PDA

View Full Version : Health Insurance



mariaf
06-05-2013, 03:50 PM
I am starting a new thread because I didn't want to hijack Cody's thread "Need Some Opinions". (Cody - I truly hope you can find some relief and answers soon)!

I was following the discussion about the situation that Cody and others find themselves in, basically caught between a rock and a hard place, with a medical condition that requires care but with no insurance. There does not seem to be an easy answer here. If a patient is lucky enough that a parent can carry them on their insurance, that buys them until they turn 26. While some employers still offer offer family coverage at a somewhat reasonable cost, many do not - and sadly, that seems to be the trend with fewer and fewer jobs offering family coverage, or any coverage at all. For young people, in particular, any entry-level job they can get likely doesn't provide insurance outside of maybe civil service jobs and a few others. As someone mentioned, the situation in other countries (like Canada) is even worse in many ways.

What are everyone's thoughts on this - and do you think the Affordable Care Act, which I believe (someone correct me if I'm wrong) requires folks to be insured by 2014 or, in most cases, be penalized will make things better? worse?

It just seems wrong that Cody and others like him are victims of a situation that is not of their making. Seems like something that the powers that be should be able to come up with a solution for.....but can't.

Just interested in hearing any thoughts.....

p.s. (Too bad there's not a system structured like Shriners Hospitals for Children, but for adults!)

rohrer01
06-05-2013, 05:21 PM
I'm not much interested in politics. However forcing people to buy insurance or be penalized will put the same burden on the common citizen as it does on businesses. Depending on the cost, some people will be forced to pay the penalty if it's cheaper than the insurance. After the insurance mandate our premiums went up over $100/mo while our coverage went way down making our out-of-pocket expenses even higher than they were. My drug coverage also went down and the copays went up.

But forcing people to buy insurance or pay a penalty doesn't help people like Cody, who don't work. How are you going to pay a penalty if you don't work? My boys don't make enough money. Unfortunately it will force many couples, who would otherwise wait, to have children so that they can qualify for state insurance. Single young men will have it the worst. Single young women who refuse to get pregnant out of wedlock will also have it bad. It "might" force some people to consider going back to university type schooling, since that package usually comes with insurance. However, college education does not equal gainful employment. Some of the most gainfully employed people I know don't have a college degree. So that will solve nothing.

You are right Maria, there is no good solution to this problem. That's why I stay out of politics.

jrnyc
06-05-2013, 06:46 PM
what is the answer then....?
people bemoan that folks like Pontiac don't have insurance
and cannot get medical help....
kids can stay on their parents' insurance til age 26, i believe...
but it costs money...
so if a penalty is not the answer....what is...???

i do not have any easy solutions....
it seems that this country will still not be covering everyone
with medical care....

who is to pay for those who do not work????...
if they can prove disability, there is Medicare...
if they can prove need, there is Medicaid...
obviously, it is not sufficient...

what is the answer as to WHO pays to cover people who cannot
afford insurance...???
who is volunteering to pay for them...???

jess...and Sparky
(vet insurance is also quite expensive...but i do advise
it...i regret not getting it for Spark the day i brought him home, as
now some companies won't cover him due to pre existing conditions!)

mariaf
06-05-2013, 10:14 PM
Again, I don't know everything about this issue, which is one reason I brought it up (to learn more).

Is there going to be a sliding scale where the less money you earn, the less you will be charged for the insurance you must purchase? Will those who are not employed qualify for insurance without charge? I honestly don't know.

As for young men having it the worst - that's probably true and I get what you are saying, Rohrer - but having a 22 year old daughter, I can tell you that (thankfully), she would not choose to have a baby early just to qualify for state insurance....which will then, unfortunately, put her in the same position as young men.

LindaRacine
06-05-2013, 10:24 PM
There is truly no good answer. I think the key is to get to these folks when they're still young, before they start having significant back pain and become disabled. Unfortunately, one someone is on disability, it's relatively rare that they get off, even if they eventually have surgery. I think these folks need to do everything in their power to get a decent education and hopefully a job that can provide benefits.

Unfortunately, doing scoliosis surgery on people who don't have insurance is not sustainable under the current model. And, I suspect as long as their is a conservative party, we will never have socialized medicine in the U.S. By the way, as it turns out, socialized medicine seems to be faltering a bit. I was told earlier this week that most physicians in the U.K. are filling their schedules with patients willing to pay cash, as there's little incentive to treat patients who are only covered by the government. And, we've seen a lot of examples in the last few years in Canada, of kids who waited on the waiting list while their curves exceeded 100 degrees.

The only solution I've ever come up with is for patients who need surgery to go to Barbados and have their surgeries performed by the volunteers who go there as part of the F.O.C.U.S. charity. I believe Americans can go there and have the surgery performed for a relatively small amount of $. I'm guessing that one could also go to someplace like India to have the surgery performed, but I'm not sure how safe that will be.

--Linda

mariaf
06-06-2013, 08:53 AM
I'm not surprised to hear that there's little incentive for doctors to treat patients covered only by government insurance.

While I was actually speaking more in general about the state of healthcare in this country, of course, patients with scoliosis are a prime example to use to see if the system works or not.

I think the key (and it's very sad) is that years ago, even in the late 70's when I was entering the work force, it was relatively easy to get a job that provided health insurance. Today, it is very difficult for most people it seems.

rohrer01
06-06-2013, 11:42 AM
I was talking to my grandson's dentist about this situation last year. He said that the state barely pays him enough to cover the supplies to give a child a dental exam. He said that he, himself, could not turn any child away, but that if it wasn't done he would go broke and not be able to help anyone. So he hires tough staff to enforce his policies about absenteeism. Which is another problem with many people with state funded insurance. They don't realize that the doctors are actually treating them for free plus cost of supplies and when they don't show up for appointments it puts the doctors in a real bind, since they could have filled the slot with a paying customer.

I'm not picking on people with Medicaid. I, myself, have had periods of time in my life where I've had to be on state assistance and times when I've had really good insurance and times where I fell into the category of no insurance. So I've felt the impact of it all. I hate to say this, but people with Medicaid do, sometimes get substandard care. They get ostracized and labeled. I personally know someone, who as a child, had surgery for scoliosis. Looking at the results and the instrumentation used, it was obvious that this person didn't get the most current hardware. So it happens with scolis, too, unless the parents know where to take their child.

Everyone is right. It's not humanly possible to completely solve this problem. As long as people get sick, the problem will exist. It's not about political parties, conservatives vs. liberals. No one can have a perfect solution. For the current situation, the best that parents can do for their children, especially if they have a sick child. is to remember that their kid/s will be 18 someday and try to save and prepare to put them on parental insurance or if it's bad enough, start the disability process before the kid ages out. I know a family who has two severely disabled boys (autistic) who thought ahead. Their kids are already on SSI and won't age out of the system. Yes, it's a pain in the bahootie to do the paperwork and the fighting and getting involved with all of the agencies. But it's worth it in the end. I guess that's all I have to say on the matter. I just don't want to see this turn into a political debate about conservatism vs. liberalism. That's not the issue and neither have a good solution. This is a forum about scoliosis and we should be supportive of each other no matter our political views.

mariaf
06-06-2013, 11:59 AM
I don't see it as a political issue either. Like so many problems in the world today, it's bigger than any one group and took years to get to this point.

I wonder (not sure if anyone knows the answer) if the insurance that folks will soon be able to buy under the Affordable Care Act will be much better than Medicaid. I am talking about the insurance for low-to-middle class folks that would (hopefully) not be ridiculously expensive (if, in fact, that's what the plan is) - like I said, I don't know much about it, but find it interesting and probably one of the biggest issues facing Americans today, along with the economy which I suppose it's all tied to (i.e., companies can't afford to insure employees and their families, etc.).

rohrer01
06-06-2013, 03:55 PM
My guess is that "if" it's affordable, it won't be worth having. The insurance companies are in the money making business. What better business than to require everyone to purchase your product. I'm guessing that the deductibles will be so high, that the insurance companies will rarely ever have to pay out anything.

mariaf
06-06-2013, 04:05 PM
That makes sense. I figure it will just be another form of not fixing the same problem. And somebody has to pay for those who are uninsured or can't afford insurance - whether we are talking about before the Affordable Care Act or after. To quote a phrase I recently heard someone use regarding another topic, it's sort of like rearranging the furniture on the Titanic.

rohrer01
06-06-2013, 05:55 PM
To quote a phrase I recently heard someone use regarding another topic, it's sort of like rearranging the furniture on the Titanic.

I couldn't have said it better myself.

SpineTime
06-07-2013, 04:24 AM
I am starting a new thread because I didn't want to hijack Cody's thread "Need Some Opinions". (Cody - I truly hope you can find some relief and answers soon)!

I was following the discussion about the situation that Cody and others find themselves in, basically caught between a rock and a hard place, with a medical condition that requires care but with no insurance. There does not seem to be an easy answer here. If a patient is lucky enough that a parent can carry them on their insurance, that buys them until they turn 26. *That is a result of Obamacare, BTW*

What are everyone's thoughts on this - and do you think the Affordable Care Act, which I believe (someone correct me if I'm wrong) requires folks to be insured by 2014 or, in most cases, be penalized will make things better? worse?!

I think it will make things better. I've read a lot of articles relating to the Affordable Care Act, aka Obamacare. I've "liked" Ezra Klein (WA Post) on Facebook, and he's been talking about the ACA lately, as the rollout starts soon with enrollment beginning this fall. Here are a couple of articles everyone on this thread might find interesting, and they answer some questions that have been brought up.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/05/what-bros-need-to-know-about-obamacare/ (has a chart showing examples of subsidies)

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/06/will-young-adults-want-obamacare-lets-ask-aaron-smith/

A lot will depend on your state and how much they want to cooperate. I'm in California, and I'm optimistic. I have family members here that are uninsured, and I hope they will be able to afford coverage. I worry about them all the time. It angers me that we don't have healthcare for everyone. Other countries with socialized medicine might not have a perfect system, but at least they don't have to worry that one bad accident or illness will devastate them financially and ruin their life. And they don't have to put off going to the doctor or refilling critical prescriptions because they can't afford it. I'm one who didn't think the ACA went far enough, but it's a start, and I do think a lot of people will benefit from it. JMHO, of course.

Lisa

mariaf
06-07-2013, 09:57 AM
It angers me that we don't have healthcare for everyone. Other countries with socialized medicine might not have a perfect system, but at least they don't have to worry that one bad accident or illness will devastate them financially and ruin their life. And they don't have to put off going to the doctor or refilling critical prescriptions because they can't afford it.

Well said, Lisa.

I hope your optimism holds true. I am looking forward to reading the articles you posted - thanks for sharing!

rohrer01
06-08-2013, 10:47 AM
Just a thought to ponder. I have a friend in Germany, where medicine is socialized. They take a FULL 50% of her wages for taxes. So, is it really any different? Well, except the insurance that we are offered has lower benefits and higher costs and limits who we can see, an insurance companies dream come true.

We, personally, are spending nearly 50% of our income on just healthcare costs, not including the taxes AND I don't have a choice where I want to go for healthcare. There is one and only one scoliosis surgeon that I can see. I'm supposed to be allowed a second opinion, but they find loopholes to prevent that. I will have to take it before the insurance board and fight if I really want a second opinion. On the other hand, if I choose to pay out of pocket I can go anywhere I want and not have to wait years on a waiting list. Unfortunately, for something so costly as a scoliosis surgery, very few people have the funds to do so.

BTW, a person can NOT be turned away in an accident situation where their life is endangered. Follow up care is a different matter.

jackieg412
07-04-2013, 03:47 PM
This is a very interesting topic. So far---I have seen large medical groups merging because of the up coming health care changes. My own surgeon's group just did so on July 1st. With the merge brought insurance changes. I was just in the office and was told by insurance personnal that it was a good thing I have an HMO medicare advantage plan. After the 1st of the year it will be hard to get a primary care doctor.I don't know what it is all about but it makes one think. As soon as I can post more---I will post on how my surgery was paid for. It was an interesting way--nothing like I have read here. I donot think there is an easy answer. Also most scoliosis {not all} is not going to take your life. So the debate may continue about coverage--or coverage as an elective surgery. We all have thoughts about function and pain though.
I say choose your occupation wisely as it is so very important.

jrnyc
07-04-2013, 05:19 PM
having insurance doesn't mean having good insurance...
no matter how long one has worked and paid into all the programs
that take money from a person's paycheck...the insurance offered
by employers or former employers leaves a lot to be desired...
and the choices are not always choices...but requirements...

the City of NY
(thank you Mr Bloomberg...didn't think i could like him less...
i was wrong) recently forced their retirees and employees who
are on Medicare to switch insurance (insurance obtained thru
employment by City) to a Medicare Advantage Plan...no choice...

this Advantage Plan has cheaper premiums...
BUT...i rather go back to the plan i had before, pay twice as much
in premiums (not including the money i also pay to Medicare)
and have the better coverage...but i am not allowed to do that..
i rather have the old plan...(even with double the premiums)
because now, there are doctors...including scoli specialists...
who have told me they do not take the Aetna Medicare Advantage Plan
that i had to switch to as of November 2012.

i will be investigating other options after husband can get Medicare
January 2014....but i do not expect to find great choices...

sooooo...my venting about insurance that comes thru employers
(or former employers) is over...

no answers....just venting...

jess...and Sparky ( puppy now has costly insurance that does not cover
pre existing conditions)

tae_tap
07-04-2013, 09:55 PM
The Medicare advantage plans are one thing that really upsets me working in the healthcare system. I have seen many of our elderly patients be suckered into changing from straight Medicare and not explained that the advantage plan sucks! The coverage and deductible are not good and most of our patients can not afford the extra bill that is left behind. Our diabetic patients have it the worse because their coverages are sliced even further.

I encourage anyone that has Medicare and the option to pick if they want an advantage plan to stay away. Find a good secondary and stick to the old way.

My vent! (smiley)

Tamena

Anthony's Dad
07-04-2013, 11:06 PM
Like winning a jackpot at Vegas, insurance is amazing when it works, but it seems like the house (read: insurance company) always wins.

If we can talk specifics: Bills are still rolling in, but Anthony's growth rod surgery in May 2013 at Rady Children's Hospital San Diego has cost more than $230,000. Of course, Anthem is a monopoly and has all these hospitals and doctors under contract, so Anthem never really pays out $230,000.

Anthony is on the same Anthem Blue Cross PPO policy as my wife, my 18 year daughter and me. I have been paying $1,722 a month for that Anthem policy which is pretty much the only insurance we can get because of my health history. Prior to the current Anthem policy, I have been paying monthly premiums of approximately $2,000 a month for coverage from Anthem or Blue Shield since I went on disability in August 2008.

Except for Anthony's surgery in May, 2013, my family has hardly seen a doctor this year. Because of my disability, I was finally able to go on Medicare Part B on July 1, 2013, so I asked my insurance broker friend (who doesn't charge me) to find new coverage for Anthony, my wife and daughter or to continue with Anthem at a lesser premium. My insurance broker talked to various insurance companies and told me that no one would cover my wife, daughter and Anthony because of Anthony's recent surgery. The only way to get coverage was to continue the existing policy with Anthem and continue paying $1,722 a month - even though I am paying for separate Medicare Part B and D coverage. The only saving grace is that my broker tells me that because of new laws (the Affordable Care Act), the insurance companies are not going to be able to deny Anthony coverage effective January 1, 2014 because of his pre-existing condition. Having said this, my broker cannot tell me whether the premium for Anthony, my wife and daughter will continue at $1,722, although she expects it should be less with one of the carriers as a result of the Affordable Care Act. However, my decision about insurance carriers will depend greatly on whether Anthony's doctors have contracts with that company.

Anthony will be facing at least one more major surgery in a few years. In all likelihood, I am going to try to return to work in a few years to pay for insurance and other bills. I worry that the Affordable Care Act will force our highly skilled surgeons to go off the grid and demand private payment for services.
I sincerely hope I am wrong.

If for some reason I'm not around, I'm grateful to know that we have amazing people in this world like the Shriners and other fine organizations to help our children. I am going to send another donation now. Shriners now takes PayPal.

--Steve

rohrer01
07-05-2013, 12:18 PM
I talked to my husband's insurance coordinator at work before signing on. She asked me about my health history and just cringed at the thought of adding me. I wanted to try to buy insurance in the private sector but was deemed "uninsurable" because of my back and heart issues. It's a real blow to hear that a healthy 30 something woman with two non-life threatening conditions is "uninsurable". I've had to go on my husband's plan. Now, unfortunately for all the others on the group plan, people like me drive the premiums up. We pay about $856/mo because the employer pays half for my husband. To add my kids would cost >$400/mo. My boys won't split the difference and pay us and my daughter and her son have Medicaid. So, my boys go uninsured because we can't afford even $400/mo more. On the up side for me, every year that I've had that insurance, the house loses. My health care costs exceed our premiums and deductibles. But it still costs us well over $1000.00/mo every month. At least I'm getting treatment that I wouldn't have been able to get otherwise, even on Medicaid. My Botox injections alone run about $4000.00 every three months. There's no way Medicaid would have ever considered paying for that. They'd rather see me be drug dependent for the rest of my shortened life. It's more cost-effective that way.

I don't know how I feel about the Affordable Care Act. I'll have to see how it affects people, especially my boys. I think back to the frontier days. No one in their right mind would have even thought about forcing people to carry insurance. Heck, it didn't even exist back then. Hardly anything was regulated, except murder.

leahdragonfly
07-05-2013, 04:44 PM
Hi rohrer,

Our family had to buy private health insurance for a few months when we moved from CA to Oregon, until I got a job with a group plan. At that time I hadn't seen an orthopedist since 1984 so my back was a non-issue, and my kids were little with no know health problems, so we got insurance without difficulty. My husband was denied, though, at age 38 because he takes high blood pressure medicine. He is otherwise healthy and his BP is well-controlled. They denied him for that reason, which we found incredible.

Yes, insurance today is a mess. When I had my first surgery and ran out my FMLA, I had to pay full-price for one month of insurance through my employer. For our family of four it was over $2200 for one month!! Totally outrageous in my opinion.