Medical insurance company RANT

[InDebtInDC]

Physicians accepting kickback or renumeration can be tricky territory. Please be careful with your comments and practices.

[PrincessPerky]

I don't have insurance, and if I did I would have paid MORE in the last 9 months than this baby would cost to deliver.....so how would insurance help me?

Now I am looking into a high deductible insurance to cover major medical issues, like cancer or the like, but I am not holding my breath.

Our kids do have insurance, and I often wonder if it actually works for us any more.

Why does it cost $30 copay for one shot? I saw the nurse for 10 minutes with three kids to get 3 shots..I paid 30 each, that is $90!!!! for 10 mintues!!!! and the shots are paid for by the state, just the injection person fee that I paid. This is the sort of thing that makes folks head to a clinic. (around here most of them are state supported and I don't take tax money when I don't have to, so we went to the doc)

After one shot last summer my youngest (then 1.5) arm swelled up huge, it was red, hot and swollen, so we called up the doc to see what was the matter. they wanted a 30$ copay..to tell me the trouble was a 1.5 year old shouldn't have a shot in the arm because this is the result. Oh and to go swimming to help out. Our doc didn't want to charge, the practice she moved to (from being independent) insisted, she saw us for 5 minutes, we should pay 30.......

That same doc is on 'extended leave'...that no one at the office wants to talk about, I can only speculate that she is in trouble for repeatedly not wanting to charge pts.

Not that I have anything against nurses, on the contrary I much prefer the two kids Nurse Midwife births to the one with a OB.... and to the many stories of friends OB births. This kid will be delivered by one very well trained midwife... and mistakes happen, but why oh why do I have to pay 30$ to have it explained to me? And how am I supposed to find a decent Ped before this baby is born if mine is on leave (prolly suspended) because she doesn't want to charge me an arm and a leg?

I think having a clinic in a pharmacy is a bit ... well convenient. And yeah convenience for consumers is profit for the company. But not to terribly unethical, when you think of it, many Docs are not so pure hearted in drug assignment. The rep comes he tells you how great it is, and you listen. thats why they get paid the big bucks to sell to you.

I think the 'cure' for health care is two fold, one stop expecting every person to be able to afford 'red carpet care' (sorry we can't, no insurance reform will make it so) and two...somehow get the insurance companies to be a bit more like car insurance. Car insurance doesn't tell you how much it costs to fix a window, they just pay up to a certain reasonable amount (after deductible) Car insurance also doesn't pay to change your oil, with our without copay....Not that I have any intention of heading to my doc for an oil change (checkup) but that has less to do with cost than convenience.

[PrincessPerky]

BTW estimated cost of a normal healthy baby delivery with NO tests (meaning no glucose test, iron test, beta strep, nor an ultrasound) is 10K..Not including any medication during birth...I had none for two kids with the midwife so I can reasonably guess I will manage this time without. Not getting the tests is a bit annoying, I think the beta strep is important, but without a Licensed Practitioner I have no option of getting one.

Honestly, I would gladly pay for some of those tests...I'd even pay a hundred or so to see this baby....but 100 on top of 10K?

And the reason I wont go to a clinic around here (state supported we do have a couple) because all reports of reputable docs they are not trustworthy...I need someone I can trust when I am in labor and not to interested in fighting.

[disneysteve]

I think the 'cure' for health care is two fold, one stop expecting every person to be able to afford 'red carpet care' (sorry we can't, no insurance reform will make it so) and two...somehow get the insurance companies to be a bit more like car insurance. Car insurance doesn't tell you how much it costs to fix a window, they just pay up to a certain reasonable amount (after deductible) Car insurance also doesn't pay to change your oil, with our without copay....Not that I have any intention of heading to my doc for an oil change (checkup) but that has less to do with cost than convenience.

This is EXACTLY what I keep proposing, to make health insurance more like car insurance. My car insurance doesn't cover oil changes or new tires or detailing or replacing worn out floor mats. I pay for that out of pocket. Even though the routine maintenance stuff on your car is vital to the life of your vehicle, it isn't covered by insurance. Just the same, "routine maintenance" on your body is vital to your health, but that doesn't mean insurance should pick up all the costs.

I also agree about the "red carpet care" you mention. It seems that everyone wants the best medicine has to offer, whether it is necessary or not, and they don't want to have to pay for it. Sorry, but it just can't work that way.

I think high deductible plans and HSAs need to expand and become more common. One benefit to these plans is that they draw in the young, healthy patients who typically forego buying insurance because of the expense and figuring that they don't really need it. By doing that, you increase the insurance pool which improves things for everyone involved.

[irmanator]

Steve what is an "HSA"?

[disneysteve]

Steve what is an "HSA"?

HSA = Health Savings Account. This is an account that gets set up and allows you to deposit money pre-tax to be used for qualified medical expenses. And the definition of qualified expenses is pretty broad, including a lot of things that health insurance wouldn't traditionally cover like OTC meds, eyeglasses and lots of other things.

The benefit is you get to pay for those things with pre-tax dollars and unlike the FSA or flexible spending accounts that were 'use it or lose it', HSA money remains in the account if it doesn't get spent. It earns interest and when you turn 65, that money can be used for anything at all, so it functions as a supplemental retirement plan.

[LivingAlmostLarge]

I hate to point out PP, but what happens if you need an emergency C-section? What will that cost you? Can you handle it? I hate it when people have no insurance and then an emergency happens and who do they expect to pay for it?

That's the biggest problem. That people don't think they need insurance until they actually need it! Then they expect others to clean up the mess.

I'm okay if you buy an HDHP, but if it doesn't cover as much as you expect, then are you fine footing the bill?

[Scanner]

I don't get it. . .people complain about a $30 copay but think nothing of going to Chuck E Cheeses and dropping $30 there.

[disneysteve]

I don't get it. . .people complain about a $30 copay but think nothing of going to Chuck E Cheeses and dropping $30 there.

Far too many people don't consider their health to be a priority. If folks would change their thinking and make it a priority, we would see healthcare costs drop significantly. Eating healthier, exercising regularly, cutting back on smoking and drinking and taking needed medications properly would go a long way in reducing overall costs and expenditures.

But then I'd be sitting around twiddling my thumbs all day.

[aida2003]

I agree with this. I think having a clinic in the pharmacy is a conflict of interest. They say it isn't because they say the patient isn't obligated to fill the prescription at CVS, but come on, if the whole point of the clinic is convenience, why would a patient leave there and then go somewhere else to get the medicine filled?

Well, I disagree slightly about this. If a patient knows for sure that other pharmacy will sell cheaper, they'll go there. Sure, if it's a difference of a buck or two, for convenience purposed, I'd buy drugs on the spot at CVS.

Maybe you think it's a conflict of interest to have a clinic within CVS, and I think I can agree with that. But what about the pharma reps and doctors. Isn't the same thing? I see as a conflict of interest, too.

Since you mentioned that nurses can diagnose only certain illnesses in the clinics, I don't see a problem that even insurance companies urge people to use clinics.
Not sure what a strep throat is, and whether a person needs to see a doctor for it. But plenty of people rush to their doctors when they have a bad cold every year. There's nothing doctors can do about the cold. So, from the insurance co. point of view, it's much CHEAPER if people run to the clinics instead. I totally agree with that.
If something is serious, then go to the doctor.

Sometimes going to the doctor is the same as going to the dentist. One dentist says your teeth are good and another says you've got 4 cavities, and whom can you believe?

[DebbieL]

Reading this thread makes me grateful to live in Canada. I have never had a problem getting in to see my doctor that same day if it was needed (me or my kid is really sick, etc.). I do go to the clinic for convenience sometimes, but that's all (if it's after hours, etc.). We have no co-pays for any sort of regular medical care (there is a small charge for chiropractic visits, etc. if your income is above a certain level - it is only about $7 I think), no charge to use medical services. If your income is low the medical is completely free. In my province, even the highest income person pays no more than $54/month individual or $108/month for any sized family. Some provinces provide the coverage for free no matter what your income level.

These headaches of worrying about treatment costs just don't exist here (at least from a patient's perspective). I feel sorry for people in the States that can't afford insurance. That must be an awful feeling to know that one bad thing happening could financially devastate you. Like I said, there just isn't that problem here no matter how broke a person is.

[sweeps]

Reading this thread makes me grateful to live in Canada. I have never had a problem getting in to see my doctor that same day if it was needed (me or my kid is really sick, etc.).

It's interesting that you say this, Debbie, because one of the arguments that some people have against Universal Health Care in the United States is that everyone will have to wait weeks to get appointments, and they will have to wait in long lines at the doctors office due to the onslaught of patients.

[Scanner]

Yeah, people get confused on that. . .I think primary care is readily available under universal healthcare.

If you need a hip replacement, yeah, sure, you may wait 6-18 months before you can get it. You may have to treat with home exercise and anti-inflammatories in the meantime.

I don't see where this is a problem. I don't know too many people who all of the sudden say, "I need a knee replacement. . .schedule me next week."

Usually there is a period of getting ready for it anyway so I don't see the big deal if a government tells you it's 9 months out until you can get yours.

I think it's a small sacrafice for the greater good.

[disneysteve]

If you need a hip replacement, yeah, sure, you may wait 6-18 months before you can get it. You may have to treat with home exercise and anti-inflammatories in the meantime.

I don't see where this is a problem. I don't know too many people who all of the sudden say, "I need a knee replacement. . .schedule me next week."

I don't know about that. Most orthopedic docs I know encourage patients to put off their surgery as long as possible until they just can't deal with the pain anymore or can't function anymore. And I don't think I've ever had a patient who was anxious to have joint replacement surgery. It was always a hard decision that they agonized over. Once they reach the point that they just can't deal with it anymore and they have mentally accepted that they need the surgery, to be told - Sorry, it will be another year before we can do it - would be devastating.

[Scanner]

DisneySteve,

But that's just it - it just changes the nature of the consultation, that's all.

The orthopedist would say, "Listen, your joint space is about half-gone in your right knee. You are going to need surgery down the road. Now. . .we all know that resources in health care only go so far. It's about a 9 month wait. You will have to decide when to go on the waiting list.

There's no urgent need to do it now. . .but you can't wait until it's unbearable because there's no way to move ahead on the list."

What's so bad about that?

Or is it better to just keep it the way it is? A few getting great health care, the middle class getting squeezed and the poor getting great health care?

No one wants to talk rationing but rationing is the only thing to talk.