Vent about health insurance and how screwed up it is

[Baby_nurse]

http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Physicians-Recommend-all-Children,-Ages-9-11,-Be-Screened-for-Cholesterol.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Yes, some docs may not agree. However, that is the recommendation.

As for tests you deem unnecessary, it's always your right to refuse. Just bear in mind that ruling things out is every bit as important as ruling things in. Not happy with your doc or the way he/she diagnoses you? Find another.

To quote Dr. House "everyone lies". I've had people lie to me about drinking, all the while smelling like a brewery. Lies about smoking while I can see their nicotine stained fingertips. Lie about controlling their blood sugar, when their A1C tells you otherwise. Rule number one, trust but verify.

[Blessed]

When I was 19 (and clearly a healthy weight as well) I had to have a fasting blood sugar because my toe got a minor infection after having surgery on it. I wish I had realized how ridiculous that was. I'd have refused.

I took my teenager in a few years back. At the time we had a $3000 dollar deductible. I stated that he had just treated my sons girlfriend for strep and mono. I knew this because they were new in town and her mom called and asked whom we saw. I told him to please only run the necessary test as I have a $3000 deductible. I was assured it would be just the routine strep test and test for mono. He ran $1400 in lab tests plus the $220 office visit. To say I was livid was an understatement. Guess what my son had. Strep and mono just like his girlfriend which I had told the Dr. I sent him a letter at the clinic stating my displeasure at this and stating that our family would no longer be using his services because of this. I dont think he cared.

I think there are tons of good Dr's that use common sense and prudence with testing. They just don't seem to be at Mayo and since that is the clinic and hospital here that is what we get. I would like our small clinic back but they closed because they couldnt compete with mayo

[disneysteve]

I told him to please only run the necessary test as I have a $3000 deductible. I was assured it would be just the routine strep test and test for mono. He ran $1400 in lab tests plus the $220 office visit. To say I was livid was an understatement.

That's ridiculous. If a patient tells me to just do a strep test and mono test, I will only do a strep test and mono test. If I feel there is another test that really should be done, I explain that to the patient but won't do it without their approval. I totally agree with your decision to find a new doctor who actually listens when you speak.

[Blessed]

That's ridiculous. If a patient tells me to just do a strep test and mono test, I will only do a strep test and mono test. If I feel there is another test that really should be done, I explain that to the patient but won't do it without their approval. I totally agree with your decision to find a new doctor who actually listens when you speak.

We need doctors like you. I would much prefer a smaller practice like yours. We got a new Dr. But still in the same monster clinic so they still get our health care dollars.

[Blessed]

It sounds like you are very dedicated and I can see where insurance gets to you on your side of it also.

[NetSkyBlue]

I took my teenager in a few years back. At the time we had a $3000 dollar deductible. I stated that he had just treated my sons girlfriend for strep and mono. I knew this because they were new in town and her mom called and asked whom we saw. I told him to please only run the necessary test as I have a $3000 deductible. I was assured it would be just the routine strep test and test for mono. He ran $1400 in lab tests plus the $220 office visit. To say I was livid was an understatement. Guess what my son had. Strep and mono just like his girlfriend which I had told the Dr. I sent him a letter at the clinic stating my displeasure at this and stating that our family would no longer be using his services because of this. I dont think he cared.

I think there are tons of good Dr's that use common sense and prudence with testing. They just don't seem to be at Mayo and since that is the clinic and hospital here that is what we get. I would like our small clinic back but they closed because they couldnt compete with mayo

It's things like that that keep me from going to the Dr for routine things. I know I should probably have a yearly physical (I've actually never had one, apart from routine BP test, etc during my annual woman's exam), but I don't have a family Dr, and don't really trust some random Dr to not perform unnecessary and costly tests. I'm perfectly healthy, and have only gone to the Dr for minor infections three or maybe four times in the last seven years. Supposedly preventative care is covered 100% under our plan, but I'm not willing to chance it for a possibly several hundred dollar lab fee to tell me I'm healthy.

[hamchan]

It honestly makes me avoid going to the doctor too. I'd rather wait it out and see what happens than risk going hundreds to thousands more in debt over something that would have resolved on it's own anyway. But then if it does wind up being serious it's just going to cost me even more.

I really do understand the rationale behind ruling out everything you can, but on the other side of this is a human being who is going to have to pay for all of it and may not have an endless supply of money to do so. I have had doctors before who took the overall cost to me into account when treating me and I really appreciated that. Unfortunately the way insurance works I am usually just stuck with whoever. I don't have much ability to shop around.

[shaggy]

It honestly makes me avoid going to the doctor too.

Any sane person avoids going to the doctor. At the very least, one has to be a well-informed consumer of medical services. My doctors know I'm going to ask questions and push back when something doesn't make sense to me. The doctors who mind that approach don't last long with me.

There are good doctors to be sure, but they appear to be outnumbered by doctors who have a complicated set of motivations, some of which involve money.

Or maybe I'm just biased because I've dealt with so many brain surgeons.

[Gailete]

As someone dependent on Medicare and Medicare supplements for my health care, I still try to be very conservative with what tests I will go through. Before even going to the doctor for other than my routine check-ups, we research what might be wrong, treatments, tests, etc. At one point they found that I stopped breathing at night, so then they wanted a 'sleep' study LOL! Anyone ever hear what is involved in a sleep study? You show up at around 9PM, they do the paperwork, and you are hustled off to bed at 11PM (no matter what your Usual bedtime is)connected to an amazing assortment of wires to monitor just about everything, and then they get you up at 5:30AM! The man telling me all this, said most of the participants just head off for work then. I was shocked. What is the point of a sleep study that doesn't even give someone a full nights (7-8 hours) sleep assuming that they will even fall asleep? At my age, I know myself and my sleeping habits and one of those is, I have difficulty sleeping anywhere but my own bed and generally have 2-3 nights per week when I barely sleep anyhow. I knew that the sleep study wouldn't agree with me and me with it so I canceled it and in the process I'm sure saved Medicare thousands of dollars. Over the past 11 years of chronic poor health, we have learned that we can say NO and will take responsibility for our own refusal to take a particular test or medication, etc. Our saying no isn't the reason for the poor health just to be clear on that.

I do think people need to take personal responsibility for their health and what their health care provider prescribes for them. Don't be afraid to ask questions and question everything. Don't be afraid to ask why you are getting lab work and what it will show the doctor (and a diabetes test following surgery where the surgical site got infected IS a very appropriate and important test no matter how 'healthy' you may look). Also don't be afraid to tell the doctor when you don't have insurance and they may give you price breaks. They may also be much more aware of the tests that they order you. Learn to call the drugstore and check about prices for medication that is newly ordered. Ask the pharmacist what meds of the same class might be available and what they would cost and let your doctor know (check first if the dr. has samples). We have found that many docs have NO clue what meds cost when ordering them. However you know they will be expensive if they give you a $75 off coupon for your first bottle!

I could give many examples of incompetency of insurance companies, hospitals, doctors, etc. But in the midst of this discussion I have to give kudos to our hospital. Last July my hubby was admitted with atrial fibrillation. Prior to going to the ER he called their business office and asked what to do since we had no money to pay, they said come anyhow. Every hospital personnel that came near my hubby, he told them that he couldn't pay them, so treat at their own risk. We eventually got bills from the treating doctors where they discounted the bills after seeing our proof of lack of funds to pay in full and I pay what we can afford monthly like clockwork. The hospital bill for 3 days however that clocked in at $17K came and we submitted paperwork yet again showing that we barely survive on the income that we had and there was nothing left to pay a bill that large. We have never gotten another bill! I honestly don't know why, whether all the paperwork and bill got lost in the computer, whether they decided to write off the bill and didn't bother to tell us or one of these days the collection agency will be calling. I think they wrote it off and I am so grateful. But the point to all that is, right from the beginning you need to work with the hospital and doctors and not let everything go until they are turning you into collections.

DisneySteve--those are really idiotic reasons for the insurance companies not to be paying, but you know that already.

[disneysteve]

At one point they found that I stopped breathing at night, so then they wanted a 'sleep' study

What is the point of a sleep study that doesn't even give someone a full nights (7-8 hours) sleep

A sleep study is a very appropriate test if there is reason to suspect you have sleep apnea (stop breathing during the night). It is not necessary to observe you for 7-8 hours to make a diagnosis. Just a couple of hours is plenty. And there are now in-home sleep studies being done. In fact, many insurance companies have stopped paying for facility-based home studies in favor of in-home ones. They are less costly, give comparable results, and the patient is much more comfortable because he is sleeping at home in his own bed.

Don't ignore sleep apnea though. It is an extremely serious, potentially life-threatening illness.

[Gailete]

Don't ignore sleep apnea though. It is an extremely serious, potentially life-threatening illness.

Not ignoring it, but just found a better way to judge what was needed. Which was my round about reason for posting. I knew I wouldn't sleep a bit and so the sleep study would be a complete waste of time and money (your tax dollars at work). Amazing the different ways to accomplish the same things!

I was an RN in my work life and so probably feel much more comfortable talking to doctors than many people. I think those that are uncomfortable talking to the doctors pay the most and go through more with less satisfaction in the end. They also don't know how to do battle with the insurance companies and many just assume that all doctors are rich and it won't matter if the docs get left holding the bill.

[disneysteve]

Not ignoring it, but just found a better way to judge what was needed.

Of course, even if you do the home study, if it turns up positive, you need to do the facility test to get you fitted and started on treatment. That can't be done at home, or at least not yet.

many just assume that all doctors are rich and it won't matter if the docs get left holding the bill.

Tell me about it. Trust me, all doctors are not rich. As a primary care doctor, I am smack at the bottom of the pay scale. I know lots of people in various occupations who earn more than I do and didn't need to go to school for an extra 7 years to get there.

[Gailete]

Trust me, all doctors are not rich

I had met my PCP socially several years before she became my doctor. She and her husband were over for dinner one night and budgeting came up. I realized that though they made much more than us, our attitude and ability to handle money surpassed them. They may have the ability to make more even as a PCP but if you don't handle it correctly it doesn't matter how much you make. One of the things that makes these forums so interesting, when someone bringing in 10 times more than we do doesn't know how to make ends meet. I can still learn from the suggestions given to them.

I do appreciate my doctor very much as she spends as much time as is needed with each patient, and that is good practice. I bet her employer doesn't though.

[disneysteve]

One of the things that makes these forums so interesting, when someone bringing in 10 times more than we do doesn't know how to make ends meet.

Very true. It really isn't about how much you earn. So many people think, "All of my money problems would be gone if I just earned $xxx more per year." In reality, you could double their salary tomorrow and their money problems wouldn't go away because they don't have an income problem, they have a spending problem. Far too many people increase their lifestyle to match their income only to find that even though they're making as much as they ever have, they have nothing to show for it.

[snafu]

As I understand it, Insurance Companies have clerks whose job description and bonus system requires they find reasons to deny claims, including claims that were pre approved before service was delivered. I wonder how physicians and patients would feel about Obama Care, government managed Health Care which has limitations and different problems fo both patients and physicians than for profit insurance companies.

I've often wondered if every driver is required to have auto/vehicle insurance, why medical insurance isn't compulsory. People don't carry insurance with a plan to crash, nor would they carry health insurance with a plan to be sick.