There are always at least two ways to look at any situation. After a really tough summer with my MS, I am thankful that I'm ready to get back to work, ie. focusing on my health and wellbeing. I will be starting back to physical therapy soon and am doubly thankful that my insurance does pay for that treatment.I like that photo above - a horse and zebra mix. A dichotomy in one creature.
Life is full of dichotomies which coexist peacefully. Today, I'd like to do something different. I'd like to ask you to answer a few questions. The result of which will show the differing opinions and experiences of the members of our community.
Here are the questions:
1. How many doctors do you have and how often do you see each one in a year?
2. Do you have health insurance? If so, how have you obtained it? ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?
3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?
4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?
5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?
6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?
7. What are your greatest HOPES when it comes to changes in how health care is provided?
Bonus questions:
Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)? Have you read any of the proposals? If you were "ruler of the world" how would you change things?
Please keep the conversation civil. No talk of "death panels" or "angry mobs."
I thank you in advance for you responses.
Please go to HealthCentral to comment (even if anonymously):
Gratitude Friday and Health Care
I'll only answer the first question.
ReplyDeleteI have three doctors, a family physician, a neurologist and a psychiatrist. I see the family physician at least once a year, but this year I've been there four times. I am newly diagnosed with MS, so this year I will see the neurologist 4 times, at least two times next year, and hopefully only annually after that. I see the psychiatrist every 4 months. (this is all relapse dependent)
I also have access to a relapse nurse, physiotherapist, social worker, nutritionist & a opthamologist. I haven't been to the nutritionist or the opthamologist yet this year, but will see them before the year is over. I've been helped by the relapse nurse and social worker at least once a month since January, and I was just with the physiotherapist a few weeks ago. I follow up with her in October unless I have a problem before that.
OK
ReplyDeleteI'll skip the questions but for the record...
ReplyDeleteWhile the rumors about limiting health care to certain people are rather unfounded, I am for it. In other words, as the planet warms and we run out of resources, as an MSer I am unfit for survival so give my healthcare, my shade and my food to those who will survive. Sounds depressed but it's not. If there is someone with better chance of survival at less cost, let them have my share. Should my life be limited, so be it. I am an unimportant pebble in the vast pond of humanity.
1. How many doctors do you have and how often do you see each one in a year?
ReplyDeleteNeurology: Dr. Generalist – 2x’s per year
Neurology: Dr. Specialist – 3 to 4 x’s per year
MRI folks – 2x’s per year
Chiropractor – 1x/month
Dentist – 2x’s/month
Family Dr. – approx 3x’s/year
Dermatologist – 3x’s/year
OB-GYN – 1x/year
Geneticist – as needed (rarely)
Physical therapist – as needed (depends on the year and how things are going with my joints)
2. Do you have health insurance? If so, how have you obtained it? ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?
Yes, I’m gratefully employed by the U.S. Government, so I have a fantastic selection of healthcare providers. Wish you all had the same choices I do! I picked Blue Cross/Blue Shield, Standard Option, family plan. I pay for supplemental dental and vision care as well.
3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?
I pay for coverage for my family, so the cost is high. The government pays $352.56 and I pay $164.58 bi-weekly. The annual deductible is $300 per member per calendar year or $600 per family each calendar year. I pay $20 per dr. visit, no referral required. Pharmacy benefits are more complicated. For Copaxone, I do mail-order and get 90 days for $65 (although Shared Solutions just wrote me that they are going to pick up the tab for a max of $50/month, so bye-bye co-pays, I think. WAHOO!) From a standard pharmacy, I pay 20% of the BC/BC Plan allowance. It’s 30% for brand names (this gets really pricey, especially for my dermatology drugs!) Dental is a royal pain and I’m not even sure where to go with that. There’s a max. of 45 physical/occupational therapy sessions per person, per year. Chiropractor visits are limited to 12 per year unless there’s a proven need that more are necessary. Inpatient hospital care is $200 per admission, if a preferred hospital, $400 if not. Outpatient is 15% if preferred and 30% if not-preferred.
4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?
1. I can go to any doctor I want, whenever I want.
2. Most hospitals and doctors take BC/BS
3. I can use it wherever (unlike an HMO that limits by geography).
5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?
1. They won’t cover anesthesia for dental work for my children, so we’ve spent thousands on things they really should have paid for.
2. Medication gets very expensive, as do MRI co-pays
3. It’s a giant pain in the a$$ to coordinate my dental and medical coverage.
6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?
1. Ever-rising cost of premiums and rising co-pays.
2. If I ever lose my job, I’m terrified of not getting insurance because of a pre-existing condition. I’m very worried that my little one will have trouble getting insurance because she has a diagnosis genetic syndrome (Ehlers-Danlos).
3. Good docs are harder and harder to find, especially in some areas because of malpractice insurance.
7. What are your greatest HOPES when it comes to changes in how health care is provided?
1. Wish everyone had the same choices I have
2. Denying coverage because of pre-exisiting conditions should be considered discrimination, as should dropping people’s coverage when they become ill and need it most.
3. Everyone should have access to high quality care.
Bonus questions:
Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)? Have you read any of the proposals? If you were "ruler of the world" how would you change things?
I should know the answer to this, but it’s late and I’m sleepy :-)
Great questions! Can't wait to see what you learn.
Ivy
Oh wow.
ReplyDeleteI'm not part of the MS community, but my answers are so different, they are so different I'll answer briefly just to highlight the disparities -
Two doctors (GYN and Internal Medicine), see GYN once a year, IM doctor about three times a year. GI referral for colonoscopy (x1). Orthopedist referral for shoulder pain (x1)
Health insurance paid by employer at no cost to me. No premiums. $100 deductible per person, $300 per family, $5000 out of pocket max per year; $15 office co-pay; 20% co-insurance (I think) prescription coverage at $5 generic, $10 Brand name
Appreciate: cost (nil), able to select who and why I see a doctor, medication coverage and no denial for pre-existing conditions
Dislike: nothing
Concerns about changes to health care: afraid I'll be forced into a plan that covers less and gives me less choices; a fear that a public option would soon become the only option as private insurers opt out (why stay in business if there is a public option?) - mind you, these are fears and not based on facts
Greatest hope - that somehow the coverage I have through a private insurer can be available (and affordable)to everyone; as good as I have it, if I become disabled I am 8 weeks away from premiums of over $2000 a month.
Perhaps, I shouldn’t wait to answer the question myself. I wanted to give everyone else a change to respond without the possibility that my views might alter those responses. But here goes:
ReplyDelete1. I have several doctors whom I see during a year. You can read my summary of one year’s annual expense in living with chronic illness.
- Primary care doctor - typically once or twice a year
- Neurologist - every 4 months unless problems occur
- Rheumatologist - every 4 months unless problems occur
- Opthalmologist - once a year unless problems occur
- Dentist - twice a year
2. Yes. Since I’m self-employed, I obtained an Individual health plan from the largest/leading non-profit health insurer in the area. It is a PPO and I have no other options for insurance.
3. Monthly premiums are now $431. I have a low deductible of $100 each for medical and pharmaceutical coverage. Out-of-network deductible is $300. Doctor’s visit copays are $25 and coinsurance rate is 10% (30% + difference in billing for out-of-network). I have prescription coverage which is capped at $1500 each year. My drugs alone cost in excess of $30,000 each year.
4. I appreciate that my doctor’s take this insurance coverage (if not, I have had to leave them). I appreciate the guaranteed renewability. I appreciate the low copay and coinsurance (although 10% of $6000 for an MRI is a bit painful).
5. I hate the limitation on the prescription coverage. I hate the limitation on the prescription coverage. I hate the limitation on the prescription coverage.
6. I worry that changes will be so minimal or incremental that they won’t truly help those patients who are in my situation. I worry that national standards will not be made at the federal standard to indicate the basic level of coverage which everyone must have regardless of health condition or gender. I worry that reimbursement regulations may become even more complex that doctor’s will cease to participate in any insurance (third-party payor) system.
7. I have hopes that finally I will have choices and protections. I have hopes that the rate at which health care costs are increasing will be decelerated. I have hopes that increased funding and incentives will provide for a stronger system of primary care and preventative medicine.
Yes, I am aware of the various proposals introduced in Congress this session. You can find a customizable side-by-side comparison of the plans on the Kaiser Family Foundation website.
After posting this, I attended the Town Hall meeting of my district’s Congressman. The atmosphere was disrespectful and disruptive, from both sides of the political/philosophical divides.
I’m all for freedom of speech. But I’m also for staying on topic. Civility and lack of self-control was sorely lacking at this event. You can read - Town Hall and Health Reform Circus - for details.