Latest Personal Insurance Drama

[Heracles 417]

This is the first time I personally had to use insurance here, as I usually paid cash for the doctors. I went to a doctor and then had a few basic tests. No real difference from going to a doctor in Aus but they do have more admin staff and nurses in the doctors office, which we just don't have in AUS. Waited 20 minutes rather than the usual 40 to an 1hour back in AUS. I would probably have had to go to a private clinic to have the lab tests in AUS. Doctor provided me some samples of the meds and I was off. Just the other day I see the explanation of benefits mailed to me. To my surprise, I was not covered. What got me the most is the cost.

$180 to see the doctor - for 15 minutes

$330 lab costs.

Are these prices for real? There is the problem right there. The NHS (government policy) would have paid the doctor $90 for the visit. $180 for a 15 minute consultation is extortion. Regarding the Lab costs, my cousin works in a private lab that does such testing. She emailed me that they wold have billed NHS $145 for these same tests.

Now the reason the insurance denied the claim is because I have two insurance polices. How is that for a joke. I have my own policy for both my spouse and I and she has her own policy covering me too. So it's a battle on which policy will cover it. Nearly $750 in premiums between us an they are denying me because of bullshit.

The fun doesn't stop there. I go to the pharmacy to pick up the prescription and I find out that they don't cover this brand, so it will cost $193 to buy. Can someone tell me how this same medication costs $47.30 to buy in AUS but $193 here? Furthermore, it comes in a factory sealed blister pack in Aus.

Now what sort of an idiot thinks the government option is a bad idea?

Edited October 7, 2009 by Booyah!

[Heracles 417]

PS The lab test and doctors visit would have cost me nothing in AUS.

[SMOKE 1,426]

PS The lab test and doctors visit would have cost me nothing in AUS.

had to throw that in didn't you?

you've been following this heathcare reform debate/b!tchfest more than i have. lemme ask you a question. if someone makes say 500%-600% above the poverty line, will gov't healthcare insurance be any cheaper than private insurance?

[sly_wolf 199]

I agree, it is ridiculous. True capitalism .... the more u can screw someone over the better. It wont last forever

[Heracles 417]

PS The lab test and doctors visit would have cost me nothing in AUS.

had to throw that in didn't you?

you've been following this heathcare reform debate/b!tchfest more than i have. lemme ask you a question. if someone makes say 500%-600% above the poverty line, will gov't healthcare insurance be any cheaper than private insurance?

What happens over there is that if you earn over $60K, have to pay a 2.5% tax on your income rather than the usual 1.5%. However, if you take out your own private policy, which is about $100 a month, you don't have to pay the 1% penalty. What they're proposing here is that people get to choose. Some employers have really crappy policies at the moment, which means a government (not for profit) option will be better for them. Not having to worry about health care costs is why there are so many small businesses in Aus.

I agree, it is ridiculous. True capitalism .... the more u can screw someone over the better. It wont last forever

But you know what, why are the 'capitalist' afraid of a government option. I think they're worried it might call out their bullshit. Their propaganda that only private industry can run something.

Edited October 7, 2009 by Booyah!

[Heracles 417]

The cost of tablets the doctor prescribed (pre-insurance):

Doctor recommended: (rejected by the insurance)

US: $133.81

Aus: $29.49

Alternative: (covered)

US: $193.00

Aus: $47.30

Edited October 8, 2009 by Booyah!

[Heracles 417]

bump. Please read Danno and Joesph. I would like your feedback.

[justashooter 430]

in America the illegals and poor get health care for free. because of this, everybody who was born here and has a job gets to pay double.

[Heracles 417]

in America the illegals and poor get health care for free. because of this, everybody who was born here and has a job gets to pay double.

Dude come on, this is racketeering at it's best. They may be adding huge costs to a hospital, but what justification is there for the other charges? a doctor is not going to treat them for free nor do they have to. The lab is not going to test them without payment. The pharmacy is not going to provide them medication without insurance or money.

There is absolutely no justification for the high cost of medication here. None. Actually they should be cheaper considering supply and demand. What is clear is that because they're billing an insurance company, they are pulling the old contractor equivalent scam and just inflating the price. Insurance companies don't care either, as they receive tax breaks for this ####### and get to charge us even more in premiums.

For someone buying it themselves, the ACCC in Aus would have fined any pharmacy with such an outrageous disparity between the wholesale and retail price.

Edited October 8, 2009 by Booyah!

[AlHayatZween 2]

Yep, you are absolutely right... it is a racket.

And sorry to hear you are bearing the brunt of it firsthand.

In your case, you do have insurance, so keep resubmitting the claim until one of your insurers pays for it... It will be a runaround, but with any luck you won't have to pay in full.

And yes, you are right... Lab fees for routine tests are exorbitant and with little reason as to way.

[Mr. Big Dog 10,747]

I gotta wonder: Why are both you and your spouse caryying the other on your insurance policy? That makes no sense to me unless adding your spouse doesn't cost extra in premiums which I would find hard to believe...

[mawilson 2,133]

I gotta wonder: Why are both you and your spouse caryying the other on your insurance policy? That makes no sense to me unless adding your spouse doesn't cost extra in premiums which I would find hard to believe...

Why is it hard to believe? My spouse doesn't cost me anything in premiums. I can also add up to 2 children for free;

3 and more would cost extra.

[Empress of Groovy 373]

I gotta wonder: Why are both you and your spouse caryying the other on your insurance policy? That makes no sense to me unless adding your spouse doesn't cost extra in premiums which I would find hard to believe...

Why is it hard to believe? My spouse doesn't cost me anything in premiums. I can also add up to 2 children for free;

3 and more would cost extra.

I'm pretty sure that's highly unusual.

[Heracles 417]

I gotta wonder: Why are both you and your spouse caryying the other on your insurance policy? That makes no sense to me unless adding your spouse doesn't cost extra in premiums which I would find hard to believe...

I wanted to have double the coverage. After all, how many people are bankrupted in this country because of insurance companies. One policy covers some things better than the other, vice versa.

Not to mention the stupid opt in opt out period #######. What bloody good is insurance when it's a hundred and one hassles?

Edited October 8, 2009 by Booyah!

[Mr. Big Dog 10,747]

I gotta wonder: Why are both you and your spouse caryying the other on your insurance policy? That makes no sense to me unless adding your spouse doesn't cost extra in premiums which I would find hard to believe...

Why is it hard to believe? My spouse doesn't cost me anything in premiums. I can also add up to 2 children for free; 3 and more would cost extra.

I'm pretty sure that's highly unusual.

Indeed.