The Vent Part Quatre

[The Dude 206]

I worked in the dental field for a number years in both a management and professional capacity. I would describe that practice as insurance fraud. I'm surprised the dentist admitted that! That's definitely a no-no.

Is that experience in Canada or the U.S.? It seems it is common practice here.

The weird thing is they didn't want payment upfront if we stayed on the cancellation list but they want it since it now that we are scheduled in. I think they wan to over bill the insurance company too, cause when we get the explanation from the insurance company you can see the price they try to charge vs what will be payed. I know when we go to take them my husband will make them recalculate the bill to 80% not 60% if they want to get payed they will have to do it. I find it crazy how we have to wait till the end of May for the first appointment when they have more then one dentist we could see and we are not picky, we just want it done.

Maybe I'm being more impatient cause I don't want to be dealing with the dentist after the baby is born and the rate things are going we will be.

Another thing to consider is that some dentists don't like certain insurance companies. Rather than just tell people that they won't take on any new patients with that insurance company, some will take the passive aggressive route and just string you along til you say "eff this" and go somewhere else.

[OBX 51]

Is that experience in Canada or the U.S.? It seems it is common practice here.

It was in Canada but there is also no shortage of "creative billing" there. Sadly overcharging the insurance companies will eventually lead to increased premiums and we all pay more.

Sounds as though figuring out dental care coverage here is just as confusing as medical. Luckily I can use my husband's US insurance in Canada and continue to go to the same office that I did before I moved.

[Udella&Wiz 325]

I can barely contain myself - it's Open Enrollment time at my husband's company.

We got the standard letter indicating rates have gone up AGAIN...so this year we're resolved that we will do the math and figure out where we can get some savings. High deductible plans are looking more attractive....I'd rather put the $$ into an HSA and pay for the deductibles I have to pay then pay the other guys a higher premium.

Of course then we have to worry about whether our current Drs are considered 'in-network' with the new plan if we switch. I absolutely refuse to switch Drs for 2 specialists that I go to. I like them and I just don't feel like showing my girly bits to yet another new Doctor, if you know what I mean

Edited April 28, 2011 by Udella&Wiz

[Marilyn. 340]

our health insurance premiums went up by about 20 to 30 bucks a check and some of our copays have gone up too... and now we have deductibles which we didn't have before...

there were cheaper plans to choose from but we like our current plan because we can basically go to whichever doctor we want..

I hear you about the girly bits.. I finally found a ob-gyn I feel comfortable with..

Edited April 28, 2011 by Marilyn.

[The Dude 206]

It was in Canada but there is also no shortage of "creative billing" there. Sadly overcharging the insurance companies will eventually lead to increased premiums and we all pay more.

Sounds as though figuring out dental care coverage here is just as confusing as medical. Luckily I can use my husband's US insurance in Canada and continue to go to the same office that I did before I moved.

Good point, I hadn't thought about it from that perspective. The problem is, the insurance companies.

I can barely contain myself - it's Open Enrollment time at my husband's company.

We got the standard letter indicating rates have gone up AGAIN...so this year we're resolved that we will do the math and figure out where we can get some savings. High deductible plans are looking more attractive....I'd rather put the $$ into an HSA and pay for the deductibles I have to pay then pay the other guys a higher premium.

Of course then we have to worry about whether our current Drs are considered 'in-network' with the new plan if we switch. I absolutely refuse to switch Drs for 2 specialists that I go to. I like them and I just don't feel like showing my girly bits to yet another new Doctor, if you know what I mean

I really hate the whole "in network" ####### that some insurance companies pull. I have a friend who at a new job, selected a doctor after signing up for his health insurance. He needed to see a specialist, and was given a referral to one who was in network. Fast forward 2 months, an invoice for $4,000 comes in the mail from the hospital where he saw the specialist at. Turns out that while the doctor was in network, the hospital where he went for the appointment was not. So, he had to pay for the physical visit, and each and every item used in his consult was billed. Afte two years and as many hearings, he had it reduced to $600. Yay U.S. hospitals and insurance, way to go.

[Krikit 1,165]

I hate the American "healthcare" (<------ oxymoron) system. Well, actually, their physicians are awesome. It's the stupid insurance industry which makes me crazy. If it wasn't so f'd up they'd save a lot of payouts for people who are visiting the Dr because they're fricking stressed by the process.

[Ontarkie 14,368]

I hate the American "healthcare" (<------ oxymoron) system. Well, actually, their physicians are awesome. It's the stupid insurance industry which makes me crazy. If it wasn't so f'd up they'd save a lot of payouts for people who are visiting the Dr because they're fricking stressed by the process.

I completely agree

[Marilyn. 340]

I really hate the whole "in network" ####### that some insurance companies pull. I have a friend who at a new job, selected a doctor after signing up for his health insurance. He needed to see a specialist, and was given a referral to one who was in network. Fast forward 2 months, an invoice for $4,000 comes in the mail from the hospital where he saw the specialist at. Turns out that while the doctor was in network, the hospital where he went for the appointment was not. So, he had to pay for the physical visit, and each and every item used in his consult was billed. After two years and as many hearings, he had it reduced to $600. Yay U.S. hospitals and insurance, way to go.

a similar thing happened to me last year.. I went to the ER and paid my copay and then a few weeks later I got the bill which I was expecting and then a little while later I got another separate bill for the doctor.. turns out the hospital was in-network but the doctor who saw me in the ER was not .. that doesn't seem right or fair at all..

oh and then to top it all off.. I actaully worked it out with the hospital that I didn't have to pay that second bill.. but I had called our health insurance before I contacted the hospital and they basically told me that I was SOL but then I guess they decided on their own and without letting me know to refile the claim but for a lower amount..(even though when I called and confronted them they said I had told them too ) so I contacted the hospital again and they said oh well.. you have to pay it.. grrr..

Edited April 28, 2011 by Marilyn.

[OBX 51]

I hate the American "healthcare" (<------ oxymoron) system. Well, actually, their physicians are awesome. It's the stupid insurance industry which makes me crazy. If it wasn't so f'd up they'd save a lot of payouts for people who are visiting the Dr because they're fricking stressed by the process.

I totally agree as well. I have had mostly good luck with MDs although at one point I had an issue that may have required a referral to a specialist if it didn't clear. So I asked the GP who she would recommend in the event I need a referral. She wouldn't even give me a name; she just told me to see who my insurance covered. Geesh where would I start? I had only been here a few months at that time. Luckily my problem cleared so I never did have to do my own search.

[The Dude 206]

The problem is, an insurance company is a for profit organization. Their explicit goal is to maximize their value for their shareholders, not the overall care of their subscribers. Some insurance companies are better than others, but by and large, they all have this systematic flaw. Profit margins should not be a determining factor in a health matter. The U.S. has the best hospitals and doctors in the world, but has the worst insurance and payment system in the world. I can only imagine how confusing and aggravating it is for someone used to a more comprehensive system.

[Krikit 1,165]

I totally agree as well. I have had mostly good luck with MDs although at one point I had an issue that may have required a referral to a specialist if it didn't clear. So I asked the GP who she would recommend in the event I need a referral. She wouldn't even give me a name; she just told me to see who my insurance covered. Geesh where would I start? I had only been here a few months at that time. Luckily my problem cleared so I never did have to do my own search.

OMG, tell me about it. I started physio a few weeks ago. They wanted me to sign off on some form which describes the type of coverage I have and that if it's wrong blah blah blah legal bs blah blah blah. So I said "I have no idea what kind of coverage I have so I can't sign this form." They told me to call the insurance carrier. *blink* Okay. So I call them and go into automated message hell. Five minutes later I hung up and said "I can't get through to a live person." They said "Did you press 0 to speak to an attendant?" I"m like..... "No. They didn't give me an option to do that." They're like..... "You always press 0 whenever you get into that kind of situation." I'm thinking..... "Well, thanks for that. I TOLD you I'd never had to call an insurance carrier before." Grrr. I think they thought I was lying. lol. So they say "Would you like to call them back?" I'm like..... "GAWD, no. Give me the form. I'll sign it."

Stupid American system.

[Canadiandggal 49]

OMG, tell me about it. I started physio a few weeks ago. They wanted me to sign off on some form which describes the type of coverage I have and that if it's wrong blah blah blah legal bs blah blah blah. So I said "I have no idea what kind of coverage I have so I can't sign this form." They told me to call the insurance carrier. *blink* Okay. So I call them and go into automated message hell. Five minutes later I hung up and said "I can't get through to a live person." They said "Did you press 0 to speak to an attendant?" I"m like..... "No. They didn't give me an option to do that." They're like..... "You always press 0 whenever you get into that kind of situation." I'm thinking..... "Well, thanks for that. I TOLD you I'd never had to call an insurance carrier before." Grrr. I think they thought I was lying. lol. So they say "Would you like to call them back?" I'm like..... "GAWD, no. Give me the form. I'll sign it."

Stupid American system.

My experience with the stupid system and insurance has been a crappy one and Ive only been here 6 months. First there was my blood work where they processed it without my insurance sending me a lovely 500 dollar bill (of course I called and straighten it out), then my son had a Speech therapy assessment which I got billed 240 dollars for and yet I signed a sheet of paper that said it was 120 a session. After a few phone calls and 3 weeks I finally got it reprocessed. They cover the initial appointment to find out if there is a problem then your on your own lol. Now I have a lovely 700 dollar bill for my ultrasound as well as a bill for the radiologist, which I am stuck with due to our annual deductible. The great thing is my baby is due October so I will not have to do the deductible again till Jan, however They only pay 80%, thats a few thousand dollars in hospital bills I will see in October.

[Krikit 1,165]

^^That makes me so mad.

[Krikit 1,165]

Has this happened to anyone else when they come back to Canada to visit? My family acts like I didn't spend the first 35 yrs of my life here. I do remember what Celsius is, really I do. I do remember where things are in the city, no I don't need directions on how to get there the fastest way to such and such! No I do not want to pretend I'm a tourist.

You know, it's funny because I'd never had that happen before (that I remember, anyway. lol.). But on this trip it's happened a few times. But what's even weirder is that I can really hear the Canadian accents now. So now I'm wondering if I'm speaking with a Southern one. lol

[Flames9_RN 358]

As much as I detest the American system--right now I would prefer it for my father. He has a crappy heart, his Ejection fraction was a crappy 25% last yr, now its down to 14%! They need to put in a different type of pacemaker ASAP, BUT before they can do that---since they dont do that in SK----He has to goto Calgary---they have to do an Echo to ensure the valves are fine--Only a 2-4 month wait for an echo!! Plus if they do find he needs a valve replacement, who knows how long that will take--then wait some more for the new Bi-Ventricular pacemaker!! So sort of sucks!! But on th epositive side, he isn't broke,lol!! With his heart history, total of 3 bypasses, stnets, etc, his insurance costs would be sky high. So its a give an d take!

What really ticks me off as a health person--is the same pts over and over again as they just dont care!! Diabetics and alcoholics! But hey, they have medicaid or medicare, so the hospital makes nay excuse to admit them, as they know they will get payment, really makes no sense! Its our taxes paying for these people. And what really ticks ya off--they treat the place like a hotel,lol Fun and games!!