Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
No, the choice for getting insurance through the bar association is still available, but it would mean completing a new application, getting another physical, and being approved by underwriting -- all of which took almost 5 months last time. That's a small amount of aggravation to go through IF I'd end up saving some money each month for equivalent coverage, but that's the difficulty -- comparing the two coverages and deciding which is best.
The bar association insurance is high-deductible ($5K or $10K, your choice), catastrophic-type coverage, while the insurance through my husband's former employer has a low deductible and covers 100% of preventive care and 70% of most other medical expenses. It's difficult for me to evaluate which is the best value for the money, when the premiums are not significantly different.
How does the co-pay provision in your husband's policy compare with the one in the policy offered by the Bar? Is there a maximum annual co-pay? I think that's important - especially because a 30% co-pay (the one in your husband's policy) - is pretty high to start with. And are either or both of these plans PPO type plans? If so - how do they work in terms of reimbursement if you go out-of network - and what do the networks look like? Any unusual exclusions/limitations in either policy (like a $25k limit on transplant operations - I've seen those before). Those are the things I'd look at in terms of comparing the policies.
Note that our Bar policy is an excess policy over our primary policies. It provides about $2 million in coverage for almost everything in excess of $25k out of pocket expenses (deductibles - co-pays - etc.) over a rolling 3 year period. My husband is on Medicare now - but my primary policy has a $10k deductible and a 20% co-pay up to a max of $3k/year. It's a PPO policy - usually 20% co-pay in network - 40% co-pay out of network. The network is excellent - e.g., covers Mayo here - Mayo in Rochester - MD Anderson - etc. Luckily we don't need places like these that often - but it's good to know we have access to top quality care if and when we need it. Robyn
What do you want to bet - a public apology for calling me a liar?
I've been writing up my hotel stays for years on Flyertalk. Here's a thread where I discussed the Four Seasons Marunouchi in Tokyo (I am robyng there - 2 messages - one on 4/13 and 4/17):
And you can look up what I said about the Ritz Carlton in Osaka - the Granvia in Kyoto - the Ritz Carlton in Berlin - the Mandarin Oriental in Munich - the Grandhotel Schloss Bensberg in Cologne - the Four Seasons George V in Paris - etc. (I'm pretty sure I wrote up all those places - might have missed one). Or I could link you to my restaurant reviews on another chatboard - but that would be beating a dead horse. Robyn
I believe you got these opinions. I also believe that people would rather complain than praise in surveys. Did you ever ask them if they would prefer another health care system like the US? Even if they were not happy with their health care plans, I doubt if they would want to come to the US and have no health care plan.
Regarding the people I know who live outside the US, through the years we have discussed the health care system (if you could even call it that) in the US and all agreed that they would be very, very nervous about their medical care being contingent upon being able to remain employed.
And none of them felt our medical care was any better than the care they could get where they were.
Regarding the two line situation in other countries, I guess I would rather wait two or three years for a hip replacement than know I could never have one at all. Ironically enough, that happened to a friend of mine who suffered from a congenital problem and needed one. She was self-employed and could not afford the cost of the surgery. I think two years would have been a small price to pay for her to wait knowing someday she could have it.
After many years of suffering, she was finally able to get some state assistance for the surgery. But that wasn't until she was in her forties. So under the American system she had to wait 40 plus years to have the problem taken care of as opposed to two in one of the systems to which you referred. It's really all in the perspective.
But you know, when we talk about other systems that may not be perfect, we can learn from them as to what not to do while creating one of our own. If Spain or France have a top notch medical care system why not look to them to see how they do it? Why look to the countries where the system isn't as good as it could be?
I never bought into the idea that just because a health care system doesn't work perfectly somewhere else, either it or an improved version of it, might work here.
...So, yes, I certainly did do something about the fraud when I found it. Ironically with the coming of computers in the 70's it became more difficult to catch these crooks. I don't know if anything is done about fraud today. I haven't been in the claims paying business for about ten years...
Good work .
Yes - there is some stuff being done about fraud today. Most of what I read is about Medicare fraud cases. Many are criminal - some involve tens of millions of dollars. Some involve doctors - some don't. There are now organized crime rings that specialize in Medicare fraud. They figure it's easier and safer than dealing drugs. This is the kind of thing I'm talking about:
I think we could do a lot more. I've read some guesstimates that Medicare is spending perhaps 1 out of every 4-6 dollars on totally fraudulent claims. A lot of these claims are for durable medical equipment. These aren't cases that involve unnecessary things. They're cases where claims are totally phony (like one crime ring was uncovered when a Medicare recipient with 2 perfectly fine legs found out Medicare had been billed under his account for a prosthetic leg).
Before we start to cut benefits drastically - let's make an effort to get as much fraud as possible out of the system. And let's allow the press to do its job too (when the WSJ - which writes quite a few articles on this issue - tries to get into Medicare records to find fraud - it is unable to find out the names of providers whose billing records look very questionable on their face due to some privacy act statutes or the like). Robyn
Yes - there is some stuff being done about fraud today. Most of what I read is about Medicare fraud cases. Many are criminal - some involve tens of millions of dollars. Some involve doctors - some don't. There are now organized crime rings that specialize in Medicare fraud. They figure it's easier and safer than dealing drugs. This is the kind of thing I'm talking about:
I think we could do a lot more. I've read some guesstimates that Medicare is spending perhaps 1 out of every 4-6 dollars on totally fraudulent claims. A lot of these claims are for durable medical equipment. These aren't cases that involve unnecessary things. They're cases where claims are totally phony (like one crime ring was uncovered when a Medicare recipient with 2 perfectly fine legs found out Medicare had been billed under his account for a prosthetic leg).
Before we start to cut benefits drastically - let's make an effort to get as much fraud as possible out of the system. And let's allow the press to do its job too (when the WSJ - which writes quite a few articles on this issue - tries to get into Medicare records to find fraud - it is unable to find out the names of providers whose billing records look very questionable on their face due to some privacy act statutes or the like). Robyn
Robyn on this we agree! People can help just by checking their bills and keeping track of all services rendered. Most people don't think about it and just trust the billing departments to do everything correctly. The person who goes over his or her grocery cash register reciept with a fine tooth comb normally does not think of checking charges on medical bills.
I believe you got these opinions. I also believe that people would rather complain than praise in surveys. Did you ever ask them if they would prefer another health care system like the US? Even if they were not happy with their health care plans, I doubt if they would want to come to the US and have no health care plan.
Regarding the people I know who live outside the US, through the years we have discussed the health care system (if you could even call it that) in the US and all agreed that they would be very, very nervous about their medical care being contingent upon being able to remain employed.
And none of them felt our medical care was any better than the care they could get where they were.
Regarding the two line situation in other countries, I guess I would rather wait two or three years for a hip replacement than know I could never have one at all. Ironically enough, that happened to a friend of mine who suffered from a congenital problem and needed one. She was self-employed and could not afford the cost of the surgery. I think two years would have been a small price to pay for her to wait knowing someday she could have it.
After many years of suffering, she was finally able to get some state assistance for the surgery. But that wasn't until she was in her forties. So under the American system she had to wait 40 plus years to have the problem taken care of as opposed to two in one of the systems to which you referred. It's really all in the perspective.
But you know, when we talk about other systems that may not be perfect, we can learn from them as to what not to do while creating one of our own. If Spain or France have a top notch medical care system why not look to them to see how they do it? Why look to the countries where the system isn't as good as it could be?
I never bought into the idea that just because a health care system doesn't work perfectly somewhere else, either it or an improved version of it, might work here.
I've spoken with lots of different kinds of people. They ranged from US citizens married to citizens of other countries who come back home for major medical needs to a cab-driver in Paris with 4 kids who complained that he couldn't afford to pay the new higher co-pays required under the French system for routine medical care. Then there are people who are ok with their health care systems for routine medical care - but unhappy when something more than routine care is necessary (this is a common complaint we hear when we speak to people from Canada). And people who have come to terms with their systems - which sometimes (but don't always) offer decent primary care for everyone (not necessarily at a cost everyone can afford easily) - but offer little in the type of high tech care for serious conditions - the care most Americans think all Americans are entitled to.
And - of course - there are people who prefer the systems in their own countries - and those who prefer the system in the US (the latter being mostly older people who like the way our Medicare system works - you can actually get a total knee when you're 90 - like my aunt just did - and not wait in line until you're dead). I could go on - but I think you get the point.
On my part - I have a few ideas about how our system should change. We have to get away from employer-based insurance. We need a single national health insurance system where everyone has to pay into the system. No ability to opt-out and pay a small fine (the Massachusetts system - which clearly doesn't work). No more Medicare. There should be different levels of coverage available (like maybe you don't want to be kept alive if you have to have x, y, z - and you can opt out of a more expensive plan that provides x, y or z). And people and providers should also have the right to 100% private medical relationships outside the system.
Premiums should be sound from an actuarial POV - and based on age and gender (both of which influence the amounts spent on medical care). Perhaps adjusted a bit so younger people pay a bit more than they should - and really old people a bit less - but perhaps not. I'd have to take a look at the numbers before I reached a final decision on that one. Perhaps geographical location too. Since Miami is the Medicare fraud capital of the US - Medigap policies cost almost 40% more down there than up here in North Florida.
No hospital or health care provider should have any legal obligation to treat anyone who isn't in this country legally - or anyone who cheats and doesn't pay for insurance - even to stabilize them.
And some more expensive medical care that doesn't make a whole lot of sense medically in terms of cost versus how long it extends life and/or improves quality of life - or extends a life that isn't worth extending - whether the life is that of a totally screwed up infant or a 90 year old who is totally out of it with Alzheimer's - wouldn't be covered at all (although people would be free to pay for it out of their own pocket). And if doing away with medical care like that doesn't cut costs enough - then we will have to ration other types of care - for things like hip transplants - and create waiting lines.
Now plans under something like this are going to be expensive - even for relatively young healthy people. So some people are going to need subsidies. Who do we as taxpayers subsidize - and how do we subsidize them? I think people should pay full freight if they can afford to. My husband and I can afford to pay for Medicare without any taxpayer subsidy - and would pay that premium. But I don't want to pay more in an insurance premium than the next guy to subsidize someone else simply because I can afford to. I think everyone who lives in this country and can afford to pay something has to be included in the discussion of who pays what and for whom (and it can't be only federal taxpayers - since fewer than 50% of all Americans are federal taxpayers these days).
That gets into a lot of political issues I don't want to discuss here. Suffice it to say that in a country like France - the large mostly legal immigrant population that tends to have no or low paying jobs and lots of kids has resulted in some nasty politics with a lot of racial overtones when it comes to all issues - including medical care issues. If you don't know what I'm talking about - google Marine Le Pen and the National Front Party. All is not fun and games in France these days. When we in France a couple of years ago - some upper middle class people we know - they're professionals - well off but certainly not rich (the kind of people who tend to have 1-2 kids in France) - were violently opposed to paying taxes to subsidize the health care of immigrant families who were having 4+ kids. OTOH - we met another friend in Berlin Germany. She's from Australia - and her husband is from India. Neither is a German citizen (and they never will be - because it's almost impossible for immigrants to become German citizens). These are also upper middle class people - and they only have 1 child. But the husband has very serious health issues (he's a transplant patient) - and the wife is a juvenile diabetic. She hates India and wouldn't move there - he couldn't get a job in Australia (he's a college professor in an esoteric area - she's a language expert who translates things like legal documents from Japanese to English and German - she could work anywhere). And the US is out of the question because they're both uninsurable. So Germany is fine for them because all their very expensive medical care is subsidized by German taxpayers. So they love living in Germany. On the third hand - we got got together with another friend in Munich Germany - a native German - and he very much opposes subsidizing the health care costs of people like our friends in Berlin - even though they are far from deadbeats.
In short - I think it's more than a little facile to say that everyone is happy with these health care systems. And if you want a real earful about health care systems - keep an eye on the UK tabloids. Some real horror stories there about the National Health System. Robyn
P.S. I met most of these people on food and travel message boards. It's a great way to "meet" people from other countries - and other parts of one's own country. What's the point of travel if you don't meet people? And - by working on different kinds of message boards - you can find people who share your interests (enjoying good food is an easy thing to have in common). And I always plan our overseas trips about a year in advance. I plan the trips - and my husband studies languages. He is fluent in Spanish - I speak Spanish ok too - and we can brush up on that when we go to Miami. But he also learned enough Japanese - German - French - Italian to get by when we visited the countries where those languages are spoken.
Robyn on this we agree! People can help just by checking their bills and keeping track of all services rendered. Most people don't think about it and just trust the billing departments to do everything correctly. The person who goes over his or her grocery cash register reciept with a fine tooth comb normally does not think of checking charges on medical bills.
Everyone needs to take this responsibility.
Agree 100%. I remember maybe 15 years ago - my father questioned something on his Medicare statement (bill for non-existent services). He spent a lot of hours trying to make a complaint - but no one listened. That is totally unacceptable today IMO. Robyn
With the billig being code by illnesss type and a ceertain amount paid for that treatment ;it isn't like the old days of separate billing. Even private insurance does it by code on treatment.Any additonal treatemnt is alos code so the price is fixed as to what is paid.
We are self employed and insurance is our biggest headache as we won't be ready for Medicare for 6 more years. Our Bl cross/ Bl Sheild runs around $5,500 a year and covers nothing with a huge deductable.
My current employer will give me insurance at the going rate for the group. Since the company is Coventry and since that company has a national operation, I can move north and stil get the same service. Coventry has a deal for retired folk that alloows a $1000 deductible, which if you have the resources for every day health care then this reduces the premium for two by about $300 a month. Additionally since I am old, and my defined benefit pension will give me $100 a month to help with health care. When you look at what is not being taken out of my pay check anymore since none of it is earned income, the former deductibles are will pay for the health insurance. But this is temporary. In three years I will qualify for medicare and then my insurance costs will drop again, and in three years after than my wife will be eligible for medicare and the expense will again drop. In the middle there, my wife will be able to get a small SS pension, so income will rise again for us at that time.
We figure that we are good to go until I am at least 76. After that, we may have a small or large inheritance(depending on how long my 82-90 year old inlaws hang on to life) which might cover some issues.
Were not really worried.
But then.... we planned for all this back when we were in our carefree 20's, before we had kids, and when most people don't think about retirement 40 years away at all. I know that neither of my kids are thinking about their retirement and one is 31. She will find that its upon her before she notices.
We are self employed and insurance is our biggest headache as we won't be ready for Medicare for 6 more years. Our Bl cross/ Bl Sheild runs around $5,500 a year and covers nothing with a huge deductable.
That's pretty good. My health insurance before medicare kicks in with a $1000 deductible is about $11,000 for 2.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
