Health care decisions
This letter has not been edited.
This situation, while heartbreaking, highlights just what is wrong with the numbers of the uninsured...those numbers include those who choose to opt out. I have carried health insurance since I was in college. Always weighing the benefits of a job before I signed on. There were times that I could have made more money, but been without health insurance. I chose to have health insurance. It is clearly time that some responsibility be put back on the shoulders of the individuals. My heart breaks for someone who is fighting cancer and medical bills at the same time, but she did have a choice to sign up for health care and she declined. Under the "socialized medicine" that some are pushing, not only will the choice be taken away, but I will now have to pay for others!
Posted by idk on August 27, 2007 02:03 PMhow is personal responsibility going to help when you're diagnosed with cancer and your insurance company denies your claim?
A little off topic, but I'm sick and tired of this stupid "personal responsibility" BS.
Posted by Tbone on August 27, 2007 02:34 PMTbone please list details of the person(s) that were denied claims. What were the reasons given for denial of claims?
Hearing this on here but never see what the details are behind it.
Posted by on August 27, 2007 02:42 PMSounds simple to me, Kama chose not to take the medical benefit offered to her. "Saving" $200 bucks a pay period. So there was no claim to be denied, Kama denied herself the coverage. She chose poorly. She's "personally responsible" for her choice, and even admits that in the article. Wasn't me, wasn't you, wasn't the big old nasty insurance company, Kama and only Kama is to blame.
Posted by on August 27, 2007 03:17 PMTbone, I would like to have the 20 years worth of health insurance premiums that I have paid over the years back! I could buy a bigger house, better car and travel a bit. But...I chose to pay the premiums and live without that "extra" money. If an insurance company denies claims, that is a completely different "animal." Believe me, I learned how important health care was when my daughter was diagnosed with type 1 diabetes. And I have fought a few battles with the insurance companies over the years. But, I made the choice to pay the premiums and when we were hit with a chronic illness, I was thankful that I had been responsible enough to choose the right thing. I feel horrible for anyone who is fighting any disease, but don't punish me now because I have been responsible all this time. People who choose to not pay the premiums enjoy the extra money that I don't have and then when something goes wrong, suddenly, I should support them with my taxes...doesn't make sense to me!
Posted by idk on August 27, 2007 04:00 PMidk - One argument I've floated many times here is to have an insurance for those in need without creating the monstrosity of a universal health coverage bureaucracy.
Let those of us who don't want or need universal coverage opt out and not have to pay anything towards it. This way we can keep our present insurance without the burden of additional expenses.
This idea usually is ignored as those who favor coverage for the "less fortunate" as they put it, also desire mandatory participation from everyone.
I say no thanks.
Posted by KW on August 27, 2007 04:10 PMMost people turn down insurance because they can't afford it even with what the employer kicks in, the last company my husband worked for, we still would have had to pay $700 a month out of pocket, who can afford that????
My Dad is battling cancer for the 3rd time without insurance so I understand what this woman is going through completely!
When he got sick the first time he lived in another country, so obviously once he returned to america, no insurance would accept him whatsoever.
Life happens when you least expect, and it's not always that persons fault......
Posted by Heather on August 27, 2007 04:10 PMTbone,
I hear and understand what you are saying. Here is my thought on this.
Cancer is terrible. A lot of cancer now can be treated, and some even cured. But, some cancer is indeed terminal. No matter what, some cancer will kill you.
Now, as a compassionate society, we would want to do anything to make sure that we have covered everything to see if we can help cancer patients survive. And I think (at least my experience) that for the most part, cancer that can be treated, is typically covered by insurance. Cancer that is terminal, however, typically is not.
Why? Because, and I will be as honest and direct as possible, what is the point? Spend hundreds of thousands of dollars to, maybe, extend someone's life for, maybe, a year or two?
This is hard to explain in writing. We have to make choices sometimes to let some people die. It sucks, and it tears at the heart, but insurance is just that. Same with a national health care plan. If we think that this cancer would have been covered in Canada, with their "free health care system," think again. Please read the following:
"A needs based assessment of breast cancer in Canada: the economic burden of illness.
Earle C, Coyle D, Wells G, Papadimitropoulos E.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 87.
Dana Faber Cancer Institute, Boston, USA.
OBJECTIVE/PURPOSE: The objective of this study was to use a population health model to estimate the cost of breast cancer progression in Canada to facilitate an assessment of needs. METHODS: Adopting the Technology Assessment Iterative Loop, as the first stage of a needs assessment, we determined the current economic burden of breast cancer in Canada. We utilized data on the health care utilization and direct care costs associated with breast cancer treatment from the breast cancer module of the Population Health Model (POHEM) developed by Statistics Canada in conjunction with the Ottawa Regional Cancer Centre. Algorithms were developed to reflect initial treatment patterns by disease stage and by age. Further algorithms were developed for treatment of disease recurrence and for palliation and terminal care. Costs were estimated from the perspective of government as payer in a universal health care system in 1995 Canadian Dollars and were estimated for up to 20 years post disease incidence. RESULTS: Seventy-seven percent of breast cancer occurs in women above the age of 50. Almost 90% present initially in stage I or stage II. The average 20 year cost of a case of breast cancer in Canada is $26,288. For women under the age of 50, the cost is $28,880, while a woman over 50 the cost is $25,514. Generally the more advanced the stage of cancer the greater the cost; for a woman aged over 50 the cost is $13,888 for stage I compared to $64,340 for stage IV. Palliation and terminal care were the most costly phases of disease progression, comprising 58% of total costs. Sensitivity analysis confirmed all of the above findings. CONCLUSIONS: We estimate that the costs of breast cancer are significant. From a needs based perspective, terminal care is both the most costly and most morbid phase in disease progression. Reductions in terminal care hospitalization would likely have the greatest impact on health care costs, and improvements in terminal care management may have significant benefits in terms of reducing morbidity."
To summarize quickly, women of advanced age (over 50), with advanced breast cancer (over stage II) are not treated in Canada, so that it saves cost, and mortality rate for treatment.
People like Truth, like to compare cost savings. Well, this is why health care costs so much less, and mortality rates are lower. In Canada, if you are a higher risk, you die without treatment. In the US, you have the ability to try at least.
We can pick all kinds of sad sob stories, and feel bad for people. But the reality of it is, treatment is rationed, and those people would have had to come to the US to spend that out of pocket if they were in a national health system similar to Canada. Now, imagine that the US option is eliminated. Sure, they saved $200k. But they are not around to spend it, because they are dead.
Somebody better make sure Truth is ok.
Even France is saying they need to copy the US health care system because there's isn't working anymore.
"Providers think that if the government sets new measures, it's just to control them and take away resources," says Teil. "With a system with no transparency like in France - when you don't have these measures - you don't have any incentives to be the best. Because nobody will know anyway that you're the best."Posted by KW on August 27, 2007 05:15 PMBy contrast, Tiel says privately-owned hospitals in the U.S. are motivated to measure and report their quality of care, which leads to better care.
2:42-
My best friend was laid off from his job. While laid off, he became sick. Doctors diagnosed him with a liver virus caused by hepatitus.
He was born in vietnam, and his family immigrated when he was about 2. Doctors suppose he got hepatitus when he lived in vietnam.
He recently got a new job. Problem is, his new insurance won't pay for the 9 months of chemo necessary to fight the liver virus. Reason? Pre-existing condition.
Are those details good enough for you?
idk - I Don't Know what you're talking about. I'm talking about people who pay for their insurance, only to have their claims denied. I'm not talking about people who don't have insurance because they didn't pay for it.
Posted by Tbone on August 27, 2007 05:21 PMMy Dad's 1st round of cancer was fought in a socialized healthcare system setting, don't even get me started on that mess.
Socialized, government run medicine is not the answer, the answer lies in insurance companies not charging ridiculous rates for practically non-existent care and making doctors their puppets, it would also help if people didn't sure for petty things......
Posted by Heather on August 27, 2007 05:28 PMTbone you missed the point entirley as mentioned by other posters - the person in the article choose to forgo health insurance, not denied due to a pre-existing condition - that is personal responsibilty. They made the choice to save a few bucks every month and now realize that was a very stupid decision after all of these bills piled up and now it must be somebody else's fault - right?
They choose to opt out and now must pay the price. How much would the premiums have been monthly vs. the bills due now? $400 per month vs. $200,000 in bills? Wow. Maybe everybody who is offered employer subsidized insurance should have to watch this persons story on video and then they'll understand that if they choose to opt out of this program they could face these type of expenses out of their own pockets.
But I'm sure you'll still feel that these people who choose no insurance will be victims if they get sick and pile up bills. I'm also sure you'ss want to supply them with some kind of government run mess.
This is the same government that cannot run the VA, Social Security, Public Education, Medicaid and Medicare properly or efficiently and you would entrust them to run everybody's health care. No Thank you.
previous 6:58 me
Posted by Jack Bauer on August 27, 2007 07:00 PMLet’s see, I pay for car insurance, health insurance, dental insurance, insurance on the house, Medicaid and Medicare. Then I read about others who opt out of health insurance, some 30% of drivers don’t bother to get car insurance, house not covered if it burns down or flooded, and somehow it becomes the governments responsibility (taxpayers) to cover the damages of the uninsured, spending hundreds of billions of dollars on the above. What’s wrong with this picture? Why do I bother?
Posted by Uno on August 27, 2007 07:41 PMJack,
An anonymous poster asked Tbone "Tbone please list details of the person(s) that were denied claims. What were the reasons given for denial of claims?" and he did. I think he was directly addressing that poster's question.
Posted by Dan2 on August 27, 2007 08:18 PMJack-
You may recall in my first message I said I was a little off-topic. I'm not referring to people who opt out. Hence, off-topic.
Thanks though Dan2.
Posted by Tbone on August 27, 2007 08:35 PMOkay, I just now read the article and think: yep, I can understand her choice. Just because she gambled, the lot of you think "F*ck her, let her die!". Pretty pathetic, if you ask me. (no, you didn't ask, and I don't care)
I advise her to hire a bankruptcy attorney after she gets her treatment (IF she gets her treatment) and IF she lives to see the "Demand For Payment" envelopes.
Good luck and may none of the above posters, especially those who think 'to hell with you' ever find themselves or their family members in your situation.
Posted by Sheila on August 27, 2007 10:24 PMSheila,
I never said "to hell with you." I feel very badly for this person. I hope that she gets everything taken care of and her health improves. The point of the original letter was that the article in question presented this as a problem for society to pay for and did not focus on the fact that this person CHOSE to go without health insurance. I have sacrificed to have health insurance. I would love to have those hundreds of dollars every month to have some fun with...but I was responsible and chose to purchase health care instead. The person in the article chose to live without health care because she didn't want to pay for it and the article suggested that this was society's (read mine and yours) problem. Individual responsibility needs to be a part of a working society. I remember a time when you could not opt out of employer heatlh care unless you could prove that you had coverage elsewhere...what happened to that? The numbers of uninsured are skewed by those who choose not to have health care. Then those numbers are used to try to shove socialized medicine down our throats. That is all. I'm not unfeeling, but I also feel like we are supposed to feel guilty somehow for deciding to be responsible and paying for health care. That seemed to be the point of the article.
It is completely clear that we will not ever just abandon someone because they don't have insurance. Most of us are either responsible enough, or lucky enough that it is a good odds bet. But it is there is a chance to be taken and accounted for.
Making everyone pay for this woman's health care is the object of both the article and many comments posted. Guilt trips are a time honored tactic.
Making this woman suffer the consequences of her choices is the point of the other posters. We don't mean we want her to die. We do want her to see that her saving money on insurance may have given her a benefit but it also gave her a large penalty. Had she been insured would she have discovered the illnesses sooner, in a more cheaply treatable stage? Does she get to keep the gains she posted from the money saved? What does she owe society at large for her survival if she does survive?
Questions, questions and more questions. The problem is that none of us, or very few, would be upset by everyone having health care. Unfortunately the problem with that is people would become wasteful. Some would do so because they are going to waste things no matter who supplies them. Others would waste them because a commodity that has no price has no value. We don't want to support the lazy or the wasteful. If health care is a government service it will be no more budgeted than any other government service. If it is restricted to those workers whose businesses which choose to offer it, it becomes harder for people to obtain.
May I play the broken record again? We need to transfer the tax benefits to the individuals and take them away from the companies. We also need to make Health Savings Accounts available to all.
Heath Savings Accounts permit the young and healthy, who often take chances by going uninsured, to set aside money for health expenses in such a way that, if those expenses don't take place, the money, eventually, is available for the individual to spend. Sort of like buying a lottery ticket in reverse...if you're lucky your number doesn't come up. The individual is the one choosing insurance company, plans and options. Just like we do with auto insurance and with supplemental health insurance for Medicare. It creates a huge marketplace where people like me, older and sicker, pay more but get more in the long run, while the young and healthy end up with minimal expenses but coverage for the big problems. The force of the marketplace is behind individuals not companies. Most businesses pick the best balance between cost and benefits for the average worker at best and the cheapest plan for the tax benefits at worst. I'm lucky because the wife of my husband's boss is very ill and they have decided to allow all employees to have HSA savings beginning in January. They will also fight the insurance companies when they "forget" that individuals and families have already been billed the maximum for the year.
Personally we have had two insurance companies drive us into the collection agencies because they failed to pay bills after the maximum had been billed. Each time we get a variation on "update the computers" and "take care of this as soon as possible." It is not easy and might be a place for legislation as all of us agree that both sides of a contract should be honored. Hmmm?
We, those of us who are against government health care, also know from experience that people who desperately need care can obtain it. If we were driven to it, my husband and I could sign over our house to the government and put me on Medicaid while my husband is with VA. I have another choice available.
After the fifth hospital stay since April I was told my ability to handle stress was gone. Any extra pressure or difficulty could kill me. I sent notices of this to all those billing us by mail fax and verbal transmission. They still call and call and call in violation of state laws on collection procedures. (I ran the collectons department for a company for a little over a year and had to call businesses not individuals so they made certain I knew the rules.)Twice in the past year I needed extreme means to survive. The costs would have been astronomical and, although we maxed out our payment portions in January, we are being billed almost daily by many of them. I have gone over hospital bills line by line against the charts and found almost a hundred thousand dollars in overbillings. Many of them are not incidental. Oddest example was a daily dose of cholesterol medication prescribed for me with a daily cost of 12 dollars per dose and four doses a day. The at home dosage is one per day. My cholesterol is 132. When I asked the doctors I got many answers which made no sense. Nurses gave me the right of it. Seems that those are "standard orders" for heart patients with diabetes. After a very nice BBQ at our home earlier this month, we got an earful from three of the ICU and Cardiac nurses. Each doctor has a standard set of meds that they will order in the absence of any allergies or other red flags. Most patients never even ask what the pills are so all is well. Patients who ask can have their medications adjusted but will have to do so every time because it is easier for a doctor to tell a nurse "standard meds plus or minus" instead of spend the time to check and see if they are all needed or helpful. 'Nother subject. That practice, and the ignorance that permits it, is a direct result of people not having any idea what costs for medical care are.
All that said, my family is suffering not from lack of insurance or lack of medical care, but lack of simple observation of the laws already on the books. One woman I spoke with threatened to attach my husband's paycheck and bank accounts for debts that are not ours they are the insurance company's.. What kind of stress would that create if I didn't know the law required a judgment to take those actions? We have now sent certified letters to all collectors. We have just finished filling out the forms for medical bankruptcy and drafting my DNR form for my doctors and my husband. We have insurance but the failure of the insurance companies to honor their contracts has increased the stress factors so that I am in and out of the hospital every month or more often with a very sick heart. A copy of the DNR, and the reasons for it have been sent, certified mail, to all still billing. Should know by this time next month if they listened. If so we may not have to go through with the bankruptcy. If not..I will see Social Security officers in September to submit my application for disability. If approved, it makes many things easier and will permit my husband to retire before he drops over from overwork. His disability and age permitted him to retire with full benefits two years ago. Besides, this way I'll get the mileage out of the slimey attorneys without ever actually hiring one since I disapprove of medical lawsuits. Going to have to think about suing colletction agencies though. A choice. My choice.
Has anyone ever thought of having an audit of hospital charges and doctors fees charted and posted online? Bet a lot of eyes would be opened. Hey, it's going to be a slow news time sometime soon.
Posted by momma y on August 28, 2007 12:55 AMWell…if you are diagnosed with a catastrophic disease – go the emergency room and pretend you can’t speak English. Then tell them you’re from Mexico. You won’t have to worry about receiving treatment or paying bills. You’ll receive the best treatment possible and won’t have to pay a cent.
So to all of those here that are whining about having to pay others’ medical bills – wake up because you already are to the tune of BILLIONS.
Posted by on August 28, 2007 01:38 AMmomma y suggests an "audit of hospital charges and doctors fees charted and posted online" which I find valid. I had an aunt who had severe kidney problems (BYU Med Center removed the wrong kidney) and she scrutinized every bill with a fine-toothed come when she started coming to Denver. She was the one who showed us that a hospital bills more for 2 Tylenol than it would cost one to buy several BOTTLES - and claim it has to do with the delivery charge (by the nurse) as if we are expected to believe that nurses don't make rounds, and couldn't deliver meds then.
When I broke a wrist in an accident, and was in the hospital, I was given 3 choices:
1) ice pack for the wrist - free (as if the ice pack didn't have to be delivered to the room
2) an injections - next least expensive - seems to be more work than delivering pills to me, but perhaps I am confused
3) Tylenol - which, for me at least, has NEVER worked well for headaches or any other form of pain.
I also suggest an audit of insurance compangy charges and fees paid charted and posted online. Remember the Texas mother who DROWNED 5 children while suffering post partum depression? The insurance company had denied payment for the anti-depressants that were working & only covered something cheaper, which didn't work for her.
For all of you who think that private health insurance companies have your best interests at heart, and are honorable enough to meet their promises to the insurance holders, please remember their mission: profit. The job of insurance companies (as any other company) is to collect as much as possible for their product (in this case insurance coverage) while paying out as little as possible for that product (in this case health care). How is this better than a single payer system - which in the 24 countries using a single payer system has led to both lower national spending on health care (1/2 to 1/3 lower than the US pays based on GDP) and both higher life expectancy & lower infant mortality rates.
Posted by Mary on August 28, 2007 05:21 AMTbone-
I misread - so I stand corrected. However personal responsibility is the theme here and it is not stupid and definitely is not BS as you put it. That is what this country was founded on - not what can the government provide me today.
I lost a child when I was pregnant between both of my children. Since it was 5 months into the pregnancy I had to be admitted to the hospital and deliver the baby.
I was in the hospital for one night.
When I got the bill for my part of the charges. I called and asked for an itemized bill.
The hospital charged me 7 times for an IV pump. The normal charge is once every 24 hours. I was out within 24 hours.They also charged me for drugs I never would have taken like alka seltzer. We also found other mistakes.
We always ask for an itemized bill for any hostpital or out-patient surgery. Even though our insurance will pay most of it up to a certain limit per year ,we still have out of pocket expenses.
We just paid a bill for the biopsy I had done. it was about $300 on our part. We called the billing office that kept calling everyday for payment and told them we would pay in full this Friday if they took 30% off the bill. They said okay. Do not hesitate to negogiate with the hospitals. If you pay all of it at once,on a credit card or if you have the money they will often knock 20-30% or more off the bill.
Posted by Can I get an AMEN! on August 28, 2007 07:51 AMMommy Y: you stated
" We have just finished filling out the forms for medical bankruptcy..."
There is no such thing as a 'medical bankruptcy'. I hope your lawyer explained that to you. When filing a bankruptcy, ALL your debts must be listed. It doesn't matter that you want to keep certain credit cards, house payments, etc. YOU MUST LIST ALL your debts, not just medical bills.
Good luck.
Can we now all please start lambasting Momma Y for the irresponsible decisions that she made in her past that have led to her now being a cardiac cripple?
Less salt, more broccoli back at the barbeque thirty years ago. Bad girl!
If we're to be consistent let's let her have it! Momma Y you suck! Who cares about your problems? You got what you deserve for not taking "personal responsibility" for your health.
So there.
Posted by on August 28, 2007 12:24 PMShiela,
The only debts we have are the medical bills, our mortgage and a past due Excel bill. We don't have any credit cards. We were cab drivers and truck drivers and never wanted them. I was badly injured while working for Yellow Cab and the medical bills were over 200K. Yellow Cab was uninsured, no workers' comp, and we won a judgment against them that stated they were uninsured and liable for all bills. They filed bankruptcy, for other reasons, and I got a judgment from the Colorado Supreme Court that we weren't liable for those medical bills. Nothing was ever paid on them. Our credit was tagged with these bills and we paid no attention since we had always paid our expenses with our earnings and didn't need credit. (Being on a truck created very little expense when both of us were there.) When we left the road we bought a this house from a private party and that is the only non-medical expense we currently have.
Please understand, I reject socialized medicine. My preference would be for people to be able to buy their own insurance outside of employment. I have given the details in other posts. I support the insurance companies right to make a profit. I just want it to be an honest profit not one resulting from their "accidental" failure to pay expenses after a maximum had been charged to us. I tried to make payment arrangements but there were too many bills that should have been paid and weren't. Three care providers, one a radiology practice, have bills over a thousand dollars each. The insurance company claims that since they didn't have any arrangements with that company I should pay them and then ask for re-reimbursement. This was for treatment given in the hospital after an ER admission. Rules for such actions declare it is legal for them to do this except in emergency situations. In an emergency the insurance company must pay any expense normally covered without regard to provider contracts. Of course they have unlimited time to "investigate" this. Doctors have problems collecting under these conditions so they go after the patient. The assumption seems to be that the insurance company will pay after the patient makes the co-pay. Telling the doctors that you don't owe a co-pay is ignored.
I would have the same problems if my car was damaged and I took it to a body shop to be repaired and paid them the deductable and then the insurance company was billed for the full amount with a notation on the payment made to cover the deductable. IF the insurance company then decided to require the deductable for the mechanical repairs even though they proof the deductable was paid, there would be a clear remedy. The customer service department at the automobile insurance agency is set up to deal with people. For health insurance there is no such remedy. We must fight the battle for each bill and it is worse because my husband's company changed insurance in December thus making a situation where we had just reached the maximum out of pocket in one insurance company for the year then had to begin all over again with Kaiser. It took us less than 4 months to totally max out our out of pocket for me and now we have two more sets of bills coming from the last two hospitalizations. Once again I must provide the proof that we have met the maximum and have to do this with at least five doctors, two medical practices and one prosthesis maker where I have been told that the insurance company has refused to pay even their stated percentage. I have decided not to get it because my share of this is over a hundred dollars.
I feel bad because we have always paid our bills before but we can't risk any judgments against his paycheck and two have already sent letters threatening such actions. It shouldn't be necessary to chase down your insurance company to make them pay the amounts they contracted for. The insurance commission is the state agency is there but I have lots of experience in bureaucratic maze surfing and they are one of the worst I have ever seen. Could be part of it is I can't spend the hours of time on hold playing the "press 1 for he department that will transfer you back to the beginning, press 2 to be put on hold and listen to the same Barry Manilow songs over and over, press 3 to be disconnected by accident when we answer or press 4 to take your chances the person answering knows how to take down information AND knows how to put you on hold without disconnecting you game.
This is health care in the business centered age. I went through a similar problem with my car after a woman ran a red light and took out the entire front right quarter of my husband's car. The mechanic actually was told I had to pay him the deductable even though the body shop clearly listed it as already paid in cash. Took about the same two hours on the phone, but the problem was settled that day and the mechanic got a check in three days. Insurance companies have to compete for car insurance in the open market. Health care is marketed in the conference rooms of business and people are irrelevant because they can't make the decision to choose another insurer. That can be changed. Until it is, there will be problems that have simple solutions requiring enormous amounts of time and energy, and money, simply because there is no incentive, no profit in marketing to the patient because the health insurance companies customers are the businesses.
I guarantee all of you that, one way or another, through higher premiums, lost wages, bankruptcy filings, Medicaid, welfare or whatever, you are paying a part of momma y's healthcare. You can't stop it or avoid it. The only people who benefit are the insurance companies who'll refuse coverage or drop you outright if they can't make a profit off of your misery. You're falling for the "responsibility" rap of the insurance industry and you're paying anyway. They get to laugh all the way to the bank and write off, to you, the taxpayer, any losses they incur. Choice, my ass. You have no choice to begin with.
Posted by Stan Broyles on August 28, 2007 01:10 PM:1:10
I DO take responsibility for my bad choice in diet and genetic. OK, not genetics. I have insurance and do my best to minimize expenses. I want the right to buy health insurance in a market that is oriented to the individual, not the businesses.
Not able to do that physically or financially now. I'll probably be out of the hospital for a month or so now before I need to go back. (My heart is so weak that I need to stop and rest for a few minutes after walking ten feet to the car if I'm driving.) For now I'm feeling better .
My husband has turned down two job offers that paid better and had better conditions to stay with the insurance company because of the pre-existing condition nightmare. We have not always had health coverage due to three month delays when he changed jobs and one year delays before pre-exisiting conditions were covered. We have always paid for insurance and I spent one year, long before my first heart attack, where we bought my diabetes medications online and economized on other things so we could survive for that year.
My husband made a suggestion, I'll put it out here with the disclaimer that it isn't MY idea, that should people decide they want socialized medicine the government should put all of them on a plan which would cover them for the waiting periods before individual insurance took over. Should be enough to teach them was his thought. His experience with VA is most informative.
Final point: people who make the right decisions don't always end up with the right results. We can't guarantee that anywhere. Why do we think the government can correct that in health care?
Stan
Lighten up. Insurance companies are businesses and are run for the benefit of the customer to make a profit. Both profit and customer satisfaction have to be present. The patient isn't the insurance company's customer. The patient's employer is the customer. One thing the bankruptcy attorney told us was that when we file the insurance company then has to deal with the doctor's lawyers so they pay pretty quick. We would pay over time but we can't get them, the insurance companies, to pay their share. I am a great negotiator. I'd be able to negotiate to ten percent of our co-pay IF the insurance company had honored the contract. Responsibility is very important but people don't care because they don't have to. Let the market really work and, like with auto insurance, those who represent a greater risk will pay a higher fee. Americans are great bargain hunters. Give them a pocketbook reason to shop for medical care AND the flat floor of equal tax benefits for individuals, they will do it.
Two hospitals have been given notice that the over-billings in my case will be reported. They have been documented and the documents scanned into my laptop (Being former truck drivers we still have all those WIN 95 gadgets and programs that had to be small to fit in a semi bunk or, in this case, a briefcase.) I had the help of one of the nurses who outlined a good area to start looking for overcharges. Found them. The billing departments of those hospitals are the ones owed 1500 and 2500 dollars respectively. In the first case I found 4800 dollars in false charges. In the second I have only found about 2200K but I'm still working back and forth between my notes, the nurses' charts and the bill. Not mistakes, actual things never administered, drugs never taken, dressing changes never done. They didn't have the special pads for my diabetic foot ulcers. My podiatrist had supplied me with all the materials necessary to dress them for two weeks. (I ended up in the ER two hours after leaving his office.) The supplies were in the patient bag next to my purse and the nurses used them. Two dressing changes a day were ordered. In the bill I am charged for three dressing changes a day and the special bandage material is charged at over 200 dollars per dressing. There is a bill for a doctor ordering a saline drip. The orders discontinued it a day later but I was charged for five IVs a day at 145 for the saline, 39 for the IV tubing, 5 for the heparin and saline used to flush the IV line and 500 dollars a day for the infusion pump Pump didn't work so it was sent back. Oh, they charged me for 12 days of that IV and added charges for other medications as well with separate tubing charges etc even though the IV tubing was changed every 48 hours. Little things like that. Nurse told me they have to use a bar code scanner to verify the right patient is billed so where the errors originate is a mystery to all except the skeptical.
It is also helpful to ask questions while you are getting health care. One poster here has mentioned he got three options for treatment, along with their costs, for a broken wrist. He must have asked a question or two.
You ever take a car or computer in for repairs and just paid the bill without asking anything?
Go ahead and beat up on the insurance companies all you want but you have one very good point hidden in the anger. We all pay for the ignorance of the actual costs of health care. You can either correct that or ask the government to open car repair shops where you just submit the bill to your insurer without asking if your 2008 Prius really needed that new distributor cap.
Posted by momma y on August 28, 2007 02:06 PMmommy y,
I am not a car. I can't drive a car. (I have a condition that makes me appear drunk but with no buzz.) I can't collect unemployment because I can't drive. I can't collect disability because I won't meet their definition of disabled until at least December (1 year). I'll probably have to go on some kind of welfare, if they'll let me, then everyone else can pay for my condition.
My employer does not pay for my healthcare because, supposedly, I'm self-employed even though I can't work and don't receive a paycheck. My employeer is not the customer. I am. My insurance has a 5K deductible and my rates are more than 6K (= 11K before I can collect a dime) a year and rising (20% this year alone). They wouldn't pay for my CT scan, the audioligist or the MRI. Yet, I still pay my premiums, the insurance company keeps cashing my checks and I'm stuck with them because, now, I have a pre-existing condition.
So that 6k premium I pay every year helps pay for other peoples heathcare, including yours, and I get nothing. I've now exhausted my MSA. Everyone faces different problems but insurance companies should not profit from their exhorbitant premiums because someone is sick.
Posted by Stan Broyles on August 28, 2007 04:58 PM"So that 6k premium I pay every year helps pay for other peoples heathcare, including yours, and I get nothing. I've now exhausted my MSA. Everyone faces different problems but insurance companies should not profit from their exhorbitant premiums because someone is sick."
If you feel you get nothing, why keep paying? Obviously, you're getting something; you're just paying more than others because of your unfortunate pre-existing condition.
The insurance companies do not profit from people getting sick. They lose money when people get sick. There is a higher chance that your condition will cost your insurance company more money than it will collect from you. That is why you are paying more.
Having said that, I do sympathize with your situation. If you post your address, I (and hopefully others) will send some cash to help you get the tests you need.
Posted by John II on August 28, 2007 06:59 PMSteve,
For most of my life I paid insurance bills and used it very little. I was an independent contractor with Yellow Cab but back then they were required to have Workman's comp for ICs too.
You are unfortunate and the problems are real. You are the purchaser of insurance but there is no incentive for an insurer to seek you out or to offer you a special plan. In the absence of a substantial market for individual health insurance you are cheated of the opportunity to really choose your plan. Know about Medicare. Was old by the doctors to go for disability in 2002 after my first heart attack. Paperwork harder than working at a job. Kept working, actually worked 2 jobs at once for a time, until my second heart attack. Returned to work after that one too but the medication made me sleepy so I got fired for falling asleep at work. Third heart attack came two months later and since then I've not been able to work.
Good luck on your claims and hope you will find a balance and a treatment if not a cure. We are going to disagree on this subject. You are right that we all share in the expenses. I say that the present situation is why we don't want to encourage the government. But who am I to talk? I'm just home from the hospital and supposed to rest in bed at least half a day. With the laptop this is my rest.
Do have a suggestion for your illness. Buy a very large wastebasket or recycle one you already have and whenever anyone offers a remedy write it down or have them do so. When you get home, or they leave, toss the papers in the trash. Be well.
Uh
Make that Stan.
The car analogy was to illustrate the level of medical cost and treatment ignorance.
My husband suggested that we see if the government will sell us all a policy that will offer unlimetd catastrophic coverage over a set level determined by our premiums. Don't mind him. I don't. Just ask him.
Posted by momma y on August 28, 2007 07:36 PMmomma y,
Your car analogy is spot on. We don't charge oil changes, tune-ups, and brake work to auto insurance, so why do we ask insurance to pay for routine doctor's visits and drug prescriptions?
Insurance is for unexpected calamity. It is not for routine expenses.
Posted by John II on August 28, 2007 08:00 PMJohnII
Thanks. Unlike health care, with cars we think someone who doesn't try to understand at least the basics is asking to be ripped off.
Once had a mechanic try to charge me for a muffler belt. Told him I'd just replaced the muffler bearings and upgraded to a geared system.
Posted by momma y on August 28, 2007 11:04 PMJohn II,
Thanks for very much for your generous offer but I've already had and paid for the tests. That's why I don't have anything left in the MSA. The final prognosis was: "It'll either go away on its own or you'll have to get used to it." My insurance is catastrophic; in case I wind up in a nightmare like momma y.
Posted by Stan Broyles on August 29, 2007 09:38 AM