Sad. I just had a horrible example of what is wrong with our health insurance system.

[Xithras]

As many of you know, I'm a college prof. As I was starting to teach my morning class today, a student walked in that I haven't seen in class for a few weeks. He seemed distracted during the class, and was obviously lost after missing so much work, so I asked him to stay afterward and speak to me.

After clearing out the rest of the students, I asked him whether he was OK, and he replied that he'd been "sick" and that he was still feeling very poorly. He went on to describe a constant pounding headache, nosebleeds, nausea, etc. It had started nearly a month earlier, and was almost nonstop. Without thinking first, I asked him what his doctor had said about it.

"I haven't seen my doctor yet. I can't afford it."

It turns out that this young man is fully insured under his parents PPO, but that he hasn't seen the doctor at all this year. Not only does he have a $35 copay to deal with, but he is also facing a $500 deductible as well. Visiting the doctor, even with his insurance, will cost $535 that neither he or his parents have. So, for now, he was planning on just ignoring it. His exact words were, "I'll wait until the semester is out and I can start a summer job, and hope it's nothing serious." This is a fully insured 19 year old kid who could be dealing with anything from severe allergies to a brain tumor.

Instead of letting him walk out, I gave him a different bit of advice. I looked up the address of the county indigent care program and told him to go over to their clinic for a checkup. They won't help people with insurance, so I told him to leave his wallet and insurance cards at home, to list his address as "homeless", and to misspell his name on the form. They would give him the help he needed, it would only cost $10, and there would be no bill afterward.

Basically, I just told a fully insured 19 year old kid to defraud the government to obtain the healthcare that he's otherwise completely unable to afford. He's going to break the law, because it's the only way he can get treated for an illness that's left him nearly bedridden for weeks.

There's no excuse for this kind of thing in the worlds wealthiest nation.

[monmouth]

1. And you are a good person, one he will not forget, ever....n/t

[Jazzgirl]

2. That is a really sad story about the state of affairs in Amurika.

I am glad that you told him how to get some help. You are right about it could be sinus problems are brain tumor. It is sad that so many people have to walk around feeling miserable even though they are insured because they can't even afford the co-pays and deductibles. Sad.

[Roland99]

63. No, it's a sad story that the OP hasn't the first clue on how insurance works

If they did, they should have told the kid what to tell his parents or ponied up $35 for the co-pay and taken the kid themselves.

[Javaman]

69. Did you miss the part about them not being able to afford the copay or the deductable?

jeez.

empathy much?

[Roland99]

70. "deductible". And apparently you don't understand how insurance works either.

*sigh*

[Javaman]

79. *sigh* neither do you. *sigh* nt

[Roland99]

89. Oh ZING! You got me

not.

Seriously, in this situation, a $35 co-pay is all that was needed. Even then, if the parents were there and explained they didn't have it but could pay it in a week or two, surely the doctor would have seen them. My ex never paid the co-pay when she took my daughter to the doctor. Left it up to me to get a bill in the mail.

As for the deductible, it doesn't apply for an office visit or even for a prescription.


$535? Sheesh. Ridiculous.

[Javaman]

92. obviously in your world, you have no idea what it means to be working poor.

go away. you are now on ignore.

So delight me with a witty retort, I will not see it and thus not be crest fallen at your superior insight.

[Roland99]

98. Got your own Jump to Conclusions mat, eh?

Who says these people are working poor? They have a PPO plan. That means either they're paying for it out of pocket (and therefore have some income to use) or have a good enough job that offers one (with them kicking in whatever portion of the premium is leftover)

And, like I said, if they were that bad off, the doctor's office would likely work with them. Esp. if he just went in on his own. His parents would get billed.

As for me having knowledge of the working poor, well, I've been there. I've been on food stamps and unemployment. I've lost a home. So be careful up there on that high horse, you might fall and get hurt and if you don't have insurance.......

[kestrel91316]

126. PPO plans suck. They are the cheap ones.

[Roland99]

141. Are you serious? PPO plans are the upper-level.

Then there's POS, then Network, then HMOs

And there might be some lower-end FFS such as is available with Medicare.

[SolidGold]

211. Didn't teach you much did it?

Guess all that time you spent being poor you never got sick and didn't have the money for the care? I have two teeth rotting out of my head and I don't have the thousands of dollars to spend on dental work to fix it. Instead I have two wisdom teeth crumbling in my mouth that hurt all day everyday.

I can make 1 of two decisions.

1. Put myself in more debt, take a small high interest loan to pay upwards of $3000 for dental work (on top of my "dental insurance" coverage). Then let my daughter and wife go without either childcare or the proper food our family needs to pay off the loan.

2. Sit for months and save small amounts until I have the money for the care. (what i've been doing for 1.5 years now)

My parents are dead, I have no one to ask for money except a bank or payday loan shark. I have insurance, I make $60k+ a year and the cost of living hasn't allowed me to put my health as a priority above my family's living expenses.

So let me ask you, is the answer to my problem a $35 deductible like you outlined for this college student?

Simple minded people simplify the answers and ditch reality at the first turn.

[Roland99]

212. Yeah, because your case is exactly like the one in the OP.

:eyes:


BTW, if you're living in the St. Louis area with a family of 3 and making more than $60,000/yr and can't come up with a few hundred dollars for dental work over a year's time then you are seriously overloaded with debt or are spending money quite unwisely.

I'd recommend going to see a financial advisor or a debt counselor.

[SolidGold]

215. You have no fucking clue what you're talking about.

If you think $60,000.00 is a lot for a family of 4 to live on please go see a financial advisor yourself, perhaps even a 2nd grade math teacher could assist you in such simple calcuations. I pay for 2 cars, childcare, a mortgage, living expenses etc. Without that our family can't operate.

Also just a quick math lesson, $3000 - isn't a few hundred dollars - 30x isn't a few its a lot.

[Roland99]

220. I don't make much more and I'm about to have a familly of 6 starting next week

and I'm able to afford the equivalent of a mortgage in a rental home in a nice part of Orlando, my car payment, car insurance, cell phones, electric, gas, tolls, food, cable, internet, health insurance and still have plenty leftover for a fun budget. Oh yeah...and my daughter's orthodontist.

You are overloaded in debt. Perhaps you should get a more affordable home, sell one of the cars and get something used.

I used to live under a ton of crushing debt. It's what many people think is the American Way (new cars, nice home, new clothes, etc.) Debt is the worst thing possible for someone.

[Zoeisright]

224. Oh gee, what an upstanding citizen you are.

It's unfortunate that you don't want to understand other people's situations are different. That's called empathy. You might want to try it.

[Roland99]

225. Oh, I feel his pain. I was in those shoes 8 years ago. Much worse shoes, in fact.

I learned my lesson in a very harsh manner.

Being unemployed for 7 months, having to sell my house (luckily well before the bubble burst), getting on food stamps, needing assistance with utilities, moving in with relatives, and eventually having to file Ch. 7 bankruptcy will wake one up in a heartbeat. I keep some low-credit limit credit cards handy for emergencies but, otherwise, I'm purely a cash basis and once my car is paid off in 10 months, I'm debt-free.

I highly recommend it.

[LanternWaste]

228. It often comes down to unwarranted and irrelevant financial...

It often comes down to unwarranted and irrelevant financial advice when a person has medical problems...

[dflprincess]

104. It can depend on the policy

My "coverage" currently has a $1,200 deductible - and I have to spend that much out of pocket, including prescriptions, before my carrier will pay a dime. After that, they'll pay 90% until I hit a max out of pocket of $3,500 (yet these amounts are lower that what the insurance "reform" bill will allow). The only exception to this are preventative/screening tests those are paid for but if any of those come back odd I'd be on the hook for any follow up.

With a PPO it could go either way. Odds are the copay will not count toward the deductible usually do not count toward the deductible. It is possible that the policy had an 80/20 or 90/10 deal set up instead of expecting the whole deductible at once. Though with the symptons this kid is having, I'd bet it wouldn't take long for any tests ordered to hit the full deductible amount. It is impossible, the way policies are currently written that there is the copay, the deductible and then the "coinsurance" amount. The deductible does not necessarily equal the maximum annual out of pocket - that can be higher.

[BlancheSplanchnik]

113. because you know what you're talking about,

I guarontee he won't respond to you.

[Roland99]

148. hmmm...interesting.

[Roland99]

143. If there's a co-pay, there's no deductible to meet

Yes, some plans apply an office visit to the deductible but they do not offer co-pays, too.

There are some that offer a limited number of visits per year (5-6, typically) with a co-pay and after that the office visit applies to the deductible.

This kid was out a few weeks so far this year and we're only in March. I doubt he's used up yearly visits.


In the case of the OP, only $35 was needed to go see a doctor (and, as I've written several times up here), he probably could have had the dr's office bill his parents if he didn't have it on him.

[quakerboy]

166. You are flat wrong in your assertions

My wife had a copay and then a deductible. They may have called the copay something else, but there was a flat fee walking in the door, and then a remainder that was billed to insurance, which paid not one dime until the deductible was met.

[Roland99]

169. A remainder of what? If you paid a "flat fee" walking in the door...

that was a co-pay. *IF* other services were performed, that's beyond just a normal doctor's visit. Those add'l services would, yes, be applied to a deductible. But if it's just an office visit, the co-pay is it. Nothing applies to the deductible.

Let's consider this scenario:

PPO plan, $5,000 deductible, $25 office visit co-pay, 80/20 co-insurance

1) Go to the doctor, pay $25.
2) Dr. wants more tests performed. Let's say it's another $500. That would apply toward the deductible if add'l services do not have a separate co-pay. This is typically BILLED to the INSURANCE company. No up-front payment required. Typically.
3) Get admitted to a hospital. Bill is $6,000. $4,500 is applied to the deductible. Remaining $1,500 is split 80/20 between insurance company/insured.


It's that simple.

[dflprincess]

170. $6000 for a hospital admit?

What year are you living in? A year and a half ago it cost just over $6,000 for me to find out the weird spot on the mammogram was benign and that was all done on an outpatient visit. That was the price after the insurance discount. (Fortunately, my employer still provided decent coverage at the time.)

Last summer my mom spent one night in the hospital and that ran just over $10,000 after the Medicare and insurance discounts.

[Roland99]

171. Oh. My. Fucking. God.

seriously?

I was just using some random numbers to explain the scenario.


ffs.

[Name removed]

217. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Roland99]

221. Nice ad hominem. Congrats.

[quakerboy]

189. You know naught of what you speak

Perhaps you have an insurance plan that works that way. Not all do.

I assure you, this is from my own personal experience. My wife went to the Dr. Paid a co-pay. Then was sent a bill for the remainder of the cost, which insurance did not cover, because she had not yet met the deductible. Other times she went in, paid a co-pay, saw a dr, and had blood drawn. At which point she got three bills in addition to her Copay. One from the Dr, for the basic visit. Another from the phlebotomist(sp?) for the blood draw. And a third from the lab for doing the testing on the blood.

Its that simple. If you have a better plan, consider yourself lucky.

[Delver Rootnose]

201. that is just not true.

I go to the doctor for regular blood tests. I pay a $35 co-pay and when I get the bill I pay an additional $160 for his sercives plus $10 for the blood draw and another $175 for the blood tests.

You really don't know what you are talking about. The only time a co-pay covered all of a visit was when I was on an HMO that I paid lots for when I worked at Sears.

[Delver Rootnose]

200. that is not true...

I have a PPO through my state cobra continuation plan that I keep because I'm unemployed and have a pre-existing condition that makes me uninsurable on the private market. It has a co-pay and a $5000 per incident deductible with a $14,500 annual out of pocket limit. I pay the $35 up front but the rest gets billed to me. So if each individual office or hospital bill does not go over the $5000 deductible or I have not paid $14,500 out of pocket not counting the co-pay I get a bill for the total amount at the lower insurance plan negotiated rate. After the deductible it is 80/20. For this wonderful plan I pay about $4000 a year. If I had to go to the doctor right at this moment and it would cost me $535 dollars I would have to beg for money from relatives to pay for it.

[Powdered Toast Man]

120. Did you miss the part where he said his parents didn't have the money for his copay?

I didn't miss it.

[kestrel91316]

125. SINCE WHEN AND ON WHAT PLANET does deductible not apply to

office visits and medications? With expensive plans it might right off the bat offer those things not subject to ded or copay, but every policy is different and most make you satisfy the entire deductible first.

$500/ mo in premiums PLUS $5000 or $7500 deductible plus then 80/20 copay for the next couple thou. And NOT ONE SINGLE THING was covered until I had fully satisfied the deductible. I had to shell out $11,000-13,500/yr out-of-pocket before i saw a single penny paid by insurance.

I dropped the policy and have had none since.

YOU are truly clueless, or deliberately acting that way to make trouble.

[Roland99]

144. You didn't have a co-pay for office visits then. That is not the case described in the OP

[kestrel91316]

154. Yes I did. I had to pay a co-pay for ALL services after the deductible until the copay limit was met

Like I said, I was out THOUSANDS every year before the insurance co had to give anybody one thin dime. And it was supposed to be a cadillac plan.

[Roland99]

157. *sigh*....that's NOT a co-pay. That's *co-insurance*

Usually an 80/20 or a 70/30 split after a deductible has been met.

[RayOfHope]

140. You're kidding, right? I have good insurance and also a $35 copay

But after ONE office visit and a strep test owed the doc over $200. Depending on what the insurance covers (mine didn't cover a certain kind of lab test) he may very well owe only $35 that day but eventually (ie SOON) that $500 after just ONE visit.

[Roland99]

145. $200 payable over at least 90 days before it would have been sent to collections

a FAR cry from the $535 the OP says the kid would have needed just to see a dr.

[nightrain]

161. yeah, I guess it's better to screw the practitioners...

sarcasm off.

(we don't usually work for free).

[Roland99]

163. I missed the part I said doctors work or will work for free. Care to point it out for me?

kthx.

[nightrain]

175. I must have missed the part where you paid then.

[Roland99]

176. Where I paid what?

[nightrain]

179. the $35 bill sent to you in the mail cuz your ex didn't have the cash?

[Roland99]

180. Shall I mail you my entire account from there? Would that satisfy you?

You are one creepy person.

[nightrain]

181. thanks.

[Mojorabbit]

193. He probably would have been

sent by the doc for an MRI or cat scan with those symptoms I am guessing. Hard to say how it would play out.

[blueworld]

210. That depends on the particular plan; my office visits apply to deductible n/t

[Maraya1969]

219. I have to pay my deductible in full before I am allowed to just use the co-pay

It is like I don't have insurance in the beginning of the year.


You're "facts" and the following condescending attitude are wrong.

[boppers]

191. Do you not understand how "living on Ramen" works?

35 bucks is a year's worth of meals.

[madmom]

110. Not to mention the costs of any meds. I have insurance and can't afford to go to the doctor either.

[LWolf]

118. I know how insurance works.

And this is exactly why I didn't want insurance "reform."

I wanted a universal, single-payer, not-for-profit health CARE plan.

[quakerboy]

164. You are sadly mistaken

My wife used to have a virtually identical plan, though the deductible higher. I had no insurance.

You pay the 35 on the spot. Then they figure out how much the bill is for the visit, and any tests you have. In my area, the cheap places start at about $100 for a normal clinic visit. $200 to 350, given the blood tests my wife has to have for her thyroid. Then they bill your for that amount, up until you hit that deductible.

The last time she went for a regular checkup under insurance, it cost her $35 on the spot, and another 178 sent in a bill later. We never once hit the deductible in any year she was insured, which means the insurance company never once paid a cent of the bills.

Now without insurance, she is free to shop Dr's, and it costs her 100-150 a visit because she picked a local guy with reasonable rates instead of having to take an "in network" place. But I digress.

I doubt a basic checkup would have cost them 535. In that you are right. But it would likely have cost them $35 on the spot, and another $115 at the end of the month when the bill went out. That would be if it was just a cold, and he was sent away with tissue and directions to take tylenol till it was done. If it had been something more serious, it could easily have hit the 350, or more when you count multiple co-pays

[truedelphi]

192. Huh? First of all,

If his parents HAD THE MONEY, then I assume they would have agreed to pay.

My instinct is that this young man was telling the truth - neither he nor his parents have $ 535 sitting around to be used for his health care. He is not working - and perhaps his parents aren't both employed, but instead hanging on to the mortgage payments and insurance payments just by the skin of their teeth.

Many families are now "one paycheck only" families. The credit cards are maxed out and the secret to their health is to "Stay healthy" or to die out right, but getting sick and needing health care is not an option.

[Zoeisright]

223. Do you know how to read?

They can't AFFORD the $535 copay and deductible.

Good god.

[sharp_stick]

3. Ridiculous isn't it

I'm amazed at the system we have in place. I don't know how we expect people to come up with deductibles for office visits, insurance in these cases is almost a waste of time.

[defendandprotect]

172. And, I think I heard on Thom Hartmann today that they've been losing 17,000 patients ....

a month? Is that possible?

However, losing 17,000 patients a year wouldn't have led to what he and

caller were suggesting is indeed a BAIL OUT for the insurance industry ...

which I've also heard discussed elsewhere due to the horrific circumstances

of the "insurance" and the lack of care!!

[Myrina]

4. ... and that type of experience isn't gonna change.

n/t

[kath]

17. yep - won't change one bit. Who's got a few hundred bucks (or more) laying around that they

can afford to spend on a doctor's visit?
Not many, especially these days.

Or system is SOOOO screwed up - in no other developed nation can people "not afford" to go to the doctor.

And this pathetic non-reform bill will not make care "affordable" for many.
Being forced to pay for "insurance" that you can't afford to use is utter bullshit.

[sabrina 1]

178. It will change in the sense that people who choose to just

pay out of pocket for doctor visits, will not be able to do that anymore. Now, they will be forced to buy the kind of insurance that the OP describes and their bills for a doctor visit will be beyond what they can afford. So, they will not go.

[Abq_Sarah]

23. There will still be copays and deductibles

People aren't going to get "free" Cadillac style health plans. The less money you have, the crappier plan you'll have. If you only afford the bronze plan the actuarial coverage level is 60%.

This bill needs a lot of work.

[Hello_Kitty]

5. What I fear about the "you can stay on your parents' plan until you're 27" thing

Is that a lot of parents can't afford to insure their kids even if they want to. I'm also picturing young adults being denied Medicaid or subsidized insurance by state agencies because "your parents have insurance so you should sign onto theirs", regardless of what kind of relationship they have with their parents, or their or their parents' ability to afford to cover them. That's what happens with college financial aid now. You could have moved away from home when you were 16 and be completely independent from your parents but they will still consider their income.

[Cal Carpenter]

27. And that's the thing

it is so hard to make people understand.

Social services through the government are extremely difficult to navigate, even if one qualifies they often get denied. And unless they have an advocate - either a friend who is a lawyer, a nonprofit org social worker, or something, they never even know.

Basically an applicant has to prove a negative (eg low/no income, low/no assets). It's easy to prove that you HAVE something with paycheck stubs, investment statement or a house note, but it's really hard to prove that you DON'T have things.

People defending the HCR bill use these absolute phrases like 'if you're really poor, you will automatically qualify for....' or 'if you're that age you can stay on your parents...' but that's just not true, or at least it's not that simple. The real world doesn't work that way. It seems to me that the people who vehemently defend this bill are either so far removed from knowing what it's like to have to decide between medical bills and utility bills, for example, or they are blinded by their own desperation and have to believe that this will work for them.

I would love to be wrong about all this.

eta: thanks to the OP for posting this, and kudos for helping the kid find a loophole that works for him. I hope he gets the help he needs. And I hope it's just allergies, heh.

[juno jones]

109. Means testing is how they get you.

Basically, you must sell off everything you've worked for before you can qualify for many programs.

It can mean the differnece between reliable transportaion and none.

It makes a difference when you actually work for a living.

[Cal Carpenter]

133. Yep

The working poor are gonna get screwed because they won't qualify for enough to make it affordable, especially with copays and deductibles and coinsurance. The truly destitute will continue to fall through the cracks because the system is so hard to navigate, especially for people lacking things like an address or a social security card.


The 'middle class' will get some crumbs in the form of subsidies. That will actually lighten the load for some people, I think. There are a few other subgroups of the population who will get a little benefit of some sort, but not much.

It's truly horrible. It drives me crazy to see people call it 'historic' and shit.

[GreenPartyVoter]

29. I think we are going to see some serious issues that will need correcting once the new law

is fully underway. Let us hope the Dems have control of Congress and the WH once that time has come.

[Hell Hath No Fury]

42. The first serious issue has ALREADY hit!

Turns out the "no child can be refused insurance for a preexisting condition" part of the bill is FUCKED UP. There is a thread here in GD on it -- check it out.

[GreenPartyVoter]

45. Yeah, I just saw that. *head thunks on desk*

[kath]

227. How has having "control of Congress and the WH" worked out for us so far?

The Prez and the fookin' "Democrats" (except for a handful - or less) didn't even seriously TRY for real reform -- it was "taken off the table" from the get-go ,then all the "public option" stuff was a bunch of gibberish buried in thousands and thousands of pages of bill that no one could understand, and Obama didn't fight for that etither.

[LWolf]

48. That's why my oldest son didn't get financial aid for college. nt

[PeaceNikki]

It's also taxable when they're 19

[HopeHoops]

6. Good for you. I've been in the same situation (but LONG ago).

All I could afford was a throat culture to see if I had strep. I couldn't find ANY clinic that would give me a culture without going through a full physical first. Not only couldn't I take the time off to schedule that, but what I made would barely have covered the culture. I'm not sure if I had strep or not, but it cleared up about three weeks later and, as evidenced by my three daughters, it didn't make me sterile.

Feel proud of what you did.

[tblue37]

54. An untreated strep infection can go "underground" in your body, causing dangerous, even fatal,

conditions many years down the road. For example, Poet Emily Dickinson died of Bright's disease. That is kidney failure caused by damage done years earlier by an untreated strep infection. Heart disease can also be cause by strep that you think you have gotten over.

A 38-year-old man here in our area who was profiled some years ago in our local paper was on regular dialysis for kidney failure and was waiting (hoping) for a transplant. He had had strep throat in his teens, and it had gone udnerground to attack his kidneys, even though he thought he had gotten well on his own, without antibiotics.

So if you have insurance and can afford the co-pays to do so, ask your doctor if there is a way to test to be sure that such damage is not going on in your system.

[HopeHoops]

209. I was tested for it a few years later (negative). At the time I had "catastrophic" insurance.

It was just for hospital stays and didn't cover trips to the doctor or lab work outside of a hospital stay. Besides, I was young and bullet proof back then.

[Echo In Light]

7. k/r

[meeshrox]

8. That gave me chills and boiled my blood...

you are correct: inexcusable!

Years ago, as a master's student, I was kicked off my parent's health plan at 25 and had to take up the school's. I was grateful to be covered, but it was disaster insurance and I had to pay separately for visits at the health center on campus.

These kids are the country's future. Those in college, even more immediately so.

I think you did the absolute right thing; I would have done the same. Who knows, but you may have saved his life...thanks for sharing!

[Cleita]

9. Never mind about defrauding the government. You may have saved his

life. A government that can't take care of all its people deserves to be defrauded. You worked the system, because the system didn't work for this young man.

[sandnsea]

10. If it's serious, at least he'll get treatment

and be grateful that $500 deductible isn't $5,000.

[Xithras]

13. If it's serious, I'm sure they'll find the $500 somewhere.

There's a big difference between, "I'm sick and need $500 to find out what's wrong" and "I have a brain tumor and need $500 to start treatment". Most people aren't going to sell off their cars and personal possessions over something that may just be allergies, but they will if they know their life is in danger.

My hope was really just that the clinic could diagnose him. If it's minor, great! If it's serious, at least he'll know and they will be able to make an informed decision about his care.

I'm not knocking insurance in general. I'm knocking the fact that modern American insurance is specifically designed to exclude the poor from treatment.

[sandnsea]

16. They won't need to cover the deductible at all

And they wouldn't if he needed expensive tests or anything either. Any medical facility would start all of this as long as a person has insurance, and if people live in states where this isn't common practice then for chrisssake stop letting red state bullshit rule everything.

And most family physicians will see a patient who has insurance, regardless of the deductible or co-pay, but most certainly with only a $500 deductible. If they don't, a person needs to find a new doctor, or like I said, stop letting this red state mentality rule everything. And I say that because I've only run into serious health care problems in two states, Nevada and Arkansas. Most states just don't treat sick patients like this.

[Lars39]

19. Most hospitals in Nashville want that deductible payed before they do any tests,

even if you have something serious wrong with you.

[sandnsea]

20. Red state bullshit, like I said

Demand better. They don't do that crap in any state I've ever lived in.

[Lars39]

22. You really need to walk a few miles in others' shoes.

[sandnsea]

24. Demand better

It doesn't have to be that way. The only two states I've dealt with serious medical payment issues are Nevada and Arkansas. Coincidence? I don't think so.

[Hello_Kitty]

38. Ever hear of gerrymandering? Here in AZ legislative districts are so rigged for the GOP

That a Democratic majority is a near impossibility, though we have been able to elect Dem governors. The lege determines what funding state agencies get and exerts a lot of legislative authority over how it's used. The only way we've been able to pass progressive legislation here is via citizens initiative, which is difficult and expensive but we've had some successes, like raising the minimum wage in 2006 and expanding Medicaid to 100% FPL way back in 2000.

That said, it's incredibly insensitive of you to flippantly tell people in Red states to "demand better" when the people we would be demanding for better are wingnut lunatics who literally do not care if people die because they are that wedded to GOP ideology.

This is what we're dealing with in AZ. http://www.azcentral.com/news/articles/2010/03/23/20100323kids-care-cost-arizona-billions.html Our Republican Governor Jan Brewer (Napolitano's replacement) is so stupid that she did not know that cutting Medicaid and KidsCare would jeopardize the federal funds in the Medicaid expansion. It had to be brought to her attention by a Democratic lawmaker.

[Name removed]

40. Deleted message

Sub-thread removed by moderator. Click here to review the message board rules.

[Raineyb]

64. Funny that, a lot of people were doing just that vis a vis this bill that just passed.

And there was a lot of STFU, being called selfish, being equated to teabaggers from people on this board who supposedly are on the same side. Imagine the crap that would come down from Republicans. "Demand better" is not the panacea you would have people believe it is.

[laughingliberal]

37. Yeah, well. Demand in one hand...

Our governor here is talking about opting out of Medicaid. And that was before HCR passed.

[Name removed]

41. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[dflprincess]

105. That happens in blue states as well

unless you're at a public hospital.

[dflprincess]

106. delete - dup

[laughingliberal]

36. That's certainly gotten more common in recent years

There was once a time when you could get care without meeting your deductible first and be billed for it later. I have encountered more and more doctors and facilities who want their payment at the time services are rendered if the deductible is not met. Last 10 years there's been a huge increase in that.

[liberation]

60. ... and that is why health care should be treated as a right

and not a profit making proposition.

[wolfgangmo]

88. This is why there are so many fundraising posters in gas stations.

.

[Machineland]

11. I've been in the same boat..

I know how that feels.. I've been down that road before. However with this new plan we should be able to get people into the doctor sooner and find these problems sooner...and should cost us less money to deal with it..instead of waiting till you magically have the money to go when things are much worse...

[Xithras]

15. This post actually wasn't about the HCR legislation.

It was about health insurance in general. I'd have posted it even if HCR weren't the hot topic of discussion right now, because it's an incredibly screwed up set of circumstances.

Honestly, I don't think the new legislation would impact this kids situation one way or the other.

[sandnsea]

32. Medicare has a deductible and 20% co-pay

So I guess it wouldn't have helped him either so no reason to advocate for that.

[progressoid]

52. Medicare? He's 19 and apparently not disabled. n/t

[sandnsea]

53. Grayson's buy-in to Medicare

The solution to all of this, right?

[laughingliberal]

95. It's a start. nt

[Mass]

119. How could he pay the deductible and copay, if he cannot at this point?

[laughingliberal]

123. I suppose I see it as a start towards solving many problems with health care

not necessarily the particular one this young man has.

[daggahead]

12. You are a good, compassionate soul. Bless you. n/t

[followthemoney]

14. God will punish you both for lying!

Only politicians are allowed to lie to serve their lobbyists and to win elections.

[prolesunited]

18. Why would it have cost $535 up front?

It would have cost $35, and most doctors have sample meds. Common generic meds are $4 most places and Meijer offers antibiotics for free.

If medical tests are needed and you have insurance, they bill the insurance company first. They don't ask for the full co-pay upfront. After you go through insurance and get the bill, you call to set up a payment plan. Most are willing to negotiate reasonable amounts, especially since they've probably gotten a substantial amount already from the insurance company.

Guess how I know this? Because it happened to me last year (when I still had insurance). I had internal bleeding and had to have an endoscopy and colonoscopy. Since I still had insurance, they put me through everything and then worked out a reasonable payment plan.

Now that I don't have insurance, because of pre-existing conditions and no job, it probably will be a different story.

I am so sick of these doom and gloom stories and downright lies being spread around here.

And for you to actually advocate committing fraud, to a student, in your office. Absolutely wrong. And you probably are risking termination by advising a student to commit a criminal act.

And before attacking me, remember, I am poor and with no insurance. But I am sick of the misinformation, irrationality and irresponsibility I've seen here on this issue.

Right now, because we have no other system in place at this time, I am happy that this bill was passed and I will be have access to health insurance. And I will continue to advocate single-payer, universal care.

[ecstatic]

26. +1. Deductibles are not required up front unless going into surgery maybe

and even if they ask, you can say no. Also, the deductible owed for a particular service is billed later and at the percentage split (80/20, 60/40 etc).

[OmmmSweetOmmm]

28. self-delete

[sandnsea]

31. And people who know better

Just chime right in as if this is normal practice. I don't get it.

[sammytko]

51. we had a worker fall off our roof and break his ankle, the hospital covered

his fees. I live in a small redneck county in S. Texas.

Same hospital was going to get Medicaid for my niece's knee injury if her school insurance didn't come through. She has a girl in jr. high and a son in college.

But in another case, hubby's ex-step-daughter was refused care even though her kids were on Medicaid or Chips. She said the caseworkers gave her a hard time cuz she was a full-time student attending a private Catholic university. She graduated and once she was working and insured had surgery. She had cancer!

It was treatable. She is a special education teacher, and is more than giving back her share to society.

I guess it is possible to be treated differently from county to county in the same state!

[sandnsea]

182. No insurance?

My daughter's kids are on SCHIP too. She works two jobs and is going to school, doesn't have any health coverage from anywhere. She'd have a heck of a time getting a surgery too, although we're fortunate that our local nonprofit hospital system doesn't turn people away. In any other circumstance, she'd be in serious trouble, I agree. That's not the situation we're talking about.

We're talking about situations like the others you referred to, where people got treatment without having to come up with co-pays or deductibles up front. Good to know that not all of Texas is so heartless as to deny health care over a $500 deductible.

[omega minimo]

35. good post

[progressoid]

47. Wrong.

Many Doctors and Hospitals are going to an upfront fee even for simple tests. I needed an ultrasound last year and I was responsible for the co-pay before the test was done and before the insurance co was billed. The same thing happened for a blood test for my daughter at a different facility.

[Roland99]

58. Co-pays are NOT part of a deductible.

[progressoid]

67. I didn't say they were.

While the OP mentions a deductible, prolesunited said they don't "ask for the full co-pay upfront". I was responding to that statement.

[Roland99]

71. My apologies. But, not all doctors' offices require test co-pays up-front.

[eilen]

204. A coworker had to pay

everything up front to have a tumor removed from her uterus. She tried to see if it would help if she married her boyfriend and got on his insurance- wouldn't work d/t preexisting condition and the surgeon didn't take his insurance. She tried to see if it would help if she got on medicaid--nope-- surgeon does not take medicaid.
She has a BS with Psyh Major and works as a home health aide making $7.50/hr, no benefits because she does not get full time hours.

She ended up throwing herself at the mercy of the State Hospital who worked something out because her surgery required a specialized robot. BTW she was out of work for 6 weeks after the procedure.
Ultimately, she had to come up with $7,000 for the surgeon and the cost of the anesthesiologist prior to the surgery. The use of the machine, the hospital bed (21 hours=$21,0000)-- that she had to negotiate with the hospital.
She is still paying back student loans.

[pitohui]

55. because drug users make up stories -- i was played by a drug addict who told me he had a brain tumor

and i completely believed it, for years, until he finally died not of a brain tumor but of a drug overdose

the OP's list of symptoms in a college age kid smells like cocaine to me, not that i'm a doctor nor do i play one on tv!

the kid has lost several weeks of college classes, in value WAY more than a $35 co-pay, so he's throwing away hundreds maybe thousands of dollars to save $35? that don't make sense

the kid is taking advantage of the OP's kind heart, in my humble opinion

[ecstatic]

73. Maybe he's not on drugs but I know I've had my share of sob stories

when I messed up in school.

[Ticonderoga]

222. Well,

I'd reserve comment until we get an update on his condition from a doctor. Please follow up on this story.

[Roland99]

57. +1

[Xithras]

66. I honestly didn't ask. As to the rest...

I see that this question has been asked by several people, but I'll respond here (I vanished for a little while because I had office hours). When I asked the student why he hadn't seen his doctor, he quite clearly relayed the money conundrum. I didn't press him on it because my own experience is closer to his than yours. When I go to see MY doctor, they ask me point blank whether any deductible is due. The bill is due, in full, within 30 days of the treatment. If I say that I don't owe any deductible and the insurance rejects part of it because I do, the doctors office WILL bill me directly, but it's almost a given that the process will take more than 30 days...so the bill I receive will not only demand the deductible, but the late fees for nonpayment as well. If I tell them that I DO have a deductible, they'll give me the option of paying it right there, or being billed for it. If I ask to be billed, I will receive the bill within a few days, and it's still due within 30 days of treatment. And if I need payments? They offer a 90 day plan with interest.

In my experience, this is fairly normal. I certainly wasn't going to attack the kid and call him a liar over it.

As for my job, that's my concern. Nobody is going to fire me for offering a student advice, especially given his circumstances. And if it came right down to it, choosing between my job and offering potentially lifesaving advice to a student with an untreated and possibly serious medical condition, there really wouldn't be a choice to make at all. I would never even consider placing my job security above the safety and well being of my students.

[ecstatic]

78. delete

already covered down thread

[laughingliberal]

97. +1000 Too few like you in today's world. nt

[Roland99]

100. What the heck kind of insurance plan do you have where a doctor's visit falls under a deductible?!?!

Are you confusing a co-pay with a deductible?

Deductibles cover additional services or hospital visits or, say, a specialist. A regular doctor will require a co-pay that does NOT count against a deductible.

[kestrel91316]

129. My AVMA plan years ago cost $400/mo premiums and then I had a $5000 or $7500

deductible to pay before so much as an aspirin or 30 seconds of the doctor's time was covered. I had to pay IN FULL for every office visit, every lab test, every prescription medication until they added up to the deductible and only then did the insurer cough up a goddamned dime (and then there was still the copay).

You are really naive. There ARE policies out there like that, and mine was quite expensive.

[Roland99]

146. For the third time here, you did not have co-pay, unlike the case described in the OP

[kestrel91316]

155. For the FOURTH time, I had to pay a co-pay after I finally used up my deductible.

Don't tell me what I had or didn't have.

[Roland99]

158. No, you did NOT have a co-pay. See post #157.

[SocialistLez]

151. My mom's insurance plan...which I'm covered under

Regular doctor visits fall under the deductible.

Last year it was a TAD bit better, we had a $250 credit to use for doctor visits (still had to pay a $20 co-pay each time) and prescriptions and then we had to start paying our deductible.

I have no clue what the deductible is this year but I know it's higher and so is the amount of $$ taken out of my mom's check every two weeks to pay for health insurance.

[nightrain]

162. that's pretty standard...

[Lydia Leftcoast]

185. My insurance plan is like that , too

Everything falls under the deductible, including office visits.

[Cleobulus]

91. I've heard some insurance plans require you to use up the deductible...

before copays kick in. Its possible its one of those plans.

[Roland99]

173. You're confusing "co-pay" with "co-insurance"

[Cleobulus]

190. Not really, like I said it depends on the plan, and what you are using it for...

some plans are so bad, even a routine doctor visit falls under the deductible and not copays.

[Roland99]

197. That's exactly what I've been saying. The case of the OP, there's a co-pay involved

It's NOT a plan where a deductible has to be met first, from what we can tell from the little bit of info provided in the OP.

[Phentex]

216. It's possible for everyone here to be right...

I have seen so many different plans with various rates it's not even funny. People on the same plan can have different benefits. It's unreal.

[Lydia Leftcoast]

186. That's how my plan works

$5000 deductible
20% copay after that for the next $25,000.

Why do I even bother?

[Roland99]

195. That's not "co-pay", that's "co-insurance". There's a difference.

[Lydia Leftcoast]

199. Still, it's onerous

:-(

[Roland99]

202. With that I can wholeheartedly agree. It's why I feel something like HR 676 is the ONLY solution.

NO co-pays
NO deductibles
NO pre-existing conditions.



But, hey, that's just too radical.

[Barack_America]

114. Honestly, anyone with his symptom is going to need at least a CT-scan.

If not a more expensive MRI.

I doubt any doctor would listen to symptoms like that and not request at least some imaging. Even if it looks like just a sinus infection, those symptoms warrant some extra measures to cover a doctor's ass, litigation-wise.

Average cost of a CT-scan of the head is at least $200-400.

[kestrel91316]

130. I think you left out a decimal on that CT scan. The last mammogram I got cost

at least $600 and that was YEARS ago.

[AllyCat]

115. Okay, so the OP used a poor choice of words "up front" but you know what?

The reality of this is that the bills would come at the end of the month and this kid obviously knows he does not have $500 to pay that part of the bill. And while there are some who will set up a payment plan, there are others that won't. The "non-profit" hospital for which I work is one of those. You pay it when the bill comes in the mail or off to the collection agency goes your account.

And the OP never mentioned anything about HCR. Just how CRAPPY our insurance system is. Funny that you should infer that this had something to do with HCR and had to come to its defense. The insurance industry doesn't need defense. They got everything they wanted with this bill and more.

[HughMoran]

135. Can afford tuition at a college, but not a $35 copay?

My PPO is worse that that and it costs me $700/month - I can't imagine not spending the $35 to go to the doctor, even if I might hit the deductible if treatment was needed. It's better than dying.

[Commie Pinko Dirtbag]

21. To anybody who's planning on chiding the OP for "deceit" or something...

...you may consider yourself, in advance, wished to die the most horrible, painful, and prolonged death you can imagine.

Have a nice day.

[kestrel91316]

131. +1000. Civilized people show compassion first and ask questions about payment later when

a person is that sick.

[hunter]

153. Can I drive the karma train?

I think the ride would start with losing one's identification on a business trip to a distant city, suffering a freakish blood chemistry disorder that caused amnesia and symptoms similar to schizophrenia, running down the street half naked and looking to all the world like a homeless dude who needed a forty ouncer and a pack of cigarettes really really bad, fighting with a cop, and getting thrown into a holding cell and forgotten over the weekend. And this would be just the beginning of the adventure!

At the very end of this ride, as the coroner zipped up the body bag, there would be some self righteous prick standing there who would say, "Tsk, tsk, let this be a lesson to you kiddies, if John Doe there hadn't been such an irresponsible fellow none of this would have happened."

Oh well, I guess that's why I don't get to drive the karma train. I have no patience with clueless assholes who are always quick to blame the victims of our cruel dysfunctional society.

[MountainLaurel]

25. Thank you for helping your student n/t

[The Genealogist]

30. Thank you for empowering the young man

It is terrible that someone in America has to stoop to fraud to get medical care. I don't see how else the young man could be treated. I suppose he could go begging to get the money. But, if he is as sick as you say he is, how long will he hold out to beg? And what kinds of humiliation is he going to get if he does beg? Called lazy, a bum, told to pull himself up by the boot straps and to "suck it up." I can hear that kind of rhetoric and more. At least you gave him an option. And that is power.

[Starry Messenger]

33. Thank you for helping him.

The barriers to health care in this country are insane.

[postulater]

34. Once I saw an undocumented worker from Mexico with multiple myeloma

I sent him to a clinic where they told him the same - to just tell them a lie and they would help him get some assistance.

Sad, indeed.

[gkhouston]

39. Please let us know how he's doing, if he tells you (and if it's okay with him). n/t

[cbdo2007]

43. Do you not have a college health center?

They usually will give students a free exam and then he could at least have seen a doctor to get an opinion.

Also, I doubt he's discussed this at all with his parents who would probably gladly pay for the initial doctor visit to at least get him on their radar. It's typical for college students to want to deal with things themselves and not involve their parents so I'm guessing if his parents actually knew what was going on they would gladly probably pay for the whole damn thing - $535.

Under your advice, he's going to lie on some forms for the initial exam but he can't keep up lying if it is a serious issue. They're going to find out and back-bill him for extra stuff that isn't going to be covered by his insurance because they're probably out of his network.

[LWolf]

50. My oldest son visited his college health center in late November.

He thought he had a spider bite on his knee. They told him it was an infected bite, and to clean it with peroxide (like he hadn't already done that) and sent him home.

By the time he showed up in mid-December to spend the holidays with us, it was horribly inflamed, and had spread up his thigh, with 2 more eruptions. He wouldn't go to a doctor here, because he has no insurance. We pressured him, and he resisted, until it spread into his groin. I spent xmas eve sitting in urgent care with him. They required payment on delivery. We are all short, but we took up a family collection to pay for the visit.

It was anti-biotic-resistant MRSA. He endured some excrutiatingly painful lancing, spent the rest of his visit on painkillers and one of the two anti-biotics left that will treat that strain, and we canceled all the family outings we'd planned.

When he got back home, he didn't go back to the college center to have it checked. He figured he could do as well himself.

[liberation]

61. Depending on the University, the student would have had access to relative comprehensive insurance

unless he opted out of it when he enrolled in classes.

[Xithras]

72. We do.

It's generally staffed by an RN and two aides who offer nothing but over the counter medicines and referrals to other clinics. There is a doctor in there one day a week, for a few hours, but it's mostly for administrative purposes. They offer TB screenings, various immunizations, and care for very minor injuries, but that's about it. Most of the students just know the office as a great place to get free condoms. It's extremely unlikely that they could have helped him.

My advice was that he go to the county clinic for an exam to determine what the problem was. If it was minor, he could be done with it at that point. If they uncovered something major, he could go to his regular doctor and just deal with the insurance company as needed. If it was serious, I'd never suggest that he have the county clinic treat him over the long term...and not just because our underfunded county clinic would limit his treatment options.

[sammytko]

44. doesn't your college provide health insurance?

My niece broke her kneecap and spent 2 nights in the hospital, etc. She is undergoing therapy this week. All was covered by her school health insurance - community college in san antonio. Its a one of the fees attached to tuition.

She did have to go a couple of rounds on the phone, but it was well worth it.

I remember my college had a full time doctor and nurse on campus. This was back in the 70s.

[LWolf]

46. And this situation will not change with the new insurance "reform." nt

[treestar]

49. It costs $35

The whole point of the deductible is you are saying that's what you can pay in the ordinary course of life.

It's amounts over that which one considers catastrophic and in need of insuring.

You're insuring heavy expenses. Not day to day expenses.

I cannot believe they don't have $35, including his parents. If his parents don't have $35 for this, then they must all qualify for medicaid and welfare.

[Roland99]

56. For typical PPO plans, the deductible is for things beyond an office visit or a Rx

If tests were required, for example, or if the kids needed to be admitted into a hospital.

Even then, if tests were required, I'm sure the doctor's office wouldn't have required payment up-front. They'd bill the insurance company and if/when they didn't pay, then the family would owe but I'm sure even then could setup a payment plan.

This story smells like a rotten egg.

[pitohui]

59. i believe the OP believes the story, but this kid is almost certainly using drugs

when somebody is standing there and telling you all about their brain tumor, they can be very convincing -- been there, done that, got that t-shirt!!!

i believed for years, i mean like 15 years, still feel like a bit of an idiot because once the person died of the drugs, then everything suddenly snapped into place and made a lot more sense...

but you wanna give people the benefit of the doubt when they're hurting...

as a teen i was desperately ill and had the awful experience of being tossed out of an emergency room for having no insurance/money, but that's a far cry from not bothering to try to go at all, if you're seriously ill and think you're dying, you'll at least try to get help

[Javaman]

76. Should I channel dr. frist or do usually make your diagnosis via the net? nt

[laughingliberal]

99. ROFL!!

Yeah, I've been an RN for many years and am a recovering addict for more years than that. Drug use was not the first thought I had on reading those symptoms. Or even the 2nd or 3rd thought.

[Name removed]

127. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Occulus]

147. I'd HATE to be your kid. n/t

[JonLP24]

149. Most probable explanation?

I knew someone with a brain tumor(which btw the OP did not say, said it could be allergies to that) and you know what made him to see the doctor? He had really bad headaches for a couple of weeks.

I've used cocaine before and never had the symptoms listed in the OP not even nosebleeds.

[laughingliberal]

168. That would be the first thing I'd think should be checked

sounds like increased intracranial pressure to me.

[laughingliberal]

167. Sorry, I have years of experience as a nurse and was a nurse confronter

in TN's peer assistance program for nurses with chemical dependency problems. I also worked my way through nursing school as the resident weekend counselor at a halfway house for female addicts transitioning from prison. I don't have a naive bone in my body where addictions are concerned.

You might want to consider that when medical professionals jump to the kind of conclusion you did, people can die. It's not impossible that is the reason but its really not the most likely. I'm equally sure the OP has enough years dealing with college students to have some powers of discernment.

I know you think you're cute but I don't agree.

[SolidGold]

218. only drug i know of that could cause this....

is cocaine and you would know your dealing with a cokehead and not someone with an illness.

i'm going to just guess he lives really close to power lines and drinks heavily. That's my assumption based on absolutely nothing.

[rgbecker]

62. The expression is all American..."Can't afford to get sick."

[ieoeja]

65. As several others have already pointed out, deductibles don't work that way.

It isn't like car insurance where the first $500 comes out of your pocket. Furthermore, doctors and hospitals frequently charge an inflated rate to the insurance company then satisfy themselves with whatever the insurance pays them.

They're doctors. Not bill collectors.

[laughingliberal]

102. It really does depend on the particular doctor and/or hospital. nt

[FarCenter]

68. Checked my alma mater's web site and they still provide student health services

Student goes to the clinic, is treated by some budding health professional, and the student fee covers any out-of-pocket expenses that are not covered by the student's insurance.

It's paid for by the health services part of the student fee if the student is enrolled for 6 credits or more.

[Emit]

74. Well, to see the doc once, it would only cost him the $35 not $535

and many people do not realize that wellness visits on some insurance plans are fully covered, so, while I appreciate exactly what you are saying, many people do not know how to use their insurance and just avoid going to see the docs for fear of high costs.

Granted, once the doc saw this man and likely ordered tests, that's when he would have to come out of pocket the full deductible. And here's my advice on that, having three kids and living previously on one income: DO NOT NEGLECT YOUR HEALTH and go ahead, see the doc and let them bill you while you try to meet your deductible. Then, pay the doc/lab/radiology back $5 per month if you have to do it that way. Most docs have been fine with me handling it this way, and are more than willing to work out a payment plan.

I fought a charge of $200 for 2 years once with a lab and never was taken to collections. It's a matter of learning how to navigate the system.

That being said, this story sucks and is what is wrong in so many ways with our health care problem (on edit, i.e. the high deductibles and such). Thanks for posting.

[Lars39]

81. Not necessarily...some offices are charging the amount of the doctor's visit

up front when the deductible has not been met, especially since we're just a few months into the new year.

[Emit]

84. Rarely have I ever been asked to pay more than my deductible

Only once with a recent root canal and that was with my lame Dental insurance. Even then they allowed me to split it into three payments.

Even if this doc did require his total fee be paid up front, it would not be the full $535. A routine doc visit in my area will cost somewhere between $65 to $100.

[Lars39]

86. Well, it happens where I'm at.

If the student doesn't have 35 bucks for a copay, the money for a first time visit or urgent care place would be out of reach too.

[Roland99]

90. *cough*BS*cough*

What office and regarding what insurance plan?

[Lars39]

93. I'm sorry you don't believe me, but it is happening in middle TN.

[Roland99]

101. You didn't answer my question so my skepticism remains.

[Lars39]

103. I am under no obligation to tell you where I go to the doctor or where I live.

[Roland99]

111. And I am under no obligation to believe a single word you type. Nor is anyone else.

[Lars39]

112. I really don't understand the "bubble" people like you.

You refuse to acknowledge that the world doesn't work the same for everyone...it's like you have no empathy or imagination or willingness to understand how other people live or how things like insurance work in other places. Sad. I can't figure out if it's because you're young or if you've just led a somewhat charmed and sheltered life, leaving you lacking in the experience department.

[Roland99]

138. Far from young and far from inexperienced

I've actually worked a fair amount in the insurance industry throughout my career. I know how the shit works (or doesn't)

[Lars39]

142. Then you should know medical offices and insurance companies

are *always* coming up with new rules and ways to screw patients over.

[valerief]

183. You may be smug but you sure are (word I'm not allowed to use to posters). nt

[tammywammy]

82. All preventative care is covered 100% by my insurance

Aetna does refuse to pay some $60 lab fee, it's not broken down into what exact test it is. They haven't paid for it the last 3 years that I can look back on (my previous job also had Aetna, but was a much crappier plan). My doctor's office has never asked for the $60. My wellness exam was covered 100%.

[kestrel91316]

134. Lucky for you. I am a medical professional and the group policy I had until several years ago

(when it went from $400 to $500/mo) had a $5000 or $7500 deductible (I forget which) and then an 80/20 copay on the next 2000 or so. I had to fork out $6000 + $5000 or $7500 + $400 = $11,000-14,000 OUT-OF-POCKET before they kicked in one red cent to cover so much as an aspirin. Preventive care was not outside the deductible. Mammograms, pap smears, birth control pills, NOTHING was outside the deductible.

I truly couldn't afford any medical care whatsoever anymore so I gave up the policy. And my professional association brags about how their policies are so great because they've got such great negotiating power. Total BS. They have crap policies. I checked recently, and they go from $500/mo for crappy HMO plans to $900/mo for a decent plan with a $1500 deductible. I don't think any of them cover preventive care visits before deductible gets used up even now. Bastards.

If I want a crappy plan I can get one with Kaiser for $200/mo. Heck, it's a better plan.

[tammywammy]

137. Yeah, my previous plan with Aetna was a PPO

I worked for a company that was less than 100 employees. Now I work with a large Fortune 100 company and they have a great plan, and I think the total cost is a little over $7000 for the plan and I pay a little less than $20/week.

It was changed this year from a HMO to where it's more "coinsurance." The deductible for myself (and myself only, no SO or kids) is $1500/year. I think it's like 80/20 until you reach the full deductible, and then the insurance pays everything 100%. It's really not bad when you think about what other plans are out there. And I have money that the company gave to set aside in an account that pays towards the deductible when you go to the doctor. So honestly if I was hurt or really sick, after what the company gave me (and it rolls over each year) I'd be out $700 or so and the insurance would kick in 100%. Prescriptions don't count towards the deductible though, but the way it's set up is for a generic I only pay 10% of the cost, so my previous generic pill cost $2.78/month. I switched over to the NuvaRing and for three months it's $47 through mail order (which I'm willing to pay, since I prefer the ring over the pill hands down).

There's no co-pays for any doctor visits or prescriptions. And when I was at the doctor's for my physical the lady just said "we'll bill your insurance and let you know if you owe anything." But I will say, when it was a standard co-pay I did always have to pay that upfront.

[hamsterjill]

75. Absolutely the right thing to do!

This 19 year old kid has his whole life ahead of him. I'm glad you knew how to advise him to get the help that he needs.

Your act is not ONLY for that 19 year old, but also for all of the other students, etc. that come in contact with him. What if he were infected with something contagious and could not afford treatment?

I hope he takes your advice, gets treated, and recovers easily and well.

[Matariki]

77. Wouldn't it be better for him to see his regular doctor

and pay off the bill later w/ that summer job? won't his doctor work out a payment plan or bill him later? I realize that many won't.

It's such a sad and probably all to common story. I hope your student is okay and it's not something serious.

[mdmc]

80. Thanks for sharing your story..

peace and low stress..

[DirkGently]

83. Well done.

[Emit]

85. Does the college you work at not have a student health services?

I ask because in my daughter's case, she is covered under our insurance, but we recently found out that she is covered under the student health services at her college. It did require that we pay a small per semester fee, which was mandated, I believe, but she can walk in there and receive services even though she is covered by our insurance - and we didn't even know until recently!

[matt819]

87. Yeah, you're right, but. . .

You want a public option or medicare buy-in? Okay, there will still be premiums and possibly even deductibles. I'm all for some sort of social safety net, but the reality is also that people need to take responsibility for themselves as well.

Back to this situation. Unless this student knows precisely what medical care his parents have received this year and the amounts paid that went toward deductibles, he may not even realize that the deductibles may have already been met. And where those payments were applied may also affect the deductible. For example, I have a $5,000 deductible, but when it comes to Rx it's much lower and I pretty much met that after I renewed my prescriptions in January. Should it be this complicated? No. Would it be nice to walk into any doctor's office and not pay a dime because the government is picking up the tab? Sure. But there is no free lunch, and had the public option or medicare buy-in been approved, we might have seen an increase in taxes. Also, and again I realize it sucks. doctors and institutions are increasingly opting out of medicaid and even medicare because of low reimbursement rates. So his parents' PPO could bow out and he'd be completely SOL. I know, I know. In an ideal world there wouldn't be co-pays or deductibles, and convoluted insurance plans. But this is the world that we are in, and it is that world, not some idyllic utopian vision, that the reform bill is intended to fix.

Back to your student's problem. The assumption that he'd be out the full amount of the deductible as well as the co-pay assumes that the visit will cost $500. I don't know about you, but my family physician's charge for a routine office visit is under $100 (part of a pretty large health care system). Even an extended visit is still under $200. Sure, tests could change that pretty quickly, but assuming from the outset that these will apply is inappropriate.

And, finally, if his PPO is part of a decent-size health care system, as opposed to the old-fashioned family doctor, he can almost certainly set up a payment plan independent of the insurance company.

Sure, you did great by referring him to a clinic, and paying nothing is better than shelling out a few hundred dollars that are hard to come by. But in this instance I think "blaming the entire system" is out of line.

[Dorian Gray]

94. Your college doesn't have an infirmary that he could go to?

That sucks for him. I hope he feels better soon.

[Lydia Leftcoast]

187. My college had an infirmary, but it was like a school nurse's office

Depends on the size of the college.

[ChiciB1]

96. Great Post, But Somehow I DON'T Think This Will Be the LAST One

of this sort! Just saw it, but can't rec... too late!

Up Is down, Down I Up, and they're too many LIARS talking CRAP out of D.C. from MOST of our "Elected" Officials!

Oh MY, I need to pray for all the little SHEEP... so MUCH wool being pulled over so many eyes! Wonder when they're going to see how many sheep died or got killed???

Yeah, THAT was a bit macabre, but sometimes I feel totally CRAPPY!! I LOVE ANIMALS!! Going out to feed my squirrels right now!!

[juno jones]

107. K&R!

Thank you for seeing this. :hug:

I hope he gets the help he needs.

[misanthrope]

108. Is there no student infirmary there?**nm

**

[eridani]

116. But, but----he can have crappy insurance that he can't afford to use until he's 27!

Isn't that WONDERFUL!

Signed, Dr. Pangloss

[trocar]

117. Moral Underground

Xithas Thanks for being helpful for that young man.

Please check out the Moral Underground by Lisa Dodson, superb book that describes this kind of necessary caring that we must do for those in need.

[SocialistLez]

152. +1 Great book

[saracat]

121. Thank you for this. I am dumbfounded that some here actually are

"defending" the insurance industry. And the callous dismissal of lack of funds is beyond belief!Whoever stated that the parents would just "dig up $500 somewhere" is way out of line.I know I couln't come up with that amount right now even if I were sick and yes the 35 dollars wouldn't be easy either.

[amborin]

122. can he not use the student health services?

otherwise, there is NOTHING in the HCR bill to control the cost of premiums or co-pays, so this will be the same sad story

[pitohui]

128. kid doesn't WANT to see a doc, he was making excuses not to

too often we are offering a solution to the wrong puzzle

[gkhouston]

203. the student health service at some universities is a joke -- okay if you've got

strep or a sinus infection, but worthless otherwise. When I was in grad school, it took them six weeks to figure out I had mono.

[kestrel91316]

124. You did the right thing. The CIVILIZED thing.

[JustAnotherGen]

132. A forgiveable Fraud

Birds gotta fly.
Fish gotta swim.
19 year olds with health insurance that don't have a dime - gotta do what they gotta do.

[Shining Jack]

136. K&R

What a horrible situation. :(

[Uncle Joe]

139. Kicked and recommended.

Thanks for the thread, Xithras.

[SocialistLez]

150. 535 dollars?

My goodness.

He isn't defrauding anyone, the doc who is charging $535 for a check up is the one committing fraud!:grr: :grr:

[MindandSoul]

156. I'm glad you cared enough to do this! It could also be a brain aneurysm!

[midnight]

159. Third world deliver of health care rears it's head. It's pay to play mentality.

This strange concept that Dr. Nancy Sniderman was articulating last year about everyone having skin in the game..... We need our taxes to stay in this country. and not be sent around the world via bombs, but to be used in life affirming ways via affordable health care... Thanks for being a caring soul. It is up to us to look out for each other.

[BlueIris]

196. Pay to play mentality.

That's an appropriate way of putting it, if you know what I mean.

[ZombieHorde]

160. Recommended. nt

[wellstone dem]

165. My daughter is on my insurance but unfortunately, the insurance doesn't cover

care in her state until the total out of pocket hits $2500. I would pay the 2500, but she is still having trouble getting care. She needs a medical professional to prescribe her medication. She used to have the university doctor do this, but is now out of school. She has gone to medical facilities who won't see her, because her insurance won't cover right now. This is even though I am willing to guarantee payment. Even when she hits the deductible limit, the insurance will only cover 40%, again because it is out of state. Fortunately, the medication is covered since she can go to Walgreens. I have great insurance, but only in this state.

[cbdo2007]

177. I would have my kid come back to the state where they can get medical treatment

rather than stay somewhere where they can't get it.

Many sacrifices have to be made in life by everyone every day. The goal is to make the situation you are in work best for you, not hope some day all the rules will change so that it fits your situation.

[Phentex]

214. Why can't she use a credit card?

If you are willing to pay the out of pocket, why can't she use one of your cards and then get the coverage she needs where she is?

[SocialistLez]

226. Weird

I just hope you don't ever have an accident out of state.

[RoccoR5955]

174. When laws are unjust, rightous people have to break the law...

It's called civil disobedience.

[dkf]

184. You did good.

I'm awed by your caring for your kids and that you would give such advice. So many times we limit ourselves because we know what the system tells us we ought to be doing. Yet this kid needs help as much as any other person out there.

I hope everything turns out ok.

[Kitty Herder]

188. K&R

[tomm2thumbs]

194. thanks for posting and for enlightening others on the insurance agency stories of 'insured' families

they need to change the word from 'insurance' to 'diseased band aid' because it is worse than helpful when money is flowing out to something that benefits no one in the long run, but drains resources that could have helped

[ejpoeta]

198. that is what we were facing before we ended up on family health plus.

our previous insurance had a deductible around that and an 80/20 split. and i have some pretty nice bills from the birth of my daughter. but after the company got rid of all except an insurance with a $5000 deductible per person as our only choice, we applied for the state plan. we were lucky, but we were just under the cap. so that means no overtime for my husband. he said if he were offered a raise he would refuse it. they do this on purpose. they don't WANT you to go to the doctor. they don't want you to use it.

i have said it before and i'll say it again. in some ways having this underinsurance is worse than having no insurance at all! when they say people will be covered, exactly what do they mean by that. because according to 'them' we were covered. and this boy is covered. but we aren't really. because not only are you paying them for 'insurance' but you can't afford to use it. how is that covered! i wish this bill actually fixed that. it might be easier to fight the people blasting this bill if i thought it would do more than just some small thing. the best i can say is that i don't agree with this bill, but it isn't socialism and there are a lot of things in it that we NEED to stem the tide.

[newportdadde]

205. One of things that I didn't see enough discussion on was deductibles and copays.

I have what would generally be considered good insurance, I get it through my employer and its sub 300 a month. However I never want to use it. Why? Deductibles. Last month after fighting a cold for three weeks I finally went in to a local CVS minute clinic. The fee for being seen was 65 dollars. I ended up paying 56 dollars. My 'insurance' saved me a whopping 9 dollars due to their contract terms. Since I had not yet met my $500 individual deductible I paid out the 56 dollars. So for me unless I get sick many many times a year or really sick this insurance doesn't do much for me and this is again 'good insurance'. I would like a healthcare system where someone making a decent wage didn't have to forgoe care. Don't companies realize that this effects productivity of workers, exposes other in the public etc?

Also let talking about doctors pimping out patients with insurance, my local GP had me on cholestrol medicine, every 4 months I would go in for a 'checkup' this consisted of him seeing me literally for less then 5 minutes and getting a blood draw, I was charged a regular office visit and paid out about 60 bucks(again deductibles). Come to find out I could have just had the lab work done at a separate testing facility(literally across the street) and it would have been 100% covered for the blood draw. So why didn't he send me over there? Was it to avoid a lawsuit? NO it was to hit me with an office visit charge because he knew I was good for the money.

Republicans are quick to point out that doctors do tests to protect themselves from liability, but what about just to line their or the hospital's pockets? How much of that goes on?

[cbdo2007]

206. Do you have an HMO option? I talk to a lot of people who have PPO

and are upset about the Deductible which is why I've always chosen the HMO option. It's always been cheaper to get the HMO and you have all the fees right there in front of you. No Deductibles. Usually even after you meet the Deductible you will still have to pay Co-insurance which is 10% or more and is usually the same price as the copay anyways. I may be crazy but I've saved thousands of dollars over the years having an HMO rather than a PPO so you may want to look into that option.

[closeupready]

207. K&R

n/t

[swilton]

208. Saddly - 'reform' will not fix this problem

It will enshrine it - this is what health insurance mandates bring us-

Thank you professor for being a humanitarian!

[blueworld]

213. I'm glad you posted, & glad you tried to help

From reading the zillions of comments, it's apparent that some folks don't realize all plans are different and that different regions of the country differ significantly about payment rules.

I just wanted to mention that there's a chance, small I grant you but still a chance, that the clinic's computer system already knows about his insurance. I've been shocked to find out how much of my medical & prescription info is "shared" even though we are supposedly guaranteed privacy. Another big laugh.