Medical Cost

[jyoutz]

Would you venture your first generation immigrant great grandparents would file a formal complaint with the state against the immigrant RN assisting them completing the patient intake questionnaire for questioning English proficiency being in country 20 years?

There are possible medical conditions such as hearing impairment, etc. that could be factors.

My only point is it’s easy to land in hot water with no ill intent.

My point is that because someone has been in the country for 20 years doesn’t mean they have English proficiency. It’s very common that 2nd generation immigrants are the people who are English proficient.

 

[mrmikey]

Still surprises me to have Canadian patients travel to California for cash pay medical care.

I'm guessing it's wait time. Good for them if they can afford it, I can't.
I can't remember the exact timeframes but when it was decided I needed a new hip after me saying the numerous cortisone injections weren't helping, it was at least a year or more. During the wait time it's all I could do to walk, couldn't sleep properly, shovelling snow was a real treat.
My left knee which I had screwed up ( this was before my hip and was the cause of hip going bad) at work was worse, again cortisone injections up the wazoo, lost track of the amount of times it was scraped (can't remember the technical term) There was at least a two year wait from time of accident to surgery but there was a difference. Once they realized it was a comp. claim, I was in less than 6 months, I think it was actually three before I had surgery.
They had even offered to send me and an assistant to Quebec (I'm in NS) for surgery which I declined as I'd be flying up but had to rake a train back....not gonna happen.

 

[Dftodd]

I ran into this once. I needed orthopedic surgery and was careful to choose a surgeon and hospital that was a provider on my insurance plan. Sure enough, when I got the bill, the anesthesiologist (who I never chose or met) wouldn’t accept my insurance and his bill exceeded the surgeon and hospital combined.

We ran into that once with an ER doctor.

The hospital was in network. But the doctor assigned to my wife was out of network.

We had a simple answer for the ER doctor when he sent us a bill and surprisingly it worked.

My wife simply called him up and told him if he wanted to get paid, he better submit a claim through our insurance first. The hospital is in network, so he better be as well.

A few months later we recieved a new bill from the doctor for $60

 

[Dftodd]

@ultrarunner I saw the same thing living within a few hours of Mayo. Lots of Canadians used to come into Minnesota to get care.

Comparing costs is hard. You would have to quantify the cost of delayed care, the much lower limits on suits for malpractice (as well as a higher standard of proof), etc. What good is cheaper care if you don't get it in time? There is also the risk that the gov will deny a procedure they deem inefficient or too costly based on age, health, etc. Essentially, the things Americans complain about insurance companies become the purview of the province. The difference is that you can find another insurance company.

Or sick your HR department onto the insurance company.

My employer has over 6,000 employees just in the US. So it's a pretty decent account for an insurance company.

Plus the HR department as contacts we don't.

My wife had to have reconstructive surgery on her elbow from a fall. She fractured both heads in the elbow, tore a ligament, and dislocated it.

She's had 3 surgery's, a manual manipulation, and three days a week physical therapy for 5 months now.

I've had to sick Marta from our HR department on insurance 6 times now. And yes, I've talked to her so much, we are on a first name basis now

It's been everything from not filling/ covering a prescription to insurance blowing off the PT provider trying to authorize more PT sessions for her arm.

And what really chaps my bottom over the PT sessions is insurance is only out $15 a session for PT The last time Marta got involved with the PT sessions, insurance called the provider and pre-authorized 45 more sessions

 

[jyoutz]

We ran into that once with an ER doctor.

The hospital was in network. But the doctor assigned to my wife was out of network.

We had a simple answer for the ER doctor when he sent us a bill and surprisingly it worked.

My wife simply called him up and told him if he wanted to get paid, he better submit a claim through our insurance first. The hospital is in network, so he better be as well.

A few months later we recieved a new bill from the doctor for $60

I ended up in the same place, but it actually took months of haggling to get there.

 

[Dftodd]

I ended up in the same place, but it actually took months of haggling to get there.

I was shocked when my wife called, told them who she was, and simply stated that if they want to get paid, they needed to file a claim with her insurance first before billing us.

2 to 3 months later, we recieved the new bill showing what insurance covered and what we owed them

 

[Torvy]

Good point on employers using their size to help.

In and out of network issues are amplified when you are rural. This is even worse if you need specialists.

Wife had to change doctors and go back and forth quite a bit to get her cataracts done. Even at that we have to go 50 miles+ into Longview or Tyler for most special care.

 

[ericm979]

My employer has over 6,000 employees just in the US. So it's a pretty decent account for an insurance company.

Yea if your insurance is through a large corp they have power.

We thought that since the insurance was the same, from the same insurer, that when I retired and we went onto insurance from the marketplace, it'd be the same. Not even close! Some doctors won't even accept insurance that's not corporate sponsored. The insurance company denies things they would have paid before. We can get that overturned on appeal but it's a hassle.

 

[Torvy]

Yea if your insurance is through a large corp they have power.

We thought that since the insurance was the same, from the same insurer, that when I retired and we went onto insurance from the marketplace, it'd be the same. Not even close! Some doctors won't even accept insurance that's not corporate sponsored. The insurance company denies things they would have paid before. We can get that overturned on appeal but it's a hassle.

The marketplace is definitely worse.

 

[ponytug]

The "out of network" surprise billing has had some legal clamp down;

NO SURPRISE Billing Act (NSA) | Anesthesia Billing and Practice Management | Anesthesia Resources

Starting with the first day of 2022, the No Surprise Billing Act went into effect. Out-of-network anesthesia providers are now prohibited from balance billing

anesres.com

That doesn't do much for all of the other insurance hassles, like enduring months of treatment by a low cost drug for the doctor being able to prescribe the clinical proven more effective drug.

All the best,

Peter