There's no way any American is going to be able to fully explain this, and you wouldn't want anyone to try. Trust me. This is a huge question. I'll give you my understanding of it as briefly as possible.We have a system of Medicare (fed gov't) that covers certain people, but only at 80% (patient would pay 20% of the costs unless they qualify for further assistance) for most services, even dialysis and transplant, and the rules for getting Medicare are a bit arbitrary. Everyone over 65 is eligible. Dialysis patients and transplant patients get it automatically thanks to some relentless advocacy in the 1970s, and people who are disabled two years can often get it, but that depends on when you become disabled. If you are over a certain age when you become disabled, you need to have work credits (you need to have earned a certain amount of income in your lifetime) in order to be eligible for Medicare. If you are someone who never worked, say a stay-at-home mother, and you become disabled at 40 with cancer, sorry. Try to hang on until you're 65. Insurance is generally group or private. What someone like me, with a history of ESRD and transplant, wants is group. Group insurance almost always comes through work, usually what we call W-2 work (a tax form, W-2 means you are an employee, not a contractor). Laws vary from state to state, the state where we live now has no mandate that employers must offer this insurance to employees. The reason that you want group is that the employer and the insurance company must offer the same deal (with minimal exceptions) to all employees (and their families) and pre-existing conditions clauses are limited. There are no health exams. Private insurance is an excellent way to get.... uh, hosed, is the most polite word I can think of. Some of the best insurance horror stories involve paying into private insurance faithfully for years, suffering a health crisis, and then having the insurance company pore over your application documents looking for anything they can call a pre-existing condition. There is a famous story about a woman with cancer who had her insurance rescinded because she did not declare a case of acne on her application. This is what people refer to when they say "uninsurable". Private insurance companies can and do turn applicants down all the time for not being healthy enough (preexisting conditions like ESRD, or our friend who has asthma, or our other friend with persistent migraines, or....) Almost everything must be pre-approved by the insurance company. Anyone who calls an insurance company, regardless of whether it is group or private, will hear a recorded message saying that basically they are not responsible for whatever their own reps say, and that you must wait for formal approval. This can take forever, with all sorts of delay tactics employed. Did you know that liver transplants are considered experimental? Either did I! Until CIGNA said so, and a 17-year-old in LA died. This is what we are up against. There are other ways to pay for health insurance, and state programs, and of course, COBRA, which is what I am dealing with now (a federal law that if you are fired or quit your job involuntarily, the company must let you continue to buy into their group insurance for a certain period of time, but you will pay much, much more than the premiums that the employees pay). I don't know all of the different rules and possibilities with health insurance, and as far as I can tell, neither does anyone else. I am sure there are exceptions to everything I just wrote. It is an incredible, self-sustaining bureaucracy. As for why Americans fear health reform, that is an equally enormous question, and I'm not exactly sure myself, since everyone I see on a regular basis, including my GP, cannot wait for the day. The people who have the most to lose from reform (insurance companies, for example) also happen to have an awful lot of money to put toward convincing everyone that it would be the end of civilization. Aren't you sorry you asked?
I'm going to post here simply because I'd like response to show up in my "new posts" section. The only comment I will make (since I am totally torn about the issue) is:There are places in American where people from countries with socialized or government health care or flocking for treatment. Ditto with health care professions flocking to come work and to gain great comments for their resumes.I have Medicare and a Cadilac (supplement plan and drug plan -- it does cost out the (censored). But you can correct me if I am wrong but I get the impression that dialysis patients are covered by medicare and provided drug help. Is it good to have bad Kidneys? Again, I am torn with the issue... Obama promised change. We got change (the banks surely did, the auto companies surely did). But change isn't good unless it is change for the better... is it? and is it?
Just one question. What happens in USA if you get chronically (possibly terminally) ill and have no insurance. Does the government step in? BTW, I didn't want to start a political debate, just be informed about a health system in another country.
bassman, your pic is really spooky. And kind of scary. :O)~
bassman, your pic is really spooky. And kind of scary. :O)~I cannot tell you how many people I have told about the cash discount. The tech/helper at the chiropracter clinic I went to was suffering from kidney stones.....she was having them at home because she did not have insurance. I told her to phone ahead and ask for a cash discount! She had no clue. One of the Dr's I go to (for MM), when we check out the Secretary cannot give me a cash discount unless I verbally ask for it. ?WTF?There are State Health agencies in most states that will help but lots of folks don't know about them and if they are told no they give up. You have to fight for it sometimes. And that is sad but that is the way it is.
I didn't have insurance when I was originally diagnosed with kidney disease in 1994. My neph did the biopsy at a huge discount and he got the hospital to discount some, too. I paid small payments, but regularly on my account without fail and when I got the balance to like $600 I called them and said that I'd send in a payment of $300 today if they would consider writing off the balance. SHe had to check with some high ups but they agreed. Apparently it's done all the time. Try it if you haven't, but you have to have a good record of payment I think. I had to give her the check # over the phone and promise that it would go in the mail and be postmarked that day. But, it saved me $300.USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
Nice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
cariad, There is lots of help for folks in the US, you CAN get it. People tend to accept no as an answer instead of actually putting forth effort and getting help for themselves. I agree that if you are sick it is not easy to fight for yourself...but the help is there if you want it. I also have been successful in getting several prescrip drug co's to send us drugs free of charge, so that help is there as well. Not everyone fits into their qualifications but some of us do. One of the requirements is that you do not have medical insurance (and no Medicare either).I believe you misunderstood the 'having medical bills written off', the Dr (or hospital) does not actually do a "write off", it does not go against your credit. You are making a deal, bargaining, getting the person to do the procedure at a lower price. This absolutely does not go against your credit. I have been doing it for 12 years now, I know. I never ever ever walk through a Dr's office or do any other medical thing without asking for a cash discount. Well, now I do because MM has Medicare.
QuoteNice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.Thanks, Bill, I'm enormously flattered. I am not back on dialysis, and have a 2nd transplant scheduled for March, but if you ever need a strongly worded opinion piece on transplant, I do believe I'm your gal. Work credits even at 65? Man, it's even worse than I thought.Kimcanada, monrein, thank you for your insight. Yes, the emotional toll can be immense, having to work up the courage and the self-esteem to advocate for yourself while ill is beyond the abilities of many people. I also imagine that it is no picnic for the providers. I have seen my GP - a lovely man, and my favorite doctor - turn people away for lack of a co-pay or cash to pay upfront. My GP is certainly cheaper than an ER, and will be able to deliver much better service, but he also occupies the bottom income rung for physicians and has to look after his own practice. Quote from: kellyt on January 24, 2010, 06:46:09 PMUSA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.I couldn't disagree with this statement more. I guess it depends on what you place under the "health care" umbrella, but I have heard of plenty of people turned away, especially with severe mental health issues. I have said this before, but in my decades of post-transplant life, I have had all but zero success getting help with prescription drugs. Having medical bills written off on your record affects all aspects of your financial life - ability to get loans, sometimes even ability to get jobs. I went to UW-Madison in 2002 for an appointment with a transplant nephrologist, after two separate calls to my insurance to make sure I was covered there. The reps said yes, absolutely. This was before those messages warning "even if the rep says you're covered, we might just surprise you." Well, United Healthcare took so long to process the claim, that I ended up going a second time 6 months later before getting a letter in the mail from the hospital saying "you were never covered here, and you now owe us $5000 for your two visits". We appealed it to the ends of the earth, finally were forced to settle for $3000, and it went on my husband's credit report as a settlement, since the insurance was group through his work. It is only now falling off his record. Murf, Bassman is right, it is impossible to discuss this without a political argument springing up. There are people here who work just as hard as anyone else, cannot get or afford insurance, pay taxes which include taxes for Medicare, pay toward the salaries of government employees (who almost always have excellent coverage) and then are allowed to fall into bankruptcy or worse when they need medical care. It is very political and very personal.
Quote from: Malibu on January 24, 2010, 06:12:09 PMbassman, your pic is really spooky. And kind of scary. :O)~Just curious BASSMAN. Is your name Bassman like a fish? You know Large mouth bass or brown bass, or is like a baritone, electric bass or acoustic bass? Fish or musical? You look like an aliein. Maybe that is what a fish/man looks like on your planet.
The problem is people wanted reform and this bill was not reform.Instead it was 1000's of pages that was loaded with legal mumbo jumbo that was wide open to interruption down the road instead of being specific. The idea of taxing people health care benefits was probably one of the most harmful things to come up in the whole thing.They should have did a single payer system (something Baucus refused to even be truly heard) and also eliminated earned income credit. Use that money that is given out in earned income credit towards health care instead.
I Hate Dialysis Message Board
I Hate Dialysis Message Board
Author
