Tuesday, January 22, 2008

Health Care Open Thread

Vic asked for it, so here it is. I invite you to share your very own health/care/insurance nightmares. Mine is pretty simple. There isn't a single child and adolescent psych inpatient bed in Bibb County. Not one. I don't need them often, for my patients, but when I do-the child is really, really in crisis. I hate telling the family to head to Atlanta.


Lorie said...

I have a son w/ High Functioning Autism. Our private self insured policy began excluding it 4 years ago. Thus Katie Beckett/ Deeming Waiver for Medicaid. It took me three years to get qualified for services under Medicaid.

Why so long? Well, Georgia just can't seem to follow the Fed Regs. Hire the most connected people w/ the worst qualifications. And after three exhaustive years, we're on. Now in the typical Georgia tradition of wasting time and taxpayer's money, we (parents of special needs children) need to reapply EVERY YEAR. BTW, there are rules in the Fed Regs which state that if the condition is life lastening, annual renewals may be changed.

Okay bad enough. Nah, just getting started. Therapy clinics are starting to close it doors due to the CMO's not paying them. The hoops they have to jump through is ridiculous.

And third, even in Atlanta, I can't find therapists, pyschologists or doctors who take Medicaid. Ooops, I take that back. I can find them BUT they know absolutely nothing about autism.

I'm starting to boil. Gonna take a breather. I'm still seething that HB 549 is still in "committee".

Tina said...

My insurance problems have been fairly typical.

(1) when my schizophrenic daughter was still on my insurance, there was no "insurance parity" (and still isn't so far as I know). Mental health was covered at 80% and had other limitations. Since she was hospitalized a number of times, I got terribly in debt and it took me years to get out from under this financial burden.
(2) I have Medicare Part D prescription coverage and SHBP, State of GA, and still my out-of-pocket was over $1300 for medicine in 2007. For a 71-year-old I am pretty much a "well baby" with no really major disabilities. It must be awful for senior citizens who are really sick.

Amy Morton said...

And, let me just toss this in the mix. When patients do realize savings as a result of health insurance, the savings often come as a result of a negotiated rate with the provider-not because the insurance company pays the bill. And, not only do we accept a significantly capped fee in order to see patients in a particular network, getting claims paid is a royal pain in the you-know-what. Insurance companies set up artificial hurdles-like authorizations and time-sensitive treatment plans that, frankly, are meaningless in terms of quality of care for patients. I do a treatment plan for every patient, but if it's required for a particular insurance company, then it has to be on their form and sent in on their schedule, which is, of course different for every company. So, I give up a portion of the fee and pay the extra administrative overhead for compliance and still frequently don't get paid by the insurance company. And, you know what else? Most of the time, our contracts with the companies prevent us from even telling the patient that there is an unpaid balance. About three years ago, when I realized that I was getting paid less than 50% of the time for my Blue Cross patients, I opted out of that network. Now, if you have BCBS, and want to see me, you have to pay out of pocket. I am still in a few networks, but regularly I consider ditching it all, reducing my fees and not accepting any insurance at all. But, I hate to do that to my patients...

Open+Transparent said...

Lord bless you, Tina.

Caregivers are truly heroes. We need to go out of our way to show them the appreciation they deserve. Selflessness is an incredible virtue.

Tina said...

Thank you trackboy1 for your nice comment. Actually I am power-of-attorny for two 100% disabled people...the other is my 82 year old uncle. But, what are families for except to care for each other. Actually I want a Guiness Book of World Records for the longest drive without putting a vehicle in reverse. I drove a cargo van from mid-GA to 40 miles north of Chicago to get my uncle and his belongings after he had an auto accident up there. Then back to GA. Never put that van in reverse one time because I was scared to drive it backwards !!!
:-) He has a prescription plan with state of Illinois and his out-of-pocket was OVER $3,000 in 2007 !!

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