Health Care In U.s. Screwed Me Over

he still stands

<rant>

So I get a bill from collections the other day in regards to a hospital visit in January. I had previously taken care of it, or so I thought, when I called BLUE CROSS BLUE SHIELD and they told me the claim was taken care of, I owed NOTHING.

Now I call them again, and I get a completely different story.

"This particular department of the hospital (radiology) is not within your network, so it isn't covered."

me - "So I should ask each person, whether it be a doctor, nurse, radiologist, etc within the hospital if they are in my network before they do anything? And I should visit a different hospital for each department that is within my network?

her - "Unfortunately that is the way it works."

ARE YOU FUCKING KIDDING ME!!!!!!!!!!!!!!!! SOME DEPARTMENTS OF THE HOSPITAL ARE WITHIN NETWORK AND SOME AREN'T???? AND BLUE CROSS'S WEBSITE SAID THE HOSPITAL WAS IN NETWORK, WITH NO STIPULATION ABOUT SEPARATE DEPARTMENTS!!!!!!!!!! NOW I OWE FUCKING $665, AND THE ONE FUCKING VISIT FOR MY WIFE (A SIMPLE KIDNEY INFECTION) IS GOING TO COST ME ABOUT $1000!!!!!!!!!!!!!!!! AND I PAY $164 / MONTH FOR THIS GODDAMN HEALTH INSURANCE!!!!!!!!!!!!!!!

FUCK ME IN THE BRAIN. DON'T USE BLUE CROSS BLUE SHIELD.

</rant>

Rygar

Did you cancel your insurance yet?

he still stands

Rygar wrote:

Did you cancel your insurance yet?

In the US you can't, when its provided by your employer. My employer only allows me to make changes (including cancellation) in November of each year.

PJPixie

I'm making $25 payments monthly to the City of Pasadena for an Ambulance Ride for my son from the Rose Bowl to the local hospital. It's gonna take a while to pay off that thousand dollar ride!! Same thing, I have Blue Cross/Blue Shield too.......and Pasadena has a PRIVATE Ambulance Service so the insurance only covered it at like 30%. But my son is fine and that is what matters (and we made it back to the Rose Bowl in the 1st quarter of the UCLA Game!!). They'll get their money at MY convenience.

Cobbelstone

he still stands wrote:

FUCK ME IN THE BRAIN. DON'T USE BLUE CROSS BLUE SHIELD.

</rant>

Really? I've had BCBS in two different states and I think it is the best/easiest to use health insurance I've had. I don't need referals and the prescriptions are ultra cheap. What state are you in? BCBS is actually a whole bunch of different companies, that's why it's called BCBS of [state]. I think it also makes a BIG difference which network your company signs up for. If you have the PPO you can pretty much go anywhere you please.

EvilMerlin

My buddy is having a hard time with his insurance right now too. He tore his ACL and dislocated his knee cap and needs surgery, however the insurance company feels that the story he told makes the injury due to his own negligance and that his knee shouldn't be this badly hurt and shouldn't require surgery, therefore will refuse to pay for his procedure. He went in to check on prices at the hospitals and he's looking at about $12,500 for a one night stay with the procedure.

Basically his insurance is telling him to hire a lawyer and get this settled, or pay out of his pocket. Which in the end he gets screwed either way and has to pay out of his pocket regardless. Great service he's getting paying his $275/month to have insurance.

he still stands

Cobbelstone wrote:

Really? I've had BCBS in two different states and I think it is the best/easiest to use health insurance I've had. I don't need referals and the prescriptions are ultra cheap. What state are you in? BCBS is actually a whole bunch of different companies, that's why it's called BCBS of [state]. I think it also makes a BIG difference which network your company signs up for. If you have the PPO you can pretty much go anywhere you please.

Arizona.

This is a recurring theme. It took me 1 hour of phone calls to reach a person to talk to. Previously they told me this bill was paid for, so I forgot about it, and now I've been turned into collections. So my credit is fucked too, and I'm about ready to buy a house so I'll stand to lose $1000s because of this on interest expense.

I'm about ready to lose my mind. These corporations are protected from the government, and the DUMB fucks that I talked to are protected by limited liability of the corporation.

PJPixie

EvilMerlin wrote:

My buddy is having a hard time with his insurance right now too. He tore his ACL and dislocated his knee cap and needs surgery, however the insurance company feels that the story he told makes the injury due to his own negligance and that his knee shouldn't be this badly hurt and shouldn't require surgery, therefore will refuse to pay for his procedure. He went in to check on prices at the hospitals and he's looking at about $12,500 for a one night stay with the procedure.

Basically his insurance is telling him to hire a lawyer and get this settled, or pay out of his pocket. Which in the end he gets screwed either way and has to pay out of his pocket regardless. Great service he's getting paying his $275/month to have insurance.

He needs to keep appealing this decision. Insurance Companies always DENY on the first attempt. They think we are all too dumb to fight their decisions.

Slip Kid

The US Health Care is really a shame here.

It only makes the companies richer and the people sicker..

Cobbelstone

Slip Kid wrote:

The US Health Care is really a shame here.

It only makes the companies richer and the people sicker..

I think this is a *somewhat* true statement, but very much oversimplified.

I agree that for people who cannot afford private insurance, the system blows and they're pretty much screwed.

But the issue raised by the original poster isn't really one of not having access, it's about bureaucratic red tape. I think that if you CAN afford insurance, healthcare in the US is pretty good. There are problems of course, and there is some very annoying bureaucracy as has been pointed out. However, I am willing to bet that in situations were health care is provided by the state the bureaucracy is 100 times worse. I have heard stories from Canadians that it takes a ridiculously long time to see a doctor, lots of hoops to jump through, etc. I've also *heard* (I don't know if it's 100% accurate) that in the canadian system the state makes trade off decisions about who can receive care in the face of scarce resources, for example, if you are elderly you will be low on the totem poll for receiving care. I don't think there is any such thing as perfect health care- whether it be provided publically or privately there are still going to be so many economic problems. I think the main problem in the US is that if you don't have the money, you don't have access. I think the government needs to step in and step that access up big time. But I also don't know if it should be 100% covered by the state, because it is not a pure public good and I don't want the government making all my health care decisions for me as long I can afford to do it myself.

EvilMerlin

PJPixie wrote:

He needs to keep appealing this decision. Insurance Companies always DENY on the first attempt. They think we are all too dumb to fight their decisions.

He put in for one, but I'm not sure what's happened since then. I'll see him this weekend so I can check up on that and see where it stands. Last Tuesday the swelling was down enough for them to operate so he's trying to get in quick. The hospital wanted a deposit though first so he's waiting for his CC to come in. Got himself a no interest one, that way he can get his knee done while continuing this with them. A company he works for as well is pitching in some money as a donation to help pay for his deposit, but they won't get him that check for about two weeks they said. So he's getting it going, it's just the hassle to get it done is beyond belief. I'm hoping it all comes out well for him.

he still stands

Cobbelstone wrote:

But the issue raised by the original poster isn't really one of not having access, it's about bureaucratic red tape.

I wouldn't really call it red tape, I'd call it misinformation.

They provided a list of hospitals "within our network."

The doctor told my wife she needed to see a radiologist for an MRI, which was provided for at the hospital "within our network."

Now they say that this specific department of the hospital isn't within our network, and we should have seen another radiologist at a different location that was within our network. (which is a Catch 22, can you see a Radiologist at another hospital and then come back to that hospital, when YOUR WIFE IS IN EXCRUCIATING FUCKING PAIN!!! Christ she needed to get it fixed, not drive around all night to make sure we were within our "network" for each department of the hospital)

Again, this is stealing in its most primitive definition. They figured out a way to reduce their coverage, its not red tape, its STEALING!!!

kh65

If all of you are having these kind of problems with private insurance (where if you want to you do have a choice, you don't have to accept your employers and can go get your own). Imagine if the govt. took over and you are told what you can do. Let me ask you this. What has the govt. ever done that is better (except fight wars) than private business?

God help us if we have fascist healthcare.

PJPixie

EvilMerlin wrote:

He put in for one, but I'm not sure what's happened since then. I'll see him this weekend so I can check up on that and see where it stands. Last Tuesday the swelling was down enough for them to operate so he's trying to get in quick. The hospital wanted a deposit though first so he's waiting for his CC to come in. Got himself a no interest one, that way he can get his knee done while continuing this with them. A company he works for as well is pitching in some money as a donation to help pay for his deposit, but they won't get him that check for about two weeks they said. So he's getting it going, it's just the hassle to get it done is beyond belief. I'm hoping it all comes out well for him.

Let me know how it goes! Poor Guy. I'm glad he's being ProActive.

PJPixie

he still stands wrote:

I wouldn't really call it red tape, I'd call it misinformation.

They provided a list of hospitals "within our network."

The doctor told my wife she needed to see a radiologist for an MRI, which was provided for at the hospital "within our network."

Now they say that this specific department of the hospital isn't within our network, and we should have seen another radiologist at a different location that was within our network. (which is a Catch 22, can you see a Radiologist at another hospital and then come back to that hospital, when YOUR WIFE IS IN EXCRUCIATING FUCKING PAIN!!! Christ she needed to get it fixed, not drive around all night to make sure we were within our "network" for each department of the hospital)

Again, this is stealing in its most primitive definition. They figured out a way to reduce their coverage, its not red tape, its STEALING!!!

What a bummer. I can totally see how crap like this happens. I'm sorry you're going thru this (I've been thru it too, my son has had 3 open heart surgeries, so many doctors covered by ins and NOT covered). It seems like it never ends.

he still stands

PJPixie wrote:

What a bummer. I can totally see how crap like this happens. I'm sorry you're going thru this (I've been thru it too, my son has had 3 open heart surgeries, so many doctors covered by ins and NOT covered). It seems like it never ends.

My thoughts are with you and your son... a much more serious situation than mine.

Peace n Love for you both.

Cobbelstone

PJPixie wrote:

He needs to keep appealing this decision. Insurance Companies always DENY on the first attempt. They think we are all too dumb to fight their decisions.

This is true, I have friends in the medical field who have advised me to keep pushing it. I've had experiences in the past where talking to one person got me nowhere but then calling back and talking to someone else changed everything. Even the original poster could try this...that situation actually sounds very odd to me- I've never heard of something like that happening- if the doctor orders a test at the same hospital it is usually covered. I'd keep trying.

he still stands

kh65 wrote:

If all of you are having these kind of problems with private insurance (where if you want to you do have a choice, you don't have to accept your employers and can go get your own). Imagine if the govt. took over and you are told what you can do. Let me ask you this. What has the govt. ever done that is better (except fight wars) than private business?

God help us if we have fascist healthcare.

We do have fascist healthcare... run by corporations rather than government. You have no choice... well I guess you do... your choice is to get fucked over by Corporation A or Corporation B.

he still stands

Cobbelstone wrote:

This is true, I have friends in the medical field who have advised me to keep pushing it. I've had experiences in the past where talking to one person got me nowhere but then calling back and talking to someone else changed everything. Even the original poster could try this...that situation actually sounds very odd to me- I've never heard of something like that happening- if the doctor orders a test at the same hospital it is usually covered. I'd keep trying.

I'll try again on Monday... I've been on the phone this AM for 2 hours and actually need to get some work done now.

PJPixie

he still stands wrote:

We do have fascist healthcare... run by corporations rather than government. You have no choice... well I guess you do... your choice is to get fucked over by Corporation A or Corporation B.

Healthcare is not just HEALTHCARE, it's a BUSINESS. Doctors are BUSINESS MEN!! It's interesting how it all works.
A typical visit to the ER could amount to numerous seperate bills.
Dr's Bill is seperate from the facility (Hosp) bill. Xrays, labs etc.
It may be that the Hospital is in-network but the Doctor that saw you is NOT in network. The X ray Dept could be In-Network or NOT, the Radiologist that actually reads the Xray's could be In-Network or not..........it goes on and on :(

Allie

wow that's crazy. I've never heard of that. Do you have the names of the people you spoke with? Do you have the name of the person you spoke to that originally told you going to that hospital was covered? ALso, was it an emergency visit? I wonder if that makes a difference.