Re: Paying for surgery when doctors don't accept insurance

[Guest guest]

The American insurance system needs a complete overhaul. There was an

interesting article in our local paper this week that said that not only do

Canadians pay less for health care than Americans do, but they are

healthier, too. The potential reasons provided in the Boston Globe article

are interesting: Canada's single-payer, universal health coverage system,

different ethnic mix, less use of illegal drugs, lower rate of fatalities

from guns, and a medical system that is tilted more toward primary-care

doctors than specialists.

http://www.boston.co.....s/2004/02/10/why_canadians_are_healthier/

I was lucky that my insurance company (I'm on an HMO plan) covered all but

$250 of the $10,000 cost of my myomectomy, which was performed in

September. The surgeon (Dr. Gaither) charged $3,100 for his services,

and my insurance company paid him $1,237, which was the maximum amount he

could get from them under his contract with them. The total cost of the

surgery (including the hospital's charges) was $10,564. If I had had to pay

several thousand dollars for the surgery, I would not have been able to

have the surgery when I did.

Cheryl

At 06:43 AM 2/14/2004 -0800, you wrote:

>IF you have a plan that covers (partially) your seeing a doctor who is

>out-of-plan, that also includes doctors who do not accept any

>insurance. Accepting insurance means that the doctor accepts whatever the

>insurance is willing to pay as full coverages. But any doctor's expenses

>will be partially covered by coverage that allows you to go out-of-plan.

[Guest guest]

I agree changes need to be made, but I don't believe the Canadian

system is perfect either. For example a women I know in Canada was

refused thyroid tests, even though her doctor ordered them. At least

here if we can convince a doctor to order a test, we can get it

done. And regarding less use of illegal drugs.....isn't pot use

legal in certain places in Canada now? That would drastically cut

the figure on illegal drug use. I'm not sure less specialty care and

more primary care is an answer either. A primary care doctor may

recommend hysterectomy, where an RE may recommend Myo, or an IR may

recommend UFE, etc. etc. If you can't get through to a specialist,

you're screwed. I've recently changed from an HMO to a PPO and so

far it seems like a good move. Maybe Americans would be happier with

more PPO type plans and less HMO type plans? I'm afraid a single-

payer, universal system would lead us to less choices in our

healthcare, definitely in procedures, and also in choices of drugs

where there is already a push to use generics to save costs. We

would save money yes, but would the overall improvement show up in

our health? Reminds me of the doctors who are pushing for tort

reform. Just takes one more right away from us, but does nothing to

improve our healthcare. Just my opinion..........

Gerri

[Guest guest]

Thanks ,

I wish I had known that GHI was the best payer in NYC because I had that

insurance for about 10 years until last year when I selected another insurancer.

I also have a government employer with the option of selecting many insurance

plans. I changed only because GHI only covers a certain geographic area, but

since I have decided on NYC, I wished that I would have not changed. Any way

I have chosen GEHA which is national plan but does not cover most of the fees

unlike GHI inclusively. Anyway I have another question for you. Did GHI

cover all of the hospital bills and any other doctors like anesthiologists even

if they were out of network. GEHA only covers 90% of in network and 70% of the

allowable limit for any doctor or procedure that is out of network. Did you

have your surgury at ST. 's? Thank you for the information, since I

need to have my fibroids out as soon as possible I do not have the luxury of

waiting again until open season.

[Guest guest]

yes Cheryle, God Bless OHIP, our health coverage in Canada, i had my surgery and

never once had to think of expenses..I ended up paying 5.00 for the phone in my

semi private room..

Its times like these i love being Canadian..

Cheryl Magadieu cmagadieu@...> wrote:

The American insurance system needs a complete overhaul. There was an

interesting article in our local paper this week that said that not only do

Canadians pay less for health care than Americans do, but they are

healthier, too