It's health insurance "open enrollment" time again in our office and I've been reviewing our health plan choices. We use just one insurance company (UnitedHealthcare) and have just one health plan (something it calls a T9-2/RXJF).
But first, let's talk about craps.
Craps is that Vegas dice game where everyone is standing around a big, walled table, kissing and yelling at a pair of dice not to come up seven. I was introduced to it a long time ago in a smokey casino in Wendover, Nevada. I immediately found the game utterly incomprehensible (and a lot of fun).
The table is a mess of numbers, lines, drawings, and boxes. There are no less than 29 different bets (and a nearly infinite number of bet combinations). The Wikipedia entry for the game prints out on 27 pages and lists 15 different subsections. It explains the simplest bet in craps: The "passline," as follows:
"If the come-out roll is 7 or 11, the bet wins. If the come-out roll is 2, 3 or 12, the bet loses (known as "crapping out"). If the roll is any other value, it establishes a point. If, with a point established, that point is rolled again before a 7, the bet wins. If, with a point established, a 7 is rolled before the point is rolled again ("seven out"), the bet loses. The pass line bet pays even money."
That's just the simplest bet. And, of course, this and every other bet in craps is so rigged that "the house always wins."
Which brings me back to our health plan.
If we want to stay with the T9-2/RXJF, we can. From our health plan manual, it pays:
"100% of in-network medical care after a $5,000 deductible. But it pays 70% of out-of-network medical care after a $10,000 deductible. There is a $30 office co-pay for network providers, but no co-pay for out of network ones. Preventative care is covered at 100%, but there is not something called a "Med/Rx Ded Combined." Pharmacy expenses are covered at $15/$40/$70, depending on something referred to as "Spec; Non-Spec." It has a $10,000 "out of pocket max" for non-network providers, but no out of pocket max for in-network care."
And that's just if we keep the status quo. There are more than 60 other plans, with names like "AA-QP/RXMM" and "XA-J/RXJF" that adjust each of the above variables in seemingly random ways. One plan has a $6,300 deductible and pays 100% after that and another has $3,750 and pays 80%. There are some that pay 50% for out-of-network providers, some that pay 70%, and some that don't pay anything. Taken together, there are over 3.2 trillion combinations of plans, deductibles, co-pays, out-of-pocket maxes, etc. that we can choose from—and that's just from one insurance company.
And, I don't need to remind you that, like in craps, these combinations are derived by smart statisticians (who insurance companies call "actuaries") that make sure, no matter what, that "the house (the insurance company) always wins."
So, if it seems to you like the "rules" of health insurance plans are longer, more filled with insider jargon, and more confusing than the rules of craps, I think you're right. There's not much difference at all.
It's just that craps is a heck of a lot more fun.