I Have What's Considered Good Health Insurance.

[Avalux]

But what does that really mean?

I've recently been suffering from chronic neck pain, secondary to a motor vehicle accident several years ago. I had an MRI done at the time which revealed herniated disks in my cervical and thoracic spine. I visited my physician to come up with a game plan and he suggested I get a recent MRI of the area to compare and determine if my condition has gotten worse.

Just got off the phone with the Aetna and the radiology facility. Here are the numbers:

Cervical Spine MRI w/o contrast: $1516.00
Thoracic Spine MRI w/o contrast: $1623.00

Total: $3139.00

My deductible is $250.00 and I am responsible for 20% of the cost of the MRIs. My amount due at visit for MRIs: $877.00

I probably shouldn't be complaining because I actually HAVE health insurance. But what good is it when I can't take care of my out of pocket costs? I certainly can't afford this right now so I won't be getting the MRIs. I laughed at the billing rep when she asked if I wanted to schedule an appointment.

:(

[hamerfan]

1. I'm glad you checked on the prices

before having the tests run. Even with insurance, health care is expensive!
Good luck to you...
hamerfan

[notadmblnd]

2. I have "good" insurance too.

it pays for everything except office visits. At over 100.00 a pop, guess who doesn't go to the Dr's office? Luckily, I haven't had to go to emergency either. Cuts, burns and broken fingers all get cared for at home.

[patriotvoice]

3. The price fixing issue (that is "affordability") needs to be dealt with, first.

When a consortium of disinterested middle-men control the flow between production and consumption sides of the supply chain, fixation is a natural result. And that natural result needs to be dealt a death blow.

Sorry about your accident and its resulting pain. I sincerely hope you find lasting relief soon.

[Lars39]

4. And consider that in other industrialized countries the entire MRI doesn't

cost what your portion is going to be. We're getting ripped off.

[antigop]

5. I just paid $1,000 for tests

I have insurance as well, for now.

I'm afraid it will only get worse.

[Greyhound]

6. Another reason why single payer is the only way. Thanks for bringing this up again. n/t

[Mojorabbit]

12. I have medicare

and I had a large out of pocket expense for my last mri.

[Avalux]

19. On medicare?

That doesn't seem right - geez.

[Greyhound]

23. Medicare is just as vulnerable to the artificial inflation created by the

insurance/health care denial companies because they operate within that system. I'd also point out that republiks or republik-like Democrats have been in charge of medicare for 30 years.

Remove that influence and see how much we will save, even after expanding coverage to include all of us.

[proud2BlibKansan]

7. I just had an MRI for neck pain

Cost me $50.

What kind of health insurance do you have? Geez, I thought mine was lousy.

[Avalux]

8. Aetna

My employer switched to them on Jan 1; HR Department gushed about how we 'upgraded'. Also have 20 bucks more a paycheck coming out for the coverage. They suck (both Aetna and my employer).

[proud2BlibKansan]

10. We have never had that policy

We had Cigna once and it really sucked.

And hey I have that same neck pain from a car wreck 15 years ago. Didn't bother me at all until 5 years after the wreck. Now I have arthritis and permanent damage. Not much they can do about it either. The pain goes all the way down my arm and my hand gets numb. It really sucks. I hope you have better luck than I have had with it.

[Avalux]

13. Sounds just like me - on my left side.

What do you do about the pain? I haven't had any problems until a couple of months ago; I have a hard time concentrating because the whole left side of my head and down my arm hurts. I don't want to take medication but I don't know what else to do.

[ellacott]

33. I just tolerate it

I don't like to take pills and they really don't help anyway. My primary doctor said she would try and get a Cat Scan instead of an MRI. Maybe they can recommend a CT scan for you too. Have you had an EMG test yet? That test is very uncomfortable and it hurts but it will test the nerves and find out which ones might be damaged.

Chronic pain is a terrible thing.

[proud2BlibKansan]

36. Yes I had an EMG

I didn't think it was that bad.

They have never recommended a CT scan.

[Avalux]

40. I have not had an EMG but may go that route.

I have an appointment with a neurologist next week. :hi:

[ellacott]

42. I had nerve damage in my arm and had an EMG

For me it was very uncomfortable but they were able to identify which nerve was damaged.

[proud2BlibKansan]

35. Chiropractor really helps

Doctor also put me on Cymbalta. It's an anti-depressant but works on nerve pain. It was wonderful. She gave me a month's worth of samples but they are gone now. And we are fighting the insurance co to pay for it.

I also have one of those neck massagers. It helps for short time frames.

But if you are just starting out with this, go to a chiropractor. I was in agonizing pain the first time my pain flared up and the chiropractor worked wonders.

[Avalux]

39. I was told a chiropractor will make herniations worse.

That's why I haven't gone to one. I was given Lyrica but have been afraid to take it because I've read horror stories of the side effects.

[ellacott]

18. I have Cigna for Dental

I work at a hospital and they offer their own health coverage. Certain tests and procedures have to go through pre-certification. I've been having a constant headache on one side of my head for about 8 months. It never goes away. I've been seeing an ophthamologist to rule out any visual problems. Both my doctors are trying to appeal the denial.

Your problem sounds very serious, and painful. It sounds like you have some serious nerve damage.

[proud2BlibKansan]

38. Fortunately it only flares up now and then

I don't have constant pain. But when it does get bad, it lasts for a month to 6 weeks. And it is intense.

I have a little pain spot at the base of the nerve that hurts all the time but it isn't unbearable.

I hope you get your pain issues resolved soon. I know how much this sucks. :hug:

[dflprincess]

45. I've had Cigna for dental for a few years and I've had to fight with them

everytime I've seen the periodontist (which I do twice a year and have been doing so for the last 20 years - they keep saying they have no record of a history of periodontal problems and my DDS keeps sending them the records).

My employer switched to Cigna for medical this year as well and I was ill when I saw even outpaitent procedures require pre-certification. Last fall my mammogram came back odd and I wound up not only having a needle biopsy but a surgical biopsy as well (thankfully, everything was benign). With the insurance I had then, I was just able to schedule all the procedures and forget about the insurance company. I hate the idea that now I would have to ask some low level clerk at Cigna to okay a procedure a radiologist has deemed necessary.

[madinmaryland]

14. Which Aetna plan do you have? (HMO)

We have Aetna PPO and the only thing we have are co-pays.

[Avalux]

16. Open Access Managed Choice.

Whatever the hell that means. :hi:

[ellacott]

9. My Doctor wants me to have an MRI but my insurance is denying it

I have what is considered good insurance also.

I hope you get treatment for your injury and that you're feeling better soon.

[proud2BlibKansan]

11. I had the MRI and the doctor prescribed meds

but the insurance co denied them.

I so hate insurance companies.

[serrano2008]

15. Dump the deductible coverage and get on something with copays

Do you have HMO or PPO? I always get the HMO cause I find that it's way cheaper to just know the fixed amount I'm paying for stuff. Otherwise, after your deductible is up you're always paying 10% or 20% or whatever, so you still have a "copay" it's just more expensive and based on the actual costs rather than a fixed amount.

Good luck!

[Avalux]

17. Can't dump it - provided by my employer. Another reason why

healthcare should NOT be attached to employment.

[DJ13]

20. A few years ago I had an MRI with no insurance

My cost?

$800

Amazing how that works, isnt it?

[Warpy]

21. For profit health insurance is the biggest ripoff out there

because they sure as hell aren't paying retail for those MRIs. The hospital isn't charging them nearly that much for them and what they're passing on to you is pure gravy.

That's something people who haven't gotten sick yet don't realize, that hospitals and doctors who think they're underpaid by insurance companies will just pass the cost on to you. That can really add up if you've gotten seriously ill. Added to the copays it can mean bankruptcy.

I've been uninsured for over 20 years. I do things like haggle with the doc to see if a CAT scan will suffice rather than an MRI, or if Xrays will do just as well as a CAT scan. I've found docs very willing to work with me and lately the hospitals are also cutting their rates, although I do pay more than an insurance company does for the same service.

Hospitals are as bad as the military for padding costs here and there to be able to afford things in totally unrelated areas. That $20 Tylenol after day surgery is going toward new technology in the OR, for instance. What we have is a totally irrational system of pricing, a for profit insurance industry interested only in denial of as much payout as they can manage while keeping the suckers roped in, and a government that couldn't be bothered with any of it.

The sickening truth is that any severe illness will likely bankrupt you, no matter what kind of insurance you have today.

[serrano2008]

24. True! Also,

Hospitals are strapped with millions of dollars in extra fees, rates, insurance, payouts etc. for malpractice and accidental deaths which could be solved with better record keeping and stricter regulation.

And additional millions of dollars for undocumented patients who come into the ER and skip out on the bill.

Single payer, Nationalized health care isn't the answer, because all of the problems at the root of the Health Care/Insurance industry are still going to be there.

[Warpy]

27. You're overstating malpractice and undocumented alien

costs. Both are actually minimal in year to year hospital operations. The former is a rare occurrence that is budgeted in and the latter is mostly covered by government monies. However, they are fine right wing talking points, blaming victims and spouting xenophobia.

A much larger problem is an enormous bureaucracy needed to cope with the Byzantine paperwork of competing insurance plans, all of which are looking for technicalities on which to deny payment. Half the health care dollar is now going to bureaucracy, including an equally large insurance company bureaucracy dedicated to denying as much care as possible.

[ellacott]

29. Malpractice costs are a huge issue with many doctors

OB/GYN and Ortho doctors pay a very high amount every year for malpractice insurance. Some doctors have stopped practicing because they can't afford the malpractice insurance.

[Warpy]

30. But not with hospitals, which was the subject here

but nice try.

Malpractice premiums to physicians were jacked up right after the go-go stock market years in the later 90s when insurance companies wanted to keep making huge profits and the stock market was no longer forthcoming.

Again, the problem is for profit insurance.

[ellacott]

41. Nice try? What are you talking about?

I work in an hospital and do billing and reimbursement. I know what the problem is and I never said for-profit insurance is not a problem. Malpractice insurance is something that has to be dealt with. If you have doctors quitting that does affect hospitals.

Regardless of how it happened malpractice insurance is a huge cost to doctors and it's for profit insurance companies that are dictating the price. Paying 40k to 100k a year in malpractice insurance is a large amount of money to pay.

[leftstreet]

32. Then they should have policed themselves

They had the collective power to force insurers to rate them progressively, based on performance and claim-free length of service.

Instead they saddled their patients with the costs.

[Mojorabbit]

48. Wait a minute

my hubby is a family physician. If someone sues him he has no choice whether or not he wants to fight the claim. The insurance company decides whether it will be cheaper or not for them to settle. Claim free means nothing. A boatload of claims on the other hand...

[serrano2008]

44. ha ha...that's funny

I was just thinking the same thing about your post. Typical of a freeper to ignore the actual argument so they can keep going back to their one main point that will fix all problems in the universe.

"the former is a rare occurrence that is budgeted in" - right, this means we're all paying for it.

"the latter is mostly covered by government monies" - right, this also means we're paying for it, and not just for "illegal aliens" but for anyone not paying their bills or uninsured and paying less that cost, which are all transferred to those of us who can pay for it.

And I did misstate both amounts as both are actually in the Billions rather than the Millions.

No matter what system is used - current, for profit, non profit, single payer, national - all of the paperwork is still there, the confusing codes are still there, and there's still gonna be some a**hole trying to NOT pay your claim.

[Warpy]

47. And there are still going to be lonely elderly people

with tummyaches a spoonful of milk of mag would cure calling an ambulance just for some human contact. That happens with socialized medicine, worldwide.

However, which is better, tolerating a few deadbeats and people who misuse the system or denying a third of your population adequate access to health care?

That's the choice we're facing in this country and I'd much rather have the former.

[wolfgangmo]

22. Try this - advice from a clinic owner

Call some MRI places and tell them that you want to get some MRI's done and you will be paying "out of pocket." After you get that then get a prescription from your doc for the procedure and then contact the insurance company and see if you can get reimbursed for services. Get ANYTHING an insurance company says IN WRITING.

You may find that the price on the MRI will be low enough so that you can afford it now. The reason for the difference in price is that the insurance companies also gouge the MRI places and the docs. They can afford to give you the MRI at a lower cost IF they don't have to deal with insurance.

Good luck.

[Vinca]

25. It's curious people think they have "good" insurance.

Get a serious illness and go over the maximum for the policy and see how good it is. There's no such thing. We need guaranteed, government-sponsored healthcare.

[Avalux]

28. It's taken for granted until something happens.

I'd still be oblivious if I wasn't having a problem requiring more than an office visit. We need something better than what we have - and it needs to be separate from employment status.

[Cleita]

26. So do I. It's called Medicare, but it's hanging on by tatters and in need of

modernization and an overhaul. I can buy supplemental insurance to cover the deductibles and co-pays. It's too bad supplemental insurance is no longer offered to workers under group plans to purchase for that reason. Of course, there would have to be legislation requiring insurers to operate like the Medicare supplements.

[raccoon]

31. Sorry this is happening to you, sparo.

Health care in the US is a friggin disgrace.

[Avalux]

34. Thanks.

We hear numbers about the uninsured all the time, but what about people like me who have inadequate coverage; who can't come up with several hundred bucks and forego treatment? The American people should be demanding reform but have been brainwashed into thinking a single payer system is akin to socialism and is bad.

[raccoon]

37. Yes, and all those American people will change their minds about that when

(a) they lose their medical insurance, or (b) their children/grandchildren lose their medical insurance.

[orleans]

43. well, it's better than mine. here is what my insurance looks like:

[dflprincess]

46. Do have a prefered provider (PPO) policy?

And, if you do, is the radiology facility on the PPO list? And, if it is on the list, did you get the prices that the facility and your insurance company have agreed on?

Last fall I had some healthcare adventures and the "gross" amount on all my claims came to nearly $10,000. Because of the agreement between Blue Cross and the facility, the amount actually due was about $4,500. I also had a $250 deductible and a 10% "coinsurance" pay. The coinsurance was was applied to the $4,500 not the $10,000.

This is another way the uninsured or under insured get screwed - they'd get nailed for the ten grand.