I am so angry right now I could smash things.

[Stonepounder]

My 13 year old grandson was at a friends house when the family cat tried to climb his leg. In his shock and surprise he stumbled backward landing on his elbow - which broke in three places. The doc who examined him determined that surgery would be needed in order to get the bones back in place, followed by rehab - without which he would never regain full use of his elbow.

My daughter previously had a job she loved, but changed to a different one si that she would have insurance. Now, tell me, what the hell good is an 80/20 policy (which is pretty much standard for employer supplied insurance these days)? Before the hospital would even do the surgery they wanted $900 up front. This from a woman who makes somewhere between $35-$40K a year, is a widow, and has 3 kids, with the youngest in daycare. Then the PT for rehab, which he is supposed to go to 3X/week will be $50/visit.

And this is a woman who took a different job from the one she loved so she would have insurance! What the FU*K is wrong with this country. My daughter did all the right things. She went to school to get the right to work in her chosen profession. She 'put in her time' to learn her job and get to the point where employers want her. She didn't choose to become a widow. Yet here she is trying to come up with $900 for the surgery and another $600/month for PT when she is already struggling to make ends meet. Do you have any idea how much daycare costs in a reputable facility?

And people have the nerve to say that 80/20 is the way to go because people should have 'skin in the game' or they will abuse the system. Yeah, right. If she had better insurance my grandson would have broken both elbows, just for the fun of it because, what the hell, mom would have to pay anything for it. And the Republican Congress and Courts are trying to take away insurance from the working poor.

My country tis of my people are dying.

[msongs]

1. file a claim against the insurance company covering the property in question. won't get the bills

paid up front but should be covered after the fact.

[JimDandy]

4. It happened at a friend's house.

The key word being 'friend', so her daughter may be loathe to make a bad situation worse, unless the 20% owed trumps the friendship.

[pnwmom]

20. A real friend would submit this to her homeowner's insurance company without a word

of complaint. Most policies cover injuries sustained on the property.

[pnwmom]

22. Here's some info about SS survivor benefits, just in case she hasn't gotten them.

Both she and her minor children are eligible.

http://www.caregiverslibrary.org/caregivers-resources/grp-money-matters/hsgrp-social-security/social-security-survivor-benefits-article.aspx

http://www.ssa.gov/pubs/EN-05-10085.pdf

[Stonepounder]

43. You could get me on a whole other rant here.

Yes, she and the kids get SS survivor benefits. But (and it is a really big BUT), SS decided that they had been paying her too much and cut her benefits by about 80% for the next year. She tried for days to get an explanation from the folks at SS and no one could really explain it to her. They were all very sympathetic (and I don't mean that as a snark) but couldn't do anything about it. Each person she talked to tried to calculate her benefit and each one came up with a different number, but in the end there was nothing to do but try and figure out how to survive.

Note that we did the math and figured out that she would actually be better off if she quit working altogether, since then she would be eligible for free health coverage from the state and she wouldn't have commuting expense or day care expense. But she believes in the good old Protestant work ethic and feels that if she can work she should work.

[pnwmom]

59. That explains it -- I knew a widow who managed to live on these benefits

and not work. I wondered how that was possible.

I'm sorry about your daughter's situation. Could it be worth it to pay for a one-time consult with a lawyer to see if a lawyer could get better results? Actually, they often won't charge for an initial consultation to see if the case is worthwhile.

[LiberalEsto]

85. County bar associations usually offer low-cost consultations

Usually around $50 for 30 minutes, give or take.

[Flatulo]

97. Absolutely right. Good advice.

[Rebl]

129. My

thoughts exactly. The friends parents should submit a claim to their homeowners insurance.

[MADem]

29. It was an accident. That's why people HAVE insurance. nt

[questionseverything]

74. but insurance takes years to settle

that would not help with the 900 up front

[MADem]

76. No it doesn't.

File a police report and the insurance company will pay up quick; they'll probably try to low ball the costs but they'll pay.

[questionseverything]

79. when ins companies settle

they want the case closed...to get that 900 up front the victims folks would have to forgo future expenses they do not even know about yet

imagine having a child laying around screaming in pain,,,and being on the phone negotiating with insurance company...not gonna get ya best result

i get that you always want to protect potus & aca but the truth is healthcare in the good ole USA is only for the rich/well off

[MADem]

91. No, it isn't. I was in an ER last month and everyone got treated. Nice strawman, though. nt

[questionseverything]

95. i have a grown child living on medicaid in illinois

she had cancer 11 years ago , had to have a complete hysterectomy which threw her into early menopause which zapped her calcium levels which zapped her teeth

many are broken off at the gum line and need an oral surgeon which medicaid no longer covers since the expansion of medicaid...afterall when ya try and cover thousands more peops with the same money something has got to give

yes when the pain from the constant deadly infections becomes too great, she can go to the er (for a new higher co pay) and get antibiotics and sometimes pain relief but they will not fix the cause

her doctors have told her it is a matter of life and death but since she has no money it does not matter

as i said before healthcare in the USA is only for the rich/well off....nothing changed with the aca in fact in some ways it is worse

[pnwmom]

104. The expansion of Medicaid was done with NEW funds -- they didn't take money from

people already receiving Medicaid and spread it around to more recipients.

I'm very sorry about your daughter but you are wrong about Medicaid funding. The Federal government has given every state that accepted the expansion the funds -- for free -- on top of whatever Medicaid money they already had. In three years, the Federal Government will pay all but 10%, but the states will have to raise that 10%. They won't be able to take it from other Medicaid recipients.

With regard to dental care, each state, unfortunately, decides on its own what benefits to offer to Medicaid recipients.

Here's more information with regard to Illinois. FWIW, it appears they do cover extractions. (I realize they should cover everything. My state covers dental work; they all should.)

http://www.hfs.illinois.gov/html/061312n.html

[Louisiana1976]

109. We need single payer. That would cover dental care.

[pnwmom]

110. It would only include what legislators decided to include.

I don't think Medicare covers dental, for example.

[questionseverything]

120. yes we need single payer

with dental and eyes covered too

unfortunately we missed that chance

[questionseverything]

113. all i know is before the aca

she was not limited to 4 prescriptions a month

her co pays were lower

and 1-2 oral surgeries a year were covered (she was on a list before)

maybe the pols thought to decrease benefits now so when the fed money slows down they could still cover everyone (without as many benefits)

illinois is a dem state too,more the shame

[pnwmom]

115. They can't do that. In three years they have to add new money -- they can't simply

spread it around to fewer recipients. And right now they have to take the new funding and spend it on recipients. So your daughter should not be impacted. Whatever is going on in Illinois, it's not the fault of the ACA.

[questionseverything]

117. not fewer recipients, fewer benefits

listen you do not have to believe me but what i am telling you is true here in illinois


here is the really stupid part, if the infection eats her jaw away (which is very possible) medicaid will spend the 100 grand plus to replace her jaw

instead of spending 3 grand now

[pnwmom]

121. This is what you said:

"which medicaid no longer covers since the expansion of medicaid...afterall when ya try and cover thousands more peops with the same money something has got to give"

They are NOT covering thousands of more people with the same money -- thus, less to go around. The Federal government gave the expansion states NEW money to pay for their new recipients.

It is, as you say, senseless and inhumane for Illinois to refuse to pay for treatment now that could result in even higher costs down the road. But this is the fault of decision-makers in Illinois, not the ACA.

[questionseverything]

124. the aca left us all at the mercy of for profit insurance companies

single payer could of fixed everything


i can agree illinois has it's own set of problems but when someone you love is suffering needlessly it is hard to make a distinction between federal dems and state dems

[pnwmom]

125. Medicare doesn't cover dental. Any single-payer plan might not cover dental.

Dental will only be covered if the legislators either in Washington or the states decide to cover it. But it won't be automatically included with medical.

I think it's terrible that your daughter has to suffer like this. Any chance that she could move to a state with better coverage?

Another possibility I just thought of. Years ago, a friend of mine got some work done that she was happy with at the dental school associated with the state university. The care was done under close supervision of the faculty dentists. Is there any University dental school within reach of your daughter?

[questionseverything]

119. extractions yes

oral surgery no

[pnwmom]

122. Extractions are a form of oral surgery. n/t

[questionseverything]

123. congratulations

seriously you think you know better than her doctors including the oral surgeon here in central illinois?

n/t my bumpkis

[pnwmom]

126. I'm sure her doctors and oral surgeon would agree that extractions are a form

of oral surgery.

[questionseverything]

127. the law changed again at the end of june

once the local docs decide what it means maybe we will be back on a list

i should never have written about anything personal and important here, i do not think potus did this to us on purpose i simply hope my family lives thru it

[pnwmom]

128. I hope everything works out, and works out soon. I agree this is terribly unfair.

And there is nothing worse than seeing your child suffer.

[MADem]

131. We're talking about a broken elbow at a friend's house in the age of Obamacare, not

a tragic dental issue as a consequence of cancer in the era of Bush.

Dental is NOT covered--but she might try ASPEN DENTAL or one of those chain places that takes payments. She might also try dental schools; they often provide free or reduced cost care in exchange for allowing students to work under supervision of qualified surgeons.

At least 20 million people disagree with your POV. That ACA expanded medicaid coverage to nearly 350,000 ADDITIONAL people in Illinois, too FWIW. From the link below:

Three million Illinois residents are currently on Medicaid. More than 349,000 people enrolled in Medicaid were able to do so because of the Affordable Care Act expansion.

If your daughter can 'patch and hold" until October she can get the care she needs, BTW:

Gov. Pat Quinn signed a bill Monday to make a few key changes to Medicaid, including restoring two types of Medicaid coverage that were cut two years ago to save money.

Adult dental care and podiatric care will again be covered by Medicaid, starting on or after Oct. 1.

Both were cut in 2012 to save money. Supporters have argued that paying for these preventative services will actually save money in the long run by keeping patients out of emergency rooms.

“This legislation is a critical step forward as we continue to reform our Medicaid system,” Quinn said.

http://www.suntimes.com/28115029-761/adult-dental-podiatric-care-will-be-covered-by-medicaid.html#.U9NKvPldWSo

I'd recommend she ask around at dental schools and get the worst bits fixed. Or go to one of these clinics for help:

http://chicago-illinois-listing-of-dental-clinics-for-low-income.illinois.aidpage.com/

[questionseverything]

132. when the law changes back it will only cover 1 or 2 surgical extractions per year

we had made a deal with local doctor to take what the state would pay for removing all her teeth if we could come up with the money for the anesthesia.....we did and were on a list when the law changed.....hopefully that doc will make the same deal again

i am glad for the expansion of medicaid but it aint all you folks make it out to be.......the state never paid for that hysterectomy as they called it "cosmetic", the limit of 4 scripts a month to someone with many on going problems means she must leave some things untreated, the co pays are too high for someone with low income and when medicaid patients get chemo, sometimes it is in the waiting room

children on medicaid are treated better here but there have been times my type 1 diabetic grandchild has run out of supplies because the state would not pay...i am not sure what families do that do not have a support system to help out

i think we should all get proper medical care just because we are human beings,that is the bottom line....the good lord did not put us here to be some insurance companies "income" or increase their bottom line

[MADem]

133. Contact the drug companies if there are prescriptions that are unaffordable; be prepared to document

need.

The Vincent de Paul society is also a good resource for people needing to fill in the gaps for truly necessary procedures. Again, be prepared to document need.

A hysterectomy being deemed "cosmetic" is just too weird for me to even contemplate. I've never heard of such a thing. Even if done to treat fibroids (not the preferred methodology anymore) it's not cosmetic.

[questionseverything]

134. i will check out vincent,that is a resource we hadnt heard of

i know you don't want to hear this but it is all a form of rationing (at least that is what it looks like to me)

our state is broke but we still try and meet our citizens needs, sometimes folks fall thru the cracks...the doc ate that entire hysterectomy bill graciously

ss is much the same, we are on our 3rd try for the grands ss disability(type 1 diabetes) and 2rd try for daughter (she has multiply med problems not just the cancer/teeth things)....the safety net is there but the hurdles to reach it seem massive

i know another young person that was just cut off food stamps because she grosses 700 bucks a month...seems insane to me when the benefit is 1.50 a meal and it produces such enormous growth in gdp (1.79 for every dollar spent)

[MADem]

135. Of course it's rationing--the same thing happens in nations with "socialized medicine."

The needs of most are met in those instances, but the needs of the few who have rare or unusual conditions are not. The differences in those instances are that FAR fewer people fall through those cracks.

None of us will be alive when all needs of all people are met. There will always be rationing of resources so long as some people are greedy and want most of the toys.

In the USA, though, the states can make the lives of their citizens better. Many choose not to, but that isn't the fault of the federal government.

If you want to do a kindness to the doctor who provided the hysterectomy gratis, go on some of those medical reviewer sites and write a glowing report as to the doc's compassion and patient caregiving--that kind of thing never hurts.

As for disability applications, it's common to be refused three, four, even five times. That's another way they "ration"--by simply saying no. Keep at it, though.

A few links that might be useful:

http://www.needhelppayingbills.com/html/patient_assistance_programs_pr.html
http://www.needhelppayingbills.com/html/illinois_assistance_programs.html

[pnwmom]

99. Insurance can take days or weeks to settle, with documentation.

And there would be plenty of documentation in this case.

[questionseverything]

106. so should the child wait around for

days or weeks to get the surgery?


that is what we are talking about...the hospital wanting 900 bucks upfront BEFORE they would do the surgery

[pnwmom]

108. No. Most hospitals don't require payment up front in emergencies like this.

That shouldn't be allowed.

[questionseverything]

116. we agree then

btw it has been about 13 years ago my grandchild was run over by a truck......we asked for nothing but the medical bills to be paid

it took the insurance company almost 2 years to settle

the difference was all the providers cared for him first, talked about money later

[SheilaT]

88. Homeowner's insurance is all about things like this.

Some years ago my very own mother tripped and broke a bone in her foot in my house and submitted a claim against my homeowner's insurance. It was rather confusing to my insurance company, a we have the same surname but lived in different states. It was absolutely the right thing for her to do and it never occurred to me to be bothered by this.

[peace13]

90. It is a matter of business, nothing to do with friendship.

That is why people have insurance! If you don't want to use your insurance never and I mean never let someone on Medicare into your house. If they get hurt Medicare will contact your insurance company, no questions asked. We had it happen to us when our friend fell off of a step at my mother's house when we were all staying at the house while mom was out of town. Accidents happen. I hope your daughter contacts her friend and gets things worked out. This young man will need the rehab for sure!

Now that I think about it. When your daughters insurance calls or writes to find out where the accident was, they will contact the other carrier!

[raccoon]

31. I was thinking that too. nt

[seabeyond]

2. i was thinking this would be covered under the home owners insurance. nt

[Laffy Kat]

3. Yes! Yes! Just what I was thinking.

Have you checked it out, Stonepounder?

[Prophet 451]

5. You guys so need an NHS

My brother suffered a very similar break when he was six. Straight off to hospital, surgery done in the morning and all it cost our family was a new pair of pyjamas for him.

[awoke_in_2003]

10. damn straight...

but we will never get it, because profits are all that are important. Fuck this kid- the CEO needs a bigger bonus check.

[Boudica the Lyoness]

23. I was thinking the same thing.

NHS is a wonderful thing.

[Prophet 451]

28. Really, the US coming to it late could be an advantage

The US would be able to study existing health systems around the world, take the funding mechanism from this one and the catchment system from that one, mix and matchign teh best bits until they come up with something uniquely American.

[Ilsa]

54. I asked the president of the AMA back in 2010 if

Their committee on healthcare reform (the AMA prez had been meeting with The POTUS) had considered such a thing as blended insurance and public options coverages that have worked in other countries. This was at a conference luncheon. His reply was something along the lines of "we don't want what they have in Canada or the UK" as if they were the only nations with healthcare. I was a bit insulted by his patronizing remarks. They really could not care less what the people wanted or needed.

[Prophet 451]

55. Satan's Name, why are these people in healthcare?

The NHS has it's faults (and teh Tories are trying to privitize it right now) but if someone suggested a US-style system of triage-by-wallet, you'd never hear from them again.

[Jackpine Radical]

81. Why? Money.

A very large proportion of physicians are motivated by monetary rather than humanitarian objectives.

[Prophet 451]

93. Completely alien concept to us

Here, doctors live a pretty nice upper-middle-class life. I got to be quite friendly with my old doctor (he retired due to teh Tory onslaught) and he had a couple of holidays a year, new car every few years, eat steak whenever he felt like it. That kind of life. Here, the only reason you go into healthcare is to help people. The government sometimes tries to take advantage of that (nurses are often underpaid, for example) and very few people get actually rich from it but they have a nice life, they're unionised with pensions and the idea that someone would get into healthcare purely for money is just alien to us.

[Jackpine Radical]

101. Here is a garbaged-up attempt at a pasted table showing US physician salaries:

(Despite the formatting problems, I think you can decipher it; just think 3 columns)

Specialty

National 6 yrs Practicing Average

Median Starting Range

Allergy & Immunology

$246,000.00

$190,000.00

Anesthesiology

$360,000.00

$265,000.00

Cardiac & Thoracic Surgery

$522,875.00

$360,000.00

Cardiology

$402,000.00

$272,000.00

Colon & Rectal Surgery

$389,700.00

$290,000.00

Critical Care Medicine

$258,750.00

$198,000.00

Dermatology

$365,450.00

$234,000.00

Diagnostic Radiology – Interventional

$469,800.00

$335,000.00

Diagnostic Radiology – Non-Interventional

$444,850.00

$330,000.00

Endocrinology

$214,550.00

$165,000.00

Family Medicine

$199,850.00

$138,000.00

Family Medicine – with Obstetrics

$207,900.00

$142,000.00

Gastroenterology

$398,800.00

$272,000.00

General Surgery

$350,000.00

$225,000.00

Gynecological Oncology

$402,000.00

$300,000.00

Gynecology

$233,000.00

$210,000.00

Gynecology & Obstetrics

$279,750.00

$200,000.00

Hematology & Medical Oncology

$314,800.00

$222,000.00

Hospitalist

$210,950.00

$165,000.00

Nephrology

$252,000.00

$180,000.00

Infectious Disease

$225,000.00

$158,000.00

Internal Medicine

$208,790.00

$145,000.00

Neonatology

$275,400.00

$196,000.00

Neurological Surgery

$589,500.00

$395,000.00

Neurology

$237,000.00

$190,000.00

Ophthalmology

$248,000.00

$210,000.00

Orthopedic Surgery

$485,500.00

$315,000.00

Orthopedic Surgery – Pediatrics

$395,420.00

$318,000.00

Orthopedic Surgery – Spine

$625,000.00

$465,000.00

Otolaryngology

$350,000.00

$222,000.00

Pediatric Cardiology

$230,900.00

$189,000.00

Pediatric Endocrinology

$187,600.00

$170,000.00

Pediatric Gastroenterology

$230,500.00

$175,000.00

Pediatric Hematology / Oncology

$210,000.00

$175,000.00

Pediatric Infectious Disease

$205,00.00

$173,000.00

Pediatric Intensive Care

$252,500.00

$195,000.00

Pediatric Nephrology

$196,000.00

$172,000.00

Pediatric Neurology

$218,200.00

$182,000.00

Pediatric Pulmonary Disease

$190,000.00

$162,000.00

Pediatric Surgery

$401,000.00

$295,000.00

Pediatrics

$202,500.00

$162,000.00

Physical Medicine & Rehabilitation

$233,300.00

$178,000.00

Plastic Surgery

$382,000.00

$273,000.00

Psychiatry

$211,000.00

$165,000.00

Psychiatry – Child

$218,300.00

$159,000.00

Pulmonary Disease

$298,000.00

$191,500.00

Rheumatology

$220,500.00

$163,500.00

Trauma Surgery

$400,000.00

$298,000.00

Urgent Care

$215,000.00

$142,000.00

Urology

$400,000.00

$250,000.00

Vascular Surgery

$405,000.00

$259,400.00

[IronLionZion]

34. Oh yeah, well you probably had to wait 30 minutes because of the socialism

conservatives tell me there are shorter waits if we block millions of people out from the system so they never get care.

[Prophet 451]

35. Strangely, no

The time my brother broke his arm, my mother took him to the hospital. But when my SO had a major kidney infection a few months ago and collapsed, I actually timed the ambulance. It took eleven minutes. It would probably have been quicker but we live out in the suburbs and they had difficulty finding us. The trip to the hospital took seven minutes.

As I said in the post above, your country could actually benefit from coming to this late. You could establish a commission, study the existing systems and then mix-and-match the best bits from each until you come up with something uniquely American.

[IronLionZion]

38. My country would benefit from more liberals and less conservatives

Plenty of studies have been done. Taiwan even came here and studied our medicare system and chose it for their national health program.

Its the sad political situation in our country that Fucks things up for everyone. National health programs have been proposed by liberals since Teddy Roosevelt 100 years ago. The best chance we had was during the post war years when our European allies set up their systems, but the anti-communist fever took over our country and killed all hope.

[Prophet 451]

40. The Cold War fucked things up for you

I have a theory that the reason the US is so ruthlessly "you're on your own", with no national healthcare system, barely any welfare programs (your social safety net is contemptable) and generally despises any form of weakness, is down to teh fifty year hangover from the Cold War making anything that can remotely be likened to socialism anathema to both the PtB and quite a lot of the public.

What I'm saying =is that most nations created social safety nets to provide for their poor and sick as an alternative to communism. It was the upper class going "if we give a little, they'll be placated". But teh US went so hard against the Soviets that you went too far the other way, eliminating even the useful parts of socialism in the aversion to anything politically on teh left.

I'm not the first person to observe that you don't really have a left-wing party in the US. You have a centre-right party (Dems), a far-right party (Repubs) and an outright fascist party (Teabaggers and I use that word in it's full technical meaning, I did my minor in PoliSci).

[ieoeja]

58. I've said the same thing.

Had we fought WW-II against the Soviets and the Cold War against the NAZIs, we would be the most radically progressive country in the world today.

[Jackpine Radical]

83. But the Cold War was itself driven by profit motives--

and, of course, authoritarian instincts.

We needed an enemy without to justify the destruction of freedom within.

[Prophet 451]

94. I'm not very well read on teh Cold War so I can't dispute that

However, the fact that the Soviets went about annexing all their neighbours should be borne in mind as well.

[Jackpine Radical]

98. Yes, but we didn't need McCarthyism & red-baiting to contain them.

[Lydia Leftcoast]

86. When I visited the UK in 2007, I made a point of asking people about the NHS

The most striking story was from a B&B landlady. She went in to her GP for an annual checkup, and the doctor told her that he suspected cancer (the landlady was a prim and proper type and didn't say where the cancer was). Two days later, she had an appointment with a specialist who confirmed the diagnosis. She had surgery, radiation, and chemo at no charge.

I asked her how much time passed between the first appointment with the specialist and the surgery.

"Two weeks," she said.

I told my brother the doctor about this story, and he said that two weeks was a very respectable time frame.

One of the scare stories that righties like to tell is that in the UK and Canada, you have to wait months for a hip or knee replacement.

I take water aerobics classes with a group who are largely seniors, many of whom had had various joints replaced. All of them have had to wait months for their surgery.

I could probably use a knee replacement, but my waiting period is turning out to be until I qualify for Medicare, because I have a high deductible insurance policy.

[Prophet 451]

96. Sorry to hear that

And yeah, if you actually work out the time you have to wait until your doctor/surgeon can fit you in, it's usually the same or less than we end up waiting here. And emergency care is, obviously, done ASAP. When my mother had breast cancer, she waited ten days between doctor and specialist and then eleven days between confirmation and operation (she's now fine).

[sabrina 1]

66. We envy you all who live in countries that value people over profit.

[Prophet 451]

71. Not sure if that's still true for us

The bastard Tories are busy trying to privatize the NHS by stealth and the Daily Mail has been running an outright hate campaign against anyone who claims welfare (which, being disabled, includes me) and too much of teh public has fallen for it.

[BainsBane]

6. Can she go to a public hospital?

Or has he already had the surgery? Most communities have public or non-profit hospitals that won't refuse service.

[awoke_in_2003]

11. But does that cover orthopedic?

that can be expensive, and I bet most wouldn't cover it. We need a national health care system, not a mandate to buy insurance from a predatory entity.

[BainsBane]

21. I agree about national healthcare

However, her grandson can't wait for new legislation. If she were in my area, I could tell her which hospital to go to.

[emsimon33]

72. Boy do I ever agree!!!!! Obama sold out by not permitting single payer to be discussed

[awoke_in_2003]

80. put that on Congress...

they started negotiations at public option. You never start a negotiations at the point you hope to achieve. Of course, the insurance companies have bought enough politicians on both sides of the aisle to where public option was never going to happen. Legislation is written on K Street, the proceedings of congress are just bread and circus.

[Stonepounder]

48. Sadly, no.

We live in Northern Kentucky, just across the Ohio River from Cincinnati. On this side of the river St Elizabeth Health Care just about has a monopoly on medical care. They own all of the hospitals and the vast majority of doctors work for them. The last 'community' hospital in the area was swallowed up by St. E a few years ago. I don't think that there are any 'community' hospitals in the Cincinnati area either.

[BainsBane]

61. How awful

That your family faces this even after ACA is just terrible.

[genwah]

7. Not to offend, but what state does your daughter live in? This place is a bucket o'crabs, but if you

can send a messagge to my inbox, and I can retrieve it, there may be other options.

I dont't spend much time here, or I'd know how to send you a message. I tried once, but either it didn't get where I wanted it to go or, if recieved, ignored. I'd ignore me too, I guess, it's too much of an insider whine-fest here, but I may know people who can help.

[hfojvt]

9. a message is sent

by clicking on the 3rd icon right of the post count.

You will not necessarily get a reply unless the receiver knows who you are.

[IronLionZion]

37. click the yellow envelope next to their username. nt

[progressoid]

8. It's why so many of us have insurance but don't use it.

When you're living paycheck to paycheck, there is no way to pay for the luxury of health care even with insurance.

[ForgoTheConsequence]

16. Yes.

Nail on the head.

[etherealtruth]

51. exactly

[BrotherIvan]

69. +1

It should have been a Medicaid expansion because that is the only positive part. The new plans are so bad, you can't use them.

[Half-Century Man]

12. I have medicare and still can't support my health care habit.

Me paying into the system for 30+ years is Skin in the Game. We are the 99%, so it seems logical to me we should be covered 99%.

[RebelOne]

64. I also have Medicare and had to have cataract surgery on both eyes

in March. Medicare only covers 80% and since I do not have a supplement policy, I had to pay almost $800 out of pocket. Who on social security can afford supplement insurance when the Medicare premium is $105 a month and on top of that a premium for supplement insurance?

[Petrushka]

13. As a widow with 3 children, she should apply for SS survivor benefits --->

http://www.socialsecurity.gov/survivorplan/onyourown4.htm

[elleng]

18. Absolutely.

[Spitfire of ATJ]

14. I guess a Republican would say she should go find a husband....

Preferably a rich Republican,....to breed more Republicans.

[Boomerproud]

67. This is not a joke. Not that long ago a Republican (can't think of his name) actually said

re: poverty. "If you don't want to be poor, get married and stay married." Yes, that is their attitude, and policy.

[Spitfire of ATJ]

78. If they had it their way women would be a disposible product.

[Louisiana1976]

112. Exactly. It's all part of the War on Women.

[Maedhros]

15. My daughter had chronic ingrown toenails, so she had to have the nails removed.

$3,000 after insurance.

Coverage does not do anyone any good, unless people can actually afford the care.

[PatrickforO]

17. Medicare for ALL Americans NOW!!!!

[Lurks Often]

39. Medicare only pay 80% of the contracted amount

the patient is responsible for the other 20%

[RebelOne]

65. True. See my post above. n/t

[busterbrown]

19. This thread is disheartening...

Don’t people in Red States have these problems. Or would they rather suffer and go broke rather than be lifted by a govt. which actually could help? Fucking Idiots...Sorry.. but its really pisses me off that they are so fucking dumb.. We could use their help in this battle for the Right To Healthcare!!

[Stonepounder]

49. Actually, KY is one of the more progressive Red states.

Mitch McConnel notwithstanding. Ky was one of the states that set up its own exchange for the ACA. We have a Democrat in the State House and with a bit of luck will be ousting the Turtle come November.

As for the anti-insurance crowd they are the same bunch of low-information, low-IQ, FOX addicted, 'hate everybody who is not a white male Christian fascist' that keeps demanding their 'libertarian' rights to keep government out of everything except their Social Security, other people's bedrooms, etc.

[Boudica the Lyoness]

24. I'd skip the PT

I've had my ankle totally replaced, two back surgeries and a broken wrist. Not once was PT recommended and I got along fine without it.

[ProdigalJunkMail]

41. boudica (I get that reference)... sometimes PT is necessary

depending on the injury. sometimes without that PT you end up with restricted range of motion and improper healing... but i do agree that it is not always needed...

sP

[Stonepounder]

50. The medical consensus was that in my grandson's case PT was required

for the reasons stated in Prodigal's comment. Without the PT he would end up with a permanent loss of range of motion.

[Boudica the Lyoness]

60. I just thought when money is an issue

professional PT could be the thing dropped. Like I mentioned above, I have been through the wars as far as injuries go, and I was told just to use the repaired parts normally, which I did. Money wasn't an issue in my cases, so that's not the reason there was no PT.

BTW, Total Ankle Replacement (TAR) is a horrible ordeal and mine had more problems than most. I was 'none weight bearing' for three months. Most people end up with some restricted range of motion in their ankle afterwards. I belong to a TAR group and most of the people, if not all, had some form of PT. I just walked as my surgeon recommend and I have full range of motion, unlike most in the group. I also swam and kicked a some republican arse.

I did go to a PT last year for an unrelated problem. I went to one session and then took the exercise sheet home and did it myself and some other stuff I thought up, lol.

I must add I'm a none conformist, out of the box thinking introvert and its served me well, so far.

Good luck to your grandson.

[Tess49]

25. If this happened at my home, I would certainly try to get the child's care paid for by my

insurance company. Hopefully, the property owners will feel the same way.

[marlakay]

100. I agree especially because their cat caused it

I would feel responsible if someone got hurt like that in my house.

I have two cats and if they did that and the peoples insurance didn't cover it I would call my farmers agent.

I figure if you invite people over to your house your responsible for what happens there. I have a pool and I think seriously about that, I have never once left my gate open.

[moriah]

26. I think that would be covered under medical payments under homeowners insurance, if they have it.

They may be renting, and I'm not sure if the landlord's insurance would cover it.

I feel very lucky for my plan on the Exchange, and I wish more people had access to the subsidies and cost-sharing benefits. I'd have to pay 10%, and I'm not in the lowest or second-lowest cost sharing bracket, with a $1200 max out of pocket. That's reasonable. I can budget $100 a month after my premium of $82.94 for health care, given my yearly income of $20,000 taking care of just myself.

I'm sorry that a plan with a workable cost sharing amount is not available to your daughter.

[LiberalEsto]

87. fyi there is renters insurance for people who don't own homes nt

[barbtries]

27. the family where he was injured

should pay and should have insurance for that. please do pursue this.

[TT_Progress]

30. Deductables are just another form of cost increase

[mnhtnbb]

32. Two very good pieces of advice in this thread

which I hope you will pass on to your daughter to pursue:

1) claim against the homeowner's insurance where your grandson was injured;

2) your daughter should file for SS as a survivor with minor children.

http://www.socialsecurity.gov/survivorplan/onyourown4.htm


So sorry this happened to your grandson. Hope he makes a full recovery.

I have been a supporter of single payer--universal health care--for a very long time.

[raptor_rider]

33. They should Bill

The insurance first!!! It's standard procedure!!! Who is her insurance company??? I know this shit. Even if there is a co-pay, they are supposed to Bill the insurance first, and then send you a bill.

[passiveporcupine]

89. This was my thought as well. I've never heard

of a hospital requiring money up front from a patient with insurance. I'd like to know more about this.

[marlakay]

102. I bet they have had a lot of non paying clients

And now expect money up front.

Our country is beyond broken.

[Louisiana1976]

114. That's right. It's fucked.

[WinkyDink]

36. And THIS is why no-one should have to depend on a billionaire's noblesse oblige. P.S. Friend-with-

cat needs to own up to some responsibility, if only through insurance (as others have said).

[LWolf]

42. This is EXACTLY why

I have not joined the ACA bandwagon.

Having insurance doesn't mean we can afford care. It's that simple.

I hope your grandson gets the care he needs.

[progressoid]

52. But it has the word "affordable" in the name!!1

[magical thyme]

56. Me too.

I missed qualifying for subsidized by a few dollars, I'm already living paycheck to paycheck and the insurance company I would have had to use the same one that left me to die some years back.

So this year I'm paying the penalty. If something relatively minor happens, it goes on my credit card. If something major happens, I'm bankrupt or dead either way.

[BrotherIvan]

68. +1

The applause will die down some when someone actually tries to use their junk insurance. My plan is absolute crap, has a deductible so high I won't use it until I'm literally dying, and doesn't cover me out of network at all, not even emergencies out of state. It costs double what my previous plan cost that covered much more. I hate my insurance and despise my insurance company for all the crap they pull. I am so mad the OP is struggling to pay for care when the family is insured.

Single Payer NOW.

[msanthrope]

44. Please, please have your daughter consult a personal injury attorney. Reputable ones will be

available for consult through your local bar.

[ecstatic]

45. It could be awkward, but what about your grandson's friend's home insurance?

Doesn't that cover personal injuries in the home?

[rock]

46. I'm really scared; I'm getting out of here!

Did that calm you down, Stonepounder?

[AngryAmish]

47. I am a personal injury attorney.

I won't take the case but he has a legit lawsuit. Tell them to get a lawyer. The bills will be covered.

[magical thyme]

57. um wouldn't it make sense to first approach the homeowner where it happened

and let their homeowner's insurance take care of it? I know my homeowners covers such things.

[AngryAmish]

62. Of course you contact the homeowner to find out who their insurance is, but never deal with

insurance companies alone. They are going to ask for a sworn statement. The statement will be conducted in such a way to minimize their liability and what they will pay out.

They will then drag the process out in hoping you will go away and the statute of limitations will bar any recovery.

Insurance companies are predators. They cannot be trusted.

Get a lawyer. THis is how we make a living.

In any event the insurance company cannot write a check to a minor. A judge has to approve a minor's settlement anyway.

[Stonepounder]

53. Thanks for all the comments.

I hadn't thought about checking the friend's insurance. I have no idea what and/or if they have any kind of homeowner's or renter's insurance, but it is certainly worth checking out. That is one that I hadn't even thought of. And of course a 'slip and fall' type of accident should be a no-brainer for coverage. I'll talk to my daughter about it when she gets home from work.

And yes, my grandson has had the surgery, has a couple of nice pins sticking out of his elbow (I haven't seen them as they are covered by the cast). He'll be in a cast for about 10-12 weeks and should be starting his PT soon. If the friend's insurance helps defray some of the expenses that would be a Godsend.

Thanks to all who suggested it. And again, yes, my daughter and the kids do get SS survivor benefits but right now they are screwed up.

[questionseverything]

73. ya need to tell us how they got the 900 bucks

up front or if the hospital relented

[NCTraveler]

63. I need to start an insurance company..

That insures you when your health insurance screws you. The state of health care in this country is a disaster. I hate listening to people tell me how good it is.

[mrmpa]

70. I had a similar break...........

though it happened at the age of 45. I fell on the property of a University (in a building), there was a concealed step behind a door I opened. I consulted with an attorney, who viewed the property & decided it was worth pursuing as a legal case. Consultation is always good.

I also had surgery & physical therapy. Due to cost you can always do one day of PT with at home exercises, they must be done religiously. My elbow does not bend all the way due to where the screws had to be placed.

Do not let your grandson leave PT without full use of his elbow.

[moonbeam23]

75. Please consider this!

Don"t blame you for wanting to smash things...this is messed up...

Consider going to your health store and getting some comfrey herbal tea and tincture...important- be sure and get the LEAF and NOT the root!!

The old name for comfrey was "Knitbone" because it helps heal broken bones...
i broke my wrist for the second time a few years ago and they wanted to do operation etc but if refused...so the ortho set it as best he could and i lived on comfrey for weeks...he took off the cast and xrayed the wrist and was shocked to see how good it healed up and wanted to hear more about what i was taking...

Of course, i attributed my miracle to his prowess in setting it....he really is a great doc...everybody says so...
Can't hurt, might help....and your grandson is so young that he should heal faster...

If you can't find stuff locally, what i took was the bone formula from Dancing Willow Herbs...they have a website...

Good luck and love and light to you all

[matt819]

77. Maybe not entirely on topic, but interesting, I think, re Obamacare

I was getting my hair cut today and got talking to the hair cutting person (okay, if you insist, stylist). I've been going to her for a few months and like her.

I don't know how we got talking about Obamacare, but she's not a happy camper. She said she didn't qualify because she didn't earn enough money. I don't know how that works, but I then mentioned that she should then at least have qualified under Medicaid. Nope. She's too young (or old, or something), or makes too much for medicaid, doesn't have children, etc. I didn't follow it all, but it just doesn't seem right.

So she gets any antibiotics she needs for free from Target and Walgreens, and she shops around for any other Rx she needs to get the best non-insured cash price. But what happens if she needs more? She's screwed.

I told her to call the state insurance department (this is NH) and also Sen. Jeanne Shaheen's office in Dover, NH. I had a recent problem with my marketplace policy with Anthem and did that and, lo and behold, problem resolved.

We've set up systems almost calculated to screw the little guy, and, let's face it, most of us are little guys. Every fucking thing is a battle, and in every situation we have to approach with cap in hand, pulling at our metaphorical forelocks and hoping against hope that there will be a ruling in our favor.

This is fucked up.

No, I'm not surprised.

[crazylikafox]

84. This is a State problem with the medicaid expansion, not Obamacare.

I was surprised to see that this was a problem in New Hampshire, but I just checked it out, & evidently the New Hampshire Governor accepted the Medicaid expansion very late, ie. approx. March 27 of this year . Please followup to make sure your friend contacts the State office. She may not have qualified earlier, but could now. If anyone else knows more about this in NH, please chime in.

[awoke_in_2003]

82. Back in the days...

when the 80/20 thing was common, medical expenses were a fraction of what they are now. 80/20 won't work for most people these days.

[Hekate]

92. As a widow, aren't she and her children entitled to Social Security benefits of some sort?

Could that make it easier or more affordable for her to get health care coverage? It's worth exploring.

Best of luck, and be sure to follow through with the PT -- that sounds like a really bad break, in every sense of the word.

[Tansy_Gold]

103. Homeowner's insurance

I do contract work for one the major homeowner's insurance companies. This is absolutely a normal, typical claim.

The mother should file immediately. If the neighbor refuses to give the information, she's no friend at all. Get a lawyer.

At the moment, worry less about politics and/or how long it takes to settle the claim. Just get the kid taken care of.

[Skittles]

105. she needs to file with the homeowner insurance, and a real friend would understand

if my cat had inadvertently assisted in injuring someone like that, I would take responsibility.

If that gal is a real friend she will understand and deal with it accordingly.

[Dark n Stormy Knight]

107. I'm sorry for your situation. I'm glad you shared it thought because my husband just stepped in

a large hole and twisted his ankle on the grounds of our doctor's office this morning. He was waiting for me and walking the grounds while he made some phone calls. Of course, he didn't come in and tell them and ask the doc to look at it. And didn't tell me until we left.

He will miss at least a few days work and he is a self-employed housepainter in the middle of a big job. It never occurred to me that they might have insurance that would cover this, but according to what some have said here, we will at least look into it.

[Doctor_J]

111. This will always be one of the problems with for profit, every man for himself

insurance. Your grandson's arm is a debit to them, and their shareholders will be really pissed if they have to pay it. The company's job is to make money for the shareholders, not provide healthcare.

Best of luck but your situation is not unique.

[Turbineguy]

118. I think this would be a

homeowner's insurance issue, not a health coverage one. It was an accident.

[dflprincess]

130. She needs to talk to her friend about contacting the friend's insurance company

I guarantee you that her health insurance company is going to do its best to find out where this accident happened and if there is another company that can be held liable.

A few days after my Mom died as the result of a fall, I got a form from her insurer (which, strangely enough was a state program called Minnesota Senior Health Options) wanting to know the details and if anyone else (meaning another insurer) might be responsible. At least once I sent the form back I never heard from them again.

The same thing happened when I broke my wrist. A week or so after the surgery I got the form from my insurer. They, however, were quite reasonable and were willing to handle it with a phone call (as my dominant hand was out of commission) and took my word for it that it was my own fault.

The bills will probably get paid faster if she gets the ball rolling now.

Though it's still disgusting she has to hassle with this.