Medical Cost

[ultrarunner]

Good point on employers using their size to help.

In and out of network issues are amplified when you are rural. This is even worse if you need specialists.

Wife had to change doctors and go back and forth quite a bit to get her cataracts done. Even at that we have to go 50 miles+ into Longview or Tyler for most special care.

It gets more interesting when your employer is also providing care/treatment even for workers comp.

Working for a hospital can be a blessing or curse…

My brother was scheduled for surgery and prepped and the anesthesia in network was delayed in the OR with a very difficult case so anesthesiologist was substituted last minute and my brother received a huge bill and was heading to collection… he called the doctor at home to complain after nothing resolved through the office.

My brother said as he had already been given an IV he was no longer capable of giving consent and all of a sudden matter resolved itself.

 

[Dftodd]

The "out of network" surprise billing has had some legal clamp down;

NO SURPRISE Billing Act (NSA) | Anesthesia Billing and Practice Management | Anesthesia Resources

Starting with the first day of 2022, the No Surprise Billing Act went into effect. Out-of-network anesthesia providers are now prohibited from balance billing

anesres.com

That doesn't do much for all of the other insurance hassles, like enduring months of treatment by a low cost drug for the doctor being able to prescribe the clinical proven more effective drug.

All the best,

Peter

That chaps my butt to no end. I had to switch from a once a month shot that managed all my symptoms to a shot every other month for the treatment.

But the every other month treatment doesn't work as well for arthritis.

This issue is the pre-approval process for the medications.

Insurance made it sound simple. Get your doctor to issue a prescription for one of these other meds and you won't lose treatment time.

They then proceeded to make my doctor fill out all sorts of paperwork, and jump through so many hoops to get me on the other drug they requested a prescription for

Insurance then screwed up the prescription my doctor sent in since switching to the new medication required a "Starter dose".

I recieved the first dose fine. The issue was getting the second dose 30 days later. They put the second dose in for 45 days.

This required me making several phone calls, and wasting so much time just to find out they screwed up the prescription.

I then had to sick the nurse practitioner handling my case on them. That little 100lb fireball took no prisoners

She got on the phone with them, they said the prescription she sent over said xxxx. She said, thats funny, because i'm looking at the prescription we sent you right now and it says XYZ.

She proceeded to hand them their butt.

Called me back when she got done with them, and informed me insurance was overnighting my next dose. And to call her back if I didn't recieve it tomorrow or if they try to charge me for expediting the medication.

With that medication, I don't even call insurance anymore. I just call my doctors office and leave a message for the nurse practitioner She's like a pitbull

 

[ultrarunner]

Some really like the Kaiser insurance model which is one stop… see the doc and pick up meds at the pharmacy on the way out.

Others don’t like the Kaiser model because it’s an all in system.

 

[Torvy]

The key is that when people have choices they can at least move away from bad coverage.

 

[kenmac]

The hospital, if unsuccessful in collections, will just put a lien on your house.

People think they are smarter than a hospital that has an entire department that has done this for the past 40 years.

But if you own nothing , there's nothing they can do. I know someone that rents, has no insurance, repairs lawnmowers, etc, for money, gets food stamps. He was in the hospital for several health issues Cirrhosis of the liver being one of them . They sent him bill after bill after bill. He just threw them away.
There are many out there that are what's called judgement proof , and he's one of those persons !

​

 

[kenmac]

I just had a stint put in last week. I paid zero because I already met my Medicare deductible of $257.00 for the yr.

 

[ultrarunner]

But if you own nothing , there's nothing they can do. I know someone that rents, has no insurance, repairs lawnmowers, etc, for money, gets food stamps. He was in the hospital for several health issues Cirrhosis of the liver being one of them . They sent him bill after bill after bill. He just threw them away.
There are many out there that are what's called judgement proof , and he's one of those persons !

​

Exactly… the ones that are vulnerable are folks that have managed to put a little away or have home equity.

One commercial here starts by asking what do you have to loose?

I know some living with few cares… no taxes, no insurance, no utilities, etc…

Once you work the system the programs from food, housing, medical care, cell phone, transportation are amazing…

 

[not2old]

But if you own nothing , there's nothing they can do. I know someone that rents, has no insurance, repairs lawnmowers, etc, for money, gets food stamps. He was in the hospital for several health issues Cirrhosis of the liver being one of them . They sent him bill after bill after bill. He just threw them away.
There are many out there that are what's called judgement proof , and he's one of those persons !

​

It's not just medical. I had a relative that got into drugs and booze. He was in his forties when he had his first contact with income tax. I don't know all the details but his first bill from them was for a couple of thousand dollars in the 1990's He told them he couldn't, pay as he had no money. To my knowledge he never had to go to court over it.

 

[tradosaurus]

My dentist said she had been trying to collect full insurance payments from my provider for over 6 months. She said it had been the same with many more patients.
Don’t know how she will be able to stay open.

 

[Torvy]

It's a game. They overcharge everybody to make up for the ones where insurance says no.

That's one reason why if you go in without insurance, the prices are lower.