6 hours ago, jcomm said:

Late to this thread, but wishing you all the Best!

Keep in that positive mode against the adversities and you'll get through it !!!

 

3 hours ago, Mike A said:

I’m sorry, but I’ve just got to ask…do you have any problems with insurance?  With your record, I wonder if you’ve made it onto some secret insurance industry blacklist 🤔?

Thank you so much @jcomm I really appreciate it.

 

@Mike A No, no blacklist however insurance is a very sensitive topic for me.  It is simply legalized organized crime in my opinion.  Like anything else important to me in my life I have had to educate myself as to their methods, the 3rd party providers they use to deny claims, the appeals processes, the verbiage and I almost went bankrupt when I had to sue BC/BS because they pre approved a 12 hour anterior/posterior fusion and then paid $1,875 on a $231,000 bill and claimed it was their UCR.  It was like $20/hr for everyone involved.  It was disgusting.  I had a sheriff knock on my door at 4am to serve me with the papers from the surgeon and rather than declare bankruptcy I went after BC/BS and won but it took 6 figures and over a year in court.   

They operate on a deny first and hope people don't appeal model but in most cases when you have irrefutable medical proof from even their Dr's AND you have done the ages of tests, injections, nerve burns, PT and EVERYONE has the same assessment thing usually get done, it's just a horrible system which inevitably someone is left to overcome when they are at their lowest already from a health perspective.  I do not have a high personal opinion of these people or their profiting off minimizing the care they have to actually give people.  Then there are the hospitals and providers who have their "pre-negotiated" rates with insurance companies but a private individual should pay full price.  So insurance gets a $81,000 bill and pays like $30,000 but if I got the same bill I have to pay the full $81,000, the system is just fundamentally flawed and insurance companies are like untouchable mob kingpins.  

The no denying pre-existing conditions combined with the upfront pricing and no surprises acts are two of the better things to happen to healthcare recently...

  

Edited May 15, 20251 yr by psolk

Hey Paul,

Totally agree with insurance being legalized organized crime.  My wife owns a specialized physical therapy practice treating mostly breast cancer survivors.  She gets as many denials as she does payments, and when they do pay it's pennies on the dollar.  Unfortunately, I only see it get worse under the current administration🙁  It's sad to think that the USA ranks so poorly in delivery of health care to it's people.  Speaking of people, wouldn't it be nice for a change if the emphasis was on quality of life and health care was for people, not major corporations!

Edited May 15, 20251 yr by tdflightsim

If there is one thing I am grateful for, its the Canadian Health Care System. Although not perfect by any means, I am sure glad its there. 

With my gull bladder diagnoses and Cancer discovery, the hospital visits for scopes, CT scans, Ultrasounds, Hospital stay and surgery. Chemotherapy visits for 4 months, Oncology visits etc, etc. Now every 6 months CT scans, and bloodwork every 3months for monitoring.  The one thing I did not have to worry about,  thoughout my whole ordeal,  was how pay for it.  (except for Hospital Parking). 

You may hear about long wait times in Canada and that can be true at times, but because health care is free (well not exactly free, we pay for it though our taxes), people go to the ER for a runny nose. 80% of the people in the waiting room should not be there. They should be going to a walk in clinic or go see their doctor. But if its life threatening, like mine was, there was no waiting. 

Hope someday my American friends will have better system for all their people. 

11 hours ago, psolk said:

 

Thank you so much @jcomm I really appreciate it.

 

@Mike A No, no blacklist however insurance is a very sensitive topic for me.  It is simply legalized organized crime in my opinion.  Like anything else important to me in my life I have had to educate myself as to their methods, the 3rd party providers they use to deny claims, the appeals processes, the verbiage and I almost went bankrupt when I had to sue BC/BS because they pre approved a 12 hour anterior/posterior fusion and then paid $1,875 on a $231,000 bill and claimed it was their UCR.  It was like $20/hr for everyone involved.  It was disgusting.  I had a sheriff knock on my door at 4am to serve me with the papers from the surgeon and rather than declare bankruptcy I went after BC/BS and won but it took 6 figures and over a year in court.   

They operate on a deny first and hope people don't appeal model but in most cases when you have irrefutable medical proof from even their Dr's AND you have done the ages of tests, injections, nerve burns, PT and EVERYONE has the same assessment thing usually get done, it's just a horrible system which inevitably someone is left to overcome when they are at their lowest already from a health perspective.  I do not have a high personal opinion of these people or their profiting off minimizing the care they have to actually give people.  Then there are the hospitals and providers who have their "pre-negotiated" rates with insurance companies but a private individual should pay full price.  So insurance gets a $81,000 bill and pays like $30,000 but if I got the same bill I have to pay the full $81,000, the system is just fundamentally flawed and insurance companies are like untouchable mob kingpins.  

The no denying pre-existing conditions combined with the upfront pricing and no surprises acts are two of the better things to happen to healthcare recently...

 

It is precisely stuff like this which makes me so grateful for the National Health Service in the UK. It may be creaking and wobbly at the moment, but I would not change this system for the world.

From this day forward I will no longer complain about the aches and pains of advancing years.

Paul, you must have been dealt stoicism in spades! 🎖🎖🎖

10 hours ago, Christopher Low said:

It is precisely stuff like this which makes me so grateful for the National Health Service in the UK. It may be creaking and wobbly at the moment, but I would not change this system for the world.

I have been watching a wonderful and entertaining series featuring the charity run Helicopter Medics where they literally bring the A&E advanced care directly to the injured parties. What a wonderful service!

What is so interesting is that this series features real patients not staged like they would be here in the U.S.

 

Edited May 16, 20251 yr by n4gix
Added link to video.

1 hour ago, n4gix said:

I have been watching a wonderful and entertaining series featuring the charity run Helicopter Medics where they literally bring the A&E advanced care directly to the injured parties. What a wonderful service!

What is so interesting is that this series features real patients not staged like they would be here in the U.S.

 

my ex missus used to work at St Georges in Tooting (for 2 and a bit years) and was on 24 hours in A and E on channel 4 back in the day. She used to pick up weekend bank shifts in A and E when i was working nights at the weekend in flight ops, it was good money as no one wanted to do it.  Gun wounds, stabbings etc etc. Shes now at the Royal Marsden I believe 

She had lots of good stories to tell.  Most i couldnt put on here.  

Alas I wouldnt wish illness on anyone in the UK, our NHS is in dire straights. 

I had to go to A and E myself the other day, more or less for some antibiotics.  7 1/2 hours. Pure Madness.

Its a really story state of affairs when you "unoffically" tell the crews if you have certain medical issues, call medaire and get it fixed properly downroute, it will be quicker and cheaper than in the UK.  Root Canals for example. 

Edited May 16, 20251 yr by fluffyflops

18 hours ago, fluffyflops said:

I had to go to A and E myself the other day, more or less for some antibiotics.  7 1/2 hours. Pure Madness.

I am at least covered by the Veteran's Administration for all of my health needs sans dental care. One has to have served a full 20 years to gain dental coverage.

I had to have two X-Rays taken a few weeks ago and asked to use the Community Care option to have it done in one of the two local hospitals rather than having to drive 70 miles round trip to the VA Hospital in Little Rock, Arkansas.

If I hadn't had VA coverage, the bill would have been $3,920 USD! The Medicare approved rate was a paltry $83.71 with zero co-pay, which is what the government considers a fair rate. This is but one example of the ridiculous disparity between those who have insurance coverage versus those who are uninsured... 

2 hours ago, n4gix said:

I am at least covered by the Veteran's Administration for all of my health needs sans dental care. One has to have served a full 20 years to gain dental coverage.

I had to have two X-Rays taken a few weeks ago and asked to use the Community Care option to have it done in one of the two local hospitals rather than having to drive 70 miles round trip to the VA Hospital in Little Rock, Arkansas.

If I hadn't had VA coverage, the bill would have been $3,920 USD! The Medicare approved rate was a paltry $83.71 with zero co-pay, which is what the government considers a fair rate. This is but one example of the ridiculous disparity between those who have insurance coverage versus those who are uninsured... 

Bill i would love to reply fully to you, but whatever I put it wont get past the mods. Simply put the NHS as its touted, just isnt as good as what it was back early 2000s, its been ruined but like alot of things its like some scared goat that you cant question or complained about. 

For example you mentioned dental coverage, its incredibly difficult to get an NHS dentist here, and even you do, youve got to pray they dont decide to go private or your done. 

Doctors too, just to be able to get a doctors appointment depending on where you are, youve got to get past someone on a desk at 0800AM who will help and youre up against other 150 people all trying the same thing at 0800, which is why most people have private here now if you can afford it.   I have it with work luckily.  

Im one of the few here that thinks the NHS either needs to be totally rethought out, or privatised, just not like the USA system is 

 

Edited May 17, 20251 yr by fluffyflops

2 hours ago, n4gix said:

I am at least covered by the Veteran's Administration for all of my health needs sans dental care. One has to have served a full 20 years to gain dental coverage.

I had to have two X-Rays taken a few weeks ago and asked to use the Community Care option to have it done in one of the two local hospitals rather than having to drive 70 miles round trip to the VA Hospital in Little Rock, Arkansas.

If I hadn't had VA coverage, the bill would have been $3,920 USD! The Medicare approved rate was a paltry $83.71 with zero co-pay, which is what the government considers a fair rate. This is but one example of the ridiculous disparity between those who have insurance coverage versus those who are uninsured... 

My point exactly Bill!    So the multi billion dollar company pays less than pennies on the dollar but the individual without insurance would have a $3,920 bill...  And here is one of the major flaws with everyone in the US being FORCED to pay into medical coverage in the US which is they are all High Deductible plans which means chances are insurance is paying their$83 and the remaining $3,840 are still the individual's responsibility!!!

There is this misnomer that healthcare means "coverage" but there is a reason that last I chacked healthcare was the #1 cause of bankruptcy in the US but the kicker was something like 8/10 of those forced into bankruptcy HAD "coverage" at the time... 

 

I feel sorry for you guys. I have never had to worry about medical bills for myself (or any other members of my family) in my entire life. We just moan about having to pay £9.50 for prescriptions

Edited May 17, 20251 yr by Christopher Low

Well for some people life just doesn't get easier but keeps introducing new challenges...

On Saturday I broke my spine in two places.  Compression fractures of T11 and T12.  Now because I didn't want to bother my Dr and because I had two critical work calls I walked around for 2 days with a broken back which was not my brightest move but I really didn't think I had a broken back.

Spent the past 3 days in hospital, in a brace from my neck to my waist but this is just another speed bump and this too shall pass.

Just a tremendous amount of discomfort right now and obviously very immobile but it could STILL always be worse and I will just need to keep that perspective as I start all over from Stage 0 again... 

Off to rest now, I think I've had 30 minutes sleep in 3 days and still trying to balance work calls and life at the same time.  

Every challenge is an opportunity to shine... 

Be well everyone, I'm always tremendously appreciative of all of the support here!!! 

 

Sorry to hear about this, Be well Paul glad you are keeping positive mate 👍

How in the world did you manage to break your spine?  Was it an accidental fall?  Anyway, hope you get better soon.

I was perusing the other posts here and want to comment on the USA healthcare system, as I think there are some misconceptions. 

The insurance=based payment model that we use here, albeit dwindling due to more govt.-provided care(more on this later), is actually not a bad system.  Up until the 1970s, most people had what is called a catastrophic health insurance policy, where one pays for all healthcare out of pocket until it exceeds a large amount, say $10,000, whereupon the insurance kicks in and covers all further care.  Healthcare was generally affordable under this system.

What changed things is when Medicare and Medicaid came online.  These programs are essentially govt. single payer health insurance plans, one for folks 65 and older and the other for folks whose income is below 139% of the federal poverty level.  With Medicare, one pays a reasonable premium to cover the 20% that Medicare doesn't cover as well as doctor visits and medication.  My mother pays about $400/month for everything and she's pretty satisfied.  If you think about it, $400/month for healthcare is a good deal for someone nearly 80 years old.

Medicaid doesn't require any premiums or copays.  Those on Medicaid get 100% free healthcare, and right now there are about 71 million Americans in this program.  

About 20% of Americans get Medicare, about 23% get Medicaid and CHIP(Children's Health Insurance Program), about 6% get the Affordable Care Act coverage which is govt.-subsidized private health insurance, and about 2% are on Veterans Healthcare, so a little over half the U.S. population is on govt. provided or subsidized health insurance.  The rest of the country overwhelmingly get their health insurance through their employers who generally pay about 50-90% of the cost.

Now, healthcare in the USA is very expensive, averaging about 2-3 times what other developed nations pay for their healthcare, which is the main reason why health insurance in the USA is so expensive, and which explains why there are so many people on govt.-provided or subsidized health insurance plans.

One of the reason healthcare is so expensive here is that Medicare and Medcaid pay much less than what is actually charged by a provider.  My mother worked in medical billing and told me that often Medicaid only paid about 20-25% of the actual charge and the patient cannot be charged for the difference, so the provider simply has to take what they consider a loss. Medicare pays a bit more, but not a lot more, maybe 35-40% of the actual charge.  So, in reality, over half the country pays a lot less in healthcare costs than the other half.  So what do you think providers might do to "remedy" this loss of revenue?  Well, they might very well jack up prices for everyone else, which IMO is exactly what they've been doing for decades, hence our sky-high healthcare costs.

What we have is a very unfair 3-tier healthcare system: one tier for those on govt. health insurance, a tier for those on employer-sponsored private health insurance, and a tier for Federal, State, and local govt. employees - about 23 million people who have their private health insurance paid for by the taxpayers - and it's usually *very* good insurance with low deductibles.  There are also private pay folks who buy their own insurance or pay outright, as well as some uninsured folks, but this is a small percentage.

In conclusion, our system is not by any means perfect and has several flaws, but it isn't exactly awful.  My main beef is that it is an unfair system in that it is not equal for everyone, with some people paying nothing, some a little, and some a lot.  Healthcare should not be this way.  We should all pay a roughly equal percentage of our income for healthcare and only the very poor should pay nothing at all.  Then there are the health insurance company shenanigans with denials which should be illegal and the company executives should be prosecuted for fraud.  Lastly, there is the egregious price-gouging that Americans suffer for many pharmaceuticals, something which hopefully will be dealt with soon.

Other countries have single-payer systems or socialized medicine, which have their own advantages and disadvantages, but the fact remains that healthcare is not free.  Other countries' citizens pay for it with their high taxes, whereas those in the USA pay for it more directly through insurance premiums, copays, and deductibles.

Dave

 

Edited July 23, 2025Jul 23 by dave2013

Jeeez Paul.  We need to send you a giant roll of bubble wrap for yourself.  Be well and take it easy.