so, who was clearly an asshole and trying to show how much better he was at raising children and running a household than I. On the other side of the table, Scott was still talking about deltas.
And so I added some stuff to the list of degrees I think you should run out and get after you get an autism diagnosis:
Law
MD
MBA
Psychiatry
Psychology
Education
Ninja
Accountant
Actuary
And then we threw a dart, chose a plan, promised to create a giant and detailed Excel spreadsheet for 2013, and turned on Homeland.
I never did find out what the delta was. But that Dana sure is freaking everywhere, isn't she?