Our Major hospital and BCBS in dispute....Hospital stating that they wont accept BCBS after 1/12/12...yikes..I have them as a secondary
insurance and they cover everything Medicare doesnt...have been great with all my testing, etc, Rituxan treatments. I only pay around $120.00 a month which is a bargain.
Just wanted to know what other health insurance you guys have an like...you guys are the best experts, since we use them alot? ha ha.
I heard Mutual of Omaha is good?????? decisions, decisions. I guess at least I have the option to change before the end of this year.
thanks guys!
Gursie
I have to ask what state you are in. Almost sounds like Minnesota. I was just to a BCBS medicare insurance meeting a couple of weeks ago and I think I know what plan you are talking about. I think it is the Choice plan. Correct.
Man, I don't know what to tell you as the BCBS is really a good plan. Do you have Medica in your state??? Over the years they have been similar to BCBS although I found them a little more controlling that the BCBS.
My insurance agent had done a study on the various insurance out there but the one that was similar to BCBS was about 20$ a month more.
Have you ever tried doing a search for insurance companies in your state. Use words like supplemental medicare insurance companies and put your states initials at the end of this phrase.
Also another phrase you could do is list health insurance companies and your states initials.
Once you have the choices come up you will find a lot of insurance companies and what they cover plus you will see which ones offer a supplemental to medicare. Life is really the pits with the insurance companies.
In MN the Mayo clinic will not take BCBS---the clinic in Rochester. If you go to the hospitals/clinics in the outlying areas of the state owned by Mayo the BCBS will work. Mayo-Rochester has had this policy off and on for many years. For some reason the BCBS doesn't enjoy paying the 300$ more that Rochester charges over other medical facilities for a cat scan. The Mayo Clinic in Rochester is notorius for charging humongus amounts as they think that they are better than every place else and deserve to charge more. I have never figured that one out. I wish someone would do a study on what John Hopkins or Cleveland Clinic charge.
Also, when you see a medical facility that has all the fancy-pancy furniture/buildings,etc one can assume that they probably charge more to pay for the fancy stuff. Just look at some of the educational settings for clinics and hospitals sometimes. Great medical care much of the time and the most run down buildings cause the colleges can't afford all the window dressing. Irish ;D
When I was at Mayo,, I thought what a beautiful place,, a person playing on a grand piano,, people bending over backwards to help you, I mean the place seemed like a mecca for healing,, and I am sure it is for some, I never saw a place where they shuttled people in every half hour,, drop you off and pick you up at your motel, its a amazing plac, and even though I was there almost two weeks,, I came away with no Dx,,
Now I cant afford to even consider getting sicker,, I lost my COBRA, am on some goofy conversion plan,, super high deducticble and no drug coverage,, theres alwys dollar store aspirin, and street corner drugs,
Insurance does vary from state to state. We tried to change our carrier last year when the premiums went up by 70%. In Wash., there's a health questionnaire you take which gives you points for every ailment you have. I flunked it even though I would say I'm pretty healthy. But Sjs gets points by itself, dry eyes, points, meibomitis, points, arthritis, points, lupus, points, etc. Flunking the test meant that no new company would accept us as clients. We had to go with a lesser coverage from our existing company - we're married to them for life I guess. Anyway, you might make sure you qualify for whatever new insurance you're thinking of changing to. And maybe it's different for insurance which is secondary to Medicare.
Anyway, eHealthInsurance.com was good resource to see what insurance companies are available in your area and what plans they offer.
Ooops...sorry guys, Im in Michigan....guess I will need to do some research. I cant go to any hospital that doesnt accept my insurance. I think by the end of the year, hoping both parties will work this out..sure they will. I cant imagine everyone cancelling their BCBS. Both parties are at fault...our entire system is just nuts!!!
Gursie
Yeah, an oh, I wont use a HMO either.. I have to have it where I can see whatever doc I prefer....I have never needed prior authorization on any of my emergency visits, or even my MRI's-CAT scans...wonderful...guess I better start praying both parties work this out!
I was trying 2 years ago to see this top neuro/headache specialist, and he didnt accept BCBS with medicare..only if I had just BCBS he would accept me..I couldnt believe it..I told him what If I paid out of pocket myself, and they said "NO" we cant see you.. I was cracking up on the phone with them...I lied and told them I had alot of cash, etc..and they said sorry and hung up. Guess I wasnt supposed to see him.
I think that is pretty unethical of them.
Gursie
The reason they wouldnt see you is then they couldnt charge you what they charge insurance companies,, its called legalized extorsion, I looked at the cost of what UPMC Presby charged for my last infusion og IVIG,, 22,000 dollars,, insurance paid almost 5,000 to settle it,, there is no reason in heck that anything should cost that much,,
Gurs, I also have Blue Cross and Medicare. I would wait right now and not make any fast changes. I know how this makes us all nervous. I haven't gotten any notices like this, at least not yet. If you, why not me? Hold on a bit and wait for more info in the mail and maybe make some phone calls to Medicare or BC.
I shall be on the lookout for something like this coming to me. I know someone younger that is disabled and is just about past the two years wait you need to get Medicare and I'm trying to keep up on this info also. Lucy
The reason the hospital/clinic charged that 22,000$ is because the health care system has been been led to blackmail ever since Medicare was voted in back in the 60's.
This is true of all of the facilities providing health care. Look at the charge for the service and then see what was allowed to be paid by the insurance company.
What it amounts to is in order to make a living the clinics/docs, etc are forced to charge an exorbitant fee because they know that what they are allowed will be so much less. We complain about the prices, but at the same time we demand good health care,
My infusion center charged over 12,000$ a month for my infusion. They get paid about 5800$ by my insurance. I have medicare and they pay aboaut 1/4 of it and my secondary provider (BCBS) pays the rest. I do not begrudge them the money. They need to hire a large staff and have to pay rent on a large infusion center and also rent on the doctors office on another floor. There is the doctor who owns the center plus a new doc who is being trained in to take over plus a PA who is very good ---salaries there to pay also.
If my infusion center billed me the 5800$ that they need they would only get paid around 2000$ the way I figured it. Not the best way to stay in business. We all complain about the charges but is cost money to run a business. My son and his wife own a business and the public are so rude to him about all the money he is making. What they don't know is that he is just eeking out a living and paying huge insurance and other costs. It is extremely expensive to keep a business going. The hidden costs are unbelievable.
I can't complain about it because I know that all the outfits doing the infusions are in the same boat. Charge huge price to get paid less. Goes for everything we have done in the medical community. Sort of really a stupid system if you ask me. Can you imagine what would happen if all the other service companies in the US would charge under the same system. Stupidity!!! Irish ;D
GURS: I can remember several times that one of the hospitals in my town would not accept BC/BS and this was before I had Medicare. They eventually settled this each time. During one of these periods, I slipped and broke my ankle at the mall and I had the sense to tell them to take me to the "other" hospital that my usual hospital wouldn't pay.
Cross fingers this will soon be settled. Lucy
I have been on medicaid while waiting on my 2 years to be up, but got notice it will run out Monday. I am sending in new info, but it won't do it, but will maybe give me 20 more days before I am cut off.
I am praying that I somehow make this for 2 years. Same thing for my husband also. Actually he is having to get a lawyer for his disability.
susanep :)
Thanks for the info...
Lucy, I read an article in our newspaper this morning, and Im confused. It says "Blue Care Network" which is different??? uhmmm
Have to check into all this...No, your right, Im not making any decisions until the final hour. I think the medicare open enrollment is only
open this year until Dec 7th..seems they changed it from Dec 31st. Its funny, both parties have huge ads in todays paper..disgusting!!!
Going to see our doc on the 7th....will send you message..
Gursie
Arghhhhhh,
Health insurance makes me crazy go nuts.
And it won't be better in my lifetime.
I know many of you don't like a single payer system, but in France everyone has national health care, doctors are paid reasonably, everyone has it.
It's simple, and I just paid cash when I went and a visit to the Primary Care doctor was 55 dollars, since I didn't have insurance for it.
The prescriptions were about 50 dollars.
And big corporations offer "add on" insurances so you can go to the most fancy private hospitals or doctors if you wish.
BY THE WAY, maternity leave is covered by national insurance, rather like unemployment insurance, and everyone had it.
The same with sick leave and family care leave.
AND all retirement like Social Security.
Well, see that's why I can't stand discussions of health care, coverage, costs, exclusions and so on.
I get on a soap box.
I may delete this as I'm sure to offend half our group.
But it just seems tragic when people don't get their needs met.
Oh, dental care isn't covered by the national plan. Which is silly, since your health depends on good dental care.
But, ..
Hugs and apologies.
Elaine
Guess im blessed to have any insurance at all......there was a time when My COBRA ran out and I basically went into
bankruptcy with my bills..
Gursie
Quote from: irish on October 29, 2011, 09:53:39 PM
The reason the hospital/clinic charged that 22,000$ is because the health care system has been been led to blackmail ever since Medicare was voted in back in the 60's.
This is true of all of the facilities providing health care. Look at the charge for the service and then see what was allowed to be paid by the insurance company.
What it amounts to is in order to make a living the clinics/docs, etc are forced to charge an exorbitant fee because they know that what they are allowed will be so much less. We complain about the prices, but at the same time we demand good health care,
My infusion center charged over 12,000$ a month for my infusion. They get paid about 5800$ by my insurance. I have medicare and they pay aboaut 1/4 of it and my secondary provider (BCBS) pays the rest. I do not begrudge them the money. They need to hire a large staff and have to pay rent on a large infusion center and also rent on the doctors office on another floor. There is the doctor who owns the center plus a new doc who is being trained in to take over plus a PA who is very good ---salaries there to pay also.
If my infusion center billed me the 5800$ that they need they would only get paid around 2000$ the way I figured it. Not the best way to stay in business. We all complain about the charges but is cost money to run a business. My son and his wife own a business and the public are so rude to him about all the money he is making. What they don't know is that he is just eeking out a living and paying huge insurance and other costs. It is extremely expensive to keep a business going. The hidden costs are unbelievable.
I can't complain about it because I know that all the outfits doing the infusions are in the same boat. Charge huge price to get paid less. Goes for everything we have done in the medical community. Sort of really a stupid system if you ask me. Can you imagine what would happen if all the other service companies in the US would charge under the same system. Stupidity!!! Irish ;D
Wont matter is they charged me a million dollars now,, I dont have any drug coverage,, I make to much on my pension and to much on my SSDI,, and my wife works full time,, so much for living the American Dream, not that I think I deserve anything more hten anyone else,, But I am willing to bet if your on welfare,, you would get IVIG if you were prescribed it,, Ya I know it cost money to run a business,, and also a infusion center, but this is just one part of why the medical system is so screwed up,, charge more and more to try and get the most amount of money they can from insrance,,, were all eeking out a living Irish,, Between me and my wife we pay 1200 a month for insurance,, I wont be eligable for medicare until Feb 2012,, and was only to keep a conversion plan becasue it covered pre existing conditions,, I asked to get a extension onmy COBRA benefits,, that was denied, so what do I do,, I worked hard, I make to much money and cant get any state or federal help, for the people who get good drug coverage,, cherish it,, once you lose it,, you will understand how bad off you really are,, bottom line is I am going to suffer retty good for a few months,, becasue I sure cant afford what they charge forsome drugs,, its either buy the drugs,, take them whileliving under a bridge or become bedridden and at least be warm when I make a mortgage payment,, again,, I wish I were in Canada or a place where the country actually cares about its citizens
It is not the all the doctors fault about the high prices for medical care. It is also the insurance companies who caught the method from the medicare system way back when.
The medical community has been forced to charge more because they won't get paid enough to stay in business. In other words, it is a vicious cycle and I am old enough to remember the 60"s and when medicare went into effect. Everybody thought it would be so great---the government would take care of us all. That is when the rules and regs started that also caused the increase in the prices.
Anytime you have government making rules and regulations to run the medical system the cost of doing business goes up. I am not trying to be a rebel rouser about this. I am just speaking from experience working in the medical community. Everytime the states and feds make more laws the medical institutions need to hire more help and cross more t's and dot more i's in order to stay afloat,
The problem is that the majority of people do not realize how restrictive all these rules and regs are. It used to be that we had to chart something in one or 2 places on the chart. This is when we had to do it by hand. Now they use the "hard copy" which was supposed to make life easier. Trouble is we now have to have the same information in 4,5,6,7,8,9,10 places which makes the need for more people to input the information. Then, what the nurses want to know is who in the heck is reading all this darn information.
Hospitals are needing to build on to make more room for "records" which are backed up on disc to save room, only it ends up that they are losing more of the info because humans inputing information to be saved is not as accurate as writing it all down. The whole thing is a mess. This is half the reason the medical care cost so much. Has nothing to do with the actual care of the patient. It is trying to keep abreast of all the rules and regs.
I would have the "state" yearly inspections to nursing homes come and follow me around while making medication pass. They watch everything you do. I made the remark one day to one of the state surveyors that it is very hard to get just one drop in a patients eye. The patients can't bend their heads, etc. Anyway, I did everything right, but because I made that one remark the nursing home had a warning written up against it with so many days to respond aboaut how to manage the passing of eyedrops. Told the Director of Nurses I would never open my mouth again!!!!
It took lots of paperwork and time to address this little fricking issue. I could go on and on. The nursing homes need to be checked on, but our home was very good and got very little infractions. One year we had none and you know what happened. The Feds came to inspect us. They spent 2-3 days in this little nursing home trying to make sure that we didn't really have a lot of mistakes. Like the state could not be trusted to survey us and report its findings.
The stress that is caused by these inspections is hard on the staff even when everything is all right. It is hard having people breath down your neck for 8 hours-10 hours a day trying to catch you do something wrong. Enough of my soap box.Such is life and I sure wish something could be done to make life easier for everyone as far as the medical insurance and coverage goes.
I don't think that anything mentioned has the right recipe to solve the problems yet. Doubt it ever will as it has grown into a giant problem---even in the foreign countries it is ballooning out of control from what I have read. Too many people getting older and sicker. Also, all the new technology is making life more complicated---more cost and more decisions. Irish ;D ;D ;D ;D ;D
Sorry, I got on my band wagon again. Just ignore me!!!!
Go to medicare.gov, they have a really good site that shows you what plans are available in your area. You can put in info about your current drugs, etc. and they'll give you an estimate about what you'll end up paying. I'm currently shopping for my medicare plan for next year, so I've been using it a lot. They cover supplemental plans, prescription drug only. I think it's a good site, and I'm sort of picky about web sites.
Quote from: gurs on October 29, 2011, 02:51:21 PM
Ooops...sorry guys, Im in Michigan....guess I will need to do some research. I cant go to any hospital that doesnt accept my insurance. I think by the end of the year, hoping both parties will work this out..sure they will. I cant imagine everyone cancelling their BCBS. Both parties are at fault...our entire system is just nuts!!!
Gursie
I agree Warmaters.....I used the Medicare.gov website last year when searching for a new prescription provider other than BCBS..they wanted $81.00 a month. I found that Wellcare offered me a cheaper plan and it was recommended for the meds I take etc. I tried them and LOVE them!
Im saving around $30.00 a month, and have no co-pays at all, and they covered some things that BCBS didnt..pays to shop around.
Gursie
gurs, Are you on a medicare supplement for your secondary carrier?? Were you on the medicare Blue rx before changing to this drug insurance. Can't remember where you are at. Irish ;D
Yes, BCBS of Michigan is my secondary, Medicare my primary. I just found out that our major hospital (Beaumont) is not going to be accepting Blue Care Network, which is different that what I have, so hopefully, I wont have to change anything. But, it leaves me wondering what would happen if they suddenly do mine next year, when I wont have an option to change? all very confusing. Im still going to research this further..guess we have until Dec 7th of this year to make any changes, instead of Dec 31st.
Gursie