HMO's revisited - Machine Underground -Tractor & Commercial Equipment Discussion Forum

Mickey · 08-12-2008, 03:36 PM

We had a discussion about HMO's about a month ago and seemed to recall a number of you weren't favorably impressed with them. At the time I said I was happy with my HMO and I still am.

Since that time I've had a physical, new Dr. He had some concern over what he thought was an enlarged liver. Ultrasound ordered. Looks like I've got a growth on one of my kidneys and something they needed a better look at with my liver. A week later I had a CAT scan. Results are in. Looks like I have a cyst on my kidney, a urologist has been called in to review. All is OK, no need of concern. Review of CAT scan show scaring on the liver. Not sure why but another specialist has been called in to review the pictures. Dr. is now believing this liver issue is cause for the low platelet count I've had for a number of yrs. Expect to get a call after the specialist has reviewed the scans and will have a better feel for why the scaring, what needs to be done and whether in fact the scaring has a roll in the platelet count. Have been stuck so many times this past week I feel like a pin cushion.

So far this has cost me $40 for 2 office visits. Test were at no charge.

I don't know how one could asked for more/better treatment that what I've received this past month. The wife has also had need of medical services this yr. Had cataract surgery on both eyes and got 2 pair of glasses. Think her total cost was under $100.

Our monthly preminum is $300-$325/mo.

If you are not receiving decent care through your med insurance you should be doing some asking and looking around for better care. It's out there, one just needs to be a little proactive in finding and taking advantage of what is available. I know some of you are limited by what your employer provides but there is nothing stopping you and others from complaining to your employer about the qlty of coverage you are receiving.

Oh, not looking for comments on me as I'm doing just fine, especially for an old gezzer, and appreciate the health care we are receiving. Decent and affordable care is out there, one just needs to look.

Deanster · 08-12-2008, 05:55 PM

Just yesterday I told the HR department that I am fed up with our health plan (Premera Blue Cross), and that I am looking for new health insurance, wherever that takes me.

My gripes: First, I pay half the premiums. That's about $5,000 per year. For that I get nickel and dimed on everything. After forking over $10k between my employer and myself, I get to pay about $2,000 dollars when my wife has another baby later this year ($2k assuming it's a routine trouble-free birth like the last one).

Just recently they refused to pay for prescription prenatal vitamins. The doctor says yes, the HMO says NO. And of all the things, to deny prenatal care is about as absurd as it gets in my opinion.

I went in for my age 40 physical where I got to sing "moon river" (think chevy chase in Fletch). The doctor decided to take a baseline EKG for future reference in case I ever had a problem & needed a comparison. The insurance company said that was not part of the physical, so I got to pay a chunk more for that.

Mickey - perhaps Oregon does an excellent job of regulating the insurance industry. Here in Washington, we had an insurance commissioner who aggressively defended patients rights. The industry funded her opponent out the wazoo, and guess what happened to her?

Do you pay 100% of your premiums? $300/month for no deductable, $20 office visits, and no special charges for lab work and testing does not sound like market rate. Where did you come across such a plan?

Mickey · 08-12-2008, 07:43 PM

Don't think it has anything to do with Oregon. The same coverage is available to you and is as close as your nearest Kaiser Permanente facility as they operate in Wa. My former employer picks up a portion of the bill but don't think it is very much. Much more likely that Medicare is picking up a larger portion of the bill than employer.

Mom also had KP, no former employer assistance, her premium was about the same and for that price they provided about $1k/month for home care. They picked up the lions share of the cost of a spendy wheel chair when it was needed. When she was near the end, KP assigned her to Hospice care. Hospice provided most of the meds at no cost, home nurse visit weekly. Other meds and health issues still picked up by KP. This yr the home care coverage dropped some.

Wife's sister and husband and an aunt & uncle also have KP for their medical coverage, they have no real issues with them. The 4 of them make good use of KP's coverage as all have health issues.

As I mentioned in that thread last month, KP has their own hospitals in larger cities and contract with local hospitals in smaller cities. All the stuff mentioned in the first post handled at one of their 2 facilities in Salem we use. Same for wifes eye surgery.

Don't take it personally but it never ceases to amaze me what people think medical insurance should cover. Things one wouldn't give second thought to as a medical issue a couple decades ago is must have coverage today. Is it any wonder why med insurance cost what it does today? I don't think med insurance was available when I was born and know maternity coverage was rare when our oldest was born and we didn't have it. Don't recall what kind of coverage we had when our youngest came along but certainly didn't think we were being deprived of anything. IMO hang-nails and sniffles are not something insurance should be taking care of but many think nothing of going to the Dr for such minor things and expect insurance to pick up the tab.

Deanster · 08-12-2008, 08:26 PM

Quote:

Originally Posted by Mickey

I don't think med insurance was available when I was born and know maternity coverage was rare when our oldest was born and we didn't have it. Don't recall what kind of coverage we had when our youngest came along but certainly didn't think we were being deprived of anything.

Something tells me that insurance didn't cost over $10,000/year back then either. What was the infant mortality rate back then? What did it costs you to deliver your children back then? I'm going to guess it was under $100.

In my mind, prenatal care is a no-brainer. The cost of investing in healthy children is a bargain compared to the alternative. This is one of the things that SHOULD separate us from third world countries and the "olden days" (as Paris Hilton put it).

Anyway, the point being that if the insurance company is getting $10,000/year for a policy that includes maternity services, why the f**k am I getting a bill for $2,000?

I will look into KP to see what they have available here. If I can get the coverage you described for $300/month, I'll buy it - and I'll send you a dozen roses!

Deanster · 08-12-2008, 08:31 PM

No roses for you!

We're sorry, but the ZIP code you entered is not within our Individual and Family Plans service area.

**irwin** · 08-12-2008, 10:39 PM

Sure seems like everyone we have to deal with in todays world is trying to get rich quick off our needs. Medical care didn't cost an arm and leg a couple decades ago, insurance rates were reasonable. If a life saving drug was discovered you didn't have to mortgage your children to get it ( think Jonas Salk)

This is a multi-faceted problem, but greed is at it's base. From the justice system allowing ridiculous claims and jury awards exceeding some small countries gross earnings, to cut throat business practices, to bloated drug manufacturers paying off our elected officials to allow them to charge the citizens of the USA much more than what they charge our neighboring nations citizens. Doctors paying crushing malpractice insurance rates and passing the cost (of course) to us. It all comes back to us, and our meager wages buying less protection.

What is the burden my grandchildren will have to carry? Insurance or food? The cost is staggering now, doubt it'll get better for my offspring.

vansimplement · 08-13-2008, 12:17 PM

Quote:

Originally Posted by Deanster

Anyway, the point being that if the insurance company is getting $10,000/year for a policy that includes maternity services, why the f**k am I getting a bill for $2,000?
!

If you find out, please let me know! In the meantime I'll continue chipping away at the ~$3,000 combined bill my wife and I had for our youngest daughter.

And get this - we went in at 5:00am in the morning, had the baby by 5:45am (she was scheduled to be induced later that morning at 7:00am but got a jump on the day). She was in the hospital that entire day, overnight, and until 5:00pm the next evening. Perfect delivery, no time for an epidural (and hence no charge), healthy baby, healthy mom, 2 days/1 night in the hospital. I was expecting a letter of thank-you and a Christmas card from the insurance company.... on well!

Mickey · 08-13-2008, 12:52 PM

Quote:

Originally Posted by irwin

... This is a multi-faceted problem, but greed is at it's base. From the justice system allowing ridiculous claims and jury awards exceeding some small countries gross earnings, to cut throat business practices, to bloated drug manufacturers paying off our elected officials to allow them to charge the citizens of the USA much more than what they charge our neighboring nations citizens. Doctors paying crushing malpractice insurance rates and passing the cost (of course) to us. It all comes back to us, and our meager wages buying less protection. ....

Yes it is an multifaceted problem. Not sure if it's greed though. Do you have any idea what it cost to be playing in this arena? Uncle Sam has so many reg nowadays it cost a fortune to even think about being in the medical business.

I was in this field when I retired and the controls were so tight it was one of the factors that lead me to early retirement. Talking to the Eng Manager close to the end, he said with the new rules just going into effect at that time, the Div wasn't going to be able to function. Less than a yr after my retirement, HP was out of the medical business and they had been in it for decades and were one of the well known equipment mfgrs.

Everyone expects perfection and more than ready to sue if something goes wrong. Dr's and hospitals have to proactive defensive medicine driving the cost way up. Since no one can be denied medical care, someone has to pay. Hospital told me the no pay % was 25% and that was 15 yrs ago. With all the influx of illegals I'm sure that number is a lot higher today.

I also wouldn't be so quick to jump on the prescription medicine industry. The cost of developing new drugs is extremely expensive and so is the approval of those drugs. Somebody has to pay the cost. Sure it's not fair the the US picks up the lions share of development cost but someone has to. Drug Co's would rather sale to foreign countries and not be able to recoup development costs than not sell at all. If the US were to enact similar regulations, new drug development would dry up quickly.

I could go on but this is getting too long.

Dean, I did some checking and KP only has facilities in Wa near the Oregon border. Did do some checking and an individual policy with KP in this area (married couple, 40 yrs old and small child) was <$500/mo. Coverage not as good as what I have, mostly from out of pocket costs standpoint, but it does cover meds.

Deanster · 08-13-2008, 01:43 PM

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