Insurance fraud is rampant! I'm talking policy premiums. Argh!
nicole___
5 years ago
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INSURANCE - Are you over or underinsured
Comments (26)Hi again, Sue, Our system is far from perfect. It's a multi-billion dollar enterprise ... and if you have a pot of honey sitting in the yard, don't be surprised if you attract a bunch of bees to go buzzing around! The system is a national one, largely ruled by the national government, and partly funded by them (but on a drastically reduced basis in recent years) - but administered provincially. The government-related agency is the only payer allowed, and I understand that in most provinces a doctor can choose to practise outside of that system, but if he does so, he must practise entirely that way, that he can't be billing the provincial system for part of the service that he offers (to avoid having him bill the lucrative stuff directly). The chief problem is that for many elective procedures, there is a long waiting list. When one has a painful hip, the prospect of waiting for more than a year to have replacement is not a pleasant experience. But I don't think that we use our operating rooms on a 24 hour basis, either. And they have beds (or O.R.s) shut down, sometimes - shortage of staff ... or shortage of money. Some people travel to the U.S. for care, at far higher cost, and some travel to such as India, where quality care is available, and at much lower cost, for people who can't wait in the line-up here (or whose service isn't covered, e.g. facial tucks - but they can be done here: private-pay). Sometimes (usually a rather small) part of their costs are recoverable from the provincial plan when they've gone elsewhere for service. While there are a good deal of tears shed over the shortage of staff, no one seems to get much out of breath running hard to get some trained people from other parts of the world to become licensed here: quite a few Ph.D.'s from various third world countries are driving cabs, here. Though a large number of Canadians can't find a family doctor, quite a few of us figure that the government isn't enthused about empowering a lot more doctors - which means more bullet holes in the rain barrel, depleting the water even more rapidly. And many of us feel that quite a few procedures currently restricted to doctors could well be carried out by nurses ... but no way are the medical associations going to stand still for any kind of nonsense like that being put into place! Plus - there's a shortage of nurses, as they cut back on training a while ago, and many of our grads move to the U.S. Same with our doctors. Seems to me that such people should reimburse for much of their training. But - we're just as bad - we seduce many such trained people from various less developed parts of the world, where such trained people are scarce and precious, and losing them something of a disaster. Also, many nurses work short hours per week per institution, in order to avoid the need to pay benefits to full-time workers. And any fool knows that a patient needs to be seen successively, day by day, by the same nurses - a lot of incipient problems can be forestalled by an observant nurse ... provided that s/he deals with the patient daily. Also - the medical system, in whatever country, is a bottomless pit. My old step-uncle, who died in his mid-80's a few years ago, had had three hip replacements. Such things were unheard of 50 years ago. And many patients undergo heart by-pass procedures in recent years: it's routine, these days. And we replace hearts, lungs, liver, kidneys, etc. (everything except heads?). I think that I heard a while ago that when a heart transplant takes place, something like 25 people are in the operating room. We old farts never heard of having MRI tests, CAT scans, etc. - but now they are reasonably commonplace (but still expensive). And they are learning of more complex (read "expensive") procedures day by day. Many Canadians are pleased with the system that we have. And there is quite a large number who complain about it. The main complaint is that people should be allowed to pay for their care, outside of the system, should they choose. To which some reply that it is possible, now - just convince some doctors that they should practise on a private basis, with all of their patients paying them directly. One of the major problems is ... ... that if a doctor sends in a request for payment for a visit, the payer must pay him ... or prove fraud. Many docs put patients through pretty quickly. And over-prescribe drugs ... partly to get the gal/guy off his/her back ... quickly? Many European countries have, generally speaking, quality health care, at much lower costs per capita than the costs under our system. And your sustem costs a lot more than ours, per capita ... and a substantial number of your people aren't covered, and do get some care, but many say that it's not first class. I'm thankful that on my occasional visits to my doc, for regular (if somehat infrequent) physical exam, he doesn't give me any indication that he's under time pressure. But we patients are aware that most of us sat for an hour or so after the time assigned to us, as well. I am mightily thankful that I've had almost no contact with the medical system for many years - haven't taken a pill in 30 years at least, I think. When my ex- (named Sue, by the way) was suffering on a downward trail with cancer a few years ago, our adult children felt that they had no complaint whatever with the care that she received. She'd been head of food service in a major local psychiatric hospital for 20 years (and ironically ... it was her gut that did her in!) and whether that enabled her to receive special treatment I have no idea, but I didn't hear any whisper of such a thing from the offspring. Good wishes to you and yours - and I hope that the New Year brings many pleasant surprises. ole joyful...See MoreWhat happens when you don't have Health Insurance?
Comments (65)Late husband worked for a health insurance company, and that was the last time we had a health insurance benefit. When he left that job, we got catastrophic care insurance, with a huge deductible. We eventually opened HSAs as well. Over the last ten years, each of us has had jobs that offered health insurance plans. We looked at the cost (to the employee) of those company plans, and the benefits, and restrictions imposed. We compared them to the cost of our current plans and benefits, (when you pay yourself, you chose who you want with no restrictions). The HSA balance creeps up over time, allowing more payments, (dental, doctor's office visits, optometrist exams,) on a schedule we controlled, instead of what the company plans would allow. Employers have been hit hard the last few years, too. The workplace plans we were offered had higher premiums than our individual accounts with Unnamed Health Insurance Company, and were not of more value to us. In spite of being a "catastrophic care" policy with a high deductible, It seems to be paying for things, or making partial payments for things, every time i turn around. Tick removed from back at walk-in facility: Paid half the bill. Prophylactic medication in case I was exposed to Lyme disease: I was stunned to have the couple bucks and change it cost. I asked the pharmacist "Isn't there a minimum dispensing fee?" Yes, she said, but the insurance covers it. If I hadn't had that policy, it would have been twenty dollars or so, for two pills. As it was, I paid less than three dollars out of pocket. I'm actually quite happy with the situation I'm in: the fewer people sticking there noses into my health care (policy wonks in DC or that lady in personnel) the better I like it. And it had no bearing on Poor Late Husband's demise: He had lung cancer, quite likely from his thirty eight years of smoking two packs a day. There were unusual circumstances that contributed to his sudden death only five weeks after diagnosis. No amount of chemo, surgery etc., would have saved him. I had a cancer scare myself, actually less than three months after his passing. I asked a nurse what would happen if I had cancer, and my insurance didn't cover treatment. She said she didn't know how that worked, and she said the doctors and nurses take precautions to not know anything about the finances of patients. That way, she said, those with or without insurance are treated the same way while in the hospital. I think it's stupid to go without insurance to have more money for lattes and cell phones, but I defend others' rights to spend the money they earn in a way that they find valuable. As for people who "End up in the emergency room because they couldn't afford a doctor" I've personally known, lived near, worked with some of those people...and they abused the emergency room option so they wouldn't have to pay. I've heard them rationalize taking a child with an earache to the emergency room to avoid a $20 co-pay at the doctor's office, and the hassle of scheduling an appointment. Then in the next breath they griped that they had to wait so long to be seen....See MoreLong-Term Health Care Insurance and Single
Comments (30)We bought LTCI last year at the ages of 49 and 51, and we're glad we did. I did not go into this with eyes half shut. I did uncountable hours of research, attended seminars, talked to people, interviewed agents, etc. I'm the type of person who doesn't allow anyone to talk me into anything - period. We bought a great policy through an A++ rated company, John Hancock. The average age one should buy LTC is 60ish - before health problems begin and the premiums are outrageous if you can even get it with certain conditions. I wasn't waiting 10 years to do so especially since our premiums would double by then even if we remain healthy...but who knows how our health will be in 10 years. Sure, we're healthy now and healthier than our parents were at this age, but no one has a crystal ball to determine how our health and at what age, will affect us. I'm not taking chances knowing DH's parents history. We have no kids or family that will care for us should we need it now or later, and to put 100% burden on the other spouse isn't fair, IMO. And even if we did have kids, who's to say they would want to interrupt their lives to care for sick parents. As cruel as this sounds, I prefer not to care for my mother as she's a difficult one now and she's relatively healthy. This LTC is piece of mind for us. While humans are living longer these days, from my research, it states that a very high percentage of people will require some kind of nursing home facility and the average time is 2.5 years. Should that time come now or later, the insurance is already there to be used. If we were to invest $$ for a rainy day to use toward this, it will take A VERY LONG TIME to match what insurance money is available to us NOW. We hope to never have to use it, but good to know it's in place if we have to, and we're lucky enough to be able to afford it. I realize many cannot. There's much to know about the various companies offering this including their ratings, how their policies work with the options & riders offered, claims stats, etc., and then choosing what is right for each individual. While most people tend to not think about LTC or discount it all together, I really think more people should learn about it and give it serious consideration. (No, I don't sell it). Frankly, IMHO, your sister is wise in thinking about her elder years that way....See MoreQuestion re health insurance wellness programs
Comments (25)Here we go again! No idea what is going on yet people are making absolute statements of "fact" and not knowing what they're talking about. Unfortunately you asked the wrong people. What you need to do first is find out what you signed. Short of advice to find out what you signed, forget all advice that is given under presumption and guess. I'm glad to hear you're going to check on what you signed. KUDOS! I'm sure you learned your lesson to sign NOTHING without getting a copy. No copy? No signature. Period. Hospitals and clinics are amazed and angered often when I won't even sign until a duplicate is out. Also, don't take their word that they'll get you a copy afterward. I made that mistake once. Cynic Rule #4: No copy? No signature! And saying "...the HIPAA law protects you" is an ignorant statement in this case. HIPAA does not protect you if you sign a waiver, which is often the first thing you have to sign for medical care. For anyone to make absolute statements of what is happening or can happen is naive since we don't know what was involved. I would doubt that it's a scam since it's through the Dr's office and given their liability in the event of a scam, they're not likely to take a chance. However, they might think something is good for you that you don't think is good for you. You're doing the right thing by finding out what you signed. Then you can start asking intelligent questions and stand a chance of getting some at least somewhat educated answers. Good luck!...See Morenicole___
5 years agonicole___
5 years agonicole___
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5 years agolast modified: 5 years agonicole___
5 years agonicole___
5 years agonicole___
5 years agolast modified: 5 years agonicole___
5 years ago
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