We will follow KidDoc so long as we have coverage or a cash option.

St Joseph has the worst billing on the face of the planet and this will rid us of that. I also know several St Joseph processes weren't ideal for the practice.

Private seems like a great option. You will take a beating on insurance, but there is no 3rd party siphoning off the top either and being the boss provides a ton of flexibility across the board that is otherwise unobtainable. You could accept Medicaid or not, or only up to a percentage of patient population. From your comments, Medicaid patients bring an important balance to your day and practice.

There is a relatively new primary care office on Victoria across from the high school with a for sale sign up.

Oh I get that. I can never get into my pcp same day. But that hasn't been my experience with pediatrics at St Joe's with KidDoc. That is something I'm not looking forward to, and something I hear is quite common practice at UPA.

histag10 said:

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Well, when you are self employed, its one of the few options you have - especially if you want to pay less than $1500/month (which was where our quotes from last fall fell when looking at private plans/PPOs)

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There are significantly better options that exchange plans if you're self employed which I've been for 13 years now. If you're interested DM me and I'll connect you with my guy. Health and benefits is all he does and he does a good job of keeping me aware of how the market is changing vs what I'm interested in and not so that I'm able to be on a plan we like that meets our needs without making me pay for a bunch of stuff I don't need.

Are you using actual insurance or a healthshare? Cuz I'm about fed up with our healthshare.

Thank you. I know several people who solely sell health insurance. We have had it quoted out multiple times. My husband had spinal surgery 3 years ago. It spikes our rates to insane levels until it hits the 5 or 7 year mark. Even without all the "fluff" that we have them take out of policies, we still end up around/over 1k per month on private plans. The only other thing we have found less is indemnity insurance. Which works well sometimes- but can also screw you horribly. It has also increased in cost significantly to around 700/month id we went that route. We have been self employed for several years, and know how to do this as well. Right now, this is what has to work for our family.

histag10 said:

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Thank you. I know several people who solely sell health insurance. We have had it quoted out multiple times. My husband had spinal surgery 3 years ago. It spikes our rates to insane levels until it hits the 5 or 7 year mark. Even without all the "fluff" that we have them take out of policies, we still end up around/over 1k per month on private plans. The only other thing we have found less is indemnity insurance. Which works well sometimes- but can also screw you horribly. It has also increased in cost significantly to around 700/month id we went that route. We have been self employed for several years, and know how to do this as well. Right now, this is what has to work for our family.

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Ok, that's fair. As long as you know there are better options that's all I wanted to communicate. Yeah that surgery is a problem most anywhere. I'm currently switching from an indemnity plan to a more traditional one with really good rates but the underwriting might be a problem for him. In your spot I'm not sure there are good options. Might ask your contacts about LiveX plans just make sure they've looked at them for you.

trouble said:

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Are you using actual insurance or a healthshare? Cuz I'm about fed up with our healthshare.

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We're currently on an indemnity plan but moving to something more traditional. Haven't ever looked at health share plans but what I have researched shows a really mixed bag of outcomes. Insurance is expensive but at least I know what to expect. Not sure health share is well enough defined at this point.

LOYAL AG said:

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trouble said:

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Are you using actual insurance or a healthshare? Cuz I'm about fed up with our healthshare.

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We're currently on an indemnity plan but moving to something more traditional. Haven't ever looked at health share plans but what I have researched shows a really mixed bag of outcomes. Insurance is expensive but at least I know what to expect. Not sure health share is well enough defined at this point.

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We've been on one for about 10 years but there's been a lot of changes in the last 2 years.

We have been on Samaritans and it's been solid so far. They covered the $30k worth of bills for my daughter's appendectomy.

I'll have to look into that one. Liberty was incredibly slow to cover costs for our preemie. We had to fight them over things like the helicopter.

Do they require a statement of faith?

Gosh it's been years since we enrolled so can't remember those application specifics, but once a year we do have to submit a pastoral verification. I just send a link to our pastor and he fills something out. No idea what they ask.

Yeah, that won't work for us. We don't currently attend church.

I dont think Solidarity requires a statement of faith, but they are Catholic so they won't cover birth control, if, etc.

Minus the whole spinal surgery thing, the best pricing/most comprehensive plan we found was actually through Texas Farm Bureau. Because it is a membership group, they get group rates on their insurance. What we learned- BMI and high risk surgeries are often disqualifiers or cause rate hikes, and preexisting conditions arent generally covered the first year (though my BMI is way lower now- won't woot!).

BC isn't an issue. Do they cover ADHD meds and visits? That's been the newest thing Liberty didn't cover in the last year.

Not sure. I know when we were self pay for that (because the insurance we were on didnt cover it), we just used a good RX code for our Adderall XR. It was like $30 at Walgreens for generic (they seem to always have it in stock). I also got our appointments lined up with our annual well check, so I was only paying out for one appointment per year, since well check was covered (just paid out of pocket for the 6 month check appointment)

Oh Liberty separates out the charges for well check and mental well check even in the same visit. Luckily, HEB and good rx help with the meds.

Bummer... might look into TXFB. The membership is $50 per year I think. Their auto insurance is pretty cheap as well

I know this topic has strayed from UPA to affordable health insurance. But this has been an eye opener for me. The struggle so many of you are facing is so frustrating for me to read. I had no idea what goes on behind the scenes when you don't have the option of a private employer plan. It is such a shame that health insurance is so closely tied to or dependent on your job or have to find something affordable and available in the marketplace or you with a share plan.

I retired from TAMU 7 years ago and have realized how fortunate I am to have met the "Rule of 80" before leaving. TAMU's benefits plan insure me, my spouse and children, and my dependent grandchildren for around $600/monthly for medical, vision, and dental. While it's definitely not perfect, I'll never complain after seeing what y'all are having to deal with currently.

But a shout out to BSW pediatricians. My children are adults now and their pediatrician recently retired, but my grandchildren are currently being seen by them and have had positive experiences.

I'm an old-timer because I remember when pediatric patients were treated at local hospitals. My son was hospitalized as an infant and a middle-schooler at St. Joseph's (before BSW had their own hospital). My pediatrician was involved in his hospitalized care throughout. Maybe the shift to Hospitalists was part of the reason to not offer pediatric services any longer? I hate to think that I would have had to travel back and forth to Temple while he was hospitalized.

Bryan-College Station could see major changes to pediatric care at St. Joseph

Love our doc at UPA.

Same doc over the last decade for all our kids. Only time we've seen someone else is for last minute sick visits and never had a complaint.

KidDoc said:

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Bryan-College Station could see major changes to pediatric care at St. Joseph

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Everything about that article was bleak

I get your point- but CHS trades for less than 10% if what it traded for when they sold. They were lucky to find a buyer. Several other non profits passed on the deal.

"Thankfully we left Bryan at 10am, surgery at 1, and back in Bryan by 5:30…TCH has phenomenal."

You answered your own question. There is a reason people have these opinions about TCH, CMC, DCMC and Cooks. This is what they do and focus on…kids, parents, etc. Left at 10 and home by 5:30 with a successful outcome is an awesome choice to have.

Saying all that, I get your point. As BCS grows, they will get to that point of having MDs local or for at least part of the week.

No doubt, couldn't ask for a better outcome and we are lucky to be that close to the premier medical communities in the world.

But the cost and stress of a 1.5 hour ambulance ride isn't nothing. We have another child who has severe asthma and have been in situations with a bad attack where all they can offer is transport rather than any sort of monitoring. That's still just pretty wild to me in a town our size.

I totally get it. I am an MD (not in BCS). I am surprised as well given the size of BCS but it will come there eventually. Really depends on the comfort of providers there. Another big issue is admitting kids w/o having specialists available for consults when needed.

Providers want what is best for their pts. If they know the correct level of support is not available, they will always prefer to send you out esp since there are facilities "relatively " close. Definitely not convenient for the families but probably the safest way.

Any update on this?