First Emergency Experience With Socialized Medicine!

[robs477]

I am re-posting this from another thread so as not to sidetrack the original post. My original intent was to just solicit opinions regarding the last 3 weeks of hell that my Wife and I have been through with her recent medical emergencies, but, because of my comments regarding my recent experiences of failing at trying to get her proper emergency medical care and diagnosis, IMHO resulting from our shift to socialized medicine, aka, the ACA and or “Obamacare” (call it what you will), I needed to start a fresh new thread.

I have always tried to stay out of politics on this site and everywhere else because I do NOT consider myself to be either a Republican or Democrat and I HATE both parties equally and believe them to be both one in the same, LIARS! To embellish their corporate puppet Masters and sell out we Americans in the process. Point being, my comments have NO hidden political agenda.

I haven’t posted this before and have kept it to myself, but some VERY, strikingly similar set of happenstances has just happened to my Wife and I for the last THREE weeks that I cannot get over, I am pissed!!!

She started off having a moving back and stomach pain and thought it was a diverticulitis attack which she gets every 3-4 yrs. Took antibiotics and within days the pain was so severe, we had to take her to the emergency room. Blood tests, CT scan, nothing…NO diagnosis, they told her it must be “Muscular”…The very next morning, she woke up in screaming pain that was so severe we had to call EMS and she went to a SECOND emergency room, this time in an ambulance….same thing, nothing…NO diagnosis, they told her it must be “Muscular”…said there’s NOTHING they could do and told her to call a GI specialist. We called every GD Dr. in Houston (and Houston is supposed to be one of the best Medical care places in the US) and they all said….”the earliest appointment we have is in mid june to early July”…WTF??? Are you kidding me??? She is in pure AGONY and extreme pain right now, they said, “Well then you need to go to the emergency room”…..SWEAR TO GOD!!!! We were (and STLL are) caught up in this GD loop of deferred responsibility where nobody gives a flying fuck and they all try to send you somewhere else just to get rid of you. And this is WITH INSURANCE….

Welcome to socialized medicine my friends! We all get to subsist to the same level of mediocrity regardless of your insurance plan.

Unless you are a gunshot wound and your guts are falling out, the hospitals will no longer run all the tests you need in one place at one time and to get in to see a specialist takes MONTHS now.

So, we, (I), had to do a LOT of reading and MORE SELF DIAGNOSIS. I think what may have happened is, the antibiotics she took for the original bout of diverticulitis KILLED ALL of her good intestinal bacteria and thus resulted in a severe case of IBS. She couldn’t poop or eat, NOTHING was working.
I got desperate and decided to call my Dr’s office that did my DS and they took her in the same day. The Dr. we seen thought it may be a kidney stone and looked at the CT scan and ruled it out as well as the gallbladder, liver, female organs etc.

After doing all my reading and research I asked for some prescription pro-biotics to help re-build her intestinal lining. She started those on Tuesday of this week and felt better almost immediately and has been a little better each day.

22 days in to this nightmare and we still have NO official medical diagnosis and they scheduled a colonoscopy 2 weeks from now (which was 3 weeks from when she needed it) and by the time she gets in there, she will be all healed and it will show nothing. Again, ALL for NOTHING! She missed 8 days of work, I missed four days and has been in shear misery and…it has already costs us thousands of $$$$ and NO F@&ING DIAGNOSIS!!!

I know there are good parts to the ACA, especially the “Pre-existing conditions clauses”! That absolutely needed to happen, BUT…we were told by THREE different medical professional, two of which were Doctors that the long waits are because there are fewer Dr’s seeing more patients. He said people are getting out of the medical field in record numbers because they aren’t getting paid by the insurance companies. They are getting 30% or less of the “Negotiated” amounts and consequently, not near as many people are going in to the medical fields and because of this trend, in time will make it even worse.

Do understand, the GREEDY GD insurance companies WILL adapt, mutate, survive and prosper no matter what. And it WILL be at our expense. Make NO mistake, a LOT of People are going to die and suffer along the way, (just as critics have said), and to believe anything different is at best deeply rooted in naivety and maybe even borderline delusional.

Can you tell I’m pissed???? You Betcha! Any good Husband would be.

 

[southernlady]

Being a squeaky wheel helps.

But even before the ACA, being an odd duck was hard. I had to push, shove, and argue that something was wrong with how my husband was acting in late 2004/2005. We saw neurologists and other specialists. It wasn't until a radiology doc read his MRI without knowledge of his age or seeing him. JUST read his MRI. He has what is called Normal Pressure Hydrocephalus. We even had one neurosurgeon in 2007 tell us he couldn't have it, he was TOO YOUNG! And this was AFTER a ventricular shunt had been place to take care of it.

I know that even before the ACA...getting into specialists took time unless it was either thru the ER or deemed an emergency by your PCP.

I am in the demographic that gets Medicare. (NO help as we make too much in retirement, but that is okay). Now if we stuck with JUST Medicare, we could see any physician that ACCEPTS Medicare but we would be responsible for 1) the initial deductible and 2) 20% of the allowed charges. So my husband and I go thru the Medicare Advantage route (too young for the Medicare Supplement to be cost effective). Because it is Medicare, we each have to have our own policy. NO such thing as a family plan. Also no such thing as a Health Savings Account unless we just set it aside. No FSA, etc.

It ALSO depends on which insurance companies DECIDE to do business in a certain state. And then we get down to county level. In the county WE live in, we have three options, original Medicare, BCBSNC, and Humana.

We tried BCBSNC cause we had GOOD experience with BCBSTN. But that is like comparing apples and oranges. Both are fruit, both grown on trees but that is where the similarity ENDS.

We live in a town that literally has one of the city lines along the NC/SC state line. There is an excellent PCP office just 5 miles from our house. But while with BCBSNC, we had to travel north or east about 45 mins to see a PCP that wasn't an Urgent Care doc. Crossing state lines popped us from IN network to out of network. So we moved over to Humana who does theirs based on zip code (a radius). Well, a 5 mile radius and my PCP in SC is IN network!

We've been dealing with Medicare alone since Dec 2011. I am JUST glad I had my DS prior to that as Medicare does NOT pay for type 2 diabetics to be on an insulin pump and those supplies are expensive. In fact, Medicare only pays for 100 test strips a month and those of us who were keeping tight control can use 10 each and every day. On employer based insurance, I was allowed my pump supplies AND 300-400 test strips a month based on how my endo wrote the prescription.

Medicare is the closest we come to single payer and finding a doctor that accepts Medicare is hard...not impossible. I know MY surgeon in Jan 2011 accepted Medicare or I would not have had my DS. But in Oct 2011, he stopped accepting new Medicare patients. His partner did accept and continues to accept Medicare and TennCare (TN's version of Medicaid) but HE won't do the DS on anyone under a 50 BMI. The other DS surgeons in the state (and there were two in Nashville in late 2010/2011) did NOT accept Medicare or TennCare.

 

[Spiky Bugger]

First, I really hope you get to the bottom of her problems. SOON!!!

However, "Socialized Medicine" is what I get at the V.A. What the ACA (Obamacare) does is force people who never had insurance to buy insurance...and maybe help them pay for it.

But the rest of what you are dealing with? I'm convinced that all the rest is due to greed, pure and simple. Well, with a little ass-covering thrown in as well.


Years ago, before Obamacare, but following some Medicare cuts, I had a conversation with my mom's PCP, a geriatric specialist.

Me: It must feel like betrayal. You went to school, studied hard, worked horrific hours and for all of that, there was supposed to be a payoff.

Him: Exactly. It IS a betrayal. Promises are not being kept.

Me: Well, there is no salvation in large numbers, but the guys who put in twenty-eight years at the Whirlpool factory and the auto factories, and then watched their jobs and their pensions leave the country are going through something similar.

Him: But they are building things, not trying to keep people healthy.


What I heard was, "We doctors should not have to go through the same belt-tightening the rest of you are going through. We're the smart kids, remember? We are exempt."

Granted, not all doctors react that way...maybe not even most. But enough of them, who are used to a very financialky secure existence, don't seem to relate to people who didn't JUST have to deal with an income reduction, but have had to move from a Payday-to-Payday lifestyle to no job, no income, no home and no hope. (And if you think back, you may recall that these are from the same group of doctors who assured us that HMOs would cause all our doctors to move to Canada. My mom's doctor was in a practice where fully 90% of his patients were HMO patients...because the doctor who started that practice later started an HMO just for seniors.)

And hospitals, such as those started by the Frists and Rick Scott (political comment), are run by human pond scum. Yes, there ARE fewer doctors seeing more patients. But that doesn't make the cause of the problem (imho) the fact that more people have access. Cuba, yep...THAT Cuba...is pumping out doctors like a good thing...even some American kids go there. But it is TOTALLY detached from a profit-motive-run medical system. Their socialized system provides better care to everyone.

Mr. Sue and I both HAVE access to the VA. He has a PPO. I have Medicare primary and a PPO secondary. We are well insured. But even before the ACA, we got tired of being treated to the equivalent of Southwest Airlines at doctors' offices. So we have a concierge program...which costs each of us several grand a year just to be patients of a doctor who agrees to have no more than 400 patients and who can see us "today or tomorrow" when we call. It's a shame, but that's what it has come to. And...when I'm pretty sure I'm getting screwed, I try to profit from it in some way. So I bought a few shares of a Vanguard health care ETF. It's doing well. Not well enough to cover the cost of the concierge doctor, bur better than investing in buggy whips, I guess.

You are resourceful...you will find a way to avoid this in the future.

But keep us posted on how Mrs. Robs is doing.

 

[southernlady]

Sue, I WISH a concierge doc was an option HERE. I'm not sure but the nearest one would be a good 90 mins away. Maybe Charlotte or Atlanta or Raleigh. So we take what we can get. Thankfully our current PCP is amenable to handling the requirements for a DS'er and now has 5 of us in his practice.

 

[robs477]

Thxs, good info Ladies, I agree guys, it’s NOT all ACA, but I do think thats significantly exasperating an already F'd up system! Sue, you guys are right also, it’s NOT just SOME of the Doctors though, it’s their GD front office that’s trained to just tell you, "well then if it’s an emergency, go to the emergency room" The people in those front offices could give a flying fuck less if you get an appointment or not and I actually ran in to several that I could tell took please in the power they had giving their denials.

I know that its just not only some of the Doctors at fault because the only way I found around the system was to call up the specialists after hours emergency numbers at 5 am and LIE and tell them my Wife was a patient in an emergency and the ER already dismissed them.

TWO different specialists, GI and Urologists called me back within the hour and TOLD their front office to get her in for an appointment! YUP, I had to friggin lie, but at least she got seen, but again, still no diagnosis. You HAVE to bypass the front office bitches too!

But, the Doctors did tell me how the system is completely broke, very, very eye opening wake up call for us.

 

[Spiky Bugger]

Sue, I WISH a concierge doc was an option HERE. I'm not sure but the nearest one would be a good 90 mins away. Maybe Charlotte or Atlanta or Raleigh. So we take what we can get. Thankfully our current PCP is amenable to handling the requirements for a DS'er and now has 5 of us in his practice.

Even where it IS an option, you are still subject to your normal deductibles and you still pay whatever your normal co-pays are...PLUS...$1500 to $1800, per year, each, for the privilege of having a doctor who is not completely overwhelmed by his/her patient load.

IOW, in addition to the $600+ we pay monthly for the PPO, and the $100 I pay monthly for Medicare, we pay $300 monthly to be "special."

That's twelve grand a year...if nobody gets sick. (We have mostly excellent coverage when we DO get sick...but I suspect that stuff like chemo is not as well covered.)

BTW, our friends in Denmark laugh when Americans mention the high taxes the Danes pay. We pay "taxes" too, but we call them things like "insurance premiums" and "college tuition!" LOL

 

[Spiky Bugger]

Sue, I WISH a concierge doc was an option HERE. I'm not sure but the nearest one would be a good 90 mins away. Maybe Charlotte or Atlanta or Raleigh. So we take what we can get. Thankfully our current PCP is amenable to handling the requirements for a DS'er and now has 5 of us in his practice.

Greer, 21.56 miles from you.

But to this city slicker, that practically requires vacation planning.

 

[DianaCox]

I do not have this problem with our insurance. We have a small company (fewer than 50 employees) PPO plan (Carefirst BCBS of VA, but since we live in CA, we are on "Blue Card" - we are both in and out of network at the same time) - we have Palo Alto Medical Foundation as our HMO part, and it is part of Sutter, which is a huge group with offices throughout the Bay Area. Even though PAMF is 20+ miles from our house, I prefer going there, because their whole system is so well organized and they have so many good doctors there. I have never had any trouble getting appointments within a reasonable time, like couple of days with urgent matters, and 2-3 weeks for routine things. But I also have the same access to BCBS doctors outside PAMF without a referral (I see a GI doc who is not at PAMF, Charles' orthopod when he broke his hip was close to the house, and my hematologists have both been outside the PAMF group as well).

I think when you have specific needs, you have to consider not only what is the least costly, but also which doctors you want to have access to. I know am fortunate that my plan has the coverage it does (there was a $2400 deductible which we met almost immediately, $20 copays and a huge network), and that we have so many good doctors in the area. When my kids were little and I was relatively healthy, I thought Kaiser was just fine - but now that I am older and more picky and we are having or could have more complex issues, I want more freedom to pick specialists and the ability to have immediate access to a wide range of doctors.

As we contemplate moving elsewhere (less costly) for our retirement, I am very much considering access to health care as part of the equation.

 

[southernlady]

Back when Charles was working and not medically retired, we had BCBS and never had issues. It wasn't until we hit the Medicare version that things went to hell in a handbasket.

Like I said, BCBSTN Medicare was a breeze compared to BCBSNC Medicare.

 

[k9ophile]

And hospitals, such as those started by the Frists and Rick Scott (political comment), are run by human pond scum.

You ought to try working for them. I did. It sucked.

I have two PCPs; one I see for all things related to my WLS. He's 126 miles from my house (and well worth the drive). The other is more local and takes care of all things not related to WLS. The first does not have any hospital privileges and does not want any. His focus of wellness treatment is not covered by many insurance companies. The second has sold his practice to LifePoint, a subsidiary of Frist and Scott's greedy for-profit company. I'm taking a wait and see attitude to see what happens. More and more private practices are being sold to hospitals due to all the changes. It takes a financial burden off the practice, yet I'm leery of what will happen to patient care.

When I entered health care 33 years ago, I never dreamed it would come to the state it has. The advances in the technical side have me in awe. Access and administration scare me shitless. ACA may be the answer; it may make it worse.

But back to Rob and Mrs. Rob, I hope things get better for you.

 

[southernlady]

Greer, 21.56 miles from you.

But to this city slicker, that practically requires vacation planning.

I must not be googling correctly cause when I looked late last year, NOTHING showed in a 50 mile radius minimum.

But I am okay with my current PCP. I have been able to see him same day (as long as it's not a Wed. He goes over to the assisted living place where my daddy was and sees patients there who can't make it to his office). I like that he has a nurse who has the RNY so malabsorption is not a mystery to him altho he didn't understand the DS but is WILLING to learn. And he is willing to run the labs we want, twice a year AND sends us copies without us even asking. IF we need a referral, he handles it to the person we want if we have one in mind.

His office is an affiliate of the local hospital system...

More and more private practices are being sold to hospitals due to all the changes. It takes a financial burden off the practice, yet I'm leery of what will happen to patient care.

And since it has been since we moved here, not sure how long he has been that way.

 

[MyNewLife]

I'd like to add my voice to a small part of the healthcare crisis that I just experienced. I tripped over a rug recently. A lifetime of experience taught me to land on my padded stomach to keep my body safe. I no longer have padding there and landed on my ribs.

I ended up in an ER. They took xrays and gave me something called tramadal for the pain. I am not a drug seeker, I haven't had a pain pill except the one they gave me in the ER for over 3 years and that was for surgery. My drug of choice has always been an anti-inflammatory. I didn't sleep more than two broken hours for almost 9 days. If you walk into an ER in pain, they assume you are a drug seeker. Unless they can prove beyond a shadow of doubt that you are in excruciating pain, they give you something that won't work.

It isn't right. I missed work, put my heart (Afib) under unnecessary strain all because people that aren't doctors (legislators) are keeping these guys scared. That and the idiots that are drug seeking, they don't need to be left out of this.

 

[Spiky Bugger]

I'd like to add my voice to a small part of the healthcare crisis that I just experienced. I tripped over a rug recently. A lifetime of experience taught me to land on my padded stomach to keep my body safe. I no longer have padding there and landed on my ribs.

I ended up in an ER. They took xrays and gave me something called tramadal for the pain. I am not a drug seeker, I haven't had a pain pill except the one they gave me in the ER for over 3 years and that was for surgery. My drug of choice has always been an anti-inflammatory. I didn't sleep more than two broken hours for almost 9 days. If you walk into an ER in pain, they assume you are a drug seeker. Unless they can prove beyond a shadow of doubt that you are in excruciating pain, they give you something that won't work.

It isn't right. I missed work, put my heart (Afib) under unnecessary strain all because people that aren't doctors (legislators) are keeping these guys scared. That and the idiots that are drug seeking, they don't need to be left out of this.

And even when you have a doctor who knows you can't take NSAIDs and is willing to WRITE a scrip for, say, 120 10mg Norco...good luck gettin' that puppy filled. I have a stash...but what about people who have an injury and get a prescription on Thursday afternoon or Friday, and take it to CVS...they are told to check back on Monday. And just deal with the pain until then. And if they go to a different pharmacy, tbey are "pharmacy shopping" and they won't fill it. And I don't even know who to be angry with about that. A four day wait for pain relief?!?

On my drugs, we had them filled at our local Pharmacy A. But then we moved, so we transferred to the new local branch of Pharmacy A, located inside a grocery store. Which closed. I went to Pharmacy B, but had to explain...and prove...that my pharmacy had closed.

 

[DSRIGGS]

We have BCBS of Indiana (wife's company's US unit is HQ'd in Indiana) even though we live in IL. We pay$175 a month and that includes the vision and dental part as well (Not BCBS) and this is for a family of four. We have a $20 office copay then nothing else...$50 ER copay then nothing else. $150 outpatient copay (MRI, CT, etc.) and then nothing else, and then $200 for an admission, then nothing else. We have seen $175K hospital bills and paid $200 copay and that is it. After $1,000 individual or $2,000 family the copays go away. We sent our son to California for a residential mental health care facility for 2 months and it was out of network but we paid $2,000 and that was it (most health plans don't pay anything for something like that) and they billed BCBS nearly $25K.

We have excellent insurance...and guess what, it is because of my wife's employer...and guess what, they are one of those damn socialiists from Europe (you know where life expectancy is longer and healhcare cost is roughly a third of ours), actually understands that if you take care of your people they take care of your bottom line.

No offense to Dr's of the world, but we all choose are path in life and no I do not feel sorry for the jackass who royally messed up my son. He makes very good money and his wife is an Anesthesiologist....so they have a 7 figure income between the two of them. Guess what, if he God forbid had his annual income knocked down to $250K a year he is doing better than 98% of America on one salary.

Everybody always wants to think they are special and tell their sob story about their industry and their job, but bottom line is the ACA is doing much more good than harm and if a Dr is bailing it that person's decision.

The biggest problem with our health care system is the 3rd party insurance who dictates what is covered and isn't, so what health care is delivered..and medical device manufacturers who sell a product to "not for profit" hospital system for 50 time what they would sell the same type product for in a different industry....why? Not for Profits don't care about cost.....the more you spend the bigger your budget next year.

In any case, yes there are some shitty aspects of the US health care system and there are some shitty docs...but there are some great docs and some great hospitals who really do look out for the patient.

It sucks but yes sometimes we have to play silly games, but in the end we do what we will for those we love.

I hope you get answers for your wife, Rob. It sucks trying to figure out these issues so hang in there and best of luck.

 

[MyNewLife]

And even when you have a doctor who knows you can't take NSAIDs and is willing to WRITE a scrip for, say, 120 10mg Norco...good luck gettin' that puppy filled. I have a stash...but what about people who have an injury and get a prescription on Thursday afternoon or Friday, and take it to CVS....

I wouldn't have needed 120. I would have needed 1 or 2 a night for 8-10 days, 16 to 20 would have gotten me to the point where I could manage. I could handle the pain when i was awake until I got so tired, I couldn't handle breathing....

I know it's the drug seekers that have really caused this but why punish the folks that have real pain. They turned me into a drug seeker and I would have taken someone elses prescription if I'd know anyone that had some. I'm a law abiding citizen but pain can drive you to lots of rotten things