I do medical billing for a decent sized medical campus (in my area at least)...we DO NOT accept auto insurance claims either...why? Well, because lets say a person has $5000 worth of medical coverage on their auto insurance, there is NO WAY of knowing how much of that they have already used, unlike traditional insurance, I can call and ask how much deductible, out of pocket, etc the person has met. It can take YEARS for auto insurance companies to pay out medical claims. They pay auto damage claims first, then consider medical claims. If the case is disupted at all and God Forbid goes to court, forget it, your Drs will be waiting forever for their money.
We just cant afford to take it and sit and wait, I would think some place large like a hospital could though.
I know people think its the Dr's screwing the insurance companies and making $$$$$....thats not always the case. We bill $90 for a normal office visit...you come in and spend about 30ish min with your Dr discussing whatever and we bill your insurance $90. They say you pay us a $40 co pay and they actually send us a check for $27.31...so thats a total of 67.31 for that time. Times that by the 40ish patients your Dr sees a day and thats just under $3k...some patients dont have insurance and some have better insurance so that number could fluxuate of course. For those with insurance, wiat 30-45 days for those insurance companies to processes and pay claims. Now, pay thats Drs staff of nurses, receptionists, and billers. Throw in rent, malpractice insurance, computers, etc....they dont REALLY make that much $$$. At least not family practice Drs in a rural area.
I dont know what the solution is
As for the FB example given above, everyone should read about the Independent Payment Advisory Board. Folks that are outraged about having to present a simple photo ID to vote tomorrow (or in the future) are going to be in for a shock when the un-elected govt committee starts exercising their power.
Originally Posted by paintlady
OP, I noticed you mentioned that Dave Ramsey is your favorite financial guru. He is my favorite, too. I have read almost every book he has written, everything he has put on his website, and have listened to his radio show for years. I'm not sure how much of him you have read or listened to, but there seem to be a few principles of his that you either missed or have chosen not to follow. The biggest one being that he is a big believer in keeping yourself insured with health insurance. He gets many callers into his show who are nearly financially ruined because they elected not to buy health insurance and then had a major medical event. In cases like yours where you say you could not afford the $250 per month premium, I am fairly certain he would advise that you cannot then afford to be going to school since health insurance is the priority. I am also fairly certain he would advise either stop taking classes and use that money to pay for the premium, or finding a job that does offer health insurance, or taking a second job to allow you to make enough to cover the premium. Everything I have heard from him is pretty obvious that he believes school is a luxury if you cannot afford your basic bills (which health insurance is a basic bill). Even barring all of this, he also teaches that you should have 3 to 6 months worth of expenses saved in an emergency fund to cover just the sort of situation you found yourself in. If you had done that, you could have paid the cash upfront and not had to wait for care. You said you were piling up cash after you were laid off, if I remember correctly. You waited until the storm hit to begin planning for it, which is completely backwards from what Dave teaches. If you were able to pile up cash after the storm hit, why couldn't you have done that before it hit and had a nice emergency fund ready?
Please don't think that I don't feel bad that you were in this situation because it does suck. I have been in the uninsured boat when my husband separated from the military and we thought we couldn't afford the Cobra payments until the insurance at his new job kicked in. So of course that three month span is when he needed to visit the emergency room because a cyst in his neck swelled up and started cutting off his breathing. CT scans are quite expensive, we found out. Luckily he didn't need surgery until after his insurance kicked in, but we still incurred thousands of dollars worth of bills. We negotiated with the hospital and got a couple of bills reduced, and made payments on the rest. We also sold our horse trailer to pay off the largest bill. It sucked but we considered it an important lesson learned that we will not go without health insurance again.[SIZE=2] We also learned to plan ahead for large expenses, such as the Cobra bill we knew was coming but buried our heads in the sand about.[/SIZE]
I already told you I live very modestly. I budget very tightly every month (and subscribe to Dave Ramsey's ideas of not being in debt, having a written monthly budget etc). I do have basic cable (but my utilities are included in my rent, and my roommates use it). I do have a smartphone but it's older and the cost between a non-smartphone plan and the one I have is $29. Which won't buy insurance anywhere that I have found. Not that I need to explain or justify this to anyone........
Originally Posted by prairiewind2
If I were hurt on the job then workman's comp would be at play, or I would be eligible for the county medical services pool. I am not currently eligible because there is at an fault party (the woman who hit me), and they cannot give me funding that someone else is responsible for (her insurance)
My understanding is there are no 'county' hospitals here, you apply for the aforementioned CMSP after you go to the ER/specialist, for which most people of my income level are eligible (except this whole at-fault-party issue).
Originally Posted by pal-o-mino
You get it. There's nowhere else for me to trim.
Originally Posted by axl
Obamacare is a factor in all this for a couple of reasons:
1. If we had universal healthcare (as it was supposed to be before the GOP got their claws into it), I'd have been taken care of, payment would have been worked out later
2. It would likely bring down premiums enough that I could potentially afford it
3. Even if it didn't, at my income level right now (essentially unemployed) it would likely be subsidized
4. Your tax dollars wouldn't be paying for me in this situation anyway - her insurance WILL be paying for all of this eventually
Oh, in the weeks between being laid off and getting the part time job, I applied to around 20 non horse related jobs at a variety of well known corporations (Starbucks, Petsmart, Petco, Best Buy...you name it I probably applied). I got no callbacks despite a professionally-edited resume and cover letter, and some serious pounding of pavement. So again, if I could get the benefits that some of these corporations provide, I would.
OP may have made an error in judgment to work in a high risk industry without insurance because a freak accident resulting in 6 figure medical bills is conceivable.
But on her specific facts, it may have been irrelevant if the deductible had been almost as much as the surgical cost. I am Canadian and I dont pretend to understand all of this but what happens in such a case? If one has insurance with a high deductible, does the insured pay the deductible up front to the hospital and then the insurer pays the rest? If so, OP still would not have gotten the care she needed in a timely manner.
The way I understand his financial advice is that health insurance is a luxury here. It takes a LONG time to build up that 3-6 months of expenses when you are a single person not making much (btw, I stopped taking classes when I saw my layoff coming). I'm using that savings I do have to pay my rent and eat this month and next so i'm not homeless.
Originally Posted by tbgurl
In addition the point here is not that I don't have health insurance, but that the woman who hit me SHOULD be paying for these expenses (via insurance), it was HER fault. I didn't do a damn thing wrong. And hell, there's no guarantee, if I had insurance, that it would have paid for this anyway, as many have stated.
Don't underestimate the possibility of ANY of you ending up in this situation.
Not available in my zipcode :(
Originally Posted by OveroHunter
I have a friend who has a brain tumor that is inoperable, seizures (multiple bad ones/day), and now pain in her leg was seen to be a tumor munching it's way thru her tibia when she went to the ER. Her state won't approve her Medicade for at least 6 months despite her being told the tumor in her leg is almost a given to be cancer. She can't get refills on her seizure meds either so she has to wait until she runs out, has an emergency (aka, BAD seizure day), and then she returns to the ER where she is given rx for another 30 days of seizure meds.
The system is totally screwed up and the insured already pay for the uninsured b/c the ER is the only healthcare anyone has access to and they often default on those bills. So, yeah... I'm for Obamacare. Why health care has to be for (unlimited) profit is beyond me.
I also have a personal story about why this is so important, although it happened to my mom, not me.
She was laid off of her job in 2009 and after looking for a while, opted to retire (she was 63 and wanted to retire anyway, it just came a little earlier than she was expecting). My dad is older and retired and covered by medicare, but she wouldn't be eligible for a few months after her COBRA would've run out. No big deal, they would just buy insurance for a few months to cover the gap, right? Well right at the end of her COBRA period, she was diagnosed with a very rare type of lymphoma. She had no symptoms but was doing a blood test for something else and her white blood cell count was high. Further testing had to be done, including a bone marrow biopsy, and she was diagnosed with this. Totally scary, totally unexpected.
Of course now she is unable to buy a policy to tide her over because she has a pre-existing condition. My parents were always responsible; insisted that I buy a high-deductible policy just in case when I was working on a horse farm and didn't have health insurance (I did, but this is when you could get one for only about $50 a month). They knew that it could bankrupt me (and them) if I had a serious accident and wasn't covered.
So my mom is facing a totally unexpected diagnosis of cancer and all the associated testing and appointments and on top of that, the scary thought that she has to go several months with no insurance! What if she was in a car accident? What if her doctors wanted to start her on chemo right away? What if her lack of access to treatment would be a life or death situation for her?? All of a sudden my parents are googling to see how much chemo costs out of pocket...at a time when they were terrified by the diagnosis alone and were now facing having to blow their retirement savings on medical bills.
It was absolutely awful and so stressful and something nobody should ever have to go through when they're already freaking out about diagnosis of cancer (or anything else). And there was nothing she could do because she simply could not buy insurance for any amount of money.
Luckily the state she is in had a stop-gap policy that she qualified for, so she was able to get that in place until Medicare kicked in. And also very fortunately her cancer continues to be just "lurking" and she is asymptomatic for now, so her doctors don't want to do any treatments at this time.
I don't know how she could've been more responsible, or planned ahead for this. And although I would vote for Obama anyway, I hope others will read this and think of how close they might come to something similar if god forbid they found themselves in situation like this.
No. The hospital does not know what your deductible or copays are. They see you have a valid insurance card, take it and treat you. Even so, the whole procedure can be messy and frustrating, as other posters have said. And later, you may have to fight with the insurance company and even the hospital and doctors. Still, at least you are not mooching off of others who do buy health insurance.
Originally Posted by JenJ
To whomever asked, it depends on the hospital in regards to if you have to pay your deductible up front.
Last year when I had my baby the OB's office wanted my $3k deductible up front, before week 36 of the pregnancy...keep in mind that in the case of pregnancies the delivery services are not billed until after you have the baby, so, you are paying for services you havent recieved yet. When I was in labor and we went to the hospital, upon check in, the hospital also wanted that same $3k deductible up front since my deductible had not been met, even though I had already paid it to the OB;s office in advance per their policy. So, I had to pay a total of $6k up front to have my child and then wait for someone to refund me.
The hospital got their charges in first, so I had to wait for the OB to bill for her services and then request my refund and wait for it...THAT was a nightmare. Turns out they want their money NOW, but when its your money they are holding they dont want to let it go...
But I have gone to the ER before knowing I had not met my deductible, it was around 2am so I anot sure if that had anything to do with it...they billed my insurance and then sent me a bill.
Prairewind...its EASY for the hospital and Dr's to find out all of that info...they call the automated provider line and viola, there it all is...its standard practice that they call to make sure your insurance is actually valid and to see what your benefits include. It may be a bit different if you are trucked into the ER via amblulance, but I assure you, if the OP went to the ER and an orthopedic on staff scheduled her for surgery, at the least the Orthos office would have called to check benefits.
Originally Posted by prairiewind2
My daughter had major knee surgery this summer and both the surgeon and the hospital took our insurance information, called the ins. company, and then contacted us and said we must pay $XXXX up front, which was their estimate of what the total deductable and co-pay portions would be.
They required it be paid before they would put her on the surgery schedule.
I got the same message.
Originally Posted by Dazednconfused
"The zip code you entered is in an uncovered area."
Yep, and they flat out told me they wouldn't accept my car insurance.
Originally Posted by relocatedTXjumpr
Which I understand...all these people have to be paid, doctors, nurses, anesthesiologists, desk staff, the titanium pins and plate, and bone graft that are now in my wrist...none of that is free. Someone's gotta pay for it...and a small practice especially can't necessarily absorb those costs.
But meanwhile, I use my hands for everything (I used to take for granted shaving my left armpit...lol...and writing left handed?! Yikes), let alone in my job. All I wanted was to be fixed and get back to work...
I agree with the OP who said most Americans plug their ears because they don't want to even THINK it could be better somewhere else...
I know there can be waiting times for tests and surgeries, BUT it is also available faster IF you are willing to go to a different hospital...
My husband injured his knee in July, went to see his GP who made an appt to a local ortho surgeon (and my husband did not like that guy to start with). After a couple of weeks, he asked his family doctor to find him someone else sooner. Yes, it involved driving 45 min. south of here, but he saw the doctor within 10 days, had arthroscopic surgery within 3!! On his second check up after surgery (would have been at the end of October), he mentioned pain in his hip... xrays and the surgeon agreed he would be a good candidate for hip replacement. That happened Dec. 4th!!! why? because people (probably the ones complaining about the length of time etc.) could not be bothered to have surgery in Dec. before Christmas!!! Within 6 weeks after surgery, he was back to taking hour long hikes in the countryside with the dog!
My case: pain in breast, ultrasound, ultrasound with fine needle biopsy, surgeon visit, and surgery (still no def. dx) within 6 weeks. It did take another 3 weeks to get results BUT "it" was out! Within two weeks of results, I had met my previous oncologist, had had a bone scan, a chest xray and liver/abdomen u/s, had met with the radiation oncologist and had had my measurements taken. Another week and radiation started...
No battle with insurance, no approval needed and so far, nothing out of pocket!
But it can't be... right? because a friend of a friend said... never mind my experience!
In my city, wait for MRI "can" be 40 days, but drive 45 min. north... 13 days! If it is an emergency, you get it right away! Geez and all the professionals athletes get to the start of the line of course!
And for the ones who say they don't want to pay more taxes to have health care... here is the Ontario premium rate chart...
Isn't $900/yr better than $900/month? and how long do you think it takes us to "recover" our premium? remember doctors' visits, lab tests, hospital stays, surgeries, radiation, chemo, etc. are all covered by this premium!
People say you have to be your own advocate! Yes, you have to be willing to go where the treatment is available if you can which helps people who cannot travel move up the line. And when the "rich" decide to go down south... good for them, patience is not their best trait most of the time, and again, they allow others to move up. Also, sometimes, if the treatment is not available in the province, the government will agree to travel to the US and will pick up the tab.
I am not sure on the details, but my ex husband was being treated in Buffalo instead of Toronto for his cancer - at the government expense, not his.
I have other examples of treatments in the US (luckily to people with out of country insurance) which were totally unnecessary but meant to cover the hospitals/doctors' a....es in case of malpractice. In one case, the patient insurance co. insisted the patient came back to Canada (flight paid for 2), did all the tests they deemed necessary and had a dx within days ... nowhere as dire as what the American doctors were thinking...
But you know better because you heard it from ....
The $250 for insurance would be made up of many cuts, not one. So yes, your $29 for a smartphone (which I do not have) would be a helpful cut. It is over 10% of the money you need. Somehow, I do not think you have really listened to Dave Ramsay, only heard the parts you wanted to hear.
Originally Posted by Dazednconfused
The county services medical pool is still made up of other people's money. A little bit of yours too, but mostly other people's.
I doubt you would be eligible for workman's comp. That is not an automatic thing; it has to be paid into first. If you are considered self employed, you will not be eligible either.
An insurance card would probably have gotten you treated, with all the other stuff being hashed out - probably frustratingly - later.
And I repeat - if you cannot afford insurance, you should not be paying for school. I should not have to subsidize your health in order for you to go to school. Nobody did that for me and I didn't expect them to.
A thought - is there any sort of student insurance available to you? It is usually more affordable.
P.S. - Keep going back to Petco, Starbuck's etc. Let them see you. Smile. Be friendly. Smile. Smile. Show interest in the business. Smile. Good luck!
Not sure what kind of hospital you have been dealing with, but mine verifies deductibles and co-pays with my insurance carrier. I have been in for emergencies three times in the past 10 months (two strokes and one head injury), and even during "off hours", they get in touch with my carrier pretty quickly and find out where I stand regarding deductibles and co-pays. I was in late yesterday afternoon for about 3 hours or so, and the hospital insurance analyst confirmed within the first hour that I had already met my annual deductible and annual co-pay minimum.
Originally Posted by prairiewind2
I will also say too that I am medically pulled from work. I'm in the process of applying for disability, but when I was first out of work and officially let go by my employer they didn't send COBRA paperwork. Instead, what I got first was a "direct enroll" option from the insurance company. The policy that was costing me a couple hundred per month was now going to cost me over $1300/month AND I'd still have a high deductible plan. Remember, I wasn't working. Where do I come up with the money? I have SEVERAL life threatening issues and many pre-existing conditions. I did finally navigate the system and was lucky to get emergency processing for state assisted health insurance but others, like my friend in a different state, are not so lucky.
We are all one accident, layoff, or dx away from being royally screwed. Almost no amount of money most of us could save would sustain you either. Until it happens to someone you care about or love it is easier to pretend this isn't happening to people in the USA. I say a nightly prayer that my friend won't pass before she is able to see an ortho and oncologist. How awful is that? All because she had the misfortune to get VERY sick and not have parents to put her on their insurance.
Moon - Thanks for the info. We haven't had any major things done and nobody's ever checked - or at least said they have - on our deductible for the small things. I'm sure they've checked to see that we really have insurance. Be stupid not to!