Brandon716
Senior Member
As many of you know, health care is the number one concern of mine domestically when speaking of national policy. I want to encourage Canadians to cherish the health care system, because if you are to lose it then it will be gone forever. Luckily I don't think that will ever happen, but it still is worth reinforcing the fact that universal care needs to remain truly universal and free of direct charge.
I don't like to bring too personal of issues into the public realm, but here is the reality of what "under-insured" means. Under-insured really is a term in the US that makes no sense, because I technically had enough coverage, they just refuse to pay based on insurance company opinion.
Here is an example of a rejection letter I got for payment of a service I received in February:
That is the reality of American health care. This is just a denial for the imaging, every other item was denied as well... I don't have any outstanding major health problems, I had a "good" PPO insurance policy from Highmark Blue Shield (a so-called non-profit private health insurance company in one of the largest national networks), and I only received this service after the doctor and his team verified I had insurance. If someone walked in without insurance, it is likely they would not have received the services I got unless they went to an ER instead. PPO plans are considered the gold standard and are far better than HMO's. You can walk into a specialist's office without a referral, like the HMO requires, as long as they are in the PPO's network coverage area.
Here is an explanation of the process: I received a rejection letter for payment at the end of March within a month of the procedure (it was completed in February) that I originally had to schedule in January, I filed an appeal the next day with the doctor I received help from. Their office forwarded with a fax all the relevant information to let Highmark Blue Shield know that it was not a pre-existing condition.
Instead the final appeal still came back with a denial and another form to do another appeal if I wanted... As if that would help.
As you can obviously see, this particular policy claims that they don't have to pay anything for the first 5 years of coverage. That means I pay them hundreds of dollars a month for 5 years before they are required to pay anything, they can reject any care based on a pre-existing condition clause REGARDLESS whether there is any validity to the cause.
I'm a middle class American by birth, I had health insurance, and since the insurance company denied payment I am going to get a collections for $2,100 out of this very simple procedure.
...and I have no major ongoing health problems or concerns. I feel terribly sorry for the working poor who have no insurance, and I feel for those with serious health conditions that require regular care. This post is in no way a pity party for myself, I'm healthy and fine (albeit with a huge collections bill coming my way). My anger is at the US health 'system' and those with more serious health concerns, like my mother who has diabetes.
This is the reality of American health care, and why its a crisis. This is not to mention those who have no insurance. And besides that, this is why Americans are sicker than our western peers: we are afraid to visit the doctor because we go bankrupt with endless bills that hit our credit reports when we seek care.
I was unable to go back for a follow-up visit as the doctor demanded payment before my checkup in May. While its not a major medical issue, it would have been nice to go for the followup.
I possibly wouldn't have been rejected if I had a corporate-backed plan, but I am an independent contractor and my policy isn't backed by a corporate or government job. Even still, certain care is denied under corporate or gov't backed plans.
Hopefully this helps give people insight as to the problems that lie south of the border and the slippery slope that is private care. Its too expensive and too anti-health even for the job holding middle class with health insurance coverage.
Canada needs to avoid this travesty at all costs.
I don't like to bring too personal of issues into the public realm, but here is the reality of what "under-insured" means. Under-insured really is a term in the US that makes no sense, because I technically had enough coverage, they just refuse to pay based on insurance company opinion.
Here is an example of a rejection letter I got for payment of a service I received in February:
That is the reality of American health care. This is just a denial for the imaging, every other item was denied as well... I don't have any outstanding major health problems, I had a "good" PPO insurance policy from Highmark Blue Shield (a so-called non-profit private health insurance company in one of the largest national networks), and I only received this service after the doctor and his team verified I had insurance. If someone walked in without insurance, it is likely they would not have received the services I got unless they went to an ER instead. PPO plans are considered the gold standard and are far better than HMO's. You can walk into a specialist's office without a referral, like the HMO requires, as long as they are in the PPO's network coverage area.
Here is an explanation of the process: I received a rejection letter for payment at the end of March within a month of the procedure (it was completed in February) that I originally had to schedule in January, I filed an appeal the next day with the doctor I received help from. Their office forwarded with a fax all the relevant information to let Highmark Blue Shield know that it was not a pre-existing condition.
Instead the final appeal still came back with a denial and another form to do another appeal if I wanted... As if that would help.
As you can obviously see, this particular policy claims that they don't have to pay anything for the first 5 years of coverage. That means I pay them hundreds of dollars a month for 5 years before they are required to pay anything, they can reject any care based on a pre-existing condition clause REGARDLESS whether there is any validity to the cause.
I'm a middle class American by birth, I had health insurance, and since the insurance company denied payment I am going to get a collections for $2,100 out of this very simple procedure.
...and I have no major ongoing health problems or concerns. I feel terribly sorry for the working poor who have no insurance, and I feel for those with serious health conditions that require regular care. This post is in no way a pity party for myself, I'm healthy and fine (albeit with a huge collections bill coming my way). My anger is at the US health 'system' and those with more serious health concerns, like my mother who has diabetes.
This is the reality of American health care, and why its a crisis. This is not to mention those who have no insurance. And besides that, this is why Americans are sicker than our western peers: we are afraid to visit the doctor because we go bankrupt with endless bills that hit our credit reports when we seek care.
I was unable to go back for a follow-up visit as the doctor demanded payment before my checkup in May. While its not a major medical issue, it would have been nice to go for the followup.
I possibly wouldn't have been rejected if I had a corporate-backed plan, but I am an independent contractor and my policy isn't backed by a corporate or government job. Even still, certain care is denied under corporate or gov't backed plans.
Hopefully this helps give people insight as to the problems that lie south of the border and the slippery slope that is private care. Its too expensive and too anti-health even for the job holding middle class with health insurance coverage.
Canada needs to avoid this travesty at all costs.
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