| Author | Message | ||
     Blake |
You don't get if for nothing. You earned it. Never forget that. | ||
| P_squared |
My grandfather, may he rest in peace, had to be driven 3+ hrs. 1 way every 2-3 weeks to the VA for his meds & treatment. Great that he got the care & it was paid for by his service in WWII. Not so great that it was an 18 hr. day every 2-3 weeks (~6+ hrs. driving, ~12+ hrs. doing paperwork, waiting, testing, etc.). You're correct in that not every VA is created equally. | ||
| Lemonchili_x1 |
I'm not sure if I want to get involved with this thread, but I'm curious how things work in the U.S. So here's a hypothetical situation - Say you're at home and you're working on your bike and you have a simple accident and injure yourself. Nothing life threatening, let's say you slip with a grinder and cut your hand badly and would at the least need a few stitches. Someone else is home and could drive you to medical care if you decide not to call an ambulance. Where would you go? How quickly would you be attended to? How much would it cost you out of your own pocket if you do have insurance? How much would it cost you out of your own pocket if you don't have insurance? | ||
| P_squared |
ER or "Rapid Care" clinic. Anywhere from immediately to HOURS. Depending on your insurance, "typical" co-pay is $75 dollars for an ER visit. If you don't have insurance, rates can vary by location, however, the ER can not refuse to give you care in the event you can't pay. Clear as mud now? | ||
| Cityxslicker |
That lil ER trip would damn near be 1000.00 bucks. How ?.... And this is based on Seattle regional, your locality numbers may vary. ER consult 95-115 depending on the facility ER facility charge 125 X ray take 125 X ray read 135 ER Surgical Proceedures 245-285 Surgical sutures and prophylactics 65 (to include bandages, aspirin, gloves, disposal) You will have another office visit for 135-155 in about two weeks to remove the sutures. This is considering that your finger was only cut, and not severed. You pay your copay 75.... The real magic starts after the billing The patient accounts bills it to your insurance for the remainder. Say 725 is billed to your insurance. About 15-22 days after your service your insurance company receives it. And DENIES the claim. the hospital comes back to you and bills you. Why did they deny it?... Because when you went in for the accident, you told the ER attending that you did it on your motorcycle, and the diagnosis was coded as accident, the Er notes will say that it occured on/around/by your motorcycle. Your insurance will deny it because at first glance it looks like it is a motor vehicle accident, and hey that could be somebody elses fault, and why should we pay, especially if there is going to be a vehicle insurance,or third party liability that we can bill. (I have seen it a thousand times) so you resubmit the bill with an accident claim rebuttal stating that nope, it was my own damn fault and it happend in my own damn garage, and nobody else is liable. (mean while the business office now has your denial back and has started assessing a late payment fee, a failure to pay goes to your credit, and you start to get fun phone calls from their collection efforts) So if you are lucky, your insuracne company will get to pay the claim in about 45-60 days after your initial visit. If they pay your claim, it will be about 318 bucks. They will cut the ER facility fee in half, the ER consult and Surgery charge will be bundled and reduced, the true number paid on the prophyaltics will be about 20 bucks, and none of the 8 dollar aspirins will be covered. So if it is a participating hospital with in your network, you will not be liable for that remainder. (they will however add it to their total number that they have to right off every year, and adjust their fees for next year based on those budget short falls from unpaid services) If it is a non participating clinic not in your network, you are liable for the remainder (and any of the late fees, collection fees, and interest fees) Read your plan benefits and exclusions very carefully. If they want to, and I have consulted on plans that have done it; if your accident has occurred because of a recreational activity, they can and will deny your claim in total if it is determined to be a named policy exclusion. The big one there that bites everyone is skiing accidents. Your employers health care wasnt meant to pay for it, if you read it carefully, most dont. Motorcycling is not far behind. It would have been worse if you had an ambulance ride. | ||
| Lemonchili_x1 |
"co-pay" isn't a term I've heard before. Is it like an insurance excess, that is you pay the first $75? | ||
| Kilroy |
Co-pay is like your "entrance fee". It is what you are on the hook for just to be seen. The co-pay amount would vary depending on what insurance plan you have. The portion of the ultimate billing totals that you are responsible for is pretty much as described above. Kilroy | ||
| Blake |
I'd expect to pay a few hundred bucks. If during daytime/work hours, I'd not visit the ER, I'd visit my own doctor. He'd stitch me up and send me on my way. Cost would be right around a US$100. Insurance companies vary widely I suppose. ER treatment may too. I live in Texas. Medical costs here seem to be reasonable. My experience is light years different from Cityslicker's. I had a motorcycle crash in 1999. I was in hospital for a full week in a private room, multiple X-Rays and lots of drugs and attention from a host of specialists. I was also ambulanced 20 miles from site of crash to Poteau, OK and then care-flighted (helicopter) to Tulsa, OK. Total cost was a mere $18K of which my out of pocket at the time was around $2K (sum total of all my "copays"). There was no issue involving my vehicle insurance. I don't see stitches for a laceration costing what City imagines, but I don't live in his city. If the doc wanted to take an X-Ray just for a flesh wound, I'd tell him/her "no." Frankly, I'm not sure I'd take off for the ER for a cut. If the cut wasn't life threatening, I'd clean and irrigate, apply antibiotic ointment, wrap and bandage and head to the doc in the morning. The ER is for life threatening or away from home medical issues. That is one of the biggest problems in America with med care right now, over-use and abuse of the ER. They now have another entity at most large hospitals, what used to be the "Emergency Room" is now rebadged the "Trauma Center". This is because the ER has become the med center of convenience. It's why if you go there, you'll have a fair chance of having to wait for some time if all you need is a few stitches. But even at the ER, I'd expect to pay a few hundred bucks, maybe three. (Message edited by blake on August 19, 2009) | ||
| Blake |
But yeah, the guy who needs a few stitches can get stuck waiting in an ER behind the actual trauma cases that require immediate attention. Go figure. | ||
| Rfischer |
'Couple years back, I got a 4 day holiday in a coronary ICU [pulmonary emboli]. Due to a billing mix-up, I got an invoice from the hospital for the most excellent services rendered: $37,000. When my BlueCross/BlueShield insurer paid the bill, they paid $19,000 as I recall [I got a statement of paid benefits from them]; my co-pay was $500. NYS is one of the most expensive states for healthcare and insurance because, like California and some other states, it has mandated an infinite array of treatments and services that must be provided and covered by insurers. Reform that, Mr. Obama, and our healthcare costs will plummet. | ||
| Blake |
Latest scheme from the Obama administration: They want "government" health care, but that word doesn't play well with focus groups, so they called it a "public plan". Now that isn't playing well either, so they have re-jargoned it to "co-op" still with all the same government mandated and government run facets as before. Liars suck.
Wake up America, please. | ||
| P_squared |
"government" or "public plan" or "co-op" or "single payer". It's ALL the same to them. | ||
| Jstfrfun |
Ok Sifo, you'er not getting it, the insurance companies are not competitive except in theyre profits. I say again PROFITS! They exist only to make money, they are not in it for humanitarian reasons, and when a system does exist for humanitarian purposes then those corporate monsters will be threatend into being competitive for the consumer. That is not to say however that the only way that can happen is to have government step in, but our government helped create this mess with there senate bills and "public programs", so maybe it is, we'll see. | ||
| Sifo |
And to get profits you need... Money? And to get money you need... Customers? And to get customers you need... To offer competitive products/prices? | ||
| Hootowl |
nearly everyone in the health industry is in it for the money. They've got to get paid just like everyone else. Insurance companies have to make money. If they don't they die. Then where would the customer be? You say profit as if it was a bad word. | ||
| Jstfrfun |
As soon as you go to the doctor for some issue you now have a pre-existing condition. If you ever drop your insurance for whatever reason, you are now uninsurable, because you are going to cost money. There are profits and then there are PROFITS! There has to be some resemblance of humanitarianism in it some where, dosen't there? If your healthcare company is a profit only company it should'nt be called healthcare, it should be called moneycare. | ||
| Sifo |
Did Michael Moore happen to explain how humanitarianism is going to develop new medical equipment, drugs, and procedures? Pre-existing conditions don't make you un-insurable. That is a false hood. It is typical for that condition to be excluded from coverage that you purchase. Even with the evil profit motive I prefer our system to a socialist system. If BO wants to completely change our system that works quite well overall I think it is up to him to provide an example of the system that he wants to model it after. Only then can you really judge what is being done. All we have now is Hope & Change. Sorry that doesn't cut it when you are hoping to change our country forever. | ||
| Jumpinjewels |
You want socialized full care medical?... go to jail, go directly to jail, do not pass go, do not collect two hundred dollars. So when I stop paying my taxes and go to jail, I'll be taken care of!! A doc I work with made a comment that "we are doomed". I sure hope not. | ||
| Blake |
interesting... | ||
| Blake |
Very interesting!
| ||
| Hootowl |
<rant> It's all BS. Until we get tort reform that includes punitive damages for bringing unfounded/frivolous lawsuits, and limits compensation for actual harm, the cost of health care will never become manageable. Until then the lawyers will continue to suck at the teat of the medical profession, the cost of malpractice insurance will be exorbitant, and all the good/evil intentioned meddling by government officials will do jack squat except make things worse by upsetting apple cart. </rant> | ||
| Blake |
Blue Cross Blue Shield of Texas is part of the Health Care Services Corp. Health Care Service Corporation (HCSC) is not a publicly traded company and does not have any investors. We are customer-owned. That means our “investors” are our policyholders. We answer to them and will always make their best interest our top priority. I just got a quote. Way better than Aetna, better coverage, better price... Blue Cross Blue Shield of Texas Health Insurance BlueEdge Individual HSA (VII) No copay $5K deductible/yr, then 100% coverage $5M max payout 46yo = $120/mo 56yo = $189/mo 64yo = $325/mo HSA: Health Savings Account Bank Savings Account tagged as HSA Contribute up to $3K/yr tax deferred May use to cover deductible & other medical expenses Qualified (per gov) med expenses include eye, dentist, prescrips. All unused including interest rolls over year to year. The Aetna, same coverage at $189/mo is getting canceled as soon as the BCBS of TX comes online. | ||
| Edgydrifter |
Our family is on the Kaiser plan and I'm quite pleased with it. They have an "urgent care clinic" near us that is open 24/7 and handles cases that don't rise to the level of emergency but which need to be addressed ASAP (high fevers, cuts needing stitches, etc.). $10 co-pay, and the monthly rates aren't outrageous--expensive, yes, but not outrageous. Plus, because it's a Kaiser facility there isn't any paperwork to fill out or claims to be made. You give them your insurance card at the triage desk along with ten bucks and you're golden. | ||
| Johnnymceldoo |
Did Michael Moore happen to explain how humanitarianism is going to develop new medical equipment, drugs, and procedures? Lol!! Its going to take doctors like our government leaders right now who put us first rather than themselves. lol | ||
| Blake |
I'm thinking of some pro-active preventative medical action for myself. Dad had an emergency double bypass when he was 55 for a 90% blockage of the left anterior descending and I've come down with just about every other physical issue he's had, so no denying genetics. I'd rather catch such a life threatening issue ahead of time instead of while on a ride out in the middle of West Texas or the like. So I call my doc. He's out sick. So I commence calling the local cardio centers asking how much for full blown stress-echo-cardiogram. This is the test that shows how the valves and cardio muscle and other structure are functioning. Get this, if I'm a pay it myself customer, I get half off compared to if I have insurance that covers the procedure. What is that about? | ||
| Alchemy |
The system is hosed. Prices are cooked up to account for the slow and short paying insurance companies and the mountain of required paperwork. It gins up the pricing. Actual cost is hidden in there somewhere. Maybe even less than you were quoted. Now tell them you will submit their Lower price to your insurer for pre-approval<grin>. I imagine if they provide pro bono service they could write off the full amount as the retail value. This is also how it is possible to provide a simplified system and provide coverage for an extra group of citizens at the same or even lower cost. But besides that, I hope your tests work out well. It is likely a good idea. There does seem to be a pattern related to age that suggests it is wise to be more careful when approaching age 50 for a variety of issues. You physician may very well support your efforts. Some of these tests are not without risk however. Everything's a deal ... | ||
| Chellem |
The real magic starts after the billing The patient accounts bills it to your insurance for the remainder. Say 725 is billed to your insurance. About 15-22 days after your service your insurance company receives it. And DENIES the claim. the hospital comes back to you and bills you. Why did they deny it?... Because when you went in for the accident, you told the ER attending that you did it on your motorcycle, and the diagnosis was coded as accident, the Er notes will say that it occured on/around/by your motorcycle. Your insurance will deny it because at first glance it looks like it is a motor vehicle accident, and hey that could be somebody elses fault, and why should we pay, especially if there is going to be a vehicle insurance,or third party liability that we can bill. (I have seen it a thousand times) so you resubmit the bill with an accident claim rebuttal stating that nope, it was my own damn fault and it happend in my own damn garage, and nobody else is liable. (mean while the business office now has your denial back and has started assessing a late payment fee, a failure to pay goes to your credit, and you start to get fun phone calls from their collection efforts) So if you are lucky, your insuracne company will get to pay the claim in about 45-60 days after your initial visit. If they pay your claim, it will be about 318 bucks. They will cut the ER facility fee in half, the ER consult and Surgery charge will be bundled and reduced, the true number paid on the prophyaltics will be about 20 bucks, and none of the 8 dollar aspirins will be covered. So if it is a participating hospital with in your network, you will not be liable for that remainder. (they will however add it to their total number that they have to right off every year, and adjust their fees for next year based on those budget short falls from unpaid services) If it is a non participating clinic not in your network, you are liable for the remainder (and any of the late fees, collection fees, and interest fees) Read your plan benefits and exclusions very carefully. If they want to, and I have consulted on plans that have done it; if your accident has occurred because of a recreational activity, they can and will deny your claim in total if it is determined to be a named policy exclusion. The big one there that bites everyone is skiing accidents. Your employers health care wasnt meant to pay for it, if you read it carefully, most dont. Motorcycling is not far behind. Although that is probably a worst case scenario, it is totally F'ed up. The real question in my mind is, of course, whether government bureoucrats are expected to do any better? Honestly, even the well-intentioned ones are reigned in by the vast majority of people with "government worker" mentalities. And if there's no profit in it besides? What government agency is going to be expected to get off their ass and pay a claim? Like, for example, and this is just off the top of my head, but, let's just say, hypothetically, your car dealership just took in 50 clunkers and is waiting for $200,000? No rush, right? My health care in the hands of professional paper pushers? Terrifies me much more. Much more. Ya can't even sue the government if they make a mistake. No. Tort reform baby. Lower costs. Classic solution to the eternal problem. You think Insurance companies are bastards with their profit? Talk to a lawyer for 15 minutes. Get the bill for $350. Let's be mad at ALL the bad guys and not just pick those evil capitalist insurance companies with their evil PROFITS (*spit-ptooey*) ->ChelleM | ||
| Cityxslicker |
ChelleM What I quoted was not a worst case scenario, that is just the matter of course, standard operating proceedure. Hell its even codified in the plan policies and guidelines. Worst case scenario would be if the finger were severed, and he was air lifted to the hospital; then it really gets ugly. Those 25k maxes get used up fast when a bird is involved. Washington state has started billing hikers, skiers, etc that require the rescue search and helo evac by the washington national guard. We never put a bird in the air for less that 6 k in air crew, fuel, and pilot on call status; once it is air borne your meter is ticking at an geometric rate. The state charged one guy for hiking out of bounds to the tune of 3.2 M; cuz of the rescue efforts, the helo and the avalanche that he started. (2002 Spring Rescue up off Mt. Baker) | ||
| Blake |
Hey Graham, back at you, what would your scenario be there Queensland, Australia? | ||
| Lemonchili_x1 |
Interesting stuff. As an Australian resident I pay a Medicare levy of 1.5% of my taxable income, and I get a Medicare card. If it happened to me (touching wood now) out of hours, I'd get someone to take me to the local public hospital emergency. I'd see them at the desk where they'd take my details (including my medicare card number), then wait 10-40 minutes to be checked out by a nurse and prioritised. I'd then wait anywhere from another 10 minutes to a few hours for a doctor to see me and stitch me up. I would get all that for free, paid for by Medicare. If they prescribed any medication I may have to pay for it, though some things like basic painkillers (Panedeine Forte etc) they sometimes give you. During normal hours I may decide to go to a doctors practice (if I can get an appointment that day) or a medical centre. Medicare has scheduled fees for medical services, and pays 85% (or 75%?) of the scheduled fee for non-hospital services. Some medical centres "bulk bill" so I just pay the difference between what Medicare pays and what they charge, and some only charge the 85% so I pay nothing. If I went to a small doctors practice I'd pay whatever they charge then claim the 85% back from Medicare. For more serious stuff - Medicare pays 100% of basic hospital services if I'm admitted to a public hospital for some reason. I get no choice of room or doctor though. If it's non-essential or "elective" I'll be put on a waiting list. I can get private health insurance and then, depending on my cover, have choice of doctor and have a private room or go to a private hospital. |
