Re: An Update and Vent about Insurance

April 18, 2006

, I understand your frustration. Keep in mind that the insurance

company has to operate within it's guidelines as well. They can't blindly

pay for everything that people ask for and control their costs for policies.

If every policy holder submitted claims that met or exceeded the amount of

premiums paid in, it would take little time before the rates were raised or

the company went bankrupt.

Not to defend the insurance company, but we don't know exactly what

information the doctors office submitted for the pre-approval. It is highly

possible that a diagnosis code was omitted or that part of your medical

record was not submitted.

I'm sure that this will be taken care of reasonably soon. If your procedure

is truly medically necessary and within the scope of you policy I'm sure it

will be taken care of to your satisfaction.

Mike

>

> Sorry I did not update sooner. Life has been crazy and hectic along

> with being very painful. Here is the scoop: Thursday afternoon we

> came home after being out in town for appointments and stuff. In the

> mail was a rather large first class mail envelope addressed to me. I

> open it up to find a letter from my insurance company telling me

> that they have denied my surgery because they feel that it is not

> medically neccessary. I was extremely mad cuz my surgery was

> scheduled for the following monday (today). It took them almost 2

> weeks to send me a letter telling me they were denying it. My

> insurance tells me that if I choose to go ahead with the surgery we

> will be stuck with the bill cuz they are not gonna cover it. Talk

> about a slap in the face and yet more stress added onto my already

> stressed out pain ridden body.

April 18, 2006

Also, you can call your ins co and ask for a Case Manager to be assigned to you.

They are YOUR advocate for anything you need.

Tucson Kitty

Re: An Update and Vent about Insurance

, I understand your frustration.

a.. Visit your group " diabetes " on the web.

b..

April 18, 2006

I will never be able to understand for the life of me why a great nation

like the USA, spending billions everyday on a futile war, can't or won't

afford 'socialised' medicine which treats everyone equally and provides

healthcare free at the point of delivery. When I visit the States I am

advised to carry no less than $5 million of health insurance!! NO LESS THAN

There are anomalies in life and I understand that but the US healthcare

situation is beyond my comprehension. I have heard so many horror stories

of people who simply can't afford the medication, including diabetes

prescriptions, and have to suffer the consequences or go cap in hand to get

what they need. So now is reliant on the bureaucratic decision of a

faceless person behind a desk somewhere before she can get the care she

needs and deserves. <<sigh>> Wake up America it's the 21st century or

haven't you heard. I'm sorry, I know this doesn't help you situation

one little bit and I wish you good luck in getting the insurance company to

see sense so that you can get care you must have.

Take care. Barry UK

An Update and Vent about Insurance

> Sorry I did not update sooner. Life has been crazy and hectic along

> with being very painful. Here is the scoop: Thursday afternoon we

> came home after being out in town for appointments and stuff. In the

> mail was a rather large first class mail envelope addressed to me.

April 18, 2006

Why should that be necessary? I rest my case.

Take care. Barry UK

Re: An Update and Vent about Insurance

> Also, you can call your ins co and ask for a Case Manager to be assigned

to you. They are YOUR advocate for anything you need.

> Tucson Kitty

April 18, 2006

I agree, it shouldn't be necessary! When my husband had terminal kidney

cancer, you should have been around to listen to me try to convince the ins co

to allow him to see a specialist at MAYO CLINIC. Mayo was not a " provider " for

our insurance! Instead, they said we had to go to the University of Minnesota,

as they had a specialist. Minnesota only had a Renal Cell Carcinoma specialist

at 2 places, and we had to wait over 2 months to get an appointment at the U.

And we had a drive thru a snowstorm the day we went there, took us 5 hrs to

drive it. Between rain storms, tornadoes, sleet, blizzards, etc, we decided to

move to Tucson, AZ, where his elderly mom is, and the best part was they had a

specialist only 10 minutes away. Yup, you guessed it, by the time we got here, 3

months later, he had moved his practice north about 2 1/2 hrs drive, haha!

Anyway, I got a case manager, as the ins company was denying different things,

and it made it so much easier. We might have a great country to live in, but we

do have a strange health system for insurance.

Tucson Kitty

--- Original Message -----

From: Barry

To: diabetes

Sent: Tuesday, April 18, 2006 3:09 AM

Subject: Re: An Update and Vent about Insurance

Why should that be necessary? I rest my case.

Take care. Barry UK

a.. web.

b..

April 18, 2006

There could be a HUGE debate over why we do or dont have socialized

healthcare. I for one DO NOT WANT IT.

I would rather pay our insurance.

Angelia in OR

An Update and Vent about Insurance

>

>> Sorry I did not update sooner. Life has been crazy and hectic along

>> with being very painful. Here is the scoop: Thursday afternoon we

>> came home after being out in town for appointments and stuff. In the

>> mail was a rather large first class mail envelope addressed to me.

>

> Diabetes homepage: http://groups.yahoo.com/group/diabetes/

>

> To unsubscribe to this group, send an email to:

> diabetes-unsubscribe

> Hope you come back soon!

>

April 18, 2006

Hi Angelina,

Why would you not want socialized medicine, with care available for everyone?

With no hassles?

Ive lived in countries with socialized medicine all my life - New Zealand,

England and now Canada, and so I guess I would be biased, but I have to admit

that I feel so sorry for my us friends.

For example, I have a home based business and take a low salary - and my monthly

premiums are zero, we also have socialized prescriptions, and I do have to pay

$300 deductible per annum, but its all taken care of after that. And if there is

a prescription I need, and its not covered, a call from my doctor is all thats

needed to get what I need.

I am not trying to start a war, honest, but I dont understand why the us system

would be better?

An Update and Vent about Insurance

>

>> Sorry I did not update sooner. Life has been crazy and hectic along

>> with being very painful. Here is the scoop: Thursday afternoon we

>> came home after being out in town for appointments and stuff. In the

>> mail was a rather large first class mail envelope addressed to me.

>

> Diabetes homepage: http://groups.yahoo.com/group/diabetes/

>

> To unsubscribe to this group, send an email to:

> diabetes-unsubscribe

> Hope you come back soon!

>

April 18, 2006

" There could be a HUGE debate over why we do or dont have socialized

healthcare. I for one DO NOT WANT IT.

I would rather pay our insurance. "

Thank you!! As a tax payer I bristle at the " socialized " part of it. Socialism

is socialism. I don't intend to get into a debate but know that I feel very

strongly about this. Ask yourself why anyone's hard earned money should go

towards taking care of strangers.

Beverle

April 18, 2006

That's fine as long as you can afford it. But there are millions in the US

who can't and for some who are diabetic the consequences can be dire. I

have no right to debate this subject because I don't live in the US but as

far as healthcare is concerned I'm thankful to be living across the pond.

Take care. Barry UK

Re: An Update and Vent about Insurance

> There could be a HUGE debate over why we do or dont have socialized

> healthcare. I for one DO NOT WANT IT.

> I would rather pay our insurance.

April 18, 2006

I think that you're on a hiding to nothing with this .

Take care. Barry UK

Re: An Update and Vent about Insurance

> Hi Angelina,

>

> Why would you not want socialized medicine, with care available for

everyone? With no hassles?

April 18, 2006

I said I would never post to the list again, but I tend to agree that something

with coverage for everyone is better. There are over 60% of the people in the

U.S. that do not have insurance coverage because they cannot afford it, and that

amount is going up every year. My friend works for the State and cannot afford

insurance because he has to pay for it and for his mortgage and everything else.

As it is he works two jobs and cues round dances to earn money.

I am lucky in this state that they do have coverage for those who don't make

enough to afford insurance. I will be having surgery tomorrow for what they

suspect to be a fast growing cancer. It is all covered but my co-pay. One of

my friends had to have surgery 2 years ago and the hospital and doctors where

she was told she had to go would not accept the CICP (she works 2-4 hours a day

at about $6/hour). She was charged something like $50,000. She has been doing

her best to pay it, paying $20/month, but they have now sued her to have her pay

it all immediately. If they had not told her that it would be covered by CICP,

she probably would have died back then. If mine was not covered (by what would

be about like the socialized healthcare), I would not be able to afford the

surgery and would just have to wait until I died.

Darlene

Re: An Update and Vent about Insurance

There could be a HUGE debate over why we do or dont have socialized

healthcare. I for one DO NOT WANT IT.

I would rather pay our insurance.

Angelia in OR

April 18, 2006

Beverly, Your hard earned money is already paying for strangers health care. We

are paying all of our wonderful (haha) politicians insurance and all the people

on various welfare programs. We should all be so lucky as to have the same care

these two groups get.

Re: An Update and Vent about Insurance

" There could be a HUGE debate over why we do or dont have socialized

healthcare. I for one DO NOT WANT IT.

I would rather pay our insurance. "

Thank you!! As a tax payer I bristle at the " socialized " part of it.

Socialism is socialism. I don't intend to get into a debate but know that I

feel very strongly about this. Ask yourself why anyone's hard earned money

should go towards taking care of strangers.

Beverle

April 18, 2006

" Beverly, Your hard earned money is already paying for strangers health care. We

are paying all of our wonderful (haha) politicians insurance and all the people

on various welfare programs. We should all be so lucky as to have the same care

these two groups get. "

So true, so true! When others are not responsible for their own care they soon

relinquish all responsibility and rely on " Nanny " for their needs. Much to

their own detriment! Along with socialized medicine will come enforced

medications and vaccinations. I will take care of myself, thank you very much!

Bev

April 18, 2006

i have a sister who is mentally retarded and emotionally disturbed thanks to

the great dysfunctional family we grew up in. None of this is her fault yet

because she can not take care of herself and believe me she has tried she

doesnt deserve the human dignity of medical care? I hope you dont consider

yourself Christian.

sharon

Re: An Update and Vent about Insurance

" Beverly, Your hard earned money is already paying for strangers health

care. We are paying all of our wonderful (haha) politicians insurance and

all the people on various welfare programs. We should all be so lucky as to

have the same care these two groups get. "

So true, so true! When others are not responsible for their own care they

soon relinquish all responsibility and rely on " Nanny " for their needs.

Much to their own detriment! Along with socialized medicine will come

enforced medications and vaccinations. I will take care of myself, thank

you very much!

Bev

April 18, 2006

I don't want to get wound up in a big debate here, and will withdraw if this

turns into that.

However, I cannot resist inserting a bit of my prejudice in regards to

socialism, medical care, and insurance in general.

I am old enough to recall as a young father and bread-winner that I had no

insurance at all, and had to pay the entire cost of medical procedures out of my

own pocket.

My first 5 children cost about $600 US EACH for the doctor's prenatal care AND

hospital costs associated with the delivery.... About a month's pay back in

those days.

Which meant that, within a few months or at most a year, I could pay off the

entire cost, and did, myself.

When Baby Number 6 came, by then I had a " good " job with insurance including

medical benefits. I was shocked to find that my DEDUCTIBLE portion of the

insurance, the co-pay, was around $800, or more than the ENTIRE cost had been

prior to my gaining insurance. At the time I thought " Thank goodness for

Insurance, or I wouldn't have been able to deal with the inflated medical

costs " . Over the years since then, I realized had I paid for the last child out

of my own pocket, without all the insurance paperwork for the doctor and

hospital, etc, it wouldn't have cost much more than my deductible portion did.

When it's " someone else's money " , whether via government program or insurance,

the costs tend to spiral higher and higher, because the " group " doesn't seem to

be as sensitive to higher costs as individuals are.

I'm now convinced insurance is the problem, not the solution. Back in the " old

days " when only a select few had insurance, it was a " good deal " .... for the

FEW.

But, if EVERYONE is insured, what is the benefit? As I view it, insurance is

now just a very large layer of bureacracy between me and my medical provider.

Insurance (or government largesse program) can serve a beneficial purpose, but

in my mind it should only provide coverage for disastrous things such as cancer

etc. that would bankrupt normal individuals.

Making the decisions about who gets what, who deserves to live at what level of

comfort, is the difficult part. It is difficult for individuals and families to

deal with, and tends to become officious and without feeling when from " on high "

from some government or insurance bureaucrat.

Jim

Re: An Update and Vent about Insurance

" Beverly, Your hard earned money is already paying for strangers health care. We

are paying all of our wonderful (haha) politicians insurance and all the people

on various welfare programs. We should all be so lucky as to have the same care

these two groups get. "

So true, so true! When others are not responsible for their own care they soon

relinquish all responsibility and rely on " Nanny " for their needs. Much to

their own detriment! Along with socialized medicine will come enforced

medications and vaccinations. I will take care of myself, thank you very much!

Bev

April 18, 2006

Shar- I am a Christian but you'll have to admit there are alot of freeloaders

out there. Sure there are alot of people iut there that need help and the ones

that really need it should get the help thet need. But our congressmae and women

and other high government officials make enough money off of us taxpayers but we

still pay for there healthcare and don't have to worry about sparing any

expense. Those who work hard and still can't afford insurance should get help.

All I was saying was that we are paying for alot of strangers so why not

everybody having the same. Waht's good for our big shots should be good enough

for us all. Right now my insurance and my husband's take his whole social

security check. We would love to have this money to spend elsewhere. I don't

know if socialized medicine would be good for this country or not but in some

ways we already have it, the top and the bottom, those of us in the middle are

the ones that are affected the most. I just wanted to point out that we already

pay for strangers health care, I didn't say it was wrong.

Re: An Update and Vent about Insurance

" Beverly, Your hard earned money is already paying for strangers health

care. We are paying all of our wonderful (haha) politicians insurance and

all the people on various welfare programs. We should all be so lucky as to

have the same care these two groups get. "

So true, so true! When others are not responsible for their own care they

soon relinquish all responsibility and rely on " Nanny " for their needs.

Much to their own detriment! Along with socialized medicine will come

enforced medications and vaccinations. I will take care of myself, thank

you very much!

Bev

April 18, 2006

And Christian principles should not be MANDATED through taxation. Christianity

is VOLUNTARY or it isn't Christianity.

Taking money, with force, from someone to pay for someone else's medical care,

is not a Christian principle, but it is what taxation and public benefits are

all about.