Insurance Costs: For doctors, health ins. workers

[greg775]

So educate me please.

I broke my foot and had to go to the orthopedist a total of four times. The first time for diagnosis. I waited two weeks and was still limping badly. I wasn't a p****. I waited two weeks, then figured I better go in lest I screw myself big-time over not getting a possible broken bone assessed.

The next 3 trips to the doc every two weeks were for him to naturally check on the healing of my foot.

 

Anyhow, as expected, on the first bill, the insurance company refused to pay for the Xray and the brace they gave me.

The next 3 visits they refused to pay for the Xray.

What the hell? Is this just organized thievery of the insurance company versus me? How the hell is the doctor supposed to assist me without Xrays showing whether the f***ing bone in my foot is healing or not?? The Xrays are NEEDED.

And the brace? I just knew insurance wouldn't pay, but again, does my insurance company want me to not wear a brace, sprain the foot again and need surgery to insert screws? As it was, my doctor avoided any type of surgery.

 

Do you share my anger at the insurance company paying HALF my costs each time? Of course I had a copay each time just to walk in and see the doctor.

Why can't insurance companies PAY THE f***ING BILL?

Am I out of line thinking I got ripped off?? (I get my insurance thru work).

Edited July 20, 2014 by greg775

[Brian]

I vote for a greg Catch All Thread for all his downer info. jk

 

I had a problem with an insurance company a couple of years ago when I had major surgery. I called ahead and got approved for coverage. It would be out of network, which I knew, and I would pay $8000 max out of pocket.

 

Get my bill and it's $46,000. I fought the insurance company on it. They said they listened to the phone call and agreed with what I said I was told but was given the wrong info and they would not cover it. I filed appeal after appeal with them and nothing.

 

I had my surgery out at Mayo Clinic in AZ and after all the appeals with Humana, I applied for financial help, in hopes of them knocking some of the costs down. Well they did, all the way down to me just owing just $3000. They were incredibly understanding and if I ever strike it rich, I'll be donating money to them.

 

F Humana

 

Just recently I got new dental insurance through work. I pay $20 a month. My dentist is out of network and have been going to this guy since I was in high school so figured I would see how much they would cover. They paid $13. How does that make sense? Why would I pay $20 a month and basically get nothing covered? Now I have to find a new dentist that is in network. Not a big deal, but I hate getting out of my comfort zone.

 

Cough, single payer, cough

Edited July 20, 2014 by Brian

[Texsox]

Dental and vision insurance rarely is a winning deal for the consumer. Basically they both know if you buy it you will use it because it is basically elective procedures. So all you are really doing is prepaying for a few things and getting a discount unlike health insurance where you might use it for a heart attack which you really can't plan for. I have the absolute worse vision coverage on the planet. They are the worst company I have ever dealt with in my life.

[bmags]

Dental sucks.

[IlliniKrush]

Dealing with health insurance is the absolute worst. My wife and I have done far too much of it for our daughter in the past year. The things they reject and make you jump through hoops to appeal is incredible.

[greg775]

Dealing with health insurance is the absolute worst. My wife and I have done far too much of it for our daughter in the past year. The things they reject and make you jump through hoops to appeal is incredible.

 

Tell us some stories. I'd be interested.

 

It seems like we Americans are going to have to start asking questions regarding our treatment. We're truly in a bind. We go in the hospital or our kids go in and we/they get treated. The doctors do their jobs and do whatever they need to do and it is all recorded on a bill.

 

Now normally, in the old days, this was fine. Let the doctors do their jobs to save us and our our loved ones and insurance paid for it all. The problem is now, the insurance companies won't pay squat.

 

So we go in the hospital, heaven forbid for 2 weeks, and need major surgery, and let's say the total cost is 500,000. Let's say our insurance pays 350,000. I mean why have insurance? What's the difference between being on the hook for 150,000 bucks or 500,000. It ruins our lives either way.

We're still on the hook for 150,000 bucks which the average Joe can't pay. Or if he can pay in one swoop his retirement is gone.

 

We're going to have to get to the point we ask the doctors to OK everything through us so we can call our insurance companies to see if they'll cover it. If not we have to refuse the medications and services beyond the bare minimum and the hospitals will be guilty of cruel and inhumane treatment toward human beings.

 

Funny thing is the hospitals would NEVER agree to such a thing. They provide treatment as they see fit, and we have to deal with the costs later. You know damn well every insurance company worker is told by their bosses to reject EVERYTHING they can. EVERYTHING.

This is insane. Lives are being ruined daily/weekly.

Edited July 22, 2014 by greg775

[Brian]

I've had talks with my Dr during visits as to how he hates insurance companies and they tie his hands sometimes.

[caulfield12]

Tell us some stories. I'd be interested.

 

It seems like we Americans are going to have to start asking questions regarding our treatment. We're truly in a bind. We go in the hospital or our kids go in and we/they get treated. The doctors do their jobs and do whatever they need to do and it is all recorded on a bill.

 

Now normally, in the old days, this was fine. Let the doctors do their jobs to save us and our our loved ones and insurance paid for it all. The problem is now, the insurance companies won't pay squat.

 

So we go in the hospital, heaven forbid for 2 weeks, and need major surgery, and let's say the total cost is 500,000. Let's say our insurance pays 350,000. I mean why have insurance? What's the difference between being on the hook for 150,000 bucks or 500,000. It ruins our lives either way.

We're still on the hook for 150,000 bucks which the average Joe can't pay. Or if he can pay in one swoop his retirement is gone.

 

We're going to have to get to the point we ask the doctors to OK everything through us so we can call our insurance companies to see if they'll cover it. If not we have to refuse the medications and services beyond the bare minimum and the hospitals will be guilty of cruel and inhumane treatment toward human beings.

 

Funny thing is the hospitals would NEVER agree to such a thing. They provide treatment as they see fit, and we have to deal with the costs later. You know damn well every insurance company worker is told by their bosses to reject EVERYTHING they can. EVERYTHING.

This is insane. Lives are being ruined daily/weekly.

 

 

It's a slippery slope. With modern technology available, the days of diagnosing injuries through "intuition/gut instinct" are simply gone as doctors and hospitals have become afraid to make any type of mistake that would expose them to a potential lawsuit.

 

So we're all subjected to a battery of expensive tests that aren't necessary 90% of the time.

 

I've always been one to side with lawyers and class-action claims if they're credible (otherwise, corporations would have TOO much protection against Joe the Topeka Plumber, but there has to be a way to balance things more equitably to protect the rights of consumers to get only the care that's truly needed without incurring costs they can't afford to pay...or will take years to pay off.

 

 

 

In China, if you have a baby, every single cost is paid back by insurance and/or the government. Of course, one caveat is the baby has to have married parents to receive this compensation. Otherwise, it's an "illegal" baby. Not only that, but mothers by law have three months off from work.

[Y2HH]

I vote for a greg Catch All Thread for all his downer info. jk

 

I had a problem with an insurance company a couple of years ago when I had major surgery. I called ahead and got approved for coverage. It would be out of network, which I knew, and I would pay $8000 max out of pocket.

 

Get my bill and it's $46,000. I fought the insurance company on it. They said they listened to the phone call and agreed with what I said I was told but was given the wrong info and they would not cover it. I filed appeal after appeal with them and nothing.

 

I had my surgery out at Mayo Clinic in AZ and after all the appeals with Humana, I applied for financial help, in hopes of them knocking some of the costs down. Well they did, all the way down to me just owing just $3000. They were incredibly understanding and if I ever strike it rich, I'll be donating money to them.

 

F Humana

 

Just recently I got new dental insurance through work. I pay $20 a month. My dentist is out of network and have been going to this guy since I was in high school so figured I would see how much they would cover. They paid $13. How does that make sense? Why would I pay $20 a month and basically get nothing covered? Now I have to find a new dentist that is in network. Not a big deal, but I hate getting out of my comfort zone.

 

Cough, single payer, cough

 

For your dental issue, it's your own fault for going out of network. I know you've been with that guy but if he doesn't accept your insurance perhaps it's time to move on.

 

 

[IlliniKrush]

Tell us some stories. I'd be interested.

Calling a neurosurgeon "unnecessary" on a head surgery because a plastic surgeon was already there.

[greg775]

Calling a neurosurgeon "unnecessary" on a head surgery because a plastic surgeon was already there.

 

Geezus. That pisses me off. I'm so sick of some aspects of life in America (this world). Good god, what has this world come to that a human being would deny that medical service??? Sickening to me. I'd rather be unemployed than be that worker who f***ing denied that service. I have principles and trying to save the company money on that one is disgusting.

Edited July 26, 2014 by greg775

[Goober]

Recently paid $1100, for an allergic reaction.

[Goober]

Glad it wasn't one of these

[Jake]

Geezus. That pisses me off. I'm so sick of some aspects of life in America (this world). Good god, what has this world come to that a human being would deny that medical service??? Sickening to me. I'd rather be unemployed than be that worker who f***ing denied that service. I have principles and trying to save the company money on that one is disgusting.

 

Greg, you'd enjoy the documentary Sicko by Michael Moore. While many of the things it points out about the American system were remedied by the ACA, it's still very insightful and it seems like it will provide the kind of heartstring-pulling that you're aiming for

[Y2HH]

Greg, you'd enjoy the documentary Sicko by Michael Moore. While many of the things it points out about the American system were remedied by the ACA, it's still very insightful and it seems like it will provide the kind of heartstring-pulling that you're aiming for

 

Terrible documentary, and completely biased.

[Jake]

Terrible documentary, and completely biased.

 

Biased? Sure. Terrible? Eh, I don't know. There are several problems about the way a few things are presented, but it's a far broader view of world healthcare than you see anyplace else.

 

And I know it's right up Greg's alley of "give me some sad healthcare stories"

[Y2HH]

Tell us some stories. I'd be interested.

 

It seems like we Americans are going to have to start asking questions regarding our treatment. We're truly in a bind. We go in the hospital or our kids go in and we/they get treated. The doctors do their jobs and do whatever they need to do and it is all recorded on a bill.

 

Now normally, in the old days, this was fine. Let the doctors do their jobs to save us and our our loved ones and insurance paid for it all. The problem is now, the insurance companies won't pay squat.

 

So we go in the hospital, heaven forbid for 2 weeks, and need major surgery, and let's say the total cost is 500,000. Let's say our insurance pays 350,000. I mean why have insurance? What's the difference between being on the hook for 150,000 bucks or 500,000. It ruins our lives either way.

We're still on the hook for 150,000 bucks which the average Joe can't pay. Or if he can pay in one swoop his retirement is gone.

 

We're going to have to get to the point we ask the doctors to OK everything through us so we can call our insurance companies to see if they'll cover it. If not we have to refuse the medications and services beyond the bare minimum and the hospitals will be guilty of cruel and inhumane treatment toward human beings.

 

Funny thing is the hospitals would NEVER agree to such a thing. They provide treatment as they see fit, and we have to deal with the costs later. You know damn well every insurance company worker is told by their bosses to reject EVERYTHING they can. EVERYTHING.

This is insane. Lives are being ruined daily/weekly.

 

This really depends on what kind of insurance you have, be it HMO, or PPO, and the coverage supplied based on the package you have.

 

While convenient, I can tell you off the bat, PPO's are expensive for people that actually use their insurance for anything more than a standard doctor visit. HMO's tend to cost on par with a top PPO, or in some cases they'll be a bit more expensive, but their coverage is astronomical since they cover *anything* your PCP requests, however, they come with the added baggage of having to see your PCP for EVERYTHING.

 

I have two personal use cases of having a child (well, my wife that did that), but one child was born under PPO the other under HMO.

 

Under the PPO, our total out of pocket expenses exceeded 4500$ throughout the birth.

 

Under the HMO, our total out of pocket expenses were about 100$.

 

----

 

An insurance plan will have 2 out of pocket expense categories, the deductible, and the patient share out of pocket, which will be capped* **.

 

So, if you have a 1000$ deductible and and a maximum out of pocket of 8000$, this is how it works:

 

All non-routine expenses will first be applied to your deductible, while most routine treatments, such as preventative care are usually covered by a co-pay unless you have REALLY bad insurance. After your deductible is met, you'll often have a co-pay of 15-20% depending on your plan...this means if you go for an MRI which costs 3500$, you'll owe 20% of that 3500$. And if you go for 6 MRI's, you'll owe 20% of that * 6.

 

* Keep in mind ALL of this has to be IN-NETWORK. Only HMO users can bend the out of network rules in an emergency by contacting their PCP and having him/her say go ahead and treat my patient. PPO users SHOULD NEVER go out of network, because a good PPO's network is so insanely big, it should be almost impossible to do so.

 

** If you stay in-network, out of pocket expenses are capped at whatever the plan sets, say 8000$. If you go out of network, there is no cap...so don't. I don't care how much you love your doctor of surgeon, if they're not in your network, move along.

 

----

 

Under the HMO this year alone, I incurred two hockey related injuries -- taking a slapshot off my inner thigh which ripped the muscle, and open palm blocking a slapshot which fractured my thumb and tore my nail half way off, which required surgery/stitches.

 

I owed 80$ out of pocket TOTAL.

 

Under my old PPO I would have owed about 1500$.

 

----

 

With anything, I'll leave you with this -- you get what you pay for. If you want to save yourself 30$ a month by getting s***ty insurance, when the time comes to pay the piper -- you'll be doing exactly that.

Edited July 26, 2014 by Y2HH

[Y2HH]

Biased? Sure. Terrible? Eh, I don't know. There are several problems about the way a few things are presented, but it's a far broader view of world healthcare than you see anyplace else.

 

And I know it's right up Greg's alley of "give me some sad healthcare stories"

 

It's just a bad documentary because it's filled with so many lies I don't have time to go over them.

 

And he completely falls off the rails when he does his whole fake Cuba thing.

 

If Cuba was so awesome, people wouldn't be leaving there under the risk of death...which they are...so he should have used a better example.

 

Michael Moore is a hack, and he's been exposed by many of his works of fiction by bending reality so it agrees with him, instead of just presenting facts.

[Y2HH]

Biased? Sure. Terrible? Eh, I don't know. There are several problems about the way a few things are presented, but it's a far broader view of world healthcare than you see anyplace else.

 

And I know it's right up Greg's alley of "give me some sad healthcare stories"

 

Here is another in a long line of anti-fact "documentaries", though this one isn't by Michael Moore (who pretty much started the biased/lie filled "documentary" fad), http://www.rottentomatoes.com/m/gmo_omg/

 

Nothing scientific backs any claims made by this docu, yet people eat it up.

 

These being called documentaries seriously needs to stop, it's like labeling fiction as non-fiction in a book store.

[Jake]

It's just a bad documentary because it's filled with so many lies I don't have time to go over them.

 

And he completely falls off the rails when he does his whole fake Cuba thing.

 

If Cuba was so awesome, people wouldn't be leaving there under the risk of death...which they are...so he should have used a better example.

 

Michael Moore is a hack, and he's been exposed by many of his works of fiction by bending reality so it agrees with him, instead of just presenting facts.

 

When I said there were "several problems" I was specifically thinking of Cuba - mainly because there are some dark sides of their healthcare system though his posse received a pretty authentic experience of what outsiders should expect.

 

The whole point of the Cuba escapade was that despite how s***ty and supposedly evil Cuba is, they have no problem having low healthcare costs and far better access than what is the case in the USA. For instance, they have far better infant mortality rates in Cuba than USA. Why? Because they don't f*** over the poor people who have children, leaving them at risk to experience infant death. The same is true of under five years old mortality rate. Cuba also generates tens of million dollars (a huge amount of money in their deflated economy) in healthcare tourism every year, so it's not a fiction that people, including Americans go there to get healthcare services that are otherwise unavailable (usually due to cost barriers in home country).

 

Kofi Annan had this to say about Cuba in 2000:

"Cuba's achievements in social development are impressive given the size of its gross domestic product per capita. As the human development index of the United Nations makes clear year after year, Cuba should be the envy of many other nations, ostensibly far richer. [Cuba] demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy."

 

Of course, the problems of Cuba in general extend into healthcare as well. You have very little right to privacy as a patient and different healthcare issues can be highly politicized (that's not unfamiliar to us). The poverty of the country extends into healthcare too, with many facilities in shoddy conditions and doctors very underpaid. The US embargo makes things much more difficult, considering the manufacturing of healthcare goods in the USA.

 

But the entire point was not to say that you should move to Cuba or install Castro as the head of HHS. It's that a country with so little could compare so favorably to us.

 

The film highlights many of the shortcomings of the US system, most notably many of the problems which were remedied just over two years later in the ACA. Details are missed and there is an obvious focus on negatives in the USA and positives elsewhere. You could also criticize him for completely ignoring the huge uninsured persons problem in the USA that existed at the time, since he just mentions it at the beginning and says he'd rather reveal what happens to people who think they are insured.

 

What the movie has going for it is that the USA indubitably has a terrible, inefficient, and unequal healthcare provisioning scheme that pales in comparison to most of the rest of the developed world and is shamefully poor when considering the vast resources available to the USA that other countries lack. There is a limit to how untruthful you can be when you are making that argument in some way, shape, or form.

 

Here is another in a long line of anti-fact "documentaries", though this one isn't by Michael Moore (who pretty much started the biased/lie filled "documentary" fad), http://www.rottentomatoes.com/m/gmo_omg/

 

Nothing scientific backs any claims made by this docu, yet people eat it up.

 

These being called documentaries seriously needs to stop, it's like labeling fiction as non-fiction in a book store.

 

There is no objectivity to strive for. You can't present facts that are absent of bias. Of course, you can try to reduce bias, account for it, not outright lie, etc.

 

I am, however, with you in that the alarmism over GMOs has become very tiresome. Still, with the corporatization of the food industry and the countless illegal and morally questionable tactics of groups like Monsanto, I understand why people would be skeptical of mainstream messages about these things.

[Jake]

Also, while we're on the subject of Cuba, this is a patently outrageous statement given that it came from the US State Department:

 

the Cuban Government made a deliberate decision to continue to spend money to maintain its military and internal security apparatus at the expense of other priorities--including health care.

 

Not only are the particulars of that statement factually false as Cuba's defense spending fell dramatically while healthcare stayed stable, it's coming from the United States of America that spends on the military at the expense of anything and everything, including the dire need for healthcare improvement

[lostfan]

Last year my insurance company took like 3 weeks to decide that yes, they were going to pay for a CT scan that I actually needed. Last week I had to go to the ER (I have a $125 deductible I think) where I had, among other things, a CT scan. Looking forward to getting that bill in the mail. If all I get is just a bill for $125 (that I haven't paid yet) then I'll be shocked, honestly.

[greg775]

Last year my insurance company took like 3 weeks to decide that yes, they were going to pay for a CT scan that I actually needed. Last week I had to go to the ER (I have a $125 deductible I think) where I had, among other things, a CT scan. Looking forward to getting that bill in the mail. If all I get is just a bill for $125 (that I haven't paid yet) then I'll be shocked, honestly.

 

I think people that work for insurance companies are the modern-day used car salesmen in terms of lowlifes on the list of workers. Remember when car salesmen were considered lowest of the low? Seriously, do these people want us to die?? I mean they obviously don't want you to have the CT scan. Is their goal to kill us off? It's ridiculous. They'd rather kill us than OK treatment.