Medical Insurance - "What the hell is happening" Cancel The title field is required!

1. Ronald Kirkman

   

   40 posts
   
   9/19/2012 8:09 PM

   Greetings;
   
   For the past few months I had some serious pain on the back of my right leg behind the knee. I finally called an Orthopaedics doctor. first question - do you have insurance - yes -blue cross & blue shield to the tune of about $14,000 per year. OK, you have to see the nurse practitioner first before you see a doctor.
   
   I go to Beth Israel Deaconess Hospital in Needham (town where I live) There is another Beth Israel Medical Center in Lexington, MA 15 miles down the road and the main hospital of course is in Boston. So, I get an appointment Tuesday, September 18. I have to go to Lexington. X-Rays are taken and then I go to the desk and the lady says my appointment is in Boston at 8:45 a.m. DUH! It's 9:30 now, why the screw up? No answer - the lady says can you make it at 2:45 p.m. in Boston, I say OK. She will scan the X-Rays to Boston.
   
   I arrive in Boston an hour early and fortunately the nurse takes me right in. Good news she said, I do not need a new knee. I have a little arthritis which is easily managed. After the exam, she said I could have Bakers cyst - Meniscus tear - Cartilage inside knee.
   
   My knee is pretty swollen and my leg is actually bigger than my left leg. Now we do an ultra sound and there is no vessel blockage and the nurse doing the ultra sound said she did not see a Bakers cyst.
   
   Now they are trying to schedule me for an MRI in Lexington cause they have the chair you sit in and put your leg in the tube or whatever. PROBLEM IS - Blue Cross has to clear this before I go. They still have not given the OK yet as I write this. I never heard of this bull shi- have any of you out there been held up by an insurance co.? Is this legal? Is this is what were coming to? I have a great insurance policy or at least I thought I did! Or, it could be my age!!!!!!!!!!!!!!!!!
   
   Thanks for letting me vent.
   
   Capt. Kirk
   Retired Alien
   Needham Golf Club
   Needham, MA

   
   
   
   
2. Clay Putnam

   

   33 posts
   
   9/19/2012 9:09 PM

   Yep Capt, happens a lot. The insurance wants to make sure there aren't less expensive means to cure your ailment.

   
   
   
   
3. Melvin Waldron

   

   43 posts
   
   9/19/2012 10:09 PM

   Sounds pretty good, they were moving you right along.
   
   I had a knee bother me last year and when explaining it to my wife who had a torn meniscus repaired a couple years ago, it sounded like the same thing. I had to go to my regular doctor, who examined it, sent me for an x-ray and scheduled an appointment with the ortho surgeon. He examined me, looked at my x-ray and said it looks ok, no arthritis, but let's schedule an MRI, MRI done and went back to ortho, by that time (about 3 to 4 weeks) knee is feeling better, ortho says no tear, I can get back out to play golf.
   
   Mel

   
   Melvin H. Waldron III, CGCS, Horton Smith Golf Course, City of Springfield/Greene County MO
   
   
4. Steven Kurta

   

   2 posts
   
   9/20/2012 5:09 AM

   Ron,
   We just got done with a calf muscle fix on our son of 17 years this year in Boston. Beth Isreal was where he was operated on. Insurance was through my Wife's employer, she's moved on since then. Ins. company is called POMCO. First time we've been with anyone other than Blue Cross/Blue Shield and we were amazed at the ease of paperwork scheduling, and service.
   That said, the whole ordeal took about two months to go from injury/diagnosis/scans/MRI's, to operation/rehab. We thought that was pretty good. Although it wasn't life threatening either, so, your mileage may vary.

   
   
   
   
5. Ronald Kirkman

   

   40 posts
   
   9/20/2012 11:09 AM

   Mel & Steve;
   
   Glad things worked out for you. I called Beth Israel this morning and still no approval for the MRI. The lady did say if I don't here from her today just show up in Lexington for a 9 am appointment. It appears they will do the MRI - approval or not.
   
   Wonder what Obama care will do?????????
   
   Capt. Kirk
   Retired Alien
   Needham Golf Club
   Needham, MA

   
   
   
   
6. Wahlin Scott B

   
   9/20/2012 12:09 PM

   Ronald Kirkman said: Mel & Steve;
   
   Glad things worked out for you. I called Beth Israel this morning and still no approval for the MRI. The lady did say if I don't here from her today just show up in Lexington for a 9 am appointment. It appears they will do the MRI - approval or not.
   
   Wonder what Obama care will do?????????
   
   Capt. Kirk
   Retired Alien
   Needham Golf Club
   Needham, MA

   
   
   Under the ACA you can appeal to a citizens board for relief, an option you do not have now.

   
   
   
   
7. Ronald Kirkman

   

   40 posts
   
   9/20/2012 3:09 PM

   Scott Wahlin, CGCS said:

   Ronald Kirkman said: Mel & Steve;
   
   Glad things worked out for you. I called Beth Israel this morning and still no approval for the MRI. The lady did say if I don't here from her today just show up in Lexington for a 9 am appointment. It appears they will do the MRI - approval or not.
   
   Wonder what Obama care will do?????????
   
   Capt. Kirk
   Retired Alien
   Needham Golf Club
   Needham, MA

   
   
   Under the ACA you can appeal to a citizens board for relief, an option you do not have now.

   
   
   You are right professor but wonder how long the appeal would take and I imagine there will be lots of appeals and the old folks will probably be last. It just may be a worst case scenario. Only time will tell.
   
   Capt. Kirk
   Retired alien
   Needham Golf Club
   Needham, MA
   
   Home of Ally the gold medal gymnast
   Home of Suni Williams - Astronaut - record holder for number of spacewalks - time on space walks - world record for longest space flight (195 days)

   
   
   
   
8. Rosenthal Gregg

   
   9/20/2012 5:09 PM

   Capt.,
   
   Do not let them push you around, as the insured you are the one in need! I thank goodness had BC/BS when going through my epilepsy and brain surgery. They were very good treating me well and no issues what so ever with my doctor and then the surgeon and hospital where the surgery occurred, all the follow up following surgery. One year later I am back to working again as an assistant superintendent, seizure free and loving life all over again. BC/BS was good to me and they never could question anything my doctors recommended or decided to do, from many MRI's pre and post surgery, to medications, eeg's, other tests than were done, also before and after my surgery! Again do not allow them to push you around, as the patient and card holder you are entitled to the best care they can provide! They are one of the best providers money can buy.....I wish no one go through what I had to, but I learned a lot, now recovered working again loving life! I will say a prayer for you this Sabbath in Temple wishing you the best in health for the future!
   
   Gregg Rosenthal

   
   
   
   
9. Richard Lavine

   

   3 posts
   
   9/20/2012 6:09 PM

   Capt.
   I blew out my Baker's Cyst behind my right knee about six months ago. I didn't even know I had a Baker's Cyst. Everybody has one (two actually). I did it by pushing and possibly extending it. I swear I heard it pop. The fluid goes into your leg and swells it, somewhat painful, and it takes two to three weeks for the fluid to be absorbed.
   
   I feel your pain with the insurers. I really think the run-around is built into their system; most people will just usually accept their findings or ruling, and just accept the bull. But, the squeaky wheel gets the grease, and you usually are dealing with ten to twelve dollar per hour clerks. You need to be persistent, and have their rule book in front of you, and quote them their own rules to your advantage. Your doctors can be your best allies, they are trying to do their best and usually they are just as frustrated with the insurers as you are.
   
   Good Luck

   
   
   
   
10. McCallum David K

    
    9/20/2012 6:09 PM

    Captain can surely relate to your problems with the medical profession. Without going into details of my current situation have had my share of runs in our health carrier as well...........Unitedhealthcare. After a colonsocopy about 6 weeks ago, I contracted diverticulitis and at the end of that the shingles. So lots of trips to the doctor of late and I usually go once a year for my annual physical in early December. I get a phone message yesterday confirming a procedure I thought I was scheduled for today and I also had the written appt slip I was given a the doctors office but no, at 6:30 pm last night i received a called confirming my 1:00 pm appt on Friday. I tried to explain,no its tomorrow, got a confirmation on my phone message and am holding in my hand the appt from your office............nope you're wrong, its Friday. So both wife and I have to change previously made plans to accomodate the doctor.
    
    During all of this in and out found a more serious issue and am now dealing with a hospital a state away about a visit to consult with them and it has been a pleasure to deal with them. One email explaining my situation and a return call from the hospital and a sweet young lady of the other end informing me I now belonged to her and if I had any further questions before my visit to call her direct line. Dealing with my local doctors it takes 10 minutes of menu crap and you never talk to who you need to talk to. I think Captain it will only get worse and us old guys will be the last served.......they figure they can out wait us.

    
    
    
    
11. Wahlin Scott B

    
    9/20/2012 7:09 PM

    David McCallum said: Captain can surely relate to your problems with the medical profession. Without going into details of my current situation have had my share of runs in our health carrier as well...........Unitedhealthcare. After a colonsocopy about 6 weeks ago, I contracted diverticulitis and at the end of that the shingles. So lots of trips to the doctor of late and I usually go once a year for my annual physical in early December. I get a phone message yesterday confirming a procedure I thought I was scheduled for today and I also had the written appt slip I was given a the doctors office but no, at 6:30 pm last night i received a called confirming my 1:00 pm appt on Friday. I tried to explain,no its tomorrow, got a confirmation on my phone message and am holding in my hand the appt from your office............nope you're wrong, its Friday. So both wife and I have to change previously made plans to accomodate the doctor.
    
    During all of this in and out found a more serious issue and am now dealing with a hospital a state away about a visit to consult with them and it has been a pleasure to deal with them. One email explaining my situation and a return call from the hospital and a sweet young lady of the other end informing me I now belonged to her and if I had any further questions before my visit to call her direct line. Dealing with my local doctors it takes 10 minutes of menu crap and you never talk to who you need to talk to. I think Captain it will only get worse and us old guys will be the last served.......they figure they can out wait us.

    
    
    I get the impression that you have a 20yo wife and run a marathon every morning, how old are you?

    
    
    
    
12. Kim Brock

    

    3 posts
    
    9/20/2012 7:09 PM

    Captain,
    Since you reside in Massachusetts, why do you have private insurance and not state insurance that Romney got passed? Please elaborate. Thanks, Kim

    
    
    
    
13. Wahlin Scott B

    
    9/20/2012 7:09 PM

    Kim Brock said: Captain,
    Since you reside in Massachusetts, why do you have private insurance and not state insurance that Romney got passed? Please elaborate. Thanks, Kim

    
    
    The ACA and Romneycare still use private insurance companies.

    
    
    
    
14. Peter Bowman

    

    11 posts
    
    9/20/2012 8:09 PM

    Scott Wahlin, CGCS said:

    Kim Brock said: Captain,
    Since you reside in Massachusetts, why do you have private insurance and not state insurance that Romney got passed? Please elaborate. Thanks, Kim

    
    
    The ACA and Romneycare still use private insurance companies.

    
    
    Thank you Captain.

    
    
    
    
15. Ronald Kirkman

    

    40 posts
    
    9/20/2012 9:09 PM

    Kim Brock said: Captain,
    Since you reside in Massachusetts, why do you have private insurance and not state insurance that Romney got passed? Please elaborate. Thanks, Kim

    
    
    Kim,
    
    As Scott said we can still use private insurance companies. My wife works in the school system and the employees are offered Harvard Pilgrim - Tufts - Fallon - Blue Cross. My wife chose Blue Cross years ago.The town pays 66% of the premium and my wife pays 34% which equals $157.53 per week for insurance. I still work part time at the club and they reimburse me the $157.53 per week.
    
    Everyone in the state has to have health insurance. If you can not afford private insurance you get it from the state. The less you make the less it costs you. My granddaughter pays $300 for state health insurance. I know people who pay $200 per month and $400 per month. Never heard of a higher figure. It has been reported about 300,000 people do not have ins. in the state. I also heard a figure that it cost the state about seven billion dollars so far to keep health insurance going.
    
    The quality of state health care is excellent. There is no waiting to see a doctor or get in a hospital.
    
    P.S. have not heard from secretary today which means I go in at 9 am tomorrow for my MRI
    
    Capt. Kirk
    Retired Alien
    Needham Golf Club
    Needham, MA

    
    
    
    
16. Rosenthal Gregg

    
    9/21/2012 4:09 AM

    Capt. Kirk,
    
    Truth is where is "Bones" when you need him? Dr. McCoy would have fixed you in an instant for sure! I should have beamed him to you on the first post! Again good luck and best wishes!!
    
    Gregg

    
    
    
    
17. McCallum David K

    
    9/21/2012 6:09 AM

    Not that its any business of yours but no she is 15 years younger than myself. I am approaching eligibility of both medicare and social security. Though I do bike and run daily, until recently, I no longer marathon. I leave that for you young guys.
    
    I figured being a smart guy like you are Scott you could have done the math within a year or two since I served two tours in Vietnam in the late 60's........but again........