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Health Insurance Woes

Rosie

Supreme Senior Member
Challenge Host
Stewart was supposed to be getting his permanent prosthesis today. When he went to get it fitted he was told that it could not be completed yet because the insurance company were refusing to pay for the type of foot that would be best for Stewart to walk normally again. Their reason; he will always have to walk with a stick anyway. First of all, how can they possibly know that. Secondly. he can already walk short distances without a stick. The prosthetist took a video of him walking without the stick and we are hoping that they will reconsider. Needless to say. I am not very happy at all. For all its faults, I really miss the NHS in England.
 

Robyn

Administrator and Grand Pooh-Bah
Staff member
Oh Rosie, you really need this crap don't you!! From the little I know of the U.S. health insurance system, it's not good. I hope you can get it all sorted out in your favour.

I don't know how Australia's private health insurance measures up to the rest of the world, but I know it's expensive. We pay $400 per month for private health insurance (and the cost increases every year!) and that only insures you for hospital visits and expenses associated with that hospital visit. Included in the $400 is payment for 'extras', i.e. part payment of things like dental, optical etc. etc. For anything not associated with a hospital visit (i.e. G.P. visits, X-rays, MRI etc. etc.) the government pays a small portion and you can't claim these sort of things on your private health insurance.

If you are on any sort of government pension (which we will never qualify for) you are given what is known as a health card and you get everything really cheap, including medications etc. My husband and I both have various medications which cost us approx. $150 per month. If we had a health card, it would probably cost around $30!!
 

doglvr49

Esteemed Senior Member
We recently went on a U.S Medicare Advantage plan through my former employer - pretty low premiums The benefits look really good on paper but I have a healthy skepticism. I'm on a couple of very expensive medications and the insurance covers them pretty well so far. I always sort of worry about the future though. Sorry you and Stewart are having to go through this Rosie.
 

Grace

Supreme Senior Member
Challenge Host
Rosie, sorry to read about the health insurance problems. Hopefully the insurance company will reconsider its decision and Stewart will be fitted with the best foot to walk normally again.
 

Poppy

Supreme Senior Member
I'm sorry your having problems with your health insurance hopefully they will see that Stewart needs this and allow him to have the prothesis that is most suitable for him.xxx
 

Barb

Esteemed Senior Member
Oh sorry to hear this, Rosie. Hopefully they will reconsider once they see the video. xxx
 

KimR.

Administrator and Supreme Senior Member
Staff member
Challenge Host
That makes me furious, Rosie.:mad::mad: I don't understand how insurance companies decide things that go against what the doctors and other trained professionals order!
 

Anita

Esteemed Senior Member
So Cold-Hearted...You pay your insurance and they hate paying out.... I hope it gets sorted Rosie ♥♥♥
 

Pekarokiki

Esteemed Senior Member
Oh Rosie that's awful.....I think though the NHS has had its day, waiting times for any procedures, even getting a GP appointment is abysmal here - think Mary is testament to that. My eldest son was rushed into A&E in November with gastric problems, he was told he needed a scan and possibly camera. He was sent home in agony and told he would be sent an appointment for later that week.........he has since gone private, seen a consultant, had the scan and camera and had the procedure done - he is still waiting to hear from the hospital with an appointment!!!
I really hope that you can get things sorted for Stuart xxx
 

Rosie

Supreme Senior Member
Challenge Host
Wow! That sounds worse than the system here Robyn. Stewart is on Medicare which is free but it does not cover everything and only covers 80% of everything else. Because his insulin was costing over $300 per month we decided to get Part D Supplemental Private Insurance. It seems that they then take over the administration of Medicare. It is they who are causing the problems. At least, though, the insulin is a lot cheaper. LOL

I am not nearly old enough for Medicare so I have to have private insurance. The problem is that the only insurance I can afford has an extremely high deductible. That means I have to make a lot of doctor visits and pay for the costs out of pocket before the insurance kicks in. Guess what! I can't afford to do that.
 

Rosie

Supreme Senior Member
Challenge Host
We have that too. It certainly cuts the cost of prescriptions but it seems that there are drawbacks as well. xxxx
 

Rosie

Supreme Senior Member
Challenge Host
Well it has been over twenty years since I used the NHS and it seems that it is falling apart in some areas. What a shame! Having said that, both my Mum and brother have nothing but praise for the system and the treatment they have had. I really hope it does not disappear altogether. xxx
 

Sue C

Esteemed Senior Member
I am soooo glad I live in Canada ... each province has their own health system but they work similarly .... everybody gets the same care (on paper anyway lol) .... we walk into a doctor's office and it's payed for, ambulances for real emergencies are paid for .. hubby has used an ambulance a couple of times for heart issues and we've never been billed .... hospital physio is paid for after surgery ... since we've retired most of our drugs are paid for as well, although I do have one that costs me $30 a month .... there is a long wait time for most specialists if it's made by our family doctor, if it's made by the hospital it's shorter....we do have a private plan for our dental, physio etc and the dental is just basic but it's about $150 a month so we are so much better off than many countries. We fuss and complain about it at times and it could be better but if we are sick it doesn't cost us to get better (although taxes are high for it).
 

JodyT

Senior Member
Thats just terrible. They are heartless in my opinion. All about money not about the person.. In my opinion Australia is the same.. Waiting lists for public health are ridiculous. I waited too long to get my private health insurance and now am paying the back premiums, just for me I pay AUD$323 a month.. Thankfully my husband is a return serviceman and is covered. I hope sense prevails and Stewart gets what he NEEDS not what they want to give him. I have my fingers crossed for you.
 
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