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101 Comments
- inactive, on 07/08/2009, -3/+63I work in insurance... I have MUCH more to say
First NEVER call us. Seriously. The people here are trained to shut you off and make sure you never call. If you call once, you will get someone who barely speaks english re-read some condition on your contract and use experts term to discourage you from calling again. If you call again, they will even be rude - maybe even make some threats of "further investigation" on your account".
ALWAYS ALWAYS write a letter, certified if possible, so you have proof. NEVER ever call, you are talking to incompetents. A call costs the company around $5, counting the employee's time and all benefits, and assuming he's american. A strong-worded letter can cost hundreds of dollars. Why? Because it has to go around many department. If ignored, they can automatically lose any further lawsuit AND might have to pay extra.
Insurance will do everything they can not to pay you - even invent stuff out. They might go as far as changing your application to make you believe you wrote something else. Trust me, I've seen it all. Always keep copies.
Oh, you wouldn't believe the number of "faxes" that they simply thrash out. That's right: they ask to fax stuff and then pretend they never got it. And if you call them, they'll tell you are "too late". That's how insurance works, trying to make you believe all kind of crap to save a few dollars. Always refer to the contract and in doubt, call the free insurance hotlines. - kingmanic, on 07/08/2009, -5/+5710. People get better care for less money and less frustration in Canada.
- borez, on 07/08/2009, -0/+47I must admit being a casual third party observer from the UK and reading all of your stories on this subject, it seem to me like these so called "Health Insurance" companies are just a bunch of deceitful, lying, scamming ***** crooks... and then some.
/correct me if I'm wrong. - reuscel, on 07/08/2009, -0/+37How do you people sleep at night?
- kingmanic, on 07/08/2009, -0/+37In a bed made of money lined with the fur of new born baby scalps with pillows of dead cancer patient skins.
- jimbo92107, on 07/08/2009, -1/+36Nine secret ways?
How about one obvious, simple way - socialized medicine.
Just say no to the HMO vampires. - realeskimopimp, on 07/08/2009, -0/+28Some dumb repub is gonna come here and talk about long wait lines.
There are NO WAIT LINES for urgent care.
Myth: There are long waits for care, which compromise access to care.
Truth: There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.
http://www.denverpost.com/recommended/ci_12523427 - yikiad, on 07/08/2009, -2/+29all one page
Don’t pay if you don’t have a say.
When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees. “If you don’t have direct control, you are not liable,” Flynn says, adding that this tack is likely to work every time, but few consumers know about it.
You may be eligible for more coverage.
Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop. One good place to check is Families USA, a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health care advocate for consumers. Another option: Contact your state’s insurance commissioner.
To get tested, talk up your symptoms.
Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed. Your plan has to pay for the test if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)
Stall first, answer questions later.
When Wendy Decenzo became pregnant with twins, she wasn’t worried about health insurance. Her husband, Chris, had made sure to get a health plan that covered pregnancy well before they started trying. But when Wendy began going for prenatal visits, coverage was denied. Their plan, Blue Cross of California, wouldn’t say why. Instead, the insurer asked the Decenzos to sign release forms allowing the plan to view their medical histories, which the law says are private.
Chris believes the company was looking for any info that the Decenzos may have accidentally omitted when they applied for coverage. If an omission were to be found, the couple might have been denied coverage. “It seemed like a fishing expedition in order to deny us,” Chris says. So they refused to sign, and three months later the plan started paying for the prenatal appointments, even going back and paying for earlier visits that hadn’t been covered. Flynn says lots of insurers try this trick, but since their review process usually lasts only 60 to 90 days, they often drop the inquiry after that. Sometimes, procrastination pays.
Letters are your best bet.
It may seem a bit inconvenient, but the old-fashioned letter is by far the best way to communicate with your health plan. “Don’t do anything over the phone. It takes forever and when you’re done there’s no record of it, so it didn’t happen,” says Rhonda Orin, a Washington, D.C.–based attorney and the author of Making Them Pay: How to Get the Most From Health Insurance and Managed Care.
Letters almost always get a response, adds Lembo, the Connecticut health-care advocate. Some plans will answer email, but many won’t. And to whom, exactly, should you address your mail? Experts recommend following your plan’s appeal process for letters and sending copies to your state insurance commissioner. Also, keep copies of every letter you’ve sent your plan and everything they’ve sent back. That way, when your insurer says, “We never said we’d cover that,” you can say, “I have it right here in writing.”
Doctors can be good weapons.
You just got four massage sessions, under doctor’s orders, for lower-back pain—but your insurer refuses to pay for them? Ask your doctor for help. He can tell the insurer he’s going to complain to the state board that regulates health plans.
“Health plans may not fear you, but they do respect the board,” says James Moss, a retired Kentucky surgeon. He intervened on a patient’s behalf and, by pressuring the board, helped the patient win coverage. Another option: Say you’ll call your congressman and/or state Medicare office to lodge a formal complaint, Moss says.
Caveat: Don’t actually contact your state board yourself if a claim is denied. Janice Weiss, a Jupiter, Florida–based attorney who fights health plans for consumers, says some of her clients who went this route ended up hurting their cases when the state agency ruled their claims invalid; that left them little recourse with their insurance companies. Instead, while working your plan’s appeals process, just suggest you may take the matter to your state.
A little research can go a long way.
If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria, says Anne Roberts, executive vice chair of the department of radiology at the University of California, San Diego. Used primarily by doctors but open to the public, it’s an up-to-date list of the types of imaging that are right for various conditions. Arming yourself with the info doesn’t guarantee coverage, but it’s a proactive step in the right direction.
There are ways to get drugs cheaper.
Doctors are often wowed by the latest and greatest drugs, which tend to be the most expensive. Make sure these newer, high-end meds are what you need before you leave the doctor’s office. Sometimes your insurance plan won’t pay for them at all; other times it’ll charge higher co-pays. In many cases, drugs have generic versions that are just as effective but cheaper than the newer ones. Always ask your doc (or the pharmacist) for generics. And if you really need a medicine that doesn’t have a generic version, order it by mail. Many plans have a less-expensive mail-order pharmacy option. Another prescription trick for people who have chronic conditions like allergies: Ask your doc to write you a prescription for two or three months’ worth of medication instead of one. Goodbye, extra co-pays. - suprememilo, on 07/08/2009, -1/+28What doesn't make sense to me is all the people who don't want government backed healthcare because then "they wouldn't be able to make important health decisions with their doctors" the government would probably be far less evil than the insurance companies.
- jjason1985, on 07/08/2009, -1/+27#1 all insurance is a ripoff.
- inactive, on 07/08/2009, -1/+27oooh nooo the government is gonna GIVE ME AN OPTION to buy their plan!
As opposed to the bottomline of the health insurance companies who will drop me the moment my surgery becomes too big of cost to justify to their shareholders. - RudeTurnip, on 07/08/2009, -0/+2510. Health insurance companies will randomly deny claims, knowing that a percentage of patients won't fight the denial.
- cristinamk, on 07/08/2009, -0/+20unfortunately, you are very correct.....
- kingmanic, on 07/08/2009, -0/+18'Yes, there are waiting lines for some elective care, but not for emergency care.'
They also never consider that most US insurance plans would not cover many of these elective surgeries either under similar criteria that would make them elective in Canada would make them uncovered in the states. So the option is wait 3mo for elective hip surgery to prevent it from getting worse in Canada, or wait until it's so serious that it's no longer elective in either system and get it right away. - beachsouthpaw, on 07/08/2009, -1/+19It seems like US healthcare for the average, middle class person is a ***** up Choose Your Own Adventure book where no matter what you do, if you get really sick, you're *****.
- reuscel, on 07/08/2009, -1/+18Dude, trying to drum up sympathy for insurance companies is a waste of time. You people are as popular as watching a puppy starve to death.
- Jacobdd, on 07/08/2009, -4/+18As a soon-to-be physcian, I implore you not to talk up your symptoms to get a test. We are obligated to investigate it, but your friend having colon cancer isn't a valid reason to get a colonoscopy. We have guidelines that are in place for a reason. A lot of it is evidence based. Healthcare shouldn't be a McDonalds drive-thru. You shouldn't go up to your doctor and say "I would like a colonoscopy, a virtual colonoscopy, 3 fecal occult blood tests." Maybe that would be fair if I could say "That will $2500 please pull up to the colonoscopy window". It cost money, in physcian time, nursing time, technology, etc... Insurance, whether private or government based, only works if you take care of yourself so that the other guy that is covered will be able to get what he deserves. If you talk up your symptoms to get a test, you are contributing to the break down in the system. You'll get your colonscopy scheduled, and so will the next guy that actually has colon cancer. But you delayed his diagnosis, congrats on being a douche.
- AngelaQ, on 07/08/2009, -1/+13You are correct. They are free to make unlimited profits by denying people life-saving treatment. Regulation is minimal.
- kingmanic, on 07/08/2009, -1/+12This does not seem to be a negative outcome.
- centran, on 07/08/2009, -0/+1110. Find a job with health insurance because health insurance companies don't play as many ***** games for fear of losing a huge account.
11. Individual health insurance is a joke. It is only good so you get treated properly at the hospital and don't get shipped off to "county." Know going into it that if you are seriously injured then your health insurance provider will find a way to cancel your coverage(retroactively). You will spend years in court to get them to pay. - tekproxy, on 07/08/2009, -0/+11Why do I need to read _tricks_ on how to actually use the service I pay for without getting royally *****?
The mere fact that articles like this exist, and several commenters have valuable tricks to add in addition to the article, should be a glaring and painfully obvious indication that something is horribly wrong. You should not have to worry about how to avoid getting dishonestly shafted by a company _you pay for_.
I read about half way into the article, and was so surprised how important it all sounded, like I should really learn this stuff since I health insurance. I've also heard plenty of horror stories from the older people at work, one included having to argue with a nurse while heavily medicated about not paying anything out of pocket until the insurance was verified. I couldn't read the rest because I was so disgusted that I should even have to be so damned paranoid and clever just to navigate the shark-infested waters that is insurance.
Has it always been like this? I'm too young to know. The solution is not clear cut. It's not "Obama." and it's not "Move to Canada.". Maybe it's because of all the unnecessary procedures done, raising the cost of business for insurance companies? Maybe there is a lack of regulation in the industry. Maybe it's just too damn expensive to go to the doctors now because everyone is so ***** sue-happy that it severely raises the insurance premiums for doctors (my friend's dad is a doctor and told me this). Maybe it's a combination.
We could just take all the extra interest our social security that we're forced to give up should have generated to ... oh wait. That's all gone too. *****, I have a headache now. I'm going to eat a cookie and lie down. - diggdat, on 07/08/2009, -0/+10Due respect to your condition, I hope all is well.
But having lived in both countries for a long time in each, I can say for every story of delayed treatment, there seems to be many many more denied coverage or cancelled policies in the US. With over 60% of bankruptcies in the US being due to medical cost, something is wrong.
In the worst case, in Canada the vast vast majority of people are treated as quickly as needed and without the stress of financial disaster looming over their heads. If you think about it, in those few cases where people felt they absolutely need faster treatment, they still have the choice to go broke, in the US. I have an Aunt in CA with an agressive breast cancer now and she is recieving treatment with no plans/concerns to visit the US. - reuscel, on 07/08/2009, -1/+10"One thing i should add - we get ripped all the time, too"
I don't see what this has to do with anything. So, you get ripped off occasionally, and that justifies denying someone life-saving care to help your bottom line because your fraud department is full of incompetents?
***** right off. - kingmanic, on 07/08/2009, -0/+7'Any sufficiently large organization is indistinguishable from a government'-Paraphrase of Arthur C. Clarke
- Paulish, on 07/08/2009, -1/+8Man, some of this I just don't agree with. If I am paying for health insurance, I don't want the company to pay for your fertility treatment. If you want a kid so badly than adopt, there are plenty of kids in the world that need a good home. If you want a kid with YOUR DNA (Isn't that kinda racism when you think about it?) than save up your money and pay for it yourself. You are not gonna die without a kid.
IMO insurance should cover health ESSENTIALS. Not for your lower back massages and fertility treatments. - bluscale, on 07/08/2009, -0/+7Thanks, this makes a lot of sense. Their fear is competent, educated people. They're the ones that will win in a court room. Naive people just complain.
- securitymonkey, on 07/08/2009, -0/+7PRO-TIP: Go with a not-for-profit Insurance Carrier. They don't answer to share holders or investors, they keep their admin costs in check and they stay in business through excellent customer service and willingness to help consumers get their claims paid with no fuss or games. I've had one for 8 years and it's been heaven!
- heresy_fnord, on 07/08/2009, -0/+79 reasons to hate private medical care. Go USA!
- RudeTurnip, on 07/08/2009, -0/+6No, it's not racism to want to make a child with your own DNA. But just the same, fertility treatments should not be covered by insurance. They are elective.
- realeskimopimp, on 07/08/2009, -1/+7GOOD
- reeds1999, on 07/09/2009, -1/+6The solution to all these problems:
Single payer plan.
Insist that congress do ths or send them home in 2010! - borez, on 07/08/2009, -0/+5Please tell.
- reeds1999, on 07/09/2009, -0/+5The health of the citizenry is a strategic asset. As our health care quality has dropped to 37th among industrialized nations, our functional illiteracy has risen to 20% and our population below 50% of median income is now 17%.
If these trends continue, it is inevitable that the US will lose its standing as the world’s leader. It is just as inevitable that if health care costs which now suck up 17% of the GDP continue to raise, as it will under the present health care system, this will happen.
Universal Health care for all citizens is an absolute necessity for the nation’s survival as a world leader, and the solution is a Single Payer Plan covering all citizens.
Do not allow the naysayers who are interested only in their own profits and their dupes destroy this great country! - kingmanic, on 07/08/2009, -0/+5Canada can do it so why not 'we're #1. We kick Ass and chew bubble gum and we're all out of bubble gum' USA. Canadian Hospital bureaucratic overhead 1% your overhead Hospital bureaucratic overhead 30%. Thats your private system vs our public one.
It's not the idea that will fail but the implementation. Most of the western nations have deployed a public health system that cost less than the US one and functions better. Are Americans inherently too inept and corrupt to make that happen?
The insurance layer takes up 30+% of the resources from Us healthcare system but provides no value to that system. In almost all metrics the US is behind Canada for care. The only ones who get better care are the elites who can pay for everything out of pocket. Those people are a tiny fraction of the US and likely does not include you.
Obama's plan may be the wrong direction as it doesn't remove the need for all the bureaucratic wrangling and allows these massive financial agencies to continue to extort you for money. They just have a non profit competitor now. - diulei, on 07/08/2009, -0/+5While true, that's not exactly a secret.
- JammoBlammo, on 07/08/2009, -0/+5Too bad you only have a 4 page internets subscription!
- catachip, on 07/08/2009, -8/+12"If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria..."
This is exactly what is WRONG with the U.S. medical system, and why it is all so expensive. People get billions of dollars worth of unnecessary imaging. If you want extra scans that your doctor thinks are unnecessary, then pay for them yourself. Everyone ends up paying more for you "persuading" your doctor because the costs are spread out as premiums over everyone! - Roedran, on 07/08/2009, -0/+4Speaking as an infertile father to an adopted child, I take offense to anyone telling me that insurance shouldn't cover at least some of the costs of *adoption*. $25,000 to adopt = more than the cost of a birth most folks reading this post take 100% for granted.
If I'm paying into my private ins. pool at my company and an employee has 10 kids, part of my payments go to helping her and her family have those kids, and I have no choice.
Fairness is in the eye of the beholder. - kingmanic, on 07/08/2009, -0/+4Explain your assertion.
Income wise Canada is very similar to the US in median and average. The US has an edge.
Demogrpahicwise we have the same spread of ages and populations
populatiowise all of our major urban centres resemble you major urban centres the only difference is our expansive north is extremely sparsely populated and expensive to service much like Alaska but much larger.
Expenditurewise, the US spends twice as much per capita as Canada does in public and private dollars on healthcare. You have the money. You just waste it.
Culturewise All of canada has a counterpart somewhere in the US. Alberta resembles Texas. BC resembles California. Toronto resembles any major US urban centre. Yellowknife resembles Anchorage without the oil money. The maritimes resemble much of the east coast.
Health wise Canada has all the same issues with high fat diets, low amounts of exercise and all of the same diseases.
Canada is the US less powerful more pragmatic twin brother. - kingmanic, on 07/08/2009, -0/+4abw1987: for profit != efficient. government != inefficient. Thats ideology not a tautology. Your government might be inefficient but many governments make it work. Once a company gets large it suffers from many of the same problems governments do. Inefficient entrenched bureaucracy. Poor leadership selection. Inability to adapt. Using size to bludgeon competition. Those are not simply the hallmarks of a government but big business as well and big business can survive indefinitely like that as well. See HP.
- inactive, on 07/08/2009, -0/+3If doctors went to school for this for 12 years, why do they call it a practice?
- AngelaQ, on 07/08/2009, -1/+4Exactly. Another one was for people who want a colonoscopy for "peace of mind". Articles like this are part of the problem.
- diggduggDOOM, on 07/08/2009, -0/+3"So if Obama thinks he can create a government health insurance company that charges less than a private company, he's out of his mind, because the only way that would happen is if we reduce our standard of care."
Private companies operate for profit. If all of that profit were re-invested in the system, or refunded to the buyer, the costs would be reduced. Every penny of profit is an added cost. The question, in my opinion, is whether health care should be a for-profit business or not. - cabdirazzaq, on 07/08/2009, -4/+7House: "Who here doesn't have any health insurance? None? None at all? Michael Moore was right. MRI's, PET scans, neuro-psych tests and private rooms for these patients. Fight the power!"
- renesisx, on 07/09/2009, -0/+3National Health Service FTW!
- jeffwmartin, on 07/08/2009, -1/+4Me having coverage doesn't stop anyone else from having coverage. There's not a finite number of insurance policies.
- diggB, on 07/08/2009, -8/+11"To get tested, talk up your symptoms."
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..................................., - shredswithpiks, on 07/08/2009, -0/+2This is precisely why insurance has ruined healthcare. We've removed the fear of having to pay money for healthcare, so nobody shops around for the best deal. People don't care if it's $2500 for a colonoscopy because the insurance company is paying. Additionally, nobody cares about finding competent doctors either. The insurance companies play games and decide which medical networks they want to sponsor and refuse to pay if you find someone else. So you end up with everyone using loads of really expensive medical stuff they didn't need to begin with, and the insurance companies get to decide which doctors get all the business. That doesn't sound like a very fair market to me.
- missinglink, on 07/08/2009, -0/+2Actually jeffwmartin, you're having coverage makes it CHEAPER for everyone else. That's how insurance works. The more people that buy in, the less it costs for everyone.
- kingmanic, on 07/09/2009, -0/+2'Please fix your typing. Median and average what?'
'INCOME wise Canada is very similar to the US in median and average. '
$50k US vs $45K CA measured in USD
We both have a extremely poverty stricken and under privileged ethnicity (Natives 5% vs Blacks 13%). Our natives tend to utilize our health system the LEAST. Not sure about your black demographic.
We both have a significant geriatric demographic. 13.8% currently in Canada are over 64. 12.6% in the US. Your comment about the baby boom may be wright or wrong but we currently have more elderly.
Cancer rates are close but Canada is lower by a few points in all categories:
http://www.cancer.ca/Canada-wide/About%20cancer/Ca ...
Canada is close to the states in the number of over weight. both have over half the pop over weight.
http://www4.hrsdc.gc.ca/indicator.jsp?lang=en& ...
A lot of care for violent crime is paid for by the state anyways. You will pay for the violence regardless if you have a public or private system. -
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