Caught in the Insurance Cogs!

kangatoo said:

I hate getting political but sometimes there is a cause worth venting about and the crap you guys go thru warrants some pretty strong words. I am curious here Kathi. What happens if you have no insurance your way?Do the poor who are unable to pay just get told, "tough luck"....you don't get lifesaving treatment?I guess your ins. companies require written referals for your treatment?
I will tell you our situation here in oz.Insurance is encouraged and indeed we had "full family" cover until our kids were able to work themselves and have their own insurance.But then the government brought in "public health" care system called MEDICARE payed for by taxpayers as a "levy...another word for tax"which all workers contributed to. So in essence we all payed "twice" if we chose to have a "private" insurer as well. The cost to my family on "private insurance" was getting out of hand....the cost about $3,200.00 p/annum.We thought it unfair to have to pay both ways so opted out of "private" insurance which left us on the goverment MEDICARE system(paid by MY taxes)
The interesting part of all this is that my surgery, chemo and other meds. costed me NOTHING.My resection cost me nothing thru medicare.
However a friend with "private" insurance for surgery still had to pay 100's of dollars because he used his insurance company policy. The only cost to me was once I was released from chemo and the outpatients hospital service I pay any further expenses(pro-rata)....a so called "gap" between the doctors/specialists bill and the fee paid by medicare for future tests/bloods etc.It costs ME around $100--200 for each follow up service.
example;
If I have an ultrasound the cost is $200.00 approx. Medicare only pays a certain amount....I pay about $100.00approx.
Basically what it means is this. Every ozzie gets so-called "free" health care(which it is not because our taxes pay for it)We can choose to have a private insurer if we wish...and pay thru the nose for it!
There are advantages and disadvantages.If we choose both we pay twice!
Private insurance; choice of doctor, private hosp. room,(access to PRIVATE hospitals as well as public), any medical conditions treated straight away....but....there is still a "gap" payment in most cases and doctors/specialist charge top dollar.Some insurers only will pay to an amount on procedures.
Public health scheme...MEDICARE;
no real choice of doctors,some elective surgery you have to wait months for(ie...hip replacements)....but emergency surgery is immediate usually. "Gap" costs are kept low.Surgery is done at "public hospitals" wherever possible.
This is only a very small indication of how things work here, it does get very involved.I shudder every time I see you guys post about the huge costs where you are and feel very fortunate over here. It still costs a lot to get follow up tests/treatment but is doable.It makes me so sad, so mad....no-one should need to have the burden of financial cost as well as cancer. It sucks big time!Sorry for the lengthy post guys but no matter where we look there is much injustice that should never be.
huggs to you all dear friends.Kathi....yah get an extra one sweetie!
Ross and Jen

kerry said:

Give 'em Hell girl!! I went through similar problems when the doctors office billed late and the insurance company refused to pay. It is so frustrating because it is NOT your fault and beyond your control.

Take care.

Kerry

PhillieG said:

Kathi,
I can relate to your situation too. I had some trouble getting approved for Erbitux. It seems once you get tough, they change their tune.
Glad you got it straighened out and are having your last round!