Healthcare Vent

[cristina1]

When did our healthcare get so frigged up that doctors don't even know what plan they participate in? We spent almost four hours this morning trying to find a doctor in our plan and kept getting different answers between the insurance company and the doctors' billing offices. UGH!!

No one seems to know what they are doing anymore. There are too many damn providers now, and no one can keep anything straight. It should not be this hard!

And, after all of that, neither one of the two pediatricians in town who accept our plan (there is over two pages of peds in the phone book) have any appointments earlier than Monday. Monday?! My kid is home sick today with a suspected ear infection. He can't wait until Monday!

I was always against National Healthcare, but have slowly been realizing that our system is getting more and more screwed up. There are just too many insurance companies now with too many forms of billing and the doctors just can't keep up. I've never seen such a bunch of clueless people in my life! UGH!!

Why did our healthcare change? My husband's company got bought out for the third time in the five years he has worked there. Another merger means another insurance plan to deal with.

[cristina1]

Oh, to wrap up my son's ear infection - now I am forced to go out of network. At least he hit his high deductible when he broke his ankle, so I'll only have to foot the bill for 40% instead of the whole thing.

[theworm[$]]

do you have urgent care clinics? Sometimes the insurance will cover that if you can't see your doc.

[cristina1]

That's where I'm going with him this evening, but they go according to the "Out of network" plan, which only covers 60% after deductible has been filled.

[mjfrombuffalo[$]]

I was going to suggest the urgent care clinic or the ER of a participating hospital.

[hadassahchana[$]]

Cristina, please, keep on being against nationalized medecine. Even though you have to pay, at least you can get decent care. I haven't had a family doctor in Canada since #4 was 1. He's 9 now. We have free healthcare, but it isn't even worth that. When I was in my accident and lost the ability to speak, tie my shoes and various other things, that was in September. I finally got a referral to a neurologist- for March the following year.

Currently, I pay approx. $900/month for a U.S. HMO which covers all of us. I don't feel that I have a choice. Nationalized medecine only ensures that everyone gets the same crappy healthcare.

Oh, and I am really sorry for all of the confusion with your insurance. That would frustrate me a lot. I hope he feels better soon.

[cristina1]

But, isn't it ridiculous to spend three hours to find a provider? When no one even knows if they participate in a particular plan it's crazy. I've found it easier to just not go to the doctor, and I've put off my own medical needs because of this crazy stupid plan we are stuck with.

[cristina1]

hadassahchana said

Cristina, please, keep on being against nationalized medecine. Even though you have to pay, at least you can get decent care. I haven't had a family doctor in Canada since #4 was 1. He's 9 now. We have free healthcare, but it isn't even worth that. When I was in my accident and lost the ability to speak, tie my shoes and various other things, that was in September. I finally got a referral to a neurologist- for March the following year.

Currently, I pay approx. $900/month for a U.S. HMO which covers all of us. I don't feel that I have a choice. Nationalized medecine only ensures that everyone gets the same crappy healthcare.

Oh, and I am really sorry for all of the confusion with your insurance. That would frustrate me a lot. I hope he feels better soon.

That's what I've always heard and was always the reason why I've been against it. (Plus my experiences with the military healthcare system, which was incompetent to say the least.) I'm just sick of the doctor bills, the rejected claims, the unanswered questions (unanswered because no one knows the answer.) Throw in the fact that a covered GYN is alost an hour away, and it's just really sad. Our last plan rocked. Too bad they took it away from us.

We can buy a plan locally for $1100 a month. We can't afford to pay that much each month. The system here needs a complete overhaul because I can see it breaking.

[jgibson2[$]]

Tina,
I ran into something similar when we went to Florida on vacation in January. I was amazed at how few providers took our insurance. After making many phone calls, I called the insurance company to ask if there was an urgent care clinic in the area that took our insurance.

The other thing to find out is whether one of your local hospitals has an urgent care clinic. They're often located in the ER, but billed like an urgent care clinic, so the cost is MUCH lower. Several local hospitals here do that. Good thing too, since the nearest urgent car clinic was decorated with latex balloons the last time I tried to go there.

[emeleel]

Wow, I feel so lucky. I have Blue Cross/Blue Shield and they are awesome - tons of doctors accept them, and I never have problems with them. It's not cheap, but it's not terribly expensive, either.

Hope your guy is feeling better really soon - and your pocketbook, too!

[pippadaisy[$]]

I totally agree. It sucks. We finally got one that I don't need to go to a doctor BEFORE I go to a doctor. No more referrals. w00t!

But what Cindy said about national healthcare. I always feel terrible for the Canadian moms on my breastfeeding list. They can't get to pediatric GIs for ANYTHING, and if they are dealing with something major like EE, forget it. They are sunk.

[frazzledspice]

I feel your pain.

And I am just so glad that Sooner managed to survive in his job after three mergers in five years. There must be an angel looking out for you guys.....

We've had the same medical plan, but the doctor groups in town have biannual revolts and try to hold up the insurance company they're with for higher reimbursements. The insurance company stands firm. They go to the other big insurance company. The doctors that are with that insurance company go to the first insurance company. (If the insurance companies had just chosen to negotiate with their respective doctors, it would be better.)

Consequently, we have to change doctors every two years because they get angry at their insurance companies.

And our own doctors don't do hospital visits anymore. They pay someone who works at the hospital to visit their patients and report to them.

The good old family doctor concept is dead, whether there's socialized medicine or not. The only difference is that it's more expensive, inconvenient, and anxiety-provoking if there isn't socialized medicine.

My daughter went to the emergency room once in November. We are still trying to figure out what we owe....

She had an ovarian cyst. There was one bill for the emergency room.

One bill from the doctor who worked in the emergency room.

One bill from the ultrasound lab.

One bill from the doctor who performed the ultrasound at the ultrasound lab.

One bill from the doctor who read the results of the ultrasound performed at the ultrasound lab.....

We are still waiting for bills from the delivery man who delivered the ultrasound film to the doctor who read it. I mean, with all this bill-padding going on, shouldn't the delivery boy get a little bit, too?

The insurance company has been dragging its heels, asking questions they already have the answers to and saying they'll decide in a month. I would say we've probably paid about $450 of our own money already....

Truthfully, I thought she had appendicitis, but I would think long and hard before I ever went to the ER in the middle of the night again, to get very little concrete care (1 Darvocet pill and a referral to a gynecologist) and a whole long breadline of people with their hands out...

[pippadaisy[$]]

Frazz,

Honestly, it isn't doctors in a snit. I'm sure that MNM and Judy (and a few others) can give you better info, but from friends in the medical profession, it's a nightmare.

The HMOs want higher profit margins. They hold the doctors to substandard reimbursements when meanwhile the price of malpractice insurance keeps going up and up and up. I had a psychiatrist who quit taking insurance because the HMO felt that everyone should be cured in 7 visits or less. Forget about anyone with chronic problems.

The problems with healthcare aren't the doctors, but the pharma companies and the insurance companies. Why on EARTH does my healthcare premium have a double-digit percentage increase every year, yet they have millions to build a brand-new office building DOWNTOWN and put their name on an arena?

We grew up with the idea that being a doctor was like buying a cash cow. It's no longer the case, and while yes, there are some who shouldn't be practicing, the laws are in favor of everyone BUT the doctors now. I was FLOORED when my gf told me that she (a nurse) and her husband (a doctor) are legally required to stop and help at the scene of an accident, but not immune from any lawsuits that might result. It's a corporate-driven world, and apparently, while the corporations need lawyers, they don't feel they need doctors.

[pippadaisy[$]]

Oh yeah... and I go to the ER as a VERY last resort. They are overcrowded because there are so many people who have no health insurance, and therefore have no doctor, so use the ER as a regular clinic. It's a mess.

[cristina1]

Our hospital is putting in an urgent care clinic. They have really expanded the hospital over the last few years and are just finishing up a major addition.

Everyone hates the current system - at least those I spoke to (and Sooner did ) today. It's confusing with so many insurance companies and each one having different claim procedures.

I don't know what the answer is, but I do know that our system is failing us. When it's easier to NOT use your insurance than use it, there is a major problem.

I took him to an urgent care clinic tonight. He has a double ear infection. Poor kid - broken ankle, double ear infection, hacking and wheezing and we are supposed to be going to NYC on Saturday on a charter bus trip. I have a feeling he isn't going to make it. Poor kid.

Frazz - Sooner was lucky. His coworker (and good friend) was laid off and has not been able to find a whole lot in the field. He's been working odd jobs trying to get something permanent - anything at this point.

My neighbor just had a baby in January. She got charged a co-pay for everything from the pediatrician, the OB/GYN, the anesthesiologist, the hospital, etc. Add in her deductibles, and she was stuck with some high bills.

[jgibson2[$]]

The dermatologist I go to takes about a half dozen health insurance plans and medicare. He takes NO HMO's because the reimbursement sucks and the only way he could afford what they offered him was to turn his office into a factory. I can get an appointment in 2 weeks, I don't need a referral, and he can spend the time with me that he thinks is appropriate.

I have BC/BS and I had one heck of a time finding a doc in Orlando who could see me on short notice. OTOH, there are so many tourists there that they don't have to take ANYBODY's health insurance. I could have had a physician make a house call for about $140 and try to get reimbursed. I'd have gotten maybe half of that back. I had to drive an hour to get to an urgent care place that took walk-ins and my insurance. I don't know what the locals do.

[frazzledspice]

pippadaisy said

The problems with healthcare aren't the doctors, but the pharma companies and the insurance companies. Why on EARTH does my healthcare premium have a double-digit percentage increase every year, yet they have millions to build a brand-new office building DOWNTOWN and put their name on an arena?

In the dispute between the doctors and the insurance companies, I agreed that the insurance companies were being unreasonable...but it doesn't make it any easier that we have to keep changing doctors because the doctors keep switching back and forth from United Healthcare to Blue Cross.

We have gotten our first taste of "socialized medicine." My hubby had gotten approved for a service-connected disability with the VA (his defensive tactic in case his latest corporate takeover went sour on us.) He decided to try the VA doctor to get his prescriptions rewritten for free.

He got an appointment within a week at a VA Health Clinic a few miles away. He was taken in promptly. The doctor rewrote his 5 prescriptions--3 for the same medicine, 2 for slightly different ones on their formulary. He received the meds for free within 4 days, by mail. (Under our co-pays, we probably pay about $100 a month for the same meds.)

He mentioned he hadn't had a colonoscopy for five years (his mother and grandmother both died of colon cancer.) VA doctor gave him a stool sample kit and told him they would do a colonoscopy if the sample was suspicious.

When he was being evaluated for the SCD (for diabetes) they took an X-ray of his heart (this had never been done since his angioplasty nine years ago) and gave him a stress test.

So far he has been pretty satisfied with the care and the lack of red tape, although he is still covered under his company plan, and probably will be unless the merger goes sour.

True the VA has priority levels from 1 to 8, and his is a 3, and that probably helps him, but from what we've seen so far, and from what we've heard from people we know, they have a pretty good program and the patients are satisfied.