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Qikdraw
08-27-2008, 04:46 PM
Ok, I have some choices to make in my life in the next 6 months to a year I'm just wondering what your thoughts are. Obviously the decision will ultimately be up to my wife & I.

I've been off of work because of my back since January, and only this september will I finally see a scoliosis doctor. I am really not happy with the way I have been treated by my doctors so far, its not that they haven't been nice, but waiting 2 weeks to get approval for an xray, or PT, or anythign at all, then waiting to make another appointment with the doctor for them to have to ask for permission for somethig else is really annoying and its just taking too long.
Not only that but I am about 90% positive that after I see the scoliosis doctor that my insurance will deny any further action on my back. I had surgery 25 years ago, and they'll just say that any problems I have now are 'pre-existing'. I just had to fight with my Cobra carrier to actually cover me after I had already elected, and paid for it. I had a tooth blow up and my dentist said my coverage was gone on the 31st of July. I tried getting it straightened out and was told it would be fixed within '48 hours', well they kept saying that for 2 weeks. On monday my doctors office called and said that I had no insurance and what am I going to do about my doctors appointment for wednesday. So I called my Cobra carrier again and talked to a supervisor who kept saying '48 hours' again. So I finally handed the phone to my wife who used to be an insurance defence attorney, she started citing all the illegal things they are attempting to pull. The next day I had health insurance back. (I haven't called my dentist yet) What they were trying to do is keep my first months payment and then start up coverage on teh second month. This is beside the fact that by law I am supposed to have a 30 day grace period where I am still covered.
I am really at wits end with this whole process. I want to get fixed, so I can go back to work. I hate sitting around the house all the time, and I just want to get fixed. Is that too much to ask?

Now here is the interesting part...

I'm Canadian and have only been in the US for 8 years. I am a Permanent Resident (green card) and am going to get my American citizenship. My mother did some research and found out that the day I move back to Canada (Manitoba) and reregister for healthcare I am 100% covered. That means no more having doctors ask for permission to get an xray done, no more asking permission to go see a specialist. The benifit to this is also no more co-pay and no worry about insurance denying me anything, no more arguements with them either.
The other good thing is that my wife can apply to enter into Canada as a self employed person, and if she starts today she'll get approved within 6 months. She also has some problems with her neck that insurance refused to look at, but if we moved to Canada she would be covered too and could get that taken care of.

So there are my options and don't know what to do about it. The problem is compounded by the fact that my wife's mother lives with us, and we pay teh mortgage and bills here. If we move to Canada that will stop and what will her mother do? She cannot afford the place on her own. My wife will also be away from her family as well.

If we did move to Canada it is not neccessarily a permanent move either. If I got my citizenship before we left I could come back with no problem, and while in Canada my wife would also get her Cdn citizenship. So both of us can move back and forth as we wanted to. Ultimately I think we will end up staying in the US, but we just do not know if there will be a break for a few years in Canada.

So if you were in my shoes, what would you do? (sorry for the length of the post)

Brad

Karen Ocker
08-27-2008, 05:37 PM
Would you have a long wait when you would return to Canada?
I suggest contact a teaching hospital in your area and see if they have a qualified scoliosis specialist who would see you in the clinic.

Re:insurance
Complain to your state insurance commissioner. Also, My understanding is that if you went into COBRA directly from a group plan, without a break in your coverage, they cannot pull the pre-existing condition trick.
Also contact your local congressman/state representative. It's an election year and sometimes that works.

Susie*Bee
08-27-2008, 07:25 PM
That's a tough one Brad. It at first sounds like a no-brainer, but then when you throw in the MIL, it makes it pretty difficult. I'll be praying for you. I want you to be able to live your life how you want to, so something needs to happen!

SIsForSarah
08-27-2008, 08:20 PM
For what it's worth, from someone living in Canada: Some days I wished I lived in the U.S. because of the really long wait times here. Sure, everything is paid for by the provincial health care system, but you have to wait a really long time for it. From what I've heard from others, it's pretty much a problem all across Canada, especially where back problems are concerned. I waited two months in a lot of pain to get a CT scan (turned out to be a herniated disc) and have now been waiting about 6 months for an MRI and an appointment with a specialist. I am not holding my breath for the appointment with the specialist, but my MRI is now booked for 2:10 a.m. sometime in late October and I only got it that soon because I said I was willing to go in the middle of the night. I realize the money factor is a huge problem in the U.S., but just keep in consideration how long you may have to wait for everything if you move back here. Otherwise, I love Canada:)

Qikdraw
08-27-2008, 09:22 PM
Would you have a long wait when you would return to Canada?
I suggest contact a teaching hospital in your area and see if they have a qualified scoliosis specialist who would see you in the clinic.

The teaching school is a good idea, I'll have to look into that.
As for waiting, well SIsforSarah is right in that there are wait times for Cts and MRIs, although those won't work on me anyway. There is a wait time for some things in Canada, but it won't take 7 months before an xray is done, like it was for me. Not only that but doctors are allowed to actually treat their patients as they want to and not have to ask an insurance company. Having dealt with both system I really prefer the Canadian system. There is a LOT less stress in dealing with it.


Re:insurance
Complain to your state insurance commissioner. Also, My understanding is that if you went into COBRA directly from a group plan, without a break in your coverage, they cannot pull the pre-existing condition trick.
Also contact your local congressman/state representative. It's an election year and sometimes that works.

The pre-existing condition trick is not from any break in coverage or not, its because my back problems go back so long. As I said I'm pretty sure that that is the trick they will pull.
California is actually pretty tough on insurance company fraud, and will act on complaints, however my Cobra carrier wisely listened to what my wife was telling them and the next day they put my health coverage on. So now we do not have anything to complain about.
I do keep telling my wife to write a book to tell people how to deal with insurance companys and to counter the tricks they pull. So far I haven't had any luck. :(

Brad

txmarinemom
08-27-2008, 09:42 PM
Brad,

USUALLY, a pre-existing clause applies NOT simply because you have/had a condition, but if you've sought *treatment* for it with the last ________ (insert period of time).

For example, I developed hydrocephalus at age 10 and had a VP shunt placed. It's never caused a problem, I've never required subsequent treatment/revision, and it is absolutely NOT a pre-existing condition.

Read your plan booklet for what is deemed pre-existing.


Regards,
Pam

Qikdraw
08-27-2008, 09:48 PM
That's a tough one Brad. It at first sounds like a no-brainer, but then when you throw in the MIL, it makes it pretty difficult. I'll be praying for you. I want you to be able to live your life how you want to, so something needs to happen!

Its not only the MIL, but the house, this is my wife's house and right now, if we sold it, we would not get anything decent out of it. We've put too much work into it to walk away with nothing from it. :( Plus I have great neighbours, and you can buy the best house on the block, but you can't buy your neighbours.


For what it's worth, from someone living in Canada: Some days I wished I lived in the U.S. because of the really long wait times here. Sure, everything is paid for by the provincial health care system, but you have to wait a really long time for it. From what I've heard from others, it's pretty much a problem all across Canada, especially where back problems are concerned. I waited two months in a lot of pain to get a CT scan (turned out to be a herniated disc) and have now been waiting about 6 months for an MRI and an appointment with a specialist. I am not holding my breath for the appointment with the specialist, but my MRI is now booked for 2:10 a.m. sometime in late October and I only got it that soon because I said I was willing to go in the middle of the night.

The main problem with healthcare in Canada are wait times for CTs or MRIs, and wait times for specialists. That is a problem, but then I have waited, and am waiting till the end of September to see a specialist. As I mentioned I've been out since January. So is that really any different? :)
Cost is high, insurance companies love to deny, and doctors have to ask non-doctors for permission to go ahead. Its about money, and not care of the patient, and I'm honestly getting really annoyed with it.


I realize the money factor is a huge problem in the U.S., but just keep in consideration how long you may have to wait for everything if you move back here. Otherwise, I love Canada:)

I love Canada, and I miss it at times. Oddly I miss my Winnipeg winters. Minus 40 ain't so bad... Really! :D

I really am torn as I love both countries, both have their great points, and not so great points. But really love of either country has nothing to do with this decision. I need to figure out what is best for me and my wife, and I really don't know what to do. I need to get back to work. That is my main issue.

My feeling right now is to go back and get taken care of there, and then in a few years come back to the US. If I had to choose right now, that would be my decision, but thats just a gut reaction right now. If my insurance company does deny me, then that will probably be the catalyst for us leaving, but right now I don't know what is going to happen. Which is also frustrating me. heh

Brad

Qikdraw
08-27-2008, 09:49 PM
Brad,

USUALLY, a pre-existing clause applies NOT simply because you have/had a condition, but if you've sought *treatment* for it with the last ________ (insert period of time).

For example, I developed hydrocephalus at age 10 and had a VP shunt placed. It's never caused a problem, I've never required subsequent treatment/revision, and it is absolutely NOT a pre-existing condition.

Read your plan booklet for what is deemed pre-existing.


Regards,
Pam

Ok, thanks Pam. :)
I'll have the wife read it. :D

Brad

Ginger W.
08-28-2008, 12:07 AM
Pam is correct on the fact that the "pre-existing conditions" apply only if you've seen a doctor over the issue before you came on board with your insurance, usually within 3 - 5 years. I've never heard of them going back 25 years.

Also, I have read postings from Canadians who were DENIED for surgery, because "the powers that be" deemed that it was not medically necessary for their particular scoliosis condition. Since you have already had surgery for your curvature, you may run up against a denial in Canada.

Susie*Bee
08-28-2008, 05:34 AM
Brad-- what really gets me is the problems you are having here, with all the "waits." I've never had to wait like that for anything with our insurance (Anthem/Blue Cross-Blue Shield). I guess it just depends... but seems so unfair. Apparently all insurance companies are not the same. But they probably ALL try to get out of paying when they can legally do so. Yes, I bet your wife could write a best-seller!

debbei
08-28-2008, 06:38 AM
Hi Brad,

I'm with Susie. When I first started reading your post, I was forgetting that you live in CA, and I said to myself, oh, these are the problems of waiting for medical services in Canada. Waiting that long for an Xray in this country is insane. We also have Cobra coverage through next April, and I don't have to fight for a thing. I scheduled my surgery in the June timeframe, and by July, the insurance company had already approved the surgery to be done in October. It does sound like eIther your insurance company or the company you are buying cobra from are trying to pull a fast one on you which just isn't legal.

I can see both sides to your dilema of where to live. Of course for me it wouldn't be a question because I coimplain when it gets below 30 degrees F here in NJ. :) You'll have to think long and hard and go with your gut. Is there a chance you can bring your mother-in-law with you?

Qikdraw
08-28-2008, 02:08 PM
Pam is correct on the fact that the "pre-existing conditions" apply only if you've seen a doctor over the issue before you came on board with your insurance, usually within 3 - 5 years. I've never heard of them going back 25 years.

Well in 2000 I did see a doctor about the same problem I have now, it just wasn't as bad as it is now. That is in my records here as I gave them that report. I don't know if they are going to deny me, I am just afraid they will. So far I have not had a good experience with the system right now.


Also, I have read postings from Canadians who were DENIED for surgery, because "the powers that be" deemed that it was not medically necessary for their particular scoliosis condition. Since you have already had surgery for your curvature, you may run up against a denial in Canada.

Well I didn't want to start a debate over what system is better, because both have their high and low points, and really it can be hit or miss in both.



Brad-- what really gets me is the problems you are having here, with all the "waits." I've never had to wait like that for anything with our insurance (Anthem/Blue Cross-Blue Shield). I guess it just depends... but seems so unfair. Apparently all insurance companies are not the same.

Actually I have Anthem, and so far they have approved everything, but the problem is its taking far too long, partally because of my doctor, who while nice, really isn't too keen on moving too fast. Luckily she is moving and I'll get another one the next time I go in. Hopefully they'll be more active in trying to get me fixed.


But they probably ALL try to get out of paying when they can legally do so. Yes, I bet your wife could write a best-seller!

Well its happened to me, and to my wife, and to my neighbour. Not only that but you can find websites abut companies that have denied based on nothing, and even have been fined for paying bonuses for denying coverage. In my Canadian viewpoint healthcare should be about health, and not money, nd I am just finding it very frustrating. :(

I just want to be able to go back to work. :(


Hi Brad,

I'm with Susie. When I first started reading your post, I was forgetting that you live in CA, and I said to myself, oh, these are the problems of waiting for medical services in Canada. Waiting that long for an Xray in this country is insane. We also have Cobra coverage through next April, and I don't have to fight for a thing. I scheduled my surgery in the June timeframe, and by July, the insurance company had already approved the surgery to be done in October. It does sound like eIther your insurance company or the company you are buying cobra from are trying to pull a fast one on you which just isn't legal.

Well so far the insurance comany has approved everything, its just taking forever to get it done. I feel that the doctor has been more willing to just wait and see if it will get better, than actively try and get the problem fixed. When she finally asked for xrays to be taken it took two weeks for approval to come to me. It just took her ages to ask for one. But even still two weeks to have an xray is stupid too.

My Cobra carrier was trying to pull a fast one, and they did finally realise I wasn't going to accept their excuses (thanks to my wife). Everything is back to normal now, and we are going to keep an eye out on them.


I can see both sides to your dilema of where to live. Of course for me it wouldn't be a question because I coimplain when it gets below 30 degrees F here in NJ. :) You'll have to think long and hard and go with your gut. Is there a chance you can bring your mother-in-law with you?

LOL Uhmmmm no. The MIL will NOT be coming with us. I have enough problems with her, I don't want my family to have to put up with her too. :D Its a good thing my wife & I love each other deeply because her moother is a deal breaker. Put it this way, she wore black to our wedding, no smiles, went behind our back to have the witnesses be friends of hers, and not who we wanted, and pretty much my wife wants to have a do over of our wedding because of all the crap she did. And its been 8 years of that. Even with that I want to make sure that she is taken care of if we do leave. Its the right thing to do.

But yeah, I really don't know what to do, and really a decision won't be made for months, I'm just venting frustration a bit, and seeing if anyone has any ideas. :D This site really is a healing place, because so many of us understand frustration and pain, and are all here to support each other, which I find very valuable to keep my sanity. :D

Brad

SIsForSarah
08-28-2008, 02:29 PM
I love Canada, and I miss it at times. Oddly I miss my Winnipeg winters. Minus 40 ain't so bad... Really! :D

I really am torn as I love both countries, both have their great points, and not so great points. But really love of either country has nothing to do with this decision. I need to figure out what is best for me and my wife, and I really don't know what to do. I need to get back to work. That is my main issue.

My feeling right now is to go back and get taken care of there, and then in a few years come back to the US. If I had to choose right now, that would be my decision, but thats just a gut reaction right now. If my insurance company does deny me, then that will probably be the catalyst for us leaving, but right now I don't know what is going to happen. Which is also frustrating me. heh

Brad

Wow, you're from Winnipeg! What's that line from that song, "Portage and Main - 40 below"? That's even a little cold for an Ottawa girl like me :) I was just thinking though, Ottawa is notorious for wait times for everything (lots of red tape in this government town, hah, hah) - do you have friends in Winnipeg who could give you estimates of the wait times up there? Maybe it's better than Ottawa, in which case, short wait times, no insurance hassles - might be just what the doctor ordered so to speak. Good luck with everything - what a tough decision.

- Sarah

Qikdraw
08-28-2008, 03:35 PM
Wow, you're from Winnipeg! What's that line from that song, "Portage and Main - 40 below"? That's even a little cold for an Ottawa girl like me :)

Yeah thats a song by Randy Bachman called 'Prarie Town'. Neil Young did a more upbeat version but I can't find it. :( I prefer it to the original. Neil Young and the Guess Who are from Wpg, I also think Crash Test Dummies is from there too. I was actually born in Halifax, but raised in Wpg, and spent 6 years in Van (which I hated because of the rainy winters), and now I am in California. :) I get around around. lol Actually so does my family. My mother is in Wpg with her husband, my father is a snowbird with his wife, My grandma is in Alberta, one brother is in BC and one lives in Jordan. (in the Middle East). Our family is a bit spread out. :D


I was just thinking though, Ottawa is notorious for wait times for everything (lots of red tape in this government town, hah, hah) - do you have friends in Winnipeg who could give you estimates of the wait times up there? Maybe it's better than Ottawa, in which case, short wait times, no insurance hassles - might be just what the doctor ordered so to speak. Good luck with everything - what a tough decision.

MB wait times were not too bad when I was there. Xrays done the same same day the doctor wants them, stuff like that. Of course it depends on what is the problem, my father waited about a year before he had is hip replacement surgery. I know I will have to get back into the system and that will require some waiting, but honestly I don't see a difference with what I am going through right now. Maybe after I see the specialist at the end of september things will change, at least I hope so. :)

A friend of mine is in TO and if I move back to Canada he wants me to move to his neck of the woods, but TO? No thank you! lol

Brad