Have you ever thought of your healthcare in the following manner?

1) you are a sick person, in need of thorough, quality doctoring with good followup

2) you go to see a doctor, who has been trained to diagnose you, prescribe  proper treatment and try to help you achieve better health

3) Your doctor is being paid by  large, wealthy health insurance companies whose goal is to try to restrict money going out and maximize profits. One of the ways they do that is by "managing" care and putting restrictions on the type, amount and quality of medical care you can obtain.

The health insurance company's goals are directly opposed to YOUR GOALS. Managed care health insurance is a third party monkey  wrench thrown into the traditionally sacrosanct doctor-patient  relationship and because they are greedy and bureaucratic, quality care is sometimes not achieved.

Kaiser insurance  group comes to mind, although there are many, many others.

Is this ethical? Is this moral? Is it legal? Should it BE LEGAL?

Fred


_________________
"We don't need socialized medicine, what we need is insurance reform."


Resmed S8 Autoset Vantage, HumidAire 3i, Resmed Quattro ffmask

What irks me is that if the patient tries to contact the insurance directly, they're usually told only a doctor is supposed to contact them about covering/not covering certain things. That's what happened to me when they refused my sleep study. I want people out there to know that insurance companies are not as all-powerful as they come across. They will try to throw their weight around, and may even threaten, but there are ways to deal with them. In my case, I asked the claims agent for the number for the Joint Commission. Just the mention of this government agency and they approved my sleep study. You don't have to be that drastic, though. There are appeals processes too, but if you can't wait I suggest contacting your state-level ombudsman. Their whole job is patient advocacy, and they can really get on insurance companies hard. Yes, there's alot of bureaucracy, and I know it's frustrating, but there's hope and help out there, so don't give up!

Kristina

P.S. If your doctor is refusing to order tests you know you need, GET A DIFFERENT DOCTOR!!!


_________________
"Sleep is the golden chain that ties health and our bodies together."- Thomas Dekker

THAB,

You are right, we don't need socialized medicine, but what we need is well thought out (and there are plenty of excellent ideas) universal health care.  I know too many people who are unable to afford health care insurance and whose lives have been devastated because of it.  My close friend who just had her second surgery yesterday for advanced thyroid cancer comes immediately to mind.  They are about to lose everything because of her medical bills.  So not only is she simply trying to stay alive, but she and her husband are breaths away from losing the house over their head.

People post here all of the time that they can't get a sleep study or a CPAP because they do not have heath insurance.  BTW, send them to www.awakeinamerica.org if you see a post along those lines.

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki wrote:

THAB,

You are right, we don't need socialized medicine, but what we need is well thought out (and there are plenty of excellent ideas) universal health care.  I know too many people who are unable to afford health care insurance and whose lives have been devastated because of it.  My close friend who just had her second surgery yesterday for advanced thyroid cancer comes immediately to mind.  They are about to lose everything because of her medical bills.  So not only is she simply trying to stay alive, but she and her husband are breaths away from losing the house over their head.

People post here all of the time that they can't get a sleep study or a CPAP because they do not have heath insurance.  BTW, send them to www.awakeinamerica.org if you see a post along those lines.

Vicki

Yeah, I believe socialized medicine would be just as bad as managed care, "gatekeeper" style health insurance. Only instead of  dealing with private insurance bureaucrats inter meddling between you and your doctor, youd be dealing with  federal and maybe state government bureaucrats. Anybody who believes the government could run an effective healthcare system is either a socialist,  or ignorant.

What we  do need is AGGRESSIVE health insurance reform. We need people in all three branches of the government (executive, legislature and judicial) who will have a  backbone and stand up to these health insurance companies inter meddling with people's doctor-patient relationship.

Note taken about the website, thanks.

Fred


_________________
"We don't need socialized medicine, what we need is insurance reform."


Resmed S8 Autoset Vantage, HumidAire 3i, Resmed Quattro ffmask

MrsBaddawg wrote:

What irks me is that if the patient tries to contact the insurance directly, they're usually told only a doctor is supposed to contact them about covering/not covering certain things. That's what happened to me when they refused my sleep study. I want people out there to know that insurance companies are not as all-powerful as they come across. They will try to throw their weight around, and may even threaten, but there are ways to deal with them. In my case, I asked the claims agent for the number for the Joint Commission. Just the mention of this government agency and they approved my sleep study. You don't have to be that drastic, though. There are appeals processes too, but if you can't wait I suggest contacting your state-level ombudsman. Their whole job is patient advocacy, and they can really get on insurance companies hard. Yes, there's alot of bureaucracy, and I know it's frustrating, but there's hope and help out there, so don't give up!

Kristina

P.S. If your doctor is refusing to order tests you know you need, GET A DIFFERENT DOCTOR!!!

Insurance companies are wealthy and can afford good attorneys, protracted litigation and have most politicians on their side. Insurance has the money to hire good lobbyists to advocate for their cause (its OK to be a tightwad to make a big profit and let people die in the process).

Things need to change...insurance needs its attitude adjusted.

Fred


_________________
"We don't need socialized medicine, what we need is insurance reform."


Resmed S8 Autoset Vantage, HumidAire 3i, Resmed Quattro ffmask

I just wanted to make people aware that you don't have to lie down and take all of the !@#! that insurance dishes out, that there are avenues to get what you need. I'm sorry you had so many problems Fred, did you then have to pay OOP? You're on a cpap now so you obviously have been diagnosed. If you paid OOP, maybe you could pursue reimbursement? I too have managed health care, and have found ways to manage them! So I don't want people to think that bad experiences are the norm, as that could discourage people when they're already discouraged by the effects of SA.

Kristina


_________________
"Sleep is the golden chain that ties health and our bodies together."- Thomas Dekker

Fred,

You can not personally attack people.  I am neither a socialist or ignorant.  This is your first and only warning.  Further personal attacks and insults and you will be permanently banned.  I understand your passion, but your comment about me (or anyone else) is uncalled for and unacceptable.

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki wrote:

Fred,

You can not personally attack people.  I am neither a socialist or ignorant.  This is your first and only warning.  Further personal attacks and insults and you will be permanently banned.  I understand your passion, but your comment about me (or anyone else) is uncalled for and unacceptable.

Vicki

I wasnt talking about you specifically, I was talking generally. It is well known that government sponsored "universal healthcare" is a socialist or communist ideology. It is associated with the Democratic party, not the Republicans or Independents. I am for maintaining a private system, but reforming it.

If you believe a government sponsored "universal healthcare" system will improve OSA diagnosis and CPAP issuance, I would have to vehemently disagree with you. Id argue things would actually get worse. Ever hear about those Candian and British socialist medicine horror  stories? Six month waits for a simple MRI?

Sorry to hear about your friends...

Fred


_________________
"We don't need socialized medicine, what we need is insurance reform."


Resmed S8 Autoset Vantage, HumidAire 3i, Resmed Quattro ffmask

Not everyone believes that universal health care is a communist plot.  I didn't realize I was a Commocrate .  There are volumes and studies about good universal health care programs.  All I can say is thankfully, our votes will cancel each other's out.  So lets drop this topic because it has become a debate and not a civil discussion.  This is not a political forum and this thread is beginning to take away from the purpose of this forum, which is to help OSA patients.  It also belongs in late night where I am moving it.

Vicki



Last edited by Vicki on Tue Sep 16, 2008 9:45 pm; edited 1 time in total
_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

MrsBaddawg wrote:

I just wanted to make people aware that you don't have to lie down and take all of the !@#! that insurance dishes out, that there are avenues to get what you need. I'm sorry you had so many problems Fred, did you then have to pay OOP? You're on a cpap now so you obviously have been diagnosed. If you paid OOP, maybe you could pursue reimbursement? I too have managed health care, and have found ways to manage them! So I don't want people to think that bad experiences are the norm, as that could discourage people when they're already discouraged by the effects of SA.

Kristina

Hi Kristina,

What happened was I went untreated for seven years, as I was disabled from severe depression/untreated sleep apnea and couldnt afford to pay OOP. Nobody cared, nobody gave a flying frick. Finally in 2006, my insurance changed to a good plan (Blue Cross Blue Shield of North Carolina) and after spending a night in the chest pain unit at a hospital in Charlotte, I was diagnosed with low blood  oxygen  saturation rates. That led to a consultation with a pulmonary specialist and that led another sleep study, this time insurance paid. Ive had good luck with Blue Cross Blue Shield of NC, but the other two insurance companies I mentioned can go to hell so far as I am concerned. I hope they go out of business. Hell, Id like to help and try to put them out of business!

Hatred? Yes, I admit it. Anytime somebody restricts my medical care to the point it negatively effects  my medical condition, I take that as a form of white collar crime. Some of these health insurance executives should be in prison IMO.

I believe in vengeance and  Id like to go into politics to fight these insurance assholes.

Fred


_________________
"We don't need socialized medicine, what we need is insurance reform."


Resmed S8 Autoset Vantage, HumidAire 3i, Resmed Quattro ffmask

I agree with you that socialized medicine isn't the answer, but there are alot of people in this country not covered by insurance at all. I kind of liked the idea that was tossed around about health savings accounts. I wonder what ever happened to that? I guess it just died in Congress. I understand after going through all of that how angry you are, I would be too, EXTREMELY angry. But please, so people like me can keep talking to you, tone it down, ok?? I really like your bluntness, but Vicki's serious about banning you. So please? Be nice? Newbies might not be able to handle it, ok?

Kristina


_________________
"Sleep is the golden chain that ties health and our bodies together."- Thomas Dekker

Well, "I" can remember affordable health care and affordable health insurance - and it was BEFORE "managed health care", BEFORE HMOs and PPOs and was all "fee for service" and worked quite well.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Well, "I" can remember affordable health care and affordable health insurance - and it was BEFORE "managed health care", BEFORE HMOs and PPOs and was all "fee for service" and worked quite well.

One doctor could maintain a private office w/one nurse/receptionist and a comfortable patient case load and afford to provide quality, caring health care to his patients, he had the TIME to get to KNOW his patients, the income to pay off his med school loans and maintain a good life style for himself and his family.

It was a time when hospitals (at least the three in our town) were all not-for-profits, two were run by religious organizations and one by a large consortium of doctors (osteopaths).

John Kennedy warned us to "beware of the gnomes of Zurich". We didn't listen. This country caused the Soviet Union to spend itself into oblivion. Our enemies watched and learned and now they've conned idiots like BushBaby, Cheney and Rummy into spending the USA into oblivion. And McCain is no smarter! He's bought into the same.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I had HMO coverage up until about 1996. It was great--because I was healthy. When I needed treatment, well, let's just say I switched my coverage the next chance I got.

My GP tells me of having to call an insurance company and "justify" a certain prescription, and the person he is talking to knows almost nothing about the drugs. At that point, he tells me, he tells the person to put someone on the line who knows something about prescription drugs, and to quit wasting his time.

Hello, I am a former nurse, notice the word FORMER!!!  I, after 15 years in what our country has been known to tout as the best health care in the world, just couldn't deal with the hypocrisy of the whole thing any longer.  I worked at a hospital the first year and got so angered by the under staffing, and knowing good and well that the administrators were upstairs in their cushy offices, with their administrative assistants, getting paid big bucks, while we were down on the floors trying to take appropriate care of the very ill patients entrusted to us, with less than adequate staff to do the job properly.  Then I decided to go into office nursing and management.  Totally enjoyed the interaction with the patients and most of the doctors, but that is when I discovered the true EVILS that exist in our insurance industry in this country.  They expect to get every dime from the insured and the employers covering the patients/employees, I mean if you are late they cancel you immediately.  But to get something paid for appropriately you have to jump through hoops and even then some MEDICAL DIRECTOR sitting in a cushy office, gets to decide if the treatment or drug or whatever the case may be is justified.  I could go on like this for ever I believe.  

I am just praying that now that I have this diagnosis and have to deal with it, i do not have to go to battle with my health insurance provider.  All I can say is if i do it will get ugly.  i have a lot of pent up frustration after all the years of watching them put patients through hell.  I guess i better get prepared for battle.