I really hope I die by accident...

[Jag]

It's that time of year again... signing up for benefits for next year. I usually just get a small 'sticker shock' and then go on with it. However... (here comes my rant)....

Due to the general population's lack of knowledge about how healthcare is paid (and WHO pays for WHAT) the insurance companies have seized this opprotunity like a starved dog on a T-bone (or a parrot with a foot, toy, perch.. you get the idea) and the health care facilities have too. Being that I work for said health care facility AND I have insurance, I'm taking it twice. They're changing our short term disability to pay less and to hold off paying longer. This will end up effecting me shortly, as I've already been off once on short term with this employer. Our COLA raise is gone, as well as our performance raise. Education is no longer paid for. (We HAVE to do education as part of our job, too!) They didn't raise our premiums (unless you're a smoker.. nailed me AGAIN!) However, they started a deductable which is going to kill me. My lab work and testing won't be paid for until the deductible is met (I have labs at least every couple of months, and at least one MAJOR test a year.. usually several). The ER and Urgent Care is no longer a copay.. it's going into a deductable (YEP, you have to pay it ALL until your deductable is met!) and I've been visiting both way too often in the last few years. So unless I am a direct admit into the hospital, the ER bill will be all mine before I get into an actual bed. Being that my heart is failing... I WILL be in the ER/hospital again in the next six months. *Sigh*

I also have a kid who needs braces, I need glasses, and a bunch of other expenses. So, I decided to bite the bullet and put money into the flexible spending account for healthcare. It's supposed to save money by taking money out pre-tax to put in an account to reimburse you for medical costs... and dental and vision costs. There are only two good things about it... 1) You save a little money on taxes since your taxable income goes down by whatever you put in there each payday, and 2) you can use the money you've chosen to put in right away. So if I want to go out and get the braces, glasses, and dental work the third week in January then I can get all that money reimbursed at that time. I don't have to wait until it's actually in the account from my paychecks.

It's not just the 'economy' that's doing this (don't buy into the hype you'll hear about that), it's the paranoia that's driving it. When you have a general population that doesn't know what the truth is, a couple little rumors can start a state of panic like you've never seen. "Corporate America" LOVES it when people panic. Why? That is the time when everyone is so busy freaking out and starting more rumors to feed the fire that it's a great time for jacking up prices then blaming whatever the people are saying is the culprit for it. No one actually looks for a reason for why things are going the way they are... they just listen to what the newspapers or Joe-blow down the street is saying and continue to repeat. Truth is, the insurance companies are scared to death of losing the millions in profit they make every week by changes to the health care system. So they jack up their prices and blame the economy. They also slip the word out that prices for private insurance will go up if any of these changes are made. Meanwhile, they're already finding ways to jack up the costs of benefits so that helps to have people saying "OMG... it's TRUE! It's making the costs go up!" and they don't even realize that NOTHING has happened yet.. it's still talk up on the hill... but they just got bushwhacked. The hope is that with all the fear and jacking up prices, they can squash any chance of change in the healthcare system. That means they can keep on reaping in the dough (more now.. because they've already raised prices), and they can stop any loss before it starts. The hospitals get to cry 'poor' because of all of the uninsured... and what a strain that's creating on their revenue. That's a crock. I can't tell you how much money is WASTED by people being sent into the ICU who do not need to be there. The hospital I work in now has docs that not only refuse to come into the hospital 'after hours' no matter what... but they don't want to be CALLED (even though they're on call!) so they put everyone who has the most remote chance of triggering a phone call to them in the ICU. Why? Cause they know we won't call them! It just burns me up. If you knew how much money it was costing everyone everytime this happens, you'd be mad, too!!

It also ticks me off when you have the AARP being SO irresponsible by churning things up with talk about 'death panels' to kill off grandma because she's too old and not worth spending money on... so we're going to hold meetings and we will decide when to 'pull the plug' on her! Again... pure non-sense! It's illegal (first and foremost) and if it wasn't, we ALL take oaths and have licenses, etc. Who on earth really thinks we're going to decide that we're going to kill people?? Insurance always has had and always will have things that they 'don't cover'. That's not going to change unless there is a major overhaul. Yes, there IS a time when some treatments and interventions are futile... even cruel. There's more education needed so that people can make more informed decisions about what they want and expect from healthcare. I get tired of seeing 95 year olds who are deaf, blind, have had no idea who they are or where they are for the last 15 years and a TON of health problems... and then we've got them on 'life support' knowing there is NO WAY they are going to take another breath on their own, but the family saw a Lifetime movie where someone made a 'miracle' recovery and if they pray hard enough they KNOW she will 'come back to them'. HUH?? (I also don't get why if Heaven's such a great place how come everyone's trying to avoid going there to 'meet the maker' that they seem to want to do on Sundays?) Do we still do all of this 'life sustaining' stuff? Yes, we do. That won't change. However, we DO also cuss them out everytime we have to suction her, turn her bony fragile hurting body, and want to rip their eyes out for putting her through this when nature is just trying to take its course... it's NEVER about money. However... since this all started you should just see the looks we get when trying to discuss 'end of life' options!! They look at us like we're wanting to shoot them in the head to turn a buck!! It's turning what we do for compassion's sake into a sham. All because the insurance companies don't want to lose some money.

Why do I want to die in an accident? Cause the other change I made was to add accidental death and dismemberment to my coverage. So if I die in an accident, not only does my wife get my life insurance, she'll also get the additional money from this policy. If she's lucky... there may be enough to turn me into charcoal after paying the medical bills

[Jag]

BTW.. just wanted to add...when we have a very elderly/very chronically ill person who we 'know' is going to code on us, we DO have conversations about how we *don't* want to break all their ribs doing chest compressions (yes, that happens frequently) and we don't want to hit that button to send 300 jules of electricity through their skin and chest wall for what is going to be a bad outcome. Dispite what you see on TV, most codes don't end well. They usually go on for quite some time, and even if they do manage to come out of it with a heartbeat, their brain is usually permenantly damaged from lack of oxygen even though we are doing compressions, etc. Real life is not what you see on TV. This is why the 'end of life' discussions come up. Nurses don't give a single thought to how much grandma is costing... we're thinking about how cruel it would be to do what we're going to end up doing before the shift is over. Some nurses have lately taken to calling the family in to sit in the room as we're running a code... so they can see that it's just not what they thought, and it's brutal to say the least on the patient. When there's no good to come of it...that's when we have an issue. No one wants to lose a patient... but there are times when we know it's for the best. I don't know if it's that part of the education gets through, or what.. but we have a lot of people who think that some divine intervention is going to happen to undo things that happened long before they came to us. It isn't. If we didn't care, we'd just do all of that without trying to get the true picture through.

[sailorkelly]

I understand. I am so happy my husband is in the military... I would hate to pay for all my doctors stuff

[RockysMom]

I work for Anthem and don't want to start a war, but everyone is so quick to blame the insurance companies and it's not all there fault. I work on the side of the business where I deal with employer based insurance policies and the number one reason why your employer adds deductibles and all that to your plans is, because they can't afford to pay for everything anymore. Jag you might remember this when Norton dropped from our network claiming we didn't want to give them a new contract. Well it was in the news, but those jerks wanted like an 80% hike in there reimbursement rate, which was insane, so we said no, what would have happened is, because at that point they would have became the highest paid hospital network in the area, everyone else would have demended it to! We couldn't do that, because that would have created more cost for our companies to pay and they would have passed the increase down to there employers and we could have lost business. Yes we didn't think about our own company, but we also didn't want to screw over our groups that would have been affected by it, mainly for me Toyota members would have been hit hard. Instead of pointing the finger at the insurance companies why don't we look at the doctors and hospitals and they money they charge for stuff. My dad had knee surgery about 3 years ago and afterwards got one of those cryo cuff things and the hospital charged almost 800 bucks for that stupid thing, are you kidding me 800.00, that is insane or how about 300.00 for a stupid xray of the foot, now if that is not a rip off I don't know what is! The insurance companies are not to blame for everything. I talk to so many doctor offices and hospitals that will wine and complain, because we didn't pay a whole 10.00 bucks, no joke. I understand how you feel medical costs are really high, I just went from a plan with no deductible this year to one next year with a 750.00 deductible. I am not saying that the system doesn't need to be fixed, but it's going to take a lot more then the insurance companies to solve this problem. One thing I agree with is people need to become more educated about there healthcare plans, I get so many people on the phone that are pissed, because they have to pay so much, but yet will tell me that didn't realize what plan they chose! Pay attention and read, if you don't understand ask someone, call your insurance company! I am more then happy to spend an hour on the phone explaining how your policy works, especially right now since open enrollment I take every single moment I get to explain to people. I get the vibe that Americans want everything handed to them and want everything done for them. I can't tell you how many people tell me well it's your job to do this and your job to do that! It's not my job to do everything for you, like the time a lady called and wanted me to call over 200 doctors to see which ones were in or out of network and was pissed when I told her that was something she would have to do, she was like but isn't that your job and I clearly told her no, that is not what my job is. I love this country I really do, but Americans need to wake up and start taking responsibility for there own stuff inculding healthcare, I agree something needs to be done, but on all side, not just on the insurance companies!!!

Sorry I think this turned into more of a rant about my job then anything, but I hear some outstanding things on the phone and really hate to be yelled at every single day!

[Rahni]

Wow, being in America and getting sick sucks. In the rest of the developed world healthcare is pretty much free!

[chinniechantel]

The US is a nightmare with insurance. I recently had Melanoma, and have seen lots of doctors. The insurance hoopla is just ridiculous, so much so I don't know how people deal with it. I spend at least 2 hours a day calling them to pay for claims, making sure they received my claims, etc. I have full medical coverage, 2k deductible, and still pay over $300 a month in medication, $200 in visit co-pays, and end up paying for about 4 tests a year that my insurance does not pay, I say does not pay because these are things they should pay for, but for some reason have not. For my surgery, the facility itself was not covered, the doctors and everything were, the facility ended up not being. We were pre-approved of course, and they assured us that everything was covered. But, you do sign that paper before surgery that says if for some reason your insurance does not pay, you are help liable. Then one doc sent my labs to the wrong lab, which was not covered, that cost me another 2k. With all I have paid in just medical billing and insurance mistakes this year I could buy a hyacinth!

[Jag]

Rockysmom,

I know, I worked for United Healthcare also for over a year as a case manager. I'm aware it's the hospitals, too. I said that... that I'm getting it twice because I work for the hospitals... The docs themselves aren't any better, either! The people who work on the levels that you do and I did have nothing to do with what the 'corporate' levels of insurance does. Private insurance follows Medicare guidelines. Whatever Medicare does, they follow suit soon after. Please re-read what I posted, you'll see reference to the hospitals as well....yes, I do remember the issue with Norton... :( My deductable is now $2000 for using the facilities in Dayton (all my docs are in Cinci) and $4000 for using facilities in Cinci or elsewhere.. even though they are in network! When I was in the hospital for my back surgery it was almost $100,000! I read the itemized bill... it was incredible what they were charging for stuff!!! Even the other stay in August when I had pericarditis... it was rediculous!! I'd much rather have a $750 deductable...

[Jag]

Originally Posted by chinniechantel

The US is a nightmare with insurance. I recently had Melanoma, and have seen lots of doctors. The insurance hoopla is just ridiculous, so much so I don't know how people deal with it. I spend at least 2 hours a day calling them to pay for claims, making sure they received my claims, etc. I have full medical coverage, 2k deductible, and still pay over $300 a month in medication, $200 in visit co-pays, and end up paying for about 4 tests a year that my insurance does not pay, I say does not pay because these are things they should pay for, but for some reason have not. For my surgery, the facility itself was not covered, the doctors and everything were, the facility ended up not being. We were pre-approved of course, and they assured us that everything was covered. But, you do sign that paper before surgery that says if for some reason your insurance does not pay, you are help liable. Then one doc sent my labs to the wrong lab, which was not covered, that cost me another 2k. With all I have paid in just medical billing and insurance mistakes this year I could buy a hyacinth!

Ah, yeah... and the facilites don't tell you that they're not in network. This is something that needs to be addressed! My doc also sent my labs to a place that wasn't covered. I got a bill for nearly $1000!!! You pay what I pay a month for medications! I've called docs back and asked if there isn't a cheaper alternative... I've also refused to come into the office to get test results because they will charge me a copay. I call and get the results myself from the place. I have to now go back to the orthopod, because there was something on the tests... but at least I know before I pay out the money! When I had my back surgery, the surgeon used some kind of bone regrowth paste that the insurance didn't cover and a hinge that they wouldn't cover because he said I really needed it with what he suspected was an autoimmune condition (he was right). He didn't charge me for it, either. I guess he did one thing ethical... even if the rest of his behavior wasn't!

[RockysMom]

One thing I hear a lot of is if someone is in a particular hospital then they assume the doctors are in network, or the other way around. An that we know is not always the case, but that is something the majority of people don't think about, but if you don't or have never worked in the health insurance industry or healthcare system period you would not know that. I think it should change though so that if your in the hospital any doc you see there is also in network, they way they do it now just seems like another way to make more money from people, because what we will do is at least with the employers I handle is if you go to an in network hospital we pay everyone at the in network benefit level even if they are not, because we know most people don't check or even have time to think about that kind of thing if it is an emergency situation. The bad thing is those docs that are truely out of network can still bill you for the difference between what they billed us and what the contracted or allowed amount is on the claim, that's where people get screwed over to and it needs to stop! Also lets please get rid of pre existing conditions!!!!

[Kevin]

Originally Posted by Rahni

Wow, being in America and getting sick sucks. In the rest of the developed world healthcare is pretty much free!

If this thread takes a turns into a political stew of sorts it will be closed.


"Nothing is FREE" Its paid for one way or another.