Health Insurance and the state of medicine today

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Countrysiders, help please! I have been in the health care field, specifically dealing with health insurance and medical coding for 11+ years. I would like to ask you all for some input which may spurn me on to follow through on a personal goal. I have worked for a big health insurance company and for physicians and for my state medical society, but my goal for years has been to find some way to inform people with no health insurance how to "defend" themselves when they have to seek medical attention at high cost (usually). Since my husband and I are trying to follow the "self-sufficiency road", I have a special fondness for homesteaders and country folks like you all. You can assist me by telling me what types of issues you see daily as a result of being either without insurance or with very limited health insurance. I don't need detailed stories, and please be kind. Is there some specific information you feel you need? Do you read newsletters or seek out website information to assist you in understanding your medical bills? Are you familiar with your local MEdicare and Medicaid carriers and their policies for payment, (musch of which drives commercial health insurances as well? I am a certified medical coder, so please believe that I am knowledgeable on these issues. I would really appreciate your input.

-- Laura (lbaumgardner@blazenet.net), May 31, 2000

Answers

I started a thread about two weeks ago about my hubby wanting to go in business for himself and asked what other self-employed people did about health insurance...some of those answers might help you.

Also,when we were without insurance for a year due to a prior job change, we were surprised to learn that our medication cost us more than it did people with insurance...because the major insurance companies have special "deals" going with the pharmacies so that the drugs cost them less....to me that doesn't seem exactly right....

Also, our hospital in the county was originally built around 1949 as a Hill-Burton hospital so they were supposed to provide some free medical care every year....they said they complied but I could never see any facts or figures....

Now the county's new hospital only has private rooms, which I think are great. Except our current insurance only pays for a semi-private room. We argued and I wrote one of my "Suzy letters" to the insurance company explaining to them in detail that when my husband has his emergency apendectomy in October that we had little time to do anything but he had to have a private room because that was all they had....now the hospital is threatening to sue us over the $100 we owe...which is all that's left of the more than $19,000 bill for three days in the hospital and the surgery....

-- Suzy in 'Bama (slgt@yahoo.com), June 01, 2000.


Laura, I spent 20 years building up a great relationship with my GP. She knows me inside and out! I now have to use my husband's provider (which is a new one to him as well) and have to switch docs to afford medical care....oh well, what's 20 years???? My husband has a heart condition and takes meds for it. He is 2 weeks out on his prescription, and has just found out that he needs to schedule a new visit with TWO docs at the new provider (1 general, 1 specialist) to renew his prescription. Oh yeah, 2 weeks is reasonable to get in and get a full workup, plus see a specialist. NOT.

This jockeying around of health care to create profits for shareholders is immoral. I am outraged. Please see today's Wall Street Journal (05/31/2000) for an article (front page) about the scumbags that make money off of people's health needs. I cannot express my revulsion enough without reverting to non-family friendly verbiage, so I won't. Good luck. And I don't blame the docs...it's the insurance leeches. Whew...thanks for letting me vent!

-- sheepish (rborgo@gte.net), June 01, 2000.


I guess what I have been dealing with the most lately is --health care versus insurance for the elderly. Lies and broken promises. Medicare and Medicaid is a joke and it is not funny. If you were smart and bought additional long term health insurance than you find out it was all a lie. It has so many "if's" that you find that nothing is really covered. I know that many will disagree but I favor social medicine. To me personally, I think there should not be any profit in the medical field. There is no need for administration in the medical field. There is no need for any paperwork. There is no need for HMO's. There is no need for insurance of any kind, for in the end, they will find a loophole or reason to deny your claim. The only medical code we need is 01=sick. I am presently asking doctors---"if we pay you half of what we now pay for insurance per month, will you treat my family for life" ? You would be suprised but the MD's say yes but the specialists say no. The hospitals are a seperate problem also.The nurses in here have also brought out good points about hypocondriacts and people with multiple suicide attempts. The nurses wanted a "how to" manual for suicide. I might suggest jail terms for attempted murder for suicide attempts and fraud for using medical care without do cause. IMHO, we will have to take the profit out of the medical field to attain medical justice. The local hospital here just bought 75 acreas of prime real estate downtown to build a 175 million dollar biotech center. Now, that is a real non-profit organization, huh ? I guess crime pays afterall.

-- Joel Rosen (Joel681@webtv.net), June 01, 2000.

we had twins last augest, talk about a nightmare, we have bc&bs only because we have small kids and both my husband and my self require daily med. the bills from the birth, nursery, and all the doctors got 1/2 paid, the insurance company would not believe that there was twins. we where threatened over unpaid bills,called daily ,and wrote to weekly. my husband then went to the carrier of the policy with the twins in tow and said " now do you believe us?" all bills where paid. even today we have problems they just do not get it ! talk about high cost - c- section, nursery , my room,other stuff was well over 6,000.00 . they did not require extra time in the hospital or special care . the nursery bill was a joke, they were with us all the time. and on top of it all durning surgery they would not tie my tubes because it was a catholic hospital,are they going to pay for the next one or two ?

-- renee oneill (oneillsr@home.com), June 01, 2000.

Afew years ago, I thought I had broke my ankle, during a holiday weekend. No insurance,, Freinds took me to the hospital, doctor looked at it, gave me an x-ray, then when it came back and looked at my chart, said "Oh , If I had known you didnt have insurance I wouldnt have ordered it, I knew it wasnt broke>" whats that about besides money? STAN

-- STAN (sopal@net-port.com), June 01, 2000.


Joel: I'm with you! Personally I like a single payer plan. We hear about these scare stories coming from Canada but thats all they are as far as I'm concerned. The administrative expenses don't have to be out of sight as evidenced by medicare---something like 3-4% if I remember correctly.

I would'nt be opposed to having tax $ pay for med school either ---if the graduating docs would pay for their "free" education by serving in community clinics for x number of years.

We're told this is a free country but I really wonder. Right now many people are trapped in dead end jobs that they hate only because of the health insurance.

Laura: As to your specific question my biggest concern is the security of our home. If either my wife or I wound up in the Hospital our home would be in jeporady because I've heard its a matter of routine around here, if you have a big bill they will attach your assets---period.

Would putting the real estate into trust protect it from this kind of thing? If so, what kind of trust?

-- john leake (natlivent@pcpros.net), June 01, 2000.


About 17 years ago, I worked as a personnel assistant for a newspaper in South Carolina, which became "self insured", meaning they carried the insurance for all the personnel. To cut costs, I had to scrutinize every hospital bill from any employee that used the insurance. You would not believe the errors on some of them. Of course, unless you were in the OR with the patient, there was no way to verify how many iv tubes, etc were used, but when a female patient was hospitalized, and charged for a urinal, or female infants were charged for circumcisions, it was obviously an error. Most of the hospitals were prompt about removing those costs when contacted, but how many of us know to request a DETAILED copy of the bill when we are hospitalized? Not many do, but it is your right, and if something doesn't make sense, or look right, call them on it, and you may get the charges removed. On another note, my husband retired from the air force, and at the time he went in, was "promised" free medical care for himself and family for life after retirement. Bull. Now we have to pay for coverage, and we are at the bottom of the barrel for consideration for appointments, etc. At least our prescriptions are still covered, but that may be the next thing to go. Here in Colorado, there is coverage through the state (after a lot of paperwork) for those without insurance and on a lower income scale, but it isn't advertised, and only if the doctor's office tells you about it, would you even know to sign up for it. I'm with Joel, I think socialized medicine-even with all its' problems, might be the better way to go. How about it, those of you in the UK and other areas where this is in place--what do you think of the services provided? Jan

-- Jan B (Janice12@aol.com), June 01, 2000.

I think all Insurance needs to be abolished. The only reason people can charge what they do for medical care is that insurance is there to pick up the tab. Get rid of the insurance and drug companies have to start marketing their drugs to real people. Get rid of the insurance and doctors have to charge you a fair rate or go broke. I think the only kind of coverage that should be allowed is non-profit medical share programs where individuals pool their money together to share the cost of medical care. There are several out the right now and they are really effective. Bills get paid and people save money. If any insurance was going to left in tact then it should be for the big stuff, and should only cover the actual cost of hospital stay and surgery. In other words there should be a specific insurance for cancer coverage or heart conditions, or Misc. lifethreatening illness. Just my opinion.

Little Bit Farm

-- Little bit Farm (littlebit@calinet.com), June 01, 2000.


I have been without health insurance for most of the past 21 years. I once perhaps broke a knuckle catching a cricket ball, and wanted to get it x-rayed. I was not about to go to an emergency room and pay emergency room charges, but called around to see how much it would cost to get it x-rayed. At that time (1992), when I could get through the telephone recording gauntlet, when I could get a straight estimate -- not even an actual price quote -- it would have cost $125-195, BUT they would only do it if I was referred by another physician. Nice racket. My knuckle healed without their benediction. I have lived in other countries, and though they were "third world" & poor, you can get an x-ray or most ordinary procedures without being referred by another of the medical racket, and you could do so at a reasonable price. In Pakistan, for instance, an x-ray cost $4. How is it possible that it should cost so much more here? The cost of medicines here in the US are also outrageous -- criminal! I also think that only a single payer system such as in Canada will solve the problem. For all its faults, at least in Canada you don't have to worry about getting snuffed out by the medical bill. As I mentioned in that other thread about health insurance, in the state of Washington now, NO insurance company will take on an individual. Period. So when I hear people whining about and politicians making hay about preserving free choice in who your physician will be, I've got to snort: we uninsured don't have even the luxury of complaining about that issue. I resent immensely being expected to contribute to the whole class of middlemen which is the insurance industry. I wouldn't mind paying for health care, but I do not wish to help buy insurance parasites their fancy cars and consumer items. And the salaries which most doctors consider their due are exhorbitant. Yes, indeed, many do work hard, many have studied long, but so do many others professions and ordinary working class folk. That they may sometimes save lives -- well, they should consider that an extra reward and priviledge, not a rationale for extortion.

-- snoozy (allen@oz.net), June 01, 2000.

Oh, one more thing, when I had my appendix out without insurance, no one could tell me how much it was going to cost. I refused surgery for hours because no one would give me even a ballpark on how much it might cost. "I can't afford to eat in restaurants with no prices on their menus," I said. Finally, the 5th year resident who actually did the surgery, talked with someone in accounting and gave me an estimate, which, as it turned out, was $1500 higher than it actually cost. My points are that A] medical personnel themselves don't know what costs are involved, and B] by the time you see the bill, you've already agreed on their little hospital form to pay for WHATEVER at whatever rate they decide. To get them to do anything, you have to basically sign over a blank check. Such a deal.

-- snoozy (allen@oz.net), June 01, 2000.


As far as the medical community charging more to people without insurance, so do dentists and they are worse about it. I needed a tooth capped and we have no dental insurance. When the quote from the dentist seemed rather high, I questioned him about it. I asked what the charge would be if I had insurance and it was literally half what he wanted me to pay. Needless to say he is not my dentist any longer.

Here in rural Iowa, good medical care is very spotty. The hospital where we live MIGHT send you a bill, but when it finally does, it is always marked overdue and then sent to collection (sometimes sent to collections first! ! ) and getting them to submit to the correct address for your insurance is a real pain.

We are buying BCBS since my Cobra is running out. We went without insurance for a number of years since we couldn't afford it, but we are getting older and it is just too risky to be without it now. We have more to lose. When you have nothing it isn't such a risk.

Also last year my daughter ran up over $30,000 in medical bills, luckily we had 2 insurances during that time and almost all of it was paid.

-- beckie (sunshine_horses@yahoo.com), June 01, 2000.


One of the times when I didn't have insurance but was suffering, my, long time family doctor saw me for free. Only his office bugged me for a year to pay for the visit when I couldn't. Then when I had insurance again, the office billed the insurance who, of course, refused to pay. Other times I've had doctors say they will accept less because I will pay at the time of the visit instead of their having to bill an insurance company and having to wait. Only the office bills me continually for the remainder of their fee even though the doctor repeatedly tells them not to. Communication between the doctor and the staff in billing would be great. Also, those medical bills are, I think, designed so that the average person can't figure out what is what and will just pay the 'amount owed' column. I know mistakes are made, I've had it happen alot to me, so I want a bill I can understand. I've also had the office bill an insurance company where I haven't had a policy for years. That has to drive the price of medical care up. Mostly I just try to stay away. Even when I do have insurance, the company finds a loop hole and refuses to pay.

-- Cheryl Cox (bramblecottage@hotmail.com), June 01, 2000.

My handicapped daughter is on medicaid, and I haven't got a clue about how it works or what it is good for. No one explained anything to me when I went in to apply, I guess they just assume that everybody they see is an old pro at "working the system". We stay out of the doctors office as much as possible, and so far, thankfully, haven't had anything really major -- nothing we couldn't have paid for ourselves, eventually, if we'd been without insurance. And when we were without insurance for several years, again, nothing major happened. But now we are looking at starting over elsewhere, and trying to make a living from a small farm, and my husband and I are in our forties, and will be without insurance again -- it's sobering. I trust God to take care of us, and to be honest, the more I see of doctors, the less I trust them, but sometimes you don't have much choice -- and those are the times that you end up with the big bills.

-- Kathleen Sanderson (stonycft@worldpath.net), June 01, 2000.

The part that I don't get is the difference in medical costs in different regions of the country. I was without insurance for several years when my children were little and we were travelling quite a bit.

In Montana, a doctor visit was twenty dollars and the antibiotic was thirteen dollars. Four weeks later, in southern Kansas, the doctor was seventy-five dollars and the same prescription was thirty! The disparity of prices from the three regions of Pacific states, Rocky Mountain and Mid-west was incredible.

While I do not understand this phenomena, I am sure it must have some impact on insurance rates for everyone, everywhere.

-- Laura Senderhauf (gsend@hotmail.com), June 02, 2000.


These are my answers to your specific questions:

Issues -- I skip routine appointments for things like GYN annual visits to save money. I hesitate longer about whether or not one of my four kids needs to go to the doctor for prolonged fever. I have to try to assess if a wound really needs stitches. Of course, this is a shame, as I shouldn't avoid routine check-ups or make medical assessments.

Read/web info regarding medical bills -- No, I don't.

Policies for payment -- I have read and re-read the policy manual, and I am aware of what is covered and not covered. I am vaguely familiar with the guidelines for precertifying a hospital stay and what is covered 80/20, etc. But all that aside, regardless of what will be covered, if one of the kids needs a leg set, we're going. Now, when I broke my toe last year, I waited a week to go.

-- Rachel (rldk@hotmail.com), June 02, 2000.



Insurance is a scam and should be illegal. Hospital and related costs, especially drugs are out of sight. Give me socialized medicine - and this is from a hospital RN who would undoubtedly experience a drop in income - though, for what I do, I shouldn't! I tell you, sometimes I'm embarrassed to be working in this "industry".

Two items of note on this subject I came across in my reading recently: first is a full length article, second a condensed version.

Article in the local paper: SBLHC to collect payments up front

Payment guidelines for outpatient procedures at Sarah Bush Lincoln Health Center change on Monday. Payments will be collected at the point of service or when the patient registers, the hospital said in a statement on Friday. Later this summer, point-of-service collections will be implemented for inpatient services. The current practice is to mail bills to patients after they receive services. Business officer interim manager Kim Wheelersaid point-of-service cllection is common in the health industry. Physiscian offices and clinic sites affiliated with Sarah Bush have similar policies in place. "This process helps our patients understand their roles as consumers of health care," Wheeler said in a statement. "When they register, their co-payment or co-insurance will be calculated so they know what portion of the bill they will be responsible for before the procedure is done." Based on the procedure, patients will be aksed to pay a portion of their bill to cover their deductible and their co-payment or co-insurance. Those wishing to know in advance how much a procedure costs may call 258-2594. although an exact figure may not be available because of a number of variables, a cost range will be provided. The health center said point of collection service help it to operate more efficiently. "It will cost us less to collect co-payments or co-insurance on a face-to-face basis rather than 30, 60 or 90 days later," Wheeler said. "Additonal costs are incurred when we have to send multiple bills, spend time trying to contact the patient and eventually collecting payments." Patients will have several payment options, including using credit cards and applying for low interest loans. Patients with limited financial means are invited to discuss payment options with registration office representatives. Currently, about 60 percent of outstanding payments are from Medicare. The rest are from insurance companies and private-paying patients. "It's difficult to operate a hospital very efficiently and keep costs down with large amounts of outstanding balances," finance director David Meeds said. "We spend a lot of time and effort working to collect payments long after services are received - that's money that could be in the bank earning interest, strengthening our bond rating and going toward equipment uprades." For more information, contact Martha Wingler at 258-2594 or 348-2594.

Article in RN magazine, May 2000 issue:

Incorporate Now!

Gist of this article is how nurses should establish professional corporations, rather than work as hospital employees, so they can bill independantly for their services. This article is way too long to put on here, but I would be happy to discuss it via private e-mail with anyone. I'm not in favor, by the way. I am in favor of Nurse's Unions, however , in case anyone wants to discuss that.

-- Polly (tigger@moultrie.com), June 03, 2000.


Just call me Joel Hoffa and lets start the TeamNursus Union. Last time we mentioned a health care workers union I was in Iowa and the state's response was--any health care provider that participates in any form of work stoppage will be jailed. I believe they called it depraved indifference to life. I think they need to bring back all the types of employees that the hospitals had in 1970. Candy strippers,orderlies,janitors,CNA's, CMA's,LPN's and pillow fluffers. Right now all these duties fall under R.N. and you don't really want my hillbilly translation of what that stands for.

-- Joel Rosen (Joel681@webtv.net), June 03, 2000.

Yes I do!! Hillbilly translate away...

Depraved indifference to life, huh? Be willing to bet that whoever said that probbly packed their Momma off to a nursing home the first time she peed the bed.

-- Polly (tigger@moultrie.com), June 03, 2000.


I've been carrying my husbands' health insurance for almost 2 yrs. now since his sudden death. The problem for me is not only the $755 a month I have to pay for the cobra plan (was not allowed another option) but now when I try to get insurance else where, they tell me NO one will accept me cause of "pre-existing" medical problems. Seems to me my only option is what they call the "hurse plan" (sp). That doesn't sound too comforting! If I am turned down by an insurance co. and then seek a job which carries the same insur., will they still reject me or do they have to carry me anyway? I hate the thought of going without insurance but also can not take any chances of losing our property over some outrageous medical bill.

-- Pat (pmikul@pcpros.net), June 04, 2000.

Thanks so much for all of your responses! Obviously, there are several "trends" I can identify with regard to your responses. a) Lack of control = lack of frustration. I think this is best represented by those of you who feel that you can't fight the system because you're not sure how. This leads to..... b) Lack of knowledge about how the system works. Even those who work in the health care industry, specifically with health insurance, are hard put to keep up with changes, fees, rules and guidelines. This should not excuse a hospital, for instance, for not providing information on their "charity write-offs" or "payment-at-time-of- service" policies, or providing a price quote, since many hospitals do have some staff member, (usually a patient accounts type person) who can provide at least a ball park figure. I have worked in health insurance billing, coding and reimbursement and I cannot reasonably keep current on all the changes impacting health care. c) Absolutely unreasonable treatment of those without health insurance. These are the people who are most vulnerable to billing issues, unfairly. Several years ago I reviewed some hospital bills for a good friend who's child had to have an emergency surgery. They were without health insurance at the time, although they did have some financial resources to defray costs, however, my friend (very astutely) kept a diary of her daughters treatments, surgery, medications and physician visits. I was able to effectively review the detailed hospital bill and determine that they were being charged for multiple IV sets per shift, (Her IV set was only documented as changed twice over the course of her 4 day stay.) In addition, the child's stitches came loose and she was re-admitted for an additional repair. The second bill reflected a visit by the respiratory therapist which never took place. Over all, the bills came down by over $400. The best offense is a good defense and my friend was extremely astute in keeping track of the services and supplies provided. I think it was Janice who pointed out that people often don't realize they can request detailed bills. Absolutely request them, (even if you have health insurance) and have a knowledgeable medical person look them over (if possible). If you don't know anyone who can look the bill over, you should be able to track some of the discrepancies (surely there will be some) if you kept a diary detailing the stay or service. I am hoping to create some kind of "Self Defense for the Uninsured" manual which will hopefully provide some basic understanding of the system and how to get through it. Any additional feedback on this is welcome. If it's any consolation to you all, one of the U.S. Attorneys under the department of Justice is getting ready to go after pharmaceutical companies, particularly for their questionable "gifts" to physicians and hospitals. These types of relationships are often in violation of the Stark Laws governing such business marriages. They drive prices up for those without the coverage. Thanks again all, and please feel free to e-mail me directly if you should come up with any other comments. Oh...one last thing...I too at one time thought that a hospital could come after your home if you could not pay the bills. That is not so! While a hospital may be no different than any other creditor, they can't take away your "shelter". In the case of homesteaders, shelter is everything. But I can tell you that I have known people (who owed money for medical services) to whine that if they pay the hospital bill, they can't pay their cable bill! It's incredible that something as important as one's health is equated to keeping cable. Also, I have known adults to refuse to pay their ($1) co-pay for state medical assistance during an office visit, because they need the money for a pack of cigarettes! I'd love to have an insurance that only required a $1 co-pay! There are two sides to every issue. I happen to be on the side of the uninsured.

-- Laura (lbaumgardner@blazenet.net), June 04, 2000.

I had an Mri last year. The retail cost $1050.00 They discounted to the insurance company down to $655.00. I had a 20% co pay on that amount. There is something wrong with this. Why does the Insurance company get a discount when I don't.

-- John A Maughan (jmaughan@mmcable.com), June 05, 2000.

John, It's not that the hospital "discounted" the insurance company. The insurance you have is likely one which your hospital "participates" in. this means that the hospital (or doctor) will accept what the insurance pays as payment in full (less coinsurances and/or deductibles.) The hospital agreed to accept $655 as the allowable amount with your portion as 20% of that amount. This is not unusual. Unfortunately, this is where people without insurance loose out. They have to pay the total billed. There is a possible alternative for those without insurance....while it is illegal for hospitals to "discount" services because this is considered a form of fraud, they may have policies established to provide "charity" write-offs for those who are indigent or without insurance. Please understand, I am not placing indigence and lack of health insurance in the same category, however, the hospital should have some policy to accomodate these people.

-- Laura (lbaumgardner@blazenet.net), June 05, 2000.

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