Health Insurance Insider: 'They Dump the Sick'

Originally posted by jibeho
reply to post by kiwifoot

 

Right now its the taxpayers that foot the bill for medicare, medicaid and e/r visits for those not covered by anything.

The system is dizzying and is swelling with internal corruption and fraud.

I am very grateful for the insurance plan that we have through my wife's employer. However, it is not cheap but it allows us to make our own decisions and to choose our doctors that are part of the network. We make sacrifices in other areas in order to afford our plan. Unfortunately, many people would rather have the latest cell phone or gadget, video game or text messaging plan than spend money on a plan for their families security and well being.

Not everyone is that way. What happens when suddenly your Ins. Company decides you have a pre-existing condition and refuses to pay? Even after you have been responsible and paid your premiums for years. It's nice to be able to play the blame game, but its just not representative of what is going on in the industry. They need to be put under for all the years of looking for inhumane ways of denying , delaying care.

It's really not that hard to understand. The purpose of insurance companies is to make money, not to provide you with healthcare. The more they have to pay out, the smaller the number on their bottom line. It makes sense that they would do everything in their power to deny coverage to the people who need it most.

For the public as a whole, a not for profit system is the best way to go.

Originally posted by bismarcksea
TRUE STORY:

We went to get a little back up supply of my wifes meds. The insurance company DENIED the refills because it was before the allowed "re up date". So we just asked the lady if we could order the refills without going through the insurance.

To our SHOCK this is what we found out.
Normal price of my wifes meds ON INSURANCE: $4 and $9 respectively.

Price of my wifes meds with NO INSURANCE: $4 and $7 dollars!

I was so FING mad, I just stood there shaking! The NERVE of these assholes to DENY us our medication and to regularly charge us $2 more for this privledge!!!!!!!!

You have to pay attention to the specific meds. Years ago I learned this, and at times would choose to NOT use my insurance as it was cheaper not to.

But, remember, those prices will usually be generic with no insurance, compared to non generic with insurance. Be sure to question that.

As well, the opposite takes place. My daughter has asthma, and so do I.

We lost health coverage for her but I still had mine. What we learned was, that for the exact same asthma medicine, my base price was almost $75.00 cheaper (me having insurance), compared to the base price for the exact same medicine for my daughter (not having insurance). When I asked why, I was told that when someone has insurance, they are capped on what they are allowed to charge. When someone does not have insurance, they charge more to make up for what they consider the losses they incur from those with insurance.

Now that, is a reason to be FING mad.

Harm None
Peace

Originally posted by jibeho
reply to post by kiwifoot

 

Anyone who walks into an E/R in this country will be treated. No one is turned away especially at hospitals designated as County hospitals. This is why our E/Rs have turned into family medicine clinics. The cost of this care given to these individuals is passed on to the taxpayer.

The county hospital in my area wanted to charge a flat $10 fee (bargain) for the E/R services to help absorb some of the costs and it was shut down because the politicians didn't think that the patients could afford it. However, these same patients have plenty of money for cigarettes, alcohol, McDonalds and tattoos.

Our system definitely needs help but throwing money at a problem when you don't have the money to spend will not ultimately solve the problem. There is a price to be paid for everything. NOTHING is free.

Yes, anyone who walks into an ER is treated, they cannot be denied treatment. But, it is definitely NOT free. Weeks later you receive a giant giant bill. Also, remember that the hospital is ONLY required to stabilize a person, and not required to do anything further.

ER's are not the place to go for basic health care, you won't receive it.

Harm None
Peace

The best insurance coverage I ever had was when I worked for two different large institutions. It was group coverage with no prior medical checkups before being insured. In additon, one of my plans allowed coverage of pre-existing conditions after a certain waiting period and also paid a large percentage of my medications.

People with health insurance do not pay top dollar. The insurance company bargains with the health care providers in order to get the lowest possible price. It's the uninsured who get the whopping bills after a long illness or hospital stay. It is estimated that 1/3 to 1/2 of all bankruptcies in this country are caused by health care debt.

Now I cannot get private health insurance because I have a pre-existing condition. Even if I could find an insurer who would take me, I'm sure it would cost me more than I have to pay for it.

What do people do who cannot get medicaid or private health insurance? Just die?

For millions of American government health insurance would be much preferable to nothing, even if you could find flaws in it. Under the Republican plans they're just out of luck.

The government already pays for coverage of federal employees, veterans, medicare and medicaid -- which have all been mentioned already in this thread. These programs are largely effective.

Government programs are not perfect -- people can always find flaws--but for most people it will be a lot better than nothing.

For those who prefer to have a profit-making insurer there will be that choice. As I understand it one will just have to have coverage of some kind in most cases. It's up to the individual to decide what kind and from whom.

I am eagerly anticipating my new insurance plan.

Originally posted by amazed

Originally posted by jibeho
reply to post by kiwifoot

 

Anyone who walks into an E/R in this country will be treated. No one is turned away especially at hospitals designated as County hospitals. This is why our E/Rs have turned into family medicine clinics. The cost of this care given to these individuals is passed on to the taxpayer.

The county hospital in my area wanted to charge a flat $10 fee (bargain) for the E/R services to help absorb some of the costs and it was shut down because the politicians didn't think that the patients could afford it. However, these same patients have plenty of money for cigarettes, alcohol, McDonalds and tattoos.

Our system definitely needs help but throwing money at a problem when you don't have the money to spend will not ultimately solve the problem. There is a price to be paid for everything. NOTHING is free.

Yes, anyone who walks into an ER is treated, they cannot be denied treatment. But, it is definitely NOT free. Weeks later you receive a giant giant bill. Also, remember that the hospital is ONLY required to stabilize a person, and not required to do anything further.

ER's are not the place to go for basic health care, you won't receive it.

Harm None
Peace

Please share your information with the hospitals in Cleveland. People walk into the e/r with colds and runny noses here. I took my child into the e/r with an unknown allergic anaphylactic (hives and swelling) reaction and we had to wait behind others with the sniffles and a fever. There was not a single traumatic case in that e/r waiting room. With the exception of my daughter. 30 minutes after sitting in the waiting room a doctor came out to check on her. Luckily the only thing that didn't swell up was her airway. 10 minutes after that we were brought back to the exam area for treatment.

The bills that get sent are rarely paid in these specific instances. That's where the taxpayer comes in.

Originally posted by ohioriver

Originally posted by jibeho
reply to post by kiwifoot

 

Right now its the taxpayers that foot the bill for medicare, medicaid and e/r visits for those not covered by anything.

The system is dizzying and is swelling with internal corruption and fraud.

I am very grateful for the insurance plan that we have through my wife's employer. However, it is not cheap but it allows us to make our own decisions and to choose our doctors that are part of the network. We make sacrifices in other areas in order to afford our plan. Unfortunately, many people would rather have the latest cell phone or gadget, video game or text messaging plan than spend money on a plan for their families security and well being.

Not everyone is that way. What happens when suddenly your Ins. Company decides you have a pre-existing condition and refuses to pay? Even after you have been responsible and paid your premiums for years. It's nice to be able to play the blame game, but its just not representative of what is going on in the industry. They need to be put under for all the years of looking for inhumane ways of denying , delaying care.

The HIPPA act of 1996 protects the insured from pre existing condition restrictions. This protection applies to company sponsored group plans and government plans. Unfortunately, private policies purchased by an individual are not protected by HIPPA and you can be excluded due to pre existing conditions. HIPPA fortunately protected me due to previous treatment for a brain tumor.

Regardless of HIPPA the pre existing condition clause still sucks. We unfortunately are unable to choose when we become ill. The red tape in the insurance business is mind altering. My medical bills way back in 1993 hit six figures within 3 weeks of the start of treatments and surgeries etc.

Hippa basically states that a preexisting condition can only be classified as a condition that was in effect six months prior to the effective date of the policy, and, further, it can only be excluded for one year after the effective date of the policy. (an exception would be a late enrollee) It should be recognized that this Hippa protection only applies to employer sponsored plans and government sponsored individual programs. Individual health insurance policies that people purchase on their own are not protected by Hippa. Individual plans not under Hippa protection are allowed to exclude a condition permanently.

www.associatedcontent.com...

I work with younger people who opt out of company sponsored health insurance because they think they will never need it. They can certainly afford the coverage but would rather spend the small savings frivolously.

reply to post by Sestias


I understand your perspective perfectly. I have traveled the winding road of insurance and illness for years.

Obama claims that his plan will compete along with the private plans. It is impossible for a private entity to compete against the government in the long run. It may look viable in the short term but the government will always win. The government will always 'find' money somewhere. When all of the private insurers fold, only one choice will conveniently remain.

Our health care system is certainly fraught with problems. I would love to see a viable solution. I don't like the fact that Obama is trying to scare the snot out of the country just so that they will buy into his ideas. He wants to rush this plan through at breakneck speed with no viable alternatives considered or presented. He is simply going to throw a $trillion at the wall to see if it sticks.

You have to whack every head of a Hydra in order to kill it. Solving our health care problem should be a step by step process that attacks the individual problems that plague the system. The abusers and the crooks on all levels are still going to be part of a new system if they are not stopped.

[edit on 25-6-2009 by jibeho]

Originally posted by jibeho
Right now its the taxpayers that foot the bill for medicare, medicaid and e/r visits for those not covered by anything.

That's not true. If you have no insurance coverage, you will be billed for any medical services. It's then an outstanding debt and it's handled like every other debt, pay it off or if you don't earn enough to make reasonable payments, have it discharged through a bankruptcy. Taxpayers only end up on the hook for those that skip or declare bankruptcy.

reply to post by mythatsabigprobe


In my neck of the woods most patients skip and leave the hospital hanging.

Here is an interesting viewpoint from the American College of Emergency Physicians.

Hospitals and physicians shoulder the financial burden for the uninsured by incurring billions of dollars in bad debt or "uncompensated care" each year. Fifty-five percent of emergency care goes uncompensated, according to the Centers for Medicare & Medicaid Services The amount of uncompensated care delivered by nonfederal community hospitals grew from 6.1 billion in 1983 to 40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured.

ACEP advocates for universal health care coverage that builds on the strengths of the nation's current health care system.
* ACEP's Task Force on Health Care and the Uninsured developed six principles to be used as a framework for expanding health care coverage to all.
* ACEP is a supporting partner of Cover the Uninsured Week held each year. During the observance in 2003 and 2004, ACEP released the results of a national study of its members, which found 81 percent of the emergency physicians said patients without health coverage are more likely to die prematurely than patients who have health insurance.
* The public's desire for health care reform has shifted over time from wholesale reform to more targeted, incremental strategies. Among the options are: shoring up Medicaid, offering vouchers to buy insurance, offering tax credits to help small employers and individuals, and providing tax relief to those who buy insurance on their own.
* Numerous polls show that most Americans support the idea of access to universal coverage, and the plight of the working uninsured clearly resonates with most of the public. But support starts to wither when people are asked whether they would be willing to pay more taxes to cover more people.

www3.acep.org...

reply to post by jibeho


How does someone 'skip', I mean, don't they have to take ID or something when they go, obviously not for critical cases etc, but say if you cut your hand, don't they get some proof of ID or a credit card?

reply to post by bismarcksea

To our SHOCK this is what we found out. Normal price of my wifes meds ON INSURANCE: $4 and $9 respectively. Price of my wifes meds with NO INSURANCE: $4 and $7 dollars! I was so FING mad, I just stood there shaking! The NERVE of these assholes to DENY us our medication and to regularly charge us $2 more for this privledge!!!!!!!!

A similar thing happened to me the first time I filled a new maintenance prescription at Walmart. My HMO charged a "co-pay" of $14 for a thirty day supply. It was one of the generics on the $4 Walmart list. When I asked why it was $14, and not $4, they said my insurance insisted on collecting a $14 copay. I told them I wouldn't take the prescription. I then said I would pay for it, WITHOUT going through insurance, which was ok with Walmart. Now, each time I refill it (I now have the doctor write a 90 day supply with 3 refills for $10 at Walmart), I just tell Walmart not to put it through my insurance. My wife and I pay $1200.00 a month for our insurance, which consumes about half of my retirement pay!
I sure hope the government comes up with something for less. I'm sick of getting ripped off by insurance companies. I spend several hours a week arguing with them about rejected claims for trivial reasons, such as not being able to read the doctor's signature on the referral form. Since when is a doctor's signature supposed to be legible?

reply to post by jam321

Maybe they should line up some veterans, so the veterans can tell how government sponsored health care is treating them.

I go to the VA hospital. I get excellent treatment. I receive follow-up care fore cancer, and other various ailments that a 40 year man should not have. I also get about $1000 in medication a month for free. VA healthcare is not too bad, and I have other options for healthcare to compare.

Those who have a problem are the ones that are filing claims for disabilty compensation. It is difficult to get the VA to recognize anything as service connected. Combine all of my service connected ailments together and I would rate at 250%. The most they will pay out is 100%. It was very difficult for me to get the VA to recognize any of my ailments as service connected, and they are all clearly listed in my military medical records.