<p>I especially think that folks who are insisting that EVERY possible method should be tried on their terminally ill loved one should shoulder a larger portion of the bill so they don’t just mindlessly say, “no expense is to great, especially because I’m not paying the tab.” It becomes very difficult for the hospital staff where they feel they are causing the patient pain and prognosis is very poor and treatment is futile and wasting limited resources (like endless transfusions that keep being rejected by the body), but patient’s family threatens litigation if treatment is discontinued.</p>
<p>For us, I got a separate bill from the anesthesiologist of the insurance reduced rate & paid 20% or whatever our plan required. Unless you’re a particularly high risk patient, often the person administering the anesthesia may be an anesthesia nurse and you MAY not get a separate bill.</p>
<p>Testing bills can be quite high. Our BCBS recently switched to having all MRI and CTs (except emergencies) pre-approved BEFORE they are conducted to help keep costs from going out of control.</p>
<p>For someone with a serious chronic health condition, like fibro, I would be VERY careful about any pre-existing condition exclusions, annual cap on out-of-pocket, annual or lifetime maximum for treatment, whether the patient is limited as to where she can receive treatment, in vs. out-of-network costs & availability, premiums, renewability (whether they can opt not to renew you because you’re too expensive), and I’m sure others have more ideas to add to the list. Ability to see specialists, as needed can also be a good feature to have, if that is possible. It has been good for us to be able to travel to find docs who know more about our health conditions than the local docs who were stumped by us. (Even though we pay our travel, it is good for us & the docs that the care is covered.) </p>
<p>We like having a PPO Blue Cross Blue Shield plan, which gives us maximum flexibility and does not exclude pre-existing conditions. Our major medical for BCBS is generally capped at $2500/person or $7500/family/year, with some exclusions (including Rx co-pays). This is one of the best plans & has NO ceiling on major medical expenses.</p>
<p>Congrats, Prezbucky! You need to compare the various plans she is eligible for & the situation will change if/when there is a marriage. We are covered by H’s insurance–it is a federal plan & he is a federal employee. Many government workers–city, state and federal–have very good health insurance options, but do explore carefully. Pre-existing exclusions are really important to look out for, especially for someone who has chronic health issues. Often these are waived if there has been no gap in coverage. Our S was covered by H’s plan & then the University plan & then a gap plan by H’s insurer & now back under H’s plan. We were careful NOT to have any gaps in coverage for S, because he has asthma & it can be tough to get a pre-existing condition covered if you have ANY gaps in coverage.</p>
<p>I don’t think I’ve ever been given an estimate for a surgical procedure before. Is that common? Frankly, I never thought to ask for one…lol. I just assumed that “it is what it is.”.</p>
<p>I would also suggest for someone with a chronic quality of life disease, like Fibromyalgia, Chronic Fatigue, etc. that it is extremely difficult to be successfully treated by physicians, they are best at medicating immediate issues or surgically dealing with problems, not quality of life.</p>
<p>Joining a Yahoo or other health group forum where you can connect with others, like we do on CC, can help her gain exposure to numerous others who have tried tons of things. This is a great opportunity to compile many ideas to try in hopes of finding something that works for her. My mother has a condition like this, she saw tons of doctors and had tons of tests and other than ruling out serious conditions, they could not help her. I found a forum and read their threads daily for about a year and we made numerous adjustments in her life that allowed her to better understand her condition and catch problems sooner. No ER visits in years thanks to the information we learned on a great forum.</p>
<p>I agree that support groups on-line for chronic conditions can be very helpful (but the quality of info exchanged varies greatly, so shop around & find one that you feel provides helpful info that is shared). We have been on several chronic disease forums for me & my kids now for many, many years and have tried some of the options mentioned on them, with some success. We have also stayed out of ERs & had minimum MD visits as well.</p>
<p>It is still good to have a good insurance plan.</p>
<p>Docs & medical centers vary about whether they provide an estimated cost for surgical & /or other procedures. Mostly recently, the oral surgeon and dentist provided them for us & the estimates were very accurate. I’m sure if you ASK ahead of time, one can be provided. I have never asked & sometimes one is offered but often not. It has never mattered to us, since we can make the co-pays & our insurance is pretty comprehensive.</p>
<p>The hardest part is going to the ER and being told that she is faking it. Makes me want to punch them…</p>
<p>There have been tests on the brain in which they measure brain activity in the “pain regions” of the brain… while they smack a part of the body with one of those knee-reaction instruments, or whatever.</p>
<p>In someone without Fibro, the brain is almost still when a person is whacked on the arm – level 1 pain, level 2 at most.</p>
<p>In a Fibro patient, the brain reaction goes off the charts. Level 7, 8, 9, 10. Those without Fibro are <em>so damn lucky</em> not to have it. </p>
<p>Yet she is a wonderful woman, beautiful in every way. I honestly don’t know how she hasn’t killed herself. I don’t mean to sound negative, but if my life were at a constant level 7-9 in pain, i don’t know how i could go on. She’s on powerful pain meds and still, a good day for her is a 6.</p>
<p>She still smiles like an angel and her eyes are the prettiest on earth. She is active; the vast majority of the time, you wouldn’t know she has a handicap unless she told you.</p>
<p>Again, I have no idea how she copes. I used to cry a little bit if i sprained an ankle or dislocated a shoulder… she has that kind of pain all the time.</p>
<p>Yea, my kids have some degree of mono (or it’s cousin) all the time. They honestly can’t remember the last time they felt good or even OK, but shoulder on. Most folks don’t know that they have a condition, except those who know them well and realize they have very limited stamina. S started a rock-climbing club in college & now has a full-time job that involves a LOT of travel. D is in a high energy field and we hope she will have the stamina to last.</p>
<p>There are different things that work for different people. I hope your fiance is able to find the best combo for her & she’s very fortunate that you are so supportive. Good support means the world for folks with chronic health issues!</p>
<p>It is common for those who don’t understand to say, “But you look so healthy” and prefer to think it’s “all in their head.” Our kids have gotten that from their well-meaning relatives and faculty! Fortunately they have been able to find some folks to help along the way, but it is tough!</p>
<p>Thanks again. She is a true champ. A beautiful woman, inside and out. I didn’t mean to hijack the thread… just wanted to share a little bit of my life and hers. Thank you again.</p>
<p>Here is the follow up. I am equal parts happy ($money to me makes me happy right? Less spent by me is a good thing) and annoyed, in light of my recent experience being unable to determine my out of pocket expense BEFORE I have a procedure.</p>
<p>We got a letter yesterday from the healthcare provider telling us that we would be receiving a credit of $109 for the services provided. Since our responsibility was 10% of the cost, I assume that means the actual charges paid by Blue Cross Blue Shield was $1090 LESS than the original estimate. That is terrific that BCBS negotiates lower rates, but why can’t they tell us in advance? We didn’t have to pay the full 10% of estimate at the time of service. Thinking back, it was kind of weird - the desk clerk asked us how much we wanted to pay and we figured we would owe 10% so might as well pay 10% of the estimated cost. Anyway, case closed and at least it didn’t cost 10% of $11,700.</p>
<p>The problem with upfront payments is that the medical provider is going by estimates, obviously. Your BC plan is not the same as your neighbor’s BC plan. Each employer negotiates what they will and will not cover and the rates at which they will cover. If your doctor submits an estimate to BC for their “Aware Gold” plan or whatever the name is, most of the time the coverage is XYZ, but your employer may have added or deleted some benefits so now they not only cover XYZ but also Q, which your medical provider has no way of knowing until the final bills come back. If you are asked to pay an upfront cost, just say no. You will send payment in after your insurance company has paid.</p>