This. THe longer they stall and deny, the more it sits in their account and earns interest. Anthem BCBS admits they screwed up and forgot to reapply something to the deductible but have refused to fix it. My DHs benefits dept is making me go through a health advocate who has been equally useless (hasn’t returned calls or emails). I got a survey monkey asking how satisfied I was. Haven’t filled it out yet 
“I don’t appreciate getting tossed out the door as if I’m a major inconvenience.”
Unless I’m dying and the only place who can save me is the hospital, I want to avoid that place at all costs. Even the best and cleanest hospitals have issues with secondary infections, MRSA, CDiff, etc. An estimate by the CDC was that each year there are approximately 2 million infections acquired from unsanitary conditions in hospitals and that those infections kill approximately 100,000 people per year. http://journals.sagepub.com/doi/10.1177/003335490712200205 Right now many hospitals are packed to the rafters with people sick with the flu, posing another risk to hospital patients and their families.
If you don’t catch an infection from the hospital itself, consider that medical mistakes were estimated to be the third leading cause of death a few years ago. https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/
If you don’t catch an infection or die from a medical mistake, hospitals are still lousy places to try to rest for recovery given the noise and the fact that someone comes in to take vitals and check on you every few hours.
Go ahead and toss me out the door ASAP, please.
The Bogleheads post that HIMom linked to is excellent. It was written by a physician and it contains a lot of useful info about going to the ER. Even if you don’t want to read the entire thread, at least check out the initial post.
https://www.bogleheads.org/forum/viewtopic.php?f=2&t=238610#p3730622
I mostly agree about the toe - I’ve broken several and just buddy-taped them and moved on. However I’ve seen instances where even broken toes need medical treatment.
Not so sure I agree about the finger. When I broke my finger, I broke it on a long diagonal. It didn’t need a cast - a splint was fine, but it did need to be set by a professional. If I had waited till the next day it might not have been able to be set properly. I have broken my pinky and just splinted it, but there are many ways to break a finger that require proper treatment unless you’re OK risking losing some mobility.
I did have a real problem with the insurance denying a CT scan for my husband one time - he went to the ER in extreme pain. They sent him for a scan and determined he had kidney stones. The insurance denied payment because I didn’t get preauthorization for the scan. If the dr. had him make an appt to go to a CT center for a scan I would have thought to call - but in an emergency situation I didn’t think “Oh, hey, wait a minute - let me call and get preauthorization”.
The problem with insurance is that the company paying the bills gets to decide whether or not they want to pay the bills. Executive and employee bonuses are based on paying out as little as possible.
There’s just a fundamental conflict of interest with the model. Single-payer anyone?
For those of us with high deductible plans, Urgent Care can be less expensive than seeing a PCP. It’s $98 for me to walk into Urgent Care and be seen by a doc. It’s a minimum of $300 for my PCP. Kroger and CVS clinics are about $75 to walk in the door. It’s no wonder why I never go to my PCP anymore.
@InigoMontoya how the heck would you have known you needed an authorization for a scan ?
Similar conflicts of interest could exist with government insurance companies as well as private ones, since governments do not have infinite money (although politicians and others something think and act like governments have infinite money – what’s another trillion dollars of budget deficit like?).
Single payer is probably significantly better than what we have now, but does not automatically solve all of the problems that plague the medical care system we have now.
Different countries have different civil service cultures than the US. Whenever US citizens talk about single payer for here, I wonder if they’ve ever dealt with the IRS, the DMV or county run health services. {Shudder}
I’d rather not be dependent for healthcare on the types of government organizations that bring us such successes as the Hawaii Emergency Management Agency’s recent alarm fiasco.
Most people would agree that the VA is not a shining beacon of high quality healthcare delivered for a reasonable cost, but that’s the closest our country offers to single payer healthcare. If our civil service culture was different or our country’s attitude towards funding and staffing civil service was different, then maybe government controlled healthcare might be worth trying. As it currently is, though… no, thank you.
I believe medicare covers about 5-6x more people than the VA. Maybe you were thinking of single-provider vs single-payer, which is a different ball of wax.
For sure there’s plenty of issues with government agencies and programs. However in terms of customer service, I don’t find United Healthcare to be any better than any government organization I’ve ever had to deal with personally.
I would rather deal with the bureaucracy of the insurance company than the government. With the insurer, at least I have a chance. And I can always change insurance companies. When we last selected an insurer for our company we did research on the companies and crossed off the ones nobody seemed to like, such as United Healthcare. Don’t have that option with single payer.
In particular, single payer wouldn’t solve the cost problems. Unfortunately. Medicare is single payer, yet it still is much more expensive than any other first world country’s system.
It’s worthwhile noting that while all other first world countries have universal health care, not all have single payer. Some countries have a system based on private insurers. There are a variety of ways to achieve universal coverage.
(Oh, and before anyone says it: NO. Preventative care does not save money. It makes people healthier, which is why we should do it, but it does not save money.)
I have not had problems with my BCBS so far and I have not had to fight with fhem as often as it sounds like many have. They have never refused to pay for the ER visits of my kids or folks, thankfully.
Insurers CAN be sued for bad faith and insureds can be given substantial awards when denials are made improperly. It is not a desirable route but at least is an option.
Single provider and single payer are different balls of wax in theory but in practice if this country went to single payer it would quickly become single provider simply because the government reimbursement rates are not sufficient for most private or nonprofit/nongovernment organizations to function without the additional money they receive from private insurance and (for the nonprofits) fundraising.
Medicare and medicaid reimbursement rates are so low that for most organizations, their ability to stay open is dependent on having sufficient private pay and private insurer patients. If private pay and private insurers go away, so do most of the nongovernment organizations. All that would remain would be the government run hospitals and clinics. So whether it’s single provider or single payer, the results would be the same.
You’ve had bad experiences with UHC, but at least there is the current possibility that you could switch to another insurer. That would also go away under single payer. And no matter how bad UHC has been, at least you have other avenues to provide pressure or provoke change. All that goes away if healthcare is 100% government controlled, too.
No, thank you.
The way people in the US default to the expensive choice (e.g. colonoscopy as primary colorectal cancer screening instead of FIT as primary with colonoscopy only if FIT finds something) while fearing inexpensive preventive care (e.g. vaccines), perhaps that is no surprise.
“You’ve had bad experiences with UHC, but at least there is the current possibility that you could switch to another insurer. “
So you think it’s that easy for a company to switch health insurance or an individual to switch health insurance when he/she is locked into the company’s current insurer?
I’m skeptical. Hospitals in particular are spending and spending and spending, building and building and building, but to what end? These lavish palaces don’t seem to me to be directed at better patient care. Other countries manage to get better results with less lavish hospitals.
“So you think it’s that easy for a company to switch health insurance or an individual to switch health insurance when he/she is locked into the company’s current insurer?”
No, it’s not easy to switch… But it is possible in most markets given enough time. And the possibility of competition keeps some of the more egregious practices in line. Unlike how government organizations operate.
“Other countries manage to get better results with less lavish hospitals.”
I agree but I’m very much a healthcare minimalist. Our family has been buying individual insurance on the private market for over 10 years now, always with high deductible plans and we’re very conscious of costs and self-triage. The polar opposite of most Americans.
Most Americans would shriek with horror if they received the government provided healthcare in a place like England. Results in terms of mortality outcomes would not be much different, but Americans would be acting like the government was trying to kill them with the ward style multiple patient hospital rooms, babies being delivered by midwives, grubby government buildings and long waits for appointments.
Americans want a magic solution… continue no-expense-spared care with few controls in lavish buildings but at a bargain cost. Not possible.
Yea, I’ve been mostly happy with my BCBS which has covered me most of my life. The few times we argued, sometimes I prevailed, sometimes they did. We are allowed to self-refer to specialists, which has been very useful to me and my kids and H. We generally get answers in a timely manner, which I like.