Healthcare industry behaving badly

[Suranis]

Many years ago I got a Toothache in America. I had travel insurance so I went to a dentist. They wouldn't accept the Travel insurance and wanted to charge me $1000 for scanning the tooth. I nodded, walked out the door and never went back. The Toothache went away. And last year I had the worst tooth extraction I ever had on the same tooth which had gone completely rotten

Hmm...

[RTH10260]

Hmmm travel insurance works generally the way that the patient pays the doctor and hospital and then gets the refund when handing in the receips back home.

[Suranis]

Hmmm travel insurance works generally the way that the patient pays the doctor and hospital and then gets the refund when handing in the receips back home.

Even if that is true, (a) that was not made clear to me when I bought it, and (b) the Dentist still refused to accept it.

[pipistrelle]

Hmmm travel insurance works generally the way that the patient pays the doctor and hospital and then gets the refund when handing in the receips back home.

Depends on the insurance.

Dentists can be weird about insurance.

[MN-Skeptic]

My experience has been that medical insurance is typically separate from dental insurance in the U.S. When working, both my employer and my husband's employer offered both medical and dental insurance. Medicare by itself does not include dental insurance.

[realist]

Many years ago I got a Toothache in America. I had travel insurance so I went to a dentist. They wouldn't accept the Travel insurance and wanted to charge me $1000 for scanning the tooth. I nodded, walked out the door and never went back. The Toothache went away. And last year I had the worst tooth extraction I ever had on the same tooth which had gone completely rotten

Hmm...

Did you try a different dentist?

[RTH10260]

Just as a late add-on: many insurance companies might have contact points or partners in the more common travel destination to assist in the search of doctors or hospitals that are not cut-throats.

[AndyinPA]

Just as a late add-on: many insurance companies might have contact points or partners in the more common travel destination to assist in the search of doctors or hospitals that are not cut-throats.

You would be thinking of another country.

[Sequoia32]

The doctors I go to have dedicated personnel whose job it is to deal with insurance companies and get necessary care approved. Because that's a job now.

Imagine if we had single-payer and American companies could compete on a level playing field with most of the rest of the world.

Yes, Foggy and a lot of other people would have to find new jobs, but Americans would be happier, healthier and fewer would be bankrupted.

[RTH10260]

Just as a late add-on: many insurance companies might have contact points or partners in the more common travel destination to assist in the search of doctors or hospitals that are not cut-throats.

You would be thinking of another country.

I was writing with an European perspective. Travel insurance will be available in two forms: worldwide with US excluded, and For US only (or combined). Premiums for US only will be significantly over "rest of world". Insurance companies will have an interest in keeping costs in the US minimized.

[AndyinPA]

Just as a late add-on: many insurance companies might have contact points or partners in the more common travel destination to assist in the search of doctors or hospitals that are not cut-throats.

You would be thinking of another country.

I was writing with an European perspective. Travel insurance will be available in two forms: worldwide with US excluded, and For US only (or combined). Premiums for US only will be significantly over "rest of world". Insurance companies will have an interest in keeping costs in the US minimized.

Gotcha!

[Suranis]

Did you try a different dentist?

Nope. I mean I was probably an idiot really, but it was my only real experiance with the system over there.

[raison de arizona]

[raison de arizona]

So I have a $3k/person, $6k/family deductible on my plan. A med I need is discounted to $3k/mo, which is way better than the $6k/mo it was last year with my old insurance, but I had to eat the first dose for the deductible. I called the drug company, who is invested in me being on this drug because it is a monthly check for them, profit! I explained to them the issue and my desire to somehow avoid the $2855 hit my insurance company was charging me. The drug company gave me a credit card number! Not only did I just get my drug for free, I got my personal deductible met! So yay.

Of course the drug company will realize huge profits over time, since this is a maintenance drug. But good for me, I guess.

Spoke too soon. It took awhile, but the health insurance company figured out that I paid with a credit card that was not in my name and reversed the money out of my deductible. Anthem Blue Cross has a program they call "True Accumulation," the way it works is that money is only applied to your deductible if it comes directly from your pocket. If someone else pays for it, you still get the drug or service, but it does not apply to your deductible. So, for instance, if my child who is going to be with his grandmother for a month this summer takes him to the doctor, and his grandmother makes the co-insurance payment with her credit card, that service will be provided. BUT- the money she pays will NOT be applied to the deductible because it didn't come from a CC that is in my name. Only payment coming from sources in my name apply to the deductible, hence "True Accumulation."

Here's the problem with that for me. The credit card that I got from the drug manufacturer back in April counted towards my drugs, and I got my dose for that month. They applied the amount to my deductible, and as such I didn't have to pay anything for May or June's doses. But now they've reversed that, and the drug provider the health insurance contracts with is billing me ~$5,700 for my drugs for the last two months. It doesn't matter that the money was paid from an outside company on my behalf, what matters is that the credit card used didn't have my name on it so it doesn't count towards my deductible. And now I owe them $5,700 for back pay from the last two months.

Assholes. I've filed an expedited appeal but I'm not holding out hope. The only reason I even noticed (they haven't billed me yet, they said it will come in the next cycle) is because I tried to make a doctor appointment today and doctor's office said my copay would be $450, which is bullshit because 1) I thought I'd met my deductible, and 2) that is way more than my copay anyway. But it turns out that since they reversed the other money (after three months) now I owe the whole thing again. And in the meantime I'm almost out of pills and am just going to have to eat 1) the cost of the doctor visit, and 2) the cost of the pills (several hundred + one that is around a grand that I will probably skip this month I guess), if I want to stay medicated.

Hate them.

Health insurance companies really are the worst.

[AndyinPA]

OMG, that's terrible! They are .

[realist]

Wow. It's fairly commonplace (in recent years) that the drug manufacturer contribution does not count for your deductible, but then that only means it will take you a much longer time to reach your full deductible amount. I've never seen anyone get "billed back" for the prior expenses.

I've also never heard (apparently because it's never come up) that just because the payment for a co-pay comes from someone's else's card that the amount doesn't count toward your deductible, but it (unfortunately) does make some sense.

The princess, for years, had a manufacturer who allowed her 4k/mo med to be purchased for a $33 co-pay. Our med coverage provider did not count the almost 4k/mo contribution by the manufacturer as toward her deductible, but she was never "billed back" for it, it just took a little longer to meet her deductible, which was only $2500. She did have to pay tax on the contribution, however.

If I were you I'd get a few more credit cards in my name and then just give them to my mom or grandmother, or whomever, to use when they may have to pay for a co-pay. Assuming you trust your family members, of course.

[raison de arizona]

If I were you I'd get a few more credit cards in my name and then just give them to my mom or grandmother, or whomever, to use when they may have to pay for a co-pay. Assuming you trust your family members, of course.

Yeah, that makes sense. I have a card I pretty much never use, I'll just send it with the kid for the summer for use in these (and any other) situations that may arise, I suppose.

[jemcanada2]

I can’t believe the US still doesn’t have a decent amount of parental leave time.

In Canada, you can choose between 12 or 18 months parental leave. The parents can split that time if the father/other parent wants to take time off as well.

[Dave from down under]

OMG!!!

I knew it was bad in the US of A… but….

From my Australian perspective
We have Medicare (Aust), that covers public health, many pharmaceuticals in full or most of the cost plus a set amount to doctors and specialists (there may be a gap we have to pay depending on the doctor we choose - so our medical Center was bulk billing (ie no gap), but has gone to above basic fees so we need pay ~$70 per visit then Medicare puts the basic $55 back into our bank account).

Because we can pay for private healthcare (tax incentive, faster elective surgery and us not wanting to be a burden on society and the public health system) - with BUPA for about $8000 pa we have full hospital plus extras like dental and pharmaceutical…

So colonoscopy in private hospital under general = $0 from us. (~$3K cost to BUPA)
Dental visit for periodic exam and clean under gas $226 - $203 (BUPA paid) = $23 I paid.

I’ve never had BUPA try to not pay, they don’t care who pays any gap, etc..

[raison de arizona]

The princess, for years, had a manufacturer who allowed her 4k/mo med to be purchased for a $33 co-pay. Our med coverage provider did not count the almost 4k/mo contribution by the manufacturer as toward her deductible, but she was never "billed back" for it, it just took a little longer to meet her deductible, which was only $2500. She did have to pay tax on the contribution, however.

Yeah. That makes sense. As I'm calming down a little here, I'm thinking that I wouldn't be surprised if the manufacturer would be willing to pick up the amount for the doses I'm getting back billed on. Or _something_. I'll wait for the bill and then give them a call and see if we can work something out between me and them and Anthem that doesn't involve me paying the full amount back out of pocket. Providing my expedited appeal is dennied. They also gave me the number for some "managed healthcare department" that may be able to help get it sorted as well. So I have options. I'm just pissed because it took so much to get everything lined up to get them to start paying for this in the first place after I changed insurances, that was a solid three months of back and forth, and I *thought* it was going fine only to find out now that it was only fine for the first month and the next two are retroactively decidedly *not fine*.

Also, I have another issue with them, they dennied a covered expense on the wife without giving a reason, now that provider is billing $400 past due on receipt. I've appealed that one as well, so I can at least get a reason why it was dennied that I can fight. But that isn't an expedited appeal so I think they said 45 days? This crap is a serious pain, especially when I have the rest of life to deal with and don't have hours upon hours to sit on the phone with these doorknobs. Well, the people I talk to aren't doorknobs. They're generally helpful and pleasant. But the situations are frustrating and the reps generally can't help me other to bounce me around to other people in other departments who also can't help me.

Garg.

[Phoenix520]

When it comes to meds and insurance companies, we left that frustration behind 10 years ago.

The insurance company wouldn’t let me refill any of sprouts prescriptions 2 days early - we were leaving town and these were crucial meds. I vented to the Costco pharmacist. He said “well, you, you can get them cheaper by not going through the insurance, and we’ll let you refill whenever you want.” So we do.

Have you tried Mark Cuban’s site?

[Dave from down under]

Additional

My wife was suffering an auto immune disease

Specialist ($175/visit $68 back from Medicare), recommended a new treatment regime (3x $3K), we spoke to BUPA they said they would organise a support team to negotiate least cost to us, specialist spoke direct to public hospital who took on full cost of treatment.
So $0 for treatment, every 3 months - blood tests $75 out of pocket (balance of $228 covered by Medicare) plus specialist (see above).

Happy to say - so far successful.
(So next tests in 4 months, if ok then 6 months, then yearly).

Some other countries have better public health systems, but ours is pretty good.

[Dave from down under]

I also believe that because our public health system is good, that private medical and insurance provide better quality service cheaper because they are competing against each other and against a functional public health system.

Iirc a study found that US surgery costs are 2x to 3x higher than in countries with decent public hospital system

[RTH10260]

@r.d.a: about your kid being at grandmother or any other family member: does the insurance not let you register any alternate caretakers? Registering an alternate cc with the caretaker is of course tricky as one cannot know which card will be used.

[raison de arizona]

@r.d.a: about your kid being at grandmother or any other family member: does the insurance not let you register any alternate caretakers? Registering an alternate cc with the caretaker is of course tricky as one cannot know which card will be used.

I dunno, but that is a good question I'll be sure to ask them next time I'm in contact. Which will undoubtedly be soon.