For those that think our healthcare needs fixing

AZRP

My hernia was bothering me last week so on Thursday afternoon I made a doctors appointment for Friday morning. I left the doctors office with a referral to a surgeon, a lab request, and an order to get a cat scan on my lung. I stopped by the lab on the way back to the office, no appointment but they took me in to draw blood. When I got back to work I called and scheduled the cat scan for today, Monday. When I got to work this morning the results of my blood work were on the fax machine. At 9:00 this morning I called to see when I could get into see the surgeon. My appointment was at 10:00 and I am scheduled for surgery on Thursday. Try that in England or Canada. -RP

Ross in Ventura

Great post Randy, we can't let the screw up our Health Care

Ross

Frank from Houma

When we lived in Scotland our youngest son needed a tonsilectomy. After he was put on a waiting list that was months long he was put on a plane with his mom and brother back to the states. Ended up both sons got tonsilectomies and shared the same room.

mad max beyond eggdome

yep, thats a great example of what works right in our health care system. ..

now, go call my sister in cody wyoming....she is a white collar worker (a secretary for a law firm there) and she can't get health insurance without paying a fortune. . . .as a small business, only 6 employees, there is no such thing as group insurance for a business that small....and as a cancer survivor, it costs my sister something like $5,000 per year to buy individual health care for herself with a deductable that is another $5,000 per year. ..pretty exorbatant for someone on a small town income. . .yet she pays the same prices for care that you have to pay in the big city for treatments. ...so yes, she can get that quick care like you are getting under your group coverage, but she basically has to pay cash for it even though she is a gainfully paid professional employee. ...that is one of the huge gaps in our medical coverage system that most people don't see. . . .they only see the indigents out there that don't have coverage. ..they don't realize that there are thousands and thousands of working people out there that can't get affordable coverage. ..its not the medical system that broken, its the health care insurance coverage systems that broken and needs fixing. ...

and even at my company with my good coverage, don't get me started on the specialized care that my disabled wife requires and the hassles that blue cross makes me go through to get her her treatments. .. .it the most stupid thing in the world. . .they would rather have her suffer and incur thousands of dollars in the hospital than provide her with simple at home treatments sometimes....its ridiculous and shows everything that is wrong with our systems sometimes. ... is it better than canada??? you bet. ... but does it need fixing??? sure does. ...

Spring Chicken

I had pretty good insurance while working for my last employer. It was a PPO plan for me because I happened to be the only employee outside their HMO area.

But the very moment I was laid off my coverage ceased. The next day I learned that I had prostate cancer and required surgery. Needless to say, I signed up for Cobra at the tune of $800 a month. Quite a chunk to have to pay with no income. And that did not even come close to touching the co-pay and very expensive drugs.

Then my Cobra ran out and I could not get insurance anywhere at any price.

Fortunately, three months later I qualified for Medicare. But get this, the same insurance company that turned me down for coverage earlier actually solicited my participation in their Medicare supplemental coverage plan, and accepted me without question.

To date, since becoming eligible for Medicare I have had no out-of-pocket expenses. I have had four epidurals (in operating rooms), back surgery, heart stents for a heart attack, shoulder, heel, leg and knee treatments, and numerous follow-up visits and blood tests, all without question or out-of-pocket expenses. I'm using my doctors of choice in every case.

Where I'm going with this is that my total medical costs for all of this has been relatively low, probably under $100k. And because I was treated properly I am now healthy enough to carry on a normal life. Without proper treatment I could have died, or worse, become a patient in a home where it might cost $300k a year just to keep my diapers changed until I died.

The system is not "out of control," it is just being 'controlled' by those who want it the way it is now. It doesn't take much imagination to figure out who those people are and why their motives.

Spring "Product Of An Earlier Time" Chicken
Spring Texas USA

bitslammer

+1 Max!

My wife has been spending hours of her own time at lunch trying to get our provide to pay for some simple things like X-Rays and an Upper GI.

They will only cover X-rays if it's from a "free standing" facility that isn't part of a hospital. Why I have no idea???? So she calls them and asks where she can go. They tell her they aren't sure?!?!?!? So basically they'll only cover x-ray service in a form that doesn't exist.

Long story short after 3-days of haggling they give us a number to call. It's another primary provider so my wife has to pay another co-pay and go to get them done. When she does they buonce the claim saying the provider that they told her to go to is "out of network."


Next for the upper GI she again has to go to a non-hospital facility. We do that and they bounce the claim saying they'll only over the Dr. fee and not the facility fee. In this case the Dr. just does the procedure there so he get's paid for only his labor but the facility charges for equipment, supplies, etc.

What next? I suppose if I need my appendix out I have to pay out of pocket for the stitches?

I'm sorry our system is broken! It works in some areas but there's no consistency. We need clear and national standards at the least. I don't care how the $$$ works these health care companies are crooks. http://abcnews.go.com/GMA/Weekend/story?id=8337500&page=1

My uncle who retired from the Navy has lived in Italy for the last 20 years and says much of this crap about waiting for months is BS. Yes...for non life threatening stuff you might wait a little, but they don't let people bleed to death in the ER which did happen here: http://www.msnbc.msn.com/id/19207050/

I'm not a fan of the current administration, but I'm glad that something might finally happen to fix the train wreck we call health care. Maybe it will work out, maybe it won't and we'll have to take another stab at it, but for years we've done nothing and it has to end.

99% of what's being said on the subject is pure bull coming from special interest groups. MD's deserve to make a fair living so I respect their concerns, but as for the big drug companies, HMOs, and other groups they can go pound salt. I find it somewhat troubling that I can own stock in a health care company. Can you say conflict of interest? The subscribers want to get well and I want a dividend.

My company's plan is self insured so I'm pretty sure the company that administers our plan gets a nice cut on the money they save by denying services.

I'm glad your situation went well AZRP, but a single "good" case doesn't mean it isn't broken.

stike

what do you pay?

til recently, i paid 15 thousand a year to insure my family of four perfectly healthy people. wife and i haven't had so much as a cold in four or five years.

we all weigh what we should and have good blood pressure, no chronic illnesses, nuthin.

i don't care if they ever fix healthcare. i want them to fix the INSURANCE (i know, that's what we're talkin about. just being facetious). we left HMO/Blue after the CEO got a 12% raise and my rates went up 15%, having been raised 15% the year before that, and before that, and before that

since 2002, the average premium has gone up 87%. in the same period, profit of the top ten insurance companies increased 428% (numbers courtesy of "Health Care for America Now)

anyone can have your coverage, as long as they pay for it or their job covers it.

stike

you can't be turned down in massachusetts. but we are commie pinkos here, everyone knows that. of course, because you can't be turned down (it's a condition the state sets), there are many insurers who simply don't insure here. which means the premiums are like a fist where a fist shouldn't be.

your comment about "control" is exactly spot on.

do i think obama and the congress have it sorted out? no. but i haven't read the entire plan, and i'd bet neither have most folks that rail against it. they are simply reacting to the propaganda put out but the insurance industry lobbyists. easier to scare folks than it is to explain. that's another example of their control.

on the basis of the vehemence of the insurance companies reaction ALONE, I'd say that there's gotta be something that has them scared in that plan.

mad max beyond eggdome

gee, medicare. ..a gov't sponsored/paid for health care program that is working for you. ..imagine that!!!! . . .every once in a while, uncle sam gets it right. ...yeah, some folks do take advantage of it ....but it has been known to work every now and then. ..glad its working for you big fella. ..

mad max beyond eggdome

thats why its called insurance stike....you pay for it for all those years. ..hope like hell you never have to use it. ...in my case with a disabled wife and two special needs kids (diabetic daughter and cleft palate son that needed 6 surgeries), i've gotten more than my money's worth out of my co-pays over the years. ..regardless i still have big problems with the insurance companies. .. particularly blue cross blue shield of massachussetts, my current insurance provider. ..

the crazy thing is, my current company, like most big companies, is "self insured". ..what that means is, they pay the insurance company the exact amount of all the claims incurred for the year, all the insurance company does is administer the plan for the company. ..there is absolutely no risk for the insurance company whatsoever. ...of course, by contract, they do get bonuses and incentives based on how well they administer the plan (read into that how well they manage and control the costs). .. .but at the end of the day, it doesn't cost them a dime. . .

but, as with any big company, the healthy folks are paying for the sick folks bills . . .just like with your car insurance. .. if you never have an accident, you're premiums are paying for the other guy's car repairs and you are 'insuring' against the possibility of ever getting into an accident. ...

Gator Bait

 
AZRP our health care is perfect . . . . I am severely diabetic which has given me premature cataracts, peripheral neuropathy and three major heart attacks. I have had hearing problems all my life and should be wearing two hearing aids, I have one. I have a special amplified phone so I do not require special services. I am classified as severely deaf and some day will probably be profoundly deaf. I was born with multiple birth defects in every joint in my legs, ankles and feet from the waist down and will have sever chronic pain for my entire life because of it. I'm talking pain comparable to broken bones. As I get older I loose more and more of my mobility. I am 58 years old and have a hell of a time walking half as far as I could two or three years ago. The U.S. Government branded me as 4F during the Viet Nam era draft so veterans benefits are a dream. They have denied me Medicaid, SSI or any type of help, they tell me I don't have enough problems. My last cardiologist (many years ago) told me that if I couldn't afford his rates to go some where else. I haven't been able to afford a dentist for 15 years or longer. I have not seen any of the specialist that I need since before the year 2000. Employment is not an option as no one will hire me. I am an insurance liability. The only income I have to my name is $700 a month from a life long income annuity that I invested in when my parents died. Normally I do not broadcast my problems to the world but in your case I have made an exception.
You think our system is so freaking perfect why not change places with me. I dare you.

Gator

 

AZRP

Jeff I can't agree with you more, my point was health care in this country is probably the best in the world. It was unbelievable what I got done in such a short period of time. Health care insurance on the other hand is another story. I'm an employer, I would love to have a product that I could increase the price 20% every year while reducing the benefits. I have not yet dealt with Blue Cross as far as getting reimbursed for any of this, but I am being taken care of in a swift manor. -RP

mad max beyond eggdome

gator,

aren't you eligible for SS disability and medicaid? ..

stike

except if i am a horrible driver my premiums go up...

in massachusetts, you can weigh 1100 pounds, smoke crack, drink a gallon of vodka a day.... premiums don't change

15k is too much for the value.

Gator Bait

 
Hi Max,

Not according to the government. That is why so many people that need help do not get it unless they go through the courts and have a good lawyer. The Social Security will send you to one of their trained monkeys er. . . doctors that gets $50 and spends less then 10 minutes determining your fate. I had one office where the physical was actually given by an assistant that wasn't even a nurse! She tested my eye sight by punching a hole in an index card with a thumb tack and had me read the eye chart through the hole. LOL, I made the mistake of telling one of the ladies with SS that the physical had set the medical profession back over 200 years and she got mad as hell at me. The SS isn't going to continue to send applicants to doctors that approve them for aid. It is corruption from start to finish. My best friend is a very competent lawyer but will not touch the case. He has researched it and says I need a specialist. Go figure. To go to court you need to have up to date medical records as evidence, they only come from doctors (specialist) that cost big bucks. If you have a disability from a job or accident there are huge benefits payed retroactive from the time of the disability. Lawyers can claim a set amount of those funds. It used to be around $5000. If your disability is not of that type, aid is not retroactive from the time of disability but starts when it is awarded, so no huge pay off the lawyers can tap into. It gets to be a very long and nasty fight.

Gator

 

Panhandle Smoker

Gator, I would re-visit the Social Security issue and re apply and re-apply again. I have known a couple of people who were entitled to benefits and had to do the roundy round with the SSA to get their benefits. One even took them to court and was awarded benefits retroactive to the date of his first claim. I would think your situation would merit SS benefits. There are organizations that look out for people in similar situations and several attorneys out there that will take on pro-bono cases. I am convinced that unless you are of age to automatically receive SS benefits that the first attempts are going to be denied automatically.

Ripnem

Jeepers man, glad your still runnin the Roost and seein Alaska.

not to mantion all the other wonderful things you do for us on the forum. Keep on Cluckin

Gator Bait

 
Hi Eddie,

Yes, your advise is right. Like I said, it is a long and nasty fight and I'm afraid I am not much into it. The government has designed the whole system to be as distasteful as possible. I need to put my thick skin on and rejoin the fight. That and remember to keep my opinion to myself when within 100 miles of a government office. :woohoo:

I'd rather quit smoking then be humiliated by the government again . . .

I confess, I have had 3 cigarettes in the past 17 weeks.

Gator

 

Grandpas Grub

 Many cases reapplying just doesn't work.

GG

Grandpas Grub

 
I am really glad your insurance is working well for you and I hope all goes well with procedures.

I am sure there are a lot of examples on both sides of the fence.

Following not directed at Randy, just some personal experiences.

England - Two years ago my Brother-In-Law had appendicitis while in England. That day he was in the hospital and apendix removed. 1 week in the hospital.

Total cost $15/day because was not a British Subject and he had to pay for the bed.

My father before passing away needed an air concentrator (oxygen). The machine could not be purchased but had to be rented. The normal billing cost was $490/month and medicade allowed 80% of $290/mo which the med. equipment company (owned by the largest hospital out here) accepted that amount. The balance was picked up by AARP insurance.

That is $290 a month for 10 years. Once every 6 months a service call could be requested. The machine cost $4,200 retail. Your and my taxes paid $3,480 a year for that machine, and for the 10 years $38,480.

That is for 1 person in a somewhat small city. So how many people across the nation have concentrators and taxes are paying $3,840 a year for all those machines.

My dad also had a bed side toilet which cost $160 to buy. Rental $45/month. Nice walker for my dad $120 to buy $27/month. These three items had to be rented to be covered by Medicade.

There was other equipment too all had to be rented.

The rental fees charged to Medicare over time are asinine and completely unnecessary. Why not allow the Med Equipment companies a good profit say 100% then the equipment no longer has a rental fee and when the person dies, the equipment is brought back into the system, refurbished (if possible) and sent back out into service. Terrible waist of money.

Over the years while in the hospital on several occasions we began to track procedure costs and supplies given/charged back to medicare.

We come to find out that there is a set fee set by the government for each procedure/stay. I can't remember the acronym for this policy but it is published and can be looked up.

Those fees are variable up and down based on a hospital's performance overall with Medicaid claims.

If the hospital can beat the cost and time in hospital for the the procedure by "X" percent those above fees/payments paid to the hospital are increased "X" percent.

If the patient takes longer and/or supplies costs more set fee code then the hospital gets penalized and gets paid less than the set fee.

We never could figure out why my dad had to be rushed out of the hospital so quickly. One doctor about 4 years before my dad passed tried to talk the family into just letting him pass away. We found out the hospital was just giving him liquid and no nourishment.

The horror stories go on and on. After that one doctor tried to get all our family on the same page, the page to let him die, we found it necessary to have a family member stay with my dad all the time. Take notes of what medicine, times, procedures that went on. There were some nurses that helped us understand the hospital money decisions vs patient care that went on. It just boggles ones mind.

It is easier for a non us citizen to get health care than it is for a citizen.

There are a lot of things that can easily be identified to be done to cut the wasted money that goes on. The problem is there are too many pockets getting greased and no one wants to loose out on their slice of the pie.

GG

Mainegg

OH don't even let me get started!!! :evil: :S we pay over 500 a month for basicly nothing. $1000.00 deductible and it covers about NOTHING. self employed and healthy for now thank god. if we go to the emergency room it covers most of that. but anything else nada. the people at the local mill here in town had fit last year as they had to start paying 25 a week for their insurance......... it covers Everything DENTAL, EYE, a pimple on their big toe if they want it looked at.. my big toe is covered only if I carry it in my hand into the emergency room lol that is health insurance in Maine. I think there are 2 companies that will write here. but I trade it for the life style so it is my payoff. and we need it about once every two years...... like I said emegency room only. and that goes to the deductable lol.

stike

self-employed are paying for this frigging train wreck.

drives me nuts....

don't get me started on taxes hahaha

Spring Chicken

Like many of us Eggheads, I served in the military, not one but two branches - Army and Navy. Both were honorable but I decided it wasn't the career I was seeking.

I knew that as a Veteran, I had many benefits available to me, including education, housing and medical. So I went to college on the GI Bill and bought my first house with the Home Loan Guarantee. I was healthy and/or covered by employer medical insurance so I saw no need to apply for my GI medical benefits. That is until I started having medical problems.

It was then that I applied for my Veteran's Medican Benefits only to be told that the Bush Administration cut funding to pretty much all non-combat related medical coverage. But they would be happy to keep my name on file should funding be re-established. It never was, of course, and because of my hesitation to apply I lost my benefits.

Granted, I am less deserving of medical benefits than many of the soldiers coming home today with both internal and external scars that will never fully heal. But I also have a few scars myself, although they don't qualify. I consider myself fortunate that I'm not that bad off.

I'm bitter, mostly, because the government promises and promises and promises to do right by all Veterans but fail to do so when they need it.

I did all the things I was suppose to do to be eligible for the benefits and now I'm not, even with a small premium. I'm pretty sure no Congressmen ever lost their medical benefits.

Spring "Low Veteran On The Totem Pole" Chicken
Spring Texas USA

Misippi Egger

Gator,

As frustrating as it can be, take a "chill pill" and continue to apply for SSI.

You deserve it with all the medical issues you face. I guess it depends on the region one is in, but last week I took care of a lady who was 39 years old and on disability (Medicare coverage). She took no medicines but was having her gallbladder out. When questioned about her disability, she said it was for Post-traumatic stress disorder, though she was on NO MEDS. The PTS was from having been raped. Now, I realize rape is a terrible ordeal, but to be 39 yrs old and not be able to ever work again. Give me a break!

you should be able to get coverage - be persistent!

Gator Bait

 
Hey Clark,

I'll try and make good use of your advice, thanks. It is amazing some of the people you see getting aid and some that aren't. I think it's time to start talking to lawyers, maybe I can find a good one.

I hope the arms are getting back to normal.

Gator

 

bitslammer

Is that kind of disability considered lifelong or would you need to be reevaluated at some time?

Gator Bait

 
Hi Chris,

I don't know. How the Government works is beyond me. :huh:

Gator

 

CBBQ

Exactly. And the people who rail that healthcare reform is just to help people that are too lazy to work...Nope!
They already have Medicaid in place for that which is another government run health agency that does okay for itself.

For 25 yrs my wife has owned a "early out" medical bill collection firm. When a medical facility is turned down for payment by an insurance compay it is turned over to my wife to figure out how to get it payed. That is working with any and all agencies along with worker's comp lawyers. To hit on stike's point about why insurance companies are so dead set against it, there are various reasons but one big one. Insurance companies say high premiums are because of high medical cost when in fact they almost always have a negotiated cost with the provider that has them pay pennies on the dollar. In the last four years I have had more than $150,000 in medical expenses. My insurance compay's actual payout has been around $30,000 because of pre-set prices. But premium rates are based on the $150,000. When the insurance companies start dropping their rates to compete with the government option it'll come out that their actual cost and reported cost aren't even close.

Other things that are put out there like "death panels" already exist. Medicare has review panels that have been doing exactly the same for years. And it was created by Republicans.
When another stink was made about veteran's having to go through their primary insurance before the VA would pay, it again was nothing new. Like Medicaid, the VA pays what your main insurance doesn't. It's been that way for years.
Now before anybody tries to blast me as a left winger, I'm not. I am a moderate that belives neither party comes close to governing according to their preached ideals. I have a mind of my own and I vote based on actions and record, not party.

Misippi Egger

As a physician, I come at this from several perspectives.

1) Tort reform is an absolute necessity. Patients who are injured deserve a fair shake, not to be made millionaires, but to be properly compensated. Lawyers should not become millionaires over other peoples' misfortunes. The only suits against me (2) have been for ridiculously frivolous claims (both dismissed), but my insurance company paid tons of money and one of the cases took 9 years!

2) The insurance industry is out of control and we clearly need health insurance reform!

3) The pharmaceutical industry needs regulation.

4) Some doctors are raping the system and that needs to be addressed.

5) Medicare drastically underpays most doctors. Medicare paid me 22% MORE in 1992 than it does in 2009 for the same services. Insurance reimbursement (our State employee plan-regulated) has increased about 4.5% per year (avg) since 1992 - probably close to the overall inflation rate. Definitely not excessive increases. The percentage of Medicare patients increases yearly.

6) Medicare volume increases yearly as the baby boomers enter the 65 age group, so the number of patients with reduced reimbursements seen by the average doctor is increasing as their office expenses are increasing.

7) I heard recently that doctors' incomes are only about 5% of the health care expenditures - definitely not the biggest contributor to the problem.

8) I make a good income, but I have had to drastically increase my volume and hours worked. I treat all comers - insurance, medicare, Medicaid, uninsured, whatever. I have always been thankful for the opportunity medicine has given me to be able to help patients. It has provided me with a good income and I give back by treating indigents as well as going on medical mission trips to provide free care in foreign countries. (The medico-legal environment in this country pretty much prevents such free care here).

9) I don't know about other areas of the country, but underinsured and uninsured patients get taken care of in this community. And they get the same care as the insured ones. That may not be true everywhere.

10) IMHO we need:
a) Tort reform
b) Insurance regulation
c) Pharmaceutical regulation
d) Easy access for ALL to health care
e) Fairness in physician reimbursement

Sorry for the long post, but there is so much CRAP on TV and it's either special interests (big business) or political 'gaming'. I'm sure many don't necessarily agree with all of this, but I have been in this for 25+ years and have been involved with the Medicaid Board as well as being on the Board of a PHO (Physician-Hospital Organization) and have seen the effects of government intervention in medicine and it is as bad as you can imagine.

AZRP

Amen. -RP

CBBQ

Nice post. As I posted up above I have a wife who owns a medical insurance "early out" collections firm. What gets thrown out there usually isn't close to the truth.