I REALLY hate our medical system!!!! - Page 3 - SLUniverse Forums
Navigation » SLUniverse Forums > Off Topic Discussion > Politics, Religion & Society » I REALLY hate our medical system!!!!


Politics, Religion & Society Topics pertaining to politics, religion, philosophy, and social issues. Not for the faint of heart. Also, do not post while drunk, suffering from food poisoning, or while on a low carb diet. You have been warned.

 
Sponsor:
LIONHEART - We Have Your Land
Reply
 
LinkBack Thread Tools Display Modes
Old 02-14-2018, 05:53 PM   #51 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Kara Spengler View Post
In the US if a doctor submits a charge and it is denied it is the patient responsibility. I think the fundamental missing assumption is that doctor's are our advocate here. Nope, they submit claims as a service to their patients and would rather not have to deal with the whole thing any more than possible (especially since the, oh, 20 insurance policies they accept will have maybe 50 different sets of criteria). How could them having 1 set of criteria be any worse?
Maybe the central reason multipayer universal is far more realistic than single payer universal in the USA of all places is because there is no chance in hell you will get Americans to agree on what that set of criteria should be. Even something as relatively straightforward as Medicaid changes drastically across state lines and sometimes even between regions in that state.

Quote:
Originally Posted by Argent Stonecutter View Post
Um.

Virtually every non-trivial encounter I have had with the US health system has involved unexpected large bills, frequently into the thousands, which I have had to pay. Yes, they "work with me" which means I often (but not always) get them paid off before the next unexpected large bill.

"The only cost to me was parking at the hospital"?

FUCK no that's not consistent with "how it is in the US".
I've been consistently saying on this thread that I want universal coverage, which is of course not how it already is in the US. The statement you quoted was in reference to how it is for people with strong coverage, which we all want to be universal. And I do think the definition of standard coverage has to be regulated so that not just any health plan can say they offer it.

Backing up a step, the topic was on why US health insurance companies collect data, and why other countries with universal healthcare do too. I did not mean to say that the uninsured can go fuck themselves...

Last edited by TrollCampFollower; 02-14-2018 at 06:05 PM.
TrollCampFollower is offline   Reply With Quote
1 User Said Thanks:
Old 02-14-2018, 06:06 PM   #52 (permalink)
Emergency Mustelid
 
Argent Stonecutter's Avatar
 
Join Date: Sep 2009
Posts: 20,500
Quote:
Originally Posted by TrollCampFollower View Post
I've been consistently saying on this thread that I want universal coverage, which is of course not how it already is in the US. The statement you quoted was in reference to how it is for people with strong coverage, which we all want to be universal.
Yes, and my response is how it is for people with good coverage. I HAVE COVERAGE, and I still get unexpected large bills, like a thousand dollars here because the anesthetist wasn't on my insurance. Or two thousand dollars there because they decided I wasn't really an emergency. Or six hundred because the doctor used a treatment the insurance company thought wasn't justified. ALL REAL CASES. With multiple companies.

I don't know what magic insurance you have that never does this to you, but these kinds of shenanigans are totally typical in the USA. The horror stories are absolutely normal.
__________________
Argent Stonecutter -- Skyhook Station -- Coonspiracy Store

"And now I'm going to show you something really cool."


The previous is a cybernetic datum published - in direct contravention of DoD Regulation #229RR3X3 - as being conducive to the physical, psychological and/or social well-being of the population.
Argent Stonecutter is offline   Reply With Quote
Old 02-14-2018, 06:32 PM   #53 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Argent Stonecutter View Post
Yes, and my response is how it is for people with good coverage. I HAVE COVERAGE, and I still get unexpected large bills, like a thousand dollars here because the anesthetist wasn't on my insurance. Or two thousand dollars there because they decided I wasn't really an emergency. Or six hundred because the doctor used a treatment the insurance company thought wasn't justified. ALL REAL CASES. With multiple companies.

I don't know what magic insurance you have that never does this to you, but these kinds of shenanigans are totally typical in the USA. The horror stories are absolutely normal.
I read a lot about this, but it's never happened to anyone I know. ...maybe state level regulations come into play? Because it seems weird that it never happens to anyone I know, but other people say it's everybody they know.

I added a statement to my post about how definitions of standard coverage need to be regulated. It's actually pretty common for the employer to intentionally buy cheap insurance to save money. That might be most of the disconnect...
TrollCampFollower is offline   Reply With Quote
Old 02-14-2018, 07:17 PM   #54 (permalink)
Emergency Mustelid
 
Argent Stonecutter's Avatar
 
Join Date: Sep 2009
Posts: 20,500
Quote:
Originally Posted by TrollCampFollower View Post
I read a lot about this, but it's never happened to anyone I know.
It's less likely to happen to you if you're younger. Once you get to the age where they start recommending regular anal probes you tend to have more hospital visits.

Also, how often do you talk about your hospital visits? It's not exactly something that comes up in casual conversation. I certainly haven't discussed my anal probes and encounters with urinary lasers in RL.

Quote:
It's actually pretty common for the employer to intentionally buy cheap insurance to save money. That might be most of the disconnect...
That's not actually a "disconnect", that's "part of the problem".

I suppose there might be some platinum insurance level where this kind of stuff doesn't happen, but I don't think it's practically available to more than a tiny fraction of the population.

It didn't used to be like this. My insurance back in the '90s was way more "platinum" than it is now, but even then it wasn't 100% no copayment coverage where the parking fee was my whole out-of-pocket.
Argent Stonecutter is offline   Reply With Quote
2 Users Agreed:
Old 02-14-2018, 07:50 PM   #55 (permalink)
Val
n00b!1
 
Val's Avatar
Sole member and president of 'Coffee Addicts' club
 
Join Date: Jul 2017
Location: glasvegas
Posts: 121
My Mood:
SL Join Date: 2006
Business: Instant Disappointment
Client: black dragon, alchemy, firestorm, singularity
Send a message via Skype™ to Val
NHS has huge issues with staff shortage and funding due to government having issues with budget as they cannot fill holes done by quite a few things such as corporations like Google avoiding taxes and plenty other similar things we might not know about. Plus, staff is getting underpaid and is overworked - again with the cuts and austerity and shite. Plenty other issues as well. But. I am alive.

OP's issue might really be the lack of 0s at the end as heard that hospitals have to bill higher plus it is a mess as every provider is different just like every hospital is. I did run into issue with permissions as often had to ring for someone else - best is to have them next to you or somehow connect to the conversation. Or find a solicitor to give you legal appointment rights and go to hospital or company in person with those. Calling is not best with such things really - write letters, send them as registered so they have to sign when they pick up and mail them to both (writing that you sent a copy to insurer / hospital).

Back to insurance. I lived in USA for few years as a kid due to ~mysterious condition~ and doctors in experimental kid hospital in Chicago wanted to see what's what for freeeeeeeeee. Still mum had to work two shifts illegally but point is ... the 'free' bit would end and since I was born disabled - hell, if any company would cover all my costs. I cannot estimate cost of my meds but I presume it would be 1k (with insurance) per month minimum. I estimate my potential wages to be 1.5k tops if in US (at 1k in UK) sooo ... yeah. Not to mention insurance, tests, doctor visits and all the fun. I do know there is a fund for poorer people but not all qualify plus you still pay loads.

I had a friend who had a web hosting company in Houston and they were doing pretty grand with money. She had been insured, as well as her husband. Unfortunately, she had a serious car accident with clear fault of other driver (went to court) ... also unfortunately, she had to spend a month in hospital. As you probably can guess - had to sell company, house and go legally bankrupt. Then again, some areas do annul hospital costs where there is no chance of the patient paying. The problem is lack of government policy.

All countries have private and public health service (or most do) and they do it both great and badly. Issues rise when there is way too many private companies dominating the market instead of public ones - it simply creates chaos. Now, Poland had ... the issue USA has now just ... with public funds as areas had their own, little NHS and their own rules. This had been disastrous when you needed to visit a specialist who was under another area (it was not geographical). My hometown was worse as it was under two so if you wanted to go to GP - you had to spend hours filling in financial forms beforehand, then had to wait for approval and then maybe you did not die ... It had no private alternative besides those for super rich.

So. NHS still wins with its own issues and 2 year queues.
Val is offline   Reply With Quote
Old 02-14-2018, 08:46 PM   #56 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Quote:
Originally Posted by Argent Stonecutter View Post
Yes, and my response is how it is for people with good coverage. I HAVE COVERAGE, and I still get unexpected large bills, like a thousand dollars here because the anesthetist wasn't on my insurance. Or two thousand dollars there because they decided I wasn't really an emergency. Or six hundred because the doctor used a treatment the insurance company thought wasn't justified. ALL REAL CASES. With multiple companies.

I don't know what magic insurance you have that never does this to you, but these kinds of shenanigans are totally typical in the USA. The horror stories are absolutely normal.
Same here. I have said before that I have good coverage ...... but it is good coverage for the US out of what is realistically available to people now.
__________________
"The debug setting for Gender in SL (AvatarSex) is an unsigned 32bit integer value. Not a boolean. I'm still waiting to see what our other options will be. =^-^=" Imnotgoing Sideways

"Ok, I have to ask, WTF is this thread even about and why is it hundreds of posts? I am out of vodka so I don't feel like reading it to find out." Cristiano

"Why? Don't like me ban me" Cathiee
Kara Spengler is offline   Reply With Quote
Old 02-14-2018, 09:17 PM   #57 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Argent Stonecutter View Post
It's less likely to happen to you if you're younger. Once you get to the age where they start recommending regular anal probes you tend to have more hospital visits.

Also, how often do you talk about your hospital visits? It's not exactly something that comes up in casual conversation. I certainly haven't discussed my anal probes and encounters with urinary lasers in RL.

That's not actually a "disconnect", that's "part of the problem".

I suppose there might be some platinum insurance level where this kind of stuff doesn't happen, but I don't think it's practically available to more than a tiny fraction of the population.

It didn't used to be like this. My insurance back in the '90s was way more "platinum" than it is now, but even then it wasn't 100% no copayment coverage where the parking fee was my whole out-of-pocket.
The ACA sought to establish minimum regulations on what is an acceptable level of coverage. It helped A LOT but didn't go far enough. I work for a self insured company, so that probably goes a long way towards getting this "platinum" coverage. And as a matter of fact, I have friends and family who expecitly mentioned having hospital stays that insurance took care of just fine...

I also hear a lot about how small companies seem to always get screwed in this manner. The system seems to force scale.

Last edited by TrollCampFollower; 02-14-2018 at 09:28 PM.
TrollCampFollower is offline   Reply With Quote
Old 02-15-2018, 04:27 AM   #58 (permalink)
Emergency Mustelid
 
Argent Stonecutter's Avatar
 
Join Date: Sep 2009
Posts: 20,500
Quote:
Originally Posted by TrollCampFollower View Post
The ACA sought to establish minimum regulations on what is an acceptable level of coverage. It helped A LOT but didn't go far enough.
Oh yes, the ACA (a Republican plan) is better than nothing. I've also had nothing. I've gone without insurance too long and had to wait before the money I was paying actually covered me after I got it again. If we had one particular injury TWO DAYS earlier we would have gotten bupkis from the insurance company despite paying premiums for almost 12 months. I'm glad that's not a thing any more.

But.

I'm not just talking about "before the ACA".

Quote:
I work for a self insured company, so that probably goes a long way towards getting this "platinum" coverage.
I have had unexpected payments when I was working for a huge company and they were self-insuring.

Quote:
And as a matter of fact, I have friends and family who expecitly mentioned having hospital stays that insurance took care of just fine...
No, it doesn't happen *every time*. But it *does* happen, and it's *not* rare. And I would be boggled if their "just fine" meant "no deductible, everything covered 100%, the biggest cost was parking".

WHICH IS WHAT YOU SAID WAS COMPARABLE TO THE USA.

Will you at least agree that the best case isn't as good.

And being able to *depend on* having the "best case" outcome is the exception. Really. It is.
Argent Stonecutter is offline   Reply With Quote
1 User Agreed:
Old 02-15-2018, 05:22 AM   #59 (permalink)
Eternal Newbie

*SLU Supporter*
Entirely without credibility
 
Join Date: Feb 2011
Location: Wales, UK
Posts: 3,553
My Mood:
SL Join Date: 21 June 2009
Client: Firestorm
Quote:
Originally Posted by Argent Stonecutter View Post
Once you get to the age where they start recommending regular anal probes you tend to have more hospital visits.
Are you sure that's a hospital you're going to, and not a camouflaged flying-saucer ?
Arkady Arkright is offline   Reply With Quote
Old 02-15-2018, 05:22 AM   #60 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Ugh, the days of the junk plans. I knew I would go a few months between grad school and working again so did the responsible thing and talked to an insurance broker. They gave me my options, all was fine. Then they called me back. Because of my epilepsy I only had the choice of a high premium/high deductible plan that explicitly would not cover epilepsy.

Even now it is rare to see an EOB (explanation of benefits) that does not have a deductible or some percentage as the bottom line, usually both. The only time I see no deductible is when I have already met the family limit for the year. [Good news hon, we can get as sick as we want this year.]
Kara Spengler is offline   Reply With Quote
2 Users Hugged You:
Old 02-16-2018, 06:58 PM   #61 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Argent Stonecutter View Post
No, it doesn't happen *every time*. But it *does* happen, and it's *not* rare. And I would be boggled if their "just fine" meant "no deductible, everything covered 100%, the biggest cost was parking".
There is a middle ground between zero copay/deductable and crippling bills. I don't mind having small bills to deter frivolous ER visits. The bills just shouldn't be thousands of dollars.

Quote:
Originally Posted by Argent Stonecutter View Post
WHICH IS WHAT YOU SAID WAS COMPARABLE TO THE USA.
Nononono, you ripped my statement way out of the greater context. This whole discussion was started because we were talking about why health insurance collected data and how other countries still used data and criteria to figure out what they'd pay for. I also said it was comparable to the USA in terms of how the provider worked with the payer and didn't automatically cover everything. According to wikipedia (source listed), 27% of Canada's healthcare expenditures are covered by the private sector because they're public system doesn't cover a wide range of things.

I mostly wanted to argue against the idea that other countries auto-pay claims with no thought. That is a widely held myth that really irks me.

Quote:
Originally Posted by Argent Stonecutter View Post
Will you at least agree that the best case isn't as good.
And being able to *depend on* having the "best case" outcome is the exception. Really. It is.[/QUOTE]

I don't think I ever said otherwise. I favor passing a much, MUCH stronger version of the ACA specifically to fix this.
TrollCampFollower is offline   Reply With Quote
1 User Groaned:
Old 02-16-2018, 07:16 PM   #62 (permalink)
Emergency Mustelid
 
Argent Stonecutter's Avatar
 
Join Date: Sep 2009
Posts: 20,500
Quote:
Originally Posted by TrollCampFollower View Post
Nononono, you ripped my statement way out of the greater context.
I don't see that.

Quote:
I mostly wanted to argue against the idea that other countries auto-pay claims with no thought. That is a widely held myth that really irks me.
And you did so by responding to a message where someone described having claims automatically covered by saying that was consistent with the USA, and said that the provider *usually* works to resolve problems when they occur? No. Even setting aside the "automatic" bit:

Quote:
Quote:
It's the provider who works with the payer almost all the time.
It's the insuree that works with the insurance company almost all the time. If the provider has to do anything, it's up to the insuree to raise the issue, plow through the insurance bureaucracy, find out what needs to happen, and make it happen.

Quote:
Quote:
The horror stories you hear are the exception, not the norm.
They're a *common exception* at best.

Quote:
Quote:
Complaints get a response bias.
I can't parse this.

Quote:
Quote:
I've also never had to talk to my health insurance company myself in my life.
You're either young or insanely lucky.

Quote:
Quote:
Approvals normally are same day.
Even after approval, unexpected bills are common.

Quote:
Quote:
If you were in the US, your provider would have worked with the payer on your behalf, just like they did in Canada.
Unless they're a big practice or a hospital, they probably don't have the time to work on problems, even if there's something they can do. If they ARE a big practice or a hospital, it may not be cost-effective for them to have enough rules lawyers on the staff, sending bills to collections is cheaper.

Quote:
Quote:
The really, REALLY big difference is that in the US, you don't automatically have insurance.
It's not, it really isn't.

Quote:
I favor passing a much, MUCH stronger version of the ACA specifically to fix this.
I don't. The ACA is based on Republican models and no variant of it will ever cover everyone.

I favor an actual universal health care bill, either with a public option or single payer.

And if public option, single billing. Why the fuck does it matter to me that the hospital subcontracted an anesthetist? My relationship is with the hospital. All bills associated with he procedure MUST BE mediated by them, and coverage based on THEIR relationship with the insurer.
Argent Stonecutter is offline   Reply With Quote
Old 02-16-2018, 08:48 PM   #63 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Argent Stonecutter View Post
I don't see that.
The thread was talking about data collection (EDIT, meaning it came up). Then it was said that single payer would mean no approval process and data collection. Then I explained why that wasn't true.

Next, Seawitch expressed the belief that Canada doesn't have an approval process.

I was trying to point out that the approval process happened behind the scenes. It happened behind the scenes whenever I used healthcare. I admit it's easier to hide this process with single payer, but it still happens. Just hidden.

I admit my exact wording in that post was carried away, my bad.

Quote:
Originally Posted by Argent Stonecutter View Post
It's the insuree that works with the insurance company almost all the time. If the provider has to do anything, it's up to the insuree to raise the issue, plow through the insurance bureaucracy, find out what needs to happen, and make it happen.
Now here is where you get carried away. No, that is not "almost all the time."

The experience older relatives and I have had is that the provider bills the insurance company, and then you get what's left over, which generally is not huge. I'm sorry you had terrible experiences, but I stand behind the statement that, that's not how it just normally works in general.

I can't find any statistics on exactly how often people with "coverage" still get stuck with most of the bill, so this argument is purely anecdotal.

Quote:
Originally Posted by Argent Stonecutter View Post
They're a *common exception* at best.

I can't parse this.
It's a tragedy when someone has an experience like yours, and I'm sorry for that. But people with terrible experiences are far, far louder than people who had good ones. That leads to a skewed perception of how often each happen. I fully agree that experiences like yours really shouldn't happen at all, and more regulation is needed for this.

Quote:
Originally Posted by Argent Stonecutter View Post
You're either young or insanely lucky.

Even after approval, unexpected bills are common.
I have much older relatives who think the US healthcare system is SUPER AWESOME. It's the baby, me, who actually tries to tell them that's not always true. I will assert that part of the reason why most baby boomers aren't sold on universal healthcare is because a far smaller percentage of them have had these terrible experiences than you think.

Quote:
Originally Posted by Argent Stonecutter View Post
I don't. The ACA is based on Republican models and no variant of it will ever cover everyone.

I favor an actual universal health care bill, either with a public option or single payer.
I'm not sure if we disagree or are just using words differently. When I say "much, MUCH stronger version" I really mean something like the German system. It still works by making people buy insurance, but is much better structured than the ACA.

Would you agree with that being an acceptable alternative to the USA's system? Defending the American system as a whole isn't what I set out to do in this thread.

Quote:
Originally Posted by Argent Stonecutter View Post
And if public option, single billing. Why the fuck does it matter to me that the hospital subcontracted an anesthetist? My relationship is with the hospital. All bills associated with he procedure MUST BE mediated by them, and coverage based on THEIR relationship with the insurer.
I'm willing to bet that, that's illegal in at least some states. That's very fishy. Was that before or after the ACA? There are a lot of rules around network compliance, even if that rule didn't exist in your state at the time. I'll have to look into that one.

Last edited by TrollCampFollower; 02-17-2018 at 11:33 AM. Reason: clarity
TrollCampFollower is offline   Reply With Quote
Old 02-16-2018, 10:52 PM   #64 (permalink)
Senior Member
 
Seawitch's Avatar
Its cold out side
 
Join Date: Oct 2012
Location: Canada the great white north
Posts: 532
My Mood:
27% of Canada's healthcare expenditures are covered by the private sector because they're public system doesn't cover a wide range of things.

The Governments of the various provinces have different system's in place but they all pay for Doctor Visits, Hospitalization, Blood test, MRI ,etc.
Drugs can be covered by the province or through your employer.
Dental, eye glasses,some eye exams, massage therapy, chiropractor, are not covered under the province plans but
can be covered by your employer. The province does cover more serious eye problems .
This is probably were the 27% figure was arrived at.
I am still interested in the form you found regarding needing approval.

Sea.
__________________
Kittens!!

Last edited by Seawitch; 02-16-2018 at 11:11 PM.
Seawitch is offline   Reply With Quote
2 Users Said Thanks :
Old 02-16-2018, 10:56 PM   #65 (permalink)
Just call me Beth
 
Aribeth Zelin's Avatar
Singing along with old music
 
Join Date: Mar 2011
Location: Out in the mists
Posts: 9,399
My Mood:
SL Join Date: Oct 4 2009
Business: Moondrops ; Tempus Fugit; Faerycat Designs; sPunk
Client: Firestorm
Also, the original post was NOT about data collection, it was about having to fight with insurance and medical providers to get things taken care of, and except for one person, it's never been about data collection.

Obviously there is data collected in every system; medical records. And that's another problem with the US system, nothing transfers, you have to fill out the same damn forms, every time, and go through the same evaluations, every time, you change doctors or medical groups.
__________________

Aribeth Zelin is offline   Reply With Quote
Old 02-17-2018, 12:34 AM   #66 (permalink)
But it refused. <3

*SLU Supporter*
 
Kamilah Hauptmann's Avatar
I'm a regular Victor Victoria
 
Join Date: Dec 2007
Location: Cat Country. Can't stop there.
Posts: 11,622

Awards: 1
SLU Creepy Avatar Competition 2014 Participant 
Searchable terms ahoy: (Ten years in Canadian private health insurance.)

Quote:
Originally Posted by Seawitch View Post
Drugs can be covered by the province or through your employer.
"Extended Health Benefits"

Quote:
Originally Posted by Seawitch View Post
Dental, eye glasses,some eye exams, massage therapy, chiropractor, are not covered under the province plans but can be covered by your employer. The province does cover more serious eye problems .
"Dental Benefits" "Short or Long Term Disability" "Health Care Spending Accounts" "Vision Benefits" "Weekly Indemnity"
__________________
Some days you herp a derp, sometimes the derp herps you.

Last edited by Kamilah Hauptmann; 02-17-2018 at 03:07 AM. Reason: Misremembered one.
Kamilah Hauptmann is online now   Reply With Quote
2 Users Agreed:
Old 02-17-2018, 05:46 AM   #67 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Quote:
Originally Posted by Seawitch View Post
27% of Canada's healthcare expenditures are covered by the private sector because they're public system doesn't cover a wide range of things.

The Governments of the various provinces have different system's in place but they all pay for Doctor Visits, Hospitalization, Blood test, MRI ,etc.
Drugs can be covered by the province or through your employer.
Dental, eye glasses,some eye exams, massage therapy, chiropractor, are not covered under the province plans but
can be covered by your employer. The province does cover more serious eye problems .
This is probably were the 27% figure was arrived at.
I am still interested in the form you found regarding needing approval.

Sea.
Yes, dental and vision are routinely not part of medical as it is in the states. Probably the rest that canada does not cover as well. Which means that 27% is actually lower if you want to try comparing the two systems.
Kara Spengler is offline   Reply With Quote
Old 02-17-2018, 05:55 AM   #68 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Quote:
Originally Posted by Aribeth Zelin View Post
Also, the original post was NOT about data collection, it was about having to fight with insurance and medical providers to get things taken care of, and except for one person, it's never been about data collection.

Obviously there is data collected in every system; medical records. And that's another problem with the US system, nothing transfers, you have to fill out the same damn forms, every time, and go through the same evaluations, every time, you change doctors or medical groups.
Right, seeing as I was the one who made the OP. I spent the good part of a day bouncing between the billing office and my insurance company. Then when I finally had the name of a person to talk to I got bounced through phone tree limbo and the person I talked to had no idea who that was. At which point I had to pass it off to my spouse (I am guessing she had even MORE fun since she is Deaf) since she had a better idea who she saw that day than me.
Kara Spengler is offline   Reply With Quote
2 Users Hugged You:
Old 02-17-2018, 11:24 AM   #69 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Aribeth Zelin View Post
Also, the original post was NOT about data collection, it was about having to fight with insurance and medical providers to get things taken care of, and except for one person, it's never been about data collection.

Obviously there is data collected in every system; medical records. And that's another problem with the US system, nothing transfers, you have to fill out the same damn forms, every time, and go through the same evaluations, every time, you change doctors or medical groups.
I agree that wasn't in the OP, but it did come up later, with this statement:

Quote:
Originally Posted by Kara Spengler View Post
I really wish we had the full indemnity insurance still as an option. The only one who should need your full medical history is your doctor and anyone concerned (like a spouse).
I was trying to answer this question, and then the thread meandered into me being expected to defend a lot of pieces of the US healthcare system that I don't support either. I admit to getting carried away with my wording, but I really don't think we disagree on that many important details. Everyone here wants universal healthcare. Everyone agrees some people get shafted without it (we just disagree on how often). Can we leave it at that?

Quote:
Originally Posted by Seawitch View Post
I am still interested in the form you found regarding needing approval.

Sea.
You said operations like hip and knee replacements need to meet criteria before the system pays for it. What do providers do to prove the criteria is met?

Last edited by TrollCampFollower; 02-17-2018 at 11:43 AM.
TrollCampFollower is offline   Reply With Quote
Old 02-17-2018, 07:10 PM   #70 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
I got the revised EOB today and it is MUCH better once they got the right coding (although I feel I should bill someone for my time). Now to wait to actually get the bill.
Kara Spengler is offline   Reply With Quote
2 Users Like This:
Old 02-17-2018, 07:15 PM   #71 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Quote:
Originally Posted by TrollCampFollower View Post
I was trying to answer this question, and then the thread meandered into me being expected to defend a lot of pieces of the US healthcare system that I don't support either. I admit to getting carried away with my wording, but I really don't think we disagree on that many important details. Everyone here wants universal healthcare. Everyone agrees some people get shafted without it (we just disagree on how often). Can we leave it at that?
Ah, I see the problem. The original bill used a more generic code (like 15 mins of physical therapy or something) and the insurance company was refusing to pay without more detailed information. They should not really need to know what the full code was though unless it was something specifically disallowed.
Kara Spengler is offline   Reply With Quote
1 User Agreed:
Old 02-18-2018, 09:34 AM   #72 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Kara Spengler View Post
Ah, I see the problem. The original bill used a more generic code (like 15 mins of physical therapy or something) and the insurance company was refusing to pay without more detailed information. They should not really need to know what the full code was though unless it was something specifically disallowed.
The detailed codes can also have very different prices. If the detailed codes means the provider gets more money, it's for their own good if they submit the form properly.
TrollCampFollower is offline   Reply With Quote
1 User Said Thanks:
Old 02-18-2018, 09:53 AM   #73 (permalink)
OccupyE9 Sluni-Goon
 
Kara Spengler's Avatar
Hail Woz, the great and powerful!
 
Join Date: Dec 2008
Location: SL: November RL: DC
Posts: 23,028
SL Join Date: March, 2006
Client: Phoenix & Firestorm
Send a message via Skype™ to Kara Spengler
Quote:
Originally Posted by TrollCampFollower View Post
The detailed codes can also have very different prices. If the detailed codes means the provider gets more money, it's for their own good if they submit the form properly.
Interesting (although strange). It would seem the correct thing to do would be, if you need more detail, to pay *something* and put an indicator on the EOB that you may get more money if further detail is provided.
Kara Spengler is offline   Reply With Quote
1 User Agreed:
Old 02-18-2018, 10:00 AM   #74 (permalink)
Cookie stealer
 
Ranae Quinn's Avatar
Echo Amarante
 
Join Date: Aug 2014
Location: Nottingham, England
Posts: 344
My Mood:
SL Join Date: 06/09/2005
Client: Firestorm
Quote:
Originally Posted by Arkady Arkright View Post
Are you sure that's a hospital you're going to, and not a camouflaged flying-saucer ?
gotta love anal probes
Attached Thumbnails
I REALLY hate our medical system!!!!-18527.jpg.png  
Ranae Quinn is offline   Reply With Quote
Old 02-18-2018, 10:01 AM   #75 (permalink)
Senior Member
 
TrollCampFollower's Avatar
 
Join Date: Oct 2017
Posts: 329
My Mood:
Quote:
Originally Posted by Kara Spengler View Post
Interesting (although strange). It would seem the correct thing to do would be, if you need more detail, to pay *something* and put an indicator on the EOB that you may get more money if further detail is provided.
I do think that providers should be required to talk to the insurance company a couple times before they bill the patient for more than a minimal copay. I know some providers do this, and I am willing to bet it is required in some areas.

At the very least, they should be required to tell the patient "this might switch to paid if the provider gives more information."
TrollCampFollower is offline   Reply With Quote
1 User Agreed:
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are On
Refbacks are On




SEO by vBSEO