Since the early 80’s, I have been involved with healthcare first hand living it daily by collecting from insurance companies as well as patients. There are many stories that have haunted me and still breaks my heart to know that this was what I did for a living. I always in the back of my mind, thought what a good actor I was, for from 8:00 to 4:30 this was my acting job. I played out the bad person asking for money from sick people. I was good at it, but hated it.
When it comes time for healthcare, I have been there and done that. Going back, I have experienced that it was not so bad in the early 80’s having insurance. My husband, Dan worked and so did I. We both carried healthcare on ourselves as while as each other. He paid bi-weekly a premium and I as well. When health issues came up and the primary insurance would not cover; such as the deductible or co-insurance, the other would pick up the balance. Life was not so complicated back then. Once the managed care and HMO’s took over, it was not possible to take out coverage to correlate the primary insurance with a secondary coverage. Perhaps, we need to change the types of plans that are out there!!
Most people do not know, if the primary insurance covers more or the same as the secondary would, then no payment would be paid by the secondary. So why would you take out a secondary insurance and pay the premium when they will not cover anything? The same goes if both parents take out coverage for their child. First, the child’s birthday would depend on who’s primary coverage it would be. Most likely you would think it would be the father’s (NOT) and if both have insurance only the primary coverage would most likely pay.
Healthcare will only cover certain items and procedures, you pay into coverage then later realize that they will not pay for certain blood work or as such. Also, most insurances require that you have to follow stages. For example, if you have a lump in the breast first you are required to have a mammogram, second a sonogram, third an MRI, surgery, Chemo, and radiation. Since I did not have the surgery required for breast cancer and I decided to do other medical treatments, they refused to pay for treatment. Is this fair, I have been paying into this insurance for over 25 years, but when I really needed the coverage it was a no-pay. We also need to research before taking out insurance from your place of work. We need to see if they are self-insured. They may use an insurance company like United Health Care as just an administrator.
Yes, there has to be a change in the healthcare, but we must all understand that it may not cover certain treatments and items. Again, such as if there is a hospital that is on your hospital plan and covers admission; however, during that stay you have some lab work or even a cat scan. The radiation department and lab department is contracted out, then the insurance may not cover them. The reason; because those departments are not part of your plan. This is also sometimes the case of ER doctors or anesthesia doctor charges.
I would like to see a change in the direction, where the deductibles are a little lower then 2,00.00 to 5,000.00 and both partners have coverage on one another, then the second insurance picks up of what the primary insurance does not. Second, that it should be our choice with what doctors advise us to make and what treatments should be given and not the insurance companies. Third, you should be able to choose your doctor and your insurance company that honors the physician fee’s. Fourth, more insurances should cover holistic procedures. Fifth, the insurance companies should not just rely on the procedure codes for the primary diagnosis, but on the individual person and what exactly was done.
For example, Dan my husband in 2007 -2008 before Obama took office, had a heart attack when he had a couple blockages and was required to have three stents. Since the procedure of stents was considered as an outpatient charge, he was discharged and later scheduled for the procedure of having the stent. We had at the time United Health Care, which our deductible and co-insurance equaled to be $500 dollars. The following year, not more than three months later Dan was scheduled for another stent. Now this is near when Obama took office and when we received a bill my eyes became as big as a quarter. While this political change in office took place, the doctors sold the heart facility back to the hospital. Well, if you did not know already this meant that the procedure codes of the facility changed and the stents were now under the hospital. The deductible and co insurance should have been the same, but nope it went up from $500.00 to 5,000.00. I did not know this until after the procedure and had to ask our doctor. This has to stop!!!! There should be the same contract agreement with all insurance companies and allow the same amount across the board. It’s not fair if I have United Health and you have Aetna, both of our co insurance is 80% and you pay more only because of the agreement between the facility and the insurance company.
Being in the inside looking out, the health care has been troubling me. The stress of knowing for many years what patients had to go through with these issues, and also having to figure out financially if they can have surgery or not. There are a lot of facilities that are private and will not take you if you do not go along with the financial program of paying on their terms.
Health Care is a business, we should understand this first and then change the concept to treating the individual person. We have to consider the pro’s and the con’s and remember we should not be a number, but a flesh and blood human being.
So, to Congress – we are not robots, we are flesh and blood humans!! We need to be treated as such. Give us a break for without us you would not be where you are today.