Getting injured in the states...

[T.O_2_FL 0]

So yesterday while walking out to the pool, I thought there was only two steps and there was three and I fell down and twisted my ankle pretty bad.

I am hobbling around and its pretty embarrassing.

Lucky I have insurance but I don't think a hospital is going to do anything about a twisted ankle. I'll just go get a tensor bandage today and some more ibuprofen.

I sprained my ankle a year and a half ago back in Toronto.....best thing to make it heal quickly is keep it wrapped in a tensor (to prevent fluid build up = swelling) as much as possible and also stay off your feet if you can! I did all those things and it healed in a couple of weeks! Also really important to do some ankle exercises too or else you may loose some mobility later on.....the key is staying off your feet.

I learned all this from my Mom who is a RN and the ER room told me the exact same thing.....good luck!

[Sprailenes 47]

I think I've figured out the co-pay thing, but what I don't understand is how one knows ahead of time if treatment will be covered or not? Case in point, I saw my GP for a sore neck. SHE sent me to physio (3 visits), I did not ask to go. That didn't work, so the physiotherapist reported back to my GP, who then (GP) sent me to the orthopedic dr. Had xrays and determined that I have DDD. Orthopedic dr sent me for a round of traction therapy. OK, so in all of this, I had to pay the co-pays only. Then, a couple of months later, I get a bill from the physio saying that I had to pay for all of it! (approx $400 for 3 - 10 minute visits). Everything else was covered, but not the physio which my GP sent me to.

So, how do you know if something that your GP refers you to will be covered or not? I would have thought that since the GP's office has my insurance info, they ought to have known whether physio would be covered..... and at least told me "This might not be covered by your insurance", and given me the option to proceed or decline. At least this was just my neck, but I can't imagine if it were something more serious, where you really don't have time to weigh the options..... if your Dr says "You need to go for a CT Scan", then I'd probably think that I ought to go!! What does everyone else do? Do you tell your Dr "thanks for the suggestion.... I'll think about it and get back to you" and then call your insurance to find out if it will be covered? I guess coming from Canada, where everything is pretty much covered unless you're told otherwise, I am just used to assuming any referred treatment is covered.

What do YOU do to avoid costly, unexpected bills?

I agree, how do you know if its covered?

Sometimes I would just rather be taxed high than have to deal with insurance.

[Emancipation 2]

Sometimes I would just rather be taxed high than have to deal with insurance.

Or.. you could live in CT where the taxes are high and you don't get anything for it YIPEEEE

[KarenCee 3]

Ah, the fantastic American Healthcare system...don'tcha just love it. *sarcasm* Yet, you can't afford NOT to have insurance.

I pay $240 a month for family coverage and another $83 for family dental...I have BCBSGA State Merit. Supposedly the best in the state, since I am state employee. Ok... Anyway, we have an HMO. 90/10 policy. $250 deductible. Not bad really. For us though, it's not so much the insurance itself...it's the cost of the care that can really hit hard even with such a generous policy:

Oct 2006 - BAD Asthma attack...ambulance ride to hospital ER, week in hospital...$17,000 dollars just for the hospital stay. Wound up with a $1000 bill. Then there was the ambulance bill, the different drs (several came into my room...stayed five minutes...I got a bill) not to mention the radiologist bill (you know, the ones that read the tests) and the meds I needed to get back to some semblance of normalcy, one of which the insurance company refused to pay for because I am "over seventeen".

July 2008 - Outpatient Surgery. Things are different now. You pay your portion UP FRONT. Or you arrange to make payments, sign a paper stating that you WILL make payments OR we will turn you over to collections if you miss ONE payment. Dr portion - $569 (and that is WITH insurance) and hospital portion - $180 (again, with insurance).

SIGH

[Fuzzness 2]

the american healthcare system is so seriously effed up, i cant believe how people just take it.

[Sprailenes 47]

I think something has to change with the system here.

I know of families who have medical bills of 10,000 dollars or more and aren't paying them.

The thing is, I know of people who tell me that my system in Canada was awful, and they would never want it. But these are people who have insurance and don't have to worry about being denied or not being able to pay.

My husbands grandmother (she's a card ) told me of her "friend" in Vancouver who needed an MRI and waited 8 months to get it done. She then said: "Well if thats socialized health care, than keep it!"

I then started to explain the system to her, because I don't think people really understand it, unless they have personally lived in it.

No our system isn't perfect. But everyone gets the same system, and I think thats really important.

[Flames9_RN 359]

Before i took my wife to the ER, Iphoned ahead and made sure they accepted blue cross/blue shield! Same thing when u phone around for a Dr. One has to ensure they take your insurance, can be quite the pain!

[KarenCee 3]

Before i took my wife to the ER, Iphoned ahead and made sure they accepted blue cross/blue shield! Same thing when u phone around for a Dr. One has to ensure they take your insurance, can be quite the pain!

OMG yes...that is the FIRST thing I always do! My benefits/provider booklet is one of the most important books.

[bradcanuck 1]

I went to a county fair (OC Fair) 2 years ago, and ate some bad hamburger (what else is new, everything at that fair is bad, tainted or old). Anyway, I got colitis. Went to the hospital where the nurse said I was fine and told me to leave. I informed her that she was an idiot and she should shut up and get out of my face immediately. (I was sore and cranky, that was NOT the time to be a diplomatic pushover)

The doctor did all sorts of scans and blood tests and it came back as... yep colitis.

I paid $400 for the visit with Blue Cross. I got to see the bill... $11,000 and change for the entire thing. Bloodwork, scans etc. I'd say I got a good deal.

[Texanadian 10]

Yep, definitely need to phone the insurance company about any upcoming scans, surgeries, etc. And definitely stay "in-network." Something that is "in-network" that costs $600 might cost $10,000 if you got it done "out-of network." Not to mention you have different deductibles for both.

My wife had an MRI done a couple years ago. It was $4,000. The insurance company paid $800 and that was it. Paid in full. She didn't even pay for anything. I thought how interesting. They can pay 20% of the bill and consider it payment in full and the hospital just accepts that. But it really screws the person who would rather just pay for the small stuff themselves and use insurance only for major operations. An $800 MRI, I could see paying myself. But $4,000? No thank you.

My wife's plan is $1100/month. To add me to her coverage, it would "only" be $800/month. LOL You can see why I went for my own coverage instead.

Why is it $1100/month? She works in a small office of about 15 people. Some of the older workers have had heart trouble, so everybody's rate goes up to compensate for it. In the year 2000 her insurance was $500 a month with a $500 deductible. So it's more than doubled in less than a decade and her deductible is $3,000 now too.

Texas allows insurance companies to give group coverage quotes to businesses. And then they can raise the price by up to 69% over the original quote (after they scan the company's medical history).

Edited July 21, 2008 by Texanadian

[Flames9_RN 359]

I probably cant explain it well, but Insurance companies pay LESS for a procedure than you would if you pay out of pocket. There was TV piece on how one fellow was upset that since he didnt have any health insurance, his heart operation cost him like $200,000, out of his pocket. BUT if he had insurance, the hospital would have only charged the insurance company something like $50,000. His thinking was hey, I should only have to pay $50,000!! I'm just happy that we have good health insurance coverage. My wife could go be a private contractor for what she does, they make alot more $$$, but no benefits, where as her federal job has excellent benefits. One thing one has to look for when looking for employment!

[Necrotica 0]

I don't even want to think about this one, heh. Réjean and I are both without insurance, and I worry almost everyday about the "what-ifs". Luckily, all that Réjean has ever had in the way of injuries are some cuts and scratches from his job. He's a woodworker, though, so it comes with the territory. Thank goodness he gets company-paid insurance that will kick in in the next couple of months or so. I'm still trying to figure out what to do about me, though... and I'm the one with all the health issues.

Also, I'm sorry to hear about your ankle! Hope it heals soon.

I highly recommend buying health insurance ASAP. Today would be best. Even if it's some el cheapo Health and Prevention plan.

My wife's health insurance is ridiculous. $1100/month for the health insurance (single coverage, just her). $3,000 annual deductible and a $5,000 max out of pocket. She went in for thyroid surgery last month. In one day, it worked out to be over $32,000 in bills.

Health insurance isn't so much about what they pay. It's about the discount the doctor's give for "having" health insurance. $21,000 of the above bill was for the hospital bill. Yet they reduced that by $19,000, leaving us to pay $2,000. Since that was before the 3K deductible, we're on the hook for the entire $2,000 hospital bill. But how weird is that? You get a 90% discount for having insurance even though insurance isn't actually paying a penny for your surgery.

Then there is the anesthesiologist bill, the pathologist bill, the doctor's bill, there is still one more bill which is being processed that I don't even know what it's for. The doctor's bill was $7800 originally and then there was an insurance discount of $4830....That makes it $2970. We had to pay 30% of that ($890) and they paid the rest. By this time we were past the deductible.

$2,000 worth of anesthesiologist bills. Paid by us.

Looking at health insurance as the immigrant, I already learned about all the co-pays and deductibles and how they split up the percentages. But I had NO IDEA there would be 5 different bills for one procedure at the hospital. I thought the original hospital bill pre-quote would be it. You should have heard me when my wife said "that's the hospital quote, now we need to get one from the doctor." WHAT??? That's like paying the mechanic after paying the dealership when you get your car fixed. Don't the hospitals pay the doctor's?

Anyways, we're almost up to $4,000 in payments out of our pocket. And to think, her insurance costs over $13,000/year in premiums.

I wish I could, believe me, but right now we're trying to live off of $11/hour for the two of us combined. Luckily I'm starting a new job as of August 4th after being out of work for over 4 months, so I may be able to afford some temporary private coverage until my husband's insurance kicks in. Unfortunately I'm going to end up going past 63 days without insurance, which means all my health conditions will be considered pre-existing and won't be covered for who knows how long. *sighs*

[Necrotica 0]

Deleted due to being repetitive and half-asleep.

Edited July 21, 2008 by Necrotica

[Necrotica 0]

I think I've figured out the co-pay thing, but what I don't understand is how one knows ahead of time if treatment will be covered or not? Case in point, I saw my GP for a sore neck. SHE sent me to physio (3 visits), I did not ask to go. That didn't work, so the physiotherapist reported back to my GP, who then (GP) sent me to the orthopedic dr. Had xrays and determined that I have DDD. Orthopedic dr sent me for a round of traction therapy. OK, so in all of this, I had to pay the co-pays only. Then, a couple of months later, I get a bill from the physio saying that I had to pay for all of it! (approx $400 for 3 - 10 minute visits). Everything else was covered, but not the physio which my GP sent me to.

So, how do you know if something that your GP refers you to will be covered or not? I would have thought that since the GP's office has my insurance info, they ought to have known whether physio would be covered..... and at least told me "This might not be covered by your insurance", and given me the option to proceed or decline. At least this was just my neck, but I can't imagine if it were something more serious, where you really don't have time to weigh the options..... if your Dr says "You need to go for a CT Scan", then I'd probably think that I ought to go!! What does everyone else do? Do you tell your Dr "thanks for the suggestion.... I'll think about it and get back to you" and then call your insurance to find out if it will be covered? I guess coming from Canada, where everything is pretty much covered unless you're told otherwise, I am just used to assuming any referred treatment is covered.

What do YOU do to avoid costly, unexpected bills?

When you get health insurance, you should get an explanation of benefits that tells you what is covered or what is not. You can also call the insurance company's customer service department and they should be able to tell you what is covered and what is not.

[Kathryn41 3,205]

As well, when your doctor wants to refer you to a specific specialist ask your doctor if this doctor is covered by your insurance plan. I was surprised how much the front office staff knows about who does accept certain coverage and who doesn't. As well, if they don't know, ask them to call and find out if they are referring you. That's another difference I noticed here - when my Canadian doctor referred me to the specialist, they set up the appointments for me and did the legwork. Here, they either tell you you need a certain type of specialist and leave it up to you to find one, or if you ask for a recommendation, they hand you the phone number and you do the legwork. Be careful as well - I had one dental office tell me that they accepted our insurance and when I got the bill, found out that they were an out-of -service provider. They 'accepted' the insurance - the insurance just didn't accept them! That was an expensive lesson to learn.

Edited July 21, 2008 by Kathryn41