ARRRGGGGGHHHHHHH!!! HMO's SUCK!!!

[PaKettle]

I am going to rant about HMO's so feel free to ignore this thread if you don't want to hear my blow off some steam!

I am paying $554/ month for Pacificare Health Insurance for my wife and I. My employer contributes about $400 of that and I contribute the rest out of my own pocket.

So today I got to get my eyes checked for an eye allergy and infection and first of all I pay $30 for the appointment because it's a specialist. While that may be a lot less than the provider's usual fee, I still think it's too much considering I am paying $554/month for health insurance! But okay, so be it. That isn't the part that has me riled up.

So they give me not one but THREE prescriptions. I specifally asked for generic prescriptions and they told me they would give me the generic equivalent at the pharmacy.

First I go to the pharmacy and they don't have one of them so I have to turn in 2 of them and then go to another one a few miles away to get the 2nd one, then I get over there and have to wait 30 minutes.

I wait the 30 minutes, get my presription for my $10 generic med fee and then go back to the first pharmacy to get the other two.

I drive back, wait in line again and get up there and they tell me that one of the prescriptions, a very common antibiotic called Doxycycline is not covered by my insurance! I say, "Are you kidding me? Are you sure there's not some mistake? Doxycycline is not some new brand name designer drug, it's a common antibiotic that's been around for years and years! How could they not cover it?"

The manager comes over finally and looks over the paperwork. "No, your insurance does not cover this. It's $45."

I say, "So isn't there something else generic that will do the same thing?"

"I don't know. I can call your doctor and ask."
"Okay. Please do that for me."

She calls the doctor and the doctor is apparently gone for the day - there is no answer. I say, "Okay, fine, I'll take the other prescription and see what I can do about getting a cheaper version of this one, tomorrow."

So I get the other prescription and it, TOO, is not covered by the insurance! It is some kind of anti-allergy eye drops. I say, "There is no generic for this??"
"No."

At this point, I am so p*ssed, I feel like I'm being raped by the AMA, HMO, BIG PHARM and everyone else.

I don't want to fight on this one, I need to get medicine in my eyes tonight, so I pay the dang $40 for this one and decide to wait on the antibiotic tablets until tomorrow.

How is that I am paying $545/month for health insurance and yet that insurance does not cover the medicine I need for a common eye infection with allergy, and they would have me pay $125 OUT OF POCKET! :
$30 - doctor visit
$10 - prescription
$45 - prescription
$40 - prescription

This is outrageous in my opinion!

What the hell good is insurance at $545 a month if it doesn't even cover the medicine the doctor prescribes for you?!?!

So, to add a little more insanity to this story, get this:
The pharmacist calls me after I get home and says the doctor called her back and although the HMO will not pay for 20mg doxycycline, they WILL pay for 100mg doxycycline!

Yes, you read that correctly: they will pay for the higher dosage of doxycycline but not the lower dosage! Um, correct me if I'm wrong, but shouldn't MORE of a drug cost MORE, not less? So I guess I'll get the 100mg caps, take out 4/5 of them and take the amount originally prescribed....

Note: this is NOT the first time this type of thing has happened to me. Last year it happened over another medication, and that one there was no substitute for and I not only that but even to get it at $40 (the real cost was around $85), I had to get a special form from my doctor sent to the HMO first.

Go figure THAT one out: I remember saying to the lady on the phone at the HMO: 'Wait a minute: Let me get this straight. My doctor prescribed a medicine for me. But you will not cover it until you get a form from him verifying that he is prescribing it for me?? Isn't that what a prescription IS?????"

Man, I hate these danged HMO's. Health care in this country sucks!

I occassionally visit some other countries, and it is ALWAYS easier and cheaper to get treated in another country, and the care is just as good if not better. One time I was in the jungle in South America and I walked to a basic hut through the mud and when I got there, I did not wait, I was taken care of immediately, the doctor checked me out, prescribed antibiotics, gave me a shot, gave me a bottle of pills, and sent me on my way, all for $25. I was well in 48 hours from the bronchitis I had contracted on the flight down. Admittedly some health care in other countries is a little dicey; but at least you can always go to the pharmacy and get something for $10-20 that will most likely treat your illness, and usually the doctors there cost about $20-25 and their service is fine. The last guy I had in a foreign country charged me $25, no wait, and he spent about half an hour going over my health profile and wrote me 5 prescriptions for various things which I filled next door for 1/4 the price of here, even with insurance.

I hope everyone who reads this will see "Sicko" by Michael Moore.

Even if you did not like his other movies or disagree with his politics, you should see this because it exposes the HMO's for the uncaring, greedy b*st*rds that they are, more concerned about the bottom line than about helping anyone. And they let thousands of people die each year rather than give them the treatment they know they need. They actually train people to turn you down if you need expensive health care procedures.

[Minnymouth]

Understand perfectly "clear" where your coming from when it comes to the meds and what HMO's will pay for.......

They won't pay for a 1,000 mg pill (high cost) but you can take 2 - 500 mg pills of the same thing and they will pay for it.....
DUH, 2 pills instead of 1??? Big price difference for the 1 pill???

STUPID........

Yes, its time for our health care to be redone..... time for medicines to keep people well to be at a reasonable price. Not many folks can afford $140.00 for 4 prscriptions (can't spell) or even 3.

I had a stress test done recently (because both brothers have heart trouble)..... cost $2300.00????????? That much money to monitor me on a treadmill???? It's cheaper to "kick the bucket"!! At least I have insurance to bury me with....

Dr. told me we need to do this test and that test now that I'm older......... DUH, if it ain't broke.... don't mess with it!!! If it don't need fixin' - leave it alone.

Even with good insurance, the co-pay will break you up on a lot of these "unforseen tests" that doctors want to run....

I don't need blood work every 3 months..... nothing wrong with my blood, sugar, etc.... once a year should be sufficient.

I stay as far away as I can from doctor's offices. Mainly, because I wouldn't be able to make my house payment each month if I didn't. Even with good insurance!!! And low co-pays!!

I have asthma and allergies, but have learned to control it over the years by breathing excercises and avoiding things I'm allergic too...
If I bought all the meds they wanted me too use:
1. I would be broke.
2. I would feel like a "zombie" everyday of my life.
3. I couldn't pay for the roof over my head.

Don't get me wrong, there are some medical conditions that require certain meds. Diabetics would be in severe danger without their meds, etc..

But for everyday stuff..... including asthma, sinusitus, and allergies, I control what I take and how much of it I take. I know my body better than any doctor does.

The only thing I will take is antibiotics, within reason. The rest I use rest, fluids, and avoidance of what causes the problem.

Works for me! And I work everyday of my life, very seldom out sick and I'm terrible allergic to everyday stuff..... dust, cologne, air freshners, candles, soap powder, etc.

Medical care has gotten outrageous price wise. The average family cannot afford it without a medical card (which only sends the price higher).

If other countries can afford national healtcare, why can't we here in the USA? I can't see me spending $40.00 for 5 pills (thats my cost with a co-pay) that cost 7 cents each to make!!

I call it "population control" when it comes to the meds. If you can't afford it - you die!! People are refused treatment every day because they can't afford it. And they die! HOw better to control the population.

A one mile trip in an "transport ambulance" is over a $1,000. And thats them doing "nothing" - just transporting you. A little rediculous, don't you think?

Yeah, I'm venting................ but so are a bunch of other folks who find the cost of medical care "unbelievable"....

Okay, I'm thru "venting".....................

[HRx]

I never had any compliants using an HMO opposed to a PPO. Many of the issues can be attributed to the the particular insurance plan a company has for its employees. More and more companies are now only offering crappy---high-cost/low-benefits HMO plans as part of thier benefits package as a way of reducing thier operating costs.

Socialized Health Care is and has been a very effective system for many countries. But one of the major reasons it's idea isn't embraced in the United States is money! Paying for Socialized Health Care would drive taxes through the roof, and many people can't afford the current state/federal tax rates as they are now; and you can imagine how wealthy people would feel about paying a higher tax rate on thier monies! Another common school of thought about socializing health care would degrade the quality of care that would be rendered to people. The fear being that to much governmental control of reimbursements, etc., would result in a degradation in quality of patient care, processes, health systems, et cetera.

The concept of Socialized Health Care in the U.S. is a very interesting topic, and is definately a realistic, and implementable system in my opinion--despite some of the negative consequences of having it. Just like the rising cost of housing, and gas prices. People will just get used to the added expenses. lol

[woohoogirl]

I could go about this subject for hours. It ticks me off, that people must choose between eating and having meds. I have a monthly copay for a single injectible med that is $200, that's on top of all my others. When I was trying to stop the bankruptcy train from leaving the station, I quit taking taking the expensive meds. I regret that more than anything.

[my4devils]

We are right there with you this week. Three of my kids came down with bronchitis on Monday- 30 dollar co-pays, 20 dollar z-packs= 150 bucks dropped in less than an hour. Dont have an HMO but a crummy health plan that has gone downhill since my husband started with his company 8 years ago. We went from paying little to the plan every month and having nearly everything covered to paying a heck of a lot in and having little covered. Our co-pays have gone up substantially too. Our medical costs are another huge motivating factor behind our BK. We are even paying for immunizations now which just seems beyond ridiculous to me! Like PP's- I could go on for pages about this. I am just hoping that a new administration next year will seriously address our health care problems.

I hope that your eye problems clear soon without having to fork out more dough!

[robivi3]

I have honestly had AVmed for 21 years and zero problems. Complications with kids and pregnancy (wife), thyroid (wife), specialists for many things, operations, a dog attack, never had any issue. Numerous emergency room visits. My wife now Insures the kids and herself with her "Avmed Classic" with the State of Florida (her employer) and I have wonderful Avmed POS with my employer (also on the wifes), none of us needs refferals and the copays are 10 bucks on mine, $5 for Generic drugs, $10 for non. Hers are 25 bucks, somewhat higher. We changed to her Avmed Classic from mine because my cost was $5720.00 per year, hers is $2160.00 per year, I guess because of the number of employees insured through the State. My AvMed POS is $260.00 per year, the classic is free for the employee.

We also have made heavy use of the Heathcare Spending Accounts for the last 20 years. Last year I put in 2200.00 which covered eyeglasses and a few other things, this year I bopped it down to 1000.00 but will increase it next year.

The other four years I had Humana or Jackson Memorial Healthplan (EXCELLENT), JMH is tied to to the University of Miami and if you are real sick that is where you are going anyway, they never hesitated at the use of any technology, SUPERB.

[Bandit]

I am paying $554/ month for Pacificare Health Insurance for my wife and I. My employer contributes about $400 of that and I contribute the rest out of my own pocket.

That is not a bad price for two people.
If you want to be covered 100% for everything A-Z, you will need to pay about $800 a month for the two of you.
Well, that will just about cover you 100% if you have Blue Cross.

[Bandit]

It ticks me off, that people must choose between eating and having meds. .

Right. If you pay for insurance you will have no food...or they can only take half of what they really need.

If you actually get sick & miss work for very long, then you still have no insurance because the payment wont be there to keep the health plan active.

Someone(s) between congress & the blackhouse is not spending the peoples money correctly as the people continue to suffer.

[Bandit]

Someone was saying PPO is better than HMO?

[JollyGG]

Socialized Health Care is and has been a very effective system for many countries. But one of the major reasons it's idea isn't embraced in the United States is money! Paying for Socialized Health Care would drive taxes through the roof, and many people can't afford the current state/federal tax rates as they are now; and you can imagine how wealthy people would feel about paying a higher tax rate on thier monies! Another common school of thought about socializing health care would degrade the quality of care that would be rendered to people. The fear being that to much governmental control of reimbursements, etc., would result in a degradation in quality of patient care, processes, health systems, et cetera.

When people complain that it would raise taxes too much and be too expensive what they don't realize is they are already paying it.

Hospital and doctor costs are higher to pay for losses from those who can't pay, some of our taxes already pay for certain social health benifits for the poor, we already pay into social security, we pay for insurance premiums, our employers some of premiums, plus then we have copays and deductibale and uncovered expenses.

Once all of that is added up each person pays more for health care in this country than in any other country in the world.

[Bandit]

When people complain that it would raise taxes too much and be too expensive what they don't realize is they are already paying it.

Hospital and doctor costs are higher to pay for losses from those who can't pay, some of our taxes already pay for certain social health benifits for the poor, we already pay into social security, we pay for insurance premiums, our employers some of premiums, plus then we have copays and deductibale and uncovered expenses.

Once all of that is added up each person pays more for health care in this country than in any other country in the world.

That about sums it up. I know a Doctor in Canada who says all Canadians have healthcare coverage because the country has a plan that works. If you get injured you do not have to fear not being able to pay in Canada.

If they can do it, then the U>S> should have been a leader in doing it but our country is not doing much leading except for making a whole lot of enemies.

The only reason I can think of is due to greed of a few stingy slobs who wont be getting that extra insurance dollar if we have universal health care. They think we don't know what the doctors hospitals & insurance companies here are doing, but we know very well.

That was a good post, Jolly

[Penny Less]

Our insurance premiums would become the tax if we had socalized medicine so you would see a decrease if anything. Also, we'd have more protection and regulation which we need desperately. Other countries don't put up with this crap, why should we?

If I were to take all the medicine I'm supposed to take, including asthma inhalers, therapy appts for my hands, etc, including premiums I'd be paying a 120% income tax.

[robivi3]

I can't speak for all Canadians, only those that i met down here. Alot used to winter here, pricing has driven them away. I never heard anything good from those i knew about the healthcare system, most complaints surrounded wait times. Some seemed to think it better here, I never heard much in favor. It was never a main topic in conversation I have to admit, just stuff I heard. I knew an Italian girl back in the 80's who, in order to use Italy's socialized plan had to wait 18 months for root canal surgery. She did and had ten teeth done in one trip, the savings paid for the trip.

I think we would see a huge decrease in service overall. I mean do you think that ANY Government is going to "F" up as all Governements do and then do well at healthcare? I know alot of recent arrivals from Cuba, do you really think that they go into a lovely hospital for immediate treatment like we were shown on TV? I have friends who moved here from New Zealand, geeeez, I thought it was paradise, they tell another story. Does anyone really believe that Governement in the US is bearauecratic and officious and that Governement in Western Europe provides a clean, efficient system that utterly caters to the needs of everyone? You would have to believe that human nature changes because of a line on a map. The scumbag Russian mafia, inhabitants of that former Socialist paradise make me belive that that can't happen. there are alot of those mammals living in Plantation and I encounter them or their horrible, crude offspring whenever i get gas over by Best Buy or shop near there. Does anyone really want to become more of a slave? That is what Governement does, it sucks money and bearaucracy expands. I am certain that there are a million and one horror stories from those Socialized Institutions in Western Europe and Scandanavia. I have friends from Sweden and Ukraine, all socialist states, they came here, they don't want to leave. Spain, a socialist paradise from which i have many friends is a great example. One complained that on his last visit home he went to a public park, the Governement gives out free needles, so wonderful of them!!!! And it's great that the public parks are now owned by the junkies and EVERY family is touched by an overabundance of drugs. It was not that way before Government tried to "resolve" the problem.

We are ALL going to die, I will likley die within 25 years, I am 48. I may die tomorrow, God forbid. My mother died at 44 after two years with ovarian cancer. My stepmother drowned seven years later after driving her car off a boat ramp at Haulover. We all die, it is a short existance. I do not wish to be cradle to graved by the Governement. If you create another bearaucracy the way Mr. Bush did with the TSA and the Department of "FATHERLAND" Security (oh trust me, when it has nothing to do it will create enemies and go ahead and laugh but one of them will be some of you) you simply dig a deeper hole and place yourself under the Institutional eye of Governement even more. I am going to die, it is unavoidable, it may not be painless but even if forced to be without Insurance I will take my chances. And, lets be honest in many cases Governement does, AS IT SHOULD, provide for those who are unable to take care of themselves. I mean those who cannot in any way work or provide.

Sorry for the mispells, they are because of haste, need to start using word before i post.

[Bandit]

I knew an Italian girl back in the 80's who, in order to use Italy's socialized plan had to wait 18 months for root canal surgery. She did and had ten teeth done in one trip, the savings paid for the trip.

That is what has already happened here though. Once a person is denied health insurance from someone like BC/BS, & their medical bills cannot be paid, they are thrown into a state plan where there is most likely at least a one year wait time just to get into the plan. Kind of like a victim of society.

One of the root canals I just had done recently, there was absolutley no way I could waited 18 months as the pain and vicadin I had to take while they decided what would be best would have killed me as - in suicide. I swear I would have taken the whole bottle & prayed for death.

[PaKettle]

Understand perfectly "clear" where your coming from when it comes to the meds and what HMO's will pay for.......


....[edit]
I call it "population control" when it comes to the meds. If you can't afford it - you die!! People are refused treatment every day because they can't afford it. And they die! HOw better to control the population.

Thanks for venting, Minnymouth! Makes me feel better that I'm not the only one upset about this crap!

Thanks to all of you who replied. It feels better to know other people are having the same type of problems.

As to someone having said that the government running health care would be a fiasco, I ask you:
Could it really be that much worse? And doesn't the government run the post office pretty well? Some complain about it but if you've ever used postal services abroad, you know that our's is probably one of the top 3 in the world, especially considering the volume of mail they handle.

Granted, it would be a challenge to come up with a National Health Care system that works and is fair and doesn't kill us on taxes. But frankly I'd be happy to put my $6600/year into taxes instead of giving it to the HMO!

Minnymouth, as to your comment above about how it's "population control - if you can't afford it - you die!", this is a good place to further my rant and discuss what happened to my brother in law at Christmas.

He had been on Medicare but his Medicare doctor moved away so he no longer had a doctor to work with under the "Medicare" umbrella. So he was using my sister's doctor but paying cash for just office visits. He had an ongoing disease - Crohn's disease, and complications from it.

Well, he got constipated in December and nothing worked so he went to the local hospital. They gave him some bowel-moving meds and sent him home. Duh! He could have done as well going to the pharmacy, and he'd already been that route and it wasn't working.

So a couple weeks later he was doing really bad, couldn't eat, couldn't use the bathroom... so he went back to the hospital.

They said he needed to be admitted to the hospital but THERE WAS NOTHING THEY COULD DO FOR HIM THERE BECAUSE HE DID NOT HAVE A MEDICARE DOCTOR ASSIGNED TO HIM.

The reason he did not have a Medicare doctor assigned to him was because NO DOCTOR IN HIS TOWN WOULD TAKE ON A MEDICARE PATIENT because it takes too long for them to get paid.

He was sent to another hospital 60 miles away but by the time he got there it was too late. His elimination system had shut down and there was nothing they could do for him. He died at the age of 62 on Christmas Day because the original hospital he went to was not willing to treat him.

I don't tell you this for sympathy. What's done is done.

I tell you this because I want everyone to read this to know just HOW BAD IT IS! The doctor at the hospital where he died told my sister that the original hospital might have saved his life if they'd have treated him when he first went in instead of sending him away for lack of a Medicare doctor.

Is this acceptable for one of the richest and most powerful countries in the world?
It is better to spend billions on a war in Iraq, or to do something about our medical system so that people don't have to die for lack of proper care?