scrubbedexpat097

The problems you can run into though are you might have selected an in-network surgeon but the anesethiologist he uses isn't in-network. Then you have a whole new kettle of fish to fight with


( I know I spelled the big word wrong.....)

Giantaxe

Not that I am going to defend the mess that is healthcare access in the US, but conceptually that's what "insurance" should be for - a pooling of the risks. Regardless of whether you are in good health, shit happens, and shit costs $$$$ in this country. My healthcare costs have been minimal for years until this year. But just one issue over the last few months has seen me blow through a five figure sum in tests alone.

ChocolateBabz

I agree but think that the premiums should cover 'full service' and not just part. I know that you can get policies like this if you want to pay $$$$$ but obviously not everyone could afford that. I also heard of a doctors office here in Houston that now wants to offer 'concierge service' - you pay them @ $6000 per annum to join their practice on top of your insurance premiums the idea being you will get better service as they will limit their practice to x amount of patients.

Noorah101

I have United Healthcare through my employer. Five years ago I had bunion surgery and since then I need special inserts for my shoes every 2 years. I use an in-network doctor. The first pair of inserts I got were covered 100%. Two years later, the next set I got was covered 100%. A few months ago I went for my third set of inserts, I assumed they would be covered 100% again...but no, I got a bill from the doctor for $500 for the inserts! I called UHC, they said as of last year my policy changed and they no longer cover orthodics. She basically said it's my responsibility as the patient, to look ahead and find out what's covered and what's not. Well...I agree...but I guess when something's been covered for 5 years, you don't really expect it to suddenly NOT be covered. I even wrote a letter to UHC asking why these are no longer covered...it's not like it's cosmetic...I need them to walk correctly to prevent further damage! (I guess they want me to have further damage so I can then get more surgery...) The letter was acknowledged, but made clear that this type of thing is no longer covered. Ugh. Now I'm paying $50 a paycheck to get THAT paid off. Don't know what I'm going to do 2 years from now...better start saving for it NOW.

Rene

AdobePinon

My employer just dumped United from our list of insurers. I am pleased, but not naïve.

meauxna

And guess how much the orthotics cost, retail, without insurance?
$500
(seriously)

cindyabs

It's even less nice to have the treatment for obesity- 1,000 would be a pretty expensive enema.

cindyabs

We have a doc like that here, but it's 1500, a bargain I guess,

cindyabs

So, I contacted the ortho surgeon as suggested by my BFF to see if I could get cost of surgery reduced due to our reduced circumstances. They DO offer indigent care and write off a certain amount. The surgeon will reduce his charge by 50 percent. I don't know yet about the amount the hospital or the anestheseologist reduced cost.
The only problem is that the dr STILL wants his 50 percent fee up front. Ironically, I can now use DH's COBRA coverage, pay the deductible and the 15percent of the charge and it's LESS than his 50 percent reduced fee. Either way, since I do not have the money I have to charge it.

Englishtart

Had an interesting last 90 mins (i'll never get back) talking back and forth between PCM, insurance co (Tricare) and a GYN Dr, i have never been to before.

My PCM told me I need to go see a GYN (not regular yearly exam) I say "fine" and get online to look for one in my area, I found one in a practise, so called them up to ask about insurance/appointment. Very pleasant receptionist, tells me I need a referral from my PCM and makes the appt' for next Wednesday

I spend the next 80 mins, going back and forth between all 3 after being told by my PCM that "it's the law now, you don't need a referral for an appt" The new GYN insisting that I do, my insurance saying it's down to your PCM

Eventually the nice receptionist (not so nice after numerous calls) tells me, "no referral, no appt" My PCM eventually says "give me details, I will send 'you' a note in the mail"

Why can't these people 'talk' to each other? Jeez! I'm worn out!

ChocolateBabz

This drives me mad as well - our Healthcare Plan states that we can go straight to a 'specialist' bypassing our PCP. But how do you know which specialist you need without seeing your PCP? My son had what I thought was a small ganglion cyst on his finger so I called our 24 nurse line who told me I should see my PCP as even if I went straight to a hand specialist they would probably want you to see your PCP before the op anyway. When I saw our PCP she said it looked like a cyst and referred me to a hand specialist - ka-ching $100 for nothing!

scrubbedexpat097

I know it's annoying and expensive but if you were in the UK you would take him to your GP first, right, who would then send you to a specialist. Same thing really except you have to pay all the co-pays.

I'm not sure by-passing the PCP is always a good idea anyway. A lot of conditions mimic each other so you may make yourself an appointment for arguments sake with a gastroenterologist because you think the acid reflux/heartburn is digestive related when maybe you should be seeing a cardiologist because it is actually your heart. At least your PCP can steer you in the right direction

Englishtart

It just seems to me sometimes, that they expect you to do all your own 'legwork' why is it that if your PCP reccomends you see a specialist, they can't make the call and sort out the 'permission' first? One call from them would be enough surely? I had to make at least a dozen calls between 3 offices, to get it sorted this morning

Bob

While ranting about cost of care....my word, parking cost, ouch...just a bit silly.

One thing that is a wee bit annoying, the baby regular health checks are covered by insurance, which is good, but we're left $4 out of pocket, this is the case every time, but the doctors admin person just won't let us pay it while we pay the $20 co-pay ad will send us a bill asking for a cheque and they wonder why we keep forgetting to send it in.

HoosierDaddy

Got this back from UHC (via my HR person at work):

< Hi,

I have spoken with the technical support team regarding this specific situation. It has been brought to my attention that the radiology services are being based out of an "office setting" vs. outpatient facility.

That is why there is a significant difference in the cost. The technical team for myuhc.com is going to add some language to notify members that this is based off of the location as "office setting" vs. outpatient facility and to be aware that their cost could be higher when services are rendered at an outpatient facility setting vs. an office setting. We all agree that a CT Scan will more then likely not be done in an office setting and that was our first clue that there was an issue with the cost estimator.



We understand for this member that they were expecting the CT scan to cost the amount (approx) indicated on the site but in reality that was not the case. >

So that's it. I'm SOL 'cos they show 'Office' on the Estimator knowing full well that it would be an outpatient setting for a CT scan.

B*stards.