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06/18/2014 12:04:32 PM · #1
What good is a primary provider if they can't see you for over a month (new patient, all providers in my area, called 'em all)?

Hell, even my 'established' primary care provider cannot set an appointment for less than a week from today, and they won't take my newly established insurance.

I've been seriously ill for over a month now, the care I have received was terrible and rushed, and so careless as to prescribe steroids when the symptoms are commiserate with cancer. (something I only figured out in the middle of the course of steroids when then symptoms got worse, not better and started to research the symptoms with Google), and now if I want a second opinion it's going to take more than a month to get in.

I'm so angry and depressed right now it's not even funny.

Our healthcare system is now WAAY worse than it was a year ago, and I'm extraordinarily displeased.

And of course, this comes on top of the loss of my 'good' coverage which happened when Humana decided to leave the state entirely at the end of last year, the tripling of my premium and the 10x increase in my out of pocket maximum costs.

--

Seriously though, I'm posting this here so that all of you who supported this can get some perspective on how well it's working out in the real world, funny enough, it seems to be working almost EXACTLY AS I PREDICTED IT WOULD, AND EXACTLY UNLIKE WHAT YOU SUPPORTERS WERE CERTAIN OF. How's all that wrong taste? Certainly bitter in my mouth.
06/18/2014 12:41:38 PM · #2
Sorry to hear your story.

Most of us still have our coverage through work. Wait until the mandate hits employer plans.... Then a whole lot more people will realize they don't have what they used to have. I know my company is currently reviewing plans that meet the mandate; I expect to dislike the results when they are implemented.

I was in the insurance business for more than a decade (now I work for a nonprofit voluntary health organization...way more satisfying). The insurance business is based on actuarial numbers. Premiums cover the risk, plus a competitive profit. If the risk goes up, premiums have to follow or the companies would ultimately fail and all policies would be worthless. A plan that extends coverage to people with preexisting health problems and provides subsidies to some folks will ultimately have to cost more to someone...or service has to decline...or both. It's a good deal if you are one of the folks with the preexisting health problems or qualify for a subsidy. Not so good for everyone else.

Imagine if they decided to have automobile policies cover preexisting accidents. Wait until you wrap your car around a tree and then get a sweet policy. How high do you think the premiums would be for your policy, especially if subsidies were given out as well? Or how about life insurance that your family could buy after your death? That would be the ultimate preexisting health issue, wouldn't it? ...and the ultimate premium, too.

The goals of the legislation may have had some merit. Universal coverage is a lofty goal. The implementation and expense to premium payers and tax payers...not so much.

Of course, each of us in the US can vote our viewpoint this fall. Since the parties were so divided on this one, it's easy to see who is responsible for the legislation and your coverage. If you like what you have and you like the philosophy behind the legislation, vote them back into office. If you don't like the result or the philosophy, vote them out. That will be the ultimate referendum on this issue. In the meantime, I'll have to wait and see what my company package looks like when the dust settles.

Remember, in a democracy the voters ultimately get the government they deserve.

(Don't know if this is in a rant category or not, but it should be. I expect that if it goes very far diverse opinions will be offered.)
06/18/2014 01:14:10 PM · #3
Cory sorry hear about your illness. I have been with you from the start opposing obamacare. It didn't take a rocket scientist to see that this was a bad policy for Americans and America in general.

I hope you can get in to see a doc soon and get this "illness" under control. I do hope It is not cancer
06/18/2014 01:34:47 PM · #4
I know there are lots of people in your situation, which is really sad.

I have an excellent health care plan through my company. I mean its REALLY good. This is for me alone, no family on my plan. My wife has her own plan. My company wont cover working spouses. I have been looking at the ACA plans and such since they became available to look at, and found that if I get a comparable plan under the ACA, just 1 year of ONLY premiums under the ACA, would pay for 7 years worth of premiums under my existing plan.

if I have no major health issues, my yearly cost today under my employer provided plan cost me roughly $3,000. Thats monthly premiums, co-pays, deductible and medications. Plus or minus a few hundred bucks year over year.

Under the ACA plans that low expenditure will go from $3,000 a year to $12,000 a year. Plus under the ACA some of my meds will no longer count towards the deductible. SO that $12,000 goes up, not sure yet by how much as I wont know the cost of the meds until I am forced to the ACA.

Also there will be additional cost because Vision care is NOT covered under the ACA, so that will be a separate cost. Then there is not a life insurance plan under the ACA. My current life insurance with my company is very good and VERY low cost. I have about $500,000 in total life insurance and it cost me about $15 a year.

One thing many people haven't realized yet, is that the subsidized premiums though tax credits actually means you get to pay full sticker price of your premiums for the year, then when it comes tax time, you you get a tax credit to lower your taxable income so you get a refund which may or may not add up to what they tell you the cost is.

While many people will be able to afford the ACA and benefit from it, I certainly cant.
06/18/2014 01:39:12 PM · #5
Originally posted by chalice:

Sorry to hear your story.

Most of us still have our coverage through work. Wait until the mandate hits employer plans.... Then a whole lot more people will realize they don't have what they used to have. I know my company is currently reviewing plans that meet the mandate; I expect to dislike the results when they are implemented.

I was in the insurance business for more than a decade (now I work for a nonprofit voluntary health organization...way more satisfying). The insurance business is based on actuarial numbers. Premiums cover the risk, plus a competitive profit. If the risk goes up, premiums have to follow or the companies would ultimately fail and all policies would be worthless. A plan that extends coverage to people with preexisting health problems and provides subsidies to some folks will ultimately have to cost more to someone...or service has to decline...or both. It's a good deal if you are one of the folks with the preexisting health problems or qualify for a subsidy. Not so good for everyone else.

Imagine if they decided to have automobile policies cover preexisting accidents. Wait until you wrap your car around a tree and then get a sweet policy. How high do you think the premiums would be for your policy, especially if subsidies were given out as well? Or how about life insurance that your family could buy after your death? That would be the ultimate preexisting health issue, wouldn't it? ...and the ultimate premium, too.

The goals of the legislation may have had some merit. Universal coverage is a lofty goal. The implementation and expense to premium payers and tax payers...not so much.

Of course, each of us in the US can vote our viewpoint this fall. Since the parties were so divided on this one, it's easy to see who is responsible for the legislation and your coverage. If you like what you have and you like the philosophy behind the legislation, vote them back into office. If you don't like the result or the philosophy, vote them out. That will be the ultimate referendum on this issue. In the meantime, I'll have to wait and see what my company package looks like when the dust settles.

Remember, in a democracy the voters ultimately get the government they deserve.

(Don't know if this is in a rant category or not, but it should be. I expect that if it goes very far diverse opinions will be offered.)


Technically we're a Democratic Republic.
06/18/2014 01:55:05 PM · #6
a government backed health savings account system would have been the way to go.

Sorry to hear about your situation Cory.

06/18/2014 02:01:14 PM · #7
i am sorry to hear of your difficulties, but no change happens without problems somewhere.
speaking from someone with a lifelong experience of government funded healthcare, for most things, the wait times can sometimes be annoying, but there are always emergency care centers (hospital if nothing else) that have wait times in the Hours, not week/months.
knowing though, that if you break a limb, or get your foot crushed with hundreds of pounds of equipment at work, that you can walk/hobble/crawl your way into a place and have any necessary ongoing treatment covered without financially ruining you is a worthy tradeoff.
"Obamacare" will get there given the opportunity to work on the flaws with transitioning, but as the only major 1st world country without this, it puts a huge problem on it's citizens for what many consider basic medical assistance.

I do not expect you to have any comfort from what i'm saying here, because what i'm saying here will not fix your current predicament, but overall the system is a proven success across the globe. it WILL get better, and, i sincerely hope, so will you.
06/18/2014 02:07:34 PM · #8
Cory, I'm really sorry for what happened :(

But still I have to say the American healthcare system is ridiculous, but not because Obamacare, but because it can help only people who already have money.

My mother had two surgeries in the last 2 years and a half - breast cancer and aneurysm and without our healthcare system she couldn't have paid for everything they have done for her. And she ran a furniture company for 40 years, she's been able to buy 3 houses for me and my brothers, so she was not so bad with her bank account. But still, without our health care system, her destiny would have been to follow her path to the grave.
06/18/2014 02:14:03 PM · #9
Originally posted by Alexkc:

Cory, I'm really sorry for what happened :(

But still I have to say the American healthcare system is ridiculous, but not because Obamacare, but because it can help only people who already have money.

My mother had two surgeries in the last 2 years and a half - breast cancer and aneurysm and without our healthcare system she couldn't have paid for everything they have done for her. And she ran a furniture company for 40 years, she's been able to buy 3 houses for me and my brothers, so she was not so bad with her bank account. But still, without our health care system, her destiny would have been to follow her path to the grave.


that's the problem in a nutshell. healthcare is insanely expensive. why? because you and I dont give a shit how much care costs. the insurance company foots the bill, they care, but they dont care if we need care, they just approve and deny what they must. At least now ACA forces them cover more, evenly for all.

but it doenst fix the problem in that you dont care how much it costs, the insurance cares but doenst care about you and the doctors care how about you but know they will get paid.

solution?

make us care about the cost of healthcare, health savings account do that by letting you keep extra money you dont spend, thus enticing you to shop around for the best/most affordable care. the providers will be forced to compete on costs.

06/18/2014 02:36:40 PM · #10
Originally posted by Mike:

make us care about the cost of healthcare, health savings account do that by letting you keep extra money you dont spend, thus enticing you to shop around for the best/most affordable care. the providers will be forced to compete on costs.


Your main point is valid, but this statement is not. Healthcare is by it's nature an inelastic demand. When we need it, we really need it and will pay whatever it costs. Sure if you have a skin blemish, you can shop around the way you do for any other consumer item, but for the large part, and for the cost expensive medical events you have no choice but to go to the nearest possible provider. If your wife goes into labor, if your father has a stroke, if you fall down and shatter your leg, it is not like thinking about buying a new sofa. You can not read reviews, compare local suppliers to on line supplies, or any of the normal ways you comparison shop. You go to the nearest hospital and pay whatever they ask.
06/18/2014 02:46:34 PM · #11
Cory, so sorry about your health and situation.. just know you are not the only one who has to deal with this frustration.. there are thousands of people who are hurting because of changes like this.

My job requires to bill out hospital ERs accounts to the insurance companies...I am a medical records outpatient ER coder/psych and ancillaries... making sure that the doctors and hospitals get reimbursed for what they do and the tests and diagnosis match so that insurance companies do pay..I see it every day and it is depressing of the charges of what is put on the bills and the payments of what is to be expected from the insurance companies..

Insurances are refusing to pay certain things now that they used to in the past, medicare is def. getting worse for covering things. We are having to send a lot of stuff back to the doctors to make sure certain words are just in the documentations so that it will be billed correctly.

It is just one hot mess.

As for the political stuff, whew that is a can of worms right there...

As far as venting goes, go all out and we are all ears for you :-)

Message edited by author 2014-06-18 14:50:24.
06/18/2014 02:58:37 PM · #12
one of the reasons the cost of health care is so high today, is the vast# of people who do not pay into it because they receive free care. Anyone going to an emergency room will be taken care of, no mater what. A great deal of these people are not in this country (USA)legally. I can go to any emergency room in my city at 10 PM and see 20 to 40 people waiting to see a Dr. just for the sniffles. Meanwhile someone with a true injury or emergency has to wait longer than normal while they clear out a room to be seen, unless you have a gun shot wound, you get treated right away.

Since I have a great health plan and an HSA, I can go to one of those 24 HR specially ER's if I need to (which I have had to do 3 times) that ONLY accept patients with insurance or can pay full cost of services at the time of treatment, NOT billed later on, pay before you leave.

sure our healthcare system is bad, but the ACA just made it worse.
06/18/2014 03:25:05 PM · #13
Originally posted by jab119:

one of the reasons the cost of health care is so high today, is the vast# of people who do not pay into it because they receive free care. Anyone going to an emergency room will be taken care of, no mater what. A great deal of these people are not in this country (USA)legally. I can go to any emergency room in my city at 10 PM and see 20 to 40 people waiting to see a Dr. just for the sniffles. Meanwhile someone with a true injury or emergency has to wait longer than normal while they clear out a room to be seen, unless you have a gun shot wound, you get treated right away.

Since I have a great health plan and an HSA, I can go to one of those 24 HR specially ER's if I need to (which I have had to do 3 times) that ONLY accept patients with insurance or can pay full cost of services at the time of treatment, NOT billed later on, pay before you leave.

sure our healthcare system is bad, but the ACA just made it worse.


You forgot about all of the lawsuits.....That also drives costs way up. We are sue happy in this country.
06/18/2014 03:44:04 PM · #14
Originally posted by jab119:

one of the reasons the cost of health care is so high today, is the vast# of people who do not pay into it because they receive free care. Anyone going to an emergency room will be taken care of, no mater what. A great deal of these people are not in this country (USA)legally. I can go to any emergency room in my city at 10 PM and see 20 to 40 people waiting to see a Dr. just for the sniffles. Meanwhile someone with a true injury or emergency has to wait longer than normal while they clear out a room to be seen, unless you have a gun shot wound, you get treated right away...
sure our healthcare system is bad, but the ACA just made it worse.


I work in one of those ER's. And FREE CARE IS the problem. and ObamaCare has made it worse. I've been in ED for 17 + years, it's always been there, but the last year or 2 seems WAY worse. ER's cost 10-100 times more than primary MD's...why?
90% of the people we see are "government sponsored" and No Pay. The majority of the patients...are just as you say...cough and cold symptoms for a day to weeks, pink eye, stomach aches, etc., All things that can be seen by a primary MD or county healthcare center. Someone has to pay for all that free EMERGENCY care...YOU with insurance and YOU who have a job...are the ones to foot the bill.
My main problem with it, is the actual emergencies have the potential of not getting the maximum attention because of the problem of people thinking that the ER is a Convenience Store. Taking up rooms and personnels time, instead of that time and effort going toward something that IS an emergency.
Main reason people stated for coming to the ER and not the Healthcare center or MD..."I don't have to wait, and my Medicaid copay is still $3."
When ACA "passed," We did have a few people show up to the ER, saying they wanted this minor thing and that minor thing checked out, now that everything is free.
The ER equals Convenience Store...Healthcare Center equals Grocery store. Which do pay more at, and why?

Life, Limb, or Function.
06/18/2014 03:48:18 PM · #15
Originally posted by cowboy221977:

You forgot about all of the lawsuits.....That also drives costs way up. We are sue happy in this country.

Agreed. Hear they "I'm gonna sue" quote a few times a day in the ER.
I sure which they would reform this first...The LOSER foots the bill for court costs and both sides lawyers. The frivolous ones would go away, then. Get people to have some skin in the game, they will think twice about things.
06/18/2014 03:52:05 PM · #16
Originally posted by jgirl57:

Insurances are refusing to pay certain things now that they used to in the past, medicare is def. getting worse for covering things. We are having to send a lot of stuff back to the doctors to make sure certain words are just in the documentations so that it will be billed correctly.

I hate to break it to you but this has been going on for at least fifty years or so, ever since insurance companies figured out how to profit by interposing themselves between the ailing and health care providers.
06/18/2014 04:01:32 PM · #17
Health care in the US used to suck.

The federal government passed Obamacare, a hodge-podge of ideas invented by conservatives in the 90s.

The law didn't change enough to begin with, and is being subverted by conservatives in congress and insurance companies.

Health care in the US still sucks.
06/18/2014 04:23:56 PM · #18
Originally posted by Frakster:

Originally posted by chalice:

Remember, in a democracy the voters ultimately get the government they deserve.



Technically we're a Democratic Republic.


technically, we're an oligarchy.
06/18/2014 04:38:36 PM · #19
Originally posted by dacrazyrn:

Originally posted by cowboy221977:

You forgot about all of the lawsuits.....That also drives costs way up. We are sue happy in this country.

Agreed. Hear they "I'm gonna sue" quote a few times a day in the ER.
I sure which they would reform this first...The LOSER foots the bill for court costs and both sides lawyers. The frivolous ones would go away, then. Get people to have some skin in the game, they will think twice about things.


You already need another doctor to say there is negligence to sue- and it is just about the most expensive lawsuit to pursue, so, there are threats from medicine seeking people in the ER- but very few frivolous lawsuits.

If you don't believe me, look on your state court website and see just how many medical malpractice cases went to trial, it is very low compared to other types of cases.

And when it comes to the argument that malpractice lawsuits are causing too much testing, too much expense, who owns the machines? you can't ask for directions in an orthopedics office without having an x-ray done, on a machine that was paid for 15 years ago.
06/18/2014 04:53:32 PM · #20
Originally posted by BrennanOB:

Originally posted by Mike:

make us care about the cost of healthcare, health savings account do that by letting you keep extra money you dont spend, thus enticing you to shop around for the best/most affordable care. the providers will be forced to compete on costs.


Your main point is valid, but this statement is not. Healthcare is by it's nature an inelastic demand. When we need it, we really need it and will pay whatever it costs. Sure if you have a skin blemish, you can shop around the way you do for any other consumer item, but for the large part, and for the cost expensive medical events you have no choice but to go to the nearest possible provider. If your wife goes into labor, if your father has a stroke, if you fall down and shatter your leg, it is not like thinking about buying a new sofa. You can not read reviews, compare local suppliers to on line supplies, or any of the normal ways you comparison shop. You go to the nearest hospital and pay whatever they ask.


yes and hospital care is the most expensive part, why? because hospitals are forced to care for everyone and not everyone can pay. that's why emergency copays are so high, the insurance companies don't want you to go there. folks who have no insurance go to the emergency room instead of the more cost effective solutions because its their only option.

so we had an environment where many went to the ER to get care and we still do. come up with a solution where people who don't need emergency care don't go to a hospital by giving them an alternative and a financial incentive not choose an ER.

Message edited by author 2014-06-18 16:57:34.
06/18/2014 05:15:00 PM · #21
Originally posted by dacrazyrn:

Originally posted by cowboy221977:

You forgot about all of the lawsuits.....That also drives costs way up. We are sue happy in this country.

Agreed. Hear they "I'm gonna sue" quote a few times a day in the ER.
I sure which they would reform this first...The LOSER foots the bill for court costs and both sides lawyers. The frivolous ones would go away, then. Get people to have some skin in the game, they will think twice about things.


This is a popular myth. The fact is that Malpractice suits are less then a single percentage point of healthcare costs. Compare that to 31 percent of all health care expenditures that are administrative. This amounted to $1,093 per capita. For every person in the country, more than $1,000 annually goes not to helping people get better, but to administration. Insurers have no incentive to hold down their administrative costs in fact, the incentive is to do the opposite, to increase their profit margin.
06/18/2014 05:31:33 PM · #22
Cory -- the republicans are always looking for stories like yours. Have you shared it with them?
06/18/2014 05:32:27 PM · #23
Sorry your not feeling well Cory and its taking forever to get you the care that you need. Hopefully it nothing serious and you can get back on your feet and feeling better.
06/18/2014 05:44:25 PM · #24
Originally posted by Mike:

come up with a solution where people who don't need emergency care don't go to a hospital by giving them an alternative and a financial incentive not choose an ER.


Look at any other industrialized democracy and you will find better solution. The US has been ranked lowest among 11 industrialized countries by the 2014 Commonwealth Fund survey for the quality and efficiency its healthcare system delivers.

"The first place was secured by the United Kingdom, followed by Switzerland. Australia, France, Canada, the Netherlands, Germany, Norway, New Zealand and Sweden were other countries being studied by researchers for their performance in providing healthcare service.

As per the report, $8,508 was spent by the US on healthcare per person in 2011, whereas the United Kingdom only shelled out $3,406 per person. However, the UK was still ranked the highest for providing better quality and safe healthcare than the US. Not only the UK, all other 10 countries did not spend as high as the US did per person, but surprisingly their quality of healthcare was still ranked higher than the US."

When you are spending twice as much and getting half as much, something is very very wrong. Perhaps we should think about fixing it.
06/18/2014 05:51:04 PM · #25
Originally posted by frisca:

Cory -- the republicans are always looking for stories like yours. Have you shared it with them?


The thing is I hear more stories like his than good stories. It doesn't take any imagination to open your eyes and look around at what is happening around you. I can speak about my location. Everywhere I look people are complaining about the ACA. The only people I have found not complaining are the people that had free healthcare before the ACA. Or may I call it the UCA (Unaffordable Care Act)
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