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  1. #1
    Senior Member cyclezealot's Avatar
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    US HMO's(hospitalization) stink !

    I really am anxious to get on with my present medical condition. I have two torn ligaments in my shoulder . Almost five weeks now. So far, took the doctor one week to get up the courage to go through physical therapy and order an MRI. Another week to get insurance clearance to get the MRI. Couple more days to schedule the MRI..
    About 5 days to process the MRI data. Almost five weeks, now waiting probably another week for authorization to see a specialist. Then wait for his schedule and consulation. Then be another week to get authorization of his likely request for surgery.. Then more time to schedule and wait for the actual surgery . I have heard that could take one month. So maybe at worst surgery will be six weeks from now?
    After two weeks, I could not take it. I am out on the bike. On my hybrid straigtening out my arm on the higher handle bar makes it feel good for awhile. When hanging at the side listless it feels like it might cramp, so keeping it straight on the bike is good, as long as I do not crash. 38 mm wheels, and I am really cautious.
    I am getting in enough bike time between the trainer and the hybrid, I am so far not loosing muscle mass. Another worry, if they find I can't do some of my duties at work how that will play out. Put me on light duty, I will suffer financially.
    So my other anxiety. I am signed up for a bike tour in late September. I will do it. 420 miles. I will cross that state even if I have to cross it with my arm in a sling..
    How does your medical insurance compare with this.? Particularily in other countries.? here in California we know our medical plans stink.
    A PPO plan would mean we would have to pay 30 % of actual medical costs, out of pocket. Might have to mortgage the house. That is no good.
    Our nephew says in Spain, where they used to live- we would have had an MRI within the week, since they are not so rediciliously expensive as here. Probably in Spain I would be two weeks into my recovery by now.. Other concern. I have to constantly stretch out the arm to stop it from freezing up. Fun.

  2. #2
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    What insurance company do you go with? I'm just curious, because when I finally get my next job, I plan on going with BCBS.

    California healthcare is crazy... but then again, healthcare in the USA is crazy in general. My father is ill, and the run around he gets sometimes is insane. C'mon, he's old and sick already! Sometimes I think they're just stalling because they hope he'll just drop dead and they can avoid paying any bills at all. And this is after he spent 34 years working as a federal employee for the government. Some thanks.

    Any chance you can switch doctors and try to get another doctor who is more aggressive?

  3. #3
    Kev
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    Honestly it is only half of what insurance company you have, the other half is who carries it. A small company you won't get near as good coverage as with a larger company. My ex-wife had to have a leap(sp?) procedure done a few years ago, and she started hemeroging(sp?) really bad so they rushed her to the emergency room. Well because she was under a paticular HMO that did not cover blood transfusion they never checked her blood, it was so low she had migraines for over a week and could not work for almost 2 weeks.

    My mom works for school district she had excellent insurance, was a PPO covered 90% of everything, we paid first doctor visit $60 and never paid a dime after that. Last I heard though they changed her deductible or whatever you call it is $600 a year for the family. You're company in a way works out their own deal with the insurance company to cover this and not that etc.. Basicaly if you get sick ALOT a PPO is normaly cheaper and more efficient but if not you are better off with a HMO. There is no good solution in the US for medical insurance except dont' get sick. I live in california to, not sure if it is bad in other states.

  4. #4
    A Heart Needs a Home Rich Clark's Avatar
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    I've had two HMO's recently. For many years I was a member of Keystone (which is a Blue Cross HMO) and they were great. I've had a lot of health issues -- major surgeries, ongoing cardiac care, broken bones, arthritis, and more -- in the past several years, and there has never been a problem with coverage, immediate approvals, tests, anything.

    Part of it is having a primary care physician and office staff that understand how to "work" the system, but the company itself has a lot to do with it.

    I say that because for a few brief months, while my wife was changing jobs, I had to go on my own employer's insurer, Aetna. And I had the same sort of bad experiences as you -- an MRI that was ordered by a specialist was turned down by the insurance, and by the time the doctor and the insurer worked it out and the test was finally scheduled and performed, I'd been in a great deal of pain for several weeks. I've had problems with prescriptions, "stealth" co-payment bills, and other issues that have less to do with the letter of the coverange than with the company's attitude. It alsways seemsed like Keystone's default attitude was that they would take care of me, whereas Aetna seemed to be in the business of denying everthing.

    Thank God, my wife ended up back in the employ of the immense University of Pennsylvania Health System (aside: UofP is Philadelphia's single largest employer) in another part of the system, and we have our old coverage back now.

    RichC
    Training: 2002 Fuji Roubaix Pro (105 triple)
    Commuting/Daytripping: 2001 Airborne Carpe Diem (Ultegra/XTR, touring wheels)
    Commuting/Touring: 2000 Novara Randonee (Sora/Tiagra/LX, fenders, lights)

  5. #5
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    Aetna sucks. I had them for a while, and I'm still fighting them to pay the bills. I'd rather have no insurance than have Aetna. :irritated

  6. #6
    Jungle lady cbhungry's Avatar
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    Petition your company to work out a better contract with the HMO. HMOs do not listin to doctors or patients, they listin to the companies purchasing them en masse. A 56 year old female had metastatic melanoma and Aetna would not pay for the experimental treatment that was probably her only hope. They said she needed to be in hospice. After she died, her work place director got gist of what happened from us and promptly fired them and went with another one. Aetna promptly lost at least 60 million in business just from the loss of their business. They do not want to lose that kind of money so many are starting to perk up their ears when the purchasing company complains.. By the way, this is just a taste of the delays iinherent in socialized medicine. (The average hernia repair in England puts you on a year long waiting list if the designated funds for your district has run close to its budget at the time the injury was incurred.)
    Ride forever, work whenever.
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  7. #7
    feros ferio John E's Avatar
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    Although I work for a small (25 employees, going on 30) telecommunications startup company, we have very good health insurance, with a choice of a PPO and an HMO, both through HealthNet. Personally, I detest the entire paternalistic gatekeeper concept on which HMOs are based and strongly advocate PPO or POS (traditional point-of-service) plans for anyone who can afford the higher premiums and deductibles.
    "Early to bed, early to rise. Work like hell, and advertise." -- George Stahlman
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  8. #8
    Senior Member cyclezealot's Avatar
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    Koffee.. Mine is one of the Blue Cross/Blue Shield HMO's.. Our company polls our members, base of 1600 to sample from for feedback as to quality. They do fair in that annual polling.
    I trust my new doctor.. I think he is trying.. Procedure, takes a week for each approval and there is no hurrying that up. So easy to see, it will take at least three approval procedures and wait imbetween for scheduling appointments..
    Another 3 weeks minimum to get to the surgery stage and 6 weeks complete recovery time after that; it is getting close to my planned bike tour across Nevada.

  9. #9
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    I was thinking of going with BCBS with a PPO and the top line insurance with the lowest deductible. I'm just figuring that the time will come when I really need the insurance, and when it happens, I don't want to get screwed because my company was trying to save a few bucks because they couldn't be bothered with getting quality insurance.

    Glad to hear your company cares, cyclezealot. My company really didn't- we got our insurance through the payroll company that provided all the human resources, and the payroll company controlled which insurance company we ended up with. I heard the payments just went up like 30%, but it's the same quality service. Go figure. :confused:

  10. #10
    Senior Member cyclezealot's Avatar
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    Koffee. My company does care, I think.. But, there are price tag limitations and medical coverage out here is going up at least 10 percent a year, last I read- if not more.

  11. #11
    Crank Crushing Redneck SamDaBikinMan's Avatar
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    These pleasantries you experienced will only get worse when people like the Hildebeast (Hillary Clinton) get their way.
    [SIGPIC][/SIGPIC]

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