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Joined: Mar 2007
Posts: 1,461
Silver_AS_Kicker
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Silver_AS_Kicker
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Quote:

But the whole American system seems very strange to me.




I think that is largely due to so many different insurers offering different plans (level of benefits). I don't know that the number of insurers (unless the government shuts them down) or the variety of plans would change a whole lot. I've seen in the Baucus (Senate Finance) proposal that they want to offer some sort of Silver, Gold, Platinum variety of packages, but that is just setting some sort of coverage levels at varying costs and applying simplistic names and calling it health insurance reform. Such profound ideas from upstanding folks who work 2.5 days a week.


Kind Regards,
Jay

Almost all of us long for peace and freedom; but very few of us have much enthusiasm for the thoughts, feelings, and actions that make for peace and freedom. - Aldous Huxley

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson
Joined: Jul 2001
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Hi Jay. After you pay your $80/month is everything included like ambulance, surgeries, hospital stays etc? We hear about people getting billed for all types of things in the hospitals in the US but if you are covered, those would be covered as well?
Our overall plan details show that there's a deductible of $65.00 per family per calendar year but I'm not sure exactly where that is implemented. Probably with prescription medicines (some cost lots of money) because I never get any medical bills for anything else during the year. We just go the doc, get tests, go to specialists etc. with no concern about the monetary part of the system.


Timo
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Dow Offline
Imperial_AS_Kicker
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Quote:

You mean benchmarking?



Yes. Like this World Health Organization study from 2006:

http://www.pbs.org/newshour/globalhealth/july-dec09/insurance_1006.html

shows some very interesting facts, like that the US average per capita expense is $6719 but in Mexico it is $718, and our average life span is 78 years, compared to their 74

and look at US vs Canada..


Dow
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Grimm Offline OP
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I don't know if Timo wants to know this but here are a few examples from my expenses this month. I do not have insurance.

I had a chest xray that was $41 and I will be billed for the radiologist seperate. The insurance would have been billed much more but the hospital gave me a discount for paying cash.

I had to have blood work done to see about starting a biologic- $750. I could not afford this so I went to a clinic here that is run through the catholic church for the working poor and uninsured. It took 2 days of paperwork and 2 office visits and funding from the tobacco tax here but they did my bloodwork for $71. The clinic is a wonderful place and they did not make me feel like a beggar.

My meds cost $50 a month.

4 months ago the rhuemy I was seeing wanted to have me pay for a CAt scan out of pocket and wanted to put me on Enbrel- out of pocket. He claimed that mtx and ssz did not work for AS and took the word of a radiologist that I had no damage. When I said hey I don't have insurance he refered me to a pain clinic because he couldn't do anything else for me. Do you actually think that would have happened if I had insurance? I don't.

As I have written before my new rhuemy looked at the same xrays and saw that I had fusion, erosion and tons of inflamation AND offered to get me on one of the biologics through the medical assistance from pharm co. and to continue me on the ssz.

So I think that a large part of the problem with healthcare is that many doctors are in the pocket of the big pharm co. and that doctors and hospitals try to get as much money as possible from the insurance companies. It's all about the insurance company money- we are no longer the consumers- they are. They only want healthy people to insure and doctors and hositals want insured people to be able to diagnose with mild but life long disease that requires brand name meds and frequent but easy office visits and lots of expensive tests ie. high cholesterol, gerd, and diabetes. (I know these are real and serious problem but they also are very profitable and require little on the doctors part.) Doctors are either part of a hospital group or an insurance group so they are more worried about what those people think not their patients. Heck our insurance companies even tell us which doctors we can see- talk about conflict of interest. Built in customers no need to perform.

I'm sorry I don't mean to be preachy but the system is messed up and it is definitely not about keeping or getting people healthy.

Anna

Joined: Nov 2003
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Very_Addicted_to_AS_Kickin
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I don't understand why the insurance companies have to have rules like IF you will use this and that we will give you a discount.

It gets so confusing when you have say my Remicade infusions, just off the top of my head but for the infusion treatment is almost $5000.00 then they charge extra for the needles, gauze, IV's, lines ect around 2 to 300

Then the insurance comes in and says well we will only pay $3000.00 for the treatment and nothing for the extras.

Why can't it just be this is going to be this price and maybe a lower price for people who don't have insurance or going to pay cash.

Lisa


Speak kindly, Live simply, Care deeply, Love generously, and BLAH, HA, HA, LOUDLY! every chance you get.

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Grimm Offline OP
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I don't know Lisa- but it really irks me that everyone BUT the patient gets a say so and makes money, the patient may not even get better. And what is said if the patient stays sick? Nothing or if you are a women you may even be told it is all in your head. HA! drives me nuts!

Anna

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So the goal is to have no different plans and no different level of benefits. Equality for all.
Who is against this??

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Very_Addicted_to_AS_Kickin
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Hi Anna,

I agree with you 100% and that is a reason I really, really want people to have an advocate for them especially with older people because they are the ones who get lost in the cracks.

When my Mom was in the hospital for 13 days before she died I had countless confrontations with nurse, therapists even some of the Drs. she had surgery for a broken hip, she had a broken shoulder and we think she suffered a small stroke during surgery and so she didn't know who she was or who we were.

After surgery the physical therapists would come in and say we are going to sit her up, I was like..like crap you are she doesnt even know who she is or where she is at. The dumb lunch lady would bring the lunch menu for her to fill out then would gripe when it wasn't filled out..I was like HELLOOOOO she has no idea where or who she is. I told the nurses do NOT let that woman back in her room or I am going to punch her lights out.

The nurses would come in and try to pull her up by her shoulder HELLOOOO it is broken!!! I said when you come on shift do you not check on your patients and see what is going on with them, their response was we don't have time to go thru every patients file and look at everything, I was like you have got to be kidding me.

After surgery they put her in a regular room, I fought to have her put in ICU and by the next day she was in there.

I have no doubt if me and my Dad had not been there for her she would have died sooner than she did.

The way the hospitals are being ran and the turnover and now they have like the CNN'S and LPN'S do all the grunt work and you hardly see an actual nurse, you push the button and sometimes 30 minutes later I would have to call back and say HELLOOOOO

I am afraid for all of us and our parents and children with the way things are ran today. If you are a patient or have a loved one please make sure they have someone that is there pretty much all the time or take shifts.

I know I got off topic but hey..lol

Lisa


Speak kindly, Live simply, Care deeply, Love generously, and BLAH, HA, HA, LOUDLY! every chance you get.

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Posts: 180
Grimm Offline OP
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Lisa it just makes my heart hurt for you when I read what your mom went through. This is absolutely what I was talking about.

There is no competition and no reason for them to strive for excellence or customer service. Why is healthcare like this??? A plumber who doesn't fix your toilet doesn't get paid and doesn't get more business.

Sending warm hugs your way- you have suffered too much.

Anna

Joined: Nov 2007
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I agree... amazing how a doctor makes a mistake and they still get paid AND gets paid again to fix it! My MIL had heart surgery about 8 years ago and they put the wrong valve in it. Had to open her up again the same day to fix it. gah! Double heart surgery!

I had an argument with may daughter's endocrine doc about my method of tx her hashimoto's thyroid problem. She said she wouldn't px her needed growth hormone if I didn't agree with the meds she wanted. I had no choice. Do it her way or walk out. Thankfully, I walked out and a couple months later she agreed to do it my way with no problem this time.

The system is messed up and it appears there is no solution to make everyone happy.

* * * * * * * * * * * * *
for whoever asked about details of insurance .... here is what we can choose from:

Insurance options with hubby's work:

$250-300 a month for blue cross & blue shield. I'm not sure what they all cover because we cannot afford it.


$40 a month for dental and it doesn't cover much. For all 7 of us to get a cleaning costs us approx $1000, plus add in about $35 for each filling. They only pay $500 per person for orthodontics (which cost $5000 or so). And all my kids need braces.

~ ~ ~ ~

We are blessed to have military retirement health insurance (which is a govt option) and most employers request we use that instead of their offered insurance. It is free for us up front.

If you go to a doc in their network, they pay 70% we pay 30% plus a copay which is about $20.

my recent example:
my rheumy visit was $375,
insurance paid them 152.78,
they wrote off 171.30
I had to pay $50.92

not bad for me, but looks like the drs lose.

If we don't use a doc in their network, we may have to pay part or all of the bill and we won't know until we get the explanation of benefits after the doc visit. There is no write off with these docs and we get to pay whatever the insurance doesn't pay.


Since I go to a doc that doesn't take insurance, I have to pay upfront. Her visits cost anywhere from $95 - $165 a visit. Blood labs are around $40.

Our px cost is excellent, though. My Celebrex ($200 normally) only costs me $3 - $9. I'm not sure what biologics would cost. I believe they pay most of my daughter's growth hormone therapy and that is about $1500 - $2000 a month.


It all gets so confusing after awhile and we always seem to have bills in the mail.


~ Trudi: homeschooling mom to 6: 16,14,11,9,7, 6 mos


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