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US health insurance

Old Dec 10th 2021, 11:09 am
  #181  
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Default Re: US health insurance

Originally Posted by Steerpike View Post
I was a classic workaholic until I was just over 50, happily working away all day and never exercising (miraculously, staying skinny). My doc convinced me I needed to exercise for the benefit of my heart, so I took up hiking, and loved it. When I first started, I was totally out of breath but my 'cardio' system adapted and I could then hike for miles at a fast pace and hardly felt anything. Recently I started going to the gym also, working on body strength and 'core' issues. The 'heart' issues seem to have started with the gym activities, coincidentally or not. So on the one hand, it seems the exercise 'improved' my heart function, but then, I wonder if it may have also caused the 'electrical' aspect to get messed up. I was so pleased with my added gym routine but now I'm not so sure ...

I filed a formal 'appeal' to the $3,500 charge with the ins. co, and also pursued it with the cardiologist. I already got a call from the cardiologist saying they would reverse the charge, but I haven't seen a reflection of that on my insurance 'page' yet.
Sounds like the insurance charge appeal is going in the right direction, that should reduce the stress levels a little and help with the heart arrythmia (I could definitely trigger episodes with stressful situations).

I was always physically very active and fit but had several surgeries to fix joint problems over the years, in a foot, both knees, lower back and both shoulders. I always used to joke that the bodywork may be rusting but the engine is good. I used to get an "executive" physical every year with my job and at age 40, and every 2 or 3 years after, the company doctor would send me for a treadmill stress test, my last one being at age 54, the year before I retired (my resting HR on the ekg was always in the 40's). On that last test the cardiologist said the results were "spectacular, and I mean spectacular". He also stressed that while there appeared to be a very low risk of cardiovascular problems, this was only a test and I could have an event tomorrow, next week, next year.... I lasted 6 years before turning up at an ER on a Sunday night with a racing heart and irregular rhythm.

I think once you get under the care of an EP you may find some good options are available.
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Old Dec 10th 2021, 7:39 pm
  #182  
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Default Re: US health insurance

Originally Posted by Steerpike View Post
Anyway - do you happen to know, if you move 'mid-year' as allowed, what happens to your deductibles, etc? Do they all re-start at zero when you move to a new insurance company?
Yes they all get reset unfortunately.
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Old Dec 11th 2021, 2:30 pm
  #183  
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Default Re: US health insurance

Originally Posted by hutchison View Post
thanks, must say the time between injury & billing is nerve racking, i was confident with the policy but always err' on the side of caution. If i was a contractor, I would be asking the insurance company to give me the 'in network ' addresses & names for emergency medical services by state, and you can usually do that by punching in the zipcode for in network providers on your insurance site. Locally, we are mostly covered by in network.

just for refs tooth extraction is surgical wisdom probably 1.5-2.5k after ins, just guessing.
oh wow. I paid privately through bupa to have a wisdom tooth root removed under sedation in March and it was £280 😢. I’m so sorry to hear of the cost for you. We are currently going through the financial aspects of whether to move to the us or not and it’s these hurdles that scare us.
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Old Dec 11th 2021, 11:54 pm
  #184  
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Default Re: US health insurance

Originally Posted by John123456 View Post
2. I've watched some horror stories about people having good health insurance and still having to pay out of network expenses.
One man had a heart attack, was taken to the nearest hospital by his neighbor, apparently the hospital wasn't in network and he received a bill for over $100K, which his insurance didn't want to cover, because the hospital wasn't in network, and despite it being an emergency, which aparently was covered by his health insurance, even if he was treated in an out of network facility.
Not a horror story but my current insurance through my work consistently tries to use 'out of network' on most of my claims. The last issue i had with them went as follows. I called them and confirmed that the provider i was seeing was in network before heading out. I also took a screen shot of the facility info on the insurance website, which stated they were in network. Still, a couple weeks later i get a notice of a bill saying out of network.

This is where it is not a horror story. I've discovered it's just something they try and pull, it's frustrating but once you call them and be angry with them for a bit they quickly reverse the charges.

My boss switched to this insurance because they cost less. I can see why.
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Old Dec 12th 2021, 12:49 am
  #185  
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Default Re: US health insurance

Originally Posted by cheradenine View Post
Not a horror story but my current insurance through my work consistently tries to use 'out of network' on most of my claims. The last issue i had with them went as follows. I called them and confirmed that the provider i was seeing was in network before heading out. I also took a screen shot of the facility info on the insurance website, which stated they were in network. Still, a couple weeks later i get a notice of a bill saying out of network.

This is where it is not a horror story. I've discovered it's just something they try and pull, it's frustrating but once you call them and be angry with them for a bit they quickly reverse the charges.

My boss switched to this insurance because they cost less. I can see why.
It is a horror story though because insurance companies pull this stunt all the time because they know that a certain percentage of people won’t pursue the charge. Every person that doesn’t is extra profit for the insurer.
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Old Dec 12th 2021, 1:00 am
  #186  
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Default Re: US health insurance

Originally Posted by Giantaxe View Post
It is a horror story though because insurance companies pull this stunt all the time because they know that a certain percentage of people won’t pursue the charge. Every person that doesn’t is extra profit for the insurer.

Agreed. The first 5 or so years, I was always calling/challenging the insurance company. I guess in the end they gave up before I did
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Old Dec 12th 2021, 8:04 am
  #187  
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Default Re: US health insurance

Originally Posted by Giantaxe View Post
It is a horror story though because insurance companies pull this stunt all the time because they know that a certain percentage of people won’t pursue the charge. Every person that doesn’t is extra profit for the insurer.
Something else I learned as early as 1990 is that when a medical facility owes you money they won’t voluntarily refund you, you need to ask for it. In 1990 I came to collect my wife from hospital after an overnight stay and they would not release her until I paid over $5k. I told them that we had already exceeded our excess for the year (I’d also had surgery in a different hospital) and insisted they call the insurance company to confirm. Unfortunately it was a Saturday morning and we got the message “Our office hours are….” So I had to pay. After the insurance company paid the bill in full I waited about 6 weeks then called the hospital who confirmed that our account was over $5k in credit and that a refund payment was not scheduled so I had to insist that they send me a check asap.

From that point on I kept a spreadsheet going to record all the claims and payments and would call the facility, including our GP offices, to claim back the overpayments. They always accept credit cards but only pay back by check. In 2015 the heart centre I had been attending ended up owing me over $6k and we had delayed a 6 month trip until I was cleared to go by the cardio doc. I turned up for what I expected to be my last appointment and the receptionist said that it would be a $30 copay so I asked her if I was not in credit? She checked and confirmed the huge credit and asked if I wanted the copay to be paid out of that, to which I replied yes, and I want a refund. She called accounts and requested the refund so I asked her if it would be paid to the credit card on file and she said no, it had to be a check so I told her that I needed the check today because tomorrow we are setting off on a 6 month driving tour of the US and Canada and the check would have expired by the time we got back, and in any case I needed the money to help fund our trip.

Even after my appointment I had to hang around another 30 minutes before they could produce the check because most of the only doctors authorized to sign the check were not in the office. (It was a Friday so no doubt on a golf course somewhere).

Rant over, thanks for listening if you made it this far.

Last edited by durham_lad; Dec 12th 2021 at 8:06 am.
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Old Dec 13th 2021, 11:38 am
  #188  
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Default Re: US health insurance

I can tell that story is from the 90s. There's no way you'd get a check same day now with everything being electronic.
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Old Dec 13th 2021, 12:14 pm
  #189  
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Default Re: US health insurance

Originally Posted by civilservant View Post
I can tell that story is from the 90s. There's no way you'd get a check same day now with everything being electronic.
That same-day check was in 2015, Houston, Texas.

I never ever had a health provider refund me any other way, usually a week or 2 after requesting it. Of course we only ever lived in Texas and Louisiana, maybe more northerly States were fully electronic.
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Old Dec 13th 2021, 5:53 pm
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Default Re: US health insurance

I occasionally receive checks in the mail from various hospital bills that have overcharged me, some I didn't even realise. I'm currently waiting to see if my kids' dentist overcharged me by $500 last month or if they just messed up their bill to the insurance.
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Old Dec 14th 2021, 10:44 am
  #191  
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Default Re: US health insurance

I never ever had a health provider refund me any other way, usually a week or 2 after requesting it. Of course we only ever lived in Texas and Louisiana, maybe more northerly States were fully electronic.
What I meant to say was more along the lines of someone being in the office that can sign the check. It todays world sigs are electronic, but check payments are usually generated in once weekly runs and not generated on an ad-hoc basis - it saves the company money.

That said, if it was a small medical practice, I suppose you might still have the MD that 'owns' the practice be able to sign a real check.
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Old Dec 14th 2021, 12:26 pm
  #192  
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Default Re: US health insurance

I have had health insurance through working at a public high school for over 25 years now. Not at all a fan of the US health system, which is health insurance, not health care. What is truly sad, is that this health insurance company in Utah, a non-profit, ha ha, is often held up as an example for the rest of the states to emulate, showing how US health insurance works!

Almost without exception, every single bill I have ever received, takes at least 2 months after the service was provided, and is wrong. Of course, never in my favor. Invariably, it comes down to the billing codes used, and requires multiple phone calls to both the insurance company and the service provider. After hours on the phone, and months later, each medical bill is eventually sorted out. I am sure most people give up or just pay their bill. The health insurance codes are so complicated they rival the IRS tax system. The minimum wage billing clerks really do not have a chance, the system is broken.
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Old Dec 14th 2021, 2:11 pm
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Default Re: US health insurance

Originally Posted by civilservant View Post
What I meant to say was more along the lines of someone being in the office that can sign the check. It todays world sigs are electronic, but check payments are usually generated in once weekly runs and not generated on an ad-hoc basis - it saves the company money.

That said, if it was a small medical practice, I suppose you might still have the MD that 'owns' the practice be able to sign a real check.
It is a big practice, about 15 cardiologists and lots of lab area to do echocardiograms, stress tests etc. That is another bugbear of mine, the tests they prescribe. On arrival at the heart hospital here in England with all my test results etc in hand from Houston, one on the doctors asked why I was given a nuclear stress test when it was obvious I was presenting with AFib. I had to respond, "I don't know, but the insurance company paid up which was all I cared about". While waiting one time in their waiting room that first visit I took time to read all the small print in the documents I was signing. A new rule during the implementation of the ACA meant that doctors had to disclosure any financial links to other medical facilities or labs that they may refer a patient to (in the private world conflicts of interests like this are strictly illegal, and in my job we went to great lengths to make sure that didn't happen, and we, and our computer systems, were audited every couple of years on this). I could see that some of the doctors in that practice were part owners of the labs in the building, so by referral to tests they were also personally making money off me.

https://wnhhc.com/
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Old Dec 14th 2021, 2:22 pm
  #194  
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Default Re: US health insurance

I could see that some of the doctors in that practice were part owners of the labs in the building, so by referral to tests they were also personally making money off me.
Not wholly surprising. My company owns the following on top of a acute care hospital, all of which refer to each other.

- Skilled Nursing Faculties
- Medical Transport
- Hospice Services
- Pharmacy Services
- Home Health
- Outpatient Rehab
- Medical Distribution Company
- Durable Medical Equipment producer
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Old Dec 14th 2021, 2:38 pm
  #195  
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Default Re: US health insurance

Originally Posted by civilservant View Post
Not wholly surprising. My company owns the following on top of a acute care hospital, all of which refer to each other.

- Skilled Nursing Faculties
- Medical Transport
- Hospice Services
- Pharmacy Services
- Home Health
- Outpatient Rehab
- Medical Distribution Company
- Durable Medical Equipment producer
At some point in the '90s the healthcare industry got itself exempted from the antitrust laws that cover all private corporations. This means a company can buy up as many other facilities in its area as it wants thus removing free competition by creating a monopoly. Health insurance companies are allowed to get together and set prices, and carve up the marketplace. There are many, many areas in the US where only a single health insurance company operates, because they agree among themselves who should operate where, saves all that nasty competition to win business by having the lowest prices or best service. In my job I've been through several antitrust training seminars and yet we still got sued multiple times and had to defend claims that we colluded with another business to set or raise the prices of our products, plus shortly before I retired we were well into a merger with another company before the SEC decided that it would give us an unfair advantage in the marketplace.

The largest purchaser of prescription drugs in the country is Medicare but when prescription drugs were finally added to Medicare about 15 years ago it was on condition that Medicare could not use bulk purchasing to get cheaper prices out of the drug companies.

Last edited by durham_lad; Dec 14th 2021 at 2:42 pm.
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