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Senior Contributor

Re: Health insurance

It is just too bad that they cannot have a clear table of what they cover, for how much, and premiums. It would make life much more simpler. Changing insurance based on cutting costs will usually end up costing more in the end.

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Senior Contributor

Re: Health insurance

yeah like quality of life.  My husband is not going to ante up for the cost of the tests they want to do to find out whether the reason I am so tired all the time is breathing related or something else.  It could possibly be heart valve they think.

2 years ago with the other policy there would have been no hesitation.  Now he is going to bank on my ability to quit smoking and that that will solve any and all problems.

It is going to be a very long summer for me.  I've smoked since I was 14 and only stopped once for about a month.

wish me luck..

Apparently I'm really paying the price for my nasty habit.

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Honored Advisor

Re: Health insurance

At least see if the plan you have now has any benefits in it for smoking cessation, counseling, meds, etc. Quitting is never easy, but it can be done.

Learning some deep breathing exercises can help you get the relaxation relief of smoking that most people miss when they quit. The truth is, anything else you do will only be that much better when you have put cigarettes aside. Good luck!
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Senior Contributor

Re: Health insurance

Don't feel lonely. I'm sure all of us have some nasty habit we've had to overcome. It just takes a commitment and lots of hard work. Have heard that habit substitution works, as long as it is a good one and not bad one (like overeating). I'm sure stressing out over the policies and DH's reactions is not helping. I agree with Kay about checking about smoking cessation coverage. Why pay for something when it is already covered?

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Honored Advisor

Re: Health insurance

Most health insurers now promote wellness to a pretty good degree.  Mine nags me to have certain screenings at prescribed intervals, too. 

 

Two thoughts on this, after sleeping on it:

If the heart issue is deemed at all threatening to life and overall health, I'd consider spending the money.  Savings aren't worth much if you are dead or disabled. 

 

If it is a sort of "wait and see how quitting smoking helps" (and it will), then it might be best not to have a diagnosis of a heart condition on the medical record.  Every strike against you is anotehr pre-existing condition, and the national healthcare law hasn't fixed all of that yet. 

 

My specialist said he was NOT going to even write down asthma, since my breathing problems seem to be environmentally/probably chemically driven.  The (former) GP we had was all for writing down emphysema, for the same problem.  Notice I said "former."   Having a chronic respiratory disease on my record would have, as the specialist noted, "followed me around on insurance for the rest of my life."  That is my kind of doc. 

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Veteran Contributor

Re: Health insurance

I believe the insurance companies spend their time and money figuring out how to not pay claims. My health insurance company is one of the few around which pays a claim the first time they receive a bill. I had one claim denied only to make a couple of calls have the claim resubmitted with the actual true tests and visit billed and it was paid immediately. The health care industry, including pharmaceutical has now turned into big for profit business. After all the claims a few years ago about a single payer health care plan setting up death panels, I now say that the insurance companies are true death panels. If you have a pre-existing condition you can't get coverage, they will let you die from it rather than paying. If they don't feel a procedure is necessary they will not approve and you can die from it. I call that death panels.

 

I am not a big fan of insurance, but it is a necessary evil. I find it funny that people say that as part of the National health care plan people have to buy some health insurance, should be a choice, but in many states you are required to have auto insurance to drive, you must wear a seat belt (which I did all the time before) and you must take hunter safety to get a hunting license.

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Honored Advisor

Re: Health insurance

Perhaps we are fortunate here in NC, on a couple of counts. First of all, health insurance companies here are nots - for- profit organizations by law. There have been attempts to change that, but the General Assembly has held the line so far, thank goodness.

As I understand it, for- profits are required to consider the interests of their stockholders above their customers. maybe tzhatz is an oversimplifIcation of a very complex subject; but, if a company is supposed to protect stockholder interests, by pursuing profits and paying dividends, it stands to reason that denying or at least delaying claims ( companies make their money off of float time...how long they can hold onto premuims without paying claims) makes business sense. We ar, after all, a captive customer base.

Second, here in NC, companies arE on,y allowed to rate higher risk clients to 150% of a standard premium. By comparison, VA allows a 300% rating. So, a guaranteed issue policy could be double or more, depending on standard premiums, by simply stepping over the state line.

Insurance, and especially health insurance is a very complex and convoluted issue. I really think that all preventative care and most screenings - at least routine ones like mammograms, PSA, etc., should be free to all citizens.
What I am seeing hints of more and more in the news, since national health care passed into law, is research reports rejecting a lot of things that we have come to see as boilerplate. When women heard mammograms in certain age groups were beIng stretched to two year s instead of annually, an uproar ensued. My husband was just told by our new physician that the PSA isn't as reliable as we once thought, too. Stations for lowering cholesterol are under closer scrutiny. Lots of drugs are losing recommended uses.

In other words, the standard of care is evolving. I am all for fewer meds and the side effects tney create, requiring more meds. Still, I believe that we are going to see ever-changing recommendations for our health care.

At any rate, we are in a good place for our needs now. How and when that may change is something I do not stay up nights worrying about. I had an in- office consult and surgical procedure, three followup visits, and an antibiotic prescription, all for less
than $260.
With electronic records, the doctor's billing person already knew what the EOB will say in a week or so, in terms of write down. My bill for services was written down about 25%, which is typical in our ZIP code. I was able to pay in full before I checked out on Monday.
Small efficiencies like that will help, too, by reducing costs for paper billing and mailings. The best thing about national healthcare
will be the elimination of duplicate tests and avoiding medications contraindications.
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Honored Advisor

Compelling doverage

As a Virginian by birth, I am actually quite comfortable with the filing of the Attorney General there, that has not as far as I know been overridden. ( BTW, unless things have changed, you do NOT have to have automobile insurance in VA...but, if you elect to operate as an uninsured motorist, there is a sgnifcant annual fee paid to the commonwealth. I guess this is a corollary to the fine for failure to carry health insurance, which I understand is a tenet od the healthcare law.)

The Constitution does provide Americans protection from being forced into entering into commerce. The case as I understand it is that this Healthcare law requires people to engage in the purchase of insurance, which is a commercial product.
Ven


Even examples like seatbelt laws are not on point legally...they do not require you to buy anything. In many states, not wearing a seatbelt is no reason for a cop to stop your vehicle...it is not a " primary offense." Also, passengers over the age tso operate a vehicle are responsible for their own lack of compliance. All interesting legal subjects.

If a person does not choose to buy health coverage, and ends up transported and treated without their consent, then the caregivers have acted according to their legal duty to act...but, they have, in doing so, created a potential financial liability for the patient. Sticky wickets abound.

There are myriad legal, moral and ethical issues in this mix. It is not a one size fits all issue.
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Senior Contributor

Re: Health insurance

I don't believe that insurance companies spends huge time and effort in not covering claims I know it.

Several years ago our oldest daughter had terrible stomach pain while in college.  First she thought it was food poisoning.  She went to the on campus clinic and they concurred.  She didn't get better, came home for a weekend for some mom loving.  I took her to family doctor.  He thought she had a UTI.  Put her on antibiotic.  She didn't get better so he over the phone upped the antibiotic script.  Still didn't get better,  he upped the dosage once more.

Still not feeling well she came home again.  Almost didn't manage to make the 3 hr drive she felt so rotten.  Took her to the emergency room.  They decided she had female problems.  Transferred her by ambulance to a larger hospital for exploratory surgery. 

That is where I made the insurance mistake.  She'd already been through one emergency room, they had the information.  New hospital asked me if it's OK for their staff doctor to do the work on her.   I of course said yes.  What they didn't tell me was that at that time not a single doctor in that hospital, or that city for that matter, was accepting the insurance we carried (BCBS).  Apparently they entire medical industry in that city were in the middle of some kind of argument with BC which has since been settled.

Well so now we are dealing with out of network insurance hassle.

Anyway they did the laprocracy (sp) and didn't know what they were looking at so had to open her up.  Turned out she had had appendicitis all along.  The appendix had burst and probably because of all the strong antibiotic therapy the appendix had encased itself.  Thus she survived a burst appendix but was one very sick girl.  10 days in the hospital and a full summer of recovery.

So get this BC covered the exploratory, covered the opening her up, covered removing the appendix but because the hospital  did not bill the procedure as an appendectomy because it had all started out as something else  or some other small discrepancy I can't remember now,BC decided they would not pay for closing the incision.  And the surgeon would not change his billing.

We argued, and argued with BC.  Was sent to their review board twice.  The review board supposedly had doctors and nurses on it along with insurance people.  But it's my guess they are not licensed doctors and nurses or else the stupidest ones the insurance company can possibly find.

They never did cover it.  We settled with the doctors office and my husband was so mad he told them he'd send them $5.00 a month till it was paid off.  They actually took that solution and after 2 yrs of 5 dollar payments wrote the balance off.

So anyway don't try to tell me that the only thing insurance companies are about is collecting premiums and then never paying.

Hospitals and doctors are crooks also.  If not explain why when you get the explanation of benefits from the insurance company it has the charge made what the insurance company allowed and then 90% of the time the hospital or doctor then accepts what the insurance allows.  Over charging is the normal practice.  And I think it is one of the biggest problems with medicine in this country.  Why we do not have affordable health care for everyone..  I don't know who pays the full charges.  People with large deductibles, the government (for all those whose medical care they cover), or is it for the write offs hospitals make on the uninsured so they can continue to say they are not profitable and therefore need to charge ever higher fees.

 

 

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Senior Contributor

Re: Health insurance

We have BCBS and pay about 9,000 a year. I have a high deductible also. My DH has had a eye injury and they did not pay anything, but applied to my deductible. My DH was so mad, but I told him if I had a smaller deductible the insurance would be so high. I have thought about looking into an insurance for eyes and teeth, but really I can't afford any more insurance at this time. I know its high but I would not sleep at night if I did not have any. We have a accident policy which should cover some of his eye bills.

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