Health and Medical Insurance in Washington - Observations (Bellevue, Federal Way: transfer, camping)

[kavm]

Do Medical Insurance Plans Need to Cover Chiropractic Treatment?

Under the Affordable Care Act (ACA), all medical insurance plans must provide coverage for physical therapy. However, health insurance companies are not required to offer coverage for chiropractic treatment.

https://curative.com/blog/does-insur...-chiropractors

Some may cover it but it's a matter for the insurance plan rather than the state. Even when the chiropractic care is covered by the plan, it is active care and not the maintenance care.

I am not unsympathetic as I am paying a fair amount of money to someone who helps me with shoulder and neck issues with massage and exercises - while recovering from injuries and surgeries relating to fractures and other injuries from an accident. Insurance paid for the physical therapy but my therapist was much better than the official physical therapist and I am paying for her out-of-pocket (as her services were never covered). So, sometimes we just have to pay for what we need. Chiropractic care does run into issues and verifiable / repeatable evidence of success issues, so your experience isn't all that surprising.

[509]

Originally Posted by 87112

What about the rep of United Healthcare? This is my new Health plan, use to have Aetna.
I will say Aetna has great customer service, no clue if they reimburse well to either DR or patient.

I have United Healthcare.

Between United Healthcare and Confluence Health somebody was ripping off me and the taxpayers for $51. It was really a scam where they were overcharging all Medicare and retired Federal employees $51 on their annual physicals.

United Healthcare actually find the source of the problem, but the supervisor stopped the investigation.

I went to the state of Washington Insurance Office. They told me that since it was a Federal health plan, they had no jurisdiction and the Federal government made sure they could not review fraud in Federal Health plans.

I even talked to Inspector General for health care fraud in DC. They said, go back, and talk to United Healthcare again!! I told them it was not about the $51 dollars, but FRAUD of thousands of Federal employees over 65. They didn't care.

I did contact the consumer fraud division of the Attorney General's office in Washington state. They were willing to take it as a fraud case.

By that time it was time for other physical!! So I decided to go through with it and see how it got billed.

Surprise...they paid in full!

Then I found out that Trump signed the No Surprises Medical Act in 2020.

Basically, if the medical community is going to rip you off, they HAVE to tell you ahead of time.

In my case, my medical plan had a preferred provider network. Confluence Health, used TWO billing addresses one in network and one outside network.

For my annual physical, they billed United Healthcare from the out of network address and that resulted in the additional $51 obligation on my part.

I can imagine the response on my part and others when Confluence Health would have to say for the purpose of the physical you are out of network. Check next time, to see if your next appointment will be in network or out of network.

KEY POINT...it was perfectly legal. United HealthCare KNEW that the clinic was ripping off their customers and DID NOTHING.

BTW. The medical establishment is working hard to repeal the No Surprises Act.

Why is that NOT a surprise??

[MechAndy]

There are several groups that have no shame in fleecing Americans.
Big Pharma and the healthcare system are major offenders.
I honestly think that they can buy policy.
They have so much power that they are about impossible to fight.

Lots of people can say that they get free healthcare and medications (and I am one of them), the truth is that nothing is free.
Nobody has ever given me anything for free, I’ve had to earn it.

My union deducted $18. per hour from my total package to give me superb coverage.
In a perfect world $12. (2/3rds of that $18.) per hour would have been nicer going into another retirement account or something else that was mine with the remaining $6. for medical coverage.

I would love to see them loose their power.
Cropping their lobbyists abilities would be a good way to start.

[DallasYankee]

Originally Posted by Transmition

You're after coverage for a lot of different treatments that are not currently accepted by the wider medical community due to a shortage of things like "evidence they work". I don't know who told you that you needed all of them, but I guess they made bank while you were in Colorado. Given the number of crunchy woo people with money in this state, I'm equally surprised they aren't more commonly available, but I'm glad my insurance money isn't going into the pockets of every placebo seller. Higher standards don't make it abysmal, the shortage of qualified practitioners however leads a lot to be desired.

Thank you for your perspective.
Sports medicine which is available to all not only in Colorado but in many other states, encompasses myriad modalities many here think are just worthless and unproven but actually help athletes, the inured and older people to function at a higher level for longer. I happen to be one of those people and I know personally that "higher standards" do not mean limiting, restricting and denying access to alternative treatment options. These are not placebos, LOL!
While I lived in Colorado in 2021, I took an unexpected tumble down a flight of stairs. Shortly afterwards, I began to have sharp pain in my foot such that I couldn't walk hardly at all without sharp pain. Over the course of a few weeks, I received a cortisone shot in the ankle joint, followed by shockwave treatments (not covered by insurance but still allowed), PT which included dry needling in the abductor hallucis and effective exercises to keep the arch from losing its mobility again. (And the costs, compared to Washington's billing practices, were remarkably cheaper!)
One way to look at this question of access and treatment choices is to consider cancer. If you are unlucky enough to be struck down with a malignancy that here has few medically accepted care options, would you say, - Well, Washington insurance says no other options for further care exist, so I guess I'll just go ahead and die?
No, you would fight to receive whatever experimental treatments or trials were happening in other states. You wouldn't call it mumbo jumbo, then, would you?

[DallasYankee]

Originally Posted by Ruth4Truth

OP, health care providers in WA say BCBS is the worst, in terms of reimbursements. They take forever to reimburse, and they're miserly about it, when they do finally pay providers. Some Urgent Care facilities in Seattle flatly refuse to accept BCBS patients. Insurance companies in WA were forced to add acupuncture coverage by a mass patient lawsuit.

Ruth4Truth, I am not at all surprised. However, BCBS is the only PPO insurance plan my husband's current company offers, so we will have to make do!
As for acupuncture, I was not aware of a lawsuit that made insurance add it to allowed coverage.
I think acupuncturists are a big part of the problem here since they effectively banned easier access to dry needling by making it a law that only "certified acupuncturists" can administer this highly effective treatment for muscle pain. (Think trigger point therapy.)
Dry needling is a western sports medicine treatment originally rooted in acupuncture, but not often offered here today by eastern medicine practitioners. It has diverged into an option only for athletes and people with chronic conditions (such as me) for whom basic acupuncture, massage, and express 5-minute chiropractic treatments are just not enough.

[DallasYankee]

Originally Posted by rkcarguy

There is a reason WA scored 48th out of 50 states for its healthcare in a recent "Money" report.

I believe it,rkcarguy!
Washington also has the worst athletes in the various sports leagues, no indoor walking/running tracks (except at various YMCAs), no outdoor tracks for elite runners and many terrible gyms.
I definitely don't want to end up a senior citizen on Medicare here.

[DallasYankee]

Originally Posted by kavm

Do Medical Insurance Plans Need to Cover Chiropractic Treatment?

Under the Affordable Care Act (ACA), all medical insurance plans must provide coverage for physical therapy. However, health insurance companies are not required to offer coverage for chiropractic treatment.

https://curative.com/blog/does-insur...-chiropractors

Some may cover it but it's a matter for the insurance plan rather than the state. Even when the chiropractic care is covered by the plan, it is active care and not the maintenance care.

I am not unsympathetic as I am paying a fair amount of money to someone who helps me with shoulder and neck issues with massage and exercises - while recovering from injuries and surgeries relating to fractures and other injuries from an accident. Insurance paid for the physical therapy but my therapist was much better than the official physical therapist and I am paying for her out-of-pocket (as her services were never covered). So, sometimes we just have to pay for what we need. Chiropractic care does run into issues and verifiable / repeatable evidence of success issues, so your experience isn't all that surprising.

My plan is to first find the kind of sports medicine treatment I need, use whatever insurance benefits I have and then I will gladly pay cash to continue to receive the care I need to function at a higher level and remain active.
We can pay 100% if that's what it takes, and I won't complain about that - I just don't want the state of Washington to block access and tell me that because I live here (for now) that I am not entitled to alternative modalities!

[MechAndy]

The people I know that have had sports medicine treatments were given this care by those that also worked with sport teams.
One friend of mine in particular is a provider and will travel with pro teams to align them up when needed.
She also does freelance work.
I’m not recommending anyone but rather a way for you to possibly find the help you need.
You might look up who is serving the local pro teams and ask them for advice.
There are lots of people in the San Francisco area that offer this, up here probably not so much.

[87112]

Originally Posted by DallasYankee

I believe it,rkcarguy!
Washington also has the worst athletes in the various sports leagues, no indoor walking/running tracks (except at various YMCAs), no outdoor tracks for elite runners and many terrible gyms.
I definitely don't want to end up a senior citizen on Medicare here.

There was a good indoor running track at High line Athletic Club which is gone now. It was in Burien. That was a very underrated club. Many different levels to the club with steam sauna and pickleball and pool for a low price. I miss it.

[CalWorth]

Originally Posted by MechAndy

I hope the wife and I never get sick here on the Olympic Peninsula.
It’s one of the main reasons I keep a house in the Bay Area.

We get either free Kaiser or a PPO that would cost us $175 per month from my retirement contract.
That is a $2,100 difference per year I’d rather keep, especially since the health care here is not really the best.

I have heard that lots of doctors don’t want to work here because the money insurance (Medicare) offers them is just not enough, and there is a real lack of doctors here because of this.

It wasn't bad here until recent years. Private practitioners had to join one of the 3 groups or flounder. My very good PCP was getting ready to retire but that forced the issue, they probably would have practiced longer.. The Virginia Mason Clinic on 8th closed. Some MDs retired, some died. No one replaced them. My specialist has held on for years, to their credit. But they are retiring & there is no replacement.

I've been told by 2 individuals who know that if we exhibit cardiac symptoms, get in car & head south.