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Message started by saxman on Dec 29th, 2009 at 3:07am

Title: unfair health care system hits home
Post by saxman on Dec 29th, 2009 at 3:07am
A few months ago I was offered a management position (a move up for me from sales) at a new company. The package that I accepted included a 6 month waiting period before being eligible for their health plan. My cycle started 2 months in.

I left behind my health coverage from previous job. I do take responsibility for not continuing it with cobra, but the costs in my case were roughly a 600% increase in premiums.

What is hitting home to me now is the inhumanity of a system that faced with two identical CH patients with K10 hits, one with means and the other without; that their horrible pain would be dealt with differently.

The cher with means, gets imitrex for example, with relief in minutes where the cher without can't afford imitrex and has to substitute cheaper meds that result in being in pain longer and more often.

Am I a commie now to think that when it comes to pain, wealthy or poor, insured or not, whatever technology might exist to ease suffering should be available equally and without  prejudice!!

This notion, when thought of in terms of one isolated hit, doesn't seem to me so awful, but this inequity must exist now, right here in the US(in my case), for many CHers entire lives!!

I'm imagining the two sufferers on you tube with their k10s being treated with different meds while standing next to each other. The well dressed one showing relief in a few minutes, while the other in shabby clothes, treated with a cheaper less effective med, squirms and moans in agony for  another 30 minutes.

Just a thought


Title: Re: unfair health care system hits home
Post by seaworthy on Dec 29th, 2009 at 6:21am

Quote:
The well dressed one showing relief in a few minutes, while the other in shabby clothes, treated with a cheaper less effective med, squirms and moans in agony for  another 30 minutes.


In Massachusetts the exact opposite scenerio may be true.

Title: Re: unfair health care system hits home
Post by Brew on Dec 29th, 2009 at 8:51am
Eat some seeds and get yourself a big ol' welder's bottle of O2. Cheaper than most co-pays.

Title: Re: unfair health care system hits home
Post by Charlie on Dec 29th, 2009 at 11:21am
It's what we are stuck with in this country that worships fee for service, rather than results. We're stuck with blackmailing doctors forcing unnecessary expensive appointments to write refills. It's borderline criminal. They tell us that it's because they can help more people....sure. No better way has been found to make medicine like your electric bill.

For now, you have to wait for Medicare or the demise of the medicine for profit system here.

Charlie  >:(

Title: Re: unfair health care system hits home
Post by Callico on Dec 29th, 2009 at 4:07pm
As one who went without insurance for over twenty years and learned to deal with the issue on my own I note that YOU made the choice.  You chose to take the new job knowing you would be without coverage for 6 months unless you were willing to cover COBRA.  While I feel for your pain I don't have much sympathy for your suffering.  Sorry, but I don't think it is my responsibility to pick up the cost for your health care when you made the choice to forego the coverage.  (BTW, I had CH for all of the years I was without ins, 5 of them as a chronic.)

Jerry

Title: Re: unfair health care system hits home
Post by Callico on Dec 29th, 2009 at 4:23pm
On rethinking my last post I felt I may have come across as uncaring.  That is not the case, and I hope you didn't take it as so.  I really do care about your health and your pain, I just have trouble with a mentallity that has been fostered in this country in the last few years that it is the government's responsibility to care for us.

As Brew suggested get the O2.  In the meantime, grab some energy drinks and slam one down as quickly as you can drink it at the very first sign of a hit.  I can usually abort within 5-8 mins if I get to it early on.  It will knock it down to a manageable level at least if it gets a hold on me before getting the drink down.  My personal preference is 5Hr Energy because it is small and I don't have to chug down 16 oz, plus it doesn't tear up my stomach as badly.  It also contains B complex that helps keep my nerves in check and settles down the irritability that comes along with CH.

As a preventative you might want to try using Kudzu.  You can get it at Health Food stores that specialize in organics, or you can find it online.  I have been buying mine from Swanson's online because of the price differential and have been impressed with their service.  I find it works as well as did Verap and Lithium and without the side effects.

Jerry

Title: Re: unfair health care system hits home
Post by Brew on Dec 29th, 2009 at 4:36pm
And the title of your post keeps making me think of the phrase, "Fair is a ball that lands between two white lines."

If you extrapolate, life itself isn't fair. Once you embrace that concept, it's much easier to get along.

Title: Re: unfair health care system hits home
Post by Kilroy 2.0 on Dec 29th, 2009 at 8:20pm
Couple of facts: There are over 1500 insurance companies in the United States. As a citizen of any given state you personal with out know which state have on average access to maybe 5 of these companies. Which by the way is why your cobra is so expensive.

If we were to not only DEREGULATE but put a stop to ALL of the State mandates you would be able to afford your insurance all by yourself. You would not need your employer or your government to pay for it.

;D

Title: Re: unfair health care system hits home
Post by Callico on Dec 29th, 2009 at 8:24pm
Gena,

You are right on the money there!  That is what we need instead of the government getting further into running our lives.

Jerry

Title: Re: unfair health care system hits home
Post by Charlie on Dec 29th, 2009 at 8:53pm
As much as I appreciate Libertarian ideas surrounding medicine...and it sounds great, I'm not about to let children and poor people die to preserve the American bootstrap esthetic. 

Insurance companies are evil as are drug companies. They are not on our side. There is nowhere near enough regulation. Making big money on medicine should be as hard as it is for us to get serious care.

Charlie

Title: Re: unfair health care system hits home
Post by Marc on Dec 29th, 2009 at 9:06pm
I'm 56 years old and in good health with the exception of 13 years of being chronic. With the exception of seeing my Neuro ONCE in 18 months - no doctor visits.

I lost a great paying job in January of this year so I've been making COBRA payments all year. When it timed out, I applied at the SAME insurance company I've been with for over 9 years (employed and COBRA time periods) for a catastrophic plan with a $5K deductible. Guess what - they won't take me because of "your headaches."

Going through O2 at record rates without my girl Vera Calan now and no Zomig NS for the occasional midnight monsters.

Looks like it's back to COBRA at twice what my mortgage payment is, if I don't want to run barefoot.

Marc

Title: Re: unfair health care system hits home
Post by Skyhawk5 on Dec 29th, 2009 at 9:14pm
Marc, if you were covered under the Cobra when you applied for new coverage it is illegal for an insurance co. to deny coverage for pre-existing.

Hope this helps, Don

Title: Re: unfair health care system hits home
Post by Marc on Dec 29th, 2009 at 10:04pm
Don, to be clear.

I am covered under Cobra. I applied for a new individual policy for which I was rejected.

I believe your reference is for new group coverage.

Title: Re: unfair health care system hits home
Post by Skyhawk5 on Dec 29th, 2009 at 11:17pm
I'll have to ask the wife about that. That is her job. I know it's under the HIPPA rules. She's the expert though, and she's asleep.

Don

Title: Re: unfair health care system hits home
Post by Brew on Dec 29th, 2009 at 11:47pm
Well wake her up, dammit! This is important stuff!

Just kidding. She Who Must Be Obeyed must also not be disturbed.

Title: Re: unfair health care system hits home
Post by -johnny- on Dec 29th, 2009 at 11:51pm

Brew wrote on Dec 29th, 2009 at 8:51am:
Eat some seeds and get yourself a big ol' welder's bottle of O2. Cheaper than most co-pays.


i second that. being in that much pain and not having insurance you learn these things. i just now got insurance and i'll still revert back to the methods i learned back then. 

i remember jonny once told somebody on the board " you dont need no stinking doctor"

Title: Re: unfair health care system hits home
Post by Kilroy 2.0 on Dec 30th, 2009 at 12:20am
I reread my post I could not find where I thought babies and old people should be left to die!

I know that now days it is the thing to blame big business for everything but please. Think for just one moment. Right now if you only have access to 5 competing companies for your business and in some states that is being GENEROUS. They are setting the prices high because they can.

Now if you could cross state lines and they had to compete with all 1500 companies across the USA DO YOU NOT THINK PRICES WOULD DROP!!!!!

That is simple economics!

Title: Re: unfair health care system hits home
Post by Donna_D. on Dec 30th, 2009 at 2:00am

Marc wrote on Dec 29th, 2009 at 10:04pm:
Don, to be clear.

I am covered under Cobra. I applied for a new individual policy for which I was rejected.

I believe your reference is for new group coverage.


The rules don't apply for individual policies. 

Marc, when your COBRA runs out you may want to check out START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or RegisterEND PRINTPAGE; There is even a link to get assistance on your COBRA payments if your job loss was involuntary.

Hope it helps.

DD

Title: Re: unfair health care system hits home
Post by Bob P on Dec 30th, 2009 at 6:38am

Quote:
Couple of facts: There are over 1500 insurance companies in the United States. As a citizen of any given state you personal with out know which state have on average access to maybe 5 of these companies. Which by the way is why your cobra is so expensive.

I wonder if this is because of Govt. regulation or do the insurance companies choose this to avoid Govt. regulation (Congress has the power to regulate commerce among the states but can they regulate you if you don't go accross state lines).

Insurance companies only have a 3.4% profit margin.  Hospital landlords have a 24% profit margin.  I think Congress has brainwashed us into making the insurance companies the badguys!

Title: Re: unfair health care system hits home
Post by Kevin_M on Dec 30th, 2009 at 6:55am

Marc wrote on Dec 29th, 2009 at 9:06pm:
I've been making COBRA payments all year. When it timed out, I applied at the SAME insurance company I've been with for over 9 years (employed and COBRA time periods) for a catastrophic plan with a $5K deductible. Guess what - they won't take me because of "your headaches."


Same here, Marc.  Paid the full 18 months allowed on COBRA and then applied for an individual policy.  Rejected, they covered me for seven years (plus 18 months COBRA) under a company's group coverage. 
  It was surprising, when COBRA ended, I had requested a "certificate of prior coverage", which states a right to individual health coverage under HIPAA, I'm eligible without a preexisting condition exclusion if I've had coverage for at least 18 months without a break in coverage of 63 days or more, which I made sure happened, a copy of the certificate was mailed with my application.
Nonetheless, rejected.  Fortunately coverage began from my new job soonafter.

I took my present job knowing insurance would be granted in the future and in the meantime paid COBRA.  Getting a job was the MAIN challenge, I thought it not a problem getting an individual policy until insurance would be granted at my first evaluation.  Nope.


Title: Re: unfair health care system hits home
Post by Marc on Dec 30th, 2009 at 8:11am
Yeah, I was a bit surprised. I was only trying to get catastrophic coverage with a $5K deductible - and I wouldn't care if they excluded CH's.

Donna, yep - I saw the pool and may have to go that way. Looks like I have until June/July.

My wife and I started a new small company after I realized that nobody loved me out in the job market, so I'm going to explore the small company co-op insurance group market next.

Marc

Title: Re: unfair health care system hits home
Post by saxman on Dec 30th, 2009 at 8:54am

saxman wrote on Dec 29th, 2009 at 3:07am:
A few months ago I was offered a management position (a move up for me from sales) at a new company. The package that I accepted included a 6 month waiting period before being eligible for their health plan. My cycle started 2 months in.

I left behind my health coverage from previous job. I do take responsibility for not continuing it with cobra, but the costs in my case were roughly a 600% increase in premiums.

What is hitting home to me now is the inhumanity of a system that faced with two identical CH patients with K10 hits, one with means and the other without; that their horrible pain would be dealt with differently.

The cher with means, gets imitrex for example, with relief in minutes where the cher without can't afford imitrex and has to substitute cheaper meds that result in being in pain longer and more often.

Am I a commie now to think that when it comes to pain, wealthy or poor, insured or not, whatever technology might exist to ease suffering should be available equally and without  prejudice!!

This notion, when thought of in terms of one isolated hit, doesn't seem to me so awful, but this inequity must exist now, right here in the US(in my case), for many CHers entire lives!!

I'm imagining the two sufferers on you tube with their k10s being treated with different meds while standing next to each other. The well dressed one showing relief in a few minutes, while the other in shabby clothes, treated with a cheaper less effective med, squirms and moans in agony for  another 30 minutes.

Just a thought

Callico? You hope I didn't think you uncaring? (I'm not sure how do the the quote thing, but I think your quote was " I'm not sympathetic") I did read your next post as well.

I thought my language " I take responsibility" would have been clear enough to indicate that I wasn't seeking a handout, rather my post was intended to make the point that there were probably folks out there, that for whatever financial reasons were being prescribed less expensive, less effective treatments resulting in more hits!!!
This seems inhumane to me, regardless of politics.

As far as you paying for my health care is concerned; just know that if you were standing next to me and we were both being hit, I would share my abortive with you.

Title: Re: unfair health care system hits home
Post by deltadarlin on Dec 30th, 2009 at 11:25am

Bob P wrote on Dec 30th, 2009 at 6:38am:

Quote:
Couple of facts: There are over 1500 insurance companies in the United States. As a citizen of any given state you personal with out know which state have on average access to maybe 5 of these companies. Which by the way is why your cobra is so expensive.

I wonder if this is because of Govt. regulation or do the insurance companies choose this to avoid Govt. regulation (Congress has the power to regulate commerce among the states but can they regulate you if you don't go accross state lines).

Insurance companies only have a 3.4% profit margin.  Hospital landlords have a 24% profit margin.  I think Congress has brainwashed us into making the insurance companies the badguys!


Bob,
I agree wholeheartedly with you about the profit margins.   Most insurance companies are not showing that large of a profit margin, so they can't be as *ebil* as people paint them to be.

I do think there has to be a better solution than the one offered by Congress, I just can't tell you what it is.

Title: Re: unfair health care system hits home
Post by Callico on Dec 30th, 2009 at 2:11pm
Saxman,

It all boils down to who pays for it.  You said if I was standing next to you and got hit you would share your abortive with me.  As would I, and I have, and will continue to do so.  The difference is I choose to do so because i see a need, not because the government comes and reaches into my wallet and takes it from me to give to someone else based on their concept of need.

I have never used imitrex.  Couldn't afford it, and now even with insurance can't afford the copay.  I've had to learn to deal with it anyway.  Because of that I had to do some research on my own and find methods that were far less expensive, and as effective (from what I hear from those using trex), and don't cause rebounds or extend cycles.  i was offered trex at the first Davcon when I got hit and turned it down because I didn't want to take it once and then feel sorry for myself because I couldn't get it in the future.  I learned to cope.

Are there inequities in the system?  Yes there are, but as President Kennedy said, (one of the very few things I agreed with him on) "Life is not fair".  My experience has been though that many of the inequities we complain about are brought about by choices we have made in the past.  My current financial condition is a result of choices I made when younger.  Some of them foolish and some of them business decisions that didn't go the way I wanted them to go.  Should someone come along now and make things equal for me?  I would not have it that way.  I made the choices, now I reap the results.  My having to deal with the results of my choices in the past has made me a much better person than if I had not had those failures that put me where I am. 

To put it in context my quote was "While I feel for your pain I don't have much sympathy for your suffering".  I stand by that.  If we were close by I would do what I could to alleviate your pain (as do many here.  you wouldn't believe the care packages that go around.) but the suffering because of allowing insurance to lapse was a matter of choice on your end.  We all make choices.  We all live with the results.  My grandmother used to tell me, "You've made your bed hard, now you have to lie in it."

Jerry

Title: Re: unfair health care system hits home
Post by Charlie on Dec 30th, 2009 at 8:03pm

Quote:
Bob,
I agree wholeheartedly with you about the profit margins.   Most insurance companies are not showing that large of a profit margin, so they can't be as *ebil* as people paint them to be.


They're worse!

Charlie

Title: Re: unfair health care system hits home
Post by saxman on Dec 30th, 2009 at 9:28pm
Callico, I think you and I really are on the same page! Believe me I kick myself now for not doing the Cobra!!!
What happens with me is that in between cycles(I actually skipped a year last year to boot) I go into denial and assume there gone forever.

I won't be making that mistake again.

Maybe someday

Title: Re: unfair health care system hits home
Post by Racer1_NC on Dec 30th, 2009 at 9:38pm

saxman wrote on Dec 30th, 2009 at 9:28pm:
What happens with me is that in between cycles(I actually skipped a year last year to boot) I go into denial and assume there gone forever.

That means you are normal.

Title: Re: unfair health care system hits home
Post by saxman on Dec 30th, 2009 at 10:02pm
no one ever called me normal before, I can't wait to tell my daughters the great news!!!

Title: Re: unfair health care system hits home
Post by Linda_Howell on Dec 30th, 2009 at 11:33pm
LMAO @ you Saxman.   ;D 

Title: Re: unfair health care system hits home
Post by Callico on Dec 31st, 2009 at 12:07am
I refuse to be normal!  Normal is only average!

I'll know mine are gone when the first shovelfull of dirt hits me in the face.  Till then, even if I go back to episodic I'll always be looking over my shoulder for the beast.

When you do get insurance back again and you get back onto the meds and the cycle ends I would suggest you stockpile for a while to be sure you don't get caught short again. 

Be proactive.  Educate yourself on other means of dealing with this stuff.  It can be done.  I went totally med free for several years.  Easy?  No, but doable.  In a lot of ways I think I was actually better off than when I was doing a lot of the meds.  I felt better overall.  Now I don't use any prescription meds other than oxygen, and if I didn't have that covered I'd get it on my own for less than copays on any of the other meds I used to be on. 

As my History prof always used to say just before an exam, "This, too, shall end."  You'll make it.  You are a clusterhead, and there is no tougher creature on this earth.  Sometimes we get knocked down and dusty, but as Ed Brown says in his motivational speeches, "When you get knocked down land on your back, cause if you can look up, you can get up."

Jerry

Title: Re: unfair health care system hits home
Post by saxman on Dec 31st, 2009 at 2:05am
thanks for the pep talk Callico. I came home from work, got hit on the drive home! a real k10!!!The first hit in several days out of the blue. I guess the pred taper is finally wearing off.
I hit the rockstar, and ice, Wow!!! I had the computer on and read your post as the hit lessened and it really did  help! It helped me fight back!! Somehow for me, as long as I keep mentally fighting back, not giving up, I can get through even the worst one. Tremendous help having allies on this site that I know are fighting there fight too!
Ahhh !! just about completely gone now

Title: Re: unfair health care system hits home
Post by saxman on Dec 31st, 2009 at 7:26am
believe it or not? whats lmao?

Title: Re: unfair health care system hits home
Post by Brew on Dec 31st, 2009 at 8:40am
Laughing
My
A$$
Off

LMAO

Title: Re: unfair health care system hits home
Post by deltadarlin on Dec 31st, 2009 at 10:30am

Charlie wrote on Dec 30th, 2009 at 8:03pm:

Quote:
Bob,
I agree wholeheartedly with you about the profit margins.   Most insurance companies are not showing that large of a profit margin, so they can't be as *ebil* as people paint them to be.


They're worse!

Charlie



Damn, Charlie!  What do *you* have against insurance companies?   

FWIW, our insurance thorugh the state is extremely good.  I've never had any problem with them denying any procedure, nor have they ever denied any form of treatment.   We're under a PPO, so I can pretty much go to any doctor I want.  When our neuro/headache specialist was located in Jackson MS, we were able to go there and the insurance picked up the costs with no problem.

Title: Re: unfair health care system hits home
Post by loopy on Dec 31st, 2009 at 12:38pm
Charlie loathes the insurance companies because they are in business to make a profit.  They should not be allowed to profit from giving you such great service.

They use a shared risk model, where they hope that they collect enough in premiums to cover the charges they will get from their customers medical providers.

hmm...

- they don't control what doctors and hospitals charge
- they don't control what sicknesses or injuries you might sustain
- they do have enormous buying power, so they can negotiate rates down to save you money
- if they make a bad risk, they have to pay anyway
- if they make a profit, it goes to their shareholders
- nobody forces you to do business with them (oh wait...that is going to change, thank God for hope & change)

Such an evil system.  Thank God the government is going to fix all of this.

Last I remember, Charlie's income is entirely provided by insurance (disability).  Damn insurance companies.  Get a rope.

Title: Re: unfair health care system hits home
Post by Charlie on Dec 31st, 2009 at 4:51pm
They kill people every day.

Charlie

Title: Re: unfair health care system hits home
Post by Brew on Dec 31st, 2009 at 5:57pm
Compared to how many who continue to live with their assistance?

Weak argument.

Title: Re: unfair health care system hits home
Post by deltadarlin on Dec 31st, 2009 at 7:43pm

Charlie wrote on Dec 31st, 2009 at 4:51pm:
They kill people every day.

Charlie


So, do you hate doctors, hospitals, cars, guns, natural disasters, and humankind in general?

Title: Re: unfair health care system hits home
Post by loopy on Dec 31st, 2009 at 8:32pm

deltadarlin wrote on Dec 31st, 2009 at 7:43pm:

Charlie wrote on Dec 31st, 2009 at 4:51pm:
They kill people every day.

Charlie


So, do you hate doctors, hospitals, cars, guns, natural disasters, and humankind in general?


Don't forget Oxygen, Imitrex and most triptans.  All have killed.  Oxygen kills every day (you can't have fires without it).



Title: Re: unfair health care system hits home
Post by jon019 on Dec 31st, 2009 at 10:51pm
I'll let you deduce what I think of health insurance companies:

For 25 years, mine (2 different co) would not cover O2. Me: why not? Them:...we don't approve it for THAT condition. Me: But why not? Them: BECAUSE we don't. Me: DON'T you have a reason?.....Them: click......

For 25 years, they would only approve "6" triptan doses per month. Me: why? Them: You can't be having that many MIGRAINES. Me: It's clusterheadache...not migraine. Them: Huh? Me: It's different! Them: We only cover 6 for migraines. Me: Haven't you been listening? Them: Yeah, migraines. Me: NO....clusterheadache! Them: ....click....

I no longer bother to call "them"...it's too stressful. I have been LIED to...given WRONG information...blown off...or just ignored. I now go through the broker....used to work great....the current one couldn't care less....he WILL regret that.

Will they eventually cover darn near anything?..yup...but reluctantly...and ONLY IF you know how to play the game. I learned...mostly HERE (ch.com)....and THAT is friggin SAD. I despair at the thought of those who have given up....and I FIRMLY believe that is the strategy...make it SO hard....most WILL give up. Give up on what they NEED...because ya can't fight city hall, right? WRONG! Not this cowboy.

So, that all is ch...enough of a battle as you all know. But now, I am dealing with cancer....frightfully common...you'd figure well, they can't mess with you on that, right? Wrong! I'm currently in a fight for coverage of a procedure that is ABSOLUTELY state of the care....I know...have researched it...and they are refusing to cover (nearly $4000). ANOTHER battle...and I grow weary...

During this I was offered "managed care"...for FREE... for those with chronic conditions. Initially I thought....GREAT....my own nurse contact with promises to manage my care for the best outcome...lead me throught the maze of treatment options...hold my friggin hand (we're ALL little boys when we're sick doncha know). Great...just great! ONLY, I read the fine print....seems if I signed up...THEY would decide what is the apppropriate treatment (not the doc)...they would decide who I could see and when...they would decide EVERYTHING.....If I chose a path, a doc, a treatment, a whatever they didn't approve of...well then...NO coverage for ANY costs. I couldn't wait NOT to sign up..........

If you are healthy...the health insurance companies love you...my best advice.... DON'T get sick (yeah, right). I ONCE made the mistake of feeling sorry for my insurance company....it won't happen again.

Are health insurance companies the ultimate evil empire? Nope...they are just eating at the same banquet (with sauce smeared on the face). My personal belief is that they build those profits on the backs and bodies of their "clients" (that's a joke son) rather than working to correct the disfunctional system...which is...the medical service costs which are just friggin STAGGERING...and I consider the MAJOR problem....

I live in DAILY fear of losing my job...with my condition(s) it could happen any day, as I am not performing to past practice after all....and I KNOW, with PRE-EXISTING conditions, I will NOT be able to get coverage...and the savings I have so diligently accumulated...so I would NOT be a "burden" on society, will be gone, gone, gone...and crying won't bring them back.....

The new "Health Care Bill" is so confusing I cannot begin to comprehend....what I do percieve is that it goes into effect 3-5 years from now....I don't expect to be here then.....

Jon


Title: Re: unfair health care system hits home
Post by Charlie on Jan 1st, 2010 at 11:56am

Quote:
Compared to how many who continue to live with their assistance?


Reminds me of the old argument that because the percentage of murders in a small country is higher than in a large country means something other than percentage. There are still a lot of dead people no matter the statistic.

Denying treatment to their own insured customers when it starts hurting balance sheets is inhumane and it happens all the time. Shame on us for allowing it. Fine, make money but do it with a conscience. Using health care to demonstrate the American self reliance ethic is ugly.

Charlie


Title: Re: unfair health care system hits home
Post by Callico on Jan 1st, 2010 at 4:05pm
When dealing with ins companies about denial of coverage always go to a supervisor at the very beginning, and then on to a manager if necessary.  Those answering the phones are given a very rudimentary training on the different types of policies, and rarely know enough to make an educated guess let alone analysis of your situation.  They also are held responsible for anything they approve without proper authority, hence it is easier to say "no" and not dig deeper into YOUR situation unless you read the specific verbiage from your own policy.  The fault lies at the feet of the insurance company's lack of training of those representing them much more than on the policies of the companies.  The turnover rate of those answering the phones is so high it is virtually impossible to keep the training at a high enough level.

Jerry

Title: Re: unfair health care system hits home
Post by jon019 on Jan 1st, 2010 at 5:28pm

Callico wrote on Jan 1st, 2010 at 4:05pm:
When dealing with ins companies about denial of coverage always go to a supervisor at the very beginning, and then on to a manager if necessary.  Those answering the phones are given a very rudimentary training on the different types of policies, and rarely know enough to make an educated guess let alone analysis of your situation.  They also are held responsible for anything they approve without proper authority, hence it is easier to say "no" and not dig deeper into YOUR situation unless you read the specific verbiage from your own policy.  The fault lies at the feet of the insurance company's lack of training of those representing them much more than on the policies of the companies.  The turnover rate of those answering the phones is so high it is virtually impossible to keep the training at a high enough level.

Jerry


Yup....ABSOLUTELY golden advice...I now know how to play the "game". Without a full rehash (see archives) this is what I've learned. Hope your experiences are better...I'm bitter.....

I work in a service industry. If we treated people like I have been treated...we wouldn't be in business....and I'm not just talking about drones on the phone...

Don't consider yourself a customer...you are not...you are an adversary...act accordingly.

Move up the chain of command at every opportunity...take names and numbers of everyone you talk to...make notes on what is said to you....keep a log.

Put everything in writing...collect every piece of paper. Denials? Fine....dispute them...get a written reply.

Get your doc in your corner. Don't leave interpretation up to the insurance company. In my case, the doc got pissed and wrote a VERY specific letter...with unequivocal statements, demands, and instructions to call if they STILL didn't understand. The insurance company HATES this because it creates a paper trail...one not open to interpretation..one that would bury them in front of a judge.

If your insurance is purchased for your company through a broker...get them on your side too. The broker IS the insurance company customer (you aint)...and they can get stuff done that will put your mind in a spin. If the broker won't respond to you...get the HR dept involved...no HR...get the owner to hammer on them. He who pays the money gets the voice.

NEVER NEVER NEVER give up...that's the strategy...they want you to....dogged determination frustrates their strategy...it can only help when they just want you off ther backs.

SIGH...I don't like being bitter...it's not me...and they did that. I'm not expecting altruism...I don't begrudge profits...but I detect no conscience or soul...it's ALL about money....and in this business...with health and lives at stake...it's GOTTA be more than that.

jon

Title: Re: unfair health care system hits home
Post by saxman on Jan 1st, 2010 at 9:10pm
someone told me once that at Dental school the future dentists practice that God awful novacaine shot to the roof of the mouth on each other.

I wish Drs. and ins co mgmt types could suffer a 5 min K10 as part of there training

Title: Re: unfair health care system hits home
Post by Charlie on Jan 2nd, 2010 at 1:16pm
Some good posts kids!

Time for another rant topic....

Charlie

Title: Re: unfair health care system hits home
Post by Brew on Jan 2nd, 2010 at 1:48pm

saxman wrote on Jan 1st, 2010 at 9:10pm:
I wish Drs. and ins co mgmt types could suffer a 5 min K10 as part of there training

That's just cruel.

Title: Re: unfair health care system hits home
Post by Charlie on Jan 2nd, 2010 at 9:05pm

Quote:
That's just cruel.


It sure is but..................

Charlie

Title: Re: unfair health care system hits home
Post by Brew on Jan 3rd, 2010 at 12:30am
But what? It's cruel.

Title: Re: unfair health care system hits home
Post by Kirk on Jan 3rd, 2010 at 6:37pm

Charlie wrote on Jan 2nd, 2010 at 9:05pm:

Quote:
That's just cruel.


It sure is but..................

Charlie


   But nothing, it is cruel.

Title: Re: unfair health care system hits home
Post by saxman on Jan 23rd, 2010 at 3:45am
I don't think my thought was cruel. Ithink that if my wish was for the Drs to suffer gratuitously then perhaps. I do not wishthem any pain but rather to be educated and to understand.

I'm in sales and very sensitive to what isn't said. I've (we've all) sensed Drs trivializing our condition. Even when being hit, many of these professionals are still categorizing us  headache (migraine/tension) people.

The result: They under prescribe, they under everything!! They wouldn't if they had felt the pain themselves.

I hate cruel.

Title: Re: unfair health care system hits home
Post by Batch on Jan 23rd, 2010 at 9:33am
Congratulations to all the participants in this post!  Without a doubt, it's clearly one of the best I've had the pleasure of reading since I started coming here not long after DJ started this site.  You've addressed a topic that’s central to why we are drawn to this forum, we're all touched one way or another by the same orphan disorder, cluster headaches. 

More importantly, your posts are well thought out and they remain focused on the issues rather than who raised them.  As such, it serves as an excellent example of how to address the many problems we all face. 

Accordingly, I think this thread needs to be moved up in the sticky section so more members and guests have the opportunity to read through it as a ready reference on an important topic.  Bill, Linda, I think you've the permissions to make this happen.

Take care,

V/R, Batch

Title: Re: unfair health care system hits home
Post by Charlie on Jan 23rd, 2010 at 12:24pm
I'll tell you what's cruel!

Getting old enough that all your doctors are the age of your kids. It's depressing and I tell people that my 28 year-old doctor is too young to have experienced any pain. OUCH.

Charlie

Title: Re: unfair health care system hits home
Post by Brew on Jan 23rd, 2010 at 12:37pm
When I picked my GP over 20 years ago, one of the top criteria was that he be about the same age as me. That way we can grow old together, and he can never blame any of my ailments on old age.

Title: Re: unfair health care system hits home
Post by Linda_Howell on Jan 23rd, 2010 at 5:18pm

Quote:
Bill, Linda, I think you've the permissions to make this happen.


Yes we do.  However the administrators and moderators do not think this is worth of being stickied.

Title: Re: unfair health care system hits home
Post by saxman on Jan 26th, 2010 at 3:56am
I really think the idea of re-naming the condition (with the new name not including the word "headache") could help with alot of our issues!
Kips syndome
trigeminal something or other

Title: Re: unfair health care system hits home
Post by Brew on Jan 26th, 2010 at 7:54am

saxman wrote on Jan 26th, 2010 at 3:56am:
I really think the idea of re-naming the condition (with the new name not including the word "headache") could help with alot of our issues!
Kips syndome
trigeminal something or other

How do you suggest that would come about? When a colloquial phrase catches on, then experts decide to identify the condition with that common term, it would do more harm than good to try to give it a new name.

How many people do you think might start searching on the internet for "Kip's Syndrome?" And should we rename this website kipssyndrome.com? You can see where I'm going. Far fewer people would get the help they need.

It would be like me changing my name at the age of 40 and then wondering why nobody ever calls or writes me anymore.

Title: Re: unfair health care system hits home
Post by Charlie on Jan 26th, 2010 at 6:08pm
Yeah....it's too late to rename the thing nor is it all bad. At least "headache" gets people to stop, look and listen...most of the time anyway.

Charlie

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