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2014-03-18 8:55 AM
in reply to: austhokie

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Subject: RE: Healthcare Rant
Originally posted by austhokie

Originally posted by KSH

Originally posted by austhokie
Originally posted by McFuzz

Originally posted by austhokie

however, the way our insurance is implemented that doesn't work...there should be a difference between preventative healthcare and emergency insurance...but when it all gets rolled into one bundle payment its harder to differentiate ideally, I believe, that everyone should be entitled to a set number of dr's visits per year that encompasses basic health care - yearly examinations, school physicals etc - these visits should be limited in cost because they occur on a regular basis/frequency - easily paid out of pocket then health insurance for no issues

So what do you do when someone doesn't do the "preventative care" and ends up in an emergency situation? 

E.g.  high blood pressure, but doesn't go the doctor (no time, even if the exam is free) or pay for maintenance medicine and then has a heart attack? 

I'd like to say tough , but I know I can't...one of the issues I see with healthcare is that people don't want to go because of the cost - not knowing how much you are going to pay out of pocket if you don't have insurance etc - I would like to think (the optimist in me) that having set fees for certain stuff would reduce the likelihood of people blowing off preventative care because of money - although I know that won't be the case

Exactly. When I have running injuries, I never go to the Dr. Why? Because I have no clue how much it is going to cost and I fear getting some outrageous bill. My coach will say, "go to the Dr." and I reply with, "I won't go because I am scared of how much it will cost". Now, I know it isn't like high blood pressure, but I seriously ONLY go to the Dr. if I HAVE to go. I wouldn't even go to the gyno once a year (going to cost me!) if I didn't need BC. That was a $120 trip I wasn't budgeting for. 

 




I was thankful to have it when I went through my surgery earlier this year - even now, bills are coming in and its amazing the stuff that is charged...

thyroid bloodwork - the standard stuff I have to have periodically now - $450 - thankfully, my insurance covers a good chunk of it but seriously!
my overnight stay in the hospital (and it wasn't even a full 24 hours) - over $20k...I only had to pay $1750 (my max out of pocket) - but the hospital sat on submitting the bill to my insurance company, so I also have to pay the surgeon and the anastethiologist, and the hospital should be refunding me nearly $1000 (but do you think they will without me getting on their ...I highly doubt it)


Just as with price ceiling and price floors, when you remove price signals from the market it gets completely distorted. People think this is a private healthcare insurance country when in reality the government already controls 50% of the market. The distortions will only continue to escalate as they take control of larger and larger swaths of the market.


2014-03-18 8:56 AM
in reply to: KSH

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Subject: RE: Healthcare Rant
I agree with your premise-- that the healthcare system in the US is a mess and needs to be fixed. Having said that, as someone who handles employee complaints about our company's coverage all the time, I have to say that the vast majority of people are badly uninformed about their own coverage. We do comprehensive orientations for all new employees and send out reams of documentation that very specifically and clearly lay out what they are and aren't responsible for, and the majority of people don't even bother to read it or pay attention to it until they get a huge bill they don't understand or weren't prepared for.

We have what I consider to be a pretty good corporate health plan and we also have a large deductible for out-of-network care. It's really the employee's responsibility to check with the doctor to ensure that the provider they choose is part of the network before they go there. The information is all pretty readily available online and the doctor will certainly tell you whether they participate in your network if you ask. You probably wouldn't have been responsible for the $2000 deductible if you'd stayed in network. And most people don't know that you can negotiate the costs of out-of-network coverage with your provider, since there's no insurance company in the middle dictating the rates.

As long as you stay in-network, and depending on the insurance company there are probably hundreds, if not thousands of in-network doctors available to you, your out of pocket costs will be much less. Out-of-network care is really meant for emergencies or where a best-in-class provider that you need to see for a particular condition isn't in your network, so you have the option of going to see that doctor and having part of the treatment covered. It's really not meant to be used for ordinary treatment like physicals, yearly exams, and well child care.

Healthcare is like anything else-- the more choices you want to have, the more it costs you. That's why HMO plans are cheaper than PPO's generally speaking. It's really up to the patient to educate themselves on the terms of their health plan and make informed decisions.
2014-03-18 9:49 AM
in reply to: jmk-brooklyn

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Subject: RE: Healthcare Rant

Originally posted by jmk-brooklyn I agree with your premise-- that the healthcare system in the US is a mess and needs to be fixed. Having said that, as someone who handles employee complaints about our company's coverage all the time, I have to say that the vast majority of people are badly uninformed about their own coverage. We do comprehensive orientations for all new employees and send out reams of documentation that very specifically and clearly lay out what they are and aren't responsible for, and the majority of people don't even bother to read it or pay attention to it until they get a huge bill they don't understand or weren't prepared for. We have what I consider to be a pretty good corporate health plan and we also have a large deductible for out-of-network care. It's really the employee's responsibility to check with the doctor to ensure that the provider they choose is part of the network before they go there. The information is all pretty readily available online and the doctor will certainly tell you whether they participate in your network if you ask. You probably wouldn't have been responsible for the $2000 deductible if you'd stayed in network. And most people don't know that you can negotiate the costs of out-of-network coverage with your provider, since there's no insurance company in the middle dictating the rates. As long as you stay in-network, and depending on the insurance company there are probably hundreds, if not thousands of in-network doctors available to you, your out of pocket costs will be much less. Out-of-network care is really meant for emergencies or where a best-in-class provider that you need to see for a particular condition isn't in your network, so you have the option of going to see that doctor and having part of the treatment covered. It's really not meant to be used for ordinary treatment like physicals, yearly exams, and well child care. Healthcare is like anything else-- the more choices you want to have, the more it costs you. That's why HMO plans are cheaper than PPO's generally speaking. It's really up to the patient to educate themselves on the terms of their health plan and make informed decisions.

Absolutely. I was in the wrong for not realizing my Dr. was now out of network with our new insurance. 

I try to understand what I'm signed up for, but it's so darn confusing. So many if/then's/but's/etc. I figure I just won't go to the Dr. unless I absolutely HAVE to, because I can't figure out what I'll be paying IF I go. I will say that I am on a PPO. Typically, when I have been on a PPO, a certain % is covered for out of network and then I cover the rest of the bill. With this PPO they cover nothing for out of network up to $2,000. 

Yes, there are lots of in-network Dr.'s, but I have had bad experiences with picking a Dr. from their list. The last gyno I went to, refused to give me BC until I went through a test they wanted to conduct to ensure I didn't have uterine cancer. I had no signs or anything that would make them think I could even have cancer, but oh no, they had to do the test, and they wouldn't give me BC till I did the test. They tried to complete the test 3 times and couldn't get it done. I got charged for them NOT doing the test, because they tried. I finally gave up and went to another Dr. My gyno now, flat out said that Dr.'s were struggling these days, they had no reason to give me that test, and they were just doing it to get money from me and the insurance company. Thus, I'm hesitant to change Dr.'s each year my insurance company changes (my company changes it a lot). 

 

2014-03-18 11:43 AM
in reply to: McFuzz

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Subject: RE: Healthcare Rant

Originally posted by McFuzz

Originally posted by Socks

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 
3-Everything is billed by code.  I write a code on a piece of paper and give it to billing
4-For each insurer there can be 20+ plans......for instance BCBS will have 20+ different plans that pay 20+ different ways
5-Look at your plan and be your own advocate.  Know what your deductible is, how it is applied and what is and is not covered under your plan.  Know which doctors are on your plan.  Is PT covered? Is DME covered?  Call your insurer or look at your booklet they mail you.
6-Most physicians are employed these days. They are just worker bees who have no control over the bill or the negotiated rates with your insurer so typically they can't just not charge you or reduce the bill. It would be like going into walmart and asking the check out person to take an extra 10% off just because. 
7-THIS IS IMPORTANT It is illegal to balance bill.  Say we bill at 200% of medicare.  Your insurance pays 150% of medicare.  Its illegal to bill the pt the balance if the doctor is on your plan. 
8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
10-You need to be your own best advocate.  It is not your doctors job to know how much your plan pays and what it pays for.  I treat everyone the same regardless as to what insurance plan they have or if they are workers comp or if they have no insurance at all.  MY goal as your doctor is to treat you with respect and give you the best possible care.  I can fix your broken ankle but I cannot fix your insurance plan. 

Socks,

Thank you for contributing, both to keep us healthy and for the "other side of the coin." 

What makes balance billing illegal?  Insurance started out paying "usual and customary" and the patient was responsible for any amount not paid by insurance.  Isn't that "balance billing?"  When did this become illegal?  (Now I understand that people sometimes got a nasty surprise when the doctor bill was $300 but "U&C" was $250 and they had to pay $50 even though they have insurance.)   If I know I'm going to see the doctor for my condition, I could ask my insurance what U&C is and ask the doctor's office what they charge and as long as neither is fictitious, I have the information to make an informed decision.  I can also call different doctors to see if there is another doctor whose charges are closer to U&C.  Where this falls apart is immediate care, where you may not know who is treating you and you don't have time to shop around. 

I also understand that medicine isn't like ordering a hamburger at McDonalds.  There is as much art as science, and the exact treatment can be hard to pin down. 

It is illegal my medicare rules. Also the contract we as a doc sign with the insurer prohibits this.  If you get thrown out of medicare you can't get on ANY insurance plans. 

If you want to know a $ amount you need to ask what % of medicare your plan is paying and which VERSION of medicare they are using as well then good luck finding that fee schedule.  For a self pay pt 100% of medicare is fair.  If you are a self pay I would ask for medicare rates.  There is NO $ we put on things.  Sometimes people are booked as something straight forward and then they start getting into the "Oh By the ways"  or they are on 20 meds etc etc makes it more complicated

2014-03-18 2:17 PM
in reply to: Socks

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Subject: RE: Healthcare Rant

Originally posted by Socks

Originally posted by McFuzz

Originally posted by Socks

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 
3-Everything is billed by code.  I write a code on a piece of paper and give it to billing
4-For each insurer there can be 20+ plans......for instance BCBS will have 20+ different plans that pay 20+ different ways
5-Look at your plan and be your own advocate.  Know what your deductible is, how it is applied and what is and is not covered under your plan.  Know which doctors are on your plan.  Is PT covered? Is DME covered?  Call your insurer or look at your booklet they mail you.
6-Most physicians are employed these days. They are just worker bees who have no control over the bill or the negotiated rates with your insurer so typically they can't just not charge you or reduce the bill. It would be like going into walmart and asking the check out person to take an extra 10% off just because. 
7-THIS IS IMPORTANT It is illegal to balance bill.  Say we bill at 200% of medicare.  Your insurance pays 150% of medicare.  Its illegal to bill the pt the balance if the doctor is on your plan. 
8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
10-You need to be your own best advocate.  It is not your doctors job to know how much your plan pays and what it pays for.  I treat everyone the same regardless as to what insurance plan they have or if they are workers comp or if they have no insurance at all.  MY goal as your doctor is to treat you with respect and give you the best possible care.  I can fix your broken ankle but I cannot fix your insurance plan. 

Socks,

Thank you for contributing, both to keep us healthy and for the "other side of the coin." 

What makes balance billing illegal?  Insurance started out paying "usual and customary" and the patient was responsible for any amount not paid by insurance.  Isn't that "balance billing?"  When did this become illegal?  (Now I understand that people sometimes got a nasty surprise when the doctor bill was $300 but "U&C" was $250 and they had to pay $50 even though they have insurance.)   If I know I'm going to see the doctor for my condition, I could ask my insurance what U&C is and ask the doctor's office what they charge and as long as neither is fictitious, I have the information to make an informed decision.  I can also call different doctors to see if there is another doctor whose charges are closer to U&C.  Where this falls apart is immediate care, where you may not know who is treating you and you don't have time to shop around. 

I also understand that medicine isn't like ordering a hamburger at McDonalds.  There is as much art as science, and the exact treatment can be hard to pin down. 

It is illegal my medicare rules. Also the contract we as a doc sign with the insurer prohibits this.  If you get thrown out of medicare you can't get on ANY insurance plans. 

If you want to know a $ amount you need to ask what % of medicare your plan is paying and which VERSION of medicare they are using as well then good luck finding that fee schedule.  For a self pay pt 100% of medicare is fair.  If you are a self pay I would ask for medicare rates.  There is NO $ we put on things.  Sometimes people are booked as something straight forward and then they start getting into the "Oh By the ways"  or they are on 20 meds etc etc makes it more complicated

So it isn't so much "illegal" as "contractually prohibited" by Medicare.  Do so, and you lose your ability to file with Medicare and get excommunicated from the entire insurance community.  (Although I can understand that what started out as an economic sanction might now have criminal charged attached.

2014-03-18 3:01 PM
in reply to: 0

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Chatham Ontario
Subject: RE: Healthcare Rant
Free healthcare in Canada might be simple for the consumer but really it is just as messed up.


I pay 36% income tax off my pay and then I have to pay 13% on everything I purchase as well. Except grocery store food its like 7% The rest of the products etc have 15% tax on them. Add that up. 13% and they already take away 36% of my income. So basically I lose 49% of my income to taxes for my free health care.

Now lets put my health care to use. I had knee surgery Dec 22 ish 2012 for a meniscus repair which turned into a removal.

Why a removal you ask?.

May 2012 I got hit by a car. Glancing blow to the knee while running. I go see my doctor he books my appointment for a specialist. By September 2012 I finally get my MRI Jun-Sept wait 4 month wait for an MRI. Surgery was to be end of Feb 2013. I had them put me on a wait/cancelation list. Lucky someone didn't want to be laid up for Christmas and I got in early. Due to walking/cycling on a damaged meniscus for 8 months it was so damaged it had to be removed. I can tell you I was in so much pain during some months I was willing to PAY for an MRI in the Michigan to speed up the process. But my Doctor refused to use it if I did.

Had I not taking the cancellation it would have been 10 months from the time I went to see a doctor until surgery. And the government takes 49% of my income away from me.

I also lose a ton of tax deductions because I make too much money. Not a lot lets be honest I am an Engineer in Auto industry and I have been stuck at the Mid 60K/yr range for income for about 10 years now. Sounds like a lot but not when my take home is about 41k.

Oh and I have to pay 2200 of that 41k into my pension plan as well. leaves me with about 39k a year for FREE health care.

Oh and I have to pay for glasses eye exams and they take an extra 1200 a year off my pay in health tax because I make over 60k a year.

I am not saying your system is better. But when systems become complex companies take advantage of that complexity so that they can make their money off it. It seems crazy how many options are available but insurance companies are masters of this confusion.

Ie I pay $800 a year to insure my motorcycle my friend has same bike cost him $1400 driving just as long similar clean records.

Edited by Techdiver 2014-03-18 3:03 PM


2014-03-18 3:06 PM
in reply to: McFuzz

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Subject: RE: Healthcare Rant

Originally posted by McFuzz

Originally posted by Socks

Originally posted by McFuzz

Originally posted by Socks

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 
3-Everything is billed by code.  I write a code on a piece of paper and give it to billing
4-For each insurer there can be 20+ plans......for instance BCBS will have 20+ different plans that pay 20+ different ways
5-Look at your plan and be your own advocate.  Know what your deductible is, how it is applied and what is and is not covered under your plan.  Know which doctors are on your plan.  Is PT covered? Is DME covered?  Call your insurer or look at your booklet they mail you.
6-Most physicians are employed these days. They are just worker bees who have no control over the bill or the negotiated rates with your insurer so typically they can't just not charge you or reduce the bill. It would be like going into walmart and asking the check out person to take an extra 10% off just because. 
7-THIS IS IMPORTANT It is illegal to balance bill.  Say we bill at 200% of medicare.  Your insurance pays 150% of medicare.  Its illegal to bill the pt the balance if the doctor is on your plan. 
8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
10-You need to be your own best advocate.  It is not your doctors job to know how much your plan pays and what it pays for.  I treat everyone the same regardless as to what insurance plan they have or if they are workers comp or if they have no insurance at all.  MY goal as your doctor is to treat you with respect and give you the best possible care.  I can fix your broken ankle but I cannot fix your insurance plan. 

Socks,

Thank you for contributing, both to keep us healthy and for the "other side of the coin." 

What makes balance billing illegal?  Insurance started out paying "usual and customary" and the patient was responsible for any amount not paid by insurance.  Isn't that "balance billing?"  When did this become illegal?  (Now I understand that people sometimes got a nasty surprise when the doctor bill was $300 but "U&C" was $250 and they had to pay $50 even though they have insurance.)   If I know I'm going to see the doctor for my condition, I could ask my insurance what U&C is and ask the doctor's office what they charge and as long as neither is fictitious, I have the information to make an informed decision.  I can also call different doctors to see if there is another doctor whose charges are closer to U&C.  Where this falls apart is immediate care, where you may not know who is treating you and you don't have time to shop around. 

I also understand that medicine isn't like ordering a hamburger at McDonalds.  There is as much art as science, and the exact treatment can be hard to pin down. 

It is illegal my medicare rules. Also the contract we as a doc sign with the insurer prohibits this.  If you get thrown out of medicare you can't get on ANY insurance plans. 

If you want to know a $ amount you need to ask what % of medicare your plan is paying and which VERSION of medicare they are using as well then good luck finding that fee schedule.  For a self pay pt 100% of medicare is fair.  If you are a self pay I would ask for medicare rates.  There is NO $ we put on things.  Sometimes people are booked as something straight forward and then they start getting into the "Oh By the ways"  or they are on 20 meds etc etc makes it more complicated

So it isn't so much "illegal" as "contractually prohibited" by Medicare.  Do so, and you lose your ability to file with Medicare and get excommunicated from the entire insurance community.  (Although I can understand that what started out as an economic sanction might now have criminal charged attached.

Yes but I was told by my biller that it is illegal as well.

2014-03-18 3:11 PM
in reply to: Techdiver

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Subject: RE: Healthcare Rant

Originally posted by Techdiver Free healthcare in Canada might be simple for the consumer but really it is just as messed up. I pay 36% income tax off my pay and then I have to pay 13% on everything I purchase as well. Except grocery store food its like 7% The rest of the products etc have 15% tax on them. Add that up. 13% and they already take away 36% of my income. So basically I lose 49% of my income to taxes for my free health care. Now lets put my health care to use. I had knee surgery Dec 22 ish 2012 for a meniscus repair which turned into a removal. Why a removal you ask?. May 2012 I got hit by a car. Glancing blow to the knee while running. I go see my doctor he books my appointment for a specialist. By September 2012 I finally get my MRI Jun-Sept wait 4 month wait for an MRI. Surgery was to be end of Feb 2013. I had them put me on a wait/cancelation list. Lucky someone didn't want to be laid up for Christmas and I got in early. Due to walking/cycling on a damaged meniscus for 8 months it was so damaged it had to be removed. I can tell you I was in so much pain during some months I was willing to PAY for an MRI in the Michigan to speed up the process. But my Doctor refused to use it if I did. Had I not taking the cancellation it would have been 10 months from the time I went to see a doctor until surgery. And the government takes 49% of my income away from me. I also lose a ton of tax deductions because I make too much money. Not a lot lets be honest I am an Engineer in Auto industry and I have been stuck at the Mid 60K/yr range for income for about 10 years now. Sounds like a lot but not when my take home is about 41k. Oh and I have to pay 2200 of that 41k into my pension plan as well. leaves me with about 39k a year for FREE health care. Oh and I have to pay for glasses eye exams and they take an extra 1200 a year off my pay in health tax because I make over 60k a year. I am not saying your system is better. But when systems become complex companies take advantage of that complexity so that they can make their money off it. It seems crazy how many options are available but insurance companies are masters of this confusion. Ie I pay $800 a year to insure my motorcycle my friend has same bike cost him $1400 driving just as long similar clean records.

THANK YOU!!!!

There is a reason Canadians come to FL in the winter and pay cash for their joint replacements............and its because they don't want to be in pain for 12-18 months until they can have their surgery.  In this country people would be all over the media whining that they are in PAIN and they have to WAIT.  I have had several college athletes from europe get hurt and their WONDERFUL nationalized healthcare refuse to pay for their surgery to be done here so they end up losing their scholarships because they can't play their sport because they have to wait a year to get their surgery.

Our system is broken, absolutely but there is no perfect system out there. 

2014-03-18 3:38 PM
in reply to: Techdiver

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Subject: RE: Healthcare Rant

Originally posted by Techdiver Free healthcare in Canada might be simple for the consumer but really it is just as messed up. I pay 36% income tax off my pay and then I have to pay 13% on everything I purchase as well. Except grocery store food its like 7% The rest of the products etc have 15% tax on them. Add that up. 13% and they already take away 36% of my income. So basically I lose 49% of my income to taxes for my free health care. Now lets put my health care to use. I had knee surgery Dec 22 ish 2012 for a meniscus repair which turned into a removal. Why a removal you ask?. May 2012 I got hit by a car. Glancing blow to the knee while running. I go see my doctor he books my appointment for a specialist. By September 2012 I finally get my MRI Jun-Sept wait 4 month wait for an MRI. Surgery was to be end of Feb 2013. I had them put me on a wait/cancelation list. Lucky someone didn't want to be laid up for Christmas and I got in early. Due to walking/cycling on a damaged meniscus for 8 months it was so damaged it had to be removed. I can tell you I was in so much pain during some months I was willing to PAY for an MRI in the Michigan to speed up the process. But my Doctor refused to use it if I did. Had I not taking the cancellation it would have been 10 months from the time I went to see a doctor until surgery. And the government takes 49% of my income away from me. I also lose a ton of tax deductions because I make too much money. Not a lot lets be honest I am an Engineer in Auto industry and I have been stuck at the Mid 60K/yr range for income for about 10 years now. Sounds like a lot but not when my take home is about 41k. Oh and I have to pay 2200 of that 41k into my pension plan as well. leaves me with about 39k a year for FREE health care. Oh and I have to pay for glasses eye exams and they take an extra 1200 a year off my pay in health tax because I make over 60k a year. I am not saying your system is better. But when systems become complex companies take advantage of that complexity so that they can make their money off it. It seems crazy how many options are available but insurance companies are masters of this confusion. Ie I pay $800 a year to insure my motorcycle my friend has same bike cost him $1400 driving just as long similar clean records.

I don't know anything about Canadian taxes, but does a part of that go to subsidize post-secondary education as well? 

2014-03-18 4:58 PM
in reply to: switch

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Subject: RE: Healthcare Rant

Originally posted by switch

I don't know anything about Canadian taxes, but does a part of that go to subsidize post-secondary education as well? 

Yep... and more generous welfare and other social spending, and bigger subsidies for various politically-favoured industries, and all kinds of other goodies.  None of that pesky defense spending though.  

Speaking as someone who has lived on both sides of the border -- there's a general rule I use to describe Canadian health care:

  • "True" emergency situations are treated as such (think heart attacks, strokes, etc.)
  • Non-emergency situations are also treated as such -- hence the huge wait times that Socks and others mention for things like orthopedic care, and the immense difficulty in finding a primary care physician who has space in their schedule to take on new patients

 

2014-03-18 5:23 PM
in reply to: Techdiver

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Subject: RE: Healthcare Rant

Originally posted by Techdiver Oh and I have to pay 2200 of that 41k into my pension plan as well. leaves me with about 39k a year for FREE health care. Oh and I have to pay for glasses eye exams and they take an extra 1200 a year off my pay in health tax because I make over 60k a year.

But these things that you mention aren't the Canadian system. They are your employers system right? Or maybe Ontario's system? I don't have to pay anything into my RRSP if I don't want to. 

Everyone pays income tax. It seems like you are saying 50% of your income goes to healthcare. 

Anyway, I'm not knocking your experience, but it is only one data point and isn't totally about healthcare. In my experience, my healthcare has served me quite well. 



2014-03-19 11:26 AM
in reply to: jeng

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Subject: RE: Healthcare Rant

Perfect example of the difference in perspective

I saw a very nice lady from Canada today.  She injured herself over the weekend. She and her husband were AMAZED at how quickly they got an appt, they didn't have to wait for hours in the waiting room and remarked how quick and efficient the clinic is.  They were pleased as can be to have gotten an appt weds after sustaining an injury on sunday because she had to wait 6 months in Canada to see an orthopod

I also saw a not so nice lady from the US who sustained an injury on the same day of less severity that then Canadian lady and was PISSED OFF she had to wait until today to be seen.  Pissed off with the paperwork pissed off at what the ER had done for her (which was totally appropriate BTW

There really needs to be a happy medium somewhere in there.  People in the US just have a McDonalds mentality.  Its a medical office not the drive thru. Emergencies happen and I can't see every ankle sprain immediately because guess what, other people are hurt worse than you and need attention first.  And I think our system TOTALLY  pushes this with ER wait times being up on billboards etc.  Drives me nuts. 

2014-03-19 1:01 PM
in reply to: Socks

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Subject: RE: Healthcare Rant
I know this is a very hot topic. Some excellent conversation and very good perspectives. That said, I think there is a lot more people should know that they don't. As it happens I am an expert in the field. I have written on the topic many times. The hard part is this discussion right here is more in-depth than most people are willing to invest to understand what is going on.

So if there is interest I would b pleased to see if I can provide an objective look at where we are and what you should know so you can get the most out of what your current choices are. Caution though, it will be long and likely in multiple parts. Then I would expect each piece to spark some lively debate.

FYI - I was hit by a car last year (twice actually but the first was minor) while cycling. I have a high deductible HSA plan (wife and I) with a $8,200 deductible and a $11,200 Maximum Out-of-Pocket. The surgery to repair my fractured hip cost $94,000 billed, ppo price $26k and the second surgery to replace the hip was $102,000, ppo price $28k. Since the driver didn't stop I had no way to ding him/her for the cost so all the costs hit my insurance. I ended up paying NOTHING out of my pocket! I will explain that too.

Is there any interest here or is this too big a topic for the time investment it will take to follow along?
2014-03-19 1:13 PM
in reply to: Stuartap

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Subject: RE: Healthcare Rant

Originally posted by Stuartap I know this is a very hot topic. Some excellent conversation and very good perspectives. That said, I think there is a lot more people should know that they don't. As it happens I am an expert in the field. I have written on the topic many times. The hard part is this discussion right here is more in-depth than most people are willing to invest to understand what is going on. So if there is interest I would b pleased to see if I can provide an objective look at where we are and what you should know so you can get the most out of what your current choices are. Caution though, it will be long and likely in multiple parts. Then I would expect each piece to spark some lively debate. FYI - I was hit by a car last year (twice actually but the first was minor) while cycling. I have a high deductible HSA plan (wife and I) with a $8,200 deductible and a $11,200 Maximum Out-of-Pocket. The surgery to repair my fractured hip cost $94,000 billed, ppo price $26k and the second surgery to replace the hip was $102,000, ppo price $28k. Since the driver didn't stop I had no way to ding him/her for the cost so all the costs hit my insurance. I ended up paying NOTHING out of my pocket! I will explain that too. Is there any interest here or is this too big a topic for the time investment it will take to follow along?

For me, I really want to know what I can do as a consumer to pick the right plan for me. It just seems that I pay all this money into health insurance and I don't get anything for it (unless I want to pick a Dr. off their list). 

 

2014-03-19 2:33 PM
in reply to: KSH

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Subject: RE: Healthcare Rant
Originally posted by KSH

Originally posted by louamerica Couple of stories: In Canada, I had to see an ortho to look after a repairing broken leg. (I was there for a year on work) the only time I could see the dr. Was at 11 pm. Free medicine might be great, but it's a to wait in line. A friend of my and his wife were in Italy. The wife stepped off the curb incorrectly and smashed into a street sign. Nose was busted and a separted shoulder. Ambulance comes, doctor does his magic, and bing bango, they discharge her. The cost was $300 US .. And they got a DVD of the X-rays and procedure for her dr. Back in the states. I have been to the hospital 2x in the last 3 years. Once for an appendectomy. The other for a kidney stone. Total cost came to about $500 Depends on your insurance. But yes. Medical insurance in the US is . In Canada it is "free" if you don't mind paying an extra 20% for everything else.

A coworker of mine is from Texas, but lived in Canada for around 10 years. She married a Canadian. All she does it talk about how great healthcare is up there and how she wishes she could go back. 

Obviously when we have in the US is broken for the consumer. 




There are frustrations with the Canadian system as well.
For minor stuff - i.e. a regular visit for a checkup or a bad flu, it can be a pain in the neck to get a doctor.

I've lived & worked in the US, Canada, Germany, Singapore, Mexico, Malaysia, Poland. No place has it 100% correct. I will suggest the US and Canada both have it less correct than many of the other places I've lived.

PS - careful regular (non-medical) Superglue on wounds. Apply only on the outside of the wound and not inside. Also - Cyanide is an active ingredient in superglue.
2014-03-19 6:39 PM
in reply to: KSH

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Subject: RE: Healthcare Rant
Originally posted by KSH

Originally posted by Stuartap I know this is a very hot topic. Some excellent conversation and very good perspectives. That said, I think there is a lot more people should know that they don't. As it happens I am an expert in the field. I have written on the topic many times. The hard part is this discussion right here is more in-depth than most people are willing to invest to understand what is going on. So if there is interest I would b pleased to see if I can provide an objective look at where we are and what you should know so you can get the most out of what your current choices are. Caution though, it will be long and likely in multiple parts. Then I would expect each piece to spark some lively debate. FYI - I was hit by a car last year (twice actually but the first was minor) while cycling. I have a high deductible HSA plan (wife and I) with a $8,200 deductible and a $11,200 Maximum Out-of-Pocket. The surgery to repair my fractured hip cost $94,000 billed, ppo price $26k and the second surgery to replace the hip was $102,000, ppo price $28k. Since the driver didn't stop I had no way to ding him/her for the cost so all the costs hit my insurance. I ended up paying NOTHING out of my pocket! I will explain that too. Is there any interest here or is this too big a topic for the time investment it will take to follow along?

For me, I really want to know what I can do as a consumer to pick the right plan for me. It just seems that I pay all this money into health insurance and I don't get anything for it (unless I want to pick a Dr. off their list). 

 



Karen that is the big question with, like all things healthcare related, no simple answers. Unfortunately the ACA has made things more difficult for most consumers to understand, and quite frankly, harder to afford. In order to best answer the question there is much I would need to know and likely more than you would like to share. So let me see if I can synthesize the key points down into a manageable size and post that. My fear is many people will not understand some parts without more context and then we are back to a full explanation of how we got here and why things are where they are. But I will try.


2014-03-19 6:58 PM
in reply to: Stuartap

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Subject: RE: Healthcare Rant

Originally posted by Stuartap
Originally posted by KSH

Originally posted by Stuartap I know this is a very hot topic. Some excellent conversation and very good perspectives. That said, I think there is a lot more people should know that they don't. As it happens I am an expert in the field. I have written on the topic many times. The hard part is this discussion right here is more in-depth than most people are willing to invest to understand what is going on. So if there is interest I would b pleased to see if I can provide an objective look at where we are and what you should know so you can get the most out of what your current choices are. Caution though, it will be long and likely in multiple parts. Then I would expect each piece to spark some lively debate. FYI - I was hit by a car last year (twice actually but the first was minor) while cycling. I have a high deductible HSA plan (wife and I) with a $8,200 deductible and a $11,200 Maximum Out-of-Pocket. The surgery to repair my fractured hip cost $94,000 billed, ppo price $26k and the second surgery to replace the hip was $102,000, ppo price $28k. Since the driver didn't stop I had no way to ding him/her for the cost so all the costs hit my insurance. I ended up paying NOTHING out of my pocket! I will explain that too. Is there any interest here or is this too big a topic for the time investment it will take to follow along?

For me, I really want to know what I can do as a consumer to pick the right plan for me. It just seems that I pay all this money into health insurance and I don't get anything for it (unless I want to pick a Dr. off their list). 

 

Karen that is the big question with, like all things healthcare related, no simple answers. Unfortunately the ACA has made things more difficult for most consumers to understand, and quite frankly, harder to afford. In order to best answer the question there is much I would need to know and likely more than you would like to share. So let me see if I can synthesize the key points down into a manageable size and post that. My fear is many people will not understand some parts without more context and then we are back to a full explanation of how we got here and why things are where they are. But I will try.

I would love to see more conversation on this topic.  I'm definitely interested to see what you post.

 

2014-03-20 10:14 AM
in reply to: switch

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Subject: RE: Healthcare Rant

If there is something you don't like about your current policy, you have until March 31st to change policies.  Otherwise, you have to keep the same policy until November 15th.  I just received the following message from Humana:

"In the past, consumers could apply for new coverage or request a change to their current health plan as needed.  With the new rules of the ACA, consumers can only purchase new coverage during the annual open enrollment period each year.  This year, the open enrollment period ends March 31, 2014.  After this date and until the next open enrollment period that begins November 15, 2014, a consumer cannot purchase new coverage or make any changes to their current health plan unless there is a qualifying life event.  Having a qualifying life event makes a consumer eligible for a special enrollment period. "

2014-03-24 1:25 PM
in reply to: Aarondb4

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Subject: RE: Healthcare Rant

I think it is fair to say that this thread is about health care and the cost of it... not what Dr.'s do in their spare time. I think the Dr. bashing can be left out of it. 

 

2014-03-24 4:55 PM
in reply to: KSH

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Subject: RE: Healthcare Rant
getting back to healthcare/insurance...

As my wife and I have been working on our taxes we pulled all of our out of pocket medical bills for last year (around $8200) as well as looking at all of our other bills. One things about it surprised me so I had to look into it more closely. My insurance plan (through my employer) covers in-network outpatient visits at 100% with a small copay, right? what I found out after really digging into the plan notes was the for any facility that bills a separate facility and provider fee for outpatient care, the provider is covered at 100% but the facility is coverage at 85% with a 15% co-insurance. This means that, depending on how a facility is set up, I could end up paying quite a lot out of pocket.

after doing that I was calling to make an appointment with a different specialist and when I asked the person on the phone who was scheduling for me how they billed, (all in one, or separate fee's) they did not know and I got transferred to their lead, who had to send me to their supervisor and finally their departmental manager who was at least able to answer it for me. Maybe this speaks more to this one clinic and their training but it is a little ridiculous how some office or systems work. at least in this case they were all nice people and tried to be helpful.

as an FYI - I work as a supervisor in an Oncology clinic for administrative staff (scheduling mostly). I have been working in the same office for 7+ years and have seen a lot of things change in that time, some for better and some for worse, but non has left patients more confused than the ACA. In fact with Washington state running its own exchange we have even encountered so many contracting issues with some of these new plans it is a wonder anyone can get seen anywhere under one of them.

I really wish we had gone with a different option (As bad as single payer sounds to most people I think it would work better here once people got used to it. I am not sure we will ever get there though - to many company/pocket book interests)
2014-03-25 9:27 AM
in reply to: Socks

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Subject: RE: Healthcare Rant

Originally posted by Socks

 

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 


8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
 

So pardon me for bring this back.... but what you are saying is you just throw out any arbitrary number based on what you think the government will give you?

 

Why would you bill 200% what medicare pays hoping to get 150%? You are telling me you can't come up with a charge for a given procedure? I mean my mechanic can. Parts/materials... and $60 an hour for labor. Hospitals invest a lot in equipment... you mean to tell me nobody can amortize hospital equipment use based on expected operation time? Seriously? 

The point is for providers to seek the best operating efficiencies to be competitive... then insurance companies offer the best cost/performance packages to consumers... at least on paper. But what happens is providers just throw what ever that can on the wall and see what sticks... and then everyone bases charges on that. 

At the end of the day, practitioners and providers do have to make ends meet. Time is money. And health care professionals should be paid well. And money needs to be invested in making it better.... but the reason it is broke is because everyone just tries to get what ever they can from the feds... because after all that money is just free and grows on trees. The rising costs of health care are completely inflated garbage due to the government involvement and everyone trying to get their piece of the tax revenue pie.



2014-03-25 9:38 AM
in reply to: bel83

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Subject: RE: Healthcare Rant

Originally posted by bel83 getting back to healthcare/insurance... As my wife and I have been working on our taxes we pulled all of our out of pocket medical bills for last year (around $8200) as well as looking at all of our other bills. One things about it surprised me so I had to look into it more closely. My insurance plan (through my employer) covers in-network outpatient visits at 100% with a small copay, right? what I found out after really digging into the plan notes was the for any facility that bills a separate facility and provider fee for outpatient care, the provider is covered at 100% but the facility is coverage at 85% with a 15% co-insurance. This means that, depending on how a facility is set up, I could end up paying quite a lot out of pocket. after doing that I was calling to make an appointment with a different specialist and when I asked the person on the phone who was scheduling for me how they billed, (all in one, or separate fee's) they did not know and I got transferred to their lead, who had to send me to their supervisor and finally their departmental manager who was at least able to answer it for me. Maybe this speaks more to this one clinic and their training but it is a little ridiculous how some office or systems work. at least in this case they were all nice people and tried to be helpful. as an FYI - I work as a supervisor in an Oncology clinic for administrative staff (scheduling mostly). I have been working in the same office for 7+ years and have seen a lot of things change in that time, some for better and some for worse, but non has left patients more confused than the ACA. In fact with Washington state running its own exchange we have even encountered so many contracting issues with some of these new plans it is a wonder anyone can get seen anywhere under one of them. I really wish we had gone with a different option (As bad as single payer sounds to most people I think it would work better here once people got used to it. I am not sure we will ever get there though - to many company/pocket book interests)

In my ordeal... I went to a surgical center that does not accept insurance. It was started by a group of doctors. They are not in anyone's network. You sign a piece of paper saying you are responsible for payment... but the facility will honor what ever your in network provider would pay. they do this so they do not have to comply with anyone's price restriction. they bill the insurance company what ever they think they can get. Many companies just pay it. But some fight it.

then the facility goes after the patients. They charged a person like $8000 for a shot. They fought it and got it reduced a fair bit. It was in the news and caused a big stink. they now tell you you do not have to pay...but they keep doing what they do. they charged me my co-pay... which I should not have had to pay because I met my max... but then my insurance didn't pay them because they could not show them they went by their price structure. they said I am not responsible for payment, yet I signed a piece of paper saying I was. As far as I know it has been dropped... but they charged $4000 for an epidural for me. Ridiculous. It's crap like that that shows you it is nothing but a system being gamed and has nothing to do with providing cost effective care. 

Single payer is even worse... because all you would do is take any restrictions away from raiding the tax revenue piggy bank. Nothing the government does is done cost effectively. NOTHING. Plenty of things the government does need to provide, but none of it is for cost effectiveness. the argument that the government needs to take over to keep costs down is complete fantasy. EVERYTHING the government provides cost more for inferior products. Medical care would be nothing different. 

2014-03-25 9:40 AM
in reply to: powerman

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Subject: RE: Healthcare Rant
Powerman

I agree with you a lot there. One reason my mom's cousin has/had junk health insurance. She paid $50 a month not to have anything covered it was because in my case last year. No insurance it was $75000 in medical bills since I had insurance that went to $25000 where I basically paid $5000 of that $25000.

I guess if I came in had it as a part of emergency surgery and could not pay the $75,000 bill because I had no insurance they could write off the whole amount on taxes also. This would also make sense on the raise of for profit hospitals.

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What can you do? You can implement small but sustainable changes that you can happily maintain for the rest of your life. The changes might have more to do with lifestyle than food.