Mail Call

[rolanni]

Remember that MRI scheduled for this evening? Today's snail brings News! from Anthem Blue Cross. After due consideration, they agree that an MRI is reasonable in the case and will allow the appointment to stand.

WTF? Anthem gets to decide if my knee hurts bad enough for me to Do Something About It?

Ghod, we need a health care system in this country. Please.

Comments

[jhetley.livejournal.com]

Anthem doesn't care whether your knee hurts. Anthem only cares whether they're going to have to pay for it . . .

Three years to Medicare and counting.

[liadan-m.livejournal.com]

please soon.

I am hopeful that the congress will give us that mythical 'public option' before the first of the year. Because as a self-employed person, I want #$%#% insurance.

[ckd]

Yeah, isn't it great that we don't have bureaucrats between us and our doctors? At least with government bureaucrats, they're not trying to make money by delaying or denying. Bletch.

MRI

[(Anonymous)]

I remember the MRI I had on my left knee. The most difficult part of the test is holding still for the whole time, especially if your knee hurts in the position in which the MRI operator places it.

Thank God, Anthem paid for my test, too.

Kay Webb Harrison
Norfolk, VA

[katmoonshaker.livejournal.com]

Thank God they decided to let you have it! I have had such... lovely conversations with insurance companies.

Me: X needs to be covered.
Insurance Idjet: Y doesn't need it.
Me: Yes, they do; reference Z.
Insurance Idjet: Oh they couldn't possibly have Z.
Me (resisting urge to use Supr Sekret Machine™ to go through phone and strangle Idjet): Yes, they do; reference two doctor's reports which you already have in your possession concerning Z.
Insurance Idjet: They aren't FITB to have Z.
Me: Let me speak to your supervisor. NOW.

I've lost track of how many times I've had this conversation. I've had it at least twenty times just about my taking NSAIDs other than ibuprofen because I'm not over 65 yet. ::head:desk:: Nevermind their records showing that I have had osteoarthritis since 1987.

[(Anonymous)]

What makes any of you think that a national system is going to be any better regarding unresticted access to health services (such as MRI) or certain medications than the current system? Look at Medicaid, and all the things that they will not cover. Be careful what you wish for!

[benbenberi.livejournal.com]

The whole business model of "health insurance" depends on their collecting as much premium as possible and paying as little in claims as they can get away with.

Many perfectly legitimate claims get automatically denied the first time they're submitted -- they'll be paid on appeal, of course, but in the meantime the insurance co. keeps the money, and if you don't go to the effort of appealing, they don't have to pay at all.

And medical review/pre-approval has almost nothing to do with actual medical need, everything to do with cost-benefit calculations (their benefit, not yours).

Darn right it's a broken system with perverse incentives.

[torrilin.livejournal.com]

Also, while we're at it, can we have comparative effectiveness research? I am sick and tired of having my glasses and orthotics be luxuries. As someone with 20/700 vision, I don't need prescription safety glasses for lab work, prescription goggles for swimming, and even a backup pair of glasses is something I pay for out of pocket. And risky surgery to fix my feet is fine, but two pairs of orthotics so I can have ones that actually fit in my shoes is right out.

this completely disgusts me.

[jl-johnson.livejournal.com]

I don't understand how a country that claims to be free and democratic, can allow it's residence the humiliation of having to suffer at the hands of greedy insurance companies.

The idea of having to wait to see if I need a medical proceedure (MRI, for example) is ludicrous! If I need a proceedure, my doctor gives me a referal (and yes they are required otherwise every hypocondreact(sp) and his brother would be wanting proceedures done, clogging up the whole system), I go to the office or building where it's done, either have it done that day or book an appointment AND. IT'S. DONE. PERIOD. No waiting to see if it's approved or not.

From what I can understand, the government option that President Obama is suggesting is for the 50 or so million Americans who don't have proper health insurance. And if the big companies don't like it, then they better make themselves more appealing to the public.

Totally against government health care.

[muehe.livejournal.com]

I really do not understand why people think having the government step in is a good thing – in anything.
The company I work for routinely shops the different health care insurance companies to get the lowest rates. Yeah, I bet there is stuff my health care might not cover – but they are trying to balance cost (mine and the companies – health care insurance is split 50/50).

So we make government health care. My taxes go up – now I am paying for mine and yours.

Sure some people can not afford health care and the human thing to do would be to pay for it for them. But I am trying to make a living myself and taking even more of my money away is not helping me. It is bad enough that the current government is de-valuing the dollars. That makes thing more expensive for me and kills the little bit I have set aside for retirement. Thanks a lot. I would love to blame Obama, but the real problem is the people in the US want a quick fix / magic pill solution for everything.

[gilraen2.livejournal.com]

Every year my insurance carefully reviews my need for Celebrex, suggests a number of cheaper alternatives, my doctor fills out a form, and they call to tell me that they have given me SPECIAL approval, but just for one year. They expect that any moment now I will recover from chronic arthritis and skip off into the sunset.

Wow, talk about a hornet's nest!

[(Anonymous)]

Medical cover in Australia works as a three tier system - emergencies are treated immediately, for free, no matter what needs doing. Non-emergency stuff means you can be treated either as a public patient (and I've experienced the 2 year wait for a knee reconstruction myself) or as a private patient if you pay extra for it - and for the 2nd knee op & preceeding MRI, I was privately covered - referred to the specialist, saw him the same day, had the MRI on the wednesday & the operation on the Friday (I got really lucky) Out of pocket costs were about $300.

The other thing is that if you earn over a certain amount and you don't have private cover, the government taxes you at a higher rate, so it's worth more to have it than not.

I personally love that Medicare covers everybody, whether you can afford private cover or not. It doesn't matter if you have a job or not, just that you're a citizen of the country, and it's one size fits all. It's not logical to me that your health cover is tied to your job - you don't stop being sick just because you lose your job, now do you?

sorry, that last one was me!

[pakwa26.livejournal.com]

(Plus, any out of pocket expenses over $1500 are tax deductible!) Go for it, USA!!!

Medicare

[catletude.livejournal.com]

And don't trust medicare to help you out. Last year I paid $18,000 of non covered expenses even though I had a doctor's prescription for it. Medicare decided I didn't really need it. I got a little bit of it back at tax time $4,000.

It's wonderfully strange when one section of government says NO (Medicare) and another section (Tax bureau) says we'll pay part of it.

Thank God I have secondary insurance as a Vet.