Rant with PREMERA Blue Cross

AKBill

AKBill

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AKBill
Pulled/tore something in knee climbing into my plane. Put me to my knees.

Readers Digest version. Within 6 weeks after my injury I saw 4 doctors they told me surgery was needed. PREMERA would not approve the surgery until 8 weeks of treatment was documented. So I had to hobble around 2 additional weeks to meet the 8 weeks when I could have been recovering to return to work....:(

Just makes me mad that an insurance company would set such a time frame for the surgery. I was told approval us to be 4 weeks then 6 weeks and now 8 weeks. I know insurance is a tough business but when you see 4 doctors and they say surgery is needed why delay what is needed?
 
Just remember...there's no such thing as "health care" with insurance companies, only "damage repair".

And that takes an act of congress.
 
My moms husband was killed by the insurance company.

The doctors said he needed immediate surgery to repair a ruptured aorta to save his life. The insurance company said no, treat it with drugs. After about 3 hours of this, he passed away. The surgeons were sure surgery would have saved his life but were not allowed to do anything because of the insurance company.

Insurance companies are allowed to determine medical procedures and tell the doctors how to do their business. cough Obama care will save you cough.
 
Welcome to the world of evidence based medicine.
 
You are rich enough to fly a plane, you are rich enough to pay for your own knee surgery.
See how that works?
Oh, and you can pay for the illegal in the next room, also. He doesn't have a waiting period because he doesn't have insurance.
 
Zeldman said:
My moms husband was killed by the insurance company.

The doctors said he needed immediate surgery to repair a ruptured aorta to save his life. The insurance company said no, treat it with drugs. After about 3 hours of this, he passed away. The surgeons were sure surgery would have saved his life but were not allowed to do anything because of the insurance company.

Insurance companies are allowed to determine medical procedures and tell the doctors how to do their business. cough Obama care will save you cough.
Click to expand...

Sorry to hear about your step father. As much as I dislike many aspects of ACA, this issue predates ACA by about thirty years and has only been a steadily increasing problem.
Starting in the 80s, insurance companies due to quickly rising premiums created insurance plans which attempted to slow the rate of health care costs. These insurance plans did so by restricting access to medical care. Hence, the concept of HMO, PPO.... and many others. In fact, ACA ignores this problem. At a fundamental level ACA is about shifting costs to the younger and healthier population and increasing coverage for those who do not have insurance. The few "cost" based triggers in the bill only apply to Medicaid and Medicare and have no effect on insurance companies.

Healthcare is a finite resource, we have tried to ignore the reality that it is rationed. The end result is we hide the rationing behind bureaucratic measures instead of making it explicit; such as China (straight economics), Canada (quality of life/social value).... The end result in the USA is we blame the insurance companies.

Tim
 
AKBill said:
Pulled/tore something in knee climbing into my plane. Put me to my knees.

Readers Digest version. Within 6 weeks after my injury I saw 4 doctors they told me surgery was needed. PREMERA would not approve the surgery until 8 weeks of treatment was documented. So I had to hobble around 2 additional weeks to meet the 8 weeks when I could have been recovering to return to work....:(

Just makes me mad that an insurance company would set such a time frame for the surgery. I was told approval us to be 4 weeks then 6 weeks and now 8 weeks. I know insurance is a tough business but when you see 4 doctors and they say surgery is needed why delay what is needed?
Click to expand...
Rationing.

BTW, I was diagnosed with a torn meniscus several years back; by the time I got an appt with the ortho, it fixed itself.
 
Zeldman said:
My moms husband was killed by the insurance company.

The doctors said he needed immediate surgery to repair a ruptured aorta to save his life. The insurance company said no, treat it with drugs. After about 3 hours of this, he passed away. The surgeons were sure surgery would have saved his life but were not allowed to do anything because of the insurance company.

Insurance companies are allowed to determine medical procedures and tell the doctors how to do their business. cough Obama care will save you cough.
Click to expand...
Puke and save you a lot of money puke.

I hate to say it, and it won't bring him back, but I'd be talking to an attorney, if nothing else than to try to change things for others.
 
Our insurance company the airline uses as their go between doesn't approve anything.

The big thing lately is their not approving ER visits unless it life threatening to the point of immediate death. One family took their daughter to the ER because she couldn't breath. It turned out she had asthma. The airline denied the claim as it wasn't life threatening.

To use my dental benefits I have to FAX a approval form from the docs office to the administrator office. Then they'll FAX and Yay or Nay back to the dentist before I am allowed to sign the "I'm Here" book.

My PCP office, which is part of a large hospital system, called me a few months ago and told me to find a new doctor. They got tired of dealing with the airline in a 1980s fashion.

Most of the pilots are dropping the medical and going to Obamacare or just not having medical insurance for their family.
 
ARFlyer said:
Most of the pilots are dropping the medical and going to Obamacare or just not having medical insurance for their family.
Click to expand...
A friend of mine was going to retire at age 62. He told me he delayed his retirement to age 65 because it was going to cost him $25,000.00 a year for health insurance and Medicare does not start till age 65...:(
 
paflyer said:
I was diagnosed with a torn meniscus several years back; by the time I got an appt with the ortho, it fixed itself.
Click to expand...

"The art of medicine consists in amusing the patient while nature cures the disease." -- Voltaire

AKBill said:
He told me he delayed his retirement to age 65 because it was going to cost him $25,000.00 a year for health insurance and Medicare does not start till age 65...:(
Click to expand...
Yup. That's exactly what I did, and for that reason.
 
ARFlyer said:
Most of the pilots are dropping the medical and going to Obamacare or just not having medical insurance for their family.
Click to expand...

From your airlines perspective the plan is working.
 
tspear said:
[snip]
Healthcare is a finite resource, we have tried to ignore the reality that it is rationed. The end result is we hide the rationing behind bureaucratic measures instead of making it explicit; such as China (straight economics), Canada (quality of life/social value).... The end result in the USA is we blame the insurance companies.

Tim
Click to expand...

This. The argument is over who has control over the rationing (insurance or government at the moment). And since virtually all heathcare is done with someone else's money, (whether it's insurance, medicaid, medicare or indigent picked up by others) the prices keep going up. (What's my incentive to even try to wade through the price/quality of care when my only impact is whether or not 1) I get well, 2) insurance will pay?) And the medical system is a poster child case of what Scott Adams termed a "confusopoly". As system where pricing is so complex it's virtually impossible to comparison shop.

John
 
paflyer said:
Puke and save you a lot of money puke.

I hate to say it, and it won't bring him back, but I'd be talking to an attorney, if nothing else than to try to change things for others.
Click to expand...

I tried. Mom and his kids don't want to pursue. I'll try again with the change for others.
 
ARFlyer said:
Our insurance company the airline uses as their go between doesn't approve anything.

To use my dental benefits I have to FAX a approval form from the docs office to the administrator office. Then they'll FAX and Yay or Nay back to the dentist before I am allowed to sign the "I'm Here" book.

Most of the pilots are dropping the medical and going to Obamacare or just not having medical insurance for their family.
Click to expand...

Don't get me started about the rip off that dental insurance is. I mean I need to get in that business. Make a person pay for it for 6-9 months before it can be used, then limit to only $1000 to $1500 of payout a year. Money tree for the dental insurers.
 
weilke said:
From your airlines perspective the plan is working.
Click to expand...

Yep! We also aren't really allowed to take sick days. If we do they wack us with bad attendance points that will be used if they decide to fire us. Also good luck calling out sick on a trip as a commuter. They stalk the non rev listings to make sure you arn't using it while sick.

I don't care, scheduling can call, yell, and threaten me via voicemail all they want.
 
If the politicians were not in cahoots with the insurance industry, we would have socialized healthcare as they do in other countries like the UK, France, Canada, etc. and the cost of drugs would be lower. Medicaid could go away, VA healthcare would not be needed. In effect, Medicaid would apply to everyone from birth to going west. Drop the present debate on a health care bill and go for what should have been done seventy years ago!
 
creweite said:
In effect, Medicaid would apply to everyone from birth to going west. Drop the present debate on a health care bill and go for what should have been done seventy years ago!
Click to expand...

God help us.
 
Unfortunately, the health insurance lobby is like the Tobacco lobby, they are never going away. Too many billions at stake.
 
creweite said:
If the politicians were not in cahoots with the insurance industry, we would have socialized healthcare as they do in other countries like the UK, France, Canada, etc. and the cost of drugs would be lower. Medicaid could go away, VA healthcare would not be needed. In effect, Medicaid would apply to everyone from birth to going west. Drop the present debate on a health care bill and go for what should have been done seventy years ago!
Click to expand...

You may want to look at those systems a little closer. England, France and Canada all have radically different solutions.
Sure in all three cases, the majority of the healthcare spending is paid and rationed by the government. But that is really the only thing they have in common.

And until you accept the premise of explicit rationing, you will not "control" healthcare costs.

Tim
 
I think something like the pre-ACA HealthyNY plan for individuals and sole props might be the only politically feasible solution to the ACA dilemma. The old-school HealthyNY plan was a stripped-down, standardized policy that could be offered by any licensed insurance company at whatever rates they liked. All the policies were identical regardless of the company issuing them. They covered Basic Medical, Major Medical, (optionally) prescription drugs, and nothing else. No mental health, no substance abuse, no chiropractic, etc.

Despite the narrowness of coverage, such policies would meet the requirements of the vast majority of Americans. Most people never use the services that HealthyNY didn't include. I think it would make a good model for the minimum acceptable Exchange policy.

Of course, I'm just being pragmatic. I would rather that Uncle had kept his nose out altogether. But the political reality is that some of the reddest states and congressional districts also have some of the highest percentages of people insured through ACA. That political reality makes philosophical arguments irrelevant. But a more stripped-down package that would be affordable, but still meet the needs of the vast majority of Americans, might be both fiscally sustainable and politically palatable to both sides of the aisle.

Rich
 
ARFlyer said:
Yep! We also aren't really allowed to take sick days. If we do they wack us with bad attendance points that will be used if they decide to fire us. Also good luck calling out sick on a trip as a commuter. They stalk the non rev listings to make sure you arn't using it while sick.

I don't care, scheduling can call, yell, and threaten me via voicemail all they want.
Click to expand...
Do you work for republic?
 
Zeldman said:
My moms husband was killed by the insurance company.

The doctors said he needed immediate surgery to repair a ruptured aorta to save his life. The insurance company said no, treat it with drugs. After about 3 hours of this, he passed away. The surgeons were sure surgery would have saved his life but were not allowed to do anything because of the insurance company.

Insurance companies are allowed to determine medical procedures and tell the doctors how to do their business. cough Obama care will save you cough.
Click to expand...

And to think most people are in favor of single payer health care. That payer [the government] has control over your destiny.
 
My wife and I pay our PCP $2K each, per year, in a "conceirge" arrangement. Unlimited visits, no waiting, relaxed atmosphere. He doesn't accept insurance, though he'll print the universal form for us to submit to BC/BS.

It's a great arrangement for us, and the contrast is stark when we visit specialists or go for imaging, etc.
 
Norman said:
And to think most people are in favor of single payer health care. That payer [the government] has control over your destiny.
Click to expand...
Check out the single payer diaster in Taiwan - half the med school grads flee the country, the rest pretend to be plastic surgeons to skirt the rules, and you gotta "bribe" for an appointment - favorite tactic is to buy an expensive bottle of wine as a "gift", which is then immediatley returned for a "refund".
 
Sundancer said:
Check out the single payer diaster in Taiwan - half the med school grads flee the country, the rest pretend to be plastic surgeons to skirt the rules, and you gotta "bribe" for an appointment - favorite tactic is to buy an expensive bottle of wine as a "gift", which is then immediatley returned for a "refund".
Click to expand...

The folks clamoring for single payor never had to deal with a single payor system. They think it's the greatest thing since sliced bread because the doc in Scotland they saw for some boboo didn't send them a bill.
 
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