Who hasn't been scrued over by healthcare providers?

Question

I've heard many horror stories about health care providers making up false excuses NOT to cover expensive operations and as a result many people have died. The Ceo's of these providers receive bonuses for the more claims they turn down. Has anyone had a MAJOR opperation covered without a fight? Other countries have free healthcare. Would this solve the problem? Do you think if we end up getting that benefit too, operations would not be denied or would the Government deny them bc they are paying for them?

I am talking about health care INSURANCE providers (sorry forgot to include Insurance). If anyone is from Canada or a Country w/ free health care let us know if they turn down your needs as well. Do they find excuses not to provide certain care (operations etc.)???

Answer 1

Everyone I know in the USA seems to have a story about their health insurance letting them down... it's pretty scary.

But the other countries with free health care (ie tax funded) have problems too- I live in England right now and there are certain drugs you can't even get here because they are not cost efficient- the national health service doesnt buy them. Some incidents of this have gotten a lot of press recently, but I wonder how many others slip through the net without us even knowing. Also, there are problems with waiting lists, and certain parts of the country getting more funding and therefore offer more services than others (they call it the postcode lottery). In theory, we would never be denied anything we needed, but it's really up to a doctor to decide and because we aren't paying them, we dont have that bargaining power (ie if a doctor doesnt take you seriously, it's a bit of a struggle to get what you want- you aren't a customer) But nothing that's obviously necessary would be denied to you because of a technicality, or the way you filled out a form (we never have to fill out any forms) so that's something- also, you can buy supplementary private health insurance to skip waiting lists and get extra non-essential treatments.

It's frustrating to know that there are drugs/treatments in other countries we wouldnt be able to get here, but I suppose it's even more frustrating to know that there are drugs/treatments that a doctor in your own hospital can give you, but wont.

Both systems cost people a lot of money (either through insurance or tax) and both result in cerain people being denied... I wish I had the answer, but it seems health care is just too expensive to go round...

EDIT: re what a previous poster said, I find it strange that people in the US get so worried about losing the right to choose doctors- in Europe, you can choose any family doctor in your cachment area, as long as there is availability, and you're allowed to change doctors in the hospital if you want... it's insurance companies that limit choice! Why would the national health service care which doctor you went to?

Answer 2

You raise a complex question.

Yes, I've had to fight my insurance company and the hospital both. Recently, CIGNA objected to a roughly $300,000 transplant for a teenager, saying it was an "experimental procedure." There was a public outcry, and CIGNA changed its mind. But the girl died before they could do the transplant.

The doctors and medical professionals in the US have become spoiled. As in anything, it's the money that rules. They have run a campaign that basically appeals to people's fears, saying if we go to a national healthcare system, you will lose the right to choose your doctors. As a practical matter, with HMOs and PPOs, that system exists now. The only thing that would change is the millions of dollars doctors would rake in. They would be employees of the national healthcare program and paid a salary--a high one, but no where near what they get now. They would still figure high on the most-admired list, still get good medical educations, and still be able to make extra money by consulting or doing procedures on the side. But basic healthcare would be on a salary basis.

The US may be advanced in lots of ways, but it is still a primitive culture when it comes to healthcare.

Answer 3

I have not. But then my health care is paid through taxation.

I live in the UK and work in the NHS (our universal health care system). It has problems, but not as many as the US healthcare system has. Despite spending much more per head of population than other developed countries, the US has worse health outcomes. http://en.wikipedia.org/wiki/Health_care#Economics Life expectancy and infant mortality figures in the US are worse than in other developed countries, despite more money being spent (and wasted) in the USA.

In the UK there are waiting lists for routine problems. Problems that can not wait are treated as emergencies. Also, in the UK, people can also have private health care.

I can understand Americans being proud of living in the richest and most powerful country in the world. What I can not understand is why Amercians settle for an expensive healthcare system where babies die that would have a better chance of life if born in another developed country.

http://www.guardian.co.uk/usa/story/0,,2167865,00.html

[Edit]For the posters above and below. The NHS has restricted access to some treatments to all based on the huge cost of certain drugs. Insurance companies in the US do the same, they just refuse the policy. In the UK and the US, people can fund treatments themselves. And with regards how much you pay, look at the figures I posted. You pay more in insurance payments for your service which does not deliver, than I do in taxation for mine which does.[/Edit]

Answer 4

I have not ever been screwed over by my insurance. I have had the same coverage by one company for almost 40 years. My son and I have both used it and have never been denied any treatment. While I understand this is not the norm I still do not support government being involved. There is no such thing as free healthcare as it is paid for by taxes that we have to pay. The programs we have in place are enough.

Answer 5

Wait wait wait....are you talking about health care providers OR health care insurance providers. Don't blame our medical system for what the insurance companies are doing. Fix the insurance companies, don't break our medical care.

Answer 6

NOPE and nobody is proposing it either. The current proposals other than the whole health insurance or fine things sounds exactly what medical professionals said needs to happens at many seminars I have been to.

Answer 7

I sure have. I've had to pay lab bills which should have been covered because my doctor used the wrong lab.

Answer 8

In Canada, we have free healthcare to an extent only. . .I hate paying for taxes. . .

Answer 9

I thought that was part of the deal ?? Isn't it ???