Health Insurance

[DeadPoolX 9]

It's not free. You pay for it through taxation. One way or another, you end up paying.

It's still WAY cheaper than paying for insurance over here. The monthly equivalent is only a fraction compared to what you pay over here, even with employer health coverage.

I know. I've done the math out of curiosity and because I was fed up with people yelling "but it's not free, you pay for it through taxation!"

I never said it wasn't cheaper. All I'm stating is that there's no such thing as "free" health care.

[Empress of Groovy 373]

My wife had a preventative mammogram carried out. Because she is under 35, insurance won't cover it. So we received a nice bill of $735 for it.

We have the top insurances coverage / policies through Anthem. What cracks me up is that you get screwed when you try to be preventative, then if your not and are diagnosed with something, they screw you again and refuse to pay the bills because then the treatment is too expensive.

Second thing is how the heck does a mammogram cost $735. I just wrote a check to the labs and everyone else asking for a fee but what the heck am I paying insurance for?

Cost in Australia Z E R O.

They should pay for it if your wife's doctor thought there was something to be concerned about, like a lump or irregularity. Was there?

I know my doctor will always create a "reason" for mammograms even if her patients are too young to have insurance cover it, if they want the piece of mind.

Yes--focus on the doctor's determination that it was necessary.

This sort of thing makes my blood boil. The U.S. system is such a fvcking mess.

[Heracles 417]

It's not free. You pay for it through taxation. One way or another, you end up paying.

It's still WAY cheaper than paying for insurance over here. The monthly equivalent is only a fraction compared to what you pay over here, even with employer health coverage.

I know. I've done the math out of curiosity and because I was fed up with people yelling "but it's not free, you pay for it through taxation!"

I never said it wasn't cheaper. All I'm stating is that there's no such thing as "free" health care.

I realize that. Heck i have said that myself for years. I too added up the figures a while back and from a cost / benefit perspective, we are being ripped here big time.

It's good to think we are getting BMW 7 series in terms of value but in reality it's more a Chevy cobalt, with conditions. Like you can only drive x miles, or you have to use certain roads and their service centers.

Then you have to factor in whether you are fortunate enough to live near a good college or large city, sure you can receive good service. What about the other 200,000,000 who don't?

[Trumplestiltskin 5,791]

Michael Moore's Sicko does a pretty good job of establishing how much of a rip-off the private health insurance industry is, and how it screws its customers on a daily basis.

Edited May 7, 2009 by Private Pike

[Heracles 417]

The irony is that downunder, from an employers perspective, they pay zero medical cost under NHS. Well, apart from a small workcover premium, which covers your medical and rehabilitation cost if you are injured at work for a few hundred a year, per employee.

Excluding insurance companies and those whose pockets they line, which company wouldn't want to get medical expenses off their books?

Edited May 7, 2009 by Constellation

[Trumplestiltskin 5,791]

The worst part I think, is that the system here contributes to a culture of fear where people are so afraid of the system that they will take risks with their health to avoid a stay in hospital, or seeing a doctor when they actually think they have a problem.

Edited May 7, 2009 by Private Pike

[Mags 112]

It's not free. You pay for it through taxation. One way or another, you end up paying.

It's still WAY cheaper than paying for insurance over here. The monthly equivalent is only a fraction compared to what you pay over here, even with employer health coverage.

I know. I've done the math out of curiosity and because I was fed up with people yelling "but it's not free, you pay for it through taxation!"

I never said it wasn't cheaper. All I'm stating is that there's no such thing as "free" health care.

I realize that. Heck i have said that myself for years. I too added up the figures a while back and from a cost / benefit perspective, we are being ripped here big time.

It's good to think we are getting BMW 7 series in terms of value but in reality it's more a Chevy cobalt, with conditions. Like you can only drive x miles, or you have to use certain roads and their service centers.

Then you have to factor in whether you are fortunate enough to live near a good college or large city, sure you can receive good service. What about the other 200,000,000 who don't?

I hear ya. I the American health system terrifies me.

[JimandChristy 1,689]

My wife had a preventative mammogram carried out. Because she is under 35, insurance won't cover it. So we received a nice bill of $735 for it.

We have the top insurances coverage / policies through Anthem. What cracks me up is that you get screwed when you try to be preventative, then if your not and are diagnosed with something, they screw you again and refuse to pay the bills because then the treatment is too expensive.

Second thing is how the heck does a mammogram cost $735. I just wrote a check to the labs and everyone else asking for a fee but what the heck am I paying insurance for?

Cost in Australia Z E R O.

They should pay for it if your wife's doctor thought there was something to be concerned about, like a lump or irregularity. Was there?

I know my doctor will always create a "reason" for mammograms even if her patients are too young to have insurance cover it, if they want the piece of mind.

Yes--focus on the doctor's determination that it was necessary.

This sort of thing makes my blood boil. The U.S. system is such a fvcking mess.

It's immoral and unethical, feel sorry for you and your wife Constellation, the sooner some people realise the health care system in the USA is not run/dictated by doctors but in fact by insurance companies the better.

[Trumplestiltskin 5,791]

Its also a fallacy that the more money you have, the better off you'll be healthcarewise. That might be true for Donald Trump, but it isn't to someone on a high middle income ($100-$150K).

There are very real stories of people losing their savings, homes and credit because of healthcare expenses. That's outrageous.

[Heracles 417]

It's immoral and unethical, feel sorry for you and your wife Constellation, the sooner some people realise the health care system in the USA is not run/dictated by doctors but in fact by insurance companies the better.

I'm in a fortunate position to be able to pay for it. The question is, what about everyone else? Or is the prevalent attitude better luck next life. AKA survival of the fittest wealthiest

[Mr. Big Dog 10,747]

Welcome to America!

What the heck to the sick and poor do in this country? They are basically fu-ked. There is no other way to put it.

For us is is no big deal but how the hell does someone on minimum wage, out of a job or food stamps pay for it?

That one test would cost more than their monthly pay check.

You're preaching to the choir.

[Heracles 417]

Its also a fallacy that the more money you have, the better off you'll be healthcarewise. That might be true for Donald Trump, but it isn't to someone on a high middle income ($100-$150K).

There are very real stories of people losing their savings, homes and credit because of healthcare expenses. That's outrageous.

That actually happened to my cousins cousin, who lives here a decade ago. Something happened to their insurance policy while they had an auto accident. They ended up having to pay over $100,000 in medical expenses.

I always thought it must be their fault or that they were not responsible enough to have the appropriate policy, now I can see they where simply screwed. Good honest people who played by the rules but where taken advantage of.

Edited May 7, 2009 by Constellation

[scandal 951]

My wife had a preventative mammogram carried out. Because she is under 35, insurance won't cover it. So we received a nice bill of $735 for it.

We have the top insurances coverage / policies through Anthem. What cracks me up is that you get screwed when you try to be preventative, then if your not and are diagnosed with something, they screw you again and refuse to pay the bills because then the treatment is too expensive.

Second thing is how the heck does a mammogram cost $735. I just wrote a check to the labs and everyone else asking for a fee but what the heck am I paying insurance for?

Cost in Australia Z E R O.

They should pay for it if your wife's doctor thought there was something to be concerned about, like a lump or irregularity. Was there?

I know my doctor will always create a "reason" for mammograms even if her patients are too young to have insurance cover it, if they want the piece of mind.

Yes--focus on the doctor's determination that it was necessary.

This sort of thing makes my blood boil. The U.S. system is such a fvcking mess.

Constellation, are you in an HMO or a PPO?

It sounds like you're in a PPO, which probably means that the terms of your insurance require you to get a pre-approval for any treatment plan. That's reasonable: what the insurance company is saying is that since you can choose any doctor you want, it's not enough for that doctor to recommend a procedure. They want to review the doctor's recommendation BEFORE you go ahead with it, and only if they pre-approve it will you be covered. Since your wife does have a family history of breast cancer there's a good chance they may have approved it. And that may even be a good enough reason for you to keep fighting and get them to reimburse you. Don't take their initial denial lying down, you can appeal higher, and even go outside the company to state regulatory boards if need be. Anyway, keep in mind for next time the need to get a preapproval.

If you're in an HMO, the philosophy is different. You're in a managed care network and your initial consultations should always be done with your PCP (Primary Care Physician) who is in-network and is supposedly looking out for your best interests (medically) and the insurance co's best interests (financially). If the PCP recommends a scan or other treatment, you're good to go - no further approvals needed.

That's one of the reasons I preferred the HMO (my company offers both options). It's also cheaper on the premiums and no annual or lifetime limits. Most people seem to prefer PPOs to HMOs since they want the choice to pick doctors. For me that didn't see so important, I liked the efficiency of the managed care model better.

PS - you're still wrong and misguided about immigration, but we'll leave that fight for another day

[Trumplestiltskin 5,791]

Well Obama has already said that he isn't going to ditch the private health insurance industry.

He's not proposing anything more than papering over the cracks of what we already have.

[Heracles 417]

Constellation, are you in an HMO or a PPO?

It sounds like you're in a PPO, which probably means that the terms of your insurance require you to get a pre-approval for any treatment plan. That's reasonable: what the insurance company is saying is that since you can choose any doctor you want, it's not enough for that doctor to recommend a procedure. They want to review the doctor's recommendation BEFORE you go ahead with it, and only if they pre-approve it will you be covered. Since your wife does have a family history of breast cancer there's a good chance they may have approved it. And that may even be a good enough reason for you to keep fighting and get them to reimburse you. Don't take their initial denial lying down, you can appeal higher, and even go outside the company to state regulatory boards if need be. Anyway, keep in mind for next time the need to get a preapproval.

If you're in an HMO, the philosophy is different. You're in a managed care network and your initial consultations should always be done with your PCP (Primary Care Physician) who is in-network and is supposedly looking out for your best interests (medically) and the insurance co's best interests (financially). If the PCP recommends a scan or other treatment, you're good to go - no further approvals needed.

That's one of the reasons I preferred the HMO (my company offers both options). It's also cheaper on the premiums and no annual or lifetime limits. Most people seem to prefer PPOs to HMOs since they want the choice to pick doctors. For me that didn't see so important, I liked the efficiency of the managed care model better.

PS - you're still wrong and misguided about immigration, but we'll leave that fight for another day

PPO. It's the top of the line anthem blue shield plan.

Edited May 7, 2009 by Constellation