I was lying on the radiologists table last February while he called the insurance company,

[CTyankee]

since he was needing the office at BC/BS to OK his taking x-rays of my incisional hernia further down into my pelvic area. My insurance OK'd it only to a certain point. The insurance bureaucrat would say Yes or No on whether the doctor could xray further because the hernia, in the drs. opinion, warranted a further look. I was being x-rayed for upcoming hernia repair surgery.

I waited for half an hour, along with the xray tech, who assured me that this was a regular thing that they had to do often and it didn't mean I had a more serious problem. So her time in the xray room and the doc's time were taken up while the insurance company made it's "informed" decision. The decision was Yes and they proceeded.

However, when anyone says to me that a "government bureaucrat" will decide what health care I get, I will merely recount my story. While my outcome was OK, I know plenty of other people whose outcome isn't so great. For instance, back in May I attended a fundraiser for a friend whose insurance covered only her surgery for removal of a cancerous tumor, not for followup chemotherapy (which was indicated and recommended by her doctor). We had to sell tickets to the event and run a raffle so this woman could live...

[Clear Blue Sky]

1. Some insurance companies require "precertification" for you to be allowed to sneeze...

[justgamma]

2. I didn't have insurance at one time,

I had a 4 month old baby. I started hemorraging really bad. I was so weak I could not walk, had to crawl to the bathroom. My hubby and a friend of his helped me get to the doctors office. Before they would see me, I had to talk to the collection office about an outstanding bill.

When I was finally seen be the doctor, the bleeding had almost stopped. His diagnosis? "You must have had a miscarriage" No tests, no nothing.

[nightrain]

10. that's criminal when you're hemorrhaging!

[murielm99]

20. No one should have to see collections before receiving care!

When my oldest was fourteen months old, my husband broke his leg at work. Of course workmen's comp was paying for his injuries. But it was a bad compound fracture and he could not work for six months. We had livestock to take care of, too. I had to take her with me because he was not mobile enough to look after her.

We received a small amount of money while he was recuperating. To this day, I don't know how we lived on it. But I was resourceful.

Some parts of his medical bills were not paid, or were not paid right away. An overdressed young woman in the business office was seeing everyone who had an outstanding bill before they could go on to their appointments. I had worked for a nonprofit home health care agency for a time. I knew about workmen's comp, and I knew my rights. I spoke to her firmly but politely. She never messed with me for long.

One day, a woman went in to see Fashionable Plate just before me. She had her diabetic son and a younger child with her. Fashion Plate did not even bother to close the door. She began berating the woman and told her that the clinic would stop seeing her unless she paid X dollars every month. The woman explained that she was paying something every month, but she had to pay for rent, insulin and food first. It was awful. When she left, the woman and I exchanged meaningful looks.

If I had been in a position to rip Fashion Plate verbally, or complain about her, I would have. But I had no power, either. Powerlessness ain't fun.

[grasswire]

3. excellent point

Is it MDs making those decisions at the ins. companies? Or is it bean counters or paper pushers?

[WCGreen]

4. As I have been saying all along....

Why don't we show commercials of minimum wage workers at call centers standing between you and your doctor...

Or worse, off shore call center operators standing between you and your doctor...

[Occulus]

67. Because they don't let cameras in.

It would kill their business.

Which means, of course, we need to start putting employees into such places that are wearing a wire or a wireless camera or some such. They won't let us pull back the curtain unless we have an employee badge.

We need insiders to fully expose them.

[wolfgangmo]

37. It IS NOT DOCS

There are a few docs employed by insurance companies. They fall into the following categories.

1 - Independent medical examiners. ALthough officially on 1099's, these ghouls get about $1500 to $3000 per patient that they deny treatment to. They are the ones you get to see when you have been on treatment for a while and the insurance company tells you to see. Their job is to say that you are perfectly fine, which they do. The ones that give actual medically supported reports are not given more work.

The last one I attended was presided over by a 75 year old dude with vertigo and who needed a stabilization cane to stand. He was also hard of hearing. He made 7 easily verifiable factual errors in his report. Upon a little research on my part I found that there are reasons why he doesn't see patients of his own (he is under investigation and will likely have his license pulled soon).

2 - Figure heads. These dupes also usually don't see patients but do publish lots of academic papers. Interestingly enough, they get huge research staffs paid for by the insurance companies to do this for them. THey sign off on any policy the insurance company number crunchers come up with.

The person telling your doc what s/he can or can't do is a clerk reading a computer screen which tells the clerk what to say. If they have any questions or the procedure is flagged (which most are) then they call an underwriter whose job it is to say no unless it is clearly spelled out in your policy, or you are poor, or you are very sick and have no immediate family to fight for you.

[druidqueen]

49. insurance co. bureaucrats

A doctor at a hospital here in Maine told me of a dealing he had with BC/BS....the surgery for his patient was approved, but they denied approval for the anesthesiologist. After spending a half an hour with a BC/BS "Customer Care" rep..he asked to speak with his supervisor. Once again the doctor explained that surgery should not be performed without anesthesia...to which the "supervisor replied "what's an anesthesiologist?" Finally, after another 30 minutes or so of the doctor explaining (I presume in words of one syllable or less) , the anesthesiologist was approved by BC/BS.


On a personal note, I was told by "Scott" (a customer care? rep who sounded like he was barely out of his teens) that my eye exam (I've been wearing glasses for over 40 years) was no longer considered a "medical necessity" (I used to only have to pay my copay). And I have what BC/BS considers to be a premium plan paid for by my employer!!! YIKES!!!!!!!!

[hobbit709]

5. Back in 2000 I had a pinched nerve in my elbow

That required surgery to move the nerve bundle from where it was. Goddamn NYLCare. They had to approve everything from seeing the specialist, the tests they wanted to run-with a separate approval for each test in a battery of standard tests, and finally the surgery. It took them 4 months to approve the surgery and it was approved only after I sent them a nasty letter telling them I was going to consult an attorney and send copies of everything to the state insurance commission. Funny thing, less than two days after they got the letter, the surgeon called and asked if I was ready for surgery on Thur.

[1monster]

36. That old threat to sue does work wonders with insurance companies when they are refusing to "act in

good faith."

An insurance company was refusing to pay for my stepdaughter's surgery and hospital stay, saying that because she was my stepdaughter she wasn't covered, even though the policy stated that stepchildren were covered and that they had been accepting premiums to cover her for nearly a year.

After a month or so of go arounds with them, I finally got really angry and told the rep, "Fine. Don't pay. I'll see you in court. And you won't just be paying my stepdaughter's medical bills, you will be paying my lawyer and punitive charges for failure to act in good faith.

A day later, I got a call from the rep telling me that they had reconsidered and would "make an exception" in my case. I told them to call it whatever they wanted as long as they paid.

A few years back a man ran over two girls on the beach. His insurance company refused to pay for any of the medical costs. The family of one girl sued that insurance company and won. The insurance company had to pay out $17,000,000 for the girl's past and future medical costs (which are and will be extensive because she was so badly injured).

However, if that insurance company had acted in good faith and had willing paid on the claims, their liability would have been only $50,000.

[wolfgangmo]

38. That's not funny.

Its standard operating procedure. Stall until you can't stall any more.

[C_eh_N_eh_D_eh]

64. And if you die, they're off the hook. (n/t)

[grantcart]

6. sitting in the office digesting the news that my wife needed emergency surgery

to get rid of Ovarian cysts the Doctor asked the admin assistant to get the insurance company on the line (at the time we had expensive PPO).

He calmly took the phone and then erupted into the Hulk screaming at the clerk that he was a Dr and that he had spent 12 years in university studying all of the science and 20 years in practice and that immediate surgery was required and that if it wasn't approved and Mrs. Grantcart died that he would inform the local authorities that the insurance company was complicit in Manslaughter.


He put down the receiver and calmly told us that it had been approved. I asked him how often he had to go crazy on the insurance company and her replied "about once a week".


After he left my wife and I wondered what kind of twilight zone we had entered (I was just returning from 20 years living overseas).

[SeattleGirl]

8. My mom's doc had to do that one time. Insurance company had

approved something, then UNapproved it for some idiotic reason (real reason being, of course, that it would cut into their profits). Doc went all crazy on the ass of someone high up in the company, and what do you know? It was suddenly reapproved.

What a fucking waste of everyone's time, though.

[grantcart]

14. archeologists will document as a fascinating tribal ritual where the witch doctor

has to engage the spirits telefonically and win approval to give good spirit to faithful tribe member.

[SeattleGirl]

15. I'm thinking you are quite correct.

BTW, glad you have a kick ass witch doc there!

[grantcart]

16. evil insurance gods have taken away our right to see any witch doctor

Now we really pray like hell.

[SeattleGirl]

22. Good point.

Though I wouldn't be surprised if the insurance companies intervened there too, and made us pay a copay to pray. :crazy:

[World Traveller]

34. Funny Comment on Witch Doctor

And absolutely correct. Hopefully, in 1000 years, if people read that article, they will think our systems was either nuts or bewitched!

[wolfgangmo]

39. YOu don't need to wait 1000 years.

How about 2 seconds. THat is about the time it takes for anyone from a civilized country to pick their jaws up off the floor and say, "are you fucking kidding me?"

Our system, of which we have none, is nuts. Let's be clear, France, England, Japan, Germany, Canada, et. al, have a system. We have a hodgepodge of crap.

[enlightenment]

7. I don't have insurance now nor have I had it for quite a while,

since I am a 'contract' employee. This January, however, I was offered a 'temporary full-time' contract for the semester (January to May). Took it, of course, because the pay was more than double what I normally get (for doing the same thing).

One of the 'perks' was health insurance. I laughed when they told me about it, because it didn't kick in (so they said) for 3 months - on a 5-month contract. Special.

So, my contract expired at the end of May. At the end of June I got this weird letter from someplace in Texas - turned out it had something to do with my health insurance. I put it aside because I knew my contract had expired and with it, the insurance. On July 12th, I got another letter, date July 6th, this one from the state public employee insurance whatever - informing me that my insurance was active "AS OF 1 JUNE 2009".

Cute, since my contract had ended at the end of May.

Last week I got another letter. This one was dated July 9th. It informed me that my insurance coverage had ENDED AS OF 30 JUNE 2009. Said right on it that it hadn't started until June 1st. Apparently, the HR people had it wrong on the start date - I needed to be employed 6 months (on my 5 month contract). Who knew?

I'm thinking about sending it to my local paper, just for chuckles. They sign me up, take premiums every month, and I never - at any point that I was aware of, anyway - was covered.

Not that I would have bothered using it for anything less than a horrific emergency, given the deductible, but still! I have to laugh, otherwise I'd be contemplating handing someone their head - and what's the point in that?

[csziggy]

29. Send a copy of that letter to your Congresscritters as a demonstration of why

Tying health insurance to a job is ridiculous. Or to the Obama For America website on HealthCare. They are as interested in stories about bad insurance stories as they are about no insurance stories.

[enlightenment]

30. Unfortunately, my senior Congresscritter is

Harry Reid.

Maybe Shelley Berkeley would be interested, though. Thanks for the thought.

[barbtries]

60. seems to me

you should get the money for the premiums back, and so should the employer.

[Rex]

9. Your life and mine are worth money and nothing else to many rich people.

We count only as dollar amounts. Humans care nothing for life, even their own kind.

[Rabrrrrrr]

11. At least a government bureaucrat will likely actually be trained in some medical shit

and not trained in the art of "maximizing profit".

I'll trust a government one over an insurance company-owned one any day.

[Posteritatis]

18. Not that he'd be micromanaging doctors' procedures in advance anyway (nt)

[Swede Atlanta]

12. Prexactly....

I don't understand why progressives on talk show and television "news" shows don't immediately slam back when conservatives throw up the "I don't want a government bureaucrat to get between me and my doctor" that today there is a for-profit insurance bureaucrat between me and my doctor.

Let's be clear, there will always be some kind of "bureaucrat" in between you and your health care provider and for good reason. The issue shouldn't be a question of the fact there will be someone but rather what is that person's role.

I have no problem at all when we have procedures that are very expensive to have someone that is going to foot the bill validate that the procedure is REASONABLE within generally accepted standards of care. Note this should be limited to procedures that are significant.

It is the same level of care you use when you take your car in to the shop. They always call me with a list of "things". I don't want to authorize an engine rebuild if the problem is isolated to a noise in the muffler. It is possible the noise in the muffler will improve with an engine rebuild but the main cause of the noise in the muffler is a hole in the muffler. Let's fix that.

[nolabels]

43. Yea, but the shocks and suspension bushings are wore out

causing the attached parts to rattle and break up going over the tough and rough roads.

The dilemma is that not everybody practices sound routines when comes to living a healthy lifestyle, nutrition. The people who make a living from physical labor do not have the same occupational hazards as someone who works in a office. I would rather have someone more closely tied to health care rather than just some bean counting clerk making those prudent decisions.

[spanone]

13. ain't that america?

[Amos Moses]

50. It's "uniquely American".

:patriot:

[Warpy]

17. I wish more civilians could hear what hospital workers hear

in terms of the time docs spend on the phone getting every little thing approved when a patient's condition changes.

Cookie cutter, one size fits all medicine doesn't fit most of us all that well and docs are spending a tremendous amount of time trying to convince basically untrained people sitting at computer terminals that yes, their patient does need the radiology/blood workup/central line/whatever.

If the system we had actually worked, this debate would not be happening. This is what I remind every single dolt who mouths the propaganda they hear from AM radio.

People don't get angry and want to completely overhaul a system if that system hasn't broken down.

[lostnfound]

19. Raffles & bake sales -- almost every week in my building for someone's sick kid or sick spouse

or sick whatever..

[wolfgangmo]

40. I was on vacation in Canada recently and it struck me.

That I didn't see a single poster or donation can by a register asking for donations for some kids or adults medical bills. Not one.

Only in America.

[progressivebydesign]

59. That's been my meme for the past year. I post that wherever I can.

Are we supposed to feel proud as Americans when people have to hold bake sales and car washes for life-saving medical treatment?

Doesn't it just blow you away that we're the only industrialized nation that does not care for it's people, actually, I think there are a few third world countries that care for their people. We're shameful.

[Leontius]

21. Two years ago I was in the emergency room when the

ER Doctor tells me there might be a bleed in my brain they weren't sure from the CAT scan and no neurologist was available to check the scan so they were transferring me to the university medical center. After getting a contrast CAT scan and an MRI they still weren't sure what was wrong. I spent the night in an intensive care room until they were able to do a cauterization of my brain the next morning and found that it was a cavernous angioma that was not serious the bill was $45,000 and my insurance refused to pay saying that the original hospital should have observed me for 24 hrs, I guess to see if I died in the meantime. When I called to ask why I was denied even though the ER doc was concerned about a bled on the CAT scan they said we don't know about any CAT scan and we deny all claims. The university appealed twice and was refused payment. One month later I developed bacterial endocarditis had to have a valve replacement and lung surgery for a pleural effusion total bill $150,000 paid no questions asked. I still don't understand what they base their decisions on but at least the second bill was covered in full.

[glitch]

23. Good Gawd. Glad you made it through all that and welcome to DU! nt

[Leontius]

26. Thanks doing great just hate the thought of another surgery in

15 or 20 years or so.

[Riley18]

24. We were between insurance and our 10 year old son fell and fractured his femur.

I took him to the hospital (now I realize I should have called an ambulance at a cost of $600.00 in our town), anyway he had to wait until the next day for surgery. Then the orthopedic surgeon operated on him and called me in the waiting room to tell me he was okay. He was sent out that day with a pair of wooden crutches and told to not walk, etc for about 6 weeks. I had to rent him a wheelchair and buy decent crutches with a credit card as I was in school at the time. I was shocked to find out the operating surgeon refused to see him again to evaluate his leg. I called around and a wonderful orthopedic surgeon in the next town offered to treat him for free. They were so nice to him that we will never forget him or his nurse. It was really ironic that several years later my son had his appendix removed at the same hospital, only now he had insurance, and they gave him a private room in a wing named after the creep who operated on his leg. With insurance they fell all over him, and the admitting nurse told him he needed his own room so that he could get his rest. It makes a huge difference in the treatment received when there is insurance.

[TexasObserver]

25. Recommend

[nilram]

27. Exactly. And we have no vote when its a private company

making the call. We CAN vote, and call our representatives, if its the government making that kind of call -- but if it's like that "evil" Canadian system, they'll let the doctor call the shots.

[wolfgangmo]

41. In Canada

It is illegal for anyone not medically licensed to over rule a medical opinion of an attending physician.

In the US it happens daily.

[madmom]

46. Is this for real? I am working on a LTTE for our local rag and this little detail would

really leave a mark. I am rebutting another letter about "socialist medicine". Anymore info regarding this would be helpful. Thanks.

[strategery blunder]

71. Can you give me a statutory citation?

I don't doubt your claim at all, but I would LOVE to bust that law over freeper "gubmint bureaucrat between you and healthcare!" ass.

[mwooldri]

72. Pretty much same for UK too. Doctors calls the shots.

Also, doctors control the purse strings as well. They're given the budgets - yep that's right, your "primary care physician" (as they're called here, they're called "General Practitioners" in the UK) are your gatekeeper to medical care. And if you need it, you get it - yes there's a wait sometimes but it depends on what for. Urgent MRIs can be done same day - non urgent may take a couple of weeks. The doc makes the call whether it's urgent or whether it can wait, and any pain controlled with medication in the meantime... and yep you don't pay an arm or a leg for that either.

[nilram]

73. Jeeze. If only. nt.

[bertman]

28. Recommended sadly. Thank you for posting this, CTyankee.

[DollyM]

31. try being totally uninsured and see the care that you get . . .

My 10 year old son broke his toe, I mean hanging off the foot broken, it was awful! We took him to the ER and they x rayed him and then wanted to take him to surgery to set his toe. The Dr. saw that we did not have insurance so he decided to manually set my son's toe back in place without anestetic. It took four nurses to hold him down and you could have heard that child's screams all over the hospital. I vowed that never again would any of my family be treated that way, insurance or not. Any of these people who don't want the goverment in their health care should have been there that day and saw how my little boy was treated because he didn't have health insurance. Our present medical care system is inhumane.

[susanr516]

45. That's terrible, Dolly

Your poor little son. :cry:

Health care for some; barbarism for the uninsured.

:grr: :nuke:

[CoffeeCat]

32. I had something similar happen...

A few years ago, I had a ruptured disc--and had a partial laminectomy.

Last year, I was in a car accident and my back hurt. I saw my Dr who
said I needed an MRI to assess what was going on and if I had additional
back damage due to the accident. Dr leaves and I hear her on the phone,
fighting with my insurance company over the MRI!

These insurance company wolves really have nerve. Who are they to question
a doctor? The schlep on the phone is probably some claims person with
a degree in Elizabethan Poetry!

I can only imagine how frustrating this is for doctors!

[Wednesdays]

33. K&R

:kick:

[subterranean]

35. Contrast that with what happens in other countries

When I lived in Japan (which has national health insurance, of course), I used the health care system infrequently, but NEVER at any time did I have to deal with any government bureaucrats. I'm sure it's the same in other countries with universal health care. You go in, you get treated. There's no waiting to find out whether your treatment is covered, and no notices after the fact that--surprise!--the insurance company won't pay for it after all.

It's unfortunate that relatively few Americans have lived outside their own country, and therefore are easily conned by the scare stories about other countries' health care systems.

[Inuca]

42. That's what drives me NUTS

when I hear the "a bureaucrat between the patient and the doctor", I really start swearing at the TV or radio at times, and I am not the kind of person that explodes easily. We all have similar stories, some more extreme, some not. I have been spared the more extreme ones so far, but I went through the typical dentist assistant having to call the insurance before a plan for action that does not involve me going bankrupt within the year can be decided upon, etc. My nicest related story is my ophthalmologist (a sweetheart) instructing that some special pictures of the inside of my eye to be taken and telling her assistant right away something like "we will have to cover this, the insurance is not going to pay" (I was not charged a penny for the pictures, by the way).

I'd rather have nobody between me and my doctors, but if it has to be somebody, I'd much rather have a NON-PROFIT entity than a for profit one. Managing health care for profit is OBSCENE.

[hfojvt]

44. if you were lying on the radiologist's table,

then how do we know you're not lying now? :P

[xxqqqzme]

51. You are not alone.

I read the title that way until I read the post.

Hey, it's health care, you're dealing w/ an insurance co, Who hasn't lied?

[hfojvt]

56. I didn't read it that way

I just HAD to make the double meaning 'joke'. I am like Attila the Pun seeing a defenseless village.

Like the Reader's Digest story of the professor who was taking attendance and when she called Lisa's name, one of her 'friends' said "She skipped class to lay in the sun'.
'Lie' the teacher said.
'Okay," the student said, "she is visiting a sick aunt."

[madmom]

47. Several years ago I went to see my dr about something don't remember what. I also got called

into the billing office which I thought was weird because we HAD good insurance and owed nothing. It seemed that my sister in law (who has the same initials as me) owed lots. She was a single welfare mom. The bimbette behind the desk after a lengthy educational session on relatives having similar names, insisted that since we had good insurance and we both had good jobs ,it was our "DUTY" to help pay for said sister in law's bill.

[Canuckistanian]

48. Think of all the costs savings with single payer

All that time the doctors, nurses and technicians spend is expensive. All the while they're waiting or making phone calls or arguing with some insurance company rep, that's wasted time and money.

I hear that a typical doctor's office is backed up by a whole staff of people just to take care of the many insurance companies' demands.

Here in Canada, a typical doctor has ONE nurse/assistant who does scheduling, taking blood samples, and submitting forms to the government, etc.

That's just one reason why we can deliver health care for much less per capita.

[mnhtnbb]

52. You had to sell tickets and run a raffle so the insurance company execs could meet their goals

for fat bonuses and the stockholders could be paid dividends.

[mnhtnbb]

53. Thank God the radiologist didn't have to call the insurance co when I

had an allergic reaction to a dye for an IVP in 1992.

[flyarm]

54. My sisters Kidney was split in half from a fall..and a thin membrane was surrounding it

with fluid to keep it from falling apart before surgery..in the ER they surrounded her with blow up things to keep her from moving even an inch..for fear the membrane would burst..while they called to get her insurace to approve the surgery..there was no one at her insurance co that could approve it at that time..the hospital kept my sister like that for 10 hours..trying to get the insurance company to pre-cert her surgery..I could not understand the delay..and i was screaming..get her in the operating room..finally I said enough damn it, do the surgery..I then signed away my financial life to get her the surgery she needed..and they finally proceeded with the surgery to remove that kidney.

Now, she had full insurance..but because her insurance required a pre-certification before surgery, the hospital was at the mercy, as was my sister and her life....of the damned insurance company and some damn pencil pusher at the insurance company!

My sister at the time was unaware of all that was going on..but I was in a war with those witholding her emergency surgery.

But they packed my sister with Blow up devices to keep her from being able to move at all..because her life was in danger should the membrane break that was holding her split kidney in place..

No one..I seriously repeat, no one ..should have to have it a requirement that some asshole in an insurance office approve emergency surgery!

[Vinca]

55. Someone made an interesting point on another post.

They wondered how insurance companies can get away with practicing medicine. That's essentially what was happening when you were on the radiologist's table.

[azureblue]

57. My story

I had an accident, and had no insurance, but enough money. The physical damage was a broken jaw, so I was able to get cash from the bank before checking into the hospital. As soon as we got to the Insurance question, the atmosphere got really frosty- they did not want to even speak to me. I asked them, "how much for a cash discount?", and I got a blank look. So I took out a big wad of bills and started laying them on the counter, side by side, and said "tell me when to stop". The look from the intake worker was priceless, and I kept laying out bills while she stammered. She didn't know what to do, at all. I told her, "here's three grand. What discount do I get, and do you want more?" By now, her super looked in, and she suddenly got real nice to me- "Oh, you can prepay and get a discount equal to the same one we give group insurance companies."

Another time, I was at an ENT's office, and they were going to give me the same BS. this time, I brought my little recorder with me, and plopped it on the counter, and told them it is on, then asked for the person's name, and why they are giving me a hard time because I don't have insurance. Talk about major back pedal, and I was allowed to see the doctor. I paid in full at the end of the visit, and asked for a discount, but they refused to give me one.

[MrsBrady]

58. my husband's surgeon told us that he himself called our

insurance company and spoke to some corporate top doctor AT the insurance company because we got rejected for surgery.

We had gotten two letters saying that the toe joint that my husband needed replaced was "experimental".
"mmmm..., no it's not", said the Dr.

Walking without pain is just so overrated. :sarcasm:

[Boudica the Lyoness]

74. The day before my total ankle replacement

the insurance company refused to cover it. They called it 'experimental'.

My doctor was stunned. He had a peer review with BC's doctor and after 6 extra weeks of suffering, (I could not bend let alone walk on the ankle at all and was in pain 24/7 with bone on bone pain), I had my new ankle. I belong to a total ankle replacement group and I was one of the lucky ones, some never get their ankle replaced thanks to insurance companies.

I'm British and was making arrangements to get my ankle replaced in England as a private patient (I haven't lived in England for 35 years). The cost was going to be $14,000 (US) to have it done in Cambridge with a superior ankle (the FDA are years behind the Europeans to approve the latest really good joints) also that included a much longer hospital stay. My ankle cost $60,000 here to replace with an older model joint. Also my out of pocket was $7,000.

America should be ashamed of it's self for how it treats it's people. Every time I see ones of those begging jars in a grocery store, (pleading for money so someone can get healed), I feel like this is a third world country. At least I can go home one day and get treated like a human being and not like a mangy dog in some back alley in a third world county.

[MrsBrady]

75. My husband's walking fine now.

The doctor did a great job.

How about you?

[Boudica the Lyoness]

76. I'm walking fine as well.

My surgeon really did a great job with my ankle. He's my hero. It's been 16 months and it continues to improve :)

[lpbk2713]

61. I showed up for an appt for an MRI ...

that was set up by my Primary Care Physician's office two weeks earlier. I was already called in to the MRI lobby of the clinic when one of the technicians told me they called to confirm and it was denied by Cigna. I had already had x-rays but that didn't show the doc enough of what he wanted to see. But as it turned out he had to be satisfied with the X-rays because Cigna wouldn't go any further.

[shireen]

62. send this to Bernie Sanders.

wait till a few more people add their horror stories, then email the entire thread to Bernie Sanders.

http://sanders.senate.gov/contact/
send the url of this thread (may need to use tinyurl.com to make it smaller) explaining what it's about.

[midnight]

63. Another example of a third party interfering with your access to medical care.

[irislake]

65. The non-American mind boggles!

[VPStoltz]

66. Two things: A friend of mine used to work for an insurance company. He evaluated physician reports.

Now mind you, this guy had NO medical training or experience yet often went himself to observe examinations that were ordered by the insurance company.
Everything was codified and kept with very narrow parameters: if they patient can move his leg a inch this way or that, it wasn't injured. Stuff like that.
Second: I heard that Putz, Frank Lutz, on NPR yesterday. Guy Rozz (?) asked him about this "government bureaucrat" thing. Lutz's work in cementing negative wording is meant to sway voters by thinking there will a SECOND level of bureaucracy - one in addition to the insurance companies. This man is a bald faced liar! Have you ever heard a right winger say, "You already HAVE a bureaucrat deciding your health decision, why would you want another one?" It's never happened. Not only these pukes liars but they are lying about what they are lying about!

[happygoluckytoyou]

68. GOP SHOULD CALL INSURANCE COMPANY TO SEE IF THEY STILL HAVE BALLS

[mwooldri]

70. GOP? Nope, certain Democrats need to call the insurance company...

they need to ask the insurance companies for their balls back, because insurance companies definitely have them and certain Democratic Party affiliates elected representatives in Congress certainly do lack them.

Mark.

[mwooldri]

69. Bloody insurance companies...

I try to pick the least evil carrier when it comes to open enrollment at work.

Our insurance covers for "semi private room". OK, that's fine.

However the hospital we went to only has "rooms". They don't distinguish between private and semi-private, they just bill for a "room".

The unnamed insurance carrier decided to process it as a "private room", paying much less than the contracted amount between the hospital and the carrier. The hospital pursued me for the bill. It took the intervention of my company's human resource department to get the carrier to make the adjustments with the hospital for the about $10,000 I was being hunted down for.

The other two carriers I have used (and I will name them because I have been on most part happy with them - Cigna and Aetna) have not given me any trouble over this at all. And we're a family with *big* medical issues - both myself and my son have "special needs" and big medical bills.

Mark.