Government Health Insurance

veni vidi vici

Active Member
Here in the State of Illinois our soon to be ex-Governor started a state run insurance program for kids so that all children would have health insurance.Ive had Blue Cross Blue Shield for the past 15 years through my Union.Since work has declined and i haven't made the hours to keep the insurance and Ive expired my eligibility for Cobra.So i signed my kids up for this.First problem i had with this insurance is i have to use a Dr.off their list,that isn't the problem though the problem is that every Dr. i called on their list wouldn't except the insurance.So after many phone calls and more Dr.lists i finally found a primary care Dr.for my children.
Last Saturday my daughter broke her ankle at Cheer leading practice so i took her to the Emergency Room and get x-rays and a temporary boot all is fine and good until i call her primary care Dr..They now are refusing aftercare treatment for my daughter.So back to the phones i go,I cannot get any help on this matter except a list of more Dr.'s. Now I'm getting really P.O'ed and frustrated having to deal with Bureaucracy and Heath Care Management AKA bean counters.So while I'm dealing with Government agencies and Dr's one of them slips and tells me that the on call Orthopedic Dr. who originally treated her at the hospital is now responsible for her after care and he has to accept the insurance we have.
*Sigh* So off i go to his office only to find out he left for vacation the day before.And to be refused because i have an expired date on my insurance card so i reschedule for the following day.To the phones i go again,and am told i now need to go to the Health and Welfare office and pick up a temporary card because i didn't receive my current dated card from them on time.I thought the DMV was slow, 3 hours i waited for them to hit a print key and still no card.I had to leave to get my daughter to her rescheduled Dr.'s appointment.On the way out the door i asked the security guard at the door if he had a marker,he asks "why" i say to draw some Cell Bars over the picture of Governor Blagojevich behind him.And then i leave.
Now i arrive barely on time to my kid Dr.'s appointment only to be told by the receptionist at the desk that my card has an expired date on it and that my daughter cannot be treated.My daughter is now crying in pain and I'm irate.I'm not sure the receptionist has ever been spoken to the way she was at that point but she picks up the phone dials a extension # (i only noticed because it was 1 digit short of 911) and she hands me the phone,Now im at the root of the problem .....A bean counter. I take a breath and try to explain the whole course of events and tell her that i have the Springfield number she can call to verify.Her response is that"It isnt my job".I dont remember much of what i said to her but whatever it wasit worked because she called Springfield and the Dr.saw my kid.
Just when i thought it couldn't get any worse,he looks at her x-ray and schedules surgery for Monday to insert a

[hr]
into her ankle.
God help us if we get Universal Health Care if this is the way the government and medical profession is going to run it.
Vent over!
 

stdreb27

Active Member
Originally Posted by Veni Vidi Vici
http:///forum/post/2872075
Here in the State of Illinois our soon to be ex-Governor started a state run insurance program for kids so that all children would have health insurance.Ive had Blue Cross Blue Shield for the past 15 years through my Union.Since work has declined and i haven't made the hours to keep the insurance and Ive expired my eligibility for Cobra.So i signed my kids up for this.First problem i had with this insurance is i have to use a Dr.off their list,that isn't the problem though the problem is that every Dr. i called on their list wouldn't except the insurance.So after many phone calls and more Dr.lists i finally found a primary care Dr.for my children.
Last Saturday my daughter broke her ankle at Cheer leading practice so i took her to the Emergency Room and get x-rays and a temporary boot all is fine and good until i call her primary care Dr..They now are refusing aftercare treatment for my daughter.So back to the phones i go,I cannot get any help on this matter except a list of more Dr.'s. Now I'm getting really P.O'ed and frustrated having to deal with Bureaucracy and Heath Care Management AKA bean counters.So while I'm dealing with Government agencies and Dr's one of them slips and tells me that the on call Orthopedic Dr. who originally treated her at the hospital is now responsible for her after care and he has to accept the insurance we have.
*Sigh* So off i go to his office only to find out he left for vacation the day before.And to be refused because i have an expired date on my insurance card so i reschedule for the following day.To the phones i go again,and am told i now need to go to the Health and Welfare office and pick up a temporary card because i didn't receive my current dated card from them on time.I thought the DMV was slow, 3 hours i waited for them to hit a print key and still no card.I had to leave to get my daughter to her rescheduled Dr.'s appointment.On the way out the door i asked the security guard at the door if he had a marker,he asks "why" i say to draw some Cell Bars over the picture of Governor Blagojevich behind him.And then i leave.
Now i arrive barely on time to my kid Dr.'s appointment only to be told by the receptionist at the desk that my card has an expired date on it and that my daughter cannot be treated.My daughter is now crying in pain and I'm irate.I'm not sure the receptionist has ever been spoken to the way she was at that point but she picks up the phone dials a extension # (i only noticed because it was 1 digit short of 911) and she hands me the phone,Now im at the root of the problem .....A bean counter. I take a breath and try to explain the whole course of events and tell her that i have the Springfield number she can call to verify.Her response is that"It isnt my job".I dont remember much of what i said to her but whatever it wasit worked because she called Springfield and the Dr.saw my kid.
Just when i thought it couldn't get any worse,he looks at her x-ray and schedules surgery for Monday to insert a

[hr]
into her ankle.
God help us if we get Universal Health Care if this is the way the government and medical profession is going to run it.
Vent over!
fun stuff.
 

chilwil84

Active Member
my girl worked in a drs office in pa where they have programs like that and most mds wont take it and the ones that do work at a loss on most cases other than regular checkups.
the funny thing was that no universal healthcare was the 1st major political issue we agreed on, and there will never be a D after my name.
good luck on the follow up care, i hope u find someone that will take it.
 

mimzy

Active Member
ugh. my heart goes out to both of you.... the whole situation is just a massive travesty.
 

tangman99

Active Member
I feel for you but you have seen firsthand what universal health care will be like in a mixed environment. No doctor worth a damn is going to participate in this program and I would be scared to death to go to a doctor that does. I work for a large health insurance company and can tell you that Blue Cross is one of the best insurance companies. With that said, keep in mind that each blue cross is independent from the others so some states may not be the best.
Call Blue Cross and look into a High Deductable HSA policy. You usually have a $3000 to $5000 deductible but once you meet it, you are usually covered at 80 to 90 percent. It's sound like a lot but when you price it out compared to 90/10 or 80/20 plan, the difference in premium will usually make up 75% of the deductable. You contribute to is like a 401K and it is tax free medical money that you build and can use later in life for health care (but not health care premiums). The good part is you have access and contracted rates to the full network of Blue Cross. Contracted rates are your friend.
If you are not familiar with an HSA high deductible plan, get familiar with it. I don't care what you have now, within 3 years this is most likely going to be the only option you will have.
 

Originally Posted by TangMan99
http:///forum/post/2872746
I feel for you but you have seen firsthand what universal health care will be like in a mixed environment. No doctor worth a damn is going to participate in this program and I would be scared to death to go to a doctor that does.
I work for a large health insurance company and can tell you that Blue Cross is one of the best insurance companies. With that said, keep in mind that each blue cross is independent from the others so some states may not be the best.
Call Blue Cross and look into a High Deductable HSA policy. You usually have a $3000 to $5000 deductible but once you meet it, you are usually covered at 80 to 90 percent. It's sound like a lot but when you price it out compared to 90/10 or 80/20 plan, the difference in premium will usually make up 75% of the deductable. You contribute to is like a 401K and it is tax free medical money that you build and can use later in life for health care (but not health care premiums). The good part is you have access and contracted rates to the full network of Blue Cross. Contracted rates are your friend.
If you are not familiar with an HSA high deductible plan, get familiar with it. I don't care what you have now, within 3 years this is most likely going to be the only option you will have.
I knew that you knew your stuff as soon as I read the 1st line. People all about the universal healthcare are so clueless it annoys me. I work in healthcare and know how it runs 1st hand. Everywhere (other than ER's) expect payment up front these days, and without decent insurance you are usually SOL. I won't even get started on what I really think...
 

geridoc

Well-Known Member
It's interesting to read TangMan's response. You can find it almost verbatim in the newspapers of the early part of the 20th century, when his employer, Blue Cross, was invented. They were sure then that this new "communist" invention (health insurance) would result in the system being overrun, and anyway, what doctor of any quality would participate in such a scheme. Well, before Blue Cross physicians were middle class - they didn't get rich until health insurance made patients less sensitive to cost. If done well, I don't see why universal health care is so terrible. After all, Veni Vidi's child did (with some difficulty) get treated. Had he tried to find a physician who was willing to settle for what he could afford to pay (0$) he would have run into far more difficulty.
 
Originally Posted by GeriDoc
http:///forum/post/2872877
It's interesting to read TangMan's response. You can find it almost verbatim in the newspapers of the early part of the 20th century, when his employer, Blue Cross, was invented. They were sure then that this new "communist" invention (health insurance) would result in the system being overrun, and anyway, what doctor of any quality would participate in such a scheme. Well, before Blue Cross physicians were middle class - they didn't get rich until health insurance made patients less sensitive to cost. If done well, I don't see why universal health care is so terrible. After all, Veni Vidi's child did (with some difficulty) get treated. Had he tried to find a physician who was willing to settle for what he could afford to pay (0$) he would have run into far more difficulty.
I'm still not for it, and don't think I will ever be. I have worked with lots of travel nurses that came from Canada where they have it and have heard MANY horror stories about the downfalls of the system. I work and I feel I earn my medical benefits and shouldn't have to sit around and wait for months and even years to have a needed surgery.
 

tangman99

Active Member
GeriDoc,
As always, I respect everyone's opinion and mine is just that also, an opinion. But , you miss two points. I never said Blue Cross was my employer, I said they were the best health care company, at least in Florida and many other states. I work in IT and have worked for many different companies as a contractor and employer including several health insurance companies of which Blue Cross has been one. I do know the business well because I architect the systems that manage them. I know how they determine premiums and process claims.
The other point is the key words were "mixed environment". This does not pertain if the whole country all of a sudden become mandatory managed care. That's a whole different ball game which I won't get into because it's mostly speculation and no one can say 100% how it would work. I personally don't think it would be a good solution over all. For those that use the ER for their personal doctor because you can't be refused medical treatment, it is a great thing. This isn't the case in all hospitals in all cities, but for most.
I recently visited the ER after I crashed my motorcycle. I sat in the ER room for about an hour which was a miracle in itself. The ER doctor saw me for 5 minutes max. For walking through the front door, I was billed $800.00. For a doctor seeing me for 5 minutes, I was billed $1000.00. Overall my ER bill between X-ray, doctors and the ER cost came to almost $2300. After contracted rates, it ended up costing me about $700.00. Still a stupid amount for what I received. While I was there, there were at least three people that came in with minor problems that were treated. One had what appeared to be a bad cold, one had a stomach ache and I don't know what the third had but they did not have insurance. Now all three of these people probably was billed the same thing I was billed, but they were billed the whole amount as they didn't have contracted rates and insurance. And as you probably already know, the ER won't collect a damn dime from any of them. So three people with no insurance give the ER and doctor around a $7000 write off and for an hour of warming a seat with my rear end and 5 minutes of a doctors time, they got $700.00 which went to pay for the uninsured that were in there.
If you have doctors participating in a Network that will guarantee payment even if at a contracted price vs what Universal health care will provide, it's most likely most doctors will participate in networks as long as they exist. In the end, who knows how it will actually work out.
The current system has it's issues. It's not very affordable which is why the HSA is the future. It puts the first X dollars on you to cover and then picks up after you pay your deductable. If you know you have to pay the first $3K, when you wake up with that sore throat, you are not going to the ER. You are going to your doctor or either an urgent care center even if you have to wait a day. When you are responsible for a big portion of the cost up front, you will take a larger role in managing your own health care.
With that said, an individual HSA policy for a young person (highly uninsured individuals) with a $1500 deductable can be had for around $70 a month with an out of pocket maximum of $3000. You do pay for the first $1500 hundred dollars for a year but if you get hit head on and lie in the hospital in a coma for a month, instead of having a $500,000 bill, you owe $3,000 max.
My .02 only. Your milage may vary. Sorry, I'm sure I've bored many of you to tears.
 
Originally Posted by TangMan99
http:///forum/post/2872972
While I was there, there were at least three people that came in with minor problems that were treated. One had what appeared to be a bad cold, one had a stomach ache and I don't know what the third had but they did not have insurance. Now all three of these people probably was billed the same thing I was billed, but they were billed the whole amount as they didn't have contracted rates and insurance. And as you probably already know, the ER won't collect a damn dime from any of them.
Yet again you hit the nail on the head. Most of our problems in healthcare costs today come from people abusing the system. It's a never ending cycle.
 

veni vidi vici

Active Member
Originally Posted by LKGRenegade22
http:///forum/post/2872979
Yet again you hit the nail on the head. Most of our problems in healthcare costs today come from people abusing the system. It's a never ending cycle.
You bring up an interesting point ,about people abusing the system.And it being a never ending cycle.Its been brought to my attention from a ER Dr. friend that chances are that my daughter may not even need this surgery,and its possible that the only reason it will be preformed is so the Provider will be able to turn a profit.He urged me to get another opinion and with his help ill be doing just that,He has referred me to one of his friends who is a Orthopedic Surgeon to review the X-ray disc i have ,free of charge.I hope for the sake of the Dr. preforming the surgery its not the case or he may end up needing to treat himself.It would be an outrage to me if someone would intentionally put my daughter through more pain and agony just to turn a profit.
IMO The whole system is messed up and unfortunately some people are forced to abuse it.Its a do or die sort of situation.Dr.'s and insurance companies get the goldmine and we get the shaft. I sure would like some of this top notch insurance that i hear politicians get that i pay for.But i would just settle to get back to work and pay my own way.
 
Originally Posted by Veni Vidi Vici
http:///forum/post/2873052
You bring up an interesting point ,about people abusing the system.And it being a never ending cycle.Its been brought to my attention from a ER Dr. friend that chances are that my daughter may not even need this surgery,and its possible that the only reason it will be preformed is so the Provider will be able to turn a profit.He urged me to get another opinion and with his help ill be doing just that,He has referred me to one of his friends who is a Orthopedic Surgeon to review the X-ray disc i have ,free of charge.I hope for the sake of the Dr. preforming the surgery its not the case or he may end up needing to treat himself.It would be an outrage to me if someone would intentionally put my daughter through more pain and agony just to turn a profit.
IMO The whole system is messed up and unfortunately some people are forced to abuse it.Its a do or die sort of situation.Dr.'s and insurance companies get the goldmine and we get the shaft. I sure would like some of this top notch insurance that i hear politicians get that i pay for.But i would just settle to get back to work and pay my own way.
I understand what you mean. My brother got laid off the week before last and he can't seem to find a job anywhere right now.
I do want to add a few things though. When you were intially calling doctors and none would accept the state insurance it is because I am sure since they started that statewide program they (the government) tightened their grasp even more and decreased what they would pay the doctor for his services, so much the doctors refuse to accept the insurance. I honestly can't say I blame them. I mean I wouldn't leave my job to go do the same thing for less money.
The abuse I was referring too here was the abuse of the emergency room. I see it on a nightly basis. People come in with toothaches, a cough, a stumped toe, headaches, weakness, rash, abdominal pain....you name it. Things they could go to a regular doctor for, but since none of them have insurance the regular doctors will not see them. So they come into the ER and constantly run up bills we end up paying. That's wht things cost what they do. I don't know the statistics but I bet something like only 25% of bills get paid...I know we just went through a HUGE reorganization where I work due to bad debt. If we had gotten paid what we were owed we would have turned over a profit but instead were millions in the hole.
 

tangman99

Active Member
"The whole system is messed up" is the understatement of the year. There are so many variables involved, when you touch one it throws the others out of wack. I have no idea what the solution is or I'd be a very popular person.
It would be a shame if your daughter did have to go through that for that reason. I would hope no doctor would do that but being realistic, I'm sure it happens.
Keep in mind that not all insurance companies are making money. Some are not for profit. They do have to keep an certain amount of money in reserve, but are regulated as to how much money they can take in.
Another cog in the machine is the doctors and insurance companies themselves. The insurance companies contract prices for procedures and doctors come up with creative ways to submit claims to get more money. I can't say I blame them as some contracted rates are really silly. I've seen billed amounts of $100 have a contracted rate of less than $5. That is rare and very extreme but it does exist. I have been very involved in developing software that catches these creative claims that get submitted to insurance companies to prevent unauthorized charges. For example, there was an actual claim where a doctor amputated a finger and submitted three claims for three amputations on the same finger. One for every knuckle as if he removed the finger one knuckle at a time. I could make a fortune being a contractor for medical coding as I know how most of the insurance company claims engines work and what they look for when they process claims.
Another abuse is running tests. Some doctors will run all sorts of tests that are often redundant so they can bill more. But we have and are currently developing claim processing software that will alert on these tests also.
It's a vicious cycle that is sort of the chicken and egg situation. You can't really point at who it to blame because each just reacts to the other.
 
I can imagine the things you have seen then. One of my ex g/f's was a insurance coder from home and she said doctors would try to bill insurance for 30+ minutes of critical care time for someone with a ingrown toenail. But you are right, things are messed up in every direction. It's hard to point one thing out without blaming that on something else.
 

veni vidi vici

Active Member
Originally Posted by LKGRenegade22
http:///forum/post/2873099
I can imagine the things you have seen then. One of my ex g/f's was a insurance coder from home and she said doctors would try to bill insurance for 30+ minutes of critical care time for someone with a ingrown toenail. But you are right, things are messed up in every direction. It's hard to point one thing out without blaming that on something else.
Ive been in the ER twice in the last 6 months.Once with my wife and once with my daughter.And neither time where either of them seen by a Dr. ....i forgot what they called themselves but they where basically nurses.I received a bill for my wife and she was charged for a Dr.'s visit even though we never saw him or her and medicine she never took. They did take off the meds. though after i called .
 
Originally Posted by Veni Vidi Vici
http:///forum/post/2873102
I used to think that the movie"JOHN Q" was a good movie.Now i realize its just someones reality put on film.Its insane!
One thing I can say is I don't think your ordeal was actually too far out of the norm these days. The few times I have been to the doctor or ER were not very pleasurable experiences and I seem to always have to call insurance and get stuff straight.
 
Originally Posted by Veni Vidi Vici
http:///forum/post/2873116
Ive been in the ER twice in the last 6 months.Once with my wife and once with my daughter.And neither time where either of them seen by a Dr. ....i forgot what they called themselves but they where basically nurses.I received a bill for my wife and she was charged for a Dr.'s visit even though we never saw him or her and medicine she never took. They did take off the meds. though after i called .
Must have been a nurse practitioner...That seems to be the new thing. I think they are working under a doctor so you get a bill for all of the above. When I went to the ER about 2 years ago for a nasty facial wound they sent in a nurse practitioner to stitch it up. When I declined and asked for a MD with some facial trauma experience I got the look...
 

veni vidi vici

Active Member
Originally Posted by LKGRenegade22
http:///forum/post/2873121
One thing I can say is I don't think your ordeal was actually too far out of the norm these days. The few times I have been to the doctor or ER were not very pleasurable experiences and I seem to always have to call insurance and get stuff straight.

I can tell you this .The administrator and the receptionist didn't have a very pleasurable experience either.Fortunately for my daughter it worked out ok.I failed to heed my own advice I/E
 
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