Wendell Potter, former health insurance exec, debunks health care "choice"

Romana

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Even when you have some choice, as in a state health exchange, it’s limited but what plans are available to you and what you can afford, and sometimes it’s a Hobson’s choice between the most adorable plan and one that has your doctors. Even with Medicaid now you must choose an insurance company to manage it, at least in NY.
 

Kamilah Hauptmann

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Huh, that's what that dumbass was trying to communicate to a Brit and myself.

Yank: In America we have choice, tho.
Brit: Choice of what?
Yank: Choice of doctors.
Me: I just got a new GP last year when I moved to this city. I went to a clinic, got some names, talked to a couple of them and picked one. What?
Yank: That's not how it works.

 

Anya Ristow

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Yank: In America we have choice, tho.
Brit: Choice of what?
Yank: Choice of doctors.
Me: I just got a new GP last year when I moved to this city. I went to a clinic, got some names, talked to a couple of them and picked one. What?
Yank: That's not how it works.
An American with employer-provided insurance is like a guy with a key to a door.
Everywhere else in the industrialized world the door is unlocked.
The American isn't going to give up that damned key for anything.
 
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Kara Spengler

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Choice?

Out of 3 meds which my doctor has determined I need (as has been unable to find alternatives for) my pharmacy has decided to fuck over my getting 1 (well actually the other 2, but this is the month the 'easy' one gets it). At first they said I had to get preauthorization, but it was always granted. Then they denied it. Then after wasting all sorts of time to find out what was going on I got my doctor to appeal it .... and then they denied the appeal.

Now tomorrow I will see my doctor and beg her to call them. I do not have letters after my name but she does.

What is my 'choice'? To die when my supply runs out? Then people wonder why I always want to have extra of every med I take.
 

Romana

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Choice?

Out of 3 meds which my doctor has determined I need (as has been unable to find alternatives for) my pharmacy has decided to fuck over my getting 1 (well actually the other 2, but this is the month the 'easy' one gets it). At first they said I had to get preauthorization, but it was always granted. Then they denied it. Then after wasting all sorts of time to find out what was going on I got my doctor to appeal it .... and then they denied the appeal.

Now tomorrow I will see my doctor and beg her to call them. I do not have letters after my name but she does.

What is my 'choice'? To die when my supply runs out? Then people wonder why I always want to have extra of every med I take.
They drove my endocrinologist to distraction once, a doctor I've been seeing over half my life and I've never seen him that aggravated.
The opthalmologist who did my Lasik quit the practice because the insurance companies w looking over his shoulder and auditing every treatment.
I lost an allergist that way too.
They down them in paperwork to put them off giving people the treatment they need if it's past the bare minimum.
 

Kara Spengler

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They drove my endocrinologist to distraction once, a doctor I've been seeing over half my life and I've never seen him that aggravated.
The opthalmologist who did my Lasik quit the practice because the insurance companies w looking over his shoulder and auditing every treatment.
I lost an allergist that way too.
They down them in paperwork to put them off giving people the treatment they need if it's past the bare minimum.
This is an uncalculated cost of the us system. Every office in the country, no matter how small, needs to have several ppl in the office just to deal with each plan.
 

Kamilah Hauptmann

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Every office in the country, no matter how small, needs to have several ppl in the office just to deal with each plan.
:qft:

Back in SLU I think I touched on this. Under single payer the office staff to doctor ratio is about 1:1. There's only one plan for most things and everyone knows the rules.
 

Fionalein

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:qft:

Back in SLU I think I touched on this. Under single payer the office staff to doctor ratio is about 1:1. There's only one plan for most things and everyone knows the rules.
Not only in this case, we have a dual system here...
Basic medical aid is available in the public system with people with verifiable enough funds being allowed to opt out and get a private insurance. Privatly insured people pay about 7 times for the same service but get some options basic aid does not cover (single rooms in hospitals, guarantee to be treated by head of the department and other shenaningans - no those cost even more and are not covered in the 7 times bill yet)...
Still we can visit every aproved doctor amd while private insurances might have a say which treatments not covered by the public system they pay ... any physicist approved by the public system can be visited by any privately insured person....

It is no way a perfect system but guess what? We have regulations and those guarantee a free market that works... feel free smack that fact into your "deregulations promote the free market" guys' faces :kittyball:
 
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Bartholomew Gallacher

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Not only in this case, we have a dual system here...
Basic medical aid is available in the public system with people with verifiable enough funds being allowed to opt out and get a private insurance. Privatly insured people pay about 7 times for the same service but get some options basic aid does not cover (single rooms in hospitals, guarantee to be treated by head of the department and other shenaningans - no those cost even more and are not covered in the 7 times bill yet)...
Still we can visit every aproved doctor amd while private insurances might have a say which treatments not covered by the public system they pay ... any physicist approved by the public system can be visited by any privately insured person....

It is no way a perfect system but guess what? We have regulations and those guarantee a free market that works... feel free smack that fact into your "deregulations promote the free market" guys' faces :kittyball:
When talking about Germany that's only partially true. Yes, there are public health insurances and private ones. The public ones are getting their fees out of a central fonds nowadays where companies and employees are paying in, and are free to make business as they want to within the law. Having a health insurance is mandatory by law. It's also possible to have e.g. an extra dental care supplemental insurance aside the basic one.

Private insurances are either possible to enter when you've got lots of money, OR you are a civil servant. There is no minimum fee for civil servants, if you do become a civil servant you are required to have a private insurance. Why? Because it is cheaper for your employer, the state.

Another important thing is that once you've switched over to a private insurance company it is almost impossible to get out again, normally you're trapped there for life.

Now you might rightfully ask - why would somebody want to get out of private healthcare if it is so hard to enter and has such big advantages? One simple reason: the older you get, the higher are your monthly rates you've got to pay. Many people in retirement are almost unable to pay it - or able to pay it, but don't have anything else much left over to live.

I do know some retired people, they are paying in the range of 8-900€/month for their private health insurance; which is quite a lot, while you only pay 150 or less when up to 30 years old sometimes.

Overall the services of basic health care are ok, you don't have to fear bankruptcy when calling an ambulance, having hip replacement or a heart transplant. Most of the costs are covered by the insurance. All stuff most Americans can only dream about it when reading the discussion here.
 
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Anya Ristow

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They drove my endocrinologist to distraction once, a doctor I've been seeing over half my life and I've never seen him that aggravated.
The opthalmologist who did my Lasik quit the practice because the insurance companies w looking over his shoulder and auditing every treatment.
I lost an allergist that way too.
They down them in paperwork to put them off giving people the treatment they need if it's past the bare minimum.
I live in a town with a teaching hospital, and there used to be an insurance plan associated with that "health care system", and as an employee of a fortune-500 company (at the time) I had that plan. It was awesome. But BC/BS took over that plan and it turned to crap.

My doctor at the time was actually a NP. I could stop in her office without an appointment and be seen. Anything she'd need to refer me to was within that system and that plan and involved no paperwork and no co-pays. Then BC/BS started limiting what they'd pay and every single service exceeded their "customary costs" or whatever the hell they called it. I never knew what anything was going to cost until they billed me. My doctor's practice was destroyed and she retired.
 

Brenda Archer

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Man, if one more smug well-paid guy who still has “good” insurance from his job asks me why I think going back to work will cost me my healthcare, I think I’m going to scream. Bullshit plans with combined premiums and deductibles that no clerical worker could possibly pay are not healthcare.

This problem might emerge if my cardiologist really can fix me and I get better. But going off anticoagulation and insulin would just land me back in the ICU so no more job if that happens.

I went around this pointless convo with my oncologist last week. I said I could never afford anticoagulation if I lost this insurance (Medicaid since I’m poor/disabled over a certain age) and she frowned at me with that expression I’ve learned means “you’re just gaming the system” and then when I left she hadn’t scheduled me for a follow up.

So what the hell do they want. The doctors must hear every week from people who refuse care they can’t pay for, but they insist it’s not their business how the patient is going to pay for it, and insist on treatments the patient may not always be able to afford. And if you say no, now you’re noncompliant. And then you’re blackballed.

The other thing we went around and around with is that she insists on a IVC filter with surgery. At first they wanted to leave it in, but now they deny it. I raised a stink because I don’t want a filter left in me if I lose my insurance (by going back to work). So I got a different hematologist who won’t require it. Judging from my reading over at NIH and other such, IVC filters are not safe to leave in.

The patient is really over a barrel when employers choose the insurance or use a plan that doesn’t cover the legal requirements. This is why I went without care in 2017, thanks to the temp agency. It’s possible I’d be fine now if they offered real insurance and I’d stayed on anticoagulation, even with gaps.

This system manufactures sick people and then denies any responsibility.

Well, at the moment I’m legit still too sick to work. People don’t believe it though, I don’t drink or smoke and look young for my age. Women are only what we look like, doctors don't listen to us, including other women. I only seem to have someone who sees what’s going on in my cardiologist. It feels very precarious. I want to start pulling copies of all my medical records, but I’m afraid they’ll think I am planning to sue. But I need to know what’s in them if I have to renew my SSDI when I’m about 60.

This situation is broken.
 

Romana

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. Women are only what we look like, doctors don't listen to us, including other women. I only seem to have someone who sees what’s going on in my cardiologist. It feels very precarious. I want to start pulling copies of all my medical records, but I’m afraid they’ll think I am planning to sue. But I need to know what’s in them if I have to renew my SSDI when I’m about 60.

This situation is broken.
When I booked my airline reservation for my trip in February I was super-concerned about my knee which had been broken. I picked the seat with the most roo (that I could afford) and saw it was designated for handicapped, crew could move you at their discretion. I panicked a bit, that I might get moved to a seat that would be harder on my knee and mobility. The clerk said I qualified for that seat. "But it doesn't show," I said, "unless I show them my scar."
I asked if I needed a doctor's note or something. She said no, I'm fine. But I think I'm going to try to print out my hospital bills anyway, or at least the checks for them.
Because if they don't see it it doesn't exist, right? Especially if you're female.
 

Kara Spengler

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The current story from my pharmacy on denying my prior authorization for my meds is they needed more clinical info, called my doctor, did not hear anything back, so closed the file. I call bullshit. She knows as much as I do that this is important. I will relay their story to her today and let her have fun going through a book of obscenities at them on the phone.

So what does the pharmacy do? They wait until the file is closed then snail mail me a notice [yes, told them to call my cell next time as you know there will be a next time]. Then snafu the paperwork when my doctor and myself are trying to fix their mess.

It is not just the mail order discount either. I can not even get it from the corner chemist using my insurance.
 

Kara Spengler

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It looks like they finally took the pre authorization, although I will believe it when I have the meds in hand. The strange thing is they would not do the pa with me there so I left the room. Talking after I found out they had been MUCH more confrontational than normal, including not wanting to approve me for the brand name drug [every neuro and nurse I have ever seen determined it was a medical necessity as it matters with antiepileptic medications and I have had seizures when put on a generic and I did not catch the change]. In fact one former pharmacy required a doctor approval to put a patient on AEDs on generics because they knew the risk was so high.