Why do they call it "health CARE" when no one gives a flip?

[Zippa D Doodah]

Nothing in particular on my mind, but am I the only one fed up with insurance companies tying the hands of doctors' ability to perform preventetive tests that could have saved people's lives, or at least have helped them avoid some debilitating condition?

As a pastor I see so many instances where this is the case.

Health CARE my foot!

 

[dadto1]

I prefer to call it "Health we don't care as long as the bottom line looks good this year Care!"

 

[Maleficent13]

You're not talking about healthcare, you're talking about insurance. Healthcare to me is the people who actually provide the care. Insurance companies are the people who sometimes try to cut corners.

And even then, it isn't always about the insurance...sometimes it's the employers who are watching the bottom line by purchasing the cheapest plan available, which provide many less options than the better plans.

 

[Zippa D Doodah]

I chose to call it health care because many insurance companies refer to their products as "health care plans". Actually I do think the problem is systemic -includes providers, insurers, and clients - but the whole term "health care" seems more Orwellian every time I find myself saying or typing it.

 

[Mugg Mann]

You're not talking about healthcare, you're talking about insurance. Healthcare to me is the people who actually provide the care. Insurance companies are the people who sometimes try to cut corners.

And even then, it isn't always about the insurance...sometimes it's the employers who are watching the bottom line by purchasing the cheapest plan available, which provide many less options than the better plans.

Technically, it's not the insurance...it's the HMO or the PPO that's doing this. A pure insurance program pays for whatever test or tests your doctor feels is necessary. Most people have been trained to want a plan where they only pay a small co-pay, but having the provider cost-manage your necessary tests is the dark side of that kind of plan.

In most HMO's, a doctor is given a budget from the HMO's, and any testing he/she orders comes out of that budget. If too much testing is ordered, the HMO cuts down the amount of money the doctor receives from the HMO for services rendered to the HMO patients. It really is a conflict of interest for the doctor between trying to provide the proper (and correct!) care, and protecting their own bottom line.

 

[Lisa loves Pooh]

United Health Care does not question a procedure if doctor deams it necessary. If I suspect or he/she suspects XYZ--they do the lab work or whatever for XYZ to make sure it is or is not XYZ.

Usually experimental stuff is excluded---so an experimental drug that may help with a condition--until it is mainstream it may not be covered (not suer exactly what the plan says).

My beef is my limitations on PT/chiro--I need PT twice this year--but met my limit and even though it was for two separate injuries in two separate parts of the year--I paid out of pocket for the second one. But that is not my insurance's fault--it is the plan that my employer paid for. I suppose I could go otu on my own and get a better plan...but it would cost me more...and not enough to justify the PT costs. However--for an accident that would require months of therapy--I'd be toast. Luckily--I did find out that you can refuse to file with insurance and my PT gave us the medicare rate They have to charge the insurance higher b/c the insurance stiffs them so much on what they are worth. But when you pay cash--they charge you the real rate. very interesting! So if it is really worth $90 of their time..they risk losing money if they charge insurance that much.

Anywho---so my beef is with my employer for the plan they chose--not insurances fault.

and I like our insurer--b/c they do not question the Doc's (now if Doc has habit of doing unnecessary things consistently--then they will evaluate the Doc and what they are doing).

 

[bicker]

I just wonder how much more do we all want to pay? I'd rather have the insurer watching costs very carefully, rather than allowing folks to charge back whatever health expenses they want to their insurance. That keeps the premiums I pay nice and low!

 

[yeartolate]

It is a very difficult question.

We blaim the insurance companies, but the consumers and physicians are part of the loop, too.

One person twists their ankle, and before they have a chance to apply ice, elevate and compress.....they are off to the Orthopedist getting full xrays and evaluation by a specialist


A few years back scores of people were glowing about how wonderful Claritin was. The same people dumped Claritin as soon as it went non-prescription and were demanding "the latest and the greatest" prescriptions their insurance would pay for. It is one thing to truly need something different, it is a whole other issue to whine because a non prescription drug is now gonna cost you money.


I am a nurse in critical care and you would not believe the number of armchair physicians are out there trying to force physicans to order things cause they read it on the internet. A few months a family member was demanding a relatively new drug for a blood stream infection. The family went as far as to talk "lawyer" talk. I sat the family member down and showed him the information on the drugs and finally said - "we are not giving it to him becasue it would likely kill him"

A friend of mine had a lower back strain and was highly angered that her MD did not order and immediate MRI. She is with Kaiser.....if she was with a non HMO --- there is a good chance that a doctor could have been pushed into it an early MRI

Don't get me started on parents parading their kids into the pediatrician's because the cold lasted *gulp* 3 days and are now demanding antibiotics.


Yeah, insurance companies interfere, but the consumers and physicans sometimes are much better.

 

[AMcaptured]

I think the real problem with healthcare isn't insurance companies but the fact that we, as a human race, generally do NOT take good care of ourselves. Instead of giving people pills for every ailment in the world, people should be eating less and better food, exercising regularly, not smoking ANYTHING, not have casual unprotected sex, not drink excessively and sleeping 7-8 hours a day. Instead people drink, smoke, overeat and don't exercise and then wonder why their cholesteral is high, why their blood pressure is off the charts and their sugar levels are uncontrolliale.

Truly, so much of what is going on in healthcare is controllable just by people taking an active part in their health instead of a passive part in it by eating crap all day long and sitting around watching tv and video games all night.

I happen to believe that many in medicine ( and I don't mean healthcare workers, i.e., doctors, nurses, etc., the majority of which are wonderful) but the CEO's of large insurance companies, medical equipment companies, pharmaceutical companies, etc. actually want people to be ill. SO many sectors are making a fortune because people are ill.
JMO

AM

 

[Zippa D Doodah]

It is a very difficult question.

We blaim the insurance companies, but the consumers and physicians are part of the loop, too.

One person twists their ankle, and before they have a chance to apply ice, elevate and compress.....they are off to the Orthopedist getting full xrays and evaluation by a specialist

I think you kind of nailed it... there are too many abusers of the system -and too many hyopchondriacs -for things to be run any other way. The whole system is rather sad, though. I am wistful as I see people trying to recover from strokes that were preventible, or fighting cancer that could have been detected earlier. I am thinking of people with histories and adequate warning signs (by some standards).

 

[bsnyder]

Lots of good points raised here.

I'd also throw out the observation that as a society, our medical technology is accelerating at an unprecedented pace yet we seem very reluctant to even debate many of the thorny economic, ethical and moral consequences of those advances, much less reach some kind of consensus.

 

[golfgal]

United Health Care does not question a procedure if doctor deams it necessary. If I suspect or he/she suspects XYZ--they do the lab work or whatever for XYZ to make sure it is or is not XYZ.

Usually experimental stuff is excluded---so an experimental drug that may help with a condition--until it is mainstream it may not be covered (not suer exactly what the plan says).

My beef is my limitations on PT/chiro--I need PT twice this year--but met my limit and even though it was for two separate injuries in two separate parts of the year--I paid out of pocket for the second one. But that is not my insurance's fault--it is the plan that my employer paid for. I suppose I could go otu on my own and get a better plan...but it would cost me more...and not enough to justify the PT costs. However--for an accident that would require months of therapy--I'd be toast. Luckily--I did find out that you can refuse to file with insurance and my PT gave us the medicare rate They have to charge the insurance higher b/c the insurance stiffs them so much on what they are worth. But when you pay cash--they charge you the real rate. very interesting! So if it is really worth $90 of their time..they risk losing money if they charge insurance that much.

Anywho---so my beef is with my employer for the plan they chose--not insurances fault.

and I like our insurer--b/c they do not question the Doc's (now if Doc has habit of doing unnecessary things consistently--then they will evaluate the Doc and what they are doing).

It is not United Health Care that allows that it is the employer that owns the plan that allows that/questions that. It really has nothing to do with the insurance company what so ever.

Dh's former job was for a company of 56,000+ employees, we had HORRIBLE coverage, high, high premiums and huge out of pocket expenses. Every time the kids needed to see their asthma dr we had to jump through all kinds of hoops to get it allowed. It was ridiculous. His new job has 20 employees, our premiums are 1/2 what they were, we don't need referrals, everything is covered, we have a $20 co-pay and a small out of pocket max. There is no reason company 1 couldn't offer better health coverage other then their bottom line.


Oh, and as for United Health, do you know that the top executive for United Health Care System has been making in EXCESS of $56 MILLION dollars the past many years. He is the highest paid executive in Minnesota, and probably most states, and people can't afford to buy their needed medications.

 

[C.Ann]

A friend of mine had a lower back strain and was highly angered that her MD did not order and immediate MRI. She is with Kaiser.....if she was with a non HMO --- there is a good chance that a doctor could have been pushed into it an early MRI

----------------------------

Sorry, but this truck a chord with me.. My DD was injured in a car accident on March 10th.. She sustained both neck and back injuries.. No one knows their own body than the person walking around in that skin.. DD knew there was a serious problem with her lower back and requested an MRI.. Of course they refused.. She saw her primary doctor 3 days later - still in terrible pain from both her neck and her back and again requested an MRI.. Nope - wouldn't do it.. Seven days later she was back to see her primary again - still in terrible pain.. He ordered an MRI of her neck, but not her lower back.. Finally she got fed up and went for a second opinion - got the MRI done and found out that she had 2 herniated discs.. So - for 21 days she was in horrid pain that wasn't being addressed because someone "else" knows her pain better than she does..

I don't believe in unnecessary tests either, but sometimes a little common sense would go a long way.. To still be in such severe pain for all that time it seems to me someone should have thought, "Hmmm..maybe we better check into this just in case.." She's having PT (in hopes of avoiding surgery) and meanwhile has wasted time out of work that could have been used for treatment.. Hopefully her Family Medical Leave Act won't run out before the treatments are completed and she's able to work..

 

[MouseWorshipin]

All I can say is that if you think it is bad now, just wait until the government takes over.

 

[Lisa loves Pooh]

It is not United Health Care that allows that it is the employer that owns the plan that allows that/questions that. It really has nothing to do with the insurance company what so ever.

Actually a couple of years ago they did a story on UHC--it is not just for my company--it is their policy as an insurance company that they will not question a doctors orders for something that is indeed cover. I.e.--they will not takethe role of doctor and refuse to pay for something b/c they don't think it is necessasry.


Aside from my limitation on PT visits--I have had nothing but praise for how we are treated.

our company has our own medical center---and they have doctors and all they see is us and they know the ins and outs of UHC. I have not been refused anything I or they thought was necessary.

So the guy made $56 million. Insurance companies insure their bens. They are not charities and do not donate to their bens. They are for profit corporations.

I'm sure Blue Cross & Blue Shields CEO isn't making a pauper's pay either.

 

[Lisa loves Pooh]

------

I don't believe in unnecessary tests either, but sometimes a little common sense would go a long way.. ..

I concur with this completely. I believe in a proactive patient--not to be confused with a hypochondriac patient.

While the internet should not be used to self diagnose--it is a very useful resource if you have an ailment that you just aren't sure whether to get it checked out or not.

 

[C.Ann]

I concur with this completely. I believe in a proactive patient--not to be confused with a hypochondriac patient..

-----------------------------

My favorite saying - based on past family experiences regarding health issues is: "A passive patient is a dead patient.."

 

[golfgal]

Actually a couple of years ago they did a story on UHC--it is not just for my company--it is their policy as an insurance company that they will not question a doctors orders for something that is indeed cover. I.e.--they will not takethe role of doctor and refuse to pay for something b/c they don't think it is necessasry.


Aside from my limitation on PT visits--I have had nothing but praise for how we are treated.

our company has our own medical center---and they have doctors and all they see is us and they know the ins and outs of UHC. I have not been refused anything I or they thought was necessary.

So the guy made $56 million. Insurance companies insure their bens. They are not charities and do not donate to their bens. They are for profit corporations.

I'm sure Blue Cross & Blue Shields CEO isn't making a pauper's pay either.

I am not disagreeing that this guy should make some money but he makes more then DOUBLE the next highest paid executive in MN (including the execs of companies like 3M), it is just a little out of whack when people can't afford medical care.

Most insurance companies, actually probably ALL insurance companies don't question what treatments/tests dr's are ordering. It is the medical companies/clinics themselves that are questioning how the dr's practice medicine. They are looking out for their bottom line. Dr's actually get kick back from some medical companies (not insurance companies but the clinics the work for) for NOT prescribing tests. An insurance may deny a procedure because it isn't covered under that policy but they don't deny a claim because it isn't necessary. Again, those issues are the direct result of what any company says they will/will not cover.


I am glad you are happy with United but you do need to realize that your praise should go to your company for offering such a comprehensive plan and not really to the insurance company.

 

[Lisa loves Pooh]

I am glad you are happy with United but you do need to realize that your praise should go to your company for offering such a comprehensive plan and not really to the insurance company.

Then I guess I am confused--why was it such a big news story at the time if all companies do this.

My understanding is some insurance companies routinely debate whether or not the doctors orders had merit.

I'm not sure I need to realize anythign when the news story was not regarding my husbands corporation and the plan they had purchased but UHC as a corporation.

 

[golfgal]

Then I guess I am confused--why was it such a big news story at the time if all companies do this.

My understanding is some insurance companies routinely debate whether or not the doctors orders had merit.

I'm not sure I need to realize anythign when the news story was not regarding my husbands corporation and the plan they had purchased but UHC as a corporation.

Some medical companies/clinics are owned by companies that own insurance companies (like United). A lot of HMO's do debate what the dr's do and that is probably why it was such a big deal to your DH's company, they weren't going with an HMO and you would have some freedom with your health care, which IS a big deal these days when so many companies do use HMO's or PPO's, which STINK when it comes to health care but they are relatively cheap for companies.

One example of what happens with a lot of HMO's, a friend was a NURSE and they had an HMO. Her 6 year old son had kidney stones and they wouldn't authorize an ultrasound to check them out nor would they authorize anything to break them up he was just expected, at 6 YEARS OLD, to pass these on his own. The dr's didn't agree AT ALL with this, she ended up going out of their HMO and paying for the procedure out of pocket, sad, sad, sad.

Like I said, you should be giving this company a HUGE pat on the back for picking something that is good for their employees and not just looking at their bottom line.