I hate....

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moonshadow
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I hate....

Post by moonshadow »

I hate the medical industry in this country.

I have twelve month of benefits statements, out of that 12, 1... ONE was billed through the insurance correctly. The provider can not for the life of them figure out how to bill it correctly again, and the insurance isn't paying anything as a result, and I'm having to foot the bill for the difference.

I HATE THE MEDICAL INDUSTRY IN THIS COUNTRY!

A POX ON ALL OF THEM! INCLUDING THE LOW DOWN SLEAZY GOOD FOR NOTHING SORRY ROTTEN PIECE OF @#$% BACK BITING LAZY ENTITLED RASCAL BOSS HOG GREEDY GARBAGE HEAP SEWER POLITICIANS THAT INSIST THAT WE HAVE THE "BEST HEALTHCARE IN THE WORLD!"

I CURSE THEIR NAMES!

MAY THEY ALL WAKE UP TOMORROW MORNING WITH ARMS 12 INCHES SHORTER AND A CHRONIC ITCHY INFECTION IN THE GROIN!!! :x

*SPIT*

Anyone who still thinks we have the "best medical care there is" obviously either simply hasn't been f-------d over by it yet OR they have a lifetime supply of Vaseline! :roll:

.... or you're one of those sleaze balls I wrote about above (members of congress) and enjoy lifetime FREE medical care!

*DOUBLE SPIT* I tell ya I'd like to knock their #$%^ teeth out.
-Andrea
The old hillbilly from the coal fields of the Appalachian mountains currently living like there's no tomorrow on the west coast.
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Fred in Skirts
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Re: I hate....

Post by Fred in Skirts »

Hey Moon, tell us how you really feel! :lol: :lol: :lol: :lol: :lol:

Having just spent time in my local ER, I do not have the same feelings as they billed the insurance correctly and the care was I was given was first class all the way. I had to take an ambulance ride there and when I got there they were getting a room ready for me and was taken to to room with the doctor and nurses already there.
I guess I am lucky to have some of the best care available in the area. When I was in Denver Co. I had to make a trip to a hospital that I had never been to before. My daughter took me in her car and when we got there all heck broke loose, the doctors came out of the wood work to check me out, I was taken back to the ER and they did everything first class and I had to stay over night. The service and care was wonderful. The insurance was billed correctly and it did not cost me one penny out of pocket.

It seems like the problem you have is not with the medical industry but with the people who are supposed to know what they are doing, BUT don't. The people who are supposed to know how to read and write don't know how to read and write. So you end up getting screwed, It is the fault of the schools and teachers who do not teach our kids how to do the things needed to keep up with today's needs.

You live in a part of the country that has historically been known as being backwards and it has come back to bite. I admit it should not be that way but it is what it is!! :(
"It is better to be hated for what you are than be loved for what you are not" Andre Gide: 1869 - 1951
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moonshadow
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Re: I hate....

Post by moonshadow »

The issue is I really have nowhere to turn. I believe this falls under private contract law, whereas while I suspect fraud, it's not the insurance company, nor the provider that's falling victim to the fraud... it's me.

The trouble is, with Medicare or Medicaid, I'm reading that a solution is a simple as filing a complaint with the state attorney's office, as the state (or Commonwealth in my case) handles issues with government contracts (such as Medicaid and Medicare). However since I'm on private insurance my only recourse is to possibly contact an attorney. A case like this would cost tens of thousands of dollars in legal/court cost... much like the matter of civil forfeiture, the legal cost outweigh the cost of just paying the provider (or the cops in the case of civil forfeiture). It's a rigged game.

If you've got good insurance, then the medical system in this country may be okay to pretty good depending on your individual circumstances, but if you don't.... it's a jungle out there.

No... our medical system is inadequate for a growing number of people. It's time for change. If we can't pass a workable universal healthcare plan in this country then AT THE VERY LEAST they need to pass laws to protect patients from the kind of practices I'm falling victim to above, where you have a provider that's clearly listing as "in network", yet insist on billing out of network and expecting me to pay the difference. That's not right, it's not ethical, and it really ought to be illegal... and I could fight it in court, and possibly win... but then.. the court cost. They've got me over a barrel.
-Andrea
The old hillbilly from the coal fields of the Appalachian mountains currently living like there's no tomorrow on the west coast.
Freedomforall
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Re: I hate....

Post by Freedomforall »

I agree with you both. I think they tell us we have the greatest to try and keep us from looking elsewhere. I had gone to several doctors that dismissed my symptoms before they found my tumors.
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denimini
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Re: I hate....

Post by denimini »

I doubt that insurance will pay you for venting of the spleen either.
Seriously, I do feel sorry for you living in a country without a good national healthcare system ........... or even a mediocre one.
My name is Anthony, please accept me for the person that I am.
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moonshadow
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Re: I hate....

Post by moonshadow »

Well, I hear the U.K. is debating on dropping their NHS and moving towards an American type (private) system.

My advice?... Don't be STUPID! FIGHT THAT WITH EVERYTHING YOU HAVE! YOU WILL REGRET IT!

The American system is NOT a good system for millions of people who can't afford to use it.

In America, if you can't afford your medical expenses, you do without. It doesn't care if your suffer or die.... it has no compassion. It doesn't care to bankrupt you, or take everything you own.

Dissolving your NHS would be the most FOOLISH thing they could do!
-Andrea
The old hillbilly from the coal fields of the Appalachian mountains currently living like there's no tomorrow on the west coast.
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Kirbstone
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Re: I hate....

Post by Kirbstone »

Moon,
The few vocal malcontents in the UK may complain about their NHS and doctors/nurses might strike over conditions &c, but the fact remains that it is there for good, period....Everybody's good.
We hear stories that in the US if you have an accident the first question asked by the paramedics is 'Who are your insurers ?' before they pick you up & stick you in the ambulance. Perhaps that's largely true, but arriving Brit. paramedics treat first, and ask relevant questions later.

The same applies here. I only had one medical episode when some 10 years ago I nearly chopped my forearm off with an angle grinder at home. MOH whisked me off to hospital.. At A&E I was promptly seen by a Nigerian doctor who carried out first class treatment and today it is difficult to find the injury scar.
Interesting for me was the staff saturation with non-nationals....Muslim reception staff, Indian/Pakistani/Phillipino nurses, Indian/African/East European doctors. They ran the place like a well-oiled machine in my experience.

Tom
Last edited by Kirbstone on Fri Mar 24, 2023 3:58 pm, edited 1 time in total.
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Myopic Bookworm
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Re: I hate....

Post by Myopic Bookworm »

Kirbstone wrote: Fri Mar 24, 2023 11:08 am We hear stories that in the US if you have an accident the first question asked by the paramedics is 'Who are your insurers ?' before they pick you up & stivk you in the ambulance.
I can verify that, though I will admit that they had two members of staff to deal with me when I turned up at the local county hospital: one to start checking over the screaming infant I was carrying, and the other to ask for my insurance details.
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Re: I hate....

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Myopic Bookworm wrote: Fri Mar 24, 2023 3:50 pmI can verify that, though I will admit that they had two members of staff to deal with me when I turned up at the local county hospital: one to start checking over the screaming infant I was carrying, and the other to ask for my insurance details.
That's the problem in a nutshell. In the USA it's all about the money and not so much about actually helping people in real distress.

I don't view the medical industry in the US as a humanitarian venture in the slightest -- simply because it too closely resembles a profit-driven wealth transfer scheme to further drive what used to be the Middle Class into abject poverty. And it's doing a magnificent job!

From an ethical perspective, nobody should profit from the suffering of others -- and those who do represent the very dregs of humanity.
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moonshadow
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Re: I hate....

Post by moonshadow »

I've had to call the ambulance a few times in my life for others (I myself have never needed the service thus far).

From my experience, they do not ask for insurance information up front. It always gets worked out later. You either have insurance or you don't.

Like any medical expense, it comes down to two possible scenarios:

If you have insurance, they will bill it and bill you for what insurance doesn't cover. [0] In this case you pay your share and life goes on, if you can't pay your share, see the second scenario (below)

If the second scenario, you either don't have insurance at all, or you are under-insured (your plan sucks), $10k deductible, etc.... in this case they bill you. If you can't pay, they take you to court and place judgements on you where they will garnish your paycheck, or possibly seize other assets you may own. WARNING: They can be as ruthless as the IRS! DO NOT SKIP OUT ON A MEDICAL BILL! THEY WILL HUNT YOU DOWN AND SLIT YOUR THROAT!!!

Now, there is one other option, if the bill is astronomical (which doesn't take much in our bloated system...) and you just don't make the money to ever realistically pay it down, you may qualify for a one time "Medicaid spend down", where the state will kick in and pay most of the bill. Understand however that this program isn't a "golden goose". I speak from experience here... a long time ago Liz broke her leg without insurance, the medical bill was in excess of $30,000. I made $7.00 per hour back then, and this was long before any state expanded Medicaid, so unless you were a minor or pregnant, you did without medical care. There was no realistic way we could afford to pay for that. We qualified for a Medicaid spend down. It paid pretty much the entire bill, however it wasn't perfect. It did NOT pay for any follow up visit. A rod was placed in her leg that was supposed to come out, but since we couldn't afford the procedure, the rod still rest in her leg today, now her bone has grown around the rod and it can't be removed. She has a hard time walking to this day as a result of it. No surgeon will touch it.

As for these stories we hear about Canadians and Brits having to wait six months for life saving treatments, or having to sit in waiting rooms for hours...

Well in the U.S. millions of people just don't receive care at all because they can't afford it. Even if you have insurance or can otherwise obtain the procedure you need, it can still be months on a waiting list.

What about waiting rooms? Amber sat in an E.R. waiting room for 8:00PM until 11:00 AM THE FOLLOWING DAY!!! She reported a motorcyclist that seemed to have a broken arm that had to wait for hours and hours, until he finally just left (we assume to go to a different hospital).

That day she was referred IMMEDIATELY to a dermatologist who stated that Amber has the worst case of eczema she'd ever seen in her practice. Her skin was practically falling off her flesh.

Why didn't she receive treatment earlier? Well... she had finally been approved on Virginia medicaid about two months prior and was on a waiting list to see the dermatologist, but that appointment would be another month yet. She had to leave her job. For the last several weeks prior to her receiving treatment, we'd have to sweep the floor several times a day. After a few hours it would look like snow flurries all over the floor. It got so bad on that final day, as she hobbled out into the living room, her feet had finally split open and she was leaving a trail of blood all over the floor, crying in agony, she could hardly get in the car. We took her to the Abingdon E.R. not wanting to deal with the local Lebanon one (which we had already tried once before and they just basically sent her back home again with no real treatment). Abingdon sent her to a specialist immediately, where that doctor put her on some samples of a new treatment (bi-monthly injections). These shots cost $10,000 a piece. At first Medicaid kicked it out, but after trying several other treatments that failed, she had to go back on the original $10k treatments.

I tell you, I get downright angry when I listen to Republicans fight against any meaningful healthcare reform in this country. They resist the expansion of Medicaid and cut it back every chance they get. Eczema is not lethal, but Amber's case was SO SEVERE, she would have eventually taken her own life... I mean, if you could have seen her skin, if you thought your situation was just as hopeless, you'd probably end your life too.

So yes, this isn't "POLITICS", this is PERSONAL! REPUBLICANS WOULD JUST SIT BACK AND LET MY DAUGHTER SUFFER. If she moves to any "red state" she'd be dead by now. If you've seen what I've seen you'd have to agree, they are the scum of the Earth. Virginia went blue for a VERY brief period, and in those two short legislative years, we managed to squeeze out the expansion of Medicaid, and that program I'm completely convinced saved Amber's life. And the GOP wants to take that away.

The fact that they hold themselves in such high regard as being "the party of Christ" makes me want to punch them in the face. They are an abomination. They are NOT "PRO LIFE", they are "pro-BIRTH" and that's IT! I don't care much for most Democrats either, but I'd rather sever my right arm than use it to cast a vote for most GOP politicians.

Matthew 5:30 And if your right hand causes you to sin, cut it off and cast it from you; for it is more profitable for you that one of your members perish, than for your whole body to be cast into hell.

[0] I'll explain this as I understand most people who live in medically civilized countries won't understand the system we have in the U.S...

Almost all private plans have a deductible that must be met. Most deductibles seem to range anywhere from $500 to upwards of $10,000. If you don't know what a deductible is, it's the amount of money you have to spend on medical expenses before you insurance will kick in.

Once insurance kicks in, they typically pay anywhere from 60%-80% depending on the plan, and assuming it's in network. There is usually an "out of pocket maximum" that seems to average anywhere from 4-10 times the deductible amount. e.g. my plan at work carries a $500 deductible with a 80/20 payment afterwards (they pay 80%, I pay 20%) and an out of pocket maximum of $2500 for the calendar year.

There are also copays that usually have to be met, in my case it's $25 for an office visit to the primary doctor, $40 for specialist, and $150 for emergency room.
-Andrea
The old hillbilly from the coal fields of the Appalachian mountains currently living like there's no tomorrow on the west coast.
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Myopic Bookworm
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Re: I hate....

Post by Myopic Bookworm »

moonshadow wrote: Mon Mar 27, 2023 3:33 am As for these stories we hear about Canadians and Brits having to wait six months for life saving treatments, or having to sit in waiting rooms for hours...

Well in the U.S. millions of people just don't receive care at all because they can't afford it. Even if you have insurance or can otherwise obtain the procedure you need, it can still be months on a waiting list.
Our system in the UK may be creaking at the seams, but it's better than the US system. One thing American critics often "forget" to mention is that anyone with a decent salary probably has private medical insurance (BUPA is the best known provider), which they can switch to if the NHS is unable to respond fast enough (or doesn't support particular treatments). My wife has done this twice. The only people who are utterly reliant on the NHS are the people who in some parts of the US would get little or no medical care at all.

When I was in the US, people asked whether I would consider staying permanently. I tried not too laugh too rudely, and explained that only three things put me off: the health system, the tax system, and the political system.
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Re: I hate....

Post by rode_kater »

Wow, that's horrible. And I've seen some horror stories on Reddit. The US really seems to be doing itself a disservice here.

The silly thing is, you know it's possible to have a functioning system. Here my experience with my SO's broken knee was fantastic (well, except for the broken knee part). After the GP had looked at it, they made an appointment at the hospital where we waited 20 minutes for the x-ray and then went of the to the "gipspoli" (plaster office?) and by the time we got there they'd examined the x-ray, saw they just needed to put a cast on it. All the checkups were also easy. One time when she was taken to the hospital by an aunt, and she surprised the aunt by being back within 25 minutes. I understand that even for NL standards our local hospital is very good.

Total costs: about 4 taxi trips to/from hospital (we have no car). (She'd already maxed out the annual deductible of €385).

I don't know what it would take for people in the US to realise that a healthy population is a productive and happy population.

Our system isn't the single payer system of the UK, nor the totally clusterf*ck of the US but a hybrid with a ton of regulation. The costs are still rising every year though. Sustainability long term is an issue.
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The thing to recall here is that the US does not have a health care system -- it has a health insurance system, and this is by design. All in the name of the almighty profit.

There was a brief moment in time during the 1990s when it looked for an instant like we might get a system like Canada's, but thanks to a positively massive PR campaign by the big insurance companies that notion got scuppered, and then we wound up with Romneycare and the "individual mandate" thus conferring onto private for-profit enterprise the power to tax the populace.

What the US has is fundamentally and profoundly evil, and smart countries should take the US as a shining example of what NOT to do.
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Re: I hate....

Post by Faldaguy »

Indeed the "Health" care insurance industry and the 'public' Medicare/Medicaid in the US were designed to funnel money to the industry, not to protect the the payers. As one who has traveled a fair bit, in recent years literally driven from the US in part due to the high cost of health coverage, I've watched International ratings of Health Care Outcomes --offered annually from numerous sources with their own bias -- but ALL clearly show the exceptionalism myth of US Health care is bogus, with the US typically running about 25th to 30th internationally; and at the bottom of all the 'rich' countries while costing ($14,000.00 annually per person)--thus two of more times per person than anywhere else on the planet, yet coming in far down the list in positive outcomes.

Here is just one example: https://www.internationalinsurance.com/health/systems/

As most of you know, we are presently based in Costa Rica, a small third world country of less than 6 million souls where typical incomes are under a $1000.00 USD per month but our ranking is 36th followed by the US at 37th -- also typical! The US capitalist system with its reverence for "individualism and dollars" is cascading into a lethal sinkhole for the masses.
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moonshadow
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Re: I hate....

Post by moonshadow »

Faldaguy wrote: Sun Apr 02, 2023 5:54 am The US capitalist system with its reverence for "individualism and dollars" is cascading into a lethal sinkhole for the masses.
In fairness, I think a lot of this just boils down to American culture, and it's getting more "individualized" as about half the voters in the U.S. today (everyone younger than 45) have not seen a major military conflict directly effect our home country in our lifetimes. Frankly I think it's spoiled us (the millennials and gen z). We don't know how to build communities anymore, we lack the ability to truly look out for one another because we've never really had a chance to practice.

We were born in the boomers world, and lived off of their crumbs, and now we live in a system where it is "dog eat dog, survival of the fittest". It doesn't make us bad people, we have just never experienced true compassion, and as a result, we don't know how to correctly dispense it.

Social Security may be defunct in a decade or two, and the millennials will be the ones to vote and drive the final nail in that coffin, because in our own collective minds, "we don't need it".

It doesn't look good, and as much as I hate to admit it, (and I hope I don't draw the CIA or FBI to this site for writing this), but what America needs right now is a good swift kick in the ass... and I mean a WWIII kind of kick in the ass. Frankly, we need to have a few major cities wiped off the map, our country needs to be destroyed so it can rebuild.... it's the only way to restore our humanity. Until such time, we're going to continue to feed off each other's greed.

And for the FBI: No... this is bigger than what I can pull off... I'm not talking about a shooting, or a pipe bomb blowing up a large building... I'm talking about something major like Russia and China joining forces and peppering the U.S. with nukes. It will suck... but it will bring us together (those who survive anyway).

I'm sorry, I know what I said will be VERY unpopular... but it's just the law of the universe. Everything has to die eventually. It's the whole circle of life thing. We're overdue... and it shows. I don't want any of this, but I'm losing hope fast.

At the microcosm level, I've seen what disaster can do to bring a community together. The humanity that arises from dread and despair can be a sight to behold.
-Andrea
The old hillbilly from the coal fields of the Appalachian mountains currently living like there's no tomorrow on the west coast.
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