This Is Why You Need Health Insurance: You Can't Afford to Pay Retail

I Have Marketplace Insurance

I signed up for my new top-of-the-line platinum Blue Cross plan in Tennessee under Obamacare. It costs half of what my former individual plan cost. I'm an Affordable Care Act supporter.

I don't like to tell people what to do. But I'm telling you to sign up for health insurance before March 31. Why? Because you can't afford not to have it.

Let me tell you a little about me. I'm 61. I was diagnosed with breast cancer 7 years ago. I had a mastectomy, several reconstructive surgeries and chemo. Thankfully,  I'm pretty healthy now and am (cross your fingers) cancer-free. I chose a bad plastic surgeon for my mastectomy and I've needed more than the usual number of reconstructive surgeries to try to fix what he messed up.

The Numbers Don't Lie - Insurance Discounts are HUGE

My last surgery was on Valentine's Day. A few little problems arose after the surgery and I ended up in the emergency room. You might be surprised by the actual charges for all of the care I received. I was. 

And the difference between what was submitted to Blue Cross and what Blue Cross allowed Vanderbilt to charge is BIG.

 Look at the following chart to see what health insurance does for you:

Shocked? The biggest thing health insurance does is to provide a discount. Sure, health insurance shares the cost of care with you once you've met your deductible. But the insurance write offs are huge. These are real figures from my surgery.

Because I had Blue Cross insurance, the allowed charges for the operating room for my surgery were $3,577.86 instead of $21,283.28. That is an 83% discount. 

My relatively straightforward outpatient surgery would have amounted to roughly $28,000 if I had not had insurance. I'm grateful that Blue Cross paid the great majority of the $7,000 which they did allow. The  75% discount came automatically from my having health insurance from the marketplace.

This Won't Happen to You, Right?

In case you're thinking you don't have to worry about this because you don't have my medical history and you're much younger than I am,  just take a look at the emergency room charges. You could end up in the ER if you were in an accident. And you could be facing $15,000 in charges rather than the $3,000 left after Blue Cross discounts. 

Since I chose a platinum plan, my out of pocket maximum expenditure for this year is $1,800. So, even with my monthly insurance payment and my out-of-pocket costs, I'm way ahead. 

Can you afford not to be insured?

Two Simple Facts about Health Insurance for 2014

I believe that health insurance is really important. 

You just can't predict when something will happen and you need it. Say, for example, you get breast cancer and need surgery and chemo. It's expensive. Really expensive. Like maybe $100,000 worth of expensive.

Fact #1 -

Just having insurance saves you a lot of money. 

Insurance companies limit what hospitals and doctors can charge you. So, for example, if my memory is correct, the hospital charges for my mastectomy (hospital charges for the surgical suite and the hospital stay excluding the surgeons' fees) were about $10,000. But, just because I had Blue Cross insurance, the charges were discounted down to less than $3,000. 

Here's another example. A few months ago I saw my primary care doctor for an office visit and lab tests. The total charge was about $250. But with the insurance discount, the doctor was happy to accept a total payment of $80 (80% from insurance and 20% from me). But, without insurance, the charge would have been $250! So, just by having insurance, you get a huge discount -- about 66%! 

There's a lot of noise right now about Obamacare (mainly negative) and I hope everyone is willing to look beyond rhetoric and understand facts. It's a little hard to do right now in states which did not set up their own exchanges (such as Tennessee) because the healthcare.gov website is not operating as it should. Since January, 2014 is the earliest date to start this insurance, there's no rush yet.

The good news: some information is already available from insurance agents who sell health insurance. 

Fact #2 - 

If you get marketplace insurance through an agent (vs. directly through the healthcare.gov website) you won't pay higher rates.

Agents can get the rates and explain the offerings available both on and off the marketplace. There are 5 companies offering insurance through the marketplace (aka the exchanges). And, just to give you a idea of how someone who understands insurance can help you muddle through the data, my pal Eric Jans (who specializes in health insurance) told me there are 54 different offerings from Blue Cross in the marketplace. And even more plans are available off the marketplace!

Ask Every Woman You Know This Question

Some of you may know that I (Susan) was diagnosed with breast cancer 7 years ago. 

I never felt a lump and I'm embarrassed to say that I had gone 4 years between mammograms. It turns out that the cancer was there on the 4 year old mammogram, but it was missed. And, apparently, that happens a lot. 

Please don't do what I did. A mammogram found the cancer and a breast MRI saved my life. At the time of my diagnosis, I had two tumors in one breast and the cancer had spread to one lymph node. Not so great. So I had a double mastectomy, chemo and 4 additional reconstructive surgeries. The treatment was not fun, but I'm still here. 

So, if you are old enough to do so, please get a mammogram every year. It increases the likelihood that something bad will be found sooner rather than later. If you have insurance, you don't even need a doctor's order to schedule a mammogram. And if you don't have insurance, there are a number of programs in Nashville to provide no cost or low cost mammograms.

Here's my request to you. Ask every woman you care about the following question:

         What was the date of your last mammogram?

A couple of years ago, we had pink banners in our windows at The Mall at Green Hills and I asked every customer -- male or female -- to give me their last mammogram date or to commit to asking an important woman in his or her life that question. A few months later, I got a call from a woman (the wife of a physician who had health insurance and who had skipped mammograms for a while) thanking me for giving her a hard time about not having had a mammogram. She went for one and found out she had cancer. That was a goosebump moment.

Mammograms really can save lives. Wearing pink ribbons is fine, but asking that one question can actually help someone you care about stay alive longer. Do it!

What's the best frame shape for my face - Part 2

Finding the best frame for you takes some work. 

In the last post, we went through some basic guidelines on frame size relative to your face. Now, let's move on to frame shape. 

You can wear more than one shape.  Really. Even if you believe you can only wear one shape, not every frame in that shape will be right for you.

Many thanks to Carolyn Snell for being our guinea pig for this post. She is living proof that there is not just one shape for you. She is lovely, talented and beautiful!

This is a fabulous shape! Current without being too trendy. Gesse by Jason Wu.

One of our pretty new striped custom frames. Good proportion, color, shape.

Again, Carolyn still looks good in this matte frame which is a more geeky square shape. Btw, it's made in the USA. 

A good rectangular shape. Maybe a tad too dark and heavy. But the shape is good.

The shape is fine, but can you see this is just too much color and contrast? All I see is glasses.

Here's a much bigger geekier cat eye. Cute, but much more of a statement. Christa by Jason Wu. His clothes are awesome, but so are his glasses.

Just so you don't think Carolyn looks good in EVERYTHING, here's a fail!
But really the big problem is the fit. She could probably wear this shape in a smaller size.

Transitions Lenses - Thumbs Up or Thumbs Down

After 10 years in the optical business, today I got my first pair of glasses with Transitions lenses. Transitions is one of several brand names for photochromic lenses which get dark when exposed to UV light and then clear up when you come indoors. 

Some people LOVE them. Gray is the most common tint color and is available on most lenses we sell here at Specs. Brown is offered on some lenses and fun fashion colors (like blue and rose) are available for special order on a few lenses.

My eyes are super sensitive to light and I can't drive even on overcast days without sunglasses. And I always get the fully-tricked out lenses (polarized with backside anti-reflective) for whiny girls who don't like the sun in their eyes. 

I could have gotten Transitions a long time ago, of course, but didn't because 

1. they don't work in the car since most windshields and windows block UV. And they don't get dark enough outside. So, they're better for people who spend more time outdoors than I do.  



See, they're just not that dark outside in full sun.

2. I've never liked the look of them. I think they always have a residual tint, even indoors, and I certainly don't need anything else to accentuate the dark circles under my eyes.

Do you see that they're still pretty gray inside?

So here's my first hand evaluation: Give me back my sunglasses. I was optimistic that Transitions would be good for walking my office dogs around the block, even if they wouldn't work for driving. But they just aren't dark enough for me. 

I kept squinting to block the sun. And, if I don't need dark circles, I really don't need more wrinkles. 

So, if you love your Transition lenses, great!  But I love my sunglasses. Sorry, Transitions!

What's the best frame shape for my face?

The question we get most often is, "What's the best frame shape for my face?"

And the answer is, "It's complicated."

Optical books give a pat answer for a few different face shapes, but with the huge range of frames available, most everyone can wear many different shapes. But not every frame in a certain shape will look good on you. When women say, "I just can't wear cat eyes," I just don't agree. You may not LIKE cat eyes, but somewhere there's a cat eye frame which will look good on you.

So, what actually makes a frame work for you?

Fit. And proportion. First and foremost a frame needs to fit your facial structure. Does the bridge fit well? Are your eyes pretty well centered in the lenses? Are the temples long enough? And, if you have a prescription that is at either extreme of the bell curve, we need to make sure your prescription will work in the frame. 

Let's take a look at a few fitting fails.

This frame is too wide. Can you see how it sticks out beyond the width of his face? 

And this bridge is too small. You could stick the tip of your pinky between the bridge of the nose and the bridge of the frame? That's not good.

Can you see that this frame is too deep (top to bottom)? Not the right proportion. Takes up too much of his face.

And, finally, one that's looks good. Thanks to Kip for being a good sport. Maybe he can force a smile next time.

We really believe that you need to come in and try on frames to see what works and doesn't. We're critical about what fits and looks good. We welcome you to try on frames just for fun any time. 

Let the Blogging Begin

Everyone says you need to have a blog.

And, since I'm attending BlogHer in Chicago next weekend, I need to pretend I am a real blogger.

At least Lulu believes in me.

One of the office dogs, Lulu, who knows the value of protecting your eyes against UV damage.