The Hospital/Insurance Run Around

[RJSquirrel]

I dont have any flowers to post, But have a need to Rant for my freinds here

I have decided to quit smoking this month for my 53rd birthday. Its my gift to me since no one else can afford my wishes any longer. BOY did this start a world of pain and aggravation. All I wanted to do is quit smoking so I can afford my new abode, save my lungs and about 400 bucks a month.

Doc orders CT scans, Cardiac Stress Test, Bloodwork from the Lab, X rays of my backside, Colonoscopy, Sleep study program bec I cant get but 2 hours sleep a day. I have never had any of these done and am told Oh you need to go get all that checked. No I dont. I cant afford healthcare even with insurance. Really ticked me off that they wouldnt even cover the prescription for the Zyban. You would think they would have covered this. Not.

I have never used my insurance at work but heard rumours of how crappy it is. I know how crappy it is now. All the above when done, and most of it wont be done is around 7500 bucks. BEC thats the maximum out of pocket expense after I have covered my 1500 dollar deductible. I know medical care is expensive now. 9000 dollars and there isnt anything wrong with me , they just want to look..YEAH Right go look somewhere else. I dont need nor want anyone probing my anus bec their curious.

So Im going to call the Doc up tomorrow and explain all this to him now. I can pay the co pays for the lab work for the blood but I just dont have 1500 dollars to cover deductibles and 5000 more to cover co pays for very expensive procedures and I feel fine. I can only guess what they had ordered If I had been feeling bad.

Anyway I know some of you have been thru this and didnt have a choise of whether or not you could pay bec you had to have it done. My sympathy for all of you who have these in your future.

Cause of Death on my toe tag shall read "Unable to pay Deductible"

[Eyebabe]

RJ...I'm gonna rant back at you to give you your doctor's perspective.

At 53 years old, there are many preventative medical things you should have done period.
Some of it has nothing to do with smoking.
For your doctor to order all those tests, there is more going on with your health that you care to recognize.

And I will tell you time and time again doctors will lose malpractice cases when they forgo a test that would have diagnosed your lung cancer or pancreas cancer or heart disease from years of smoking.
Bec if they wait until when you actually have more symptoms and then you are told you have three months to live...you will sue for delay of diagnosis and win.

If you knew your health insurance was "crappy" with large out of pocket expenses, you should have budgeted over the past several years for such an expense. But people don't do this because their health care is not worth it until they need it. They would rather have a large screen TV, go on a nice vacation, or hit the casino.
I watch my family do it to their doctors. I watch some of my patients do it to me.

Certainly there are those poor folks who are so terribly squeezed, many of them, and they need help; it's a difficult predicament.

I would recommend you begin to save as a catastrophic medical issue could wipe you out financially and you wouldn't have a choice like you do now.

Insurance companies make profits. They charge their customers lots of money and pay their providers as little as possible. They are the middle man that has all the control, makes all the rules, and keeps the big money. Obamacare gives them cart-blanche to an even greater extent.

As a physician, we are very sympathetic to the patients' stress over medical bills. But just like rent, food, and other things in life, you must budget for it.
I'm sure your doctor can run these necessary tests in stages, prioritizing them so to speak, and that will ease the financial pain. We are partners with patients; we advocate for you; we want what is best for you and we will work with you....but you have to work with us.

Peace out <3

[Ray]

I'll through a small assortment of pocket change into this, this time coming from someone with a lot of medical personnel in the family, as well as the unfortunate first-hand experience as a patient.

1) Face it: The insurance industry runs the medical world. Physicians and therapists are all required to "get permission" to do almost anything. It's totally ridiculous. However, knowing that, and letting my doctors know I know that, we can work together to make it easier on both of us, by being mindful of where tests and treatments are done, minimizing my outlay.

2) Given the choice, I have ALWAYS opted for the best coverage I can get, despite the added costs. When I was first given the chance to get supplemental coverage (Aflac-type), I jumped right on it. Yeah, I have paid-in several thousand dollars more over the last 30 years, but when I got a cancer diagnosis a few years ago, that investment paid off in spades. With about $220,000 dollars in total medical and surgical expenses, my share was about $250.

[Junebug]

I feel your pain RJ. I've had it with insurance companies...let me vent.

Hubby and I are small business owners and our GL insurance was eating us alive. In 2008 we employed 28 commercial cabinet installers and we primarily dealt with new school constructions. Our insurance rates were based on the number of employees, plus we were paying an outrageous monthly rate for our own catastophic health insurance with a $4,000 deductible. That health policy was useless for ordinary health care, but we paid it because we weren't getting any younger. You know what I mean. Anyway, after the stock market did the "big" drop so did our work load. Our business was forced to downsize to a handful of 6 installers, but that made no difference to the insurance provider because they're allowed to set their rates based on the head count of the previous years employmees. Liability insurance is mandatory and that's o.k., but don't charge us for 28 when there's only 6. But no, commercial nsurance providers can get away with this and when they did we had to drop our health coverage because that was a luxury we could no longer afford.

A few months before we dropped it, my husband started having health issues, specifically light headedness. I noticed a correlation between the onset of his symtoms and what he'd eaten. He consumes soft drinks all day and his symptoms would flare up after eating something sugary for breakfast. Add to that his family history of Type 2 diabetes. Simple fact is, hubby is into junk food and he won't change his ways. So we go to the doctor and the doc get his family history does fasting blood work, an EKG, BP check, and a test for blood circulation in his lower extremities. The test results were normal, well almost normal. One point higher and his fasting blood sugar would have been in the abnormal range. So I'm thinking they'll order a glucose tolerance test, but no, instead they ordered a crapload of expensive tests that had nothing to do with his symptoms, family history or blood work results. The insurance company declined coverage because the diagnosis code did not indicate he needed those tests. To make a long story short, he didn't get the tests done because he couldn't afford to. The doctor seemed unconcerned and that was that. The insurance company would have probably covered further tests to rule out diabetes but the doc didn't order them and those tests are much cheaper... that wouldn't have cost them anything.

Our backs were against the wall. Hubby was scared, thinking he was going to drop over dead at any moment. Still convinced his symptoms were related to sugar, I suggested that he lower his consumption of soft drinks, take his vitamins, and stop eating honey buns for breakfast. Hubby followed my Rx and his symptoms vanished. The only time they reoccur is when he goes back to his old ways. Both of his parents have Diabetes and his sugar should be monitored, but what do you do when everyone else is making the decisions.

Now it's just the two of us keeping the business alive. Commercial jobs are things of the past and we're just getting by doing custom residential cabinetry. Hubby does all the building and he trained me to work in the shop with him. He won't let me use the table saw but I can do just about everything else and we do the installs together.

Forget about health insurance, because we can't afford it. We depend on God for that.