Medical Insurance, a ripoff, or legit?

[Peaches]

I have insurance from my husbands work. We pay 300 bucks a month for it. If I ever have to have surgery again, it is worth it but, I have to wonder about these companies and the providers that give us medical care.


I go to my local outpatient walkin clinic, called urgent care. I get a bill, for 150 dollers, insurance covers all but 50 of it.

My son had to go to them today, with ear problems. Since he doesn't have any insurance whatsoever, he is billed 80 bucks. Thats great, I believe, but, why do these medical providers overcharge our insurance for my care.>????

[Aria]

Did you and your son have the same medical problem? If not, different procedures and tests cost different amounts of money. Just a thought

However, I completely agree that healthcare/medical insurance is not right in this country. I come from a medical family, my parents own and run a medical business and deal with lawyers and doctors on a daily basis, I can't even begin to tell you how sickening that whole situation is. Lawyers being given favors by doctors to refer patients, doctors overcharging insurance. For example, some doctors of a well known clinic were sued recently for charging insurance companies for 3x the amount of time a patient was in therapy. Then you have the cost of high medical costs because even the good doctors have to retain insane medical insurance because of lawsuits. Its a huge mess.

[walkerglassmire]

Then you have the cost of high medical costs because even the good doctors have to retain insane medical insurance because of lawsuits.

There's your kicker right there. Cuz of our litigation-happy society, most Drs are having to carry insurance in the MILLIONS of dollars to cover all the lawsuits. And thats even for those that in say, 30, 40 even 50 year long practices, NOTHING has ever gone wrong.

Though linking back to the OP a bit, the cost difference might also be that a LOT of places, from what I see, will give folk with no Ins a break on price so that they get paid. They know the Ins Companies have DEEP pockets, so have no problems going after a LOT of pennies. heh Heck, my mom was in the hospital a while back, shattered her leg in like 4 places. VERY ugly. She didn't have and Ins, and not a big income. All but one of the Drs wrote off ALL their charges, meaning she didn't have to pay penny 1.

[Peaches]

I wasn't quite so lucky. My mom was in the intensive care unit for two weeks, no insurance. Title 19 would have lost her, her home. Since we didn't want to lose the home that she left us, and yes, its the one I grew up in. we had to pay the whole bill.

[Fratricide]

All insurance is a rip off.

Vehicle insurance is Government mandated so that the insurance companies dont go broke.

House insurance Well this doesnt even cover your whole house, you also have to add Fire, flood, natural disaster... etc insurances on top of normal house insurance to make your house truly covered.

Health insurance. This in no way insures that you will be healthy. You pay X amount to the insurance company that gets to decide which proceedures they will and wont cover, and you have to pay a co-pay at the time of service. Kind of rediculous if you ask me. If you pay $300+ a month to the insurance company, the least they could do is that one time you actually need to see the doctor they could pay for it 100%. Not this... Well we dont cover that type of surgery because it has been deemed elective or not cost effective for the benifit you get from having it.

Tis all just a ruse to make the insurance companies Make money off of people that have no other means of providing health care for themselves.

[Peaches]

I needed physical therapy after my last back surgery. Doc wanted me to go 4 times a week. Copayment? 25 bucks EACH visit. Needless to say, I didn't get the physical therapy I wanted or needed, not to mention, the two I tried were , well, I can't say it here.

[Tsarevna]

All insurance is a rip off.

Health insurance. This in no way insures that you will be healthy.

Well, duh it doesn't insure you will be healthy. That's not it's function. It's the same way as life insurance insn't there to make sure you never die.

The function of Health Ins. is to make sure you don't go broke just because you got sick/hurt. Also, it gives you a much better chance of seeing the doctors you need to see, and getting the care you need. This is because many doctors won't see uninsured patients.

Anyways, is it a ripoff? Yes. But is it completely essential that you and your family be insured? Yes.

Take my tale as an example.
.............................................

I bought health insurance when I was self employed the year before last. It was from a reputible company, and for a good price, less than $100 per month. Granted, that would leave me with high co-pays if something should happen, but at least I was covered. I filled out a questionaire about my past health, such as,
"Have you had surgery in the last 5 years?"
"Have you had psychological problems in the last 5 years, including depression?"
"Have you had any neurological problems?"
"Have you had chronic fatigue?"
"Have you been hospitalized in the past 5 years?"
"Do you have diabetes?"
Etc, etc.

I signed at the bottom that i filled the form out to the best of my knowledge and truthfully. I got accepted and enrolled into the policy.

The policy said I could have 1 breast exam and 1 pap smear, for free, each year. I thought, "o that is nice." So that was the first thing I went out and got my exam. I was nice and healthy in those respects.

But I didn't feel quite right sometimes, I had weird pains in my torso that couldn't be written off as "just heartburn" or "just indigestion". Long story short, I needed to get rid of one of those organs that isn't vital.

So, I see a surgeon, the arrangements are made that I have surgery on X date last year. But, I got sick a few days before my surgery, probably with viral meningitis. (It was never properly diagnosed.) I went to the ER for this, and had a $100 co-pay. This is nice, because usually, if you go to the ER without health insurance, they send you to the back of the line (behind patients that are insured,) make you sit there in pain (in the lobby) without treatment for a long time, then bill you thousands and thousands of dollars for your non-prioritized care. (I have seen this before, first hand. I have seen a child with a broken arm, bawling, get told to sit down in the lobby until "payment arrangements," meaning contracts binding his mother to pay, were drawn up.)
I was happy I wasn't one of the misfourtnuate uninsured. I was seen right away.

The ER visit didn't really help me much, the docs sent me home for bed rest, and said to come back if my fever got higher. Well, it didnt. I was able to proceed with my non-vital organ removal surgery a few days later. That surgery was uneventfull. I stay a night in the hospital, go home the next day.

That was when I got the letter. The letter from my health insurance company saying they were opening up a pre-existing condition investigation on me. I needed to sign a release form so they could look at all my medical records from the past 5 years. (The letter threatened, in other words, not to pay most of my bills should I refuse to do this. This to me, is called extortion, and racketeering (you gotta pay for protection!)

I was very confused about this, because, prior to my surgery, I called my health insurance company, and asked for pre-authorization. They said over the phone that I should go ahead and have my surgery, that it was no big deal. "Pre-authorization is for transplant patients, etc." they said.

So I signed the form, and long story short, I was dumped from my health insurance company. I got checks in the mail, giving me back all the money I ever paid my insurance company, then I got the letter saying they never should have accepted my application and insured me 'cause I lied on it.

They said I didn't mention that I had allergies. (Pollen, etc.) I didn't mention that sometimes I felt tired. (They reguarded this as chronic fatigue. I reguarded this as overwork trying to re-furbish a house/yard, preparing it for sale, and the side effects of allergy medications also included fatigue. It wasn't real fatigue! I stopped taking the drugs and sold the house and was fine!

On these grounds, I got left with the $24,000 medical bills. I even had to pay the for the "free" pap smear/breast exam. $24,000 is not the cost that an uninsured patient would be billed, it is the price they would have billed the insurance company. I was not able to apply for un-insured patient adjustments because I was "techincally insured" at the time of my surgery.

I am now in the process of declaring bankruptcy. I have consulted a lawyer, and he said "if it says on your medical records that you actually did feel tired, you won't win your case." I said but, but, but "I was taking drugs with side effects of fatigue!" he said, that won't matter to a judge. He showed me past examples of trials vs these big insurance companies where patients lost in similar circumstances. Legal precident has been set, that if a patient has a heart attack and needs a triple-bypass, and the insurance company wants to dump him because he didn't say he had sleep apnea, they can.

So, the lawyer refused to take my case. In the city that I live in, (a large city, not a town) there are only 5 medical insurance lawyers. 3 of them fight for the insurance companies, 2 of them are a father/son team that defends patients. This is for a city (and suburb area) of 3+ million people.
The patients almost never win, therefore lawyers won't touch these cases with a stick.

I now have health insurance from my work,(I had to stop being self-employed.) I pay $145 per month and it is worth every penny. This new insurance company REFUSED to pay for my yearly pap smear/breast exam, which irks the hell out of me. (The policy for this company is that preventative medicine is not covered. Period.) How stupid is that in the age where early detection is essential?
............................

My bankrupcty lawyers says there are no medical bankruptcies. (Even though more than 50% of bankruptcies are from medical expenses alone. All bankruptcies are legally considered the same, implying that you spent your money unwisely.)

I need to now make a list of all possesions, stock, money, cars and things that I own. Next I can choose which of these things I can save. Any stock/bonds other than things in an IRA (retirement) account will be seized when I file chapter 7. Any vehicles I have worth more than $4,000 will be seized when I file. (If my car is worth more than $4,000, I must pay my debtors the difference, should I want to keep my car.) I am allowed to keep $X amount in furniture, $X amount in clothing, and any uniforms/work related tools I am allowed to keep, if I am employed. I am allowed to keep X amount in jewelry, the rest can/will be siezed. I am very lucky not to own a house, and not to have car payments. If I had car payements, likely my car would just be seized.

Every time I start working on the list of my possesions I start crying. I don't know if things my grandma made me before she died will be taken. My college fund is going to be wiped out. Yes, the fund my father worked so hard for to build for me, since I was 1 years old. Gone. He is now a disabled veteran and cannot help me with my education anymore. I don't know if I can keep my computer, is it considered furniture? I don't know if my wages are going to be garnished.

Having health insurance from work means you cannot be dumped from your insurance company, like I was, because of a pre-existing condition. I cannot stress enough that everybody, even rich people, need health insurance from work (and make sure you can keep it if you quit/lose your job). If you came down with heart failure, lymphoma, lung cancer, was in a car accident and needed a liver transplant, things like this cost more than anybody except Bill Gates could afford.

Think my story can't happen to you? It is happening to millions of Americans, and people in Europe that I tell my tale to can't even fathom it. They have socialized medicine. We here in America need it, everybody gets sick, everybody should pay into a plan, like social security. We can't allow this crap to happen to people. I have been financially set back 10 years or more, I don't know how long it will take me to recover. Screw insurance companies, and the cold-hearted bastards that run them.
Get health insurance, and keep it. Then vote for change.

[snickel]

Hello Tsarevna,

I'm truly shocked, even if I knew before about the scams the insurance companies were pulling off (and they try their best to do it in Europe, too, I assure you) it's still different to read a detailed account.

I believe every word you wrote.

[AA0]

Everytime I hear a horrible story of insurance I am very glad I don't live in the US. The US healthcare system is in need of a major overhaul.

[MadDwarf]

the insurance industry is a joke in the US. its just a means for fat hairy old men to get richer while the middle class gets poorer.

I come from Canada and now live in the US and I will say this without a shadow of a doubt I regret it. I miss my public health system and even though it has flaws it works and its 10 times better than the system here in the US of A.

I always had to laugh everytime one of my Canadian friends used to ask how I was enjoying the low taxes here. They were of course always shocked when I told them I was paying the same amount as in Canada when you figured in the cost of health insurance in this country. No joke by the time I'm done paying all the extra crap each month I end up paying just as much as I did in Canada off my income. In Canada I had the bonus of just having the government take it off .

Your tale Tsarevna scares the crap out of me and for the first time I'm thinking about over riding my wife's objections and moving us all to Canada. I mean really can't you sue them or something and ask them to prove that you lied ?

[Tsarevna]

Your tale Tsarevna scares the crap out of me and for the first time I'm thinking about over riding my wife's objections and moving us all to Canada. I mean really can't you sue them or something and ask them to prove that you lied ?

I really wish the insurance company would charge with a crime. Because if they did, I would get a lawyer from the government for free, to defend me. But they havn't, they just said I commited "misrepresentation" on the questionaire. It's like a contractual violation, kind of like the situation that if you made a character in Horizons called ****tard or something else nasty, and Horizons banning you from playing the game. They would say you violated the Agreement meaning, the EULA.

I asked the lawyer if we could do just what you said, ask the insurance company to prove that I lied. I signed a contract that said "to the best of my knowledge, this is true." It looks like things are in my favor, right? The lawyers says "wrong!" The burden of proof lies with myself, for some messed-up reason. Legal precident (other cases similar to mine that have already been tried) means that I would have to prove that I was unaware of my own feelings of "being tired", which I obviously was not, being that I compained about them to the doctor. My claim that drugs made me tired, not something medically wrong with me, would have to be proven somehow. This cannot really be proven. We can't go back in a time machine and interview myself on the day I was tired.

Can it be proven that I actually took the free samples of medication? Not unless I have video footage of myself popping the pills. Did my doctor write down "I gave Tsarevna X amount of free sample pills today" in my medical records? No she did not. What's in the records is that I complained that I felt tired on day X. It is my misfortune that my doctor did not write down my explination of WHY. I complained that day I didnt want the allergy pills anymore, and that I was doing a huge amount of yard work. Well, my doctor didn't write that down either.

So it's my explination, my "hearsay" as they say in the legal world, vs medical records that techincally show fatigue was present, and the insurance questionaire that showed that I checked the box "no" with chronic fatigue.

It's really messed up, I have also heard that, if you have a procedure/surgery, insurance companies can call it "experimental" to avoid paying the bill. Even if something has been done for 30 years, they can call it that, then argue in court all-day-long in front of a judge, what exactly the word "experimental" means.

The fact that I was accused of a crime (but not formally charge) and punished for it (with a fine! I consider the $24,000 to be an unfair fine) just shows how messed up the healthcare system is. And the legal system.

I will also pay more in loans, because of my bankruptcy, possibly get turned down from higher-paying jobs, (because employers look at your credit score/record) and even pay more for my car insurance because those companies adjust rates based on credit score too. I can't file bankrupcty again for 8 years (chapter 7, anyway) after this, so, what happens if my new insurance refuses (to pay for) some surgery or procedure in the future and I need to declare again but cannot? I'm not trying to sound like a whiner, I'm just dismayed at all the implications this single event has on my life for at least 8 years into my future. I'm sure I'm not even aware of all the implications yet.

This is all for a simple, day-surgery. What would have happened to me if I was say, 65 years old and had part of my colon removed, or a double-bypass? I'm lucky that I'm young and I can rebuild.

Canada isn't such a bad idea, I've thought about moving there myself. Half of Americans are on anti-depressants are there because of stupid crap like this in life that shouldn't happen. People wonder why we are on drugs, it's cause we live in a madhouse.

(Did I mention that I applied for the "State X" Health Plan, but didn't qualify because I had "too many assets" to be considered poor? I made less than the yearly income for the poverty line, but, because I had a college fund, I was "too rich" to get state-sponsored healthcare. I had to spend my college fund first, get poor, then get treatment. It's sick.) After my bankruptcy, I might qualify for the Health Plan, but since I make just over the minimum wage, maybe not.

EDIT: By cashing out the stock I had in my college fund, to pay the rent, fix the car, eat food, buy prescription drugs (because I was too sick to work) Uncle Sam (the government) considered that income. INCOME! I had to pay taxes on this "income" and pay a tax agent to file my taxes for me. I had to pay this agent $200 because stock sale income requires expensive forms to file. This is sick, sick SICK!

[MadDwarf]

holy mother of god.

And to think ya'lls grand pappy dies on the beaches of Normandy to defend this ? We now send young people to Iraq to possibly die to defend this ?? When I read stories like this I think to myself is this all worth it ?

Your Story Tsarevna is a tragedy and a farce of the American way of life all at the same time. The procedure cost $24,000 ? That NOTHING to corporate america. Its bloody peanuts and this Insurance company made that back 10 million times already. So for them to pay that out is nothing, but to you it was everything. Corporate america and especially the health insurance system is corrupted and morally bankrupt. Mark my words it continues to to act this way there will be in this country an eventual reckoning for it all.

So sorry you are having to go through this all.

[snickel]

The way I understand it your case would have to have a special and decisive feature that none of the already tried court cases had... I am really angry at the first judge who ruled in favor of the insurance company.

But that doesn't help you in any way. Looking to the future and college -- any chance of a scholarship for you?

[Sigi]

Pure horror.
I really wish you the best of luck to overcome this. And I hope you'll find a way to get justice.
Good luck!

[walkerglassmire]

I'll leave out my horror story of a family friend dieing bcause of the insurance company (yes, they CAN get away with basically killing people) and ask a slightly off track question: You (Tsarevna) have used the term Chronic Fatigue many times here. The word Chronic is defined (loosely, don't have time to pull up a real def) as repeated. Aka, multiple times. Did you complain to your Dr. multiple times about "feeling tired"? If it was only once, it is HARDLY Chronic. Sounds like a technicality, but the legal system is BUILT on bloody technicalities. (Is working as a legal assistant these days <shudders>)

[MadDwarf]

I'm sure if a lawyer could be found that would take the case you would win if the system wasn't so against punishing big business. You would never get past a judge who could see the real issues at hand. That is an Insurance company lieing cheating and manipulating a situation so they do not have to pay out a measly $24G's. At the very least they could have paid for the procedure then dropped the person in question. That would have been the right the morally good thing to do. But since when does corporate america do anything that is good and morally ethical ?

[Chioxin]

Tsarevna...

*BIG draggie hug*

That's absolutely horrible, and scares the poo out of me! =( I really hope things turn up for you, that's just miserable.

Reading that makes me sick of insurance and all that crap. I hate middle men, and see them as "middlemen." I'm still new to all this stuff though and find it overwhelming that I need all sorts of coverage for everything under the blue moon.

Bleh, I don't know... When did life get so boggled and complex? =P

Again... *BIG squishy hug to Tsarevna* I hope things look up for you quickly! Hang in there.

[Tsarevna]

Thanks so much guys,
I cannot tell you how much your words of support mean to me. It's really hard to get past the stigma of the "irrisponsible credit-card user" who gets him/herself into trouble (with debt.) I paid off my credit card right after my surgery (lol)

I've started listening to the Dave Ramsey show, he's a financial advisor on the radio, and has a book out about how to get out of debt and build wealth. (Google him, if you don't know who he is, he's cool. You can listen to him online.) Even he says on the radio something like "Just face it, you are in debt because of your own actions, own up to it!"
I just want to scream at the radio "NOOO! I didn't do anything wrong!"
And to make matters worse, I even heard him recommend the same company that screwed me over as a "good" health insurance company. I think I'm going to write him a letter. But seriously, I love the guy, he just needs to be informed.

PS: I'm scared to put the name of the company on a public forum, I'd probably get sued for slander. But if anybody wants to know who it is, give me a private message and I'll spill the beans.

About college, I did not perform well in high school, so I will have to start in Community and work my way back up, maybe a transfer degree. I might be poor enough to get grants now, and untill my birthday next year I "should" be able to get some VA assistance (from my Dad's disability). The bad news is, it ends on my birthday next year (it's a time restricted benefit) so I need to make an appeal to extend it. The thing that worries me, is if I am not a 40-hour-per-week worker, I lose health insurance coverage from my work. This prospect makes me want to faint, so, with working full-time, maybe I'd take 1 or 2 classes (at a time). I'll figure it out somehow.


About the fatigue,
I know I wasn't diagnosed with chronic fatigue, because my doctor doesn't believe the condition even exists! She thinks it's either an un-discovered *new* disease (like Lyme disease before it was discovered) or a symptom of environmental toxicity or allergy. Or just one of the side-effects of being depressed.
I wrote down, on my insurance application, that I had depression for a number of years, (I was bullied in Jr. High School and had a not-so-nice stepfather) then I pulled out of depression once I graduated, then went back into it when some family members died. Then I pulled out of it again after time passed, and my mom divorced the evil-dude. So I let them know of my history of that, but I guess my fatal mistake is not saying (on the app.) that depression caused my fatigue. But, I thought it was self-explanitory, because, who the heck has ever seen somebody spunky when they are depressed?

**My advice would be, if anybody has to fill out one of these apps, it to say "In the past, I had health problem X, which caused _________,_______,_______, "and, in those blank spots, enter anything you can think of. Such as, if you have an allergy to beestings, tell them that you have life-threatening throat swelling, itchiness, vomiting, nausea, fatigue, blurred vision or whatever happens to you when you get stung. Cause, if you don't list this all the SYMPTOMS, later the insurance company can nail you for not telling them the symptoms, even if you have already told them about the actual CAUSE of the symptoms. If you needed to have your foot amputated from a car crash, the insurance company might look back at your records and then say "Oh, you didnt tell us about your blurred vision, we never should have issued you insurance in the first place." No joke.
Also, if you can't remember all the things you complained about in the past 5 years, get a copy of your own health record from your doctor, it will probably cost you $25, and list all the stuff there, or just staple it to your application and write on it "I don't feel comfortable filling out forms, take a look at my records and decide for yourself."

Anyways, I stay positive cause I know things could be a lot worse. I fear that our troops coming home without limbs are going to get screwed over in ways I can't even imagine, and this just makes me sick.

walkerglassmire, i'd like to hear your story if you have the time. If you don't want it to be public, message me if you want, im a good listener.

[walkerglassmire]

Not a whole lot to tell. I was young at the time, so my ma tells the story better. First off, I WILL say who it was. And I don't really care if they sue me. Mayhaps it will get the word out about their practices.

Family friend had Kaiser insurance. Big company. Facilities all over the place. Went in complaining of general problems. They sent him away. This became worse and worse till, a little over a year later, he went in with <not sure good word, so I'll use Back Door PM if you need a translation> bleeding. To "get rid" of him, their words, not mine, they sent him to a proctologist specalist that was in the same building, and always had been. The Proc told him withing 30 seconds of seeing him that, you SHOULD NOT be here. You should have NEVER ben here, you should have had a Lower GI MONTHS ago, and at this point the test will probably KILL you. So, he went to the Oncologist, got the Lower GI, and sure enough, he had Colon Cancer, it was VERY advanced, and he was dead about 2 months later.

Had ANYONE there taken a look at him to begin with, the Oncolo told him that it was treatable and most likely surviveable had he NOT BEEN IGNORED. So, because Kiser's policy is to get rid of people and not send them to specalists, he died.

And, to this story, I'll tack on an addon, that anyone in Colorado (where I'm at) probably heard about. About 6 months ago now, a mddle aged man, suffering from a heart atack was NOT ALLOWED to ENTER a Kiser facility because he was not properly insured. His daughter, frantic, went in and dragged a nurse out to get him. The nurse looked out, and told her to call an ambulance, as there was nothing they could do. They then called Security to prevent them from taking him inside, leaveing him dieing on the sidewalk out front. The facility had a basic trauma unit inside, and there were nurses and Drs that could have helped him inside.

The ambulance finally showed up about HALF an HOUR later, loaded him up, and took him to the hospital. On the way, they, in about 5 minutes, were able to give him the proper treatment to keep him alive. After a friggin HALF AN HOUR of dieing in a friggin SIDEWALK.

So, I put it to you all. Kieser is a money grubbing star child of the WORST possiable from Big Business and why it should NOT be in control of our health care and by extension, our VERY LIVES!!!

Sorry for the rant, I return you to your regularly scheduled thread, and I am TRULY sorry about your plight Tsarevna. If there was anything I could actually do other than offer an electronic shoulder, I would.

Walker out.

[Tsarevna]

Ughf im so sorry glass. One of my best friends just died of lung cancer 1 year ago (almost to the day.) She had back pain, and the docs didn't want to find out what was wrong, just said "probably a pinched nerve" and put her on heavy opioid drugs. She was drugged so often that she didn't notice the burning sensation in her lungs when she breathed. It was only one day when she forgot to take her opiates that she noticed that pain. She had a chest x-ray (maybe other scans, I don't know) and the pulminologist told her she had pneumonia again, and gave her antibiotics. ANTIBIOTICS!
She took those for a week or two and started to really, really have pain in the lungs, unbearable pain. It was then she went back to another doctor (a cardiologist I think) who took x-rays again and was shocked. It was clear she had lung cancer. She was a pack-a-day smoker for 60 years so it was hardly something out-of-the-blue.
Every other doctor the cardiologist showed the x-ray to said diagnosed caner immediately, and they were all shocked that the pulminologist couldn't recognize it. There was talk floating around about how he should lose his medical liscense but I think nothing came of it.

She died 2 months after that X-ray, she tried chemo but everybody knew it wouldn't work. About 1 month after her death a bunch of news articles came out on CNN, etc, about how "lower back pain" is the FIRST symptom of lung cancer and it should never, ever be ignored. Her medical "care" came from Kaiser, in Vancouver, Washington.