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BizB
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Bend over
2009-11-13 |
The future of medicine and paying for treatment must change. Just this one story is evidence of the fact that there's something very wrong with the existing system.
Last November, I went for a sleep study. The sleep study took place at a hospital that is run by the same parent company as my insurance provider, Promedica. I was diagnosed with sleep apnea and was prescribed a CPAP machine. Promedica had many durable medical equipment companies listed in their provider book, so I began calling around to find one that stocked CPAP machines. After calling several and being told at each that they only deal in prosthetics, I gave up and called the customer service number for my insurance provider. They informed me that there was only one company on their provider list that deals with CPAP machines. This particular DME company, too, is run by Promedica. I went and got my CPAP and was informed that I wasn't actually purchasing the CPAP, but doing a rent-to-buy thing. I was to be billed for $20 or so each month for "about a year". I explained to the woman that I didn't want to do a rent-to-buy and that I would prefer to get the payments done and over-with up front. I was told that it couldn't be done.
There was an initial bill for the services they provided totaling almost $400. My responsibility was 20% of that amount. Then, for the past year, my insurance company has been billed (by themselves) $101.00 for machine rental.
| Item |
Amount |
My portion |
| Initial Billing |
$400 |
$80 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Monthly Bill |
$101.00 |
$20.61 |
| Total |
$327.32 |
So far, I've paid over $300 for this machine. The RETAIL value of this machine is $475. So, what, exactly, did I pay for each month when they deduct almost $200 from my paycheck? I'm very tempted to contact the state board that regulates insurance, but I don't think that will do any good. It's a systemic problem. There is no competition when it comes to insured citizens. I know this because once I left my CPAP hose at Talix's house. I had to replace it. To do so, I called the very company that provides me with my monthly bend-over. They wanted $80 for the hose. $80 for a $10.00 hose. I contacted another company in the area that is outside my insurers network and explained that I needed to replace my hose and that it would be cash, not insurance. The lady told me that the price was $80.00 according to her computer, but that they might give discounts for cash payments. She checked with someone and returned to the phone. A few hours later, I had a new hose that I purchased with the cash discount for the low, low price of $20.00. I still got bent over, but I paid for time. I didn't have to wait for it to come in the mail.
Now, I'm not sure that competition will solve the problem, either. I say this because of my recent experience with the vet visit to get Diz's neck looked at. The entire procedure cost me $215.00. I paid cash. I could have gone to any vet's office in the entire city. There were no restrictions placed on me by anyone. None. However, I didn't shop around. I went where I was familiar and comfortable with where I'd gotten good service in the past. I didn't even ask how much it was going to cost to get the wound fixed. It didn't matter. Diz was going to get well, no matter the cost. I would assume that people, when caring for themselves, would take the same attitude. It's not like you can call around and ask the care-provider, "How much would you charge to diagnose the pain in my left arm?" It just doesn't work like that.
Some have suggested that a pay-for-service system would wake up the public and generate real competition among health-care-providers. Some say a single-payer system (like in Canada) will make health-care more affordable for all. I don't see either working. There are plenty of examples worldwide of single-payer systems and they, by and large, are not the best system for the patient. Similarly, if you use veterinary care as an example of pay-for-service systems and what they offer, it doesn't appear to be a real solution, either. I believe the solution exists elsewhere. I would like to see the Nurse Practitioner (NP) actually practicing medicine. Preventative health care is said to lessen the need for more major care, later. If I could hire an NP's services on a monthly basis, I'd more likely visit that NP to get simple things taken care of. What if you could retain an NP's services the way you would a lawyer's services. In such a world, I could pay a NP a set fee for n visits per year before I would incur additional expenses. The NP could then take care of simple maintenance things and refer the patient to a physician if they see a problem that they can't or shouldn't handle. Mandatory NP visits on a bi-monthly basis in order to maintain lower monthly health-insurance costs would probably even be an attractive alternative to the current system.
Weigh in. I'd love to hear your thoughts on how the USA can correct the current abuses by the insurance companies. |
 revitup314 Sat Nov 18 11:24:33 PM
Biz - we both agree with your opinion about the NP idea. The insurance, and possibly someday, NO insurance, is not working. It would be worth it to try your idea. Sounds great. Wish you could somehow convince someone to give this a chance. You are very intelligent and have many good ideas. 
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 BigBro Thu Nov 16 04:40:24 PM
that's the thingy... a nose pillow!
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 Betty Boop Thu Nov 16 03:12:59 PM
medicare allows and covers a "nose pillow" every month for pops. He can get new hoses quite often too but not as often as the filters and pillows. I think the thing is saving our marriage! - well, maybe my sanity too.
On Tuesday we got flu and pneumonia shots and I found that they wiped out all memory from my head. It was either the shots or I am becoming a blond again!! All brain power is gone. 
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BigBro Thu Nov 16 03:03:56 PM
I need a new nose thingy for my mask. I've had the same part for a while now, and I think it's breaking down over time...
Planned that way by the manufacturer. Just like bags of chips that don't have a zip type seal to keep the damn things fresh.
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 BizB Thu Nov 16 01:28:59 PM
ERrrrr.... what I mean is... ummm...
No. I'm not doing paying for it. I currently owe $89.00 for the most recent months' rental fees. I just got the bill for November's fee.
I need to get a new mask.
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BizB Thu Nov 16 01:27:12 PM
Screw you all!
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BigBro Thu Nov 16 01:08:27 PM
Are you done paying for the CPAP or is there more to go???
Not a debate kind of a forum is it??? Everyone is too nice to argue.
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Betty Boop Thu Nov 16 11:09:41 AM
I get the feeling no one wants to wade in the waters of your latest subject. I was going to say tirade but that wasn't quite the right word. I guess "subject" will have to do.
Our dinner last night was fun. K&J had a wonderful trip to Costa Rico but are glad to be home again.
Well, it is time for lunch - El Rancheto today. Have to get my south of the border fix. Arturo awlways asks about my granddaughter. He thinks she is such a cutie. Wonder why?!?
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BigBro Tue Nov 14 01:25:33 PM
http://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850
check out the website above.
Reply |
BigBro Tue Nov 14 01:13:42 PM
I was reading on-line at my google news feed that I use as a homepage. I saw an article in the Globe and Mail (one of Tornoto's news papers)on how the Canadian health care system had failed for prompt access to health care to specialists or emergancy care having specialists available. So I clicked on the headline thinking, OK I finally fould where the US had upped the guys to the north. What I found was an article that indeed compare health care systems, and found that out of the G-8 countries Canada's access for specialists was second to last for all these countries. The US was last. It wasn't even a part of the article's focus. It was just plain assumed that USA health care was the worst.
I've heard that our government is the worst in the world, except when compared to all the others. This is not true of our health care system. We might look to see what country has the worlds lowest infant mortality rate, because it is typically young unwed mothers that can least afford healthcare. This would be a great place to start an investigation into what actually works.
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