Why Insurance Sucks In America

[DiaperBigBoy]

So, here is my lovely insurance story.

So, I had MassHealth to begin with. (Which is free care through the state, but it doesn't pay for diapers, only hospital visits, and no doctor visits.) So most of my medical bills and problems, I had to go through the hospital. ANyways, I had that insurance, and then I was taken off that and put on Uncompisated Care, and then BMC Health Insurance....okay, so before I went on BMC, My Mass health covered all the visits to the hospital and all my medical bills and prescriptions

I had been going to my doctor and she segested(sp) a sleep study, after about several weeks, she told me I have sleep aphna....(In which I thought, wow I coudl die in my sleep if I stop beathing.) But before that, she said I had Sleep Ensuria...I told her before I was having wetting accidents at night, and was stressed about a lot of things happen in my life, so she thought that was causing it. She told me to relax. (HA, that'll never happen) anyways, she said to be on the safe side, if you see a Urilogist I will prescribe the diapers, because she didn't think I really ahd it, but after the sleep study, she was sure it was a stress and aphnea...she told me to excerise every day for an hour. I don't know what that'll do, but maybe it'll help...

....But then I switched to the BMC, and it didn't cover any of them. EVEN the diapers....or my normal medication....It took me about 3 months to finally get this whole "diaper" thing under control. The medical supply store that gave them to me, gave them to me for 2 months, and told me that Mass Health would cover it, but then my "circamstance in living" changed, and I got bumped too BMC, by my choice..cuz I think it was a best of the worst...I was normally getting my diapers in the beginning of the month, now I get them at the end of the month

Anyways, when I went to get my new supply for January, they told that I can't have them till the 27th of every month, which means, I get them every other month. Anyways, I didn't get my January supply yet and they aren't even going to give me 2 for february....and then I have to reapply in march, every 3 months, it's totally stupid. I have to go through that again, and they'll change the date again. GAWH!, it's almost not worth it.

I swear only in America, can you get away with BS like that and nobody cares. I talked to so many people and the best I got was my insurance to cover a months of diapers, that I was suppose to pay for...But I already had those, so I don't see where the justice is...

Just some comment BS on insurance and diapers.

[redneck diaper boy]

Like it or not America has the best healthcare system in the world.

Insurance companies are in business to make a profit for their investors.

My family health insurance cost about 12,000 bucks last year. Between me, my wife and children, they payed out over 35,000 bucks. They lost money on us. The only reason I am still insured is because I have a group policy.

So, here is my lovely insurance story.

So, I had MassHealth to begin with. (Which is free care through the state, but it doesn't pay for diapers, only hospital visits, and no doctor visits.) So most of my medical bills and problems, I had to go through the hospital. ANyways, I had that insurance, and then I was taken off that and put on Uncompisated Care, and then BMC Health Insurance....okay, so before I went on BMC, My Mass health covered all the visits to the hospital and all my medical bills and prescriptions

I had been going to my doctor and she segested(sp) a sleep study, after about several weeks, she told me I have sleep aphna....(In which I thought, wow I coudl die in my sleep if I stop beathing.) But before that, she said I had Sleep Ensuria...I told her before I was having wetting accidents at night, and was stressed about a lot of things happen in my life, so she thought that was causing it. She told me to relax. (HA, that'll never happen) anyways, she said to be on the safe side, if you see a Urilogist I will prescribe the diapers, because she didn't think I really ahd it, but after the sleep study, she was sure it was a stress and aphnea...she told me to excerise every day for an hour. I don't know what that'll do, but maybe it'll help...

....But then I switched to the BMC, and it didn't cover any of them. EVEN the diapers....or my normal medication....It took me about 3 months to finally get this whole "diaper" thing under control. The medical supply store that gave them to me, gave them to me for 2 months, and told me that Mass Health would cover it, but then my "circamstance in living" changed, and I got bumped too BMC, by my choice..cuz I think it was a best of the worst...I was normally getting my diapers in the beginning of the month, now I get them at the end of the month

Anyways, when I went to get my new supply for January, they told that I can't have them till the 27th of every month, which means, I get them every other month. Anyways, I didn't get my January supply yet and they aren't even going to give me 2 for february....and then I have to reapply in march, every 3 months, it's totally stupid. I have to go through that again, and they'll change the date again. GAWH!, it's almost not worth it.

I swear only in America, can you get away with BS like that and nobody cares. I talked to so many people and the best I got was my insurance to cover a months of diapers, that I was suppose to pay for...But I already had those, so I don't see where the justice is...

Just some comment BS on insurance and diapers.

[BoTox]

Insurance is about spreading the risk. Insureds * Premium - medical costs = +profit/-loss. People don't often stay in business in the loss column. They either have to drive costs down or premiums up. Simple equation and the biggest reason I endeavor to stay healthy.

Most people don't remember the old days when insurance was called Major Medical, which meant it only covered things that were large out-of-pocket expenses. I believe I had to pay the first $500, then 20% of everything up to $2,500 of my own money before it kicked in. There was no drug coverage in those days, either.

[Red Barchetta]

That is part of the reason I don't even bother "filling" my prescription for diapers - it's a lot easier to just pay for them out of my own pocket (that plus after all the BS, you still get the cheapest ones possible, and they don't work worth a s*&t!).

But I also get aggravated, and just give up with medical insurance easily - I have already NOT taken drugs I should have been because they cost too much to just pay for them myself, and insurance was giving me a hard time - so to avoid the aggravation, just don't use them - was, and continues to be my response.

[t baby]

It all depends on which state you live in whether or not they will even cover the cost of diapers. I have Humana and they do not cover the cost of diapers in VA but leven if they did it would be the cheap ones and i would much rather pay for them out of my pocket and get the best.

[Jedward]

If you think state insurance is bad try dealing with the Veteran Adminstration. It too me almost 5 years for them to recognize that my incontinence was service connected and then another 2 to determin that diapers were the most effective way to deal with it. Now after 7 years of fighting they will re-emburse me for my diapers, but the form are insane, and they pay you back almost a month after they get them.

[Floaty_Boy]

Like it or not America has the best healthcare system in the world.

Insurance companies are in business to make a profit for their investors.

My family health insurance cost about 12,000 bucks last year. Between me, my wife and children, they payed out over 35,000 bucks. They lost money on us. The only reason I am still insured is because I have a group policy.

I have to disagree with the first line of this one.

America may have the best medical care in the world, but I definitely don't think it has the best healthcare system. The medicine is great, the system for supplying it is hideously broken. I can go to my veterinarian and get antibiotics for my dog that cost $50 per bottle for 100 pills. The same antibiotic at the same dosage would (and has) cost my insurance company $250 per bottle for 20 pills. How is that even possible unless the fix is in? If it costs $.50 to make a pill at one factory, why does it cost so much more to make at another factory?

And I really have to wonder why the insurance industry puts up with that kind of garbage. I'm sure the lobbyists for both the medical establishment and the insurance industry go head-to-head all the time on some of this stuff, but I would think that kind of price manipulation would cause an all-out war between the two groups.

Personally, I'd like to see them settle it out with a cage match...

End Rant.

Othwerise, Redneck is totally right. Health Insurance Companies are NOT about health, they are about making money.

--Floaty

[Red Barchetta]

Othwerise, Redneck is totally right. Health Insurance Companies are NOT about health, they are about making money.

--Floaty

That in itself IS the problem. It's kind of the same thing with actual drug companies - the point is to make money, but anything that would actually "cure" means less sales - so, it's actually better, business wise - to just treat, but not cure (if possible) whatever it is that ales you. - that is till they have already made big profits off something, and now wish to move on to something else that will produce even more profits.

What you really need, but probably will never happen - is health insurance and drug companies that care MORE about peoples health than they do about making a profit. - However, that would cause there stock price to drop - that equals fewer investors, and that equals less money to operate with. So realistically, there is no win/win scenario. At least not till basically the whole world stops caring about personal wealth, and instead cares about the benefit to man in general - but humans in general are still far to greedy for that kind of thinking on a large scale.

[Alan UK]

Like it or not America has the best healthcare system in the world.

[rant]

Where on EARTH did you get that from? Have you tried the healthcare systems in every other country, or are you just spouting the normal "It is from the USA, therefore must be the best in the world" stuff?

Here in the UK, we consider that we have a pretty mediocre healthcare system, yet if anybody from around the world turns up on our doorstep with a medical problem, we will look after them. In the UK, you could turn up to any hospital, and see a doctor/consultant without having to prove that you have paid the correct people the correct amount of money. Yes, it may take a little bit of waiting, but then if you are imjured you probably don't have anywhere better to go.

I'm not saying that America is neccessarily worse than anywhere else, just please remember that you are just one country amongst about 200. Don't believe the press when they say that everything you have is bigger/better/more democratic than anywhere else - they are just trying to gain the popular vote.

I love the States, and visit regularly. What intreagues me is that the majority of people are so blinkered in their views, and don't even read international news

(Ok, I have my tin hat on and am ready for the incoming assault that I've just put myself up for)

[/rant]

[BoTox]

Where on EARTH did you get that from? Have you tried the healthcare systems in every other country, or are you just spouting the normal "It is from the USA, therefore must be the best in the world" stuff?

Here in the UK, we consider that we have a pretty mediocre healthcare system, yet if anybody from around the world turns up on our doorstep with a medical problem, we will look after them. In the UK, you could turn up to any hospital, and see a doctor/consultant without having to prove that you have paid the correct people the correct amount of money. Yes, it may take a little bit of waiting, but then if you are imjured you probably don't have anywhere better to go.

Actually, it pretty much works like that in the US. The chronic things that don't require emergency medical treatment are the ones that are the most frustrating. Most advanced medical facilities are great at saving lives because it is heroic, exciting and rewarding. The chronic stuff that is mundane and boring is where a system is made or broken. Unfortunately, I believe most are broken.

Get the lawyers out of the medical field and it might be worth while again.

[diapernh]

the medical system in the US is just flat out down-right stupid. The Medical insurance industry makes no sense. How can they ever make money when they do stupid ass things like they do. Ok, I got sleep apnea and use a machine. I can go online and buy said machine for $1300, how much did my insurance company pay...... ALMOST $3,000

I needed a new mask, online i could have bought it for $175, the company i HAVE TO go through billed my insurance company $400. Now tell me this makes sense.....

They should tell their subscribers to find the best price for their supplys and they will pay for them. keep the cost down.

The insurance companies should just set an amount that they will pay for a month's supply of diapers and you order what you want, and pay the difference.

[AutieAB]

Like it or not America has the best healthcare system in the world.

A healthcare system that treats it's rich differently from it's poor doesn't deserve that title.

[dpr13ca]

I live in alberta canada and get all my diapers thru workers comp.Every now and then they will try and grow a brain and decide to cut off my supplies.

Luckily in alberta we have a program called aids to daily living that covers incontinence supplies.They will pay 100% for most low end diapers(fpq,depends etc) if you want to upgrade to a better product (tranquility etc) then you have to pay an upgrade charge,as an example the tranquility atn costs 23 cents each upgrade to get them.The only problem is that if the program doesnt cover a certain diaper(molicare or abena) then you cant even get them ordered in ,the program will also cover waterproof pants and cloth diapers as well if that is what you use.

[redneck diaper boy]

So tell me this. Do the rich people, in the UK, use only the NHS?

In America, the poor get Medicaid which covers all expenses. If you have any money you have to pay. Illegal alliens get healthcare in America!

A healthcare system that treats it's rich differently from it's poor doesn't deserve that title.

[InDpnds]

Re: "America has the best healthcare in the world," I'd change that to has some of the best hospitals and clinics in the world. That is, they are equipped to the hilt with high-tech gizmos and staffed with extremely well-trained doctors and support staff. Some of the hospitals can treat virtually anything that can be treated. But the system, well, that's enough ammo for a major rant, to be sure! I have a conversion policy for my medical insurance and although it's quite expensive, it's totally useless, at least for the money I've put into it. But if you can join a group and get coverage that way, that may be the best possibility. I hope I can end up doing that someday.

[Red Barchetta]

So tell me this. Do the rich people, in the UK, use only the NHS?

In America, the poor get Medicaid which covers all expenses. If you have any money you have to pay. Illegal alliens get healthcare in America!

Umm, the problem is it dose not cover all medical expenses (I know first hand, because we are considered disabled, myself and my GF get Medicare, and I also get Medicaid [2 different things]) Medicare will cover hospital expenses, and SOME prescription drugs (but only up to a certain $ amount - forget what it is), Medicaid will cover doctors visits (if the doctor chooses to except it, but a lot do not), and picks up some of the slack for prescription drugs not covered by Medicare, but still only up to a certain $ amount. Medicaid, and Medicare will somehow split the cost of any test done in the hospital (if you have both).

What neither will pay for is medical testing equipment needed outside a hospital (such as a machine to test blood/sugar level at home exc.). There are also some operations that would be considered preventive for something more serious, that neither will cover. Example, if you are extremely obese, and nothing is working to get your weight down - they will cover they expense of operation for complications caused by being so heavy, but not an operation to get rid of all the excess fat. (that makes no sense to me, it would cost less to just remove the extra fat, then to keep paying for complications caused by it but....)

That's just a few examples off hand, there are several other scenarios where the problem may not be immediately life-threatening, but could cause problems later on that are.

No I am not saying pay for such things just because someone wants it done (in some cases it is not really medically dangerous, more cosmetic), but if you are at a point where it is medically dangerous, and a doctor agrees, and anything short of surgery is not helping (enough) why not?

As for the home testing equipment, again, if there is a real medical problem where not having it can be dangerous, why not?

Covering illegal aliens, that if called being humane (if you have a real medical issue, it should not matter who you are, where you come from, or what your legal status is), but they could go a step farther, and actually help prevent even more problems latter - especially if you are actually a citizen.

[AutieAB]

So tell me this. Do the rich people, in the UK, use only the NHS?

Most do use the NHS, yes, but some people do choose to go private. However, those who can afford to do so are in no way obligated to - it's a personal choice that individuals are free to make. The quality of healthcare is no different between the two sectors (although I don't doubt you'd get more personal attention in a private (smaller) hospital).

The point is that the NHS is legally mandated as being "free at the point of use" and that levels the playing field between the rich and the poor. The poor get access to the same quality of healthcare as the wealthy because they're treated in the same hospitals, by the same doctors and with the same medicines.

In the USA, two people can lie in adjacent beds with identical conditions and be treated quite differently depending on whether they have Medicaid or insurance, and within that, how expensive their insurance is. Surely there can't be any way to justify that?!

In America, the poor get Medicaid which covers all expenses. If you have any money you have to pay.

But the quality of healthcare available for Medicare recipients is different to that available to those with insurance. It's a two-tier system between the haves and the have nots and that's my criticism. Using the area where my Fiancée lives as an example, there are numerous hospitals. If you get mashed by a car, the paramedics (EMTs) ask which hospital you'd like to be taken to. If you are taken to two of the three I'm thinking of, they'll treat you, yes, but afterwards, if you can't provide insurance details, they'll sue the a*se off you for thousands and thousands of dollars. If you choose the third, a so called public hospital they'll patch you up and ship you out as fast as they can; they won't charge as much for it but they'll still come after you! The rich don't have to worry about such things, the poor do.

There's a quote, I can't remember the exact words or who said it but it goes something along the lines of "the mark of a true civilisation lies in how it treats its sick and its poor."

Illegal alliens get healthcare in America!

As is in the UK (although we don't use the rather distasteful term "alien" which seems commonplace in America).

I should shortly be a legal "alien" in the USA and I won't qualify for any public assistance (Medicaid or otherwise) until I've held LPR status for five years, regardless of how dire my personal circumstances hypothetically become. Given that a disability I have (see sig) means that I may or may not be capable of working over any given period, that is a real worry for me.

Re: "America has the best healthcare in the world," I'd change that to has some of the best hospitals and clinics in the world.

Exactly. In the USA, new treatments are pioneered in the most expensive (and therefore well funded) hospitals and only the rich or those lucky few who can get charity backing can afford to access them. In the UK we also have some of the best hospitals in the world, leading the way with new treatments for this and that. However, the pioneering work is often done in NHS hospitals and is available to all, regardless of their ability to cough up vast sums of money at their time of greatest need.

The USA is a very expensive place to be sick. The UK is less so, and that's why I wrote my original statement (which I stand by).

AutieAB

[BoTox]

In the USA, two people can lie in adjacent beds with identical conditions and be treated quite differently depending on whether they have Medicaid or insurance, and within that, how expensive their insurance is. Surely there can't be any way to justify that?!

As is in the UK (although we don't use the rather distasteful term "alien" which seems commonplace in America).

I should shortly be a legal "alien" in the USA and I won't qualify for any public assistance (Medicaid or otherwise) until I've held LPR status for five years, regardless of how dire my personal circumstances hypothetically become. Given that a disability I have (see sig) means that I may or may not be

AutieAB

Sounds like you have a grudge against the US already. Excuse me if I'm proud of my homeland and our great contributions to the world at large.

You know, I'll tell you the same thing I'd tell anyone bitching about the US: You can always go back to where you're from if it is so darned great there and it sucks so much here in the US.

The US healthcare system isn't perfect but you can get what you need when you need it if you are in need.

[AutieAB]

Sounds like you have a grudge against the US already. Excuse me if I'm proud of my homeland and our great contributions to the world at large.

You know, I'll tell you the same thing I'd tell anyone bitching about the US: You can always go back to where you're from if it is so darned great there and it sucks so much here in the US.

Two comments.

(1) My opinion on a country's healthcare system is only a very small part of my opinion of a country in general. I was not bitching, they were thought out criticisms - there's a difference and I do not hold an anti-US grudge.

and

(2) I'd follow the woman I love to hell and back. It's all a matter of sacrifice.

If you don't mind, I don't do arguments on forums so I'm stepping away from this as of now.

AutieAB.

[BriGuy]

My wife is Diabetic and I have quite a few frustrations with the health insurance that we have. First with the amount we pay out each month for our premium the co pay is out of the roof. They barely cover any of her test equipment, (test strips etc). They DON'T cover birth control. We can only get coverage through group policies and NO ONE will allow me to purchase health insurance on the side because she is diabetic. We hemorrhage money each month to pay for insurance that isn't doing anything for us. Its BS. Look Diaperedbigboy, they are DIAPERS you will survive without them or purchasing them on the side. You have other choices. Cloth diapers are much cheaper in the long run and you can re-use em. My wife and I don't have a choice. If we don't shell out the dough she to buy her stuff, she will die. Talking about a pain in the ass? Since when was it a choice to be diabetic? She didn't ask for it... *frustrated*

~Brian

P.s. I case anyone was thinking diabetes is, or can be caused by lifestyle choices and what we eat, that is not entirely true. My wife had a virus that attacked her pancreas killing it off.

[BoTox]

Insurance is a business. They do not do it for free or to lose money. The idea is that over the lifetime of a person, based on the health and history, the fee they collect will be equal to or greater than the expenses they've paid out. They make money hand over fist on me. I've had very little medical expense in the 25 years I've been out of my parent's policy. I've effectively paid MORE and gotten LESS than almost any person I know.

[Guest diamondback688]

My wife is Diabetic and I have quite a few frustrations with the health insurance that we have. First with the amount we pay out each month for our premium the co pay is out of the roof. They barely cover any of her test equipment, (test strips etc). They DON'T cover birth control. We can only get coverage through group policies and NO ONE will allow me to purchase health insurance on the side because she is diabetic. We hemorrhage money each month to pay for insurance that isn't doing anything for us. Its BS. Look Diaperedbigboy, they are DIAPERS you will survive without them or purchasing them on the side. You have other choices. Cloth diapers are much cheaper in the long run and you can re-use em. My wife and I don't have a choice. If we don't shell out the dough she to buy her stuff, she will die. Talking about a pain in the ass? Since when was it a choice to be diabetic? She didn't ask for it... *frustrated*

~Brian

P.s. I case anyone was thinking diabetes is, or can be caused by lifestyle choices and what we eat, that is not entirely true. My wife had a virus that attacked her pancreas killing it off.

which type is she?

[dlsmd]

My wife is Diabetic and I have quite a few frustrations with the health insurance that we have. First with the amount we pay out each month for our premium the co pay is out of the roof. They barely cover any of her test equipment, (test strips etc). They DON'T cover birth control. We can only get coverage through group policies and NO ONE will allow me to purchase health insurance on the side because she is diabetic. We hemorrhage money each month to pay for insurance that isn't doing anything for us. Its BS. Look Diaperedbigboy, they are DIAPERS you will survive without them or purchasing them on the side. You have other choices. Cloth diapers are much cheaper in the long run and you can re-use em. My wife and I don't have a choice. If we don't shell out the dough she to buy her stuff, she will die. Talking about a pain in the ass? Since when was it a choice to be diabetic? She didn't ask for it... *frustrated*

i didnt eather but guess what i hav to bye every thing my self and most insurence companys will conseder my condition "preexisting" so thay wont! cover my diapers cloth or other wise

now u might say "use a cath" but i tell u thoes hurt alot alost thay iritate the hell out of me

oh by the way no insurance will pick me up at eney cost because of all the problems i hav (im incon, manic deprsiv, and i hav a varry bad back

to the point that if i get hit just right in my neck im dead!!!!

if u dont like my post just ignorr it but its the truth

and i live in the usa so as far as im conserned the medical system sucks

and just for thoes that think all the latest advancements in medical care come from the us ur roung actualy most come from rusha