Sicko

[SnyderShrugged]

Or not having the ability to purchase said healthcare, even though you work full time.

If you work full time then there is no excuse for staying at a job that doesnt meet your basic family needs. Insurance is a need and should be budgeted for. I realize that sounds harsh, but thats what all of us have had to do, isnt it? I know I left a few jobs and at least one entire career because it didnt match my needs. It's part of life as I see it.

unfortunately, there will always be the truely helpless and that was the intent (the un-abused version) of Medicaid and Medicare originally was for. I see the abuse and administrative nightmare of these programs every single day and trust me when I say that it's a miracle that anyone gets their procedures covered when dealing with the miles of red tape and stupid requirements that come with the job. (Gosh, the stories I could tell you)

[Predicto]

We did. It wasn't subsidized. We paid out of our pocket, full price. And it wasn'y that expensive. It was like $160/month.

If you make 8 bucks an hour (or are unemployed), that is a huge expense. Plus, it is a lot more expensive in many places.

That is plain and simple smart business. Why should you be able to come to me to pay for a condition after you develope it?

I know it is smart business from the insurer's point of view. That doesn't change the fact that as soon as you develop a preexisting condition, you better already have insurance (and good insurance), because and your family are screwed forever from getting a new insurer, under our current system.

[SnyderShrugged]

If you make 8 bucks an hour (or are unemployed), that is a huge expense. Plus, it is a lot more expensive in many places.

I know it is smart business from the insurer's point of view. That doesn't change the fact that as soon as you develop a preexisting condition, you better already have insurance (and good insurance), because and your family are screwed forever from getting a new insurer, under our current system.

I think this is simply a difference in ideologies. We are on polar opposite sides of economics and role of govt, so we could probably go all evening in debate and both make sense to ourselves.

I honestly don't see why someones life decisions and status should be remedied on the backs of anyone but themselves. Please don't mistake me here, I fully feel that assistance is the right thing to give for those that are helpless (the old, infirm and unable to literally care for themselves)

But, beyond that type set, the rest of us are in the game for ourselves and our families and need to do whatever it takes to provide for them. That may mean doing uncomfortable things like working 2-3 jobs or going without cable and a cell phone while you work to change it. It's what we all should be expected to do.

So, in short, if your job pays $8 an hour and you cant swing insurance after cutting out all other non-essentials, well, get a second $8 hr job like most of America would do without suggestion. Another option is to get a job that pays $16 hr. Why wouldnt this be the way to be?

[LiveStrongSkins]

Kaiser Permanente almost killed me literally. Those people high up in these insurance companies are scum. I went into my doctors office literally 12 times over the course of a 3 month period. I had blood in my urine, my flow was interrupted and intense burning. They had advice from a teaching hospital (Johns Hopkins) to run a CT scan. That was on the third visit. Visit 4, 5,6,7,8,9,10,11,12 all were just switching anti-biotics and testing me for STD's. One time they sent me away by telling me to take metamucil for the bowel problem and cranberry juice from the urinary problem. :doh: One night I wake up to bladder spasms and my body not allowing me to use the bathroom in any way. I get rushed to the hospital where they immediately do a CT and see a stage 4 tumor in my prostate that spread to the abdomen and lungs. My oncologists was pissed and said himself that them catching this earlier would have prevented the need for surgery and radiation all together. I needed intense chemo to shrink this massive tumor. Maybe one day they will fix this corrupt system.

[SnyderShrugged]

Kaiser Permanente almost killed me literally. Those people high up in these insurance companies are scum. I went into my doctors office literally 12 times over the course of a 3 month period. I had blood in my urine, my flow was interrupted and intense burning. They had advice from a teaching hospital (Johns Hopkins) to run a CT scan. That was on the third visit. Visit 4, 5,6,7,8,9,10,11,12 all were just switching anti-biotics and testing me for STD's. One time they sent me away by telling me to take metamucil for the bowel problem and cranberry juice from the urinary problem. :doh: One night I wake up to bladder spasms and my body not allowing me to use the bathroom in any way. I get rushed to the hospital where they immediately do a CT and see a stage 4 tumor in my prostate that spread to the abdomen and lungs. My oncologists was pissed and said himself that them catching this earlier would have prevented the need for surgery and radiation all together. I needed intense chemo to shrink this massive tumor. Maybe one day they will fix this corrupt system.

ummmm, how exactly is your insurance company the bad guy here? Wouldnt you kind of lay some blame on the physician and staff?

[Predicto]

I think this is simply a difference in ideologies. We are on polar opposite sides of economics and role of govt, so we could probably go all evening in debate and both make sense to ourselves.

That is probably true, although I actually consider myself a centrist in terms of role of economics and role of government. I do beleive in safety net programs, however, not just from a moral standpoint but also because they promote social stability and undermine the appeal of radical political movements, thus allowing the rest of us to prosper.

[LiveStrongSkins]

ummmm, how exactly is your insurance company the bad guy here? Wouldnt you kind of lay some blame on the physician and staff?

"It was determined that a CT wasnt needed at this time"

[Predicto]

I have 2 friends who are doctors for Kaiser. Both adamantly claim that Kaiser does not pressure them to change their medical diagnoses for financial reasons.

[SnyderShrugged]

"It was determined that a CT wasnt needed at this time"

the Dr makes that call, not the insurance company (despite urban legend)

[SnyderShrugged]

I have 2 friends who are doctors for Kaiser. Both adamantly claim that Kaiser does not pressure them to change their medical diagnoses for financial reasons.

Thats pretty much the case at our company as well. It's bad business for no real gain to do so.

[LiveStrongSkins]

Well maybe alot of it is misdirected anger. I'm only 22 so I dont understand all the details of the health insurance field but I just know that my situation didnt have to be as bad as it was. It just seemed funny to be that everytime I mentioned a Ct scan or some type of imaging he would act as if he didnt hear me. It was extremely frustrating.

[SnyderShrugged]

Well maybe alot of it is misdirected anger. I'm only 22 so I dont understand all the details of the health insurance field but I just know that my situation didnt have to be as bad as it was. It just seemed funny to be that everytime I mentioned a Ct scan or some type of imaging he would act as if he didnt hear me. It was extremely frustrating.

You know what? I totally respect you for thinking clearly on that. It's way more than I have seen from many others in the past (including myself once in awhile!)

It's a very common thing I see happening in the press these days. Most people tend to lump all of their medical stuff into one big package while not seeing the definite multiple players involved behind the scenes.

It's very easy to do considerring your pain is real and that seeking whom to go to isnt foremost in your mind.

To me, there needs to be a new initiative between insurers and health care providers that ensures there is quality and seemless communication behind the scenes, just like it appears to be in the view of all.

This is probably why nationalized insurance has the appearance of something beneficial to many. The problam being, the complexity that already causes most of today's insurance woes would be even worse and no system private or public could handle that.

[Predicto]

Well maybe alot of it is misdirected anger. I'm only 22 so I dont understand all the details of the health insurance field but I just know that my situation didnt have to be as bad as it was. It just seemed funny to be that everytime I mentioned a Ct scan or some type of imaging he would act as if he didnt hear me. It was extremely frustrating.

That must be hard to stomach.

Still, medicine is a tough field and no one is perfect.

Believe me, they would rather do a CT scan and a simple operation afterwards rather than a huge operation later when everything is all messed up.

[LiveStrongSkins]

Yeah I didnt mean to come off as ignorant in previous posts. I probably should have kept my mouth shut on the issue since I dont know the ins and outs. I guess I kinda made my own assumptions that if this guy is really that intent on not doing any kind of imaging then there must be something bigger going on. I've learned alot though since then. I've learned to be more of an advocate for myself. Because someone is a doctor does not make them above mistakes. Thats why now If I am feeling a certain way I research the topic so I know whats to be expected. Alot of those conversations can steer a Dr. one way or the other.

[SnyderShrugged]

Yeah I didnt mean to come off as ignorant in previous posts. I probably should have kept my mouth shut on the issue since I dont know the ins and outs. I guess I kinda made my own assumptions that if this guy is really that intent on not doing any kind of imaging then there must be something bigger going on. I've learned alot though since then. I've learned to be more of an advocate for myself. Because someone is a doctor does not make them above my mistakes. Thats why now If I am feeling a certain way I research the topic so I know whats to be expected. Alot of those conversations can steer a Dr. one way or the other.

hey man, for what its worth, I really hope all is getting better now and I'll say a few to the big guy for ya if you still need a lift.

[LiveStrongSkins]

hey man, for what its worth, I really hope all is getting better now and I'll say a few to the big guy for ya if you still need a lift.

:laugh: All is well now though. With that type of cancer... two years means you are cured. I hit that mark last month. I'm in school to be a paramedc, so im lovin life. I've put it behind me and have even spoken to the doctor and let him know all is well and there is no hard feelings. I guess sometimes I still get a little emotional about it.

[SnyderShrugged]

:laugh: All is well now though. With that type of cancer... two years means you are cured. I hit that mark last month. I'm in school to be a paramedc, so im lovin life. I've put it behind me and have even spoken to the doctor and let him know all is well and there is no hard feelings. I guess sometimes I still get a little emotional about it.

awesome!

[SnyderShrugged]

I hope you consider this germaine to the discussion too.

http://www.ronpaullibrary.org/document.php?id=479

Diagnosing our Health Care Woes

September 25, 2006

No one disputes the diagnosis: American health care is in lousy shape. As a practicing physician for more than 30 years, I find the pervasiveness of managed care very troubling.

The problems with our health care system are not the result of too little government intervention, but rather too much. Contrary to the claims of many advocates of increased government regulation of health care, rising costs and red tape do not represent market failure. Rather, they represent the failure of government policies that have destroyed the health care market.

It’s time to rethink the whole system of HMOs and managed care. This entire unnecessary level of corporatism rakes off profits and worsens the quality of care. But HMOs did not arise in the free market; they are creatures of government interference in health care dating to the 1970s. These non-market institutions have gained control over medical care through collusion between organized medicine, politicians, and drug companies, in an effort to move America toward “free” universal health care.

One big problem arises from the 1974 ERISA law, which grants tax benefits to employers for providing health care, while not allowing similar incentives for individuals. This results in the illogical coupling between employment and health insurance. As such, government removed the market incentive for health insurance companies to cater to the actual health-care consumer. As a greater amount of government and corporate money has been used to pay medical bills, costs have risen artificially out of the range of most individuals.

Only true competition assures that the consumer gets the best deal at the best price possible by putting pressure on the providers. Patients are better served by having options and choices, not new federal bureaucracies and limitations on legal remedies. Such choices and options will arrive only when we unravel the HMO web rooted in old laws, and change the tax code to allow individual Americans to fully deduct all healthcare costs from their taxes, as employers can.

As government bureaucracy continues to give preferences and protections to HMOs and trial lawyers, it will be the patients who lose, despite the glowing rhetoric from the special interests in Washington. Patients will pay ever rising prices and receive declining care while doctors continue to leave the profession in droves.

[Bonez3]

only if you didnt carry the proper amount of coverage and that lies on the insured's shoulders, not the insurance company. You arent "owed" X amount of treatments that you didnt contract for.

There is no "Crisis" in insurance. That's a manufactured political flavor of the decade.

It's a symptom of making poor choices in your own personal health care.

This is a riot, the day the insurance co. picks up a full bill or doesn't dispute treatment multiple times (and sometimes until the pt outright dies) will be the day we aren't in a crisis.

I've seen some of the best health care policies in triplicate (multiple insurances) fail to pick up bills- and you're gonna suggest there isn't a crisis.

[Bonez3]

Yeah I didnt mean to come off as ignorant in previous posts. I probably should have kept my mouth shut on the issue since I dont know the ins and outs. I guess I kinda made my own assumptions that if this guy is really that intent on not doing any kind of imaging then there must be something bigger going on. I've learned alot though since then. I've learned to be more of an advocate for myself. Because someone is a doctor does not make them above mistakes. Thats why now If I am feeling a certain way I research the topic so I know whats to be expected. Alot of those conversations can steer a Dr. one way or the other.

Before I read your dialogue I posteed the above post. There was a definite reason why imaging wasn't done, IT"S A 2 TON WHITE ELEPHANT IN THE ROOM- INS. CO.

Any doctor would know to get a CT if the history you provided is right, trust me. To say the economics weren't involved is not being a realist. Now, the case history obviously has more to it, but this overall picture is not far from alot of peoples experiences. Doctors can be blamed, don't get me wrong, but you better bet your ***** that they are influenced in every decision by insurance co.s.

And SnyShrug- this ain't a perfect world, so don't suggest just getting a 'higher paying job'.

[SnyderShrugged]

This is a riot, the day the insurance co. picks up a full bill or doesn't dispute treatment multiple times (and sometimes until the pt outright dies) will be the day we aren't in a crisis.

I've seen some of the best health care policies in triplicate (multiple insurances) fail to pick up bills- and you're gonna suggest there isn't a crisis.

I'm sorry that you feel that way and ample points to the contrary have already been made and discussed in this thread (with great candor in fact!).

Sometimes it's really tough to see the forest for the trees and that's especially true when dealing with the serious concerns involved in Healthcare. Emotions run high and it's so easy to fall victim to negativity in that state and aim blame sometimes where it shouldnt be. All this I understand with compassion.

Remember, strict HIPPA and numerous other DOI regulations make it nearly impossible for any company to make it a practice to deny large and serious claims for any amount of time or regularity. The checks in place to ensure that all is in line are so rigorous that I firmly suspect that we all have higher premiums as a result of having to admister, abide, and then prove you are doing so, back to the Federal reglators.

The facts just don't support your theory. And thats all it is in this case. No one has laid any claims to the contrary that mistakes, errors, and abuse do in fact happen in something as complex as healthcare. I only advance the theory (since I work in this arena daily specifically addressing issues that have been raised as my chosen career) that it isnt a crisis.

[Bonez3]

I'm sorry that you feel that way and ample points to the contrary have already been made and discussed in this thread (with great candor in fact!).

Sometimes it's really tough to see the forest for the trees and that's especially true when dealing with the serious concerns involved in Healthcare. Emotions run high and it's so easy to fall victim to negativity in that state and aim blame sometimes where it shouldnt be. All this I understand with compassion.

Remember, strict HIPPA and numerous other DOI regulations make it nearly impossible for any company to make it a practice to deny large and serious claims for any amount of time or regularity. The checks in place to ensure that all is in line are so rigorous that I firmly suspect that we all have higher premiums as a result of having to admister, abide, and then prove you are doing so, back to the Federal reglators.

The facts just don't support your theory. And thats all it is in this case. No one has laid any claims to the contrary that mistakes, errors, and abuse do in fact happen in something as complex as healthcare. I only advance the theory (since I work in this arena daily specifically addressing issues that have been raised as my chosen career) that it isnt a crisis.

Facts usually support theory. But, you show me how HIPPA has that much to do with the checks and balances of insurance companies and I will have surely learned something new today.If you can prove that fact I will be surprised. And where in AMerica, in any sector, are the checks 'so stringent'- that's comical right there.

But, the key words are 'denying it for any extended amount of time'. The classic triple denial of insurance cos. are a great example. Usually, they will deny a few times and the party will stop pursuing. Or, if services rendered, they will deny paying long enough so interest accrues.

I will grant you the fact that premiums are high b/c of all the BS paperwork. Forest, trees and anything else- to argue that insurance companies don't squeeze every cent out of the holders while routinely denying care in the name of procedure and protocol is as painful as a splinter in the eye.

You don't feel facts support my theory. But I see daily and experienced personally the delay of cancer treatment b/c certain 'steps' had to be achieved before a real treatment could be initiated. Staring Cancer in the face and being told you can't be treated until so and so sees this or that is a classic Ins. Co. move and well documented, with cantor if you want.

[SnyderShrugged]

Facts usually support theory. But, you show me how HIPPA has that much to do with the checks and balances of insurance companies and I will have surely learned something new today.If you can prove that fact I will be surprised. And where in AMerica, in any sector, are the checks 'so stringent'- that's comical right there.

But, the key words are 'denying it for any extended amount of time'. The classic triple denial of insurance cos. are a great example. Usually, they will deny a few times and the party will stop pursuing. Or, if services rendered, they will deny paying long enough so interest accrues.

I will grant you the fact that premiums are high b/c of all the BS paperwork. Forest, trees and anything else- to argue that insurance companies don't squeeze every cent out of the holders while routinely denying care in the name of procedure and protocol is as painful as a splinter in the eye.

You don't feel facts support my theory. But I see daily and experienced personally the delay of cancer treatment b/c certain 'steps' had to be achieved before a real treatment could be initiated. Staring Cancer in the face and being told you can't be treated until so and so sees this or that is a classic Ins. Co. move and well documented, with cantor if you want.

I understand that you dont wish to see facts, and that dealing with cancer must be such an awful event. I honest and truely have both sympathy and empathy for your situation and anger. I've acknowledged that insurance companies arent perfect, just like most large corporations and that mistakes unfortunately happen in complex, mega transaction environments as in health insurance.

Try to see the vast difference between an auto ins. claim and a hospital claim for a moment. Maybe that can help with context. In an auto claim, there is a limited number of parties involved. An insured, an adjuster, and maybe a 3rd party payee. In a hospital stay claim. Each person who walks into your procedure has potential to submit their own claim depending what you are dealing with in terms of procedure. That can be a radiologist, the anesthesiologist(sp?) the support staff, , etc, etc, etc,. All of these then have to be reconciled one by one with your contracted agreement and the claim calculations made individually (not en masse).

Cant you see that it's a miracle of process design that the 98 plus % of claims processed properly occur everyday?

Just the fact that Hippa and other regulations exist at all put the claims themselves under a deep microscope. Hippa alone mandates large scale auditting both internally and externally. Understand that most insurance companies are under stiuct state and feceral regulations that mandate a 98% claim accuracy rate or higher in many cases. Then add in that most employer groups contract for an additional accuracy percentage on top of the other regs. This literally means that millions of claims are audited everyday both internally and more so, externally to ensure that these contractual obligations are met. My company has over 50% of it's staff (20K employees) strictly devoted to auditing and inspecting adjudicated claims. The enormity of what takes place to ensure that you get every single penny (yes, we audit to such a fine degree of granularity that a one penny difference is a failed audit claim, show me many other transactional that works with such tight boundaries)

The penalties for claim slow and undepayments are monstrous and are not worth the severe risk to incur because they are far beyond what would be saved by denying the claim to begin with. It's simple logic, even if you refuse to see it.

So, I ask that you try to keep an openmind, like Livestrong did and try to use logic when considerring what you are accusing here. What it sounds like you are upset about is that insurance companies don't often cover what they werent contracted to cover. That blame lies on the insured and many times, their employer who negotiated out various services of their contracts in order to work down the premiums. You can't logically ask anyone to pay more than they agreed to in a contract, despite the emotions involved.

It's the responsibility of the insured to maintain and select the proper coverage amounts. That means you have to actually do work and research about what your plan covers and doesnt. The n you plan a way to offset the gaps if you are worried. If not, you take the risk.

I personally get around the whole thing by having selected a plan that involves a Health Savings account. My family plan has a monstrously high deductable to meet, but it's premium is proportionately lower as a result. I the put what I would be paying out in Premium fees into an interest bearing account instead. I use this account to pay my deductables and misc health expenses (Rx etc) throughout the year. At the end of the year I get to keep the difference. After just 2 years of doing this, I am already rolling over a great deal of unused money that I would have lost if I had paid that in premium. Once I get the account up to a certain dollar level, then I can turn that money into an IRA or CD if I wish. I use it as a dual purpose account. It's my health insurance money as well as an investment over time.

Look into all the options that exist if your current plan isnt working. You will be surprised at how much is there that you don't use currently. Most insurance providers are offerring free online classes, sessions at retail outlets, and other great resources to help with the complexity. In fact, even though I dont work for them, I can offer an awesome resource thats free from United health (I think it's them). It's a small guide book called Health Insurance for Dummies. I actually use it on the job because it helps explain things simply to the lay person. Also, I'd be happy to try and help via PM if you need it too.

Any advice and direction I can give are yours.

[Bonez3]

I appreciate the picture you paint, and offering advice and direction is noble. However, I got all the advice you had to offer in a previous post:

So, in short, if your job pays $8 an hour and you cant swing insurance after cutting out all other non-essentials, well, get a second $8 hr job like most of America would do without suggestion. Another option is to get a job that pays $16 hr. Why wouldnt this be the way to be?

So simple indeed, like your description of this near perfect (98 % efficiency) insurance system.

Also, it is not anger that drives my motives. And Cancer is awful, but so are many other diseases- many of which require extended treatment. You keep thinking that b/c people pay a certain amount year in and year out, that when the time comes to get their rightful due they always get what they deserve- BUT THEY ARE SO EASILY DENIED. But, if they could have predicted the kind of DZ they were gonna get and how much treatment would be needed and a medical anomoly on top of that than they could have got the super duper cover everything b/c it would all be in the letter of the contract. SUREEEEEEEEEEEEEEEEEE, thats how medicine works. All patients can predict how much any myriad of conditions will cost. GET REAL!

Sorry you don't see that everday. The fact that nobody can litigate against a company that can prove the world is flat with enough paperwork if they wanted to. Sure, 98%.

[SnyderShrugged]

I appreciate the picture you paint, and offering advice is noble. However, I got all the advice you had to offer in a previous post:

So simple indeed, like your description of this near perfect (98 % efficiency) insurance system.

Also, it is not anger that drives my motives. And Cancer is awful, but so are many other diseases- many of which require extended treatment. You keep thinking that b/c people pay a certain amount year in and year out, that when the time comes to get their rightful due they always get what they deserve- BUT THEY ARE SO EASILY DENIED.

Sorry you don't see that everday. The fact that nobody can litigate against a company that can prove the world is flat with enough paperwork if they wanted to. Sure, 98%.

Oh, I see that you won't be rational nor even friendly. Good luck with that as I'm sure most can see the points I made as valid where yours, well...

If pointing out the harsh realities of life (many of such i've gone through myself too) isnt something you can discuss with logic and calm, then you are really just wasting my time.

may God bless you and help you through your tough time of life anyway.

good day