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I used to work for a large health company. I sat next to a guy whos son had got into a serious car accident. Here is how the story was told to me. The hospital figured that it would take him a long time to recover. The insurance wouldn't cover much of it because the cost was way too high. The surgeons didn't want to operate on him because he would be at a risk of dying. No surgeon wanted to be the one that was responsible for his death. So, this giant health care company told the parents. " We recommend just pulling the plug. His chance of survival is too slim and it is very costly to try."
Well, the parents were really upset. They did, however, have a secret weapon. The guy was a stake president with The Church of Jesus Christ of Latter Day Saints. The guy called up Thomas S. Monsen (the prophet; though not at the time). He asked him for help. He didn't want them to let his son die. So, the prophet Thomas S. Monsen called the health care company to straighten it out. To avoid bad press, the health care company let the boy stay in the hospital.
Surgeons were not allowed to do charity work unless it was fully paid. Plus, the condition of the boy was severe enough that a lot of surgeons didn't want to do the work. In other words, they were not allowed to schedule the necessary surgeries. What could the parents do? Somehow they convinced some surgeons to come in the middle of the night to perform surgeries in the room. I guess you might call them "off the book" surgeries. The surgeons were taking a great professional risk doing so. It was against hospital policies.
Three years later the boy made a full recovery. The parents practically lived at the hospital and it cost millions of dollars. Still, it was a full recovery.
---------------------------------------------------------------------------------------------------------------It was at this same non-profit health company where my grandmother was treated. She broke her hip. She was about 80 years old at the time. The thing is that she was getting better. When she got great care in the ICU she would feel a lot better. The thing is that there are requirements about how long you should take to get well. If you are older or less healthy, it might take longer. However, laws only allow the provider to get paid for a certain length of time.
What the health company did was max out the insurance they could get. Once that happened, they would somehow work to get her vitals up for just a few hours so they could transfer her out of the facility. Once she was transferred out of the facility her vitals would drop back simply because she was never ready to be released in the first place. Sadly, she ended up dying at a nursing home without good care. Could she have recovered fully if given more time? I think so.
-------------------------------------------------------------------------------------------------------------------In a large meeting at the same company, they told us that our benefits would be in line with other non-profits; not that great. In fact, my spouse had better benefits than me through the company I worked for. They argued that it was a matter of meeting the market of other non-profit companies.
It was at the same meeting they announced that preventative care wasn't in their best interest. The actuary said, "We make more money treating problems then preventing them. Since we might lose your good health benefit from you leaving your job, we are not putting any money or time into preventative care." Wow, this is from one of those great non-profit companies "trying to help people."
-------------------------------------------------------------------------------------------------------------------Monopolies are known for taking advantage of their power status. They charge high prices and limit supply. They don't work super hard at customer service because they don't have to.
Health companies become brazen. Imagine having the werewithal to bilk the insurance for everything you could even at the peril of your patient. "I know you're going to die soon, but let me keep you alive until I get all the money from your insurance."
I have been charged for items not performed. One time I went in with the swine flu. The doctor asked me if I wanted to get a shot. I said no and didn't receive it. Then, the doctor filled out that I tolerated the injection well and signed it. My insurance was billed over $500. I tried to fight it by calling both parties and it was fruitless. My brother says, they billed him for things they didn't do on multiple occasions. He wasn't able to get the bogus charges removed either.
-------------------------------------------------------------------------------------------------------------------One health company asked me to pay it all up front; over 2k. So, I did and put it on my credit card. Then, they billed my insurance the same amount; a double billing. Then, I tried to call like everyone in the hospital. There isn't a single person to answer the phone except one operator that knows nothing.
When I went to fax documentation into the credit card company, the person at the desk told me they got a double billing from the same company. I called the state insurance fraud division and the secretary told me that she had a fake charge on her account for morphine she didn't get. She had to go in person and talk to the risk manager and tell her she worked in insurance fraud before the charge was removed.
------------------------------------------------------------------------------------------------------------------There are countless stories of people dying because they couldn't afford care. I have chosen not to go to the doctor many times simply because it was too expensive or because I didn't have insurance.
-----------------------------------------------------------------------------------------------------------------My father-in-law had a stomach problem. So, he went in for a test where they stick an endocscope down your throat. The charge for that was 22k. And, the doctors said it didn't give them any new information that was useful. My father-in-law stated, " I am not going to go back into the doctor again. It's a ripoff. I don't care if someone else is paying for it." He is on Medicare.
-------------------------------------------------------------------------------------------------------------------My father was having heart problems. He was instructed to get testing. It cost about 25k to get a few tests done. And, it wasn't helpful. The tests were inconclusive.
-------------------------------------------------------------------------------------------------------------------Personally, I just think health care is way too expensive. It costs about the same as my house payment and the decuctible is so high I might as well not have insurance. I mean if something really bad happened, it would help unless I got dropped for a pre-existing condition like farting too much.
Every time I have tried to get healthier I have found insurance doesn't cover that. They only cover problems after you get really bad off. A gym membership seems too expensive, but I sure can afford to spend 8k per year for basically nothing.
-------------------------------------------------------------------------------------------------------------------Insurance and health care reform is a top priority for the American public. Polls show that everybody wants it. It's the companies and politicians that want to keep it the way it is. They tout free markets and support monopolies and restricted access. It's time to change health care. Everybody knows it. Now, let's do it!
If you want to get involved or have your own health care story to tell, email Jim Davis: car1ear2jar3 at yahoo.com