Sicko - Health Insurance Poll Inside

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TxBrew

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SWMBO is watching Sicko right now. What I saw he went around to people who's insurance denied valid claims that ended with death IE guy with cancer died because insurance would not cover some procedures.

Anyone here ever been in a similiar boat before? Health insurance not pay for something legit.
 

Kevin Dean

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My wife's best friend, Sue, is a single-mother of two boys (23 and 6). She was a small Japanese woman (but all-American!) who was rather fit but certainly not a health nut.

Her older son was murdered because he witnessed an illegal dog fighting ring doing some "dumping" of dead dogs... Obviously this caused stress. She began smoking cigarettes.

6 months later she was diagnosed with cancer. The insurance company paid for the first round of chemo and surgery which left her unable to speak, smoke or eat anything harder than bread (the cancer was throat cancer) for 6 months. Before that 6 months was over, the cancer had returned.

The insurance company refused to administer a second round of chemo citing the "inneffectiveness" of chemo that early after a first surgery. So, persistant, she found other doctors willing to perform a tested-but-not-yet-mainstream procedure involving chemophotosensitivity that has an extremely high sucess-rate.

The insurance company refused THIS time to pay for "non-standard" practices because she smoked (nevermind that the doctors certified that the tumor existed the day she lit the first one). It's the same, they told her, as refusing a liver-transplant to an alcoholic.

She had to pay for the procedure, after-care and all that out of her own pocket which was, I assure you, not a small sum.
 

Cheesefood

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TxBrew said:
SWMBO is watching Sicko right now. What I saw he went around to people who's insurance denied valid claims that ended with death IE guy with cancer died because insurance would not cover some procedures.

Anyone here ever been in a similiar boat before? Health insurance not pay for something legit.
Tx, dealing with this problem is about 95% of my job. One of the largest insurance companies in the country, Blue Cross / Blue Shield, refuses to get into a contract with us regarding reimbursement for two of our 3 hospitals. As a result, people living next door the the hospital have to travel hundreds of miles to another hospital.

Other major insurance companies simply refuse to reimburse at an acceptable level so we have to tell our patients that either they're going to be liable for the remainder (hundreds of thousands of dollars) or they can't treat with us.

I know many of you are going to cry BS on us and say we should treat everyone, but Dr's aren't charities. If you want the best Dr's, you have to pay them the best salaries. Drugs aren't free. These huge machines like MRI's aren't cheap.

I could go on and on, but in the interests of my company I won't. If you ever want to talk about it over a beer, I could give you a lot of insight. Insurance companies let people die every day simply because they don't want to pay a good hospital as much as another company is willing to pay. And Im not talknig about a few bucks, I'm talking about 80% reimbursement versus 15% reimbursement.
 

Kevin Dean

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Cheesefood said:
I know many of you are going to cry BS on us and say we should treat everyone, but Dr's aren't charities. If you want the best Dr's, you have to pay them the best salaries. Drugs aren't free. These huge machines like MRI's aren't cheap.
My family has a long list of health-care professionals so I certainly won't call BS there... Doctors need to make a living just like everyone else.

[rant]I don't blame the doctors, I blame "the system"... American capitalism. Firstly, schools and universities used to operate for the purpose of furthering our understanding of the world. Increasingly, universities and schools are run like corporations (some actually ARE) with the purpose of profit. Schools now fund research in hopes of getting patent rights rather than helping the world at large. This is reflected on the STUDENT'S side - medical school is EXPENSIVE and even non-doctorate professions are insane.

Secondly, "Big Pharma" claims that they need "incentive" to research drugs and they've lobbied strongly (along with the software industry) for draconian patent laws that actually make sharing illegal. This eliminates competition, deprives the market of generics, and costs the insurance industry which passes it on to the patient.

The problem is that being "healthy" is considered a luxury, not a basic right. As long as healthcare decisions (on all levels) are made by someone who has "profit" on their list of objectives, it is the patients who will suffer.

[/rant]
 

Neomich

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SWMBO is a doctor and she tells me stories all the time of people saying " I have x dollars, what can that get me?" Or "how come the insurance doesn't cover that?" Doctors have to make a living like the other poster said. They spend a LOT of money going to school to make a good living. There's a constant struggle to balance providing quality treatment and making a profit.

Healthcare is a complex subject. In one way, I take a view that if you can't afford the treatment, then you just don't get it. Yes, it will result in death but everyone dies. On the other hand, you've got to realize the humanity of the situation. Sure, I don't want my loved ones to die because the insurance company won't pay for a life saving procedure.

I think if health care professionals and businesses were given more financial breaks, perhaps the cost of healthcare could come down. Make all doctors exempt from income taxes or something and they wouldn't need to charge as much. Besides, health care providers give back to the community enough already. And don't get me started on the malpractice lawsuits.........
 

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I think the two largest problems with our current system are:

1) It is based on an insurance model yet it does not behave like one. Your car insurance for example does not pay for preventative maintenance, only for unexpected expenditures due to accidents. In the case of a driver who never has an accident, this allows the insurance company to collect large sums of money without ever paying out a dime. Health insurance does not work this way even though it is based on this model; instead, it does pay for preventative maintenance, so the insurance companies have to raise premiums and deny coverage in order to remain profitable. This brings me to my next point...

2) The insurance companies are for-profit enterprises. Does the idea that someone profits off your health make anyone else here sick? Now I am a gung-ho free market capitalist and I have no problem with most companies making a profit, but the healthcare industry shouldn't be one of them. If insurance companies were not driven to increase their profits, they would be more inclined to act in a benevolent way.

Personally I don't want the government involved in my healthcare in any way shape or form; but I believe there is a way to provide affordable healthcare to everyone by making a few adjustments to the system as it currently exists without handing it all over to Uncle Sam.
 

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While American capitalism has faults like the occasional person being denied for insurance, it has also created the best and most innovative medical system in the world. People aren't flocking to Canada and Cuba for medical procedures. Far more people are harmed by long lines, unapproved procedures that leave them with no options (at least in the States the government doesn't stop one from paying out of pocket), and the lack of innovation in socialized countries than by denied claims in the US.
http://www.freemarketcure.com/
Sorry for the rant TX
 

Evan!

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not myself, but my friend/coworker did. He tore his ACL last year and had to go through a big operation and a bunch of rehab. Now, we had (not anymore!) the kind of crazy insurance that covers exactly NOTHING until you reach your annual deductible---$2k for single users. He easily met that with the ACL tear. After you reach your deductible, it's supposed to pay for everything. Well, the doctor told him he needed more physical therapy so that it would heal properly, and he did so. Then the insurance denied his claim and put him on the hook for 4 grand. They claim it wasn't necessary. Huh? Turns out the stupid doctor didn't verify the procedure with insurance before proceeding...and now my friend is getting shafted. When a doctor says you need therapy, it's just f*cked up to have your insurance company come along and say, "ah, yeah, I don't think so".
 

Bobby_M

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I just elected my 2008 healthcare yesterday and I chose a HDHC (high deductable $2500 family) so that I can contribute to an HSA (healthcare spending account). I'm all for this system because I've always had to pay out just UNDER the Fed/State minimums for itemized healthcare deductions. Of course FSA use would help there but I'm not contributing to a use it or lose it account. At least now I can catch a tax break on any out of pocket spending I have to do.
 

david_42

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The only case I know of personally, the woman in question went to an "alternative" practitioner for treatment of back pain because she didn't want to get her ruptured disk operated on. Ended up permanently in a wheelchair & her regular insurance refused to cover further treatment.

Other than that, everyone I know has received reasonable coverage. Which, of course, will never make 60 Minutes.

[Wish I could use my HSA for the dogs.]
 

brett

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TheJadedDog said:
I think the two largest problems with our current system are:

1) It is based on an insurance model yet it does not behave like one. Your car insurance for example does not pay for preventative maintenance, only for unexpected expenditures due to accidents. In the case of a driver who never has an accident, this allows the insurance company to collect large sums of money without ever paying out a dime. Health insurance does not work this way even though it is based on this model; instead, it does pay for preventative maintenance, so the insurance companies have to raise premiums and deny coverage in order to remain profitable. This brings me to my next point...

2) The insurance companies are for-profit enterprises. Does the idea that someone profits off your health make anyone else here sick? Now I am a gung-ho free market capitalist and I have no problem with most companies making a profit, but the healthcare industry shouldn't be one of them. If insurance companies were not driven to increase their profits, they would be more inclined to act in a benevolent way.

Personally I don't want the government involved in my healthcare in any way shape or form; but I believe there is a way to provide affordable healthcare to everyone by making a few adjustments to the system as it currently exists without handing it all over to Uncle Sam.
What's holding people back from forming a non-profit or "credit union"-like private healthcare? You know, people pay in, the provider pays out, they only cover their costs. No profit. No taxes.

It's not perfect, but it's a heck of a lot more fair than what we have now. Plus it seems less wasteful and corruption-prone than government-ran healthcare.

And why is basic healthcare so crazy expensive in the first place? Malpractice insurance. The US government is denying medical licenses to skilled doctors that happen to have gone to medical school in Communist Russia. Why is it that I can't choose to seek care from an unlicensed doctor in the first place, if I choose? It's my body.

I'll be honest, I think the government and heathcare insurance companies are in bed together. So I just cannot in good conscience vote for more government control.
 

ohiobrewtus

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When I had my back procedure I made sure to take care of everything myself. I did not leave it up to some dingbat making $10/hr working at my surgeon's office.

I called my insurance company, explained to them the procedure that was going to be done, and asked them exactly what they needed. Then I called my surgeon's office and passed that information along to them and asked them to send the required documents to my insurance company. My Dr. office called me a couple of days later and told me that everything was all set and the insurance company was satisfied.

Unless I know better from previous knowledge, I generally think that most people are idiots (except homebrewers of course :rockin: ), so I called my insurance company again to verify that they had everything that they needed and that all aspects of my procedure were going to be covered. I did all of this 3 weeks before my prodecure.

I've got a 100% plan so the whole thing cost me about $120 in office co-pays. The system certainly is flawed, but I don't feel sorry for anyone who trusts anyone working within 'the system' to have your best interests in mind. Make sure things get done, don't count on someone else doing their job properly because far too often they do not.
 

TheJadedDog

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brett said:
What's holding people back from forming a non-profit or "credit union"-like private healthcare? You know, people pay in, the provider pays out, they only cover their costs. No profit. No taxes.

It's not perfect, but it's a heck of a lot more fair than what we have now. Plus it seems less wasteful and corruption-prone than government-ran healthcare.

And why is basic healthcare so crazy expensive in the first place? Malpractice insurance. The US government is denying medical licenses to skilled doctors that happen to have gone to medical school in Communist Russia. Why is it that I can't choose to seek care from an unlicensed doctor in the first place, if I choose? It's my body.

I'll be honest, I think the government and heathcare insurance companies are in bed together. So I just cannot in good conscience vote for more government control.
I couldn't agree with you more here. Perhaps you misunderstood, I am not advocating government run healthcare; in fact as a privacy advocate I am completely against it.

I'm not sure why there aren't any non-profit insurance companies right now, I happen to think they should all be non-profit and based on a savings model rather than an insurance model.

As for malpractice insurance, don't get me started! I have friends who are doctors in FL where they have a 3 strikes and you lose your license law. Problem is, the malpractice insurance companies get to decide whether they will settle or not; so if your malpractice insurance decides to settle 3 times you lose your license, even if you had a case you would win in court! Now that is crap.

(Maybe I just hate all insurance companies, hmmm...)
 
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TxBrew

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Does anyone know if Joe Q. Public gets cancer without insurance. Does he get treated then billed or does he just not get treated since he can't pay upfront.
 

Cheesefood

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TxBrew said:
Does anyone know if Joe Q. Public gets cancer without insurance. Does he get treated then billed or does he just not get treated since he can't pay upfront.
By law, a hospital cannot refuse treatment. However, a dirty little secret is that they can do a wallet biopsy while you're unconscious in an ambulance and see if you have insurance, then decide whetehr you're going to County or to a "good" hospital. If you're in the ER, having insurance is the difference between being treated when it's your turn and not being treated until there's no one else left..

Without insurance, you will likely not get to schedule follow up appts. You will need to try to get Medicare or COBRA then find a care clinic who gladly accepts either of those. In reality, you will not get treatment until you become very, very ill and are in the final stages of dying.

Cancer is an incredibly expensive disease to treat. Your body wants you to die, but doctors can fight it off. There is no one-pill cure. Chemotherapy can help, but it causes all sorts of other complications that need to be treated. Radiation is the same way. Surgery can be successful if you catch it before it metastisizes. There are a lot of points of failure and people can and do successfully sue hospitals and doctors for being unable to treat.

Ironically, did you know that the leading cause of death for cancer patients isn't the disease, but starvation and malnutrition?
 

Dude

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Right now, I don't worry about health insurance because i get decent coverage being in the military. However, I'm a strong proponent of doing health care similar to the way Canada does. it sucks that people can't afford to get simple medical procedures done unless they are covered fully. These are people that even have decent jobs.
 

Cheesefood

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Just one thing to realize, peeps. Sure, we don't have social healthcare, but we do have favorable working conditions which means that the best doctors flock to the U.S.

We also don't have 40% income tax for everyone.
 
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A little long but pretty interesting...

I ran into this situation once with my wife. She had a kidney transplant back in '83 from one of her brothers. Lasted 16 years but she got recurrent disease in the the mid 90's and we knew eventually she was going to need another transplant (her other brother stepped up). We moved to Tucson from Milwaukee in '97 and by '99 it was time and wanted to go back to her original transplant team. Her surgeon for the next transplant at UW Madison was world renowned as he was the 1st to ever do a liver/pancreas transplant. The other on the team and who did her 1st transplant invented the machine to keep cadavar kidneys in tact for ~24 hrs.

Anyway, naturally this is a pre-auth ordeal with insurance. We had a PPO so could go out of network at lesser coverage so we were heading back to WI. I got a lot of history and skillz with insurance and I battled with this company (was Intergroup) for months. They kept rejecting the authorization. Some of the commentary coming back was:

"How do we know this one will not fail as well?" WTF? it lasted 16 years and she had two kids!!!!!

"Our experts in the medical field deny because of..." So, you're telling me your experts are more expert than this team huh? Where's there NE Journal of Medicine write-ups and spin off transpant teams across the globe?

4 days before the transplant is scheduled they're still denying. I tell them, we're going to have the xplant anyway and you will pay out of network coverage which was 70% and we'll just battle this after. That night I wrote a letter that was addressed to the Insurance Commission of AZ recapping the whole event that I was documenting along the way. I called some moron at the Ins company related to appeals and asked for their fax # and told him you need to be staring at that machine while this comes in to hand to the highest entity you know there else I'm faxing it on. I had a cover letter stating that this will be sent to the State of AZ Ins commission in 1 hour. 1/2 hour later some dickwad called me and approved the procedure and at in-network rates of 90%. I said don't you mean 70% and he said, we'll take care of this for 90% Mr Desert.

Frrrrruuuuccccccckkk oofffff - how many people have gone through hell or died because they don't know the ropes of this insurance mess. I've just got so much experience with these arseholes I know the ropes better than they do most of the time.
 

mr x

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Cheesefood said:
Jfavorable working conditions which means that the best doctors flock to the U.S.
Favorable working conditions doesn't mean the best show up, just an increase in volume. Some of the doctor's I've seen leave Nova Scotia for the US, I wouldn't wish them on my worst enemy...
 

Cheesefood

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mr x said:
Favorable working conditions doesn't mean the best show up, just an increase in volume. Some of the doctor's I've seen leave Nova Scotia for the US, I wouldn't wish them on my worst enemy...
What do you call the guy who graduates last in his med school class?

Doctor.
 

mr x

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Yeah, I don't have much respect for the profession either. Attitude combined with a lack of accountability.
 

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My mom had a horror story of being really sick, her insurance rep told her she "could" go to the Mayo for tests. She went and then a different rep told her no she shouldn't have gone and refused to pay. This went on for so long and it was a real good rep, bad rep situation where there was one guy saying yes and another guy saying no. Ultimately she her treatment was not covered and she had to pay for it.

I am self-employed and the only way I can do this is because my wife get insurance through her job. Problem is she hates her job so she is basically working just for the insurance. I think its a strange system. And actually I do know both Drs and parents who were dual citizens here and in Canada and moved to Canada because of the medical situation. I had a friend whose child has a chronic condition and they bolted here. They are now in BC and the said the conditions up there are a huge improvement.
 

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Neomich said:
SWMBO is a doctor and she tells me stories all the time of people saying " I have x dollars, what can that get me?" Or "how come the insurance doesn't cover that?" Doctors have to make a living like the other poster said. They spend a LOT of money going to school to make a good living. In one way, I take a view that if you can't afford the treatment, then you just don't get it.
:off: Waaa ... cry me a river. You've got to be kidding me. Oh no, I only make $400,000 a year. You don't like paying alot to go to medical school then don't do it. It's not like she went through years of medical school and at the end got this astronomical bill served up with a mint.

AND, she took an oath to serve humanity. She doesn't like it, then don't do it any more.

Neomich said:
Make all doctors exempt from income taxes or something and they wouldn't need to charge as much. Besides, health care providers give back to the community enough already. And don't get me started on the malpractice lawsuits.........
Yeah, right. And if you believe that, then I got this wonderful bridge I have for sale. That's simply a rediculous notion. Besides, once you reach a certain income, that tax bracket is maxed out and the taxes that a doctor is paying (which isn't as much as you might think because they can afford to hide their income better) affects them much less than it does people in a lower tax bracket.

It’s not just the insurance companies. I think it’s very important to look at the lawyers. Every state should pass tort reform regarding malpractice law-suits with caps on non-economic damages. Two of the top 10 lobbyist in D.C. are trial lawyer association and they are constantly fighting tooth-and-nail against tort reform for malpractice suits. Lawyers are getting richer, and that is driving good doctors out of areas where they are needed.

High malpractice costs lead to increased costs from the doctors. Also, the fear of being sued, and their resulting skyrocketing malpractice premiums, has prompted many doctors to increase non-essential tests to cover their asses.

One of the highest costs in the healthcare industry is the cost of medicine. Pharmacuetical companies encompass all of their R & D and marketing costs in their U.S. markets. This is way a pill developed and manufacturered in the U.S. costs less in Canada than in the U.S. Those costs should be distributed across all markets, and not just the U.S.
 

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I kinda like the idea of everyone having a basic health package provided by the government, with insurance companies offering additional benefits plans beyond that. Ie, you get cancer, your basic insurance will cover the "standard procedure" treatments at a local hospital. Your paid insurance, if you have it, will give you access to the doctor of your choice and wider access to less proven/more experimental treatments. That way, everyone will at least get some treatment, but the market still controls quite a bit of the process. Of course, I've yet to enter "The Workforce" and start dealing with all of this myself, so what do I know :p.
 

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Another thing that's against us in healthcare in the US is apathy; Health insurance companies have no reason to really care about our welfare. My ex works in medical billing, and the amount of sloth, laziness and inefficiency of insurance companies she encounters every day is staggering. One HMO (whom I won't name but reminds me of a German king) will outright refuse every single claim that comes into their system. Then when it's submitted again, then they will examine and process it. Many times the insurance will lose a claim, say it's not existant, claim it wasn't coded right, or simply say it's patient responsibility.

If the government is going to get involved with healthcare, what I would like to see the government do is make it regulated like any other large industry. At the very least, make all the billing systems the same and more efficient, and make the companies accountable to process their claims. They do it with power and utility companies, and the telephone company, why not health insurance?

"oh but etoj, won't this make premiums higher because insurance companies are paying more claims?" Good question! Well, yes it will. But imagine this; a single claim can be on the books with both a hospital and an insurance company floating around for years at times before it is finally paid. My ex has claims extending back to 2005! And she works for a hospital. So salary is being paid for her to babysit accounts that could be taken care of quicker, along with salary being paid at the insurance co workers as well. The billing system itself is so convoluted and complex, and they like it that way. It means that patients don't have patience (ha) to read and understand their bills, so they don't bother and just pay whatever it says to pay. They bank on the fact you won't read your bill and just cut them a check.

I also like the idea of a 'credit union like' health insurance. I belong to a credit union and will never ever go to a bank again. Banks are bloodsucking leeches.

In closing, you know those statements that say "Explanation of Benefits" you get after going to the doctor? Save those! Remember what your deductible is supposed to be with your health insurance plan, and if you get a EOB that says you still owe on the deductible and you KNOW you've paid it, call them! Call them and bitch them out!

And david_42 for some reason I thought you were talking about using Hot Side Aeration on your dogs!
 
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