OT - NO POLITICS Off Topic 2019 part XVIII - Treat or Trick

[jgatie]

I believe it is about having choice and from what I gather (correct me if I'm wrong) there isn't much of a choice in the US. At least your friends who moved to Canada had the choice between public and private, unfortunately they got sick and subsequently felt they would have been better off with private.

I don't know what taxes you pay there but here it is around 30-40% of your income depending on what you earn and personally (everyone is different) I'd prefer to pay a couple of percent more in income tax knowing in the case of an emergency I can just walk into a public hospital and I am covered.

Canada is universal payer, there is no choice between public and private.

Emergency room visits are covered no matter the patient's insurance status or ability to pay. A US hospital cannot refuse an emergency.

 

[Deleted]

Emergency room visits are covered no matter the patient's insurance status or ability to pay. A US hospital cannot refuse an emergency.

So in that scenario a person wouldn't be billed afterwards?

 

[Glove Malfunction]

I pay $688 a month just for myself with Anthem BC/BS. It is going up to $ 775 in January. This is with a $ 6100 deductible and an out of pocket max of $ 8150. I have drug coverage too but since my meds are generic the co-pay is just $5 apiece but that's going up to $10. I get one physical, one annual with the OB-GYN and one mammogram a year with zero charges for the visits or tests so that's something.

I pay a bit less (~$450 a month), but have an $8400 deductible. It has definitely affected my care decisions. Needless to say, I'll be choosing a different plan this coming year.

This seems a germane conversation, because I got a call from my previous insurance company this morning after they did an audit and found that CVS billed a prescription (non generic, unfortunately) to them in March, when the coverage had ended at the turn of the year. She said she'd help me file a claim with my new insurance, but with my deductible, I'm pretty sure it won't get paid, so I'll be out like $900.

 

[Glove Malfunction]

Canada is universal payer, there is no choice between public and private.

Emergency room visits are covered no matter the patient's insurance status or ability to pay. A US hospital cannot refuse an emergency.

It is true that US hospitals cannot refuse to treat someone in the emergency room. but that is a far cry from it being covered. They will absolutely provide the care. But they will also absolutely bill you for it if you don't have insurance.

 

[jgatie]

So in that scenario a person wouldn't be billed afterwards?

Got stabbed in the eye by a drunk wielding a glass back in 1994. I didn't have insurance. Geisinger Hospital in Wilkes-Barre PA saved the eye via emergency surgery. Never got a bill. Eye needed more surgery to save the sight. Got referred to Mass. Eye and Ear for a retinal reattachment and vitrectomy, a very serious surgery at the time. Never got a bill.

To tell the truth, Mass Eye and Ear probably made money off me, because they flew in 6 surgeons to observe and billed their hospitals for the training. Teaching hospitals are big in this area.

 

[jgatie]

It is true that US hospitals cannot refuse to treat someone in the emergency room. but that is a far cry from it being covered. They will absolutely provide the care. But they will also absolutely bill you for it if you don't have insurance.

And they never collect, and it is against the law to report it to credit agencies. See my story above.

 

[Glove Malfunction]

Not if you need an MRI, a CAT scan, a biopsy, to see a specialist, advanced treatments/procedures, or anything else public health care denies or makes you wait months/years to get. I have friends who moved to Canada, took them one bad illness to wish they could have the supposedly terrible US health care back.

To be fair, both the US and Canada have very good to excellent health care. They just take two very different approaches to pay for it.

 

[jgatie]

To be fair, both the US and Canada have very good to excellent health care. They just take two very different approaches to pay for it.

Yes, Canada concentrates on preventive medicine and general practitioners, so specialties and advanced procedures take longer to see or get, if available at all. They are probably healthier overall, but I'd much rather be in the US if something bad or rare happens. The doctor told me there were only two places in the world that could save my sight back in 1994, luckily one happened to be in my hometown, the other was Johns Hopkins in Baltimore.

 

[Glove Malfunction]

And they never collect, and it is against the law to report it to credit agencies. See my story above.

This is not true. They may not have collected in your case, but they absolutely bill for their services. I don't know when your incident was (which sounds scary indeed), or what Pennsylvania had as far as a free care pool or other recompense mechanism at the time. Based on my almost 20 years in health care, I can guarantee you they don't just write off every single bill for someone without insurance. Someone got a bill, it just may not have been you. And it may have been unique to the circumstances in your case that time.

As an aside, you're lucky to have been seen at MEEI. They are some of the best surgeons in the world.

 

[Deleted]

Got stabbed in the eye by a drunk wielding a glass back in 1994. I didn't have insurance. Geisinger Hospital in Wilkes-Barre PA saved the eye via emergency surgery. Never got a bill. Eye needed more surgery to save the sight. Got referred to Mass. Eye and Ear for a retinal reattachment and vitrectomy, a very serious surgery at the time. Never got a bill.

To tell the truth, Mass Eye and Ear probably made money off me, because they flew in 6 surgeons to observe and billed their hospitals for the training. Teaching hospitals are big in this area.

Free or not, I'm glad your eye was saved and you got the treatment you needed. Horrible thing to have happen.

 

[Gee Wally]

It's just two different ways of doing things. If I go to a doctor and he says I need an MRI, I call the MRI center and get it in a day or so. If I need to see a specialist, I call for an appointment and get it in a day or so. Nobody from the government has to approve it, there are a dozen or so MRI or specialist joints within driving distance, and I don't have to wait. But I pay through the nose for health insurance.

Other countries regulate what you can get, you are put in a long line to wait, emphasis is placed on General Practitioners instead of specialists, less populated areas often are not allocated the expensive machines needed for diagnoses, and you pay through the nose in taxes. But health care is free.

ummm..it also depends on each of our individual insurance plans and companies.

Dr. Welby doesnt just walk through that door either.
As well as what they will or wont pay for. I've had many contested issues over the years where with BCBS I've had to put up a fight.

So it isnt also 'other countries' but also 'other insurances' here in the States.

 

[jgatie]

ummm..it also depends on each of our individual insurance plans and companies.

Dr. Welby doesnt just walk through that door either.
As well as what they will or wont pay for. I've had many contested issues over the years where with BCBS I've had to put up a fight.

So it isnt also 'other countries' but also 'other insurances' here in the States.

True. I didn't mean to make it seem like there were no restrictions here. They just aren't government mandated, and in my experience, the services offered are superior to my knowledge of the Canadian system. Both are obviously flawed.

 

[Fenway]

My insurance company is decent but they are a sticker for out of network referrals

 

[jgatie]

Free or not, I'm glad your eye was saved and you got the treatment you needed. Horrible thing to have happen.

Funny story, 20 years after that happened my younger brother was driving through the Big Dig tunnel and a brake drum came off a semi in front of him and crashed through his windshield. Hit him on the side of the head, broke his collar bone, fractured his skull, and tore off most of his ear (it was hanging by a thread). After getting it sewn back on by the ER plastic surgeon at Mass General, he had to have it cleaned out and tested at Mass Eye and Ear next door. My surgeon, Dr. Alex Jalkh, was walking the hallway outside where my brother was being treated. I introduced myself, and he remembered me and the surgery he performed 20 years prior. That's a Harvard guy for you.

 

[Bruinaura]

My insurance company is decent but they are a sticker for out of network referrals

We are keeping our same plan next year with the exception that there is no out of network coverage (used to be a separate higher deductible for out of network).

Since over 99% of our claims were in network, we were comfortable with that. Nashville is a great area for doctors.

Which guarantees that someone next year will turn up with some huge out of network claim and gripe about it.

 

[jgatie]

This is not true. They may not have collected in your case, but they absolutely bill for their services. I don't know when your incident was (which sounds scary indeed), or what Pennsylvania had as far as a free care pool or other recompense mechanism at the time. Based on my almost 20 years in health care, I can guarantee you they don't just write off every single bill for someone without insurance. Someone got a bill, it just may not have been you. And it may have been unique to the circumstances in your case that time.

As an aside, you're lucky to have been seen at MEEI. They are some of the best surgeons in the world.

Sure they send a bill. There's no real penalty for not paying because they can't ding your credit.

As to MEEI, the referring doctor had me going to John's Hopkins because it was closer. I asked about Mass Eye and Ear because it was close to home, and he replied "Ok, so you want the best."

 

[Glove Malfunction]

Sure they send a bill. There's no real penalty for not paying because they can't ding your credit.

As to MEEI, the referring doctor had me going to John's Hopkins because it was closer. I asked about Mass Eye and Ear because it was close to home, and he replied "Ok, so you want the best."

These days, you can also go to Bascom Palmer in Miami, but for my money, I'd still want MEEI.

 

[jgatie]

These days, you can also go to Bascom Palmer in Miami, but for my money, I'd still want MEEI.

Easy choice for me, I needed 6 weeks recovery and my mom was a nurse, so I came back home to the South Shore.

 

[McGarnagle]

The prices that hospitals and medical providers charge for routine things are criminal, and they've gotten away with it for decades because of the insurance market. $100 copay to have a doctor put a tongue depressor in and look at your throat for 40 seconds. $60 for an aspirin tablet at the hospital. I think they once charged my dad like $150 for putting a heated blanket on him when he was groggy after a surgery. It's despicable.

 

[Gee Wally]

Funny story, 20 years after that happened my younger brother was driving through the Big Dig tunnel and a brake drum came off a semi in front of him and crashed through his windshield. Hit him on the side of the head, broke his collar bone, fractured his skull, and tore off most of his ear (it was hanging by a thread). After getting it sewn back on by the ER plastic surgeon at Mass General, he had to have it cleaned out and tested at Mass Eye and Ear next door. My surgeon, Dr. Alex Jalkh, was walking the hallway outside where my brother was being treated. I introduced myself, and he remembered me and the surgery he performed 20 years prior. That's a Harvard guy for you.

Holy crap.

 

[Gee Wally]

My insurance company is decent but they are a sticker for out of network referrals

They should name a room after you at the Mt. Auburn.




Right now the only reason Im still working is because of health insurance need.

I do have to invest some time in researching Obamacare/Mass Health stuff.

 

[Alicat]

Had my mid back adjusted today and I feel like a new person. I feel balanced and I can actually breathe without coughing and even better, my headache stopped a few minutes after I left the office.

My lower back is a work in progress but I'm pain free and I haven't had any numbness down my legs in 2 weeks.

Slow and steady wins the race.

I pay $30 per visit and I met my deductible in network so I won't truly know how much extra it will cost me until they actually bill my insurance.

 

[rfournier103]

Had my mid back adjusted today and I feel like a new person. I feel balanced and I can actually breathe without coughing and even better, my headache stopped a few minutes after I left the office.

My lower back is a work in progress but I'm pain free and I haven't had any numbness down my legs in 2 weeks.

Slow and steady wins the race.

I pay $30 per visit and I met my deductible in network so I won't truly know how much extra it will cost me until they actually bill my insurance.

I see a chiropractor every week to get adjusted. Since my insurance only covers a handful of visits, he offers a very generous per-visit plan after the insurance is exhausted.

One of the best decisions I’ve ever made.

 

[Troublesome 85]

This makes me happy. Finally I see a case where the guilty are being held accountable. Tired of seeing people being let off or getting slaps on the wrist because they're young or some other nonsense excuse. These dumbasses were literally on social media not showing remorse and telling each other not to "snitch". Too bad its not snitching when ur not in the life. These kids couldnt even live that life. But will get a whole dose of it in prison.

 

[Alicat]

I see a chiropractor every week to get adjusted. Since my insurance only covers a handful of visits, he offers a very generous per-visit plan after the insurance is exhausted.

One of the best decisions I’ve ever made.

I am so glad I decided to try it again because it feels damn good to wake up pain free.

I'm not sure how many visits I get but I do know it re-sets after 1/1