Insurance Company (Health not meant to be political))

[valkmc]

I am sick of Blue Cross Blue Shield-I am scheduled for a test, one I would rather not have, it involves a long probe and a camera. I just turned 52 and was scheduled to have it last year but BCBS said not. This year they say you can have it, it is coverd under routine health care. I make the appointment and am scheduled for Monday the 17th. The hospital calls me and says we need to warn you about your coverage, the test is coverd if it is labeled routine however if the Dr finds anything that needs to be removed or examined more, the procedure is then listed as a medical procedure and subject to your deductible and payment by you. 

I have no other option than BCBS because that is what my employer offers, when you read the benefits list all it says is the routine test  is covered, so I call BCBS and ask them this question:

If I have the test and the DR finds a polyop or cancer or anything he needs to look at I am not covered? They say yes that is correct, you will then be required to pay for the test and any other procedures required. I say thank you to your insurance company, thank you to my employer for changing our coverage to $2500 deductible and thank you to the hospital and Dr for charging $1500-$1800 for a test that will take 45 minutes.

So I will pay if I am sick and if I am not the insurance company will use part of the premiums I and my employer pay them in a year, and still make a profit. The seems backward to me. This is a twisted, twisted system, there has to be a better one for eveyone involved. I just wish someone could figure it out.

Sorry about the rant but typing seems to lower my blood pressure.

[Robert]

I feel your pain in more ways than one. My health insurance doesn't have a checkup feature like yours so I always have a deductible. But this may help you out the rate that they bill the insurance co is much lower than the one you would get billed. So if the service offered is 1600 you could get billed 700. sometimes less. Thats one of the reasons I have insurance to get the discount that is offered because paying full price is bs. I hate that I have to pay premiums plus pay for my tests because they usually dont hit the deductible limit. So I pay twice and the insurance co doesn't pay and they still raise my rates, good scam huh?

[G-Man]

Check directly with BCBS.  I'm not sure the hospital is correct, or they may be covering all their bases by getting you ready to pay everything just in case.

A routine test or exam is just that, routine, regardless of the findings.  In fact, the routine testing is designed to catch something in its early phase to make the prognosis better.

I believe you should be covered for the initial exam, however, subsequent visits or procedures would then require deductable payments.

And, of the people getting paid, the Dr. is getting the least, trust me.

[valkmc]

That's what I thought G-Man but I called BCBS, it amazes me that if something is found it goes from routine to medical and BCBS changes the payment.

I wasn't sure but I assumed if medical is like most other things the person doing the work (Doctor) gets the least pay. I don't blame them or insurance or anyone else the system has made this type of mess and we need a plan. I just am not sure who is qualified to come up with one.

[sugerbear]

actually G-man, the people that do ALL the setup, teardown and cleanup get paid the least.
the dr walks in looks through the scope for about 20 min, then walks out.

speaking from experience.


did coding and billing for a dr office for 3 yrs, along with -ray.

[G-Man]

That's just plain wrong and I don't like it one bit.  This little rule they have will just stop people from having routine tests......for the same reason people don't go to doctors in the first place for routine testing,.....they're afraid something will be found.

Try to find something in the new health care reform bill that addresses this.  You won't find anything because this ius a real problem.  The bill doesn't have any real solutions, but you'll be fined if you don't have this $hitty coverage.

Sorry.....I just made it political.  

[Hoser]

Routine checks saved my life.  Don't skip it just to save money.  Hoser

[G-Man]

Yes, but the doctor forked over 140 thousand, that he'll/she'll be paying back for 30 years, and invested 8 years of training in order to be able to look at, and understand, your entire lower GI tract within 20 minutes.  The techs sat through a few in-services, maybe, with no investment of time or money.  The doc also needs to hire you to do their coding and billing in order to get paid for the procedure and pay malpractice in-case something goes wrong with the procedure or the diagnosis.  

This comes from my experience as a physician.

[G-Man]

Routine checks saved my life.  Don't skip it just to save money.  Hoser

Words of wisdom, and Amen brother.  Unfortunately, there are many who struggle and are afraid.  Fear can paralyze a person into inactivity.  My ex-mother-in-law was so afraid of a diagnosis that she already new, that she actually waited until her breast was deformed before seeking treatment.  Her fear ultimately killed her.  A very sad story that too many folks live through daily.

[sugerbear]

do you work in a hospital? or private practice?

what kind of a dr are you?


didn't you know going in the investment would be that large?
140 thousand in school. the drs I know make that much in a couple a months. they also get a "spending" account from the hospital of about 600,000 (yes thats 6 hundred thousand) a year for expenses. (that ANYTHING he/she feels helps in his/her practice) digital cameras, big screen tv for home so he/she cam work on their power point presentation for the  meeting they go to every few months. also paid for by the hospital.

yes you have a great education, yes you have expenses, but so do we. we also get treated like peons, pay dearly for health ins( most hospital based drs pay NOTHING.
and if you go to court, we go too, (i,ve been twice myself) and he hosp and dr tried to put it off on me(refer back to peon status).

i went to school for two years at Washington University here in st louis so i could earn 40-50 thousand a year. my school cost 35,000. i also have loans to pay off.
step out of line i would get fired on the spot. if a dr goofs up, well he's "practicing

i live in a $120,00 home, how much does your cost?


sorry no tears here.