What happens when you don't have Health Insurance?

kitchenwitchOctober 27, 2008

My son is almost 25 years old, and healthy. He is employed full time, but without health insurance (contract job). He doesn't make that much money and he can't afford it. If he's in an accident or needs surgery -- what happens?

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After our DS aged out of DH's medical coverage we bought a 'catastrophic' package for him. (After all, we would be the ones covering any expenses!) This was a Blue Cross/Blue Shield policy and it was quite inexpensive *because* it was limited to big-bill problems.

As it happened, DS had an emergency appendectomy; became infected after stitches were removed; spent weeks in hospital on IV with antibiotics -- in a private room because of the infection. The policy covered absolutely everything. (The only thing lacking IMO was that they wouldn't sue the incompetent surgeon!)

    Bookmark   October 27, 2008 at 10:50AM
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If he's in an accident or needs surgery -- what happens?

The main reason most people file for bankruptcy is uninsured (or underinsured) medical expenses.

    Bookmark   October 27, 2008 at 11:37AM
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if there is an emergency the hospital will treat him and then payment will be determined. They will not turn him away in case of an emergency.

He then could be stuck with huge bills that take a long time to pay.

If he needs routine things done (vaccinations ect) I don't think that some dr's will even see him without up front payment or credit card information.

No matter what, he will be treated if there is an emergency. The bill could be crippling to him though. You need to ask him if he can afford to NOT have insurance. I am younger (30) and I made 21,000 on my first job. I paid 150/month for insurance (which didn't include dental). You need to make it work. At least, try to get insurance for emergencies.


    Bookmark   October 27, 2008 at 11:39AM
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Thank you all for your replies. My sister told me that her son had an emergency without insurance and the hospital "wrote him off" like a chartiy case. Don't know if every hospital does this...

    Bookmark   October 27, 2008 at 12:34PM
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Some do, some don't. The point is, THEY make the decision. For your son to gamble that the hospital will not come after him, at a time when funding is being diminished on almost every level, is extremely risky. Every charity case is funded by taxpayers like you and me.

Get a catastrophic health policy - it's cheap insurance, and should be all he needs.

    Bookmark   October 27, 2008 at 12:48PM
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He may in fact be able to get care in an emergency. If he shows up at an emergency room bleeding to death, he is likely to get stitched back up. It is less likely he could get, say, physical therapy to properly rehabilitate an injury, or needed prescription medication, unless he has the money to pay out of pocket.

    Bookmark   October 27, 2008 at 5:18PM
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I can only tell you how one did it where I used to work. Yes there was a specific amount in the budget for services they could write off. But, it was a very small amount compared to the billing they do issue, and I was told by an administrator that this option is usually used up very quickly and therefor doesn't help a lot of people who would hope for that exemption of payment. Also some hospitals (and physicians offices) will negotiate costs or offer reduced costs to people who are self-pay and ask about it.

The temporary catastrophic insurance can be a life-saver. There is another way for people who are employed, but don't have insurance coverage to get some. It is the high deductable plan, and a health care savings account or IRA. You need to watch the terms on these, as some eat everything you put into it at the end of the year, and others roll it over. The monies you invest in these accounts are pre-tax, and can be banked and make money in some plans and spent toward your deductables, and expenses, and even over the counter meds. The higher the deductable, the cheaper the insurance, and Uncle Sam has given some real protection for people who need to buy their insurance this way.

It's still not cheap on a monthly basis, but, most working singles can afford it and they have money waiting, tax sheltered, to pay their part of a bill. It just can't be used to make their insurance payment. In a pinch, almost anyone can afford to cough up two or four or five thousand of a hospital bill. It's better than a bankruptcy.

When I had my first child, the hospital bill and physician's bill came to less than a thousand dollars. When I had my last pregnancy, I had to give the obstetrician five thousand UP FRONT. God knows what the hospital bill would have been. You cannot afford to not be insured. It's the only reason I am still working until I am old enough for medicare. BTW, if he can't afford two to three hundred a month for a policy like that, how would he ever be able to afford to pay a for a supplementary medicare policy or medicare part D? LOL.

    Bookmark   October 27, 2008 at 5:53PM
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my husband is now out of work and we lost our health insurance in September. I have a policy that costs $167 per month, my husbands is $207 ( he smokes) and DS's policy is $70 per month. I have to say I think that this is pretty reasonable! COBRA on the otherhand was $1300 per month for the three of us. Crazy thing is they are with the same Health insurance company, but do not include vision or dental.

    Bookmark   October 27, 2008 at 6:22PM
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From what I pick up by reading in this forum, is that you all are responsible adults as I am. We pay our bills and we have insurance. Not everyone is like that. My sons don't have insurance, they just go to the ER when they get sick and walk away from the bills. They have raised their kids like that, as far as I know neither of them have has had any medical insurance except for a couple of years when one of them worked at an aircraft plant.

BTW, I can confirm what was said about cheaper insurance. You can buy hospitalization insurance a lot cheaper than full medical. You have to pay for doctor's visits and a lot of doctors will reduce that if he knows the circumstances.

    Bookmark   October 27, 2008 at 9:03PM
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Thank you all for your replies. My son, like so many his age, thinks he's bulletproof and with all his other expenses such as commuting costs, student loans, rent, etc, feels that insurance is too costly and he'll just have a benefit concert if he needs one, but I'm just not comfortable with that plan! I am looking into very basic coverage for an emergency because I know a few twenty-somethings that have had to have surgery and never thought that they would -- fortunately they had insurance (parent-paid, actually) so they had good care (in one case it cost hundreds of thousands of dollars!).

So far the cheapest I've found is $125.00/month, has a high deductible for office visits (he rarely goes to the doctor), but will pay hospital bills with a $500.00 co-pay. A higher co-pay might bring that down, I hope. I really thought that by now he'd have a job with benefits, but he's in TV and that industry doesn't seem to work that way. We're in NJ, which has an under-30 dependant insurance that is attached to my employee benefits -- full coverage for over $200.00/month. I have a daughter that just graduated college, and I'm also helping her pay her insurance -- she works in a hair salon -- no bennies, unless you count hair color, LOL. I don't remember this being an issue when I was their age. Many of my kids' friends do not have benefits with their jobs. Why are so many kids with jobs without insurance?

    Bookmark   October 28, 2008 at 11:54AM
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Because more and more, starter jobs don't come with many, if any, benefits. Most Gen Y'ers aren't doing union jobs, or are working as contractors, which is cheaper for companies because they don't have to pay ANY benefits. Google, for instance, like many Silicon Valley companies, does this extensively.

When I worked at a dot-com, I was one of the oldest people there at 50. They offered health bennies - actually very good ones - but no employee life insurance, for instance. Most of the employees were so young, they didn't care or want life insurance. I had to go out and buy my own, which turned out to be a good thing, in the end.

And most parents don't work at union jobs any more either, so the option of continuing to cover dependents after age 18 or 21, is just about non-existent these days.

And if the breadwinner gets laid off, the COBRA costs for continuing insurance can be extremely high. We belong to the highest level plan from Kaiser HMO, for example: $800/mo for individual, $1150/mo for couple, $1475/mo for family with 2 kids....and yes, it goes up even higher past that. If my DH were laid off, we would barely be able to afford this policy and would probably have to switch to a catastrophic hospitalization with high deductible plan.

Here's where the media headlines relate to us all on a personal level. It isn't just kids who lack health insurance - a great many workers of ALL ages do. My BIL was laid off and hasn't had group health in over a decade offered to him, only contractor jobs. He finally sprang for a policy on his own after forming an LLC - barely six months before he had a mild heart attack!

    Bookmark   October 28, 2008 at 12:29PM
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OT: I've written before wondering why so many kids *need* to go to college -- often incurring big debt to do so. I also wonder why many businesses *require* college degrees for mundane jobs.

Your daughter is a college graduate? And she works in a hair salon? Could you explain, please? Do your kids' college graduate friends have jobs that utilize their degrees?

    Bookmark   October 28, 2008 at 12:34PM
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I find that young candidates for entry-level professional jobs are often all about "show me the money." Our company doesn't pay particularly high salaries, but we have very good benefits. A lot of young folks don't care about stock or 401(k) contributions or life insurance. They want cash and they want it now.

I'm very glad to have fully paid health insurance. And after another 18 months, I'll be working only as much as I need to in order to keep the insurance.

    Bookmark   October 28, 2008 at 2:05PM
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As an MD, I consider this question from many angles all the time. First, it is true that most office-based physician services can be substantially discounted for cash because 1) the insurance contracts are not going to pay what the doctor charges anyway, and 2) there are no collection costs. Second, it is also true that people in their second and third decades often do not have any major health problems so it is not an entirely irrational decision for them to forgo health insurance in favor of a few more lattes and a new phone (they contribute a significant percentage of the 'uninsured tragedy' BTW). Third, although hospitals may provide some degree of write-off, as another poster stated this is entirely at the hospital's discretion. Depending on the solvency of the facility, your son's income and assets, and issues such as county funding for indigent care he could easily be stuck with a huge bill - it might be less huge than the 'full' bill but still five figures. So a cheapo catastrophic coverage policy is a very wise investment. Fourth, the #1 health risk of males his age is trauma, not some rare leukemia, so just remind him that in a serious car accident it doesn't matter that he's a great driver, it's all about the drunk in the other car. Trauma care can get expensive very very fast. As a side point, should he need medication the WalMart $6 med list is pretty useful.

    Bookmark   October 28, 2008 at 2:05PM
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modern life interiors

call yur state insurance board maybe they can help.

    Bookmark   October 28, 2008 at 9:47PM
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It is really foolish not to have some kind of major medical insurance plan even if you are in your 20's and healthy. DH had a ruptured appendix and spent two weeks in the hospital when he was 20. I was diagnosed with cancer when I was 25 and underwent treatment for over two years at a cost of hundreds of thousands of dollars and that was over 25 years ago. That would not be considered an emergency until you're on your death bed. Fortunately we never went without insurance coverage even though our incomes were very small at the time. Granted insurance coverage is more expensive now but as others have pointed out you can get something at a more reasonable cost to cover you in case of a major medical problem.

    Bookmark   October 28, 2008 at 11:43PM
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Chisue: DD went through a vo-tech program while completing her junior & senior years in high school and got her cosmetology license. Being a hair stylist is a great trade and she loves it, but I cautioned her about limiting herself to that career when she was so young -- we never know what the future holds. So she went to college, had great experiences including a semester in Italy and now has a BS in business. Necessary for a salon job -- maybe not, but if she wants to own her own business or do something else someday, she has that education & degree. I didn't go to college, and whenever I was on a job interview, it seemed to be a sticking point for most employers, so I think that college is important and often expected, at least where we live.

Something mary md7 said got me thinking about the job choices these kids make. Actually very few of my kids' friends have traditional corporate jobs. "Show me the money" could be one factor but also flexible hours and office environment are important to them. These kids are happy to go in later or leave early (working less than 40 hours), or have a more relaxed atmosphere, and they're not thinking about benefits like health insurance and 401ks. Some of these kids have more than one job -- easier to fit in band practice, perhaps. And even in their early mid-twenties many still live at home -- no rent to make. We live in an affluent area (although we're not one of those families!), so maybe some of it can be chalked up to spoiled kids or is it a whole generation? It took my son a few years out of school to get a full-time job -- his business is hard to break into -- and he free-lanced and worked as he could and it seems that a lot of kids are doing that. They're not sitting home all day, but they're not really getting anywhere either. I'm not sure if that's choice, or if it's what's available to them.

But back to topic, I agree that health insurance is necessary!

    Bookmark   October 29, 2008 at 10:50AM
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I work for the largest aerospace company in the U.S. and have been here for 28 years. We see a whole new type of employee begin their first jobs here. Engineers, program managers, etc. They have a whole different work mentality than I do do along with people of my age, along with a whole different dress code - long hair, tatoos, piercings, etc. My company doesn't discriminate based on looks - if they're an engineer with the right degree that is all that matters, but it is interesting to see this new generation join the workforce.

    Bookmark   October 30, 2008 at 1:02PM
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I worked in broadcast tv for 9 years during my 20s and always had health insurance and other benefits from the companies. I worked for 4 different tv stations.

I now work in our community hospital and see many people in the ER without health insurance. Our hospital system does have a financial aid program for uninsured patients but it's not a guarantee. We give them the packet but the business office decides if the patient qualifies for assistance. They require paychecks, tax statements, etc. to back up claims.

If people don't pay, their bills are sent to collection agencies. Walking away means your credit rating gets trashed.

    Bookmark   October 30, 2008 at 1:19PM
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"As an MD, I consider this question from many angles all the time. First, it is true that most office-based physician services can be substantially discounted for cash because 1) the insurance contracts are not going to pay what the doctor charges anyway, and 2) there are no collection costs."

Sady, most MDs do not discount for cash. While carefully researching health insurance plans last year, I asked my doctors what the charges would be if I had no insurance and was paying cash. In every case I would be charged the same exact price they charged the insurance company, even though the price is inflated because they know the insurance company never pays the full amount.

So, for example, they'd bill an insured patient and an uninsured patient the same amount, $500 for a mammogram. The insurance company would only pay them $326 and the doctor would have to accept that. The cash patient, however, would have to pay the full $500.

Nice health care system we've got here in America, no?

    Bookmark   October 30, 2008 at 3:10PM
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kitchenwitch -- Thanks for answering my question. It sounds as though your DD was able to go to college without accumulating backbreaking debt. It's great that she now has two degrees in her bag!

Our DS has been a paramedic -- now completing his college degree as a DH, and as a DF to his own DS. His friends are now several years out of college and I know of few who are working in jobs that utilize their degrees. Our DIL teaches 8th grade math in the inner city and is constantly upgrading her skills, so her degrees are in use. But most of DS's friends are pushing papers from one side of a desk to the other or are in sales, even (ick) retail. (I say 'ick' because they say it!)

It seems to me that high school degrees used to mean something -- up to when, twenty years ago? Now the business world requires college degrees for entry positions, and the college grads are about as world-wise, reliable, *educated* as HS kids used to be.

I'm certainly not knocking higher education. I just wonder why *everybody* thinks he has to go, for the main purpose of getting a decent job, and why people go so into debt to for a degree they will not use.

Sorry to get so off-track. Glad you agree about getting the health insurance.

    Bookmark   October 30, 2008 at 3:41PM
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pipersville carol -

My sample size might be a little larger than your sample size. You also have to distinguish between office services provided by a physician and tests performed at a facility. Even tests performed inside a doctor's office are sometimes actually 'owned' by a different corporate entity that is leasing space. It is financially ridiculous to drive away cash patients by charging them "full rate" because the cost of collections from an insurance company can run 25% of the actual payment...whereas the cost to collect cash at the door is zero. The most obvious sign of the common sense of the cash basis practice is the increasing trend towards cash-only practices, which are deliberately scaled to be affordable to the middle class (I'm not talking about the premium concierge care model). I can assure you that unless you are in some part of the country that has scarce medical resources such that the docs still get reasonable payment from most of their insurance contracts, there exists a sensible office that will deal for cash.

    Bookmark   October 30, 2008 at 6:13PM
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I was a single self employed mother of three who for years went without health insurance for myself. My reasons were:
First and foremost putting food on the table, a roof over our heads and clothes on our backs.
Not educating myself on ways to obtain affordable health care, always thinking I'd figure it out "later".
At the age 41 I purchased major medical insurance and at the age of 42 I was diagnosed with cancer that included not only the initial chemo but TWO stem cell transplants over a 8 year period.
A major medical insurance plan saved me from financial ruin. I did have a high deductible, but coming up with $2,000 or $3,000 a year was doable compared to the almost $1,00000 in medical bills I've incurred thru the years.
Many of my co-workers did not have insurance. My advice to them? YOU CANNOT afford NOT to have it.
Help educate your loved ones who do not have insurance...even if it means doing the "leg work" for them...Help them help themselves :)

    Bookmark   October 31, 2008 at 1:53PM
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DH & I have never been without health insurance, even if it meant cutting back on other things (and at one time it definitely did!). Please help your son to get some type of insurance. We have friends who insured the wife & daughters but not the husband (he was around 30 & also felt invincible). He got bitten by a spider & got an infection. He wound up in the hospital & then developed bacterial pneumonia. The total bill was around $30,000. They had to work out a payment plan with the hospital. Health insurance is usually pretty reasonable for young men. That $30,000 bill would have paid for many months of premiums.

Sometimes doctors or hospitals will write people off (I work for a doctor's office). However, many will at least attempt sending the person to collections first. This can mess up someone's credit, which could especially be a problem these days.

With regards to why companies don't offer insurance: many small companies just can't afford it. DH & I owned our own business & we talked to several insurance agents. We literally could not afford to contribute toward the employee premiums without cutting their wages & applying that amt. toward the premiums instead. We offered this to the employees as an option but no one wanted to do that. We wanted to provide benefits like these, but we just couldn't. We were barely making enough to take home anything ourselves. The company I now work for almost lost health insurance coverage. A certain percentage of employees have to sign up for the coverage or the insurance company can decline to insure that group. We had a good policy, but most people thought it too expensive & didn't sign up. They had to do a massive change to even maintain coverage for the group. It's the same with life & disability. We had an agent come to the company I now work for to set up life & disability. We ended up without disability because not enough people signed up for it.

    Bookmark   October 31, 2008 at 3:35PM
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I posted earlier on here. My husband is not working but we are finding the money to pay for our own insurance. DH, who never goes to the doctor needed to go this week. So, the office visit is $40. I knew that blood tests etc were not covered, but would go to our deductable. The admin in charge, called me to one side, and asked if we would like them to bill us direct for the blood work etc. We would not be able to count it towards our deductable, but it would be 60% cheaper! We can still count the amount on our taxes (DH had major dental this year and I have had lasik). This doctors office was obviously willing to work with us. Just thought this may help someone.

    Bookmark   October 31, 2008 at 3:36PM
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kittiemom -- Your spider bite story makes me want to offer a warning. DH was trimming hedges in our yard one summer day. He didn't feel a bite, but a few hours later he had a swelling on his forearm that got larger and developed a 'bull's eye' pattern.

I called our MD who said, basically, "Nevermind." I asked if it could be a brown recluse bite. He said, "We don't have those in Illinois."

I called the poison control center. They thought it could be serious and said to call the entomology department at the Field Museum. The person there who answered my call asked if I could see 'jaw marks' on the bite. Yup, there they were, like a pair of parenthesis marks.

He said to get my DH on antibiotics immediately! Brown recluse and other spiders can be anywhere; they hitchhike in shipments from other parts of the world. He said to expect the wound to get worse and that the flesh around it would develop necrosis (die) from the poison the spider injects when it bites.

After 'educating' our MD...DH got the antibiotics. He ran a little fever; the arm became swollen and was hot to the touch. The flesh did die off in a ring about the size of a silver dollar. It took over a month to start healing. Now you can't see where it was.

Three months ago a spider bit me on the first joint of my index finger while I was deadheading geraniums. I didn't feel the bite, but later the joint doubled in size and I could see the jaw marks. It has taken over three months for all the poison to leave.

So! These bugs may be small. You may not feel the bite. If you can see jaw marks and swelling doesn't go down in a few hours and you develop a bull's eye at the site...you may need an antibiotic. Don't delay!

    Bookmark   October 31, 2008 at 5:40PM
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My uninsured 24 year old son was in car accident and someone called an ambulance. He must have been acting confused so the paramedics took him to the hospital. He told the paramedics and the hospital that he did not have ins but they talked him into all kinds of tests. They did an MRI and a CT scan and a bunch of other stuff. He was there for 12 hours. The bill was $30,000!!!

    Bookmark   November 1, 2008 at 12:09PM
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Many/most offices will have that sign hanging up that they expect payment at time of service unless arrangements are made previous to the appointment. The reason I said that is that reminds me of my dentist. He is not on my approved list of dental providers, and that means I pay a lot more out of pocket for his services. I also did not know, and was never told, that he will reward people who pay up front, instead of letting the insurance companies do their thing and paying the remainder by being billed later. I discovered the billing secret when I was arranging to have some major work done, like crowns and bridges. I found out that cash on the barrelhead before the work results in a substantial discount. If you pay at time of services with a credit card, you still get a discount, only a bit less because of their card fees (makes sense). If you let them submit the claims, which can take weeks and months, if the insurance makes mistakes, you will end up paying the full price. You have to ask..........they don't tell you.

    Bookmark   November 1, 2008 at 12:58PM
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pipersville, in response to your comment about doctors charging cash patients the same as they bill insurance, there is a good reason. It is against the law (insurance) to charge different amounts for the same procedures. The only legal way for a physician to discount anyone is to not take insurance at all and run a full cash practice. The physician could not be contracted with any insurer including Medicare. It would be considered Insurance Fraud to charge different amounts.

Most people are totally unaware of the power of these profit making insurance companies. Their CEO's are racking in their huge bonses, while most doctors can barely make ends meet and must follow their rules. Their practice is totally dictated by insurance companies which under pay them. The treatment of their patients are determined by the Insurance Comapny. Any discussion about healthcare in this Country never addresses the profits made by Insurance Companies and the power they possess. They make huge profits off the amounts they charge and totally control health care in this Country.

    Bookmark   November 3, 2008 at 1:13AM
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Does anyone know the distinction when an MD 'doesn't accept Medicare assignment' and when one 'opts out of Medicare'?

My orthopod (hip replacement) 'opted out'. I paid him in cash. Medicare paid on all the peripheral expenses around the surgery: pre-op, hospital fees, tests, orthopod's assistant, Visiting Nurses and PTs after the surgery.

When I visit an ENT who doesn't accept Medicare assignment I pay his fee directly; they file with Medicare; Meidcare reimburses me part of the fee.

Can Medicare deny me partial reimbursement for my hip surgeon's fee? His office refuses to file, but has sent me their office billing sheet, showing procedure numbers and dates and amounts charged and paid. I have filed once; been denied once; re-filed and have yet to hear back.

(THe first denial was because I 'failed to fill in the location where the surgery was performed' -- although there was no such question on the form!)

    Bookmark   November 3, 2008 at 10:03AM
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When a physician opts out you will not get reimbursed from Medicare. This doctor should have you sign a document explaining this to you. You have to agree that he has opted out of Medicare and if you decide to use him, you cannot get any reimbursement from Medicare. This physician is not permitted to file with Medicare.

Non assignment means that this physician will not accept what Medicare pays and bills you directly. You can then send your receipt to Medicare and get paid directly from Medicare. The physician is permitted to only charge you the 'limiting charge' permitted by law which is generally 15% above Medicare's allowed amount.

Many physicians are opting out of Medicare because of the low amount paid to doctors. But you must be informed of this before you agree to be treated by them. You must sign a document stating that you knew this and accepted those terms. If you didn't, the physician can be reported to Medicare.

    Bookmark   November 4, 2008 at 12:04AM
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jane_ny -- I totally get it that MDs can't live on decreasing and late-paying Medicare assignment. I did sign the form, knowing the MD had opted out and that his office would not file for reimbursement for me. (Why? Because this is the top hip guy in the Chicago area and he'd done my other hip three years ago.)

Then I happened to visit the ENT, who doesn't accept assignment, but does file, and I got a partial reimbursement of his fee. So...I got to wondering.

It seemed to me the major difference was that the surgeon was saying his office wouldn't file for me. That didn't mean *I* couldn't file, so I did.

It seems to me that the agreement is between the MD and Medicare: He says he won't file claims. If Medicare will pay, say, $2000 on a hip replacement to an MD who has NOT opted out, can't I be reimbursed that amount? The 'overage' is between me and my MD.

I thought it was worth a try. (sigh)

    Bookmark   November 4, 2008 at 10:39AM
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chisue, I feel your pain. Our government has decided if a doctor decides not to accept Medicare's payment, they will be penalized as will the patient. Its unbelievable but true. The doctor has no say in this at all and can be charged with Medicare abuse if they filed a claim. Medicare does not want people to choose their doctors. They want all or nothing. They punish the patient by not allowing them to get reimbursed, even for a partial amount. You have paid into Medicare for many years, yet you have no say as to how you choose to use it.

The doctor is in a worse position. He cannot treat a Medicare patient and accept their small payment and ask the patient to pay the balance. Most people don't realize that Medicare does not allow doctors to set their own fees. They must accept what Medicare dictates or they can be charged with insurance fraud. They do not permit doctors to allow patients to pay what they can afford. If Medicare allows $60.00 for a visit and pay 50% of that visit, the doctor must collect the other 50% from the patient. He cannot accept just the 50% Medicare pays. He can be charged with insurance fraud for not collecting the balance due from the patient.

You will not collect one dime from Medicare. The doctor is not permitted to file a claim for you or he could go to jail. Lets just hope this new administration tries to correct the terrible injustices of our health-care system.

Glad you found a good surgeon,


    Bookmark   November 4, 2008 at 10:53PM
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Thanks, Jane. I'm resigned to hearing from Medicare that they won't reimburse me a thin dime.

It took several calls to discover that *I* can file directly -- doesn't have to be an MD who files *for* me. So that's what I did, providing proof the operation took place, etc.

I wonder what it will take to oust insurance companies from dictating health care in this country.

    Bookmark   November 5, 2008 at 12:25PM
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by all means have him get some type of insurance, I was 36 when I had a bad m/c accident. Spent three weeks in the hospital with a few surgeries and the first explantion of benifits was around the 700k mark. Spent the next seven months in and out of the hospital with a total of 26 surgeries trying to save my leg, the last being my left below the knee amputation, Thank goodness I had insurance. At his age he might think he is bullet proof, or this will never happen to me, just as I did, but that way of thinking did not stop the distracted 20 y.o. from crossing the double yellow line and driving right into my leg.

    Bookmark   November 5, 2008 at 2:54PM
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Interesting explanation on the Medicare situation - though that was a little OT. It supports my opinion on one of the major things wrong with our healthcare system - it needs to function like other market driven businesses. People need to be able to choose healthcare providers and facilities based on quality and price depending on what is most important to them. And providers need to compete based on same. Our current government/insurance company/managed care ecosystem strongly discourages this.

In our capitalistic, free market economy providers and consumers alike are driven by their individual economic needs and desires. Physicians will find ways to make the income they desire - including not going into medicine at all - which is already happening in primary care. Both are also driven by quality but the current controlled system prevents and/or strongly discourages consumers from obtaining the best quality care - which is ultimately less expensive in the long run. And it does nothing to allow for "rewards" to providers or facilities that are highest quaility.

Consumers are told where they can go regardless of cost/quality and providers are paid the same no matter how competent they are. Private insurers follow the lead of Medicare so this is largely the work of government intervention into healthcare - something it seems many people would like to see more of. Be careful what you wish for as they say.

    Bookmark   November 6, 2008 at 2:21PM
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My son was in a motorcycle accident. A woman made an illegal uturn and he smacked nto the side of her car. nHe had no health insurance at all ( a typical situation seen in trauma centers).

He sued the woman for damages in order to get the money to pay for the hospital. Of course, that means that all our insiurance rates go up, niot that she shouldn't have been held responsible.

The hospital where I work is required to treat everyone who walks through the ER door. They lose a bundle on it.

Son #2 has catastrophic insurance. I hope he never has to test it. In the meantime, he goes without medical care.

I have excellent incurance. Every time I go to the doctor they order a barrel of tests, knowing they'll get paid. The whole system is nuts. I hope we soon see the day when having health insurance is not related to your employment and becomes affordable. I think then the quality of care we receive will go down. Sad, but true.

    Bookmark   November 6, 2008 at 6:00PM
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>>I think then the quality of care we receive will go down. Sad, but true.Actually, if you compare the US to other Western countries, we spend twice as much on healthcare, but our mortality is NO better, and in many instances, worse - infant mortality being one glaring example.

    Bookmark   November 6, 2008 at 10:13PM
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We have 'state-of-the-art' expensive end-of-life care -- every treatment and costly gizmo in the book and the MDs and techs to employ them, usually with no improvement to quality of life. THAT will cease.

But maybe we'll rise above third world countries in day-to-day and preventive care that does improve quality of life.

    Bookmark   November 7, 2008 at 10:52AM
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We're currently worse than third world countries in terms of day to day and preventive care? Which third world countries?

    Bookmark   November 7, 2008 at 1:57PM
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That is why we need Universal Health Insurance. Mr. President-elect, are you listening?

    Bookmark   November 10, 2008 at 7:59AM
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I'm sure Obama is listening; however, due to the Bush/Cheney off-balance sheet wars at a cost of $10+ billion per month, it is virtually impossible to quickly implement a full universal healthcare system. Expanding the children's preventive health programs, however, which were either reduced or in constant danger of being totally eliminated under the current administration, would be an excellent start.

It is political viable - remember the Democrats do NOT have a filibuster-proof majority in Congress - and relatively inexpensive for the positive gains it produces. It is ridiculous that this country does not cover the cost of the full range of immunizations needed by all children under 12.

    Bookmark   November 10, 2008 at 11:45AM
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tishtoshnm Zone 6/NM

There are many things that need to change with healthcare in this country some of which may be alleviated (or worsened) by government intervention. Another question would be though, how many of us are willing to make lifestyle changes that improves our chances of not developing costly chronic conditions. Are we ready to make our children eat better, exercise more, forego McDonald's, lose weight, etc.

One thing that Dh and I are evaluating is where we see things headed for healthcare. We are young, 30 ad 35 and he works for the state and as of right now would receive health coverage when he retires. However, we have no idea what the health coverage is going to look like 20 years from now and if we would be able to afford it. We are changing our habits so that we are less likely to need chronic medications, etc. There are some things that we cannot control, but those things that are within our control, we should start taking responsibility and change.

    Bookmark   November 10, 2008 at 1:34PM
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"we should start taking responsibility and change."

Some of us already do!

    Bookmark   November 10, 2008 at 1:58PM
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gibby, free markets don't work by themselves and in healthcare, they won't work.

If I have a stroke tomorrow, do you think I will be able to call around and find which doctor charges the least?

If I am hit by an automobile tomorrow, requiring immediate trauma care, how am I to determine which hospital I should go to to get the cheapest care or the best value?

Free market may work in choosing a primary care physician. However, it doesn't work if you need specialized care either immediately or in the near future.

How can anyone who is very sick find a suitable physician? Doesn't happen. Your primary care doc, if she is part of your care, will refer you to a specialist she is comfortable working with or referring to. She won't even know how much the specialist charges and why should she be expected to know or make a referral on that basis?

I speak to the above from experience. DH needed aftercare for MRSA after surgery. I was trying to find out how much it would cost in order to make a decision of where to get it. NO ONE COULD OR WOULD TELL ME. Not the clinic, not the hospital, not the doctor. They simply didn't know and couldn't predict. I spent 3 days trying to find out, going in person to business offices. DH, who was hospitalized, obviously couldn't do that. If I couldn't find out, how could he or any other person in similar circumstances?

You obviously don't have a clue what it's like to try to get health care for something other than a cold or you wouldn't be writing something so ridiculous as saying the free-market should determine how we purchase health care.

Free markets are something that works when you shop for a car. Not for health care that is needed immediately.

    Bookmark   November 12, 2008 at 11:37PM
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I also have a 26yo son that "refuses" to purchase health insurance. He also is not making a whole lot of income (delivering pizza - though he SHOULD be doing more with his life-long story). But when I mentioned the catastrophic to him (never heard of it till this board). He said - didn't need it. NJ has Charity Care. All he would have to do is show his pay stubs and he will qualify. I did look it up and apparently there is such a thing. (So I feel "a little" better). I'm still going to bug him about it because I know he needs a surgey that even when he gets insurance will have to wait until the intial wait period is over. But right now he's paying off his CC debt through a liquidation and tells me in Feb that will be through and then....

    Bookmark   November 23, 2008 at 7:55AM
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Good for him, then, that he at least researched the subject and has plans to deal with it! Good luck to you both going forward.

    Bookmark   November 23, 2008 at 11:33AM
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annie -- Boom! Your DS is in an accident. He needs extensive medical care. Who do you think is going to pay for it? Yes...YOU are!

So, buy a catastrophic coverage health policy *for* him. You are protecting yourself. (You don't even have to tell him about it.)

    Bookmark   November 23, 2008 at 12:27PM
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I didn't read all the replies, but it looks like you got some good advice.

A good high deductible, hospital and ER only, policy would be good. You can always make payments on the deductible part of the hospital bill.

I don't know about all states, but in Texas, your auto insurance policy has medical coverage as well.

    Bookmark   November 23, 2008 at 1:48PM
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"I don't know about all states, but in Texas, your auto insurance policy has medical coverage as well. "

Ah... but that isn't nearly enough.

A Med-Evac helicopter will run $15,000... which ate up my benefit.
Thank God I had health insurance when a hit-and-run driver left me between two trucks....

    Bookmark   November 23, 2008 at 4:37PM
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luann -- OW! When was that? Are you OK now?

    Bookmark   November 23, 2008 at 5:30PM
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It was in 1999 and I still have residual damage (memory, balance, still in therapy for neck/shoulder damage).

Healthy, good driver... and in a split second everything changed because someone did not want to wait for their green light at a busy intersection.

I would be hundreds of thousands of dollars in debt without insurance.

    Bookmark   November 23, 2008 at 8:57PM
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luann -- I suppose we're to say that's a 'good outcome'. I'm very sorry this happened to you. Did the eejit driver have any insurance, or should I ask if you were able to recoup and expenses from him/her?

    Bookmark   November 24, 2008 at 10:52AM
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hit and run... never got him/her.

    Bookmark   November 24, 2008 at 1:03PM
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No your auto insurance won't cover everything, but it will be something.

I wasn't suggesting anyone rely on it for their basic insurance, but be aware that you do have it - in addition to.

There are a lot of drivers on Texas streets and highways who do not have auto insurance at all - that's the main reason our insurance is as high as it is.

Although we have always had good health insurance, until Medicare, we get a higher limit on our auto insurance than is required by state law.

    Bookmark   November 24, 2008 at 1:19PM
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Right now, 'private' health insurance cost-shifts from the healthy to the unhealthy. That's the essence of a risk pool. I would like to see some splitting out of this risk pool into a group of folks that better maintains their own health and a group that doesn't. For example, to qualify for the We Be Healthy policy you would have to be a non-smoker (blood/urine test), and have a normal BMI. That's it. With those two yes/no criteria you would carve out the vast majority of the group of patients who are not personally responsible for their own health. I'm not even worried about blood pressure or cholesterol because those can both be under genetic control. Just keep it to what is under the individual's control. Don't smoke, eat right, get some exercise.

It's time for some finger pointing and the fingers need to point at the unhealthy, most of whom make themselves that way.

    Bookmark   November 24, 2008 at 3:37PM
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Hmmmm... define normal BMI.

I know many men - who are extremely physically fit - that have high BMI due to muscle mass.

Would they be "normal" under your "We Be Healthy policy"??
Or are they personally irresponsible for being physically fit?

    Bookmark   November 24, 2008 at 4:34PM
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I think we need to realize the importance of friendship and good family in times like these. I am lucky now that in a few days I will have health insurance for the first time. Although, if something was to happen to me, I have many good friends and a wonderful family who I know will take care of me, who won't let me live off the streets...

in our society, investing in frienship is an importance that goes unnotticed too many times. This investment, is in a sense, insurance of the greatest kind.

    Bookmark   March 5, 2011 at 2:30PM
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"I have many good friends and a wonderful family who I know will take care of me, who won't let me live off the streets...".

I think the best way to investing in friendship and the love for your family is to take care of your own needs such as purchasing your own health insurance, so that you will not be their burden, IF, you incur hundred and thousands, or may be millions dollars worth of medical bill.

    Bookmark   March 6, 2011 at 11:29PM
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I agree with Azmom. How can friends and family be the best insurance? Do you think they should pay for heart surgery, transplants, frankly any sort of surgery? They would be on the street along with you.

I'm afraid you are living in a fantasy. Sounds nice, but the reality is it won't pay your bills. Take care of yourself.


    Bookmark   March 7, 2011 at 11:19PM
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Greetings kitchenwitch,

Along with whatever other problems he'll/(he'd) have? ...

... (he'd)/he'll cry a lot.

ole joyful

    Bookmark   March 10, 2011 at 3:40PM
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Ghosh! It is really a sin to not to have any insurance in thios world when each one is having one. It is good to have Health Insurance because it will help you in the unexpected time when you are in the need of the money. Like if some one from your beloved has met with accident and you may not be having much finance to pay his/ her bills then this insurance companies will come to your rescue. Not only this, this is also good investment.

Here is a link that might be useful: Health Insurance

    Bookmark   March 11, 2011 at 3:51AM
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Brianclaudia, are you selling something? People who post with links the first day they register often are.

Back to the subject, what happens when you don't have insurance? Here's my brother's story, almost two years ago: Age 57, his job was greatly cut back due to the building trades recession, but the bosses talked him into not filing for unemployment and staying on the payroll (no benefits) for about 5-7 hours of work per week. Stupid brother thought it was more honorable to not collect unemployment and be eligible for COBRA, so he gradually depletes his retirement accounts (complete with penalties for early disbursements), and is working his way thru his savings. His mortgage on his condo is underwater and he owes more on his car than he can sell it for, and his credit cards aren't maxed out but pretty loaded, but he's holding out and living fairly frugally. He has about $42,000 in the bank from an inheritance.

He fell off a curb and broke his hip. Surgery for putting in a rod. After a week in the hospital, he's moved up to the rehab floor, puts $7000 on his credit card because the hospital demands that up front. If not, he'd be kicked out completely. After a week, he can move to a nursing home for rehab. They demand the money upfront for one month, which is $12,000 including physical therapy; he wrote a check from his savings. Before he left the hospital, the bill for hospital services (surgery and the first week, but not any doctor bills) was $70,000.

He eventually had another two weeks after the first month at rehab, (another $6K, paid from savings). Then he started getting the doctor bills, which were mainly for the ER and surgery.

So by this time, his savings is down about $20,000. He can't work, because the company completely folded, and he can't file for unemployment because for two years he had not worked the necessary hours to qualify.

He paid for some of the doctor bills from his savings. He lives about 600 miles from me, had no other family where he lived, the other two brothers live about 2000 miles in the other direction. He's not the most pleasant of people, and no one wants him to move in with them. He finally located an old friend back in the state close to the two brothers and moved in there. House was foreclosed, he lost his car pretty fast, went thru the rest of his savings before he could file bankruptcy.

Last I heard (he quit talking to me because he didn't want to hear what I would say), he was trying to get permanent SS disability.

That's what happens when you don't have insurance. No one has friends who will pony up $100,000 for hospital/doctor/rehab for you. You're delusional if you think that will happen. And yes, I guess he was taken in by an old friend in the end.

If he ever gets his disability (which requires an attorney because almost all disability claims are initially rejected) he'll have Medicare, and should be okay.

    Bookmark   March 11, 2011 at 10:20AM
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Late husband worked for a health insurance company, and that was the last time we had a health insurance benefit. When he left that job, we got catastrophic care insurance, with a huge deductible. We eventually opened HSAs as well.

Over the last ten years, each of us has had jobs that offered health insurance plans. We looked at the cost (to the employee) of those company plans, and the benefits, and restrictions imposed. We compared them to the cost of our current plans and benefits, (when you pay yourself, you chose who you want with no restrictions). The HSA balance creeps up over time, allowing more payments, (dental, doctor's office visits, optometrist exams,) on a schedule we controlled, instead of what the company plans would allow.

Employers have been hit hard the last few years, too. The workplace plans we were offered had higher premiums than our individual accounts with Unnamed Health Insurance Company, and were not of more value to us.

In spite of being a "catastrophic care" policy with a high deductible, It seems to be paying for things, or making partial payments for things, every time i turn around. Tick removed from back at walk-in facility: Paid half the bill. Prophylactic medication in case I was exposed to Lyme disease: I was stunned to have the couple bucks and change it cost. I asked the pharmacist "Isn't there a minimum dispensing fee?" Yes, she said, but the insurance covers it. If I hadn't had that policy, it would have been twenty dollars or so, for two pills. As it was, I paid less than three dollars out of pocket.

I'm actually quite happy with the situation I'm in: the fewer people sticking there noses into my health care (policy wonks in DC or that lady in personnel) the better I like it.

And it had no bearing on Poor Late Husband's demise: He had lung cancer, quite likely from his thirty eight years of smoking two packs a day. There were unusual circumstances that contributed to his sudden death only five weeks after diagnosis. No amount of chemo, surgery etc., would have saved him.

I had a cancer scare myself, actually less than three months after his passing. I asked a nurse what would happen if I had cancer, and my insurance didn't cover treatment. She said she didn't know how that worked, and she said the doctors and nurses take precautions to not know anything about the finances of patients. That way, she said, those with or without insurance are treated the same way while in the hospital.

I think it's stupid to go without insurance to have more money for lattes and cell phones, but I defend others' rights to spend the money they earn in a way that they find valuable.

As for people who "End up in the emergency room because they couldn't afford a doctor" I've personally known, lived near, worked with some of those people...and they abused the emergency room option so they wouldn't have to pay. I've heard them rationalize taking a child with an earache to the emergency room to avoid a $20 co-pay at the doctor's office, and the hassle of scheduling an appointment. Then in the next breath they griped that they had to wait so long to be seen.

    Bookmark   March 11, 2011 at 9:03PM
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Slightly OT:

A family I know is supported by the parent who works as a manager at McDonald's. She has five children, and a spouse. It's easy and trendy to revile big, money-making corporations, but sometimes folks forget that there are real human beings paying for their college education, learning to hold their first job, or supporting their families, serving us from behind those counters.

So, basically, she supports her family managing a restaurant that sells unhealthy food.

Her employer pays 100% of her health care premium.

The irony is delicious.

    Bookmark   March 12, 2011 at 6:37AM
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