People living in USA. Please come and talk to me about health care.

[ilovemydogandMrObama]

It's been about 10 years since I lived in the USA, and my mom is a doctor, so didn't really have to worry pay much in insurance.

How does it work with children? Prescriptions? Deductible and co payment?

DS gets hypoallergenic formula on prescription and DD has asthma, so both are pre existing conditions....

How much are GP appointments? Am wondering about an HMO.

[tadjennyp]

Well I think she deserves it then

[marenmj]

oh yes, and I am also about a pool... I desperately wanted a water birth but DD was deemed high risk when I went in and they wouldn't let me near it.

[marenmj]

fingers crossed for you

very about the diamond necklace - not so much about the 9 years of ttc and 3 mc's before she had her DC, so not really begrudging a little celebration on their part.

[tadjennyp]

Had a fright yesterday when dh forwarded a load of forms from HR about changing insurance but on closer inspection we don't have to change. I know I've not been impressed with them but I was suddenly scared witless that a new company wouldn't accept my pregnancy as a pre-existing condition. Phew! Luckily dh's company is also absorbing the 9% rise in medical costs so our premiums don't go up. V generous! I have my booking-in (intake) appointment with the nurse in a couple of weeks so hope to get some more info about the system here in Oregon.
at diamond necklace - I gave birth to ds in a pool too!

[marenmj]

yes, #1 reason for bankruptcy in the US is medical bills, with the vast majority of those people being employed WITH insurance. Healthcare is a shitstorm of epic proportions. Living in the UK, I used to get furious when family members would email around outright lies about the reality of socialised medicine (DH's family leans towards the "libertarian" set - except of course when out stumping for Prop 8 ). Oh, and for a very blood-pressure-rage inducing video, the Daily Show had a very good one of Glenn Beck saying that the US healthcare system was irretrieveably broken following a (minor) op he had and then his "best system in the world" speeches 18 months later. Absofuckinglutely ridiculous. I would laugh except I know that DH's family listens to him and buys his books (he's mormon, so he MUST be trustworthy!), so it just makes me terribly sad.

Anyway, just thought I would report back as we've made a bunch of appointments for all of us to see GP's under our HMO and apparently on this one there is no co-pay since they are in-network.

Sorry to hear you've been having a rough time, tadjennyp. If it makes you feel better, DD was born in Twickenham (where the c-section rate is something like 37%) and I was equally paranoid that I would be section'd without, er, due labour . I was seriously considering going in to hospital with a note pinned to my shirt telling them not to section me under any circumstances!

I know a couple women who have chosen to have their babies in a birth center rather than hospital because it's MUCH cheaper and they won't pressure you to take the medication. I'm personally on the fence with those since one of those women is the type who had a perfect, soft-focus, water birth that took 3 hours start-to-finish, with no painkillers, that she likes to wax poetic about. Her DH bought her a diamond necklace as a "birth day" present afterwards. After labouring for 26 hours all I got was a load of stitches!

[mathanxiety]

The only people who couldn't see the wisdom of the public option were those who never held a low paying job, unfortunately. Medical bills are the number one reason for people filing personal bankruptcy in the US, I have read somewhere.

[jabberwocky]

Actually, if you are out of work, you can get Medicaid. It's the people in slightly lower-wage jobs who have the biggest problem earning too much for Medicaid but not enough for individual plans. That's why I was for the public option in the new bill.

[tadjennyp]

Yes, it's funny that my friend and I arrived two years ago and we've both had lots of problems with the insurance company! (Not the treatment, or access to any providers). At one point we were both phoning them so often that the girls would ask if I was Mrs X (my friend) and she'd be asked if she were me! We must have been the only two girls with British accents phoning them to
say, 'but you said you'd pay for this and now you're not!'
They refuse to send any written confirmation of the information they give by phone - is this standard? And their policy of not paying for anything they haven't authorised even though they're only open 8-5 in the week is just immoral imho. But like I say, I'm quite willing to believe that it's my insurance company that are a pile of shite and not that the system itself is irrevocably broken. (Unless you're out of work and then you're stuffed if you fall ill).

[jabberwocky]

tad, I know that kind of thing can happen with insurance companies but in 25 years of paying for my own insurance I've really never had a problem. Honestly, some of the biggest companies are the worst, like BCBS. You do have to dig in with them. But others like Mutual of Omaha, American Medical Security and Golden Rule are very good ime.

[JJ]

Sorry - that's unclear. I had a somewhat difficult birth and a c-section was a viable option. Had I not had such an excellent and sympathetic ob/gyn, I would have had one.

[JJ]

tadjennyp - just to reassure you, the only reason I didn't have to have a c-section when having my son in the US was because of my lovely ob/gyn who knew how terrified I was of one. Ask around and see if you can get a recommendation for someone. Women are usually quite willing to discuss their doctors; it's a good conversation starter as well.

[tadjennyp]

Let's face it, certain news corps run by a Mr R Murdoch? like to sensationalise anything to hammer home their points. I have to say that I have had excellent care from all my providers in the US in the last 2 years, but then again I must have been lucky and was pretty impressed with almost all of the ones I saw in the UK too. I lived in Germany for a couple of years too and you have to pay for health insurance there. I paid student rate and had access to any doctor I wanted or needed to see at no extra cost. I liked that system!

[mathanxiety]

Usually there's a website with preferred providers or some such list. But you have to contact the doctor and find out from them too, and double check when you go for the appointment.

According to Fox "news" coming up to the healthcare vote, people die in the streets of Britain waiting to be seen by the terrible, incompetent NHS-payrolled doctors. Apparently, it improves a doctor's professional ability by about 500% if he or she is paid by an insurance company, run for profit by MBAs. And apparently, nobody in Fox "news" has ever had any coverage denied because of pre-existing conditions, or had to fight for D&C coverage (I had to do this too, Tadjennyp).

[tadjennyp]

Don't get Fox News fortunately! Listened to the radio show for a little while just to get a different view as he seemed to be quite popular.

I'm certain the care will be absolutely fine, it's the insurance company that are the problem. You know, you phone them and ask if you can see such and such, they say yes, then you get a bill, you phone again and they say, 'oh no, don't know who told you that!' They've done that to friends on a regular basis too. One friend's son needed a heart scan which they paid for then a couple of weeks later another friend was referred by the same doctor for the same thing and they were refusing to pay for ages. I am quite happy to believe that we just have an awful insurance company but that's what's worrying me really. Sorry to completely hijack this thread. I bet there are good insurance companies out there too!

[SatinandTat]

OK Tadjennyp firstly stop watching Sean Hannity. He is a total twat, along with O'Reilly and all the other idiots Fox News employs. They are aiming at the lowest denominator or society. There got that off my chest. My experience of American child birth was fabulous. The midwife stayed beyond her shift so she could see my baby, I had a wonderful obstetrician and wrote my birth plan exactly the way I wanted things to be. I was induced and in labor for hours and hours. At no point did anyone suggest a c-section as my baby was in no danger. As for the bills, well we paid very little as we had great insurance that covered most things - I am so sorry I cannot be more specific but it was years ago. We were obviously in a very fortunate position with the two of us working for a huge corporation that had a good insurance scheme. Sorry I seem to have left the original intent of the thread but I wanted to reassure you.

[tadjennyp]

I hope so. The trouble is that people only tell horror stories as they are the most interesting, aren't they?! No-one wants to hear about the time you went in to the hospital in labour, got the same midwife all the way through and gave birth without pain relief in the pool, the way my youngest was born! The way you hear some people talk about the NHS here, no-one gets any treatment ever and if they do, it's all substandard! It does have its problems, but it's nowhere near as bad as the Sean Hannitys of this world make out, having never set foot in a UK hospital!

[jabberwocky]

I know the rates are said to be higher but in actuality I don't really think so. Plus, you always get a private room and the option to use the nursery. And no one would ever dream of forcing you to take a shower unassisted if you felt you needed help. Since I haven't used the NHS I obviously can't say for sure but 6 years of comparison via MN has told me a lot. I think you will be pleasantly surprised.

[tadjennyp]

To be honest, I've always been pretty satisfied with the NHS and I'm quite worried about having this baby here in the US Jabberwocky! C-section rates seem to be higher here and I don't want any intervention if I can help it!

I don't think my insurance company has many providers in network so I have to be so careful who I see. It would be nice if they could be open outside of office hours to check whether you can go to x or y provider. My friend (who has the same insurance) had a miscarriage on Christmas Eve and couldn't contact them. She had to go in for a D&C on Boxing Day and has had to pay several grand as the insurance has assumed it was an abortion as that is the same procedure. She doesn't want to fight it because she was heartbroken about the miscarriage, but I don't trust the company at all.

[jabberwocky]

earlybird, yes you can definitely barter. Although they will not for the most part tell you that up front I know many people who get their bill substantially reduced afterward. The thing is, the insurance companies demand a huge discount on everything so costs have to be inflated so they can then be discounted. But afterwards, on an uninsured person the hospitals are generally open to negotiation. On the whole, I really don't think it's that bad for the average person who is relatively healthy - and with the new legislation things should get better for those with pre-existing conditions. The things I have read in my 6 years on MN regarding the NHS make me shudder. I know the US isn't perfect but I've been pretty content for the most part.

[mathanxiety]

The costs can be huge, though. When DD2 was born the hospital sent me an itemised bill for something between $24,000 and $25,000, for a delivery that took 40 minutes from when we arrived at the hospital door, with no pain relief, no anesthesia, and just a resident on duty, and I left 24 hours later. DD didn't even spend time in the newborn nursery.

The OB/GYN bill for the prenatal care came later, but that was also covered 80/20, and we also paid in installments. The hospital bill was just a courtesy bill, as we had insurance at the time, and the insurance paid 80% in the end. We paid the rest in increments.

WRT Medicaid in its various forms most states are either bankrupt or almost bankrupt. Many are way behind in payments to doctors and hospitals, and everyone else who does business with them. Doctors do not have to accept Medicaid patients in some areas they are few and far between, and many of course stop seeing Medicaid patients when they don't get paid, and only see self-pay or insured patients. It can be difficult to find someone willing to accept your Medicaid coverage.

And unless you are a citizen, have a green card, or are an undocumented pregnant woman, you will not be eligible. The type of coverage that you can get if you're pregnant is not the same as regular Medicaid. Regular Medicaid coverage has strict income limits. Pregnancy coverage has income limits afaik, but is available even if you have insurance but that insurance doesn't cover maternity care. When your baby is delivered, the coverage stops after a certain period and you have to apply for regular Medicaid.

[mloo]

I was born in a Kaiser hospital (1967), my mom died in one, and my other folks are still with them. Can't complain. They've been good for us, but our health package comes thru a local govt. (County + State) employer, which may make a difference.

[marenmj]

many hospitals also bill one amount for insurance and a different amount for cash.

I don't think it's so much that they expect to barter, but that the price structure is set at something inflated for insurance, but they agree to a smaller portion for people who pay themselves since the know that the alternative is getting nawt.

Usually they will also agree to a monthly payment plan arrangement, iirc.

[Earlybird]

FWIW - my Bil went to the hospital accounts office the day his Mum was discharged. He calmly told the clerk that they'd only pay 60% of the bill (the part not covered by insurance), and the hospital agreed without argument!

It seems many hospitals almost expect to barter on the bill - at least according to my BIL.

[ilovemydogandMrObama]

Wow. A lot of information there. That's me busy this evening! Thanks so much .

I like the idea of HMOs, but maybe in practice they aren't great?

Am rather traumatized by the whole issue of health insurance as my dad was in a car crash (uninsured) taken to nearest hospital, spent 13 days in intensive care. every day the doctor said he would be helicoptered to county hospital, when they thought he could be moved. Unbelievable. There he was on life support, unconscious, and the doctor was talking to me about how I was going to pay for it. Oh, and I was 16 years old.

at 'Don't know what happens to those who exceed their allowable amount...' It makes you wonder though...

Riven, you have my mobile, and were going to text me when you found your diary?