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Old Sep 17, 2012, 04:45 PM
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faerie_moon_x faerie_moon_x is offline
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So let me tell you how awesome the American health care system is.

I was suicidal since I was 12 years old. Never got any help for my mental health issues, due to money.

Not in treatment now, due to money.

Have fought my whole life to overcome suicidal tendancies.

In July I had gallstones and had to have my gallbladder removed. Then the stones. Then I got pancreatitis so they put a stent in my bile ducts. Of course they put one in that has to be removed, which means another surgery. Which I'm due for now.

Of course now they want a huge co-pay up front, thanks to my ****ing awesome $15,000 a year insurance which pays for NOTHING, and the only "payment plan" is to do half. Which is still huge. And I can't afford it. I won't ever be able to afford it.

So now, I can't have it removed. If I don't have it removed, I will get sick or injured and die. So, awesome. Thank you, greedy bastard surgeons and insurance companies, for all your help. Thank you so much for making this choice for me. Thank you. I so appreciate it. OH, and of course, they are the only GI surgeon group in the city. Thank you for monopolizing my health. Because I chose to get gallstones and I chose to get pancreatitis. That was so damn awesome.
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  #2  
Old Sep 17, 2012, 04:52 PM
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As medical practitioners, the "first, do no harm" principle is key.

If the stent has the potential to inflict illness and/or death, then harm has been done.

I would seriously take this up with legal aid (in Canada, this is legal representation if you cannot afford it). Don't know if you have something similar or not.

I am sorry you have to deal with this mess.

Blue Poppy
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  #3  
Old Sep 17, 2012, 05:17 PM
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i don't know what to say you're probably like me in that bracket where we work so considered to make too much money to qualify for medicaid. but i also thought that here in the states, a hospital can't refuse you treatment if you were to go in with an emergency? of course you dont want to wait for it to get to that point. i have the $15k/yr health ins too... anthem... yet i have to pay $4500 per person before they cover. then it's random who's a provider in the plan, and often i still have to pay 30% after that. it is so ****ed up. it's like you might be better off to leave working, get welfare, so you can get health insurance.

every american should have all health care they need, food, water... basic needs should be basic rights. tax the top 1% already god dammit %$&%$^#^&
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  #4  
Old Sep 17, 2012, 05:48 PM
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Quote:
Originally Posted by BlueInanna View Post
i don't know what to say you're probably like me in that bracket where we work so considered to make too much money to qualify for medicaid. but i also thought that here in the states, a hospital can't refuse you treatment if you were to go in with an emergency? of course you dont want to wait for it to get to that point. i have the $15k/yr health ins too... anthem... yet i have to pay $4500 per person before they cover. then it's random who's a provider in the plan, and often i still have to pay 30% after that. it is so ****ed up. it's like you might be better off to leave working, get welfare, so you can get health insurance.

every american should have all health care they need, food, water... basic needs should be basic rights. tax the top 1% already god dammit %$&%$^#^&
Ding ding ding! We have a winner! Anthem! The "anthem" they sing "How many people can we kill while eating steaks on our yacht." Do you know that song? It's a catchy tune. Sounds like you've heard it before.

I'm exactly in that bracket. I'm too poor to help myself and too rich to get help. Haha... Yup, that's me.

We do have legal aid, but yet again I make too much money.

This is not a hospital. It's a surgery group. So they schedule the mandatory removal at their 'center'. Which means if you can't pay you can't go in. My friend says it should have been part of the original proceedure and should not have a seperate co-pay. I did a nice little bipolar meltdown on them, though. Screaming "I AM NOT RESCHEDULING THANKS FOR MURDERING ME!" (One benefit of being bipolar... freaking out on people who really are rude )The ***** hung up on me. Not even a "have a nice day...."
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  #5  
Old Sep 17, 2012, 07:13 PM
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Did you also talk to anthem yet? Or just the surgical center?

i've been on the phone with anthem a lot recently, finally turning in all the pdoc invoices and therapist invoices that i've procrastinated on. like the $540 pdoc appt for my son where they reimbursed me $50... gee thanx... but anthem actually let me know last week that 1 of the hospital rides in the past year, that the ambulance co overcharged me which is illegal in california apparantly, and anthem is reporting them! everywhere i look companies trying to take advantage of someone in an emergency situation, trying to rip people off. and if we don't know about all these laws... we're screwed. so now i get to sue this ambulence company, nice, like i have time for that.
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  #6  
Old Sep 18, 2012, 10:07 AM
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faerie_moon_x faerie_moon_x is offline
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Originally Posted by BlueInanna View Post
Did you also talk to anthem yet? Or just the surgical center?

i've been on the phone with anthem a lot recently, finally turning in all the pdoc invoices and therapist invoices that i've procrastinated on. like the $540 pdoc appt for my son where they reimbursed me $50... gee thanx... but anthem actually let me know last week that 1 of the hospital rides in the past year, that the ambulance co overcharged me which is illegal in california apparantly, and anthem is reporting them! everywhere i look companies trying to take advantage of someone in an emergency situation, trying to rip people off. and if we don't know about all these laws... we're screwed. so now i get to sue this ambulence company, nice, like i have time for that.
I am calling my insurance company today. I'm also going to call the hospital to see if there is a way to set up the surgery directly through them vs. the surgeon's office. They refused to schedule me at the hospital, which makes me think they were doing it on purpose to get this co-pay out of me. I don't want to go to the surgical center. I don't know if anyone has had pancreatitis but I assume it feels quite a bit the same way as when the face huggers burst out of your chest in Aliens, except it's happenign in your abdomen instead. It's a common side effect of these stupid surgeries so I'm terrified to have it happen again.

PS
I work in healthcare, and me and my friend were talking and she works in billing. And we both think that it should be part of the original surgery since it is a removal of the item. It shouldn't be considered a whole seperate thing....
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  #7  
Old Sep 18, 2012, 10:21 AM
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Well I really hope anthem will back you up on that, they should, they don't want to pay anymore either.

Sorry you're going through this whole nightmare, it's total b.s.

Those things are called facehuggers? I never knew, but makes sense, and ouch major ouch
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  #8  
Old Sep 18, 2012, 10:22 AM
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Trippin2.0 Trippin2.0 is offline
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LOTS OF SWEARING, EVERY DIRTY WORD IN MY BILINGUAL VOCABULARY!!!!! I would be swearing at them in person if I could, I'd be doing so much more than swearing, actually. I cant believe they did this to you...

I'm too pissed off for sweet supportive things to flow from my fingertips right now... sorry. But know that I'm thinking of you my friend, pls keep me updated, and pm me anytime
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  #9  
Old Sep 18, 2012, 10:58 AM
hamster-bamster hamster-bamster is offline
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There is nothing worse in the States than being in this limbo state when you make too much money for aid but not enough to self-pay, and have no insurance through work. I am sorry this is happening! With the kind of work you are doing, I was sure that you would have employer-sponsored insurance.
  #10  
Old Sep 18, 2012, 12:01 PM
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faerie_moon_x faerie_moon_x is offline
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Quote:
Originally Posted by hamster-bamster View Post
There is nothing worse in the States than being in this limbo state when you make too much money for aid but not enough to self-pay, and have no insurance through work. I am sorry this is happening! With the kind of work you are doing, I was sure that you would have employer-sponsored insurance.
The sad thing is, Hamster, I do have insurance through my employer. It's just a terrible insurance that costs a lot of money.

In this instance, though, I believe it is the surgeons trying to scam me. Holding my life against me to ensure they get extra money.
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Old Sep 18, 2012, 12:04 PM
hamster-bamster hamster-bamster is offline
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Quote:
Originally Posted by dark_heart_x View Post
The sad thing is, Hamster, I do have insurance through my employer. It's just a terrible insurance that costs a lot of money.

In this instance, though, I believe it is the surgeons trying to scam me. Holding my life against me to ensure they get extra money.
In my county, you can sue for $10K in Small Claims Court - at least something.
  #12  
Old Sep 18, 2012, 12:27 PM
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faerie_moon_x faerie_moon_x is offline
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In my county, you can sue for $10K in Small Claims Court - at least something.
If I die, I hope my husband can sue them for everything and their whole company gets shut down. This type of unethical behavior needs to be prosecuted, and I guess if I die I would hope that other lives can be saved in my memory if nothing else.
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Old Sep 18, 2012, 12:29 PM
hamster-bamster hamster-bamster is offline
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Quote:
Originally Posted by dark_heart_x View Post
If I die, I hope my husband can sue them for everything and their whole company gets shut down. This type of unethical behavior needs to be prosecuted, and I guess if I die I would hope that other lives can be saved in my memory if nothing else.
What I meant was to sue now for not doing this operation as part of the original procedure, and then settling the lawsuit out of court via an agreement to have them perform the operation for free.
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  #14  
Old Sep 18, 2012, 02:12 PM
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faerie_moon_x faerie_moon_x is offline
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What I meant was to sue now for not doing this operation as part of the original procedure, and then settling the lawsuit out of court via an agreement to have them perform the operation for free.
This might actually be a good idea. I'd like to see them burn.

Oh, maybe I should call the guy in our town that rats out all the bad businesses. Make it public.
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  #15  
Old Sep 18, 2012, 03:34 PM
hamster-bamster hamster-bamster is offline
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If you live in a large metro area and want to make it public, you can post a negative Yelp review. For smaller towns, the penetration of Yelp is not that great - yet. There are also sites where people post reviews and ratings of doctors, exclusively.
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  #16  
Old Sep 18, 2012, 03:40 PM
hamster-bamster hamster-bamster is offline
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Another venue is Change.org. I have seen and personally signed petitions for access to healthcare by individuals. You may want to register an account, look around, and see if you can spot similar situations. If it is a matter of life and death and there has been fault on the part of the surgeons, some people will sign. It does not always guarantee success, but it is worth pursuing. I get notifications when petitions are signed are successful, and there has been a fair number of such notifications. Just a thought.
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  #17  
Old Sep 18, 2012, 04:03 PM
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faerie_moon_x faerie_moon_x is offline
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Thanks, Hamster.

I started a yelp review yesterday but then it asked me to make an account, and I was way too triggered to do that. So I just canceled. I think I will do that, though. I once did a bad review of a place that ruined my car instead of fixed it on google. I don't remember what the google thing is called...
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Old Sep 18, 2012, 04:07 PM
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DarkHeart- sorry if i missed over it, but what did Anthem say? do they see this as part of the original procedure? Will they help at all?
  #19  
Old Sep 18, 2012, 04:14 PM
hamster-bamster hamster-bamster is offline
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Quote:
Originally Posted by dark_heart_x View Post
Thanks, Hamster.

I started a yelp review yesterday but then it asked me to make an account, and I was way too triggered to do that. So I just canceled. I think I will do that, though. I once did a bad review of a place that ruined my car instead of fixed it on google. I don't remember what the google thing is called...
I believe it is called Google Places, but I am not sure. On Yelp, yes, you need an account, but only your first name will be displayed. Your last name will be hidden.
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  #20  
Old Sep 18, 2012, 05:09 PM
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faerie_moon_x faerie_moon_x is offline
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DarkHeart- sorry if i missed over it, but what did Anthem say? do they see this as part of the original procedure? Will they help at all?
You didn't miss. I have not been able to call them yet today. Making phone calls while I'm at work is very difficult since I am making and receiving them all day.

One thing that does get me, though, is that not a doctor or a nurse or even a practice manager has tried to contact me about why I canceled this appointment which is extremely important to my health. It just shows how much the doctor cares about a patients health and it's really just about the money.
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Old Sep 18, 2012, 06:20 PM
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This is sooooooo freaking unfair! It really seems to me (like others said) this should be considered part of the original surgery. Why can't they let you go to the hospital besides them trying to make all the money themselves?!

I'm going thru a situation with hubby, he has colon cancer. The surgeons, hospital and olcologist are working with us. He has no insurance due to him losing his job in December after 30 years. His plant closed down.

But these doctors, surgeons and hospitals ect....... make so much money! They can write off these amounts. No problem!! Did you get thru to the insurance company yet? What did they say if you got thru?

I'm praying for you! I can't see how they can turn you away at a hospital if it's life or death. Where I live (Virginia) they have to treat you at the ER even with no money or insurance. They can make up a payment plan on the sliding scale, after reducing the cost for you. They can write off most of it. If they will, you gotta pester them though.

With the cost of healthcare in todays time it's CRIMINAL really. Let us know whats going on.
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  #22  
Old Sep 18, 2012, 08:59 PM
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Dark Heart, we went through some of the same illnesses. I had an emergency removal of my gallbladder two days after Thanksgiving. Two months later, after intermittent pain I finally went in to the ER and found I had pancreatitis. I was in the hospital 8 days, had mild congestive heart failure due to the huge amount of IV fluids, had an ERCP to clean out the common bile duct in which they cut the spincters rather than putting in a stent, and finally a transfusion. Tomorrow I am having an upper endoscope because I have continued to have pain a couple of times a week but it is not pancreatitis. They are going to look at my stomach to see if they can figure out what it is. Luckily I have medicare and supplementary insurance with Blue Cross and everything was covered.
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  #23  
Old Sep 19, 2012, 09:31 AM
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faerie_moon_x faerie_moon_x is offline
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Here's my update after speaking with Anthem....

So, it does not matter that this is a follow up proceedure. I always have a $600 co-pay for outpatient surgery. Always. Just like even if I get pancreatitis ever 2 months for a whole year, and have to stay in the hospital for a week every time, that first four days I have a $4000 co-pay. Always.

Remember, I pay $15,000 a year for this insurance.

There is no catastrophic that, once I reach that then everything is just covered. But, there is a cap so really a catastrophic for them to say "We're done paying for the year." That's good to know.

And every year, our HR director informs us that this is the absolute best possible insurance on the market for our money, so we won't be switching.... I have called BS on that for years! If only I was as psychic as my psychosis tells me I am, I would have changed before all this happened!

So, now, I am searching for a surgeon who will offer a payment plan, because the one who put this death device in my body doesn't offer that.....
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  #24  
Old Sep 19, 2012, 11:28 AM
hamster-bamster hamster-bamster is offline
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Maybe it would not hurt to write to that doctor threatening negative reviews and a report to the Medical Board and demanding forgiveness of the copay.
  #25  
Old Sep 19, 2012, 11:50 AM
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faerie_moon_x faerie_moon_x is offline
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Originally Posted by hamster-bamster View Post
Maybe it would not hurt to write to that doctor threatening negative reviews and a report to the Medical Board and demanding forgiveness of the copay.
I could pay it over time. The issue is that they want half the day of surgery (which was Friday and I live paycheck to paycheck, with no savings account,) and they had scheduled me for it the Friday before. But they don't offer a payment plan except for half up front and half in two weeks.

There is no way I could save up that kind of money in the 6 weeks with my normal paycheck, let alone after I was off of work in the hospital for two weeks and off a third, especially since I had only 3 days of paid leave and the short term disability only paid me for 5 days missed at 60% of my pay.

I just need a surgeon who does payment plans... and if I can't find one I guess I'll go into the ER once it gets infected....
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