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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #11  
Old 10-02-2008, 11:15 PM
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Terry Terry is offline
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I know what you mean KBear. I was aware of the full facts behind the McDonalds Case. Most people accept things at face value any more as critical thinking has gone out the window. Most people are settling for being fat and lazy and allow others to do their thinking for them. They are mere sheep being led to the slaughter. When the middle class are no more because the wealthy, the politicians, the corporations, the other countries, all got richer and richer while we paid the lion's share I will count the money I invested over the years and retire comfortably and peacefully.

I have not paid an interest payment on a credit card in almost twenty years. I look at all sides to the story. When my Republican friends send me the e-mails trying to discredit all who stand in their way I look to www.snopes.com and other sites to sift through the BS. I have saved the maximum amount in my retirement plan for years. While others are bailing out of the stock market I am buying right and left. I am buying low to accumulate a lot of shares. When the market goes back up I will be sitting well (I hope). I am most fearful about the corruption that has run amuck for the last several years in corporate America. Americans have stood by the sidelines and allowed this to occur. They bought in to the religious right and thought the party was represented with God on it's side. If life is so precious, why does it not matter after it is born? Life should be sustained by good healthcare, good jobs for Americans rather than foreign markets and, select shareholders in this country, why are we filling prisons with poor people, drug addicts, mentally ill people, people of color, why are we sending valuable life overseas to die, why do we have the death penalty for people if we believe in life? Why, Why, Why?

I am sorry for the losses you experienced over your accident. You can truly relate to what I went through. Tort reform is what corporate America and insurance companies want to sell to the masses. As mere sheep, most of us will buy it. Until we get injured ourselves and find how it is slanted to have the insurance companies win. They have attorney's that come in with the sole purpose of wearing you down. Most people get intimidated and run. Not me and, not you. We were fighters. Good for you.

This post will probably tick off a few people and is off topic. Go to www.snopes.com and check out the politics page. Look up Obama and McCain. The lies spread about Obama cover a full page. The one's about McCain and Palin cover a small percentage. It's obvious someone has a vested interest in trying to systematically destroy Obama as a candidate. I wonder if it is because of his color. Before anyone answers this check out the disparity of the sentencing laws between powder cocaine (primarily white, middle class to wealthy person's drug) vs. crack cocaine (primarily black person's drug). We are filling up prisons with person's of color in record numbers. Who said we weren't still racists?

I still hate seeing the little guy get trampled. A classic example is how few of us get our much needed surgeries paid for on this forum. If all of you are tired of it as well stand up, go to the window right now and yell; "I'm mad as hell and I'm not going to take it anymore."

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #12  
Old 10-03-2008, 03:17 AM
kimmers kimmers is offline
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I had to reply because there are many good things said on this post. Interesting conversation guys.
Going back to the original topic, and the Hayes assessment report, I'd like to mention a few things about my favorite insurance company (tongue in cheek), Blue Cross. Blue Cross comes by its decision to not cover ADRs by the TEC assessment, which if you look it up is a bunch of doctors who decide on treatments.
I also found with BC that when I drove through the points in my appeals about how many years ADRs have been done and what success they have had in Europe with ADRs and studies backing the treatment, BC came back with that there were not American studies going back five years after FDA-approval of the Prodisc.
Well, since it was 2007-2008, and the Prodiisc was approved in August 2006, of course there were not. And when the retired neurosurgeon, "board-certified", and supposedly independent, spoke to my doctor, that was the argument they gave to my doctor. It didn't matter that studies showed that there was less adjacent disc disease after Prodisc. How can you argue with their logic?

It basically didn't matter that my doctor was asking for a surgery that cost less, had less recovery time, less chance of adjacent disc disease, and was overall better for me, the patient.

Regarding this particular insurance, I found out the following: I had less chance of suing BC since I was from a group policy and not individual, if I sued it was going to be through federal court because our plan was governed by the ERISA laws (i.e. take at least 18 months and cost us a bundle (I was quoted 45-50K by an attorney), which I don't totally understand yet, I might be able to go to arbitration but that wasn't clear and the Dept of Managed Health Care doctors sounded like they were nuts.

The Dept, which is supposedly independent, had the audacity to suggest that I didn't have a real spine problem and that I had "multiple somatic complaints". This was because I have had running injuries. The kicker was that my doctor's office, the PA, made the mistake of saying I had a history of depression, which is false. Well, one doctor, the one who said the above, started out his report with This is a 45 year old woman with history of depression and multiple somatic complaints.

Well not to belabor things and get off my soap box, about Blue you-know-what, this really ticked me off and gave credence to my belief that the Dept is in the back pocket of the insurance companies. One of the first things I thought about was, 'How about if I was a woman who actually had depression?' I feel that was an awfully inflammatory and discrimatory comment.

You guys or gals on here know I am for single-payer healthcare and why. I think if we were left as individuals to choose our own healthcare, I would not be insured. As it stands now, i do not believe I would be insurable. I went through the uninsurable thing several years ago when I was rescinded by an insurance company. I cannot remember why, I think it was because I had gestational diabetes with a pregnancy, or I had a D & C operation. Anyway, I was dropped and my only avenue for insurance that time was through California's major risk insurance. The problem was the premiums were like Cobra, but I would not go without insurance after I got in a car accident at 24 and I did not have insurance. That cost a lot.

I was in the major risk pool for two years and then got regular employer-sponsored insurance either through my job or my spouse's. It was good insurance but it was expensive, prohibitive for some people.

So the government might screw up the insurance bit a little bit or a lot but I do not believe they could do a worse job than the insurance companies we have today. The $70, 000 plus bills we owe for medical care make that clear to me. However, I think if the state was allowed to dictate the care and people had to be insured, state governance might work. The only thing is the insurance companies need to be taken out of the equation. They have done a bang up job with their share-holder profits and left us dying by the road. Think about what oversight they have? They have powerful lobyists and I think it is shameful that supposedly one of the richest countries in the world has such abysmal healthcare.

Kimmers
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hurt back lifting, herniated disc at L4/L5. DDD

Last edited by kimmers; 10-03-2008 at 03:20 AM.
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  #13  
Old 10-03-2008, 08:30 AM
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Terry Terry is offline
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I agree Kimmers. That's my biggest problem with America today. Profit over people. I'm very sorry that your surgery did not get covered. It's horrible when we have good insurance policies and they play with our lives. How come we are not allowed to be a part of the choice in what will fix us? It's all about making shareholders money like you stated. I hope you do continue to fight for the care you deserve.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #14  
Old 10-03-2008, 10:10 PM
sahuaro sahuaro is offline
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Would some form of a national health system really take care of the corruption in insurance companies? Would we have an easier or even harder time getting our surgeries approved?
__________________
2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #15  
Old 10-04-2008, 07:57 PM
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Harrison Harrison is offline
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Exclamation Mangled Healthcare

I’ll add my 2 cents too – with a question: did anyone see Healthcare Around The World on PBS? If I were king for a day, I would make all of elected officials watch this program. And again. And again. And again!

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/synopsis.html

It featured five other capitalist healthcare systems from around the world; the analysis and presentation was incredibly clear. Please try to find it in your local area or just read the web site content.

The points made are many. But one thing is for sure – if we Americans can do what Taiwan did – rebuild the national healthcare system from scratch – there is hope for all of us. For what it’s worth, the folks I know in Taiwan are pretty happy with their quality of care and choice of medical specialists. But we are not Taiwan for a long list of reasons. I fear our collective road to wellness will be painful, given the gridlock in Washington, entrenchment of business interests (big pharma, big insurance) and frankly, how unhealthy we Americans have become as a population of 310 million.

So I ask you, could Americans muster up the will – along with its elected officials – to completely rebuild the healthcare system?! Wouldn’t it have been nice if we spent the $700,000,000,000 on this national problem?

But as an editor, I am showing one of my many biases. So I’ll shut up, watch the news and say a lot of prayers!
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  #16  
Old 10-04-2008, 10:39 PM
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Terry Terry is offline
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I like Japan's approach where everyone is made to purchase health insurance. This would drive the costs downward if insurance companies are not allowed to make such a huge profit. Another solution would be that insurers are required to put a certain percentage of their profits in to subsidizing the insurance needs of the poorer people who cannot afford the whole package.

It sounds like Switzerland is on a decent track as well. Maybe this is one piece of capitalism that needs to be eliminated as, health care is a right for Americans. We deserve to be healthy. There should be incentives for people that do not smoke, drink alcohol, and exercise. There should be disincentives for people who choose unhealthy lifestyles.

I think that America is still a great country. If we truly make this a priority we can come up with a solution that will make America healthy.

Thanks for the decent article Harrison.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #17  
Old 10-06-2008, 11:46 AM
Justin Justin is offline
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Default My $.02

http://www.nchc.org/facts/cost.shtml

"Universal Basic Coverage" is not necessarily the best tests, the best drugs, and the best programs. It is a safety net so that people can get the average tests, drugs, and programs. Most importantly tests, drugs, and programs covered by the right level of care.

Just because there is no official program to cover the uninsured right now does not mean the insured population does not pay for the uninsured population, as Terry pointed out. The uninsured inherently drive up health care costs. People who don't have insurance still need health care, so they get it by going to ERs and not paying the bill, or only paying part of the bill. The ER costs exponentially more than does a regular primary care physician's office, and by the time someone goes into the ER for a problem, they need much more tests and drugs and care than they would have had they sought care earlier.

Quote:
Americans without health insurance will spend $30 billion out of pocket on medical care this year, according to a new report by George Mason University and the Urban Institute.

The government will pay about 75% of an additional $56 billion in health costs - or $42 billion - for the uninsured. The rest is covered by private physicians, community groups and hospitals.
So uninsured spend about $30 billion a year out of pocket, but $56 billion either comes from your tax dollars (the government), you (assuming you'll be a physician), or the hospitals where you receive health care. None of those groups can afford to foot the bill--especially not hospitals. So what do they do to cover it? They charge more for services. Higher health care costs translates into higher premiums for employers. Higher premiums for employers means employers cant afford to cover as much. So they have to do one of a few things:

1. Raise premiums or out of pocket costs for employees
2. Get a cheaper insurance plan that covers fewer things
3. Drop coverage.

And all of these things are happening according to the National Coalition on Health Care

Quote:
Premiums for employer-based health insurance rose by 6.1 percent in 2007. Small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.2
Quote:
The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300, or 10 percent more than they did in 2006.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).
Quote:
# National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage.2
# Economists have found that rising health care costs correlate to drops in health insurance coverage.8
Now, as more and more people become un and under-insured, more and more people are showing up to the ER for problems that a PCP could handle, and fewer and fewer people are paying their bills in full. This costs hospitals more, which costs health insurance providers more, which costs employers more, which leads to fewer benefits and fewer people being insured. This cycle eats away at the insured population and fuels the growing cost of health care. Of course there are other reasons why health care costs so much, but this is a big one.

$56 billion dollars is nothing to sneeze at.

Even though the Obama plan will cost $50-65 billion a year once fully implemented, we're already paying that just for having such a large uninsured population and that number is set to rise in the coming years. So why not implement a plan that will stop this cycle using the same amount of money we're spending currently? We may even save money if it makes our population healthier and therefore in less need of heroic health care efforts.

Of course, just my $.02
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  #18  
Old 10-07-2008, 08:36 PM
Justin Justin is offline
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Default A Must Watch...

Watch the video in the link below:

http://www.cbsnews.com/video/watch/?id=4256735n

U.S. Health Care Gets Boost From Charity
"60 Minutes": Remote Area Medical Finds It's Needed In America To Plug Health Insurance Gap

Quote:
(CBS) This segment was originally broadcast on March 2, 2008. It was updated on July 9, 2008.

One of the decisive issues in the presidential campaign is likely to be health care. Some 47 million Americans have no health insurance, and that's just the start: millions more are underinsured, unable to pay their deductibles or get access to dental care.

Recently, 60 Minutes heard about an American relief organization that airdrops doctors and medicine into the jungles of the Amazon. It's called Remote Area Medical, or "RAM" for short.

As correspondent Scott Pelley first reported last March, Remote Area Medical sets up emergency clinics where the needs are greatest. But these days that's not the Amazon. This charity founded to help people who can't reach medical care finds itself throwing America a lifeline.
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  #19  
Old 10-07-2008, 09:54 PM
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Terry Terry is offline
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Justin:

That was one of the most heartbreaking videos I've seen this year. I am a Rotarian and am proud of what we do for people overseas. We are remiss in this country, when we have all of these people that are Americans and, they have such difficulties getting health care.

This is a travesty.

Thank-you for sharing this video.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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