Mike,
My wife’s dentist called Aetna (Who at the time managed our dental plan through Ford Motor Company), and got her pre-approved for a crown on one of her teeth.he told me that I would have to pay $100, or whatever my part was (it was fairly small).
When he got in there, he found the tooth was in much worse shape that he had originally believed, and so he did a procedure called an inlay instead. The inlay still made a “permanent” repair to the tooth, and best of all, it cost the SAME money.
Aetna, who at the time, managed Ford Motor’s Dental plan, balked. Their on-staff company quack said it was not medically necessary, and denied the claim outright.
After months of wrangling, the dentist ate half the price and I ate the other. The fiasco cost me $300.
It’s something I’ll ALWAYS remember.
I can assure you, if I ever get half a chance to burn them, I most assuredly will.
I come and stay in New York frequently, and do have Health Insurance from HIP. Luckily most of my time I reside in Russia. Here in USA even with insurance people still get ripped with so called COPAY! What is COPAY? Why should I pay additional money for treatment if I already pay for insurance? I’m sorry to say, but USA if far from being richest, greatest and whatever people say about it. Honestly don’t believe it will ever get better here.
One day, I had a kink in my back that really wasn’t a problem. But in the evening, the pain got worse on a dime it seemed. I was in so much pain that I couldn’t walk. I ended up having to drive myself to the emergency room and have someone come out to my car with a wheel chair while I tried to find a position that was comfortable. The room wasn’t busy and I was seen right away and they ran checks for kidney stones just as precaution. I was prescribed vicodin for 2 days and felt better. I later got a letter from my HMO stating that I was being given a warning that my visit was not “a emergency case” and that further visits for such would be charged full price. I could barely walk! The pain suddenly got worse! That’s not emergent? I wasn’t going to drive around looking for an urgent care center which aren’t very common nor are 24 hours. I went to the closest hospital center and it was even the one I most commonly go to as it happened to be close by (It usually is a 20 min. drive from where I live) Besides, how was I supposed to know it wasn’t something serious? Luckily, I haven’t paid for this . . . yet.
I have BcBs via my employer (big corporate financial company).
I have the plan that costs the most so that it would cover the most, yeeeahhhhh…
Few years back I had a high ankle sprain, I went to the ER and paid a co-pay of $147.00, they casted my ankle and told me to make an appoitment to see the regular doc in a week, next 2 days my toes went black due to the circulation cut of on my foot, due to cast…
I went to urgent care, payd a co-pay of $40.00 to have them cut/take the cast off and sell me a $60.00 legg brace, as the urgent care doc said ”cast was a mistake due to the large amount of swelling”.
Few days later I went to see the regular doc (co-pay of $30.00) he does some X-rays and tells me ”good news you only riped one ligament and over stretched the rest of em and didnt break the bones, all you’ll need is some therapy, and if you have pains later on we could talk about surgery to patch up the one ligament”, orders me to go to therapy 2 times a week for the next 6 weeks and than switch to once a week until I feel good enough to run.
I go to the therapy the first day and pay $30.00 co pay and I am informed it will cost the same each time I come there, I havent gone there again, I used up all my PTO and had to claim un-paid time off and went broke within a month.
2 years later I still have the swelling and discoloration in my toes and circulation problems in my right leg, I dont play soccer any more due to the fear of going bankrupt
I am going to get a much better medical plan soon, I am going to get a Canadian citizenship
GOD BLESS CANADA
I am looking forward to seeing the film in Bellaire, MI. I work at North Country Community Mental Health right in town. Majority of our “consumers” are medicaid recipients. The problem with physical health coverage is not as severe as the problem with mental heatlh coverage. Most insurances covered only 6 sessions for therapy. Luckily the Parity act will hopefully equalize insurance to cover both physical and mental health services. Who knows? They probably will find a way around it. Thank you Michael for another great film from a fellow Northern Michigander.
I wanted to add to this conversation. I am a part time employee of a grass roots health advocacy non profit. My health care coverage has always been through my husband’s employer plan. When my husband retired in January at age 65, he became eligible for medicare. We opted to continue my coverage through his employer with COBRA until we could find a different plan. The cost of that coverage is $1675. each month!
I have been turned down flat by two other plans because I have high blood pressure treated and controlled with medication. I am a very healthy 63 year old normal weight registered dietitian with no surgeries or other hospitalizations since 1983, no cancer no chronic disease. Something needs to be done to address this. Please.
I consulted with an Human Resources friend before selecting my health care plan. I had Kaiser Permanente and I decided to switch. I wasn’t unhappy with Kaiser, they just don’t have the greatest reputation around here and I just wanted a better plan. The joke is that some doctors graduate at the top of their class and some at the bottom… the ones at the bottom end up at Kaiser. I have to hand it to them though with their ‘one-stop-shop’ - very convenient if you have to get x-rays or bloodwork. Everything you need is right there. Anyway, out of the dozen or so options I had she recommended the Aetna plan.
I hurt my shoulder playing baseball. So I make an appointment with my primary care physician - $15 co-pay. He sends me a referral to an ‘in network’ orthopaedic surgeon. Another $25 co-pay, because he is a ’specialist’. He checks me out, xrays, etc and prescribes me 4 weeks of physical therapy, three times a week. Apparently the ‘in network’ physical therapists are specialist too… $25 per trip. The physical therapy place does not have evening hours, so I have to take time off from work to go. To top it off, the Physical Therapist ‘gives’ me some already used thera-bands to do exercises at home with - I get a bill in the mail about 4 weeks AFTER I finished physical therapy with a charge of $5 per band that I thought I was ‘given’. Silly me, nothing is for free.
Another trip to the orthopaedist for the follow-up - another $25. His recommendation? Surgery… and then more physical therapy.
Nearly $400 later, I am in the same boat I was in before I went to get help… and I’m still paying every 2-weeks for my great health care plan.
I realize that I am complaining, but I couldn’t imagine what it would cost me if I didn’t have this great insurance. I’m lucky that I can afford to pay the endless co-pays.
My son had an emergency cat scan of his abdomen after a fall. I paid my $100 copay, and thought everything was fine until about 3 months later I got a notice that I was in collections for 690 dollars for the cat scan (this was about 10 years ago). Turns out that there was a mixup in billing, which was not my fault, but the emergency room registrar’s fault. When I finally had a conference call between the collection agency and the insurance company, the insurance company paid $170.00 to fulfill the obligation. I would have had to pay $690.00, for an original bill of about $580.
That’s outrageous, for them to pay less than 25 percent of the original bill, when I would have had to pay it ALL. Worse yet, I work as an RN in that VERY SAME ER!
I am an actress, and was fortunate to get a job right out of college. It was a national tour, and I was delighted to learn that I got health insurance because I am diabetic and the costs add up quickly since I have an insulin pump…the costs of those supplies is astronomical and that doesn’t even include the insulin and all the other supplies I need to live.
So needless to say I was happy that I’d have insurance. Except it didn’t cover pre-existing conditions for a year. A YEAR, which was the duration of my contract. The pre existing conditions thing kills me. You are supposed to pay the insurance companies to give you NOTHING for a fixed amount of time before they will actually cover the expenses for conditions you had when you got the plan. So you’re throwing money down the drain pretty much. There’s always the chance that you’ll get hit by a car or something but there are much cheaper plans out there that will just cover you in case of an emergency. I need help on my prescriptions.
So for a year, while I was working and supporting myself fully in all other respects, my parents had to pay extra money to keep me on their health plan. Then, after my contract was over, I had coverage for sixteen additional months. Good, well, at least now my prescriptions would be covered finally. WRONG. The company I had been working for switched insurance carriers to a company that would not cover ANY of my diabetic prescriptions-not my insulin, test strips, insulin pump supples, nothing. So I had to pay for those things out of my pocket. If you know anything about diabetic supplies you know they add up pretty quickly. I had to purchase the lowest quality testing meter on the market and still spend about $100 a month out of my pocket buying test strips that are compatible with it.
I am now on the state health plan and it’s been great for me. A very decent price with complete coverage on my diabetic supplies with NO waiting period because it was a “pre existing” condition. To all who have had difficulties, I suggest looking into it in your area and see if you have the same luck. For a fraction of what insurance cost me before I am getting everything I need.
I am a physician and my wife is a mid level provider. We both have the highest tier insurances available through both of our jobs. We both went in for PREVENTIVE care appropriate for our age. Guess who got the bill….we did!! If that doesn’t sum up health care nowadays I don’t know what does!! After 6 phone calls and a few hours of fighting we worked a deal out but why the hell did we need the highest tier insurance on two HEALTHCARE jobs if neither would pick up PREVENTIVE care!!
This may seem small potatoes (comparatively-speaking), but here goes.
My wife is an R.N. at a large, local hospital which–in order to combat rising healthcare insurance costs–created their own insurance company. Issues with out-of-network providers aside, our claims were continually being rejected (usually two or three months after they were filed). We often spent our leisure time placing phone calls, split between our insurance carrier and our dentist’s/family doctor’s/pediatrician’s office in order to coordinate payment. After a dozen or so of these calls, we were informed–finally–as to why we were being rejected; it turned out that we had failed to file a form which stated that our family did not have a secondary insurance carrier. My question is: What does it matter if I had carried insurance through my employer (I don’t)? Could my wife’s insurance reject claims for my children simply because I wasn’t “fair” and split the costs of medical visits between their company and my provider?
My wife and I just had a baby. We have Oxford insurance. The bills for the doctor came out to about 20K. The doctor doesn’t take her primary insurance so we fixed naturally her secondary insurnce (Oxford) would pay since the doctor participates. We to my surprise, Oxford did not pay. They denied the claims. Said we need deinal EOBs from the primmary insurance company stating the doctor doesn’t take that insurance. So I got those and sent them to Oxford. Oxford said wait 20-30 days and they should be processed. Well after about 30 days, the claims were DENIED AGAIN!!! When I called to find out why they said the never received the denial EOBs so there was nothing to process. It took them 30 days to tell us that and I have copies of the EOB that I sent them. This has been going on now for 6 months and I don’t now when it will end……..
I’am hardworking man with a family that is stuck in middle class. my wife and I work hard to make ends meet , but with a child on the way I’am alreday paying $650 a month for health care. with my wife pregnant I dont know if we can afford this baby..
Between health insurance and car insurance in this country, I don’t know which is worse when it comes to costs.
I have Harvard Pilgrim now and to me it’s useless. High co-pay amounts and the vision coverage shouldn’t even be called “coverage” because it doesn’t cover anything. It covers an eye exam and that’s it - no glasses and no contacts.
I’ve had two knee surgeries over the past 4 years and each visit to physical therapy is $20. I had to go 3 times a week for at least two months, and then 1 or 2 times a week for the next three months.
Last week I went to the dentist and needed a crown. That cost me $597. My previous crown cost me $500.
I was in a car accident several years back and sustained permenant injury to my back. After years of treatment with a chiropracter and feeling great, State Farm cut off my medical for the injury. There reason was I was getting to dependent on it. Years later I still see a chiropracter for treatment and pay out of my own pocket. My current insurance won’t cover previous injuries, what a crock of s—. I would not be surprise if the real CEO of State Farm is Darth Vader.
I was deathly ill - high fever - could barely function due to what I believed to be a brown recluse bite. I live in a very rural area and had to drive 25 miles to the nearest ER. My insurance (Blue Cross Blue Shield FEP) refused to cover any of the charges because it was not an accident. An accident is defined as not intentionally caused…. I did not intentionally become ill…… enough said and the 1,000.00 charge was all on me.
I’m from the UK (although live in California now). Was on the receiving end of America’s “health care” system last year when I discovered a small lump in my back. Went to get it checked out and it was a tumor (benign thank god) but was advised to have a small outpatient’s procedure to remove it anyway.
I have *full* health & dental insurance (a PPO provided through my employer). As it was an outpatient’s procedure I was at the hospital less than two hours in total. I had a local anaesthetic, to whip the little lump out was around 20 minutes, I spent an hour “coming to” and then my wife drove me home.
The hospital sent my insurance company a bill for over $27,000 (TWENTY SEVEN THOUSAND dollars). The itemized bill showed $837 for the shot, $950 for the procedure and $25,500 dollars for “supplies”.
It’s an 80/20 split so I had to pay over three and a half thousand dollars - which I have only just finished paying off after a year of repayments. A plane ticket to England is $700 so would have been cheaper to have flown home and got it done there for free - which is what I will be doing next time unless I’m too sick to travel in which case I’ll be spending my time worrying myself even sicker about what this is all going to cost me.
I’m active duty military and while on leave back from Iraq last fall, I took my wife to a hospital in the middle of the nite literally for urgent care/emergency center and the military screwed me over and is making me pay over 500 dollars because I didn’t call ahead and let them know about it… how about that sh%t!
I am a single mother and in live in the state of Missouri. Becuase of Matt Blunt I lost insurance for my son. I know have to pay 1/4 of my income pre tax to keep my son insured. With all the copays it was cheaper for me to take him and pay cash at a minute clinic than to go to the urgent care. When I asked my employer if I can cancel my insurance I was told not until it is time to renew. What is that? I don’t know much about all the big insurance words they use. I just know that these politicans suck. Bush and Blunt and all the others dont know and dont care about the American People. Why is this called the land of Freedon? Shouldn’t it be called the land of the haves and have nots?
I used to live in the US some time ago and I`m gonna say something that most won`t like, all this troubles with insurance and health care IS ALL YOUR FAULT, if people would stand against abuse like this things would be very different. I have had 2 job offers to return to the US and never in my life I would return, you people live the worst quality of life possible.
I have UniCare through my husband’s job. Every year the price goes up as well as the co-pays. My benefits have not gotten any better so why do I have to pay a higher amount?
When I gave birth to my son’s I had to go to a hospital that was not the greatest in the area. Quit frankly it was ghetto, including a good percent of the staff. If I wanted the insurance to pay I had to go to that hospital to give birth and I had no choice. When we took the tour I almost started crying. I know a girl who is on public aide and got to have all 3 of her children at the nice hospital in one of the richest communities in the country.
I’d leave my story about my insurance company…but even though I’m in my twenties, I’m healthy, and I don’t smoke, I can’t get approved for insurance. My health insurance plan: don’t get sick.
I have actually not had health insurance since 1997 and have given birth to 4 healthly children outside of the medical system - no drugs, no stitches, no “surprise” C-sections. Guess what? I haven’t needed the insurance. I do plan to look into getting some, but maybe I’d be better off investing the money I would pay and using it if some emergency ever did happen! Also, in a worse-case-scenario bankruptcy is probably easier to get than some insurance payouts! I am NOT saying I would ever want to exercise the bankruptcy option. I am just choosing different financial risks for now.
The healthcare insurance premium for my husband, myself, and our 2 year old son runs $568 a month. That comes out to $6,816 a year. We only have a yearly income of $36,088. I can only make an educated guess that even if we did go universal healthcare, any taxes that may be charged would be significantly less than almost $7,000 a year. That’s not including the deductibles, co-pays, and the 20% of the bill that we pay on top of the insurance premiums. I know that we’re one of those families that really cannot afford this amount of premium for healthcare insurance, but with our having a small child, my husband being an asthmatic, and my being treated for clinical depression, the costs of the premiums versus paying for our treatment and prescriptions directly is really a crapshoot, not to mention (God forbid) if something catastrophic should happen to one of us. I’m not blaming any industry in particular for the high premiums or the high medical charges. The litigious, insurance, and medical industries all have a hand in the complete and utterly broken United States healthcare system. I think that the Kucinich / Conyers bill on Universal / Single-Payer healthcare plan deserves a good look by the American people. This is a very convoluted situation and I can only hope that something can and will be done soon as soon as possible to fix this crisis.
Wow I watched the Oprah show and saw what your movie was actually about. (I will have to watch it now) Any way when you showed the american soldier mention that her health care was not great I totally understood. I think that the military gets screwed as for health care. The military doctors aren’t trained for as long as civilian doctors. I have my own stories but the worst is that my mom died of cancer because they(army doctors back in the 80’s and 90’s) never checked her for anything even after years of being sick. She had flu like systoms and thats what they told her she had. By the time a civilian doctor found it is was too late, it had spread.
It’s so sad that insurance cost so much & so does healthcare. If you don’t get a job that provides insurance you better not get sick or pregnant. When I found out I was pregnant I had a good job but they didn’t provide health insurance, they were a small business. Well I applied for medicaid and was told I made too much money. I called several doctors to see what I could do. They said they could work out a payment plan, $600 a month until I had the baby. Then I would have the hospital bill, and all the lab bills. And that’s about what all the doctors told me. So here I was pregnant with no healthcare and couldn’t go see a doctor cause they all wanted money. I got mad an emailed the governor of my state to see what he could do. Well then someone called me and got me on medicaid, imagine that. I paid a portion of my doctors visits and the labs but the rest was taken care of by medicaid. It’s a shame you have to go through all that just to look out for yourself and your unborn child. All I wanted was to make sure my baby was healthy when he came into this world. We really need to do something in this country. How many more are out there in my situation or worse.
If you look up ED (Erectile Dysfunction) on the AMA website, they will tell you it is important for the patient to be screened for heart disease, tumors, high blood pressure as for the cause of this symptom. But upon presenting to the doctor for this problem, my insurance company will not pay for anything that has to do with ED. Even a simple blood test, or heart function testing etc. Of which they would pay for if you came in for shortness of breath (another symptom). They say that they do not pay for the diagnosis and treatment of ED. But presenting with the problem is NOT a diagnosis nor a treatment.
Still paying for my own testing to discover the cause of the problem!
I have on many occasions gone to the doctor and been told that this test, or that test, is too expensive etc. On other occasions, I have been told that the doctors do not know your insurance company and that every person gets the same care. Why then, upon entering the clinic or hospital, the first questions are “do you have health insurance?” Why do the doctors choose your treatments based on what they think you can afford? By looks? By some code on the chart that lets them know your insurance status?
Just wondering.
My husband has worked for the same employer for approx. 17 years but even his employer can’t get us good coverage. When he started working for this company our deductible was only $200. Since then they were talked into a high deductible healthcare plan with a $4,000 deductible plus we have a health savings plan. We aren’t poor people by any means but who can afford to spend an extra $300 a month just on prescriptions. That doesn’t include the actual doctor’s visits. I ended up just stopping mine and my son’s meds. We have satisified our deductible once by the middle of December. We have never been sick people and when I think of the money we have paid in health insurance over the years and what they have actually paid on our bills, it makes me sick.
My parent’s are self employed almost 61 and 60. They barely make ends meet and haven’t had insurance for years. Mom had a heart attack. Mind you she is all of 100 pounds but has high cholesterol. My mom’s bills were well over $100,000 dollars when all was said and done. Nobody wanted to help and they risked loosing all they have which isn’t going to even take care of them when they retire anyway. Who on earth is going to insure either of my parents with their ages. They will be paying so much for nothing.
Insurance companies are horrible.
If you have a pre-existing condition you are pretty much out of luck unless you are wealthy. My mother had breast cancer 17 years ago and has been fine since and STILL cannot get health coverage for less than $9,000 a year. She doesn’t make too much more than this for a yearly income. The system is scandalous and ridiculous. Profit, not health, is all the system cares about.
I am director of orthopaedic trauma surgery at a level one trauma center in LA. I had a patient transfered to our institution for higher level of care for severe fractures of the leg. We did multiple surgeries, stabilized him and finally were able to discharge him. His insurance company denied our claims for payment because I am “out of network”.Since we didnt have an agreement in place before we took care of him, we ended up doing all the work for free. But thats not the worst part.
I asked for him to be seen by a plastic surgeon and physical therapist in network, both of which were denied for lack of documentation. Now the guy is starting to get the bills delivered to him for the uncovered portion. He’s not allowed to return to see me for medical any further…… I dont think there is one part of this whole story that the insurer has actually agreed to pay for…
I banged my head hard snowboarding.
A few days later, I began to have very bad headaches. These continued to increase over the next few days and were not lessened with over the counter aspirin.
I went to my HMO doctor, at a respected teaching hospital. He simply gave me high dose Ibuprofen. That actually can lead to bleeding increasing. The pain went away for about 1 day with the Ibuprofen, then came back the following day like gang busters.
I went to the ER, and had a head CT immediately, which should have been requested by the doc at the prior visit. They find that I a a large subdural hematoma, a slow bleed in the brain, that the blood has pooled so much that the brain has been pushed to the side, and is beginning to push down on the brain stem. If it had pushed more, I wouldn’t be here to write this note, I would have been dead. Emergency neurosurgery was performed. The problem, I nearly died, because the HMO doc did not want to have the cost of the head CT at the start, that would have told him exactly what was happening. This was supposedly a good HMO. Help!
A couple of years ago i broke my scapula in a soccer accident. Getting it fixed was not a problem, I had a steel bar implanted to support the bone as it grew back together. At the time i was covered by my college health care. When i graduated and looked for an individual plan, there were only two companies to choose from, Aetna and Anthem and they immediately labeled me a level 3 risk.
I recovered fully from my surgery and the only issue was the bar still in my body( not causing any discomfort or issues). To lower my risk level i would have had to have another surgery to remove the bar. Only then would they even consider lowering my status to a somewhat normal level. With the bar, i am paying triple what a normal healthy individual would be. But the risk of another surgery would seem to only raise my costs and put me in an unecessarily risky situation, just to make it financially affordable. Is this a conundrum???
Bank of New York/United Healthcare
Almost 2 years later we can not resolve a 74,000 bill.
The Bank of NY states it has talked to United Healthcare the administrator for the banks self insured plan. United Healthcare states they have heard nothing from my husband’s former employer.
It is a shell game. My husband is on permanent disability the Bank of New York self insures with Metropolitan Life and is supposed to get an increase every year. They have told us we are mistaken that is only if he goes back to work. We had a long term care plan sold to us by Johnson & Johnson the woman and children company the plan will not pay out and J&J says too bad.
We need to stop the large corporation self insurance discrimination …… many families are being discriminated against and companies fire the well spouses causing a catch twenty two. Families with illness and disability should be poor. The American Government must stop this discrimination.
I have good and bad to report here. First off, I have nothing but good things to say about New York State’s Healthy New York plan. An HMO sponsored by the state which is a very affordable option for many. Their employees are attentative and they have always worked hard to make sure that I am covered. My issue has more been with the low payment the my Dr receive from the HMO’s, forcing them to see more patients than they possibly can. My visits are always rushed and details are constantly missed. My Dr’s staff never call back with information on critical test results and you end up being just another number in the system.
When my 9 year old was born, my maternity stay was pre-certified. Unfortunately, there were complications, and my baby required a 4 day stay in NICU and another 5 days in the hospital. After we were discharged from the hospital, we were informed that the insurance was not going to pay for the NICU expenses or any of my baby’s hospital stay because the stay was not pre-authorized.
Somehow, the possibility of two patients at the end of a maternity hospitalization did not occur to the insurance company.
We went round and around with the insurance company about this literally until my son started kindergarten!
Also, I work as a social worker at a state psychiatric hospital. We are the option of last resort for mentally ill people with no health insurance. We have a huge problem with patients/clients/consumers stabilizing at the hospital, getting discharged, and coming back within a matter of weeks because they cannot afford their medications. It infuriates me that a month’s supply of atypical antipsychotics costs as much as a car payment or a month’s rent. Atypicals like Risperdal have fewer side effects than the older drugs like Haldol, they work better, and people are more likely to take them. People don’t take antipsychotics for fun, and they can make the difference between being able to work and function as an adult in society, and being completely disabled and unable to care for the most basic activities of daily living.
It doesn’t make any sense that we make things so hard for people who have already been dealt a hard hand by life.
When I was a kid, I was told that I had a bicuspid heart valve. During my latest physical, I requested an EKG to check on the bicuspid heart valve. Since I requested the EKG, I’ve been denied health insurance from Humana. Once you are denied from one vendor, no other insurance carriers will cover you. The only way that I have been able to get health insurance is to lie on the forms. My heart is fine, I’m 45 and race mountain bikes. I am self-employed, so I have to obtain my own health insurance. The system is broke when a healthy person can be so easily denied access to basic health insurance.
When my wife and I had our first child there were some complications with the delivery. Everything is fine now, but it was pretty traumatic at the time and it kept both my wife and newborn her in the hospital for much longer than expected. At the end of the whole experience the medical costs came to over $15,000. Thank goodness we had insurance through my employer that basically took care of all of these unexpected costs. I ended up paying about $1,250 in out of pocket and deductible expenses and that was it. We would have been in big trouble without our Blue Cross insurance plan.
Don’t forget to take a look at self insured corporations that fire family members because
someone in their family is ill. That’s right the whole family should be treated like lepers.
After all the United States Government does nothing to stop it.
I think I’m about to sum it up for many thousands in the USA. I have insurance, it covers about 70% of my medical costs, I’m responsible for the other 30%—can’t afford to buy secondary policy so……a big hospital stay would bankrupt me.
I’m one of 20,000 pharmacists that manage medication for 36 million folks in California. Unfortunately there are 300,000 insurance clerks processing claims, copays and tracking annual deductibles. Fortunately The California Universal Health Care Act of 2007, the Senator Sheila Kuehl bills SB’s 840 and 1014 eliminate the need of these private insurance clerks - one of the most rapidly costly segment of health costs. One simplified paper processing system is much more convenient and less costly. Society chose machines over bank tellers in the seventies, chose touch tone telephones over rotary systems and operators to make long distance calls in the sixties. It’s time now to simplify and choose direct deposit over private insurance company paper pushing clerks.
I had to have surgery to break up and remove kidney stones 4 times all without any insurance coverage. The surgery was necessary in every case because they were too large to pass and could not be zapped because they were fiberous. I applied for Minnesota Medical assistance and was denied every time. Working full time making minimum wage was enough for the state to deny me coverage. The large debt I was left with between hospital and clinical bills meant that at 24 y/o I had to file bankruptcy.
I don’t understand how someone making minimum wage no matter if they work full or part time can be denied state medical coverage. It clearly is not enough money to pay medical bills, yet is too much to have the state help you pay them.
Bankruptcy has been an all to frequent option lately, due to lack of insurance payment. Policies are so fouled up that many of my patiets come to me thinking they have great coverage having bought the policy specifically for chiropractic care only to find out later that the coverage was denied after services were provided for reasons of medical necessity. I might be able to wrap my mind around this better if the patient didn’t benefit at all from the care recieved. However, the patients get better and feel great after each adjustment. Hell, many of my patients have come off a great many of their medications with long term care. This is the problem with the health care industry in the USA, it is driven by drugs, drugs and more drugs. They’ve got medication for everything from headaches, hemoroids and hard-ons. If your kid is hyper active prescribe a chemical equivalent to heroine to calm them down.
In 1967 I made 1.65 per hour and could afford medical care. Things have changed.
The stories I hear in rural America are about how many folks lose everything they have when they are uninsured or inadequately insured when hospitalized. The state, the hospital or a law enforcing agency steps in and sells patients homes, possessions so that health costs can be recouped.
A neighbor told me about several incidents of this nature, one involving a relative. When everything was auctioned off, they bought some of the furniture so the patient would have something left once released from the hospital.
A friend’s boy friend was hospitalized resulting in an obvious negative outcome. To recup costs the hospital attempted to sell the patient’s home only to find out that the house wasn’t in his name.
As a self-pay patient, I have inquired about the costs of office visits but the cost of the visit is unknown necessitating a return phone call with that information.
Back in the ’90s, I worked for an attorney recruiting firm in Manhattan. One of our clients was Aetna. Aetna’s corporate offices were located in Connecticut. When they wanted to hire an attorney, they contacted us. Out of all the companies that we worked with, Aetna PAID THE HIGHEST FEE TO US ($50,000.00 per attorney hired). Almost double what other companies paid - and they were the ones to come up with that figure. My boss was over the moon. In addition, all attorneys that they wanted to interview were FLOWN VIA PRIVATE AETNA HELICOPTER from Manhattan to Connecticut and back. The costs must’ve been staggering - costs paid for by denying claims.
Last May, my husband was diagnosed with an unusual form of cancer. Fortunately, his type of cancer, while unusual, can be cured through a very radical (but not experimental) surgery. I found the surgeon that developed the technique, we traveled to see him and my husband was accepted as a patient. Great news but then we hit a wall with the insurance company. This specialist, after many years of working with and trying to recoup expenses from insurance companies had stopped participating in any provider networks.
So, the insurance company absolutely refused to pay anything for the surgery even though it is the only documented procedure that can treat this type of cancer. I spent countless hours on the phone begging and pleading for my husband’s life. I was sent from dept to dept and we finally got a notice that they would cover the dr “in network”.
We had to pay for the 10 hour surgery up front ($25,000.00) and thanks to family, we were able to raise the money and my husband had the surgery. After more fighting with the ins co. they finally sent our reimbursement check for $4,000.00. Not nearly enough to help us cover the travel expenses and remainder of his treatment. And not anywhere near “in network” coverage (80%)
My husband is doing well and finishing up his treatment. Everything is being paid for by credit cards and personal loans. We are just crossing our fingers that we don’t have any more big financial issues after his treatments are over. We’ll be in debt for the rest of our lives but at least I have hope of life with my husband and our daughter has her dad.
I know you are supposed to comment only on American Health Insurance. I’m Mexican but I have health insurance from New York Life, which is an American Company. It’s the worse mistake my father could have ever made. Well, not him, his company.
See, on January I had to have this emergency procedure. On a friday night, I had to go to the hospital because I wasn’t feeling so well. On the hospital (the one closest to my house and the one that is not in the middle of a dodgy neighborhood. Mexican guys will understand, one of the best hospitals, the ABC, is in the middle of one dodgy neighborhood), they told me I had a Giant Ovarian Cyst and that I had to be operated or I risked infection. So, they operated me and things were fine. Or so were they until my mom gave the hospital my dad’s Insurance Card.
First of all, they told us they wouldn’t pay because the hospital I went to was not on the list of the hospitals we were intitled to use. After explaining to the asswipes of the insurance company that its the closest hospital to our house and they didn’t have the time to check “the list” while their daughter was in pain and yelling, they finally understood and gave us a break. This might sound as if it was solved quickly, but on the contrary, it was slow and it took a while. It got to the point where some stupid woman from the insurance company came to my hospital room and started discussing with me issues about the coverage from which I had no idea and insisted on me solving the money issue right away. I was all by myself on the room, my parents were away for the moment. I was bagdered with many questions about our coverage and this woman kept blaming us for picking the wrong hospital. Even more, she told me up to how much was the bill ascending up to that moment. That caused me a lot of emotional distress. She told be that it was around 12,000 dlls. For me, my parents would have to pay it with a pound of flesh.
It turns out this bitch was lying. The bill was lower, but still, the inssurance didn’t want to pay it. It wasn’t until the legal department of my father’s company and the company’s doctor contacted the inssurance company that they agreed to pay us. And of course, they didn’t pay 100% of the bill. The bill was about 8,000 dlls and the insurance just gave us about 5,000. Also, they neglected to include the surgeon’s fees and we had to pay that too. To make matters worse, it took New York Life ONE MONTH to send us the check and ANOTHER MONTH so the check appeared on my mother’s account.
To be honest, we had no problem paying the rest of the money. But what’s the point of having insurance if they are not going to help you out? Even more, when they delay the help after you spent hours begging them for help. Nobody deserves that treatment, not the family and not the pacient.
I WORK AT A PHYSICAL THEARPY CLINIC AND THE INSURANCE INDUSTRY BLEW ME AWAY. I DIDN’T KNOW IT WAS SUCH A CUT THROAT BUSINESS. FROM DOCTORS GETTING PAID OFF BY THE COMPETITION TO A PATIENT GETTING A RX FOR 12 VST AND THE INSURANCE COMPANY ONLY GIVIN THEM LIKE 9 VISTS CAUSE THEY DONT WANNA PAY FOR 12. ITS JUST CRAZY AND IT BLOWS MY MIND EVERYDAY I GO TO WORK IS A NEW EXPIERENCE FOR ME.
Health insurance is bad, but even paid prescription coverage is WORSE. I get $1500 a month Social Security and WITH my ExpressScripts “coverage” my total prescription bills for my wife and I are $1200. It doesn’t leave much for rent, utilities, and groceries, and I’m rated as making too much to qualify for assistance. You should do a film on that too!
My HMO is Aetna. I’m lucky, because I work for the state of PA, and the coverage is excellent. But only if you don’t have to use it.
I volunteered with the Red Cross in New Orleans in October 2005. I worked on the Emergency Rsponse Vehicles that carried hot food, snacks, and clean water to those still hanging on in their neighborhoods, and my kitchen, in Kenner, was the first to go into NOLA. In fact, my crew went in on the 2nd day that the city allowed the Red Cross to enter. I got sick immediately, the same day, and grew more and more ill over the next week, until I had to go to the only emergency clinic available, where I was told I had strep throat. I gave them my insurance info, got better, and went on.
A month or so later, I got a notice from Aetna that they would not pay the bill because: a) I hadn’t gone to my primary physician (who was 100 miles away!), b) I hadn’t shown it was an emergency, and c) even if it was an emergency, I hadn’t gone to a hospital ER. I wrote to Aetna telling them I a thousand miles away from my primary, was so ill I couldn’t stand up at the time, and that because it was the NOLA area, there WAS no hospital ER. The clinic was IT. A few weeks later I got a bill from the clinic, telling me Aetna had refused payment. This time I called Aetna, and gave them hell. The woman who took my call was nice enough, explained that I still hadn’t shown a dire need for service, and even if I had, I had failed to abide by the out-of-network requirements. She said she would see what she could do. I never heard from either Aetna or the clinic again. I still don’t know if the bill was paid.
now I know I have no right to complain cause I live in Canada and pay almost nothin for heath care but here in small town newfoundland where there are only a few doctors to see , they treat you like your just a means to an end for a pay check anyway . Take my last vist to the doctor , I told him my troubles and as I was tellin him , He was writing the proscrption , then he proceeded to chew me out , tellin me he was gonna drop me as a painet cause I missed my last appointment , which was during a record snow strom and I was stuck at work for 21 hours , so you know I couldn’t get there , and people have to put up with this cause there are no other doctors to see , conver belt script men , its sad really , so I may not know about the money aspect of the american health care system but alot of us here in small town newfoundland can relate to the dehumanizing aspect of it . It just makes me mad
have a good day if you can
R.N. Thorn , Carbonear , Newfoundland , Canada
My family has to pay about $21,000 a year for health insurance and it is not even the best out there. Now to many this would not seem a large price to many people, but my family owns their own business and this is very large sume to be paid by my dad. $21,000 for health insurance this would pay for about two years of college, but sadly it does not. Health insurance in this country is out of control. 50 million Americans have no health insurance and isn’t this suppose to be the best country in the world? So GOD BLESS AMERCIA!
I studied abroad in Southern Mexico the summer before my senior year in college. There I contracted Dinque fever (a form of Malaria contracted from a mosquito), which left me with a fever of a 103 degrees for a week and jaundice. Prescription asprin would not come close to healing me. Blue Cross/Blue Sheild would not cover the medical bills because they said I did not seek care from my primary physician in North Carolina. Thank goodness I was in Mexico where the cost was managable.
My Insurance provider CENTRAL RESERVE LIFE has $146,000 in premiums that my employers has paid over the past 7 years of my employments with them. I have never had a claim until I was injured in an accident and after 6 months they have paid 3 bills. Those bills had to be faxed 8 times, mailed twice (they returned them once since I paid for a proof of signature on delivery card) and eventually sent to a supervisor. I spend 45 minutes a day on the phone with their “customer service” reps trying to get them to pay bills that they claim they do not have. My doctor has sent them the bill so many times that now my doctor is refusing to bill them and is turning me over to collections. I am a person that has worked my whole life and has always had insurance. I eventually have turned them over to the State Insurance Commissioner here in Missouri….we will see if those people are interested in doing their job as well. In a million years I would have never thought that this would happen but it is. I could get better coverage in India! canot wait for the movie to come our my insurance company would be a great exapmle they are KING of the run around!! But quick to cash my premium check!!!
hey there 9 years ago i was in a serious accident and i have to were 2 braces that assist me in walking i cant get insurance because of the preexsisting and my braces cost 1000 dollars each i dont go to the doctor because i cant afford it i dont qualify for medicaid because the government says i make to much money wich isnt over 20,000 a year why is it that if canada can give there citizens free health care cant the US do the same…there are naural cures for almost everything..diabetes..being one of them yet the drug compaines and doctors keep saying your sick you need this…it is all a scam …a scam for money for the government the doctors and the drug compaines it is very sad to see so many americans without health insurance or so many of them stuggling with there bills to pay for medicine that is covering up the problem NOT FIXING IT…i say we all move to Canada…A!!!
we use to live in indiana and we had to move back to florida while we were using the governement heath care.my daughter got sick we had to take her to emergency room , got there instead of letting my daughter see a doctor they insisted in the medical coverage . we had to wait for 3 hours till they verify that and another 4 hours waiting for a doctor who end up seeing my daughter for 2 minutes after 7 hours of wait in the mergency room and giving her a tylenol and the funny part i got a bill of 2000 dollars wich i m never going to pay a 7 hours wait and 2 minutes spent by a doctor and a tylenol that costed me 2000 dollars.
by the way my daughter was 2 years old and it feels like it s rather coolect money to pay the rich doctors than save a 2 years old life.
Several years ago my young son needed surgery. I had previously (2 months before) changed jobs and COBRA’d my insurance so at the time of my son’s surgery I actually had 2 plans, my old one and the new one. My husband, son and I were in the pre-op waiting area and someone from the hospital came in to tell us that they could go ahead with the surgery but it would not be covered as neither insurance company was willing to cover the cost - they each pointed fingers at the other company insisting they pay. My husband got on the phone and fortunately he can be quite persuasive - we were able to get one of the company’s to take responsiblity. However the fight went on long after the surgery was over. The cost I payed to COBRA my family health plan was over a $1,000/month.
I go to college, and had a healthcare plan through the college becasue it was required to attend. It is fairly inexpensive, and is not worth much but i need to have it in order to attend, Catch - 22. I broke my toe on campus at 7pm on a friday night, it was a compound break and the bone was shattered through the skin. The health center on campus was closed (it closes at noon on fridays, and remains closed until Tuesday at 12 noon). I go the local emergency room, have the thing set, and stiches to close the wound from the bone poking out. All seems well, next i have to go to the pharmacy to fill the Antibiotics and Pain medicine my foot was killing me. I call the healthcare company/insurer to ask if the will cover the antibiotics and pain meds or any part thereof.. they say they will not pay for this becasue a broken “toe” can be dealt with at the health center (which is closed for 3 1/2 days out of the week) and that is not deemed an emergency, even though i explained the bone was sticking out, and I couldnt stop the bleeding until the emergency room doctor took care of it? The prescriptions cost nearly 200 dollars mostly for the antibiotics that is need to aviod a bone infection which can become deadly if not treated. I go to the only pharmacy open, its in a “Price Chopper” supermarket that is open all night. I told them my insurance didnt cover the medications, and the pharamacist told me they give a discount to people not insured, and so he gave me that discount, the total with the pain meds was 30 dollars, if i had covereage it would of cost over 200. What sense does that make? I was grateful and they get all my buisness now. TO MAKE IT WORSE, the insurance denies my claim, flat out, They didnt send me the bill, they billed the college itself, which in turn billed me…I was forced to pay it in 14 days or i was threatened with removal from the semester if i didnt pay. No arguments, no appeals, no nothing, 850 dollars later I paid. I got rid of the “college plan” and now pay for a state plan that is inexpensive. I think all insurance does is it INSURES you get billed, run around, bullied and riped off in the end,,,, thats all……..Im sure in Canada, the prescriptions would of been 10 dollars for the same thing, and that would of been the FULL price,
Larry, June 4,07
COB or coordination of benefits is a very important item in that a person or persons having more than one insurance can “coordinate” to pay a service in full. COB guidelines are mandated by federal and state goverment and most plans will want to know which parents birthday is first in the calendar year. ie: if your wife has the birthday of Feb 1 and yours is Mar 1. Your wives plan will be prime for any shared children you have. Your plan as secondary would cover and remaining copays or co-insurance amount left over. Get it!!
I was working full time for Walgreens and had their insurance through BCBS of Illinois. After the Pharmacy decided to cut my hours and give them to cheaper labor, they terminated my insurance because I wasn’t working full-time anymore. With that, I lost my coverage for my bipolar medication and the money to pay for my psychologist and psychiatrist. Soon after that, I was let go and spent almost six months out of work with no medication for my condition.
RE: U.S. citizen’s experience with ER visit in Sydney, Australia.
For work reasons, my family and I spent two months in Sydney, AU (March-April 2007). During that time, our 18 month old son went to the ER for a very high fever (104.9F). The hospital did not accept our insurance carrier.
We were required to pay 100% out of pocket.
The bill was $90.00.
The high quality of the hospital, physicians and staff were no less than the quality here in the Silicon Valley. I do not know the tax or insurance structures in Australia; my familiarity with its healthcare system makes me think Australia is doing something right. Maybe we should investigate this further?
I had a conversation with my doctor yesterday about health insurance. She said that her husband wanted to let go of their four person policy as it was just to high costing for four young, healthy people. This is coming from an MD! I told her that I will pay out of pocket for any alternative therapy (accupuncture, chiro…) to keep healthy rather than test my luck in a hospital! Did you know that Magnesium is used as a pain remedy (DHONES BACK PILLS) and is good for you (in small doses)? I’d rather use something nautral and needed than a liver eating pill that would not be cover in my plan anyhow. Germany, Russia, China are all looking like fine places to retire and receive better healthcare!
Everybody seems to have complaints about the system but the doctors, nurses and technicians that are responsible for delivering healthcare here in the U.S. are among the best in the world. The main problem with the U.S. healthcare system is the involvement of the insurance companies. Moore’s film will address this in greater detail but 30% of our healthcare dollar goes to insurance administration, executive salaries and insurance company profits. The U.S. spends twice as much per capita as the average per capita amount spent by other industrialized nations. Eliminating the insurance stranglehold and replacing it with the system used by these other nations (either single-payer or non-profit insurance cooperatives) will reduce the substantial amount of waste in the current system. Approximately 95% of the heathcare dollar goes to actual healthcare delivery in these countries and only 5% goes to administration. The same is true for Medicare here in the U.S. which is our version of nationalized healthcare for those who can survive until age 65. Moore’s film will hopefully inform Americans about the scam that exists now and will galvanize the public to demand significant reform including a Medicare for all system. Only 16 days and counting until Sicko opens. Can’t wait.
I am one of the lucky ones — I am still clinging to the health insurance offered through my former employer. My premium is $858.00 per month for my husband and me, including a prescription service. We are doing everything possible to hang onto this policy. Thank goodness we own our trailer, and my husband is handy. He has fixed our refrigerator with parts from a leaf blower (and the leaf blower still works, too!), and he keeps our truck running. We have sold virtually everything in the trailer except a sofa and recliner (purchased at yard sales). My job search is going slowly, but I am optimistic. As I wrote, I know that I am one of the lucky ones. I am still hanging in there … as long as the refrigerator holds out. Bless you, Michael Moore.
Dan’s got nothing on me. When we had our first child, my wife got very ill and the baby had to be delivered on an emergency basis six weeks premature. Our daughter spent her first 24 days in the hospital’s neonatal unit. My wife was in the hospital for eight days. We received incredible care. Our total bill was in excess of $100,000. Thanks to our insurance we paid about $400 out-of-pocket. We are forever grateful for the wonderful care we received and the coverage that paid for it.
The only good health insurance is through my University which is, by the way, run like like a public utility. While in school my health care was included. I could see my doctor whenenver I wanted to. Birth control was part of the package. Needless to say, once I graduated, I was REJECTED from coverage complete from BC of CA because I was sick once several years ago. My job doesn’t offer health insurance. Luckily, I live in the fabulous state of California that beleives in offering reproductive healthcare (”Family Pact”) to uninsured people for little or no cost…just because it is a human right (CRAZY, I know). On the right track but NOT ENOUGH.
My mother is morbidly obese and unable to exercise due to severe ankle and feet problems. She has tried numerous diet programs with little success. All of her doctors agree that she needs the lap-band surgery to help her loose weight, which would eliminate at least half of her medical problems. But insurance will not cover it, saying it’s an “elective” surgery. Numerous letters and pleas to the insurance companies by both my mom and her doctors have gone unheeded and my parents simply cannot afford a $20,000 procedure out of pocket. At this rate, my mother will be dead far earlier than she should be, and it can all be fixed with this one procedure. If she could loose just some of the weight, it would not be so difficult for her to exercise. Why do insurance companies have no problem dishing out money for monthly medications that could be eliminated entirely by a one time procedure they WON’T cover?
The President of the United States suggests that Americans purchase their own health insurance if they do not qualify for government assistance or are not afforded insurance by their employers.
I have a PhD and have been working as a college professor since I graduated school. I have never been offered health insurance by the universities that have employed me. I have tried to purchase health insurance and have been denied twenty-three times because I broke my leg six years ago. I do not qualify for government assistance.
I was unfortunate enoughh to have gotten injured at work. Workers’ Compensation Insurance (The Hartford) has treated me like a criminal. They harrassed me by phone, had me followed and filmed (I have the films), and probably ruined my engine when I tried to show up in court with evidence that they had tampered (big time) with the filmed evidence. They sent me to fake doctors for fake reports that said I was fine when I wasn’t.
I fight for everything. They cut off everything, my pills, my physical therapy, my treatments. It’s miserable because I cannot use my other insurance for treatment. It is against the law. Although I have three to four insurances at all times, often I pay out of pocket, which I can ill afford.
Please bring to light how bad workers compensation patients are treated. Please help us.
Marilyn Michalak
This website tells the story of a friend who is in a precarious situation with his family’s health and walking from CA to Colorado to raise money. So sad that in the world’s richest country a man with a brain tumor is worried about his medical bills.
I was wondering if you can find me a answer. I was on the drug Viagra for quite some time and my insurance was paying for them. Until then without warning my insurance stopped paying for it. And till this very day. I don’t have one vaild reason why they stop paying for my pills.And i am very upset about it. Please help me find my answer. By the way, Loved your last movie….Keep doing what your doing and that’s TELLING THE TRUTH AND LET THE WORLD KNOW HOW MESSED UP THE WORLD IS…….LATER!!!
My company has United Healthcare as our healthcare provider. We changed from a different provider on January 1st, 2007. The insurance company didn’t process our paperwork correctly, so none of our employees were enrolled in the system until late January. My doctor of 10 years would not take my appointment without a valid insurance card. I had to go elsewhere and pay out of pocket. When I finally was enrolled at the end of January, I wrote a letter to United Healthcare asking for my January premium back (a total of $92.50). They said that that wasn’t possible. For some reason, my company did not take them to court. I have filed in small claims court and have a court date in Arizona set for August 16th, 2007. I have a trail of email from the healthcare company that is clearly shows that we didn’t have coverage. I am only seeking my premium for January and I am 100% confident that I will win. I am far more interested in winning the case than getting the money back. If anyone from your organization would care to join me on my court date, I would welcome the company.
Why should I have to visit my doctor and pay him to renew prescriptions that I will be taking for the rest of my life. Why can’t I have a prescription written for a five year limit instead of one year. Obviously it’s all about the Co-Pay!!!!!!!!!
I am an asthmatic and the only way I can get health insurance is through a major employer. The american dream is squashed for so many. This is McWorld and the go to college and get a good job with good benefits is a myth. I have worked in health insurance and we are in crisis- people in the industy say way have less than 5 years until total collapse. Small business premiums went up at least 30% in one year. People are denied for needing a band aid. There is no safety net. We need to get serious - look at your family and look at your friends — someone is hurting and is not because they are overweight and don’t exercize. It is because the system is not working. It is a different world, my great grandfather in the depression took care of his community and people paid him with turnips because that’s all they had. We have all this great technology that can save you but then ruin your life because you can’t afford anything else — this is not right. The thing that gets me is how long Congress is going take to overhaul this and in that time there will be no accountability for the insurance company and the medical community. We need to band together and speak up and march.
Last February, I fell in my own driveway taking out the garbage. As a result of some black ice, when I slid, my leg twisted in such a way that it broke from my ankle halfway to my knee.
I took an ambulance to the ER, where I sat in excrutiating pain for 5 hours before I was sent to the back of the ER. There I saw a PHYSICIAN’S ASSISTANT. Two weeks later, I got a bill from the ER for seeing a doctor WHO I NEVER SAW–and my insurance wouldn’t cover it because he wasn’t part of their plan.
Ok, so then I start visiting specialists. Everywhere you go now, you have to sign a form that you will be responsible for paying whatever your insurance doesn’t cover. You don’t have any choice in the matter. However, these doctors also sign contracts with the insurance companies to accept their payments.
So, I start back recovering after my surgery and the bills start rolling in, as do statements from my insurance company (Blue Cross Blue Shield) stating that “this doctor is a preferred provider, you are not responsible for the remainder of this bill.” Meanwhile, I’m getting letters from the doctor and the hospital demanding that I pay up.
I send them the notice from the insurance company stating I’m not responsible as they overcharged for services they had previously agreed upon payment for.
Ok, so finally I agree to pay the one bill my insurance company didn’t approve, which was the ER doctor I never saw. $157 to the hospital, which has also sent me a bill for $489. I send them my credit card information on the stub for $157.
Three days later I get a receipt back for $489. Stupid me, I should have expected them to do this.
Unfortunately, they really have me by the throat, because I had to have a second surgery on my leg 8 weeks after the first, and knew that was coming, and here I am trying to sort all this out.
Mind you, I’m out of work on disability and my pay has been cut to 80% and then 60% on disability and finally my disability even ran out and I was stuck without pay!!
So, I tell them I’m not paying the other $157, as that was what I had agreed to pay them, and they are welcome to take it out of the payment they made without my permission at the same time my mortgage is due. I also tell them I let my bank know not to accept any more charges from the hospital without calling me first. Of course, they don’t want to hear this.
Then the orthopedist’s office gets involved and starts sending me bills for money they said the insurance company hasn’t paid, and their story is the same, “You agreed to pay all charges that your insurance company didn’t cover.”
“My insurance company has a contract with you–you are supposed to charge what is agreed upon”
“Take that up with your insurance company–we have your signed statement here.”
Yes, my foot was dangling by a thread, I would have signed anything!
Fortunately, I got through the next surgery and had that completed successfully.
Unfortunately, within 2 weeks, everything was sent to collections!
My husband and I wound up paying nearly $2K out of pocket to clear the whole mess up. This winter, if it snowed or iced up the least little bit, I refused to leave the house. Is that sad, or what?
I’ve been in graduate school for 3 years and haven’t been able to afford dental insurance. As a result I’ve got 2 teeth that have needed root canals for years. I finally graduated and got a job (which doesn’t provide insurance) and got myself some dental insurance that I can’t really afford but feel is necessary. Well, about two weeks later one of my teeth got an abcess and I was in agony. I went to the dentist who referred me to an endodontist.
The endodontist they referred me to no longer took my Blue Shield insurance, so I found another and got the soonest appointment I could. When I got there, in tears from the pain, they told me that if I wasn’t referred directly to them they couldn’t see me because my insurance wouldn’t cover it. After a LOT of tears on my part and thanks to a sympathetic person at the reception desk, they agreed to see me. After verifying my insurance they told me that there was a 3 month waiting period on all major procedures and that I would not be able to have my root canal for THREE MONTHS! They apologized and sent me on my way!
How can any medical professional send away someone who is crying because their pain is so bad? The woman at the desk felt awful for sending me away and encouraged me to call my health insurance provider and see if they’d remove the 3 month hold. I did, they wouldn’t. After being transferred to 3 or 4 different people (all while my tooth hurt so badly I could barely speak), I was finally told “it was in the paperwork you signed, and there’s nothing we can do about it.”
So only 2 more months until I can get my root canal. I have had Blue Shield insurance for 2 years now and until this point I’d had no problems. But to turn someone away and tell them there’s nothing they can do, despite the fact that it’s an emergency and “you signed the paperwork” makes me SICK.
I have the bluecross tonik plan. after being on the plan for several months i was diagnosed with bi-polar disorder. bluecross wanted to look further into the case…after 3 months, THEIR doctor had determined that i had a preexisting condition and that no claims would be paid. I had never seen a doctor before diagnosis…and had no record of having the disorder. They will not speak with my doctors and their “doctor” has never contacted me. they said i’ve had it for years and should have known because sometimes i admitted to getting “sad”. To date i have spent over 12,000 dollars and they are yet to pay for a single claim.
My Insurance cancelled by default- not ! BlueCross, Thank You!
A few years ago I was hospitalized with pulmonary embolism. Little did I realize how many people die of blood clots each year. I survived, as may do not and often have re-occurrences. BC/BS apparently know the facts better then I. Prior to the 2 week stay in the hospital, I never had a claim. I missed one monthly BC/BS payment of $120.00, when I called about catching up the late payment I was informed my premium jumped to $400 plus. I’m sad to say the only insurance I can afford at this time is catastrophic insurance, meaning I will be on the hook for the first 10k of expense should I need coverage.
I’m sick over the excessive profiteering by the insurance companies, drug companies, petroleum companies and the government wasting our tax dollars.
I once went to a dermatologist, waited a month for the appointment, waited two hours in the waiting room. The doctor “examined” me for less than 5 seconds. I complained that seemed like it wasn’t enough time to do a proper diagnosis. He said it was. I made a formal complaint with Blue Cross and Cedars Sinai HMO in Los Angeles… I sent a reply back that I was considering sueing in small claims, cause I didn’t feel I was getting what I paid for, a REAL exam, NOT a 5 second “look”… then I got a phone call, left on my answering machine from the HEAD of the HMO, swearing at me, saying, “if you sue us, we’ll sue you back, and take every cent from you… youll have nothing left”. Ouch!
FIrst of all I consider myself to be republican and generally don’t endorse Moore’s messages but health insurance in America has me fed up and it’s abou time someone made a documentary about it. My wife’s employers company went out of business while she was 6-7 months pregnant leaving us with no coverage. No insurance company would accept her or (get this) me for that matter while she was pregnant becuase it was too big of a risk for them. They wouldn’t take me anywhere because they said that it was too big of a risk that they would then be forced to take on a potentially unhealthy baby seeing as how the law would force them to once they insured me. As a result, we were forced to go on the state plan. Did our deductibles transfer that we had met for the year? Of course not. Once my daughter was born on March 24th I called to get private coverage again since she was healthy and the state premiums were so expensive. I was told we had to wait until April 1st because they don’t issue effective dates for other than the 1st of the month. what???? Of course all the medical expenses of the labor/birth were incurred between the 24th and 1st. Left with no other choice I accepted a personal plan starting on April 1st and then had to put my daughter on her own expensive state plan to bridge the gap between the 24th and the 1st. But get this: When I called to cancel the state plan seeing as how I had private April 1st coverage for my family I was told tha I was required to keep the state plan on a new born for a minimum of 60 days despite the fact I had secured other coverage for my family. What??? Here’s the best part: The same company that administers the state plan in Wisconsin (WPS) also was the company I bought the private plan with. I questioned how it could even be legal for the same company to take premium from the same person for the same time period. I was told those are the rules and the state plan is ran by a differnt divison of their company. Even better? Deductibles, of course, don’t transfer again. And the state plan is supossed to help people? I stand to meet 3 deductibles in oh about a year for nothng we did wrong. Victim of the system I’ve been told… Great… I consider myself to be educated in insurance and waded through all the b.s. and expense to make sure my family didn’t go without coverage. It’s no wonder the poor and less educated give up and go without!
In 1997 I had an ectopic pregnancy (the fetus “stuck” in the fallopian tube). I was in unbelievable pain and my husband took me to a local urgent care/ER. The ER couldn’t perform the surgery, so they took me by ambulance to where my OB/GYN could operatre. Later, the insurance company told me that they wouldn’t cover the ambulance ride because it wasn’t pre-approved. Luckily I had a WONDERFUL ER Dr. He called the insurance company and chewed them out. He said he ordered the ambulance because the fetus was close to rupturing and if my husband had taken me to the other hospital it could have ruptured and I would have died. The insurance company finally agreed to pay the $500 bill thanks to my wonderful (and morally sound) Dr. I can’t wait to see the movie!!! My neighbor and I have plans to go see it. I’m now a teacher in NC with so-so coverage, but I teach in a low socio-economic area where many of my students and their families don’t have insurance. One of my students had what sounded like bronchitis this past year and his mom couldn’t even take him to the Dr.!!! Sometimes I wish I lived in Canada…
May 28th, 2007 at 11:30 am
Mike,
My wife’s dentist called Aetna (Who at the time managed our dental plan through Ford Motor Company), and got her pre-approved for a crown on one of her teeth.he told me that I would have to pay $100, or whatever my part was (it was fairly small).
When he got in there, he found the tooth was in much worse shape that he had originally believed, and so he did a procedure called an inlay instead. The inlay still made a “permanent” repair to the tooth, and best of all, it cost the SAME money.
Aetna, who at the time, managed Ford Motor’s Dental plan, balked. Their on-staff company quack said it was not medically necessary, and denied the claim outright.
After months of wrangling, the dentist ate half the price and I ate the other. The fiasco cost me $300.
It’s something I’ll ALWAYS remember.
I can assure you, if I ever get half a chance to burn them, I most assuredly will.
May 28th, 2007 at 3:34 pm
I come and stay in New York frequently, and do have Health Insurance from HIP. Luckily most of my time I reside in Russia. Here in USA even with insurance people still get ripped with so called COPAY! What is COPAY? Why should I pay additional money for treatment if I already pay for insurance? I’m sorry to say, but USA if far from being richest, greatest and whatever people say about it. Honestly don’t believe it will ever get better here.
May 28th, 2007 at 5:40 pm
One day, I had a kink in my back that really wasn’t a problem. But in the evening, the pain got worse on a dime it seemed. I was in so much pain that I couldn’t walk. I ended up having to drive myself to the emergency room and have someone come out to my car with a wheel chair while I tried to find a position that was comfortable. The room wasn’t busy and I was seen right away and they ran checks for kidney stones just as precaution. I was prescribed vicodin for 2 days and felt better. I later got a letter from my HMO stating that I was being given a warning that my visit was not “a emergency case” and that further visits for such would be charged full price. I could barely walk! The pain suddenly got worse! That’s not emergent? I wasn’t going to drive around looking for an urgent care center which aren’t very common nor are 24 hours. I went to the closest hospital center and it was even the one I most commonly go to as it happened to be close by (It usually is a 20 min. drive from where I live) Besides, how was I supposed to know it wasn’t something serious? Luckily, I haven’t paid for this . . . yet.
May 30th, 2007 at 7:08 pm
I have BcBs via my employer (big corporate financial company).
I have the plan that costs the most so that it would cover the most, yeeeahhhhh…
Few years back I had a high ankle sprain, I went to the ER and paid a co-pay of $147.00, they casted my ankle and told me to make an appoitment to see the regular doc in a week, next 2 days my toes went black due to the circulation cut of on my foot, due to cast…
I went to urgent care, payd a co-pay of $40.00 to have them cut/take the cast off and sell me a $60.00 legg brace, as the urgent care doc said ”cast was a mistake due to the large amount of swelling”.
Few days later I went to see the regular doc (co-pay of $30.00) he does some X-rays and tells me ”good news you only riped one ligament and over stretched the rest of em and didnt break the bones, all you’ll need is some therapy, and if you have pains later on we could talk about surgery to patch up the one ligament”, orders me to go to therapy 2 times a week for the next 6 weeks and than switch to once a week until I feel good enough to run.
I go to the therapy the first day and pay $30.00 co pay and I am informed it will cost the same each time I come there, I havent gone there again, I used up all my PTO and had to claim un-paid time off and went broke within a month.
2 years later I still have the swelling and discoloration in my toes and circulation problems in my right leg, I dont play soccer any more due to the fear of going bankrupt
I am going to get a much better medical plan soon, I am going to get a Canadian citizenship
GOD BLESS CANADA
May 31st, 2007 at 7:49 pm
I am looking forward to seeing the film in Bellaire, MI. I work at North Country Community Mental Health right in town. Majority of our “consumers” are medicaid recipients. The problem with physical health coverage is not as severe as the problem with mental heatlh coverage. Most insurances covered only 6 sessions for therapy. Luckily the Parity act will hopefully equalize insurance to cover both physical and mental health services. Who knows? They probably will find a way around it. Thank you Michael for another great film from a fellow Northern Michigander.
May 31st, 2007 at 8:46 pm
I wanted to add to this conversation. I am a part time employee of a grass roots health advocacy non profit. My health care coverage has always been through my husband’s employer plan. When my husband retired in January at age 65, he became eligible for medicare. We opted to continue my coverage through his employer with COBRA until we could find a different plan. The cost of that coverage is $1675. each month!
I have been turned down flat by two other plans because I have high blood pressure treated and controlled with medication. I am a very healthy 63 year old normal weight registered dietitian with no surgeries or other hospitalizations since 1983, no cancer no chronic disease. Something needs to be done to address this. Please.
June 1st, 2007 at 3:51 pm
I consulted with an Human Resources friend before selecting my health care plan. I had Kaiser Permanente and I decided to switch. I wasn’t unhappy with Kaiser, they just don’t have the greatest reputation around here and I just wanted a better plan. The joke is that some doctors graduate at the top of their class and some at the bottom… the ones at the bottom end up at Kaiser. I have to hand it to them though with their ‘one-stop-shop’ - very convenient if you have to get x-rays or bloodwork. Everything you need is right there. Anyway, out of the dozen or so options I had she recommended the Aetna plan.
I hurt my shoulder playing baseball. So I make an appointment with my primary care physician - $15 co-pay. He sends me a referral to an ‘in network’ orthopaedic surgeon. Another $25 co-pay, because he is a ’specialist’. He checks me out, xrays, etc and prescribes me 4 weeks of physical therapy, three times a week. Apparently the ‘in network’ physical therapists are specialist too… $25 per trip. The physical therapy place does not have evening hours, so I have to take time off from work to go. To top it off, the Physical Therapist ‘gives’ me some already used thera-bands to do exercises at home with - I get a bill in the mail about 4 weeks AFTER I finished physical therapy with a charge of $5 per band that I thought I was ‘given’. Silly me, nothing is for free.
Another trip to the orthopaedist for the follow-up - another $25. His recommendation? Surgery… and then more physical therapy.
Nearly $400 later, I am in the same boat I was in before I went to get help… and I’m still paying every 2-weeks for my great health care plan.
I realize that I am complaining, but I couldn’t imagine what it would cost me if I didn’t have this great insurance. I’m lucky that I can afford to pay the endless co-pays.
June 1st, 2007 at 11:44 pm
My son had an emergency cat scan of his abdomen after a fall. I paid my $100 copay, and thought everything was fine until about 3 months later I got a notice that I was in collections for 690 dollars for the cat scan (this was about 10 years ago). Turns out that there was a mixup in billing, which was not my fault, but the emergency room registrar’s fault. When I finally had a conference call between the collection agency and the insurance company, the insurance company paid $170.00 to fulfill the obligation. I would have had to pay $690.00, for an original bill of about $580.
That’s outrageous, for them to pay less than 25 percent of the original bill, when I would have had to pay it ALL. Worse yet, I work as an RN in that VERY SAME ER!
June 2nd, 2007 at 12:10 am
I am an actress, and was fortunate to get a job right out of college. It was a national tour, and I was delighted to learn that I got health insurance because I am diabetic and the costs add up quickly since I have an insulin pump…the costs of those supplies is astronomical and that doesn’t even include the insulin and all the other supplies I need to live.
So needless to say I was happy that I’d have insurance. Except it didn’t cover pre-existing conditions for a year. A YEAR, which was the duration of my contract. The pre existing conditions thing kills me. You are supposed to pay the insurance companies to give you NOTHING for a fixed amount of time before they will actually cover the expenses for conditions you had when you got the plan. So you’re throwing money down the drain pretty much. There’s always the chance that you’ll get hit by a car or something but there are much cheaper plans out there that will just cover you in case of an emergency. I need help on my prescriptions.
So for a year, while I was working and supporting myself fully in all other respects, my parents had to pay extra money to keep me on their health plan. Then, after my contract was over, I had coverage for sixteen additional months. Good, well, at least now my prescriptions would be covered finally. WRONG. The company I had been working for switched insurance carriers to a company that would not cover ANY of my diabetic prescriptions-not my insulin, test strips, insulin pump supples, nothing. So I had to pay for those things out of my pocket. If you know anything about diabetic supplies you know they add up pretty quickly. I had to purchase the lowest quality testing meter on the market and still spend about $100 a month out of my pocket buying test strips that are compatible with it.
I am now on the state health plan and it’s been great for me. A very decent price with complete coverage on my diabetic supplies with NO waiting period because it was a “pre existing” condition. To all who have had difficulties, I suggest looking into it in your area and see if you have the same luck. For a fraction of what insurance cost me before I am getting everything I need.
June 2nd, 2007 at 4:02 pm
I am a physician and my wife is a mid level provider. We both have the highest tier insurances available through both of our jobs. We both went in for PREVENTIVE care appropriate for our age. Guess who got the bill….we did!! If that doesn’t sum up health care nowadays I don’t know what does!! After 6 phone calls and a few hours of fighting we worked a deal out but why the hell did we need the highest tier insurance on two HEALTHCARE jobs if neither would pick up PREVENTIVE care!!
June 4th, 2007 at 2:14 am
This may seem small potatoes (comparatively-speaking), but here goes.
My wife is an R.N. at a large, local hospital which–in order to combat rising healthcare insurance costs–created their own insurance company. Issues with out-of-network providers aside, our claims were continually being rejected (usually two or three months after they were filed). We often spent our leisure time placing phone calls, split between our insurance carrier and our dentist’s/family doctor’s/pediatrician’s office in order to coordinate payment. After a dozen or so of these calls, we were informed–finally–as to why we were being rejected; it turned out that we had failed to file a form which stated that our family did not have a secondary insurance carrier. My question is: What does it matter if I had carried insurance through my employer (I don’t)? Could my wife’s insurance reject claims for my children simply because I wasn’t “fair” and split the costs of medical visits between their company and my provider?
June 4th, 2007 at 10:39 am
My wife and I just had a baby. We have Oxford insurance. The bills for the doctor came out to about 20K. The doctor doesn’t take her primary insurance so we fixed naturally her secondary insurnce (Oxford) would pay since the doctor participates. We to my surprise, Oxford did not pay. They denied the claims. Said we need deinal EOBs from the primmary insurance company stating the doctor doesn’t take that insurance. So I got those and sent them to Oxford. Oxford said wait 20-30 days and they should be processed. Well after about 30 days, the claims were DENIED AGAIN!!! When I called to find out why they said the never received the denial EOBs so there was nothing to process. It took them 30 days to tell us that and I have copies of the EOB that I sent them. This has been going on now for 6 months and I don’t now when it will end……..
June 4th, 2007 at 10:51 am
I’am hardworking man with a family that is stuck in middle class. my wife and I work hard to make ends meet , but with a child on the way I’am alreday paying $650 a month for health care. with my wife pregnant I dont know if we can afford this baby..
June 4th, 2007 at 10:53 am
Between health insurance and car insurance in this country, I don’t know which is worse when it comes to costs.
I have Harvard Pilgrim now and to me it’s useless. High co-pay amounts and the vision coverage shouldn’t even be called “coverage” because it doesn’t cover anything. It covers an eye exam and that’s it - no glasses and no contacts.
I’ve had two knee surgeries over the past 4 years and each visit to physical therapy is $20. I had to go 3 times a week for at least two months, and then 1 or 2 times a week for the next three months.
Last week I went to the dentist and needed a crown. That cost me $597. My previous crown cost me $500.
No wonder I can’t get out of debt.
June 4th, 2007 at 11:48 am
I was in a car accident several years back and sustained permenant injury to my back. After years of treatment with a chiropracter and feeling great, State Farm cut off my medical for the injury. There reason was I was getting to dependent on it. Years later I still see a chiropracter for treatment and pay out of my own pocket. My current insurance won’t cover previous injuries, what a crock of s—. I would not be surprise if the real CEO of State Farm is Darth Vader.
June 4th, 2007 at 2:43 pm
Got some work done on my eye and an adenoidectomy. Insurance covered both.
I know you only put up bad stories, so this will never be on the site. But you know, just to say.. sometimes insurance really does work.
June 4th, 2007 at 8:42 pm
I was deathly ill - high fever - could barely function due to what I believed to be a brown recluse bite. I live in a very rural area and had to drive 25 miles to the nearest ER. My insurance (Blue Cross Blue Shield FEP) refused to cover any of the charges because it was not an accident. An accident is defined as not intentionally caused…. I did not intentionally become ill…… enough said and the 1,000.00 charge was all on me.
June 4th, 2007 at 11:02 pm
I’m from the UK (although live in California now). Was on the receiving end of America’s “health care” system last year when I discovered a small lump in my back. Went to get it checked out and it was a tumor (benign thank god) but was advised to have a small outpatient’s procedure to remove it anyway.
I have *full* health & dental insurance (a PPO provided through my employer). As it was an outpatient’s procedure I was at the hospital less than two hours in total. I had a local anaesthetic, to whip the little lump out was around 20 minutes, I spent an hour “coming to” and then my wife drove me home.
The hospital sent my insurance company a bill for over $27,000 (TWENTY SEVEN THOUSAND dollars). The itemized bill showed $837 for the shot, $950 for the procedure and $25,500 dollars for “supplies”.
It’s an 80/20 split so I had to pay over three and a half thousand dollars - which I have only just finished paying off after a year of repayments. A plane ticket to England is $700 so would have been cheaper to have flown home and got it done there for free - which is what I will be doing next time unless I’m too sick to travel in which case I’ll be spending my time worrying myself even sicker about what this is all going to cost me.
June 5th, 2007 at 3:48 am
I’m active duty military and while on leave back from Iraq last fall, I took my wife to a hospital in the middle of the nite literally for urgent care/emergency center and the military screwed me over and is making me pay over 500 dollars because I didn’t call ahead and let them know about it… how about that sh%t!
June 5th, 2007 at 11:48 am
I am a single mother and in live in the state of Missouri. Becuase of Matt Blunt I lost insurance for my son. I know have to pay 1/4 of my income pre tax to keep my son insured. With all the copays it was cheaper for me to take him and pay cash at a minute clinic than to go to the urgent care. When I asked my employer if I can cancel my insurance I was told not until it is time to renew. What is that? I don’t know much about all the big insurance words they use. I just know that these politicans suck. Bush and Blunt and all the others dont know and dont care about the American People. Why is this called the land of Freedon? Shouldn’t it be called the land of the haves and have nots?
June 5th, 2007 at 1:54 pm
I used to live in the US some time ago and I`m gonna say something that most won`t like, all this troubles with insurance and health care IS ALL YOUR FAULT, if people would stand against abuse like this things would be very different. I have had 2 job offers to return to the US and never in my life I would return, you people live the worst quality of life possible.
June 5th, 2007 at 2:09 pm
I have UniCare through my husband’s job. Every year the price goes up as well as the co-pays. My benefits have not gotten any better so why do I have to pay a higher amount?
When I gave birth to my son’s I had to go to a hospital that was not the greatest in the area. Quit frankly it was ghetto, including a good percent of the staff. If I wanted the insurance to pay I had to go to that hospital to give birth and I had no choice. When we took the tour I almost started crying. I know a girl who is on public aide and got to have all 3 of her children at the nice hospital in one of the richest communities in the country.
June 5th, 2007 at 3:09 pm
I’d leave my story about my insurance company…but even though I’m in my twenties, I’m healthy, and I don’t smoke, I can’t get approved for insurance. My health insurance plan: don’t get sick.
June 5th, 2007 at 3:31 pm
I have actually not had health insurance since 1997 and have given birth to 4 healthly children outside of the medical system - no drugs, no stitches, no “surprise” C-sections. Guess what? I haven’t needed the insurance. I do plan to look into getting some, but maybe I’d be better off investing the money I would pay and using it if some emergency ever did happen! Also, in a worse-case-scenario bankruptcy is probably easier to get than some insurance payouts! I am NOT saying I would ever want to exercise the bankruptcy option. I am just choosing different financial risks for now.
June 5th, 2007 at 4:58 pm
36.
The healthcare insurance premium for my husband, myself, and our 2 year old son runs $568 a month. That comes out to $6,816 a year. We only have a yearly income of $36,088. I can only make an educated guess that even if we did go universal healthcare, any taxes that may be charged would be significantly less than almost $7,000 a year. That’s not including the deductibles, co-pays, and the 20% of the bill that we pay on top of the insurance premiums. I know that we’re one of those families that really cannot afford this amount of premium for healthcare insurance, but with our having a small child, my husband being an asthmatic, and my being treated for clinical depression, the costs of the premiums versus paying for our treatment and prescriptions directly is really a crapshoot, not to mention (God forbid) if something catastrophic should happen to one of us. I’m not blaming any industry in particular for the high premiums or the high medical charges. The litigious, insurance, and medical industries all have a hand in the complete and utterly broken United States healthcare system. I think that the Kucinich / Conyers bill on Universal / Single-Payer healthcare plan deserves a good look by the American people. This is a very convoluted situation and I can only hope that something can and will be done soon as soon as possible to fix this crisis.
June 5th, 2007 at 7:31 pm
Wow I watched the Oprah show and saw what your movie was actually about. (I will have to watch it now) Any way when you showed the american soldier mention that her health care was not great I totally understood. I think that the military gets screwed as for health care. The military doctors aren’t trained for as long as civilian doctors. I have my own stories but the worst is that my mom died of cancer because they(army doctors back in the 80’s and 90’s) never checked her for anything even after years of being sick. She had flu like systoms and thats what they told her she had. By the time a civilian doctor found it is was too late, it had spread.
June 5th, 2007 at 7:47 pm
It’s so sad that insurance cost so much & so does healthcare. If you don’t get a job that provides insurance you better not get sick or pregnant. When I found out I was pregnant I had a good job but they didn’t provide health insurance, they were a small business. Well I applied for medicaid and was told I made too much money. I called several doctors to see what I could do. They said they could work out a payment plan, $600 a month until I had the baby. Then I would have the hospital bill, and all the lab bills. And that’s about what all the doctors told me. So here I was pregnant with no healthcare and couldn’t go see a doctor cause they all wanted money. I got mad an emailed the governor of my state to see what he could do. Well then someone called me and got me on medicaid, imagine that. I paid a portion of my doctors visits and the labs but the rest was taken care of by medicaid. It’s a shame you have to go through all that just to look out for yourself and your unborn child. All I wanted was to make sure my baby was healthy when he came into this world. We really need to do something in this country. How many more are out there in my situation or worse.
June 5th, 2007 at 7:49 pm
If you look up ED (Erectile Dysfunction) on the AMA website, they will tell you it is important for the patient to be screened for heart disease, tumors, high blood pressure as for the cause of this symptom. But upon presenting to the doctor for this problem, my insurance company will not pay for anything that has to do with ED. Even a simple blood test, or heart function testing etc. Of which they would pay for if you came in for shortness of breath (another symptom). They say that they do not pay for the diagnosis and treatment of ED. But presenting with the problem is NOT a diagnosis nor a treatment.
Still paying for my own testing to discover the cause of the problem!
June 5th, 2007 at 7:54 pm
I have on many occasions gone to the doctor and been told that this test, or that test, is too expensive etc. On other occasions, I have been told that the doctors do not know your insurance company and that every person gets the same care. Why then, upon entering the clinic or hospital, the first questions are “do you have health insurance?” Why do the doctors choose your treatments based on what they think you can afford? By looks? By some code on the chart that lets them know your insurance status?
Just wondering.
June 6th, 2007 at 12:04 am
My husband has worked for the same employer for approx. 17 years but even his employer can’t get us good coverage. When he started working for this company our deductible was only $200. Since then they were talked into a high deductible healthcare plan with a $4,000 deductible plus we have a health savings plan. We aren’t poor people by any means but who can afford to spend an extra $300 a month just on prescriptions. That doesn’t include the actual doctor’s visits. I ended up just stopping mine and my son’s meds. We have satisified our deductible once by the middle of December. We have never been sick people and when I think of the money we have paid in health insurance over the years and what they have actually paid on our bills, it makes me sick.
My parent’s are self employed almost 61 and 60. They barely make ends meet and haven’t had insurance for years. Mom had a heart attack. Mind you she is all of 100 pounds but has high cholesterol. My mom’s bills were well over $100,000 dollars when all was said and done. Nobody wanted to help and they risked loosing all they have which isn’t going to even take care of them when they retire anyway. Who on earth is going to insure either of my parents with their ages. They will be paying so much for nothing.
Our government must do something!!!!
June 6th, 2007 at 12:54 am
Insurance companies are horrible.
If you have a pre-existing condition you are pretty much out of luck unless you are wealthy. My mother had breast cancer 17 years ago and has been fine since and STILL cannot get health coverage for less than $9,000 a year. She doesn’t make too much more than this for a yearly income. The system is scandalous and ridiculous. Profit, not health, is all the system cares about.
June 6th, 2007 at 1:05 am
I am director of orthopaedic trauma surgery at a level one trauma center in LA. I had a patient transfered to our institution for higher level of care for severe fractures of the leg. We did multiple surgeries, stabilized him and finally were able to discharge him. His insurance company denied our claims for payment because I am “out of network”.Since we didnt have an agreement in place before we took care of him, we ended up doing all the work for free. But thats not the worst part.
I asked for him to be seen by a plastic surgeon and physical therapist in network, both of which were denied for lack of documentation. Now the guy is starting to get the bills delivered to him for the uncovered portion. He’s not allowed to return to see me for medical any further…… I dont think there is one part of this whole story that the insurer has actually agreed to pay for…
June 6th, 2007 at 2:20 am
I banged my head hard snowboarding.
A few days later, I began to have very bad headaches. These continued to increase over the next few days and were not lessened with over the counter aspirin.
I went to my HMO doctor, at a respected teaching hospital. He simply gave me high dose Ibuprofen. That actually can lead to bleeding increasing. The pain went away for about 1 day with the Ibuprofen, then came back the following day like gang busters.
I went to the ER, and had a head CT immediately, which should have been requested by the doc at the prior visit. They find that I a a large subdural hematoma, a slow bleed in the brain, that the blood has pooled so much that the brain has been pushed to the side, and is beginning to push down on the brain stem. If it had pushed more, I wouldn’t be here to write this note, I would have been dead. Emergency neurosurgery was performed. The problem, I nearly died, because the HMO doc did not want to have the cost of the head CT at the start, that would have told him exactly what was happening. This was supposedly a good HMO. Help!
June 6th, 2007 at 8:42 am
A couple of years ago i broke my scapula in a soccer accident. Getting it fixed was not a problem, I had a steel bar implanted to support the bone as it grew back together. At the time i was covered by my college health care. When i graduated and looked for an individual plan, there were only two companies to choose from, Aetna and Anthem and they immediately labeled me a level 3 risk.
I recovered fully from my surgery and the only issue was the bar still in my body( not causing any discomfort or issues). To lower my risk level i would have had to have another surgery to remove the bar. Only then would they even consider lowering my status to a somewhat normal level. With the bar, i am paying triple what a normal healthy individual would be. But the risk of another surgery would seem to only raise my costs and put me in an unecessarily risky situation, just to make it financially affordable. Is this a conundrum???
June 6th, 2007 at 12:14 pm
Bank of New York/United Healthcare
Almost 2 years later we can not resolve a 74,000 bill.
The Bank of NY states it has talked to United Healthcare the administrator for the banks self insured plan. United Healthcare states they have heard nothing from my husband’s former employer.
It is a shell game. My husband is on permanent disability the Bank of New York self insures with Metropolitan Life and is supposed to get an increase every year. They have told us we are mistaken that is only if he goes back to work. We had a long term care plan sold to us by Johnson & Johnson the woman and children company the plan will not pay out and J&J says too bad.
June 6th, 2007 at 3:50 pm
We need to stop the large corporation self insurance discrimination …… many families are being discriminated against and companies fire the well spouses causing a catch twenty two. Families with illness and disability should be poor. The American Government must stop this discrimination.
June 6th, 2007 at 6:13 pm
Healthy New York State Sponsored HMO.
I have good and bad to report here. First off, I have nothing but good things to say about New York State’s Healthy New York plan. An HMO sponsored by the state which is a very affordable option for many. Their employees are attentative and they have always worked hard to make sure that I am covered. My issue has more been with the low payment the my Dr receive from the HMO’s, forcing them to see more patients than they possibly can. My visits are always rushed and details are constantly missed. My Dr’s staff never call back with information on critical test results and you end up being just another number in the system.
June 6th, 2007 at 6:24 pm
When my 9 year old was born, my maternity stay was pre-certified. Unfortunately, there were complications, and my baby required a 4 day stay in NICU and another 5 days in the hospital. After we were discharged from the hospital, we were informed that the insurance was not going to pay for the NICU expenses or any of my baby’s hospital stay because the stay was not pre-authorized.
Somehow, the possibility of two patients at the end of a maternity hospitalization did not occur to the insurance company.
We went round and around with the insurance company about this literally until my son started kindergarten!
June 6th, 2007 at 6:33 pm
Also, I work as a social worker at a state psychiatric hospital. We are the option of last resort for mentally ill people with no health insurance. We have a huge problem with patients/clients/consumers stabilizing at the hospital, getting discharged, and coming back within a matter of weeks because they cannot afford their medications. It infuriates me that a month’s supply of atypical antipsychotics costs as much as a car payment or a month’s rent. Atypicals like Risperdal have fewer side effects than the older drugs like Haldol, they work better, and people are more likely to take them. People don’t take antipsychotics for fun, and they can make the difference between being able to work and function as an adult in society, and being completely disabled and unable to care for the most basic activities of daily living.
It doesn’t make any sense that we make things so hard for people who have already been dealt a hard hand by life.
June 6th, 2007 at 11:09 pm
When I was a kid, I was told that I had a bicuspid heart valve. During my latest physical, I requested an EKG to check on the bicuspid heart valve. Since I requested the EKG, I’ve been denied health insurance from Humana. Once you are denied from one vendor, no other insurance carriers will cover you. The only way that I have been able to get health insurance is to lie on the forms. My heart is fine, I’m 45 and race mountain bikes. I am self-employed, so I have to obtain my own health insurance. The system is broke when a healthy person can be so easily denied access to basic health insurance.
June 7th, 2007 at 2:01 pm
When my wife and I had our first child there were some complications with the delivery. Everything is fine now, but it was pretty traumatic at the time and it kept both my wife and newborn her in the hospital for much longer than expected. At the end of the whole experience the medical costs came to over $15,000. Thank goodness we had insurance through my employer that basically took care of all of these unexpected costs. I ended up paying about $1,250 in out of pocket and deductible expenses and that was it. We would have been in big trouble without our Blue Cross insurance plan.
June 7th, 2007 at 2:40 pm
Don’t forget to take a look at self insured corporations that fire family members because
someone in their family is ill. That’s right the whole family should be treated like lepers.
After all the United States Government does nothing to stop it.
June 7th, 2007 at 3:25 pm
I think I’m about to sum it up for many thousands in the USA. I have insurance, it covers about 70% of my medical costs, I’m responsible for the other 30%—can’t afford to buy secondary policy so……a big hospital stay would bankrupt me.
June 7th, 2007 at 7:11 pm
I’m one of 20,000 pharmacists that manage medication for 36 million folks in California. Unfortunately there are 300,000 insurance clerks processing claims, copays and tracking annual deductibles. Fortunately The California Universal Health Care Act of 2007, the Senator Sheila Kuehl bills SB’s 840 and 1014 eliminate the need of these private insurance clerks - one of the most rapidly costly segment of health costs. One simplified paper processing system is much more convenient and less costly. Society chose machines over bank tellers in the seventies, chose touch tone telephones over rotary systems and operators to make long distance calls in the sixties. It’s time now to simplify and choose direct deposit over private insurance company paper pushing clerks.
June 8th, 2007 at 6:27 am
I had to have surgery to break up and remove kidney stones 4 times all without any insurance coverage. The surgery was necessary in every case because they were too large to pass and could not be zapped because they were fiberous. I applied for Minnesota Medical assistance and was denied every time. Working full time making minimum wage was enough for the state to deny me coverage. The large debt I was left with between hospital and clinical bills meant that at 24 y/o I had to file bankruptcy.
I don’t understand how someone making minimum wage no matter if they work full or part time can be denied state medical coverage. It clearly is not enough money to pay medical bills, yet is too much to have the state help you pay them.
June 8th, 2007 at 12:26 pm
Bankruptcy has been an all to frequent option lately, due to lack of insurance payment. Policies are so fouled up that many of my patiets come to me thinking they have great coverage having bought the policy specifically for chiropractic care only to find out later that the coverage was denied after services were provided for reasons of medical necessity. I might be able to wrap my mind around this better if the patient didn’t benefit at all from the care recieved. However, the patients get better and feel great after each adjustment. Hell, many of my patients have come off a great many of their medications with long term care. This is the problem with the health care industry in the USA, it is driven by drugs, drugs and more drugs. They’ve got medication for everything from headaches, hemoroids and hard-ons. If your kid is hyper active prescribe a chemical equivalent to heroine to calm them down.
Enough!!!
June 9th, 2007 at 5:47 am
In 1967 I made 1.65 per hour and could afford medical care. Things have changed.
The stories I hear in rural America are about how many folks lose everything they have when they are uninsured or inadequately insured when hospitalized. The state, the hospital or a law enforcing agency steps in and sells patients homes, possessions so that health costs can be recouped.
A neighbor told me about several incidents of this nature, one involving a relative. When everything was auctioned off, they bought some of the furniture so the patient would have something left once released from the hospital.
A friend’s boy friend was hospitalized resulting in an obvious negative outcome. To recup costs the hospital attempted to sell the patient’s home only to find out that the house wasn’t in his name.
As a self-pay patient, I have inquired about the costs of office visits but the cost of the visit is unknown necessitating a return phone call with that information.
….and so on.
Can’t wait to see your movie.
June 10th, 2007 at 6:45 am
Back in the ’90s, I worked for an attorney recruiting firm in Manhattan. One of our clients was Aetna. Aetna’s corporate offices were located in Connecticut. When they wanted to hire an attorney, they contacted us. Out of all the companies that we worked with, Aetna PAID THE HIGHEST FEE TO US ($50,000.00 per attorney hired). Almost double what other companies paid - and they were the ones to come up with that figure. My boss was over the moon. In addition, all attorneys that they wanted to interview were FLOWN VIA PRIVATE AETNA HELICOPTER from Manhattan to Connecticut and back. The costs must’ve been staggering - costs paid for by denying claims.
June 10th, 2007 at 9:40 am
Last May, my husband was diagnosed with an unusual form of cancer. Fortunately, his type of cancer, while unusual, can be cured through a very radical (but not experimental) surgery. I found the surgeon that developed the technique, we traveled to see him and my husband was accepted as a patient. Great news but then we hit a wall with the insurance company. This specialist, after many years of working with and trying to recoup expenses from insurance companies had stopped participating in any provider networks.
So, the insurance company absolutely refused to pay anything for the surgery even though it is the only documented procedure that can treat this type of cancer. I spent countless hours on the phone begging and pleading for my husband’s life. I was sent from dept to dept and we finally got a notice that they would cover the dr “in network”.
We had to pay for the 10 hour surgery up front ($25,000.00) and thanks to family, we were able to raise the money and my husband had the surgery. After more fighting with the ins co. they finally sent our reimbursement check for $4,000.00. Not nearly enough to help us cover the travel expenses and remainder of his treatment. And not anywhere near “in network” coverage (80%)
My husband is doing well and finishing up his treatment. Everything is being paid for by credit cards and personal loans. We are just crossing our fingers that we don’t have any more big financial issues after his treatments are over. We’ll be in debt for the rest of our lives but at least I have hope of life with my husband and our daughter has her dad.
June 10th, 2007 at 7:37 pm
I know you are supposed to comment only on American Health Insurance. I’m Mexican but I have health insurance from New York Life, which is an American Company. It’s the worse mistake my father could have ever made. Well, not him, his company.
See, on January I had to have this emergency procedure. On a friday night, I had to go to the hospital because I wasn’t feeling so well. On the hospital (the one closest to my house and the one that is not in the middle of a dodgy neighborhood. Mexican guys will understand, one of the best hospitals, the ABC, is in the middle of one dodgy neighborhood), they told me I had a Giant Ovarian Cyst and that I had to be operated or I risked infection. So, they operated me and things were fine. Or so were they until my mom gave the hospital my dad’s Insurance Card.
First of all, they told us they wouldn’t pay because the hospital I went to was not on the list of the hospitals we were intitled to use. After explaining to the asswipes of the insurance company that its the closest hospital to our house and they didn’t have the time to check “the list” while their daughter was in pain and yelling, they finally understood and gave us a break. This might sound as if it was solved quickly, but on the contrary, it was slow and it took a while. It got to the point where some stupid woman from the insurance company came to my hospital room and started discussing with me issues about the coverage from which I had no idea and insisted on me solving the money issue right away. I was all by myself on the room, my parents were away for the moment. I was bagdered with many questions about our coverage and this woman kept blaming us for picking the wrong hospital. Even more, she told me up to how much was the bill ascending up to that moment. That caused me a lot of emotional distress. She told be that it was around 12,000 dlls. For me, my parents would have to pay it with a pound of flesh.
It turns out this bitch was lying. The bill was lower, but still, the inssurance didn’t want to pay it. It wasn’t until the legal department of my father’s company and the company’s doctor contacted the inssurance company that they agreed to pay us. And of course, they didn’t pay 100% of the bill. The bill was about 8,000 dlls and the insurance just gave us about 5,000. Also, they neglected to include the surgeon’s fees and we had to pay that too. To make matters worse, it took New York Life ONE MONTH to send us the check and ANOTHER MONTH so the check appeared on my mother’s account.
To be honest, we had no problem paying the rest of the money. But what’s the point of having insurance if they are not going to help you out? Even more, when they delay the help after you spent hours begging them for help. Nobody deserves that treatment, not the family and not the pacient.
June 10th, 2007 at 11:00 pm
I WORK AT A PHYSICAL THEARPY CLINIC AND THE INSURANCE INDUSTRY BLEW ME AWAY. I DIDN’T KNOW IT WAS SUCH A CUT THROAT BUSINESS. FROM DOCTORS GETTING PAID OFF BY THE COMPETITION TO A PATIENT GETTING A RX FOR 12 VST AND THE INSURANCE COMPANY ONLY GIVIN THEM LIKE 9 VISTS CAUSE THEY DONT WANNA PAY FOR 12. ITS JUST CRAZY AND IT BLOWS MY MIND EVERYDAY I GO TO WORK IS A NEW EXPIERENCE FOR ME.
June 11th, 2007 at 1:46 pm
Health insurance is bad, but even paid prescription coverage is WORSE. I get $1500 a month Social Security and WITH my ExpressScripts “coverage” my total prescription bills for my wife and I are $1200. It doesn’t leave much for rent, utilities, and groceries, and I’m rated as making too much to qualify for assistance. You should do a film on that too!
Love, Hope, Peace, & Christ Be With You,
Cal-el & Swissy
June 11th, 2007 at 5:01 pm
My HMO is Aetna. I’m lucky, because I work for the state of PA, and the coverage is excellent. But only if you don’t have to use it.
I volunteered with the Red Cross in New Orleans in October 2005. I worked on the Emergency Rsponse Vehicles that carried hot food, snacks, and clean water to those still hanging on in their neighborhoods, and my kitchen, in Kenner, was the first to go into NOLA. In fact, my crew went in on the 2nd day that the city allowed the Red Cross to enter. I got sick immediately, the same day, and grew more and more ill over the next week, until I had to go to the only emergency clinic available, where I was told I had strep throat. I gave them my insurance info, got better, and went on.
A month or so later, I got a notice from Aetna that they would not pay the bill because: a) I hadn’t gone to my primary physician (who was 100 miles away!), b) I hadn’t shown it was an emergency, and c) even if it was an emergency, I hadn’t gone to a hospital ER. I wrote to Aetna telling them I a thousand miles away from my primary, was so ill I couldn’t stand up at the time, and that because it was the NOLA area, there WAS no hospital ER. The clinic was IT. A few weeks later I got a bill from the clinic, telling me Aetna had refused payment. This time I called Aetna, and gave them hell. The woman who took my call was nice enough, explained that I still hadn’t shown a dire need for service, and even if I had, I had failed to abide by the out-of-network requirements. She said she would see what she could do. I never heard from either Aetna or the clinic again. I still don’t know if the bill was paid.
June 11th, 2007 at 6:21 pm
now I know I have no right to complain cause I live in Canada and pay almost nothin for heath care but here in small town newfoundland where there are only a few doctors to see , they treat you like your just a means to an end for a pay check anyway . Take my last vist to the doctor , I told him my troubles and as I was tellin him , He was writing the proscrption , then he proceeded to chew me out , tellin me he was gonna drop me as a painet cause I missed my last appointment , which was during a record snow strom and I was stuck at work for 21 hours , so you know I couldn’t get there , and people have to put up with this cause there are no other doctors to see , conver belt script men , its sad really , so I may not know about the money aspect of the american health care system but alot of us here in small town newfoundland can relate to the dehumanizing aspect of it . It just makes me mad
have a good day if you can
R.N. Thorn , Carbonear , Newfoundland , Canada
June 12th, 2007 at 10:31 am
My family has to pay about $21,000 a year for health insurance and it is not even the best out there. Now to many this would not seem a large price to many people, but my family owns their own business and this is very large sume to be paid by my dad. $21,000 for health insurance this would pay for about two years of college, but sadly it does not. Health insurance in this country is out of control. 50 million Americans have no health insurance and isn’t this suppose to be the best country in the world? So GOD BLESS AMERCIA!
June 12th, 2007 at 11:43 am
I studied abroad in Southern Mexico the summer before my senior year in college. There I contracted Dinque fever (a form of Malaria contracted from a mosquito), which left me with a fever of a 103 degrees for a week and jaundice. Prescription asprin would not come close to healing me. Blue Cross/Blue Sheild would not cover the medical bills because they said I did not seek care from my primary physician in North Carolina. Thank goodness I was in Mexico where the cost was managable.
June 12th, 2007 at 2:22 pm
My Insurance provider CENTRAL RESERVE LIFE has $146,000 in premiums that my employers has paid over the past 7 years of my employments with them. I have never had a claim until I was injured in an accident and after 6 months they have paid 3 bills. Those bills had to be faxed 8 times, mailed twice (they returned them once since I paid for a proof of signature on delivery card) and eventually sent to a supervisor. I spend 45 minutes a day on the phone with their “customer service” reps trying to get them to pay bills that they claim they do not have. My doctor has sent them the bill so many times that now my doctor is refusing to bill them and is turning me over to collections. I am a person that has worked my whole life and has always had insurance. I eventually have turned them over to the State Insurance Commissioner here in Missouri….we will see if those people are interested in doing their job as well. In a million years I would have never thought that this would happen but it is. I could get better coverage in India! canot wait for the movie to come our my insurance company would be a great exapmle they are KING of the run around!! But quick to cash my premium check!!!
June 12th, 2007 at 2:54 pm
hey there 9 years ago i was in a serious accident and i have to were 2 braces that assist me in walking i cant get insurance because of the preexsisting and my braces cost 1000 dollars each i dont go to the doctor because i cant afford it i dont qualify for medicaid because the government says i make to much money wich isnt over 20,000 a year why is it that if canada can give there citizens free health care cant the US do the same…there are naural cures for almost everything..diabetes..being one of them yet the drug compaines and doctors keep saying your sick you need this…it is all a scam …a scam for money for the government the doctors and the drug compaines it is very sad to see so many americans without health insurance or so many of them stuggling with there bills to pay for medicine that is covering up the problem NOT FIXING IT…i say we all move to Canada…A!!!
June 12th, 2007 at 3:24 pm
I’m in the military and have free medical.
June 12th, 2007 at 4:01 pm
we use to live in indiana and we had to move back to florida while we were using the governement heath care.my daughter got sick we had to take her to emergency room , got there instead of letting my daughter see a doctor they insisted in the medical coverage . we had to wait for 3 hours till they verify that and another 4 hours waiting for a doctor who end up seeing my daughter for 2 minutes after 7 hours of wait in the mergency room and giving her a tylenol and the funny part i got a bill of 2000 dollars wich i m never going to pay a 7 hours wait and 2 minutes spent by a doctor and a tylenol that costed me 2000 dollars.
by the way my daughter was 2 years old and it feels like it s rather coolect money to pay the rich doctors than save a 2 years old life.
June 12th, 2007 at 5:29 pm
Several years ago my young son needed surgery. I had previously (2 months before) changed jobs and COBRA’d my insurance so at the time of my son’s surgery I actually had 2 plans, my old one and the new one. My husband, son and I were in the pre-op waiting area and someone from the hospital came in to tell us that they could go ahead with the surgery but it would not be covered as neither insurance company was willing to cover the cost - they each pointed fingers at the other company insisting they pay. My husband got on the phone and fortunately he can be quite persuasive - we were able to get one of the company’s to take responsiblity. However the fight went on long after the surgery was over. The cost I payed to COBRA my family health plan was over a $1,000/month.
June 12th, 2007 at 5:49 pm
I go to college, and had a healthcare plan through the college becasue it was required to attend. It is fairly inexpensive, and is not worth much but i need to have it in order to attend, Catch - 22. I broke my toe on campus at 7pm on a friday night, it was a compound break and the bone was shattered through the skin. The health center on campus was closed (it closes at noon on fridays, and remains closed until Tuesday at 12 noon). I go the local emergency room, have the thing set, and stiches to close the wound from the bone poking out. All seems well, next i have to go to the pharmacy to fill the Antibiotics and Pain medicine my foot was killing me. I call the healthcare company/insurer to ask if the will cover the antibiotics and pain meds or any part thereof.. they say they will not pay for this becasue a broken “toe” can be dealt with at the health center (which is closed for 3 1/2 days out of the week) and that is not deemed an emergency, even though i explained the bone was sticking out, and I couldnt stop the bleeding until the emergency room doctor took care of it? The prescriptions cost nearly 200 dollars mostly for the antibiotics that is need to aviod a bone infection which can become deadly if not treated. I go to the only pharmacy open, its in a “Price Chopper” supermarket that is open all night. I told them my insurance didnt cover the medications, and the pharamacist told me they give a discount to people not insured, and so he gave me that discount, the total with the pain meds was 30 dollars, if i had covereage it would of cost over 200. What sense does that make? I was grateful and they get all my buisness now. TO MAKE IT WORSE, the insurance denies my claim, flat out, They didnt send me the bill, they billed the college itself, which in turn billed me…I was forced to pay it in 14 days or i was threatened with removal from the semester if i didnt pay. No arguments, no appeals, no nothing, 850 dollars later I paid. I got rid of the “college plan” and now pay for a state plan that is inexpensive. I think all insurance does is it INSURES you get billed, run around, bullied and riped off in the end,,,, thats all……..Im sure in Canada, the prescriptions would of been 10 dollars for the same thing, and that would of been the FULL price,
June 12th, 2007 at 6:32 pm
Larry, June 4,07
COB or coordination of benefits is a very important item in that a person or persons having more than one insurance can “coordinate” to pay a service in full. COB guidelines are mandated by federal and state goverment and most plans will want to know which parents birthday is first in the calendar year. ie: if your wife has the birthday of Feb 1 and yours is Mar 1. Your wives plan will be prime for any shared children you have. Your plan as secondary would cover and remaining copays or co-insurance amount left over. Get it!!
June 12th, 2007 at 8:16 pm
I was working full time for Walgreens and had their insurance through BCBS of Illinois. After the Pharmacy decided to cut my hours and give them to cheaper labor, they terminated my insurance because I wasn’t working full-time anymore. With that, I lost my coverage for my bipolar medication and the money to pay for my psychologist and psychiatrist. Soon after that, I was let go and spent almost six months out of work with no medication for my condition.
June 13th, 2007 at 9:19 pm
RE: U.S. citizen’s experience with ER visit in Sydney, Australia.
For work reasons, my family and I spent two months in Sydney, AU (March-April 2007). During that time, our 18 month old son went to the ER for a very high fever (104.9F). The hospital did not accept our insurance carrier.
We were required to pay 100% out of pocket.
The bill was $90.00.
The high quality of the hospital, physicians and staff were no less than the quality here in the Silicon Valley. I do not know the tax or insurance structures in Australia; my familiarity with its healthcare system makes me think Australia is doing something right. Maybe we should investigate this further?
June 13th, 2007 at 10:26 pm
I had a conversation with my doctor yesterday about health insurance. She said that her husband wanted to let go of their four person policy as it was just to high costing for four young, healthy people. This is coming from an MD! I told her that I will pay out of pocket for any alternative therapy (accupuncture, chiro…) to keep healthy rather than test my luck in a hospital! Did you know that Magnesium is used as a pain remedy (DHONES BACK PILLS) and is good for you (in small doses)? I’d rather use something nautral and needed than a liver eating pill that would not be cover in my plan anyhow. Germany, Russia, China are all looking like fine places to retire and receive better healthcare!
June 14th, 2007 at 1:46 am
Everybody seems to have complaints about the system but the doctors, nurses and technicians that are responsible for delivering healthcare here in the U.S. are among the best in the world. The main problem with the U.S. healthcare system is the involvement of the insurance companies. Moore’s film will address this in greater detail but 30% of our healthcare dollar goes to insurance administration, executive salaries and insurance company profits. The U.S. spends twice as much per capita as the average per capita amount spent by other industrialized nations. Eliminating the insurance stranglehold and replacing it with the system used by these other nations (either single-payer or non-profit insurance cooperatives) will reduce the substantial amount of waste in the current system. Approximately 95% of the heathcare dollar goes to actual healthcare delivery in these countries and only 5% goes to administration. The same is true for Medicare here in the U.S. which is our version of nationalized healthcare for those who can survive until age 65. Moore’s film will hopefully inform Americans about the scam that exists now and will galvanize the public to demand significant reform including a Medicare for all system. Only 16 days and counting until Sicko opens. Can’t wait.
June 14th, 2007 at 11:59 am
I am one of the lucky ones — I am still clinging to the health insurance offered through my former employer. My premium is $858.00 per month for my husband and me, including a prescription service. We are doing everything possible to hang onto this policy. Thank goodness we own our trailer, and my husband is handy. He has fixed our refrigerator with parts from a leaf blower (and the leaf blower still works, too!), and he keeps our truck running. We have sold virtually everything in the trailer except a sofa and recliner (purchased at yard sales). My job search is going slowly, but I am optimistic. As I wrote, I know that I am one of the lucky ones. I am still hanging in there … as long as the refrigerator holds out. Bless you, Michael Moore.
June 14th, 2007 at 12:06 pm
Dan’s got nothing on me. When we had our first child, my wife got very ill and the baby had to be delivered on an emergency basis six weeks premature. Our daughter spent her first 24 days in the hospital’s neonatal unit. My wife was in the hospital for eight days. We received incredible care. Our total bill was in excess of $100,000. Thanks to our insurance we paid about $400 out-of-pocket. We are forever grateful for the wonderful care we received and the coverage that paid for it.
June 14th, 2007 at 12:10 pm
The only good health insurance is through my University which is, by the way, run like like a public utility. While in school my health care was included. I could see my doctor whenenver I wanted to. Birth control was part of the package. Needless to say, once I graduated, I was REJECTED from coverage complete from BC of CA because I was sick once several years ago. My job doesn’t offer health insurance. Luckily, I live in the fabulous state of California that beleives in offering reproductive healthcare (”Family Pact”) to uninsured people for little or no cost…just because it is a human right (CRAZY, I know). On the right track but NOT ENOUGH.
June 14th, 2007 at 2:13 pm
My mother is morbidly obese and unable to exercise due to severe ankle and feet problems. She has tried numerous diet programs with little success. All of her doctors agree that she needs the lap-band surgery to help her loose weight, which would eliminate at least half of her medical problems. But insurance will not cover it, saying it’s an “elective” surgery. Numerous letters and pleas to the insurance companies by both my mom and her doctors have gone unheeded and my parents simply cannot afford a $20,000 procedure out of pocket. At this rate, my mother will be dead far earlier than she should be, and it can all be fixed with this one procedure. If she could loose just some of the weight, it would not be so difficult for her to exercise. Why do insurance companies have no problem dishing out money for monthly medications that could be eliminated entirely by a one time procedure they WON’T cover?
June 14th, 2007 at 3:52 pm
The President of the United States suggests that Americans purchase their own health insurance if they do not qualify for government assistance or are not afforded insurance by their employers.
I have a PhD and have been working as a college professor since I graduated school. I have never been offered health insurance by the universities that have employed me. I have tried to purchase health insurance and have been denied twenty-three times because I broke my leg six years ago. I do not qualify for government assistance.
Thanks, America.
June 14th, 2007 at 4:06 pm
I was unfortunate enoughh to have gotten injured at work. Workers’ Compensation Insurance (The Hartford) has treated me like a criminal. They harrassed me by phone, had me followed and filmed (I have the films), and probably ruined my engine when I tried to show up in court with evidence that they had tampered (big time) with the filmed evidence. They sent me to fake doctors for fake reports that said I was fine when I wasn’t.
I fight for everything. They cut off everything, my pills, my physical therapy, my treatments. It’s miserable because I cannot use my other insurance for treatment. It is against the law. Although I have three to four insurances at all times, often I pay out of pocket, which I can ill afford.
Please bring to light how bad workers compensation patients are treated. Please help us.
Marilyn Michalak
June 14th, 2007 at 8:10 pm
This website tells the story of a friend who is in a precarious situation with his family’s health and walking from CA to Colorado to raise money. So sad that in the world’s richest country a man with a brain tumor is worried about his medical bills.
June 14th, 2007 at 8:15 pm
I was wondering if you can find me a answer. I was on the drug Viagra for quite some time and my insurance was paying for them. Until then without warning my insurance stopped paying for it. And till this very day. I don’t have one vaild reason why they stop paying for my pills.And i am very upset about it. Please help me find my answer. By the way, Loved your last movie….Keep doing what your doing and that’s TELLING THE TRUTH AND LET THE WORLD KNOW HOW MESSED UP THE WORLD IS…….LATER!!!
June 14th, 2007 at 10:16 pm
My company has United Healthcare as our healthcare provider. We changed from a different provider on January 1st, 2007. The insurance company didn’t process our paperwork correctly, so none of our employees were enrolled in the system until late January. My doctor of 10 years would not take my appointment without a valid insurance card. I had to go elsewhere and pay out of pocket. When I finally was enrolled at the end of January, I wrote a letter to United Healthcare asking for my January premium back (a total of $92.50). They said that that wasn’t possible. For some reason, my company did not take them to court. I have filed in small claims court and have a court date in Arizona set for August 16th, 2007. I have a trail of email from the healthcare company that is clearly shows that we didn’t have coverage. I am only seeking my premium for January and I am 100% confident that I will win. I am far more interested in winning the case than getting the money back. If anyone from your organization would care to join me on my court date, I would welcome the company.
June 14th, 2007 at 10:21 pm
Why should I have to visit my doctor and pay him to renew prescriptions that I will be taking for the rest of my life. Why can’t I have a prescription written for a five year limit instead of one year. Obviously it’s all about the Co-Pay!!!!!!!!!
June 14th, 2007 at 11:41 pm
I am an asthmatic and the only way I can get health insurance is through a major employer. The american dream is squashed for so many. This is McWorld and the go to college and get a good job with good benefits is a myth. I have worked in health insurance and we are in crisis- people in the industy say way have less than 5 years until total collapse. Small business premiums went up at least 30% in one year. People are denied for needing a band aid. There is no safety net. We need to get serious - look at your family and look at your friends — someone is hurting and is not because they are overweight and don’t exercize. It is because the system is not working. It is a different world, my great grandfather in the depression took care of his community and people paid him with turnips because that’s all they had. We have all this great technology that can save you but then ruin your life because you can’t afford anything else — this is not right. The thing that gets me is how long Congress is going take to overhaul this and in that time there will be no accountability for the insurance company and the medical community. We need to band together and speak up and march.
June 15th, 2007 at 9:02 am
To bring everyone up to speed…
Last February, I fell in my own driveway taking out the garbage. As a result of some black ice, when I slid, my leg twisted in such a way that it broke from my ankle halfway to my knee.
I took an ambulance to the ER, where I sat in excrutiating pain for 5 hours before I was sent to the back of the ER. There I saw a PHYSICIAN’S ASSISTANT. Two weeks later, I got a bill from the ER for seeing a doctor WHO I NEVER SAW–and my insurance wouldn’t cover it because he wasn’t part of their plan.
Ok, so then I start visiting specialists. Everywhere you go now, you have to sign a form that you will be responsible for paying whatever your insurance doesn’t cover. You don’t have any choice in the matter. However, these doctors also sign contracts with the insurance companies to accept their payments.
So, I start back recovering after my surgery and the bills start rolling in, as do statements from my insurance company (Blue Cross Blue Shield) stating that “this doctor is a preferred provider, you are not responsible for the remainder of this bill.” Meanwhile, I’m getting letters from the doctor and the hospital demanding that I pay up.
I send them the notice from the insurance company stating I’m not responsible as they overcharged for services they had previously agreed upon payment for.
Ok, so finally I agree to pay the one bill my insurance company didn’t approve, which was the ER doctor I never saw. $157 to the hospital, which has also sent me a bill for $489. I send them my credit card information on the stub for $157.
Three days later I get a receipt back for $489. Stupid me, I should have expected them to do this.
Unfortunately, they really have me by the throat, because I had to have a second surgery on my leg 8 weeks after the first, and knew that was coming, and here I am trying to sort all this out.
Mind you, I’m out of work on disability and my pay has been cut to 80% and then 60% on disability and finally my disability even ran out and I was stuck without pay!!
So, I tell them I’m not paying the other $157, as that was what I had agreed to pay them, and they are welcome to take it out of the payment they made without my permission at the same time my mortgage is due. I also tell them I let my bank know not to accept any more charges from the hospital without calling me first. Of course, they don’t want to hear this.
Then the orthopedist’s office gets involved and starts sending me bills for money they said the insurance company hasn’t paid, and their story is the same, “You agreed to pay all charges that your insurance company didn’t cover.”
“My insurance company has a contract with you–you are supposed to charge what is agreed upon”
“Take that up with your insurance company–we have your signed statement here.”
Yes, my foot was dangling by a thread, I would have signed anything!
Fortunately, I got through the next surgery and had that completed successfully.
Unfortunately, within 2 weeks, everything was sent to collections!
My husband and I wound up paying nearly $2K out of pocket to clear the whole mess up. This winter, if it snowed or iced up the least little bit, I refused to leave the house. Is that sad, or what?
June 15th, 2007 at 12:19 pm
I’ve been in graduate school for 3 years and haven’t been able to afford dental insurance. As a result I’ve got 2 teeth that have needed root canals for years. I finally graduated and got a job (which doesn’t provide insurance) and got myself some dental insurance that I can’t really afford but feel is necessary. Well, about two weeks later one of my teeth got an abcess and I was in agony. I went to the dentist who referred me to an endodontist.
The endodontist they referred me to no longer took my Blue Shield insurance, so I found another and got the soonest appointment I could. When I got there, in tears from the pain, they told me that if I wasn’t referred directly to them they couldn’t see me because my insurance wouldn’t cover it. After a LOT of tears on my part and thanks to a sympathetic person at the reception desk, they agreed to see me. After verifying my insurance they told me that there was a 3 month waiting period on all major procedures and that I would not be able to have my root canal for THREE MONTHS! They apologized and sent me on my way!
How can any medical professional send away someone who is crying because their pain is so bad? The woman at the desk felt awful for sending me away and encouraged me to call my health insurance provider and see if they’d remove the 3 month hold. I did, they wouldn’t. After being transferred to 3 or 4 different people (all while my tooth hurt so badly I could barely speak), I was finally told “it was in the paperwork you signed, and there’s nothing we can do about it.”
So only 2 more months until I can get my root canal. I have had Blue Shield insurance for 2 years now and until this point I’d had no problems. But to turn someone away and tell them there’s nothing they can do, despite the fact that it’s an emergency and “you signed the paperwork” makes me SICK.
June 15th, 2007 at 7:32 pm
I have the bluecross tonik plan. after being on the plan for several months i was diagnosed with bi-polar disorder. bluecross wanted to look further into the case…after 3 months, THEIR doctor had determined that i had a preexisting condition and that no claims would be paid. I had never seen a doctor before diagnosis…and had no record of having the disorder. They will not speak with my doctors and their “doctor” has never contacted me. they said i’ve had it for years and should have known because sometimes i admitted to getting “sad”. To date i have spent over 12,000 dollars and they are yet to pay for a single claim.
June 15th, 2007 at 8:01 pm
My Insurance cancelled by default- not ! BlueCross, Thank You!
A few years ago I was hospitalized with pulmonary embolism. Little did I realize how many people die of blood clots each year. I survived, as may do not and often have re-occurrences. BC/BS apparently know the facts better then I. Prior to the 2 week stay in the hospital, I never had a claim. I missed one monthly BC/BS payment of $120.00, when I called about catching up the late payment I was informed my premium jumped to $400 plus. I’m sad to say the only insurance I can afford at this time is catastrophic insurance, meaning I will be on the hook for the first 10k of expense should I need coverage.
I’m sick over the excessive profiteering by the insurance companies, drug companies, petroleum companies and the government wasting our tax dollars.
The middle class is falling hard!
Thanks for taking on the SOB’S
June 15th, 2007 at 10:18 pm
I once went to a dermatologist, waited a month for the appointment, waited two hours in the waiting room. The doctor “examined” me for less than 5 seconds. I complained that seemed like it wasn’t enough time to do a proper diagnosis. He said it was. I made a formal complaint with Blue Cross and Cedars Sinai HMO in Los Angeles… I sent a reply back that I was considering sueing in small claims, cause I didn’t feel I was getting what I paid for, a REAL exam, NOT a 5 second “look”… then I got a phone call, left on my answering machine from the HEAD of the HMO, swearing at me, saying, “if you sue us, we’ll sue you back, and take every cent from you… youll have nothing left”. Ouch!
June 16th, 2007 at 10:37 am
FIrst of all I consider myself to be republican and generally don’t endorse Moore’s messages but health insurance in America has me fed up and it’s abou time someone made a documentary about it. My wife’s employers company went out of business while she was 6-7 months pregnant leaving us with no coverage. No insurance company would accept her or (get this) me for that matter while she was pregnant becuase it was too big of a risk for them. They wouldn’t take me anywhere because they said that it was too big of a risk that they would then be forced to take on a potentially unhealthy baby seeing as how the law would force them to once they insured me. As a result, we were forced to go on the state plan. Did our deductibles transfer that we had met for the year? Of course not. Once my daughter was born on March 24th I called to get private coverage again since she was healthy and the state premiums were so expensive. I was told we had to wait until April 1st because they don’t issue effective dates for other than the 1st of the month. what???? Of course all the medical expenses of the labor/birth were incurred between the 24th and 1st. Left with no other choice I accepted a personal plan starting on April 1st and then had to put my daughter on her own expensive state plan to bridge the gap between the 24th and the 1st. But get this: When I called to cancel the state plan seeing as how I had private April 1st coverage for my family I was told tha I was required to keep the state plan on a new born for a minimum of 60 days despite the fact I had secured other coverage for my family. What??? Here’s the best part: The same company that administers the state plan in Wisconsin (WPS) also was the company I bought the private plan with. I questioned how it could even be legal for the same company to take premium from the same person for the same time period. I was told those are the rules and the state plan is ran by a differnt divison of their company. Even better? Deductibles, of course, don’t transfer again. And the state plan is supossed to help people? I stand to meet 3 deductibles in oh about a year for nothng we did wrong. Victim of the system I’ve been told… Great… I consider myself to be educated in insurance and waded through all the b.s. and expense to make sure my family didn’t go without coverage. It’s no wonder the poor and less educated give up and go without!
An Irate republican
June 16th, 2007 at 11:59 am
In 1997 I had an ectopic pregnancy (the fetus “stuck” in the fallopian tube). I was in unbelievable pain and my husband took me to a local urgent care/ER. The ER couldn’t perform the surgery, so they took me by ambulance to where my OB/GYN could operatre. Later, the insurance company told me that they wouldn’t cover the ambulance ride because it wasn’t pre-approved. Luckily I had a WONDERFUL ER Dr. He called the insurance company and chewed them out. He said he ordered the ambulance because the fetus was close to rupturing and if my husband had taken me to the other hospital it could have ruptured and I would have died. The insurance company finally agreed to pay the $500 bill thanks to my wonderful (and morally sound) Dr. I can’t wait to see the movie!!! My neighbor and I have plans to go see it. I’m now a teacher in NC with so-so coverage, but I teach in a low socio-economic area where many of my students and their families don’t have insurance. One of my students had what sounded like bronchitis this past year and his mom couldn’t even take him to the Dr.!!! Sometimes I wish I lived in Canada…