THR The Deed is Done - Becky Joins the Hipstas/Hipsters

[Nylsor]

Just wondering with the VAT and income taxes and luxury fees and petro tax what is your total percentage of income that you pay in taxes?​

Honestly, Randy, I don't know exactly. But I'm sure that somewhere on the net there is a site that will tell you. Quite a lot I would think.

When I say you pay with taxes it is a percentage of your income before taxes, plus for all the unemployed you pay with your income tax for their healthcare.​

You do. But again, I've always paid from my income but the amount I've got back in drugs, clinics, blood tests for my Type1 diabetes, far outweighs the money I've put in. And I don't want to think that there are folk out there who can't get treatment because they can't afford it

You pay for your healthcare with taxes and have no choice as to whom performs your surgery and because you can not get a service from a surgeon within a reasonable amount of time you pay an additional fee to have this done privately, but you get to choose who performs the surgery. What happens to the people that can not afford to go private, they just hang out and wait until the line goes down?​

Exactly - except it's not supposed to be like that. The government issues guidelines that state a certain time in which you are supposed to receive consultant led treatment. I think it's eighteen weeks. But the first out patient app counts within those eighteen weeks. It certainly doesn't mean your surgery takes place within that time. The NHS service is patchy within the various areas. For example, my neighbour was diagnosed with uterine cancer. She was seen by a specialist, scanned, had a radical hysterectomy followed by seven weeks of radiotherapy. That all happened within three and a half months. All free.

 

[BeckyR]

Nylsor randy62 Nylsor, your comments were so interesting. They backed up much of what I've heard, but added a very personal level of detail. I would find it hard not to be able to choose my own providers. There is definitely a difference in quality, not to mention whether or not you feel your provider is a good "fit." Somehow, we have to find a way to provide healthcare for all, but I would not want to give up the ability to choose my providers, nor would I want to wait for care as people do in the UK and Canada (don't know about other countries). I'm certain my husband would not be alive today if we'd had to wait for some of the things he had done, or just had to take the luck of the draw in terms of providers. He'd be dead many times over, given all the challenges he has faced.

US Medicare has some elements of the British system. We pay in (thought payroll taxes) throughout our working career, and our employers (if we are not self-employed) pay in as well. Then, at 65, we can go on Medicare and the coverage is really excellent -- especially if you have one of the supplements -- and we also have total freedom of choice, of any provider who accepts Medicare, which is nearly everyone. If you go on a Medicare HMO, your choice of providers has some restrictions. If you take original Medicare (no supplements), it's an 80/20 plan -- they pay 80% and you pay 20% for things like doctor's services. It's different with hospitalization -- too complex to go into here. But if you take the Medigap supplement (which I have) your out of pocket costs are reduced to nothing at all. (There are a variety of supplements -- not all cover 100% of the co-pays and deductibles.)

Most Americans have insurance through our employers, which makes it more difficult to change jobs, especially if the place you want to work doesn't offer insurance. The sky-high cost of medical insurance has kept our salaries down. Very few Americans realize this, but we are paying through the nose for our insurance in the form of lower wages and salaries, in addition to the portion of insurance we pay, the co-pays, etc. Plus, the insurance changes every day and it can be a nightmare to keep up with the networks and requirements.

Here's a weird example: When my husband had cancer, we tried hard to stay in network with our insurance and use the providers who would be covered. But one time, when my husband was hemorraghing, I took him to the emergency room (of an in-network hospital), and it turned out that the doctor who treated him was NOT in our plan's network. We received a huge bill -- they can charge anything they want if the expense is not covered by insurance -- and the insurance company refused to pay. What was I supposed to do? My husband was going to bleed to death. Was I supposed to ask the doctor, "Oh, excuse me, are you a United Healthcare approved physician?" And if he told me he wasn't, what was I going to do? Say -- sorry, let him bleed while you find an approved physician? This bill we didn't pay, because it was so wrong, and it ruined my husband's credit.

In another instance, both the hospital and the insurance company told my husband that the hospital was in-network, but then it turned out that it really wasn't, and we had to pay $7,500 for the difference. If we'd fought that one, we'd probably have won, because my husband kept notes with the dates and times of the phone calls, but you reach a point of exhaustion where you just can't keep battling these bills when you are also battling the cancer. Also, we were sufficiently grateful to the hospital for saving my husband's life that we just paid it and put it behind us. It took us two years to pay it off.

I can't even calculate how many hours we've put in on the phone, etc., working through all the bills, and we had what is considered to be one of the best insurance plans available.

Now that I cut us loose from my school's plan, and we are on the Medicare plus Medigap, it is a different world. We get the care we need and never see a bill. We do pay a monthly bill for the Medigap, in addition to $105/month each for part of the Medicare, and we paid in all of our working lives, so nothing is "free." But it is a great system for us, and I'd hate to see it ruined. It is as though an enormous stone rolled off our back. Doctors like it, too, because they can't stand fighting the insurance companies. They have to maintain huge staffs to fight these claims, which the insurance companies try not to pay. When we went on our new plan, they all lit up and said things like, "This is great! No more problems!" A lot of doctors withdraw from various insurance plans because they simply can't deal with it and still make a living.

Then there are the millions of people who don't have any coverage, and can't get it at any price -- because they have a pre-existing condition or a million other reasons.

I'd like to see something like Medicare for everyone, but there is a lot of resistance in the US to a "single-payer system," which is what Original Medicare is. With all the supplementary plans and HMOs, there is still a role for the insurance companies. But, like most Americans, I would not be willing to sacrifice the freedom of choice or take on those enormous wait times that exist in some other countries.

There's much more I could say, about the reasons why health care is so expensive in the US, but I won't keep going on. This is enough for one day. One reason for added costs is that we don't have those wait times. Canada budgets a certain amount for health care, and the wait times are factored into those costs. It is a trade-off that the country as a whole is willing to make, although many Canadians cross the border to the US for elective surgery or to avoid wait times on other things.

Such a complex field.

Hope all is going well for both of you, and Mike and Sue.

Hugs!

 

[BeckyR]

nmay51 I am so glad you have a strong support system. Still, for those who live alone (like you and my best friend from college) it does take an extra level of planning and courage during recovery. There are so many tiny things that need to be done that are hard to do alone, and your friends can't be there every moment. Like you, my friend had to pay the total cost of her THRs -- about $30,000 each, including everything. It took her life's savings, and she also took out a mortgage on her home, but she remains totally grateful that she was able to do it, because it was the price of getting her life back. Still, it is mind-boggling, because there are many people who simply can't find a way to pay for it, and what are they supposed to do? At some point, everything that makes life worth living is gone, when you have something this disabling.

 

[randy62]

BeckyR how LNG ago did this happen with the er visit for your husband was he on your plan? Or his own plan? And the inn vs OON facility how long ago?

 

[BeckyR]

randy62 Hi, Randy,

First, congratulations on being given a ticket to ride once again! What a huge step toward freedom!

Regarding your questions:

I can't remember the exact dates with the two incidents. My husband's most intensive treatment for cancer was between April 2008 and January 2009, so it was somewhere in that window. He probably had 15-20 hospitalizations in all, and multiple ER visits. I think that the issue with the hospital being OON when both the hospital and insurance company told him, by phone, on the same day, that it was IN network was when he was on a Medicare Part C PPO plan -- United's "Complete Choice." When the bills were rejected, the hospital was actually stunned to learn that they had not been In-Network at that time. Multiple people were involved in these calls. So, even though, both the hospital and the insurer had given us incorrect information, they still said that we were responsible for the differential, which I think was about $7,500. In that case, if I had fought it, I think I'd have won, because all calls are recorded and my husband had the dates and exact times for every call, and the names of everyone he spoke with. But as I said in my earlier posting, we were just worn down to a state of complete exhaustion and made a payment plan. In retrospect, even if we'd been told it was OON we probably would have gone there because they were so extraordinary, but this was clearly a mess when nobody in the hospital or the insurance company could be relied on to give us correct information.

After that "experience," I shifted my husband to my health insurance plan at work (also with United), because we were definitely NOT saving money by using the Medicare part C plan. When we took it, we didn't expect the kind of catastrophic problems that arose.

The second experience, with the physician who was OON when the ER was In-Network (same hospital) was after my husband had been shifted to my plan. I recently read through some of the ultra-fine print on the website for my school insurance plan (also United), and it does say that even if you go to an IN-network facility, you need to verify that all providers are in-network, because some of them may not be. That seems crazy to me. Am I supposed to ask the anesthesiologist, the laboratories, and all of the ancillary providers if they accept my plan? I thought the hospital is supposed to coordinate the care. But the insurance company put this statement on their website, so now we are all responsible. I had a colonoscopy this year, and actually tried to verify in advance that the anesthesiologist was in-network, and nobody could give me a straight answer or tell me who the anesthesiology provider would be. It's all contracted out. On the day of the test, before he put me under, I actually did ask him, "Do you accept United?" What if I had a heart attack or was unconscious? Am I supposed to magically ask the ambulance service if they accept United?

Bottom line is that even if you have insurance, it only means that maybe they will pay and maybe they won't. They themselves can't tell you, and if they do tell you, they will not be accountable if what they say is wrong.

With the Lovenox "experience," my husband had been on Coumadin after having deep vein thrombosis (DVT) with embolisms to his lung. The Coumadin failed, and he got another DVT. At this point, his oncologist and cardiologist agreed he had to be on Lovenox or he would die. At first, United told us it was covered with a $30 copay. Then they told us a $100 copay. Then they told us it would not be covered. They paid for one prescription, but only gave us 5 shots instead of 30. Then they refused to pay at all. We appealed it through all levels of the company. Even though it was listed on their formulary, they said it really wasn't covered. Even though my husband's oncologist and cardiologist phoned and wrote to say he would die without it, they wouldn't budge. If not for the Veteran's Administration, which made a special exemption to cover it at a cost of $9/month, I don't know what we would have done. We were truly dancing on the edge of a sword. When you appeal, they bury you in paperwork and form letters and delay and delay -- probably hoping you'll die before their decision gets reversed.

Last year, after doing some research, I learned that I could actually cover my husband through Medicare with the Medigap F plan, which covers every penny of your medical treatment -- no copays, no deducibles, no nothing. It was much more affordable than I thought possible. Because he was switching from my health care plan, it was considered a "status change" and there was no pre-existing condition clause. It was a miracle. We pay $105/month for Medicare Part B, and $334/month for the Medigap F supplement. (My husband is 78, so I never thought it could be that affordable.) Given the amount of ongoing medical care he needs, and all the tests and doctor's visits, this saves us thousands of dollars a year even if nothing goes wrong. If something does go wrong -- Katy bar the door if you don't have this kind of coverage. The copays alone on my school insurance plan would wipe us out. Even though they say there is an out-of-pocket maximum, a lot of things are not counted toward the OOP max, and then there's always the question of whether they'll cover it at all, as described above.

I just turned 65 the other day. I waited to have my THR until I could switch to Medicare and the Medigap F, so that I wouldn't have to pay the co-pays, etc., on my school insurance plan. I couldn't have afforded to have this surgery, even WITH insurance, if not for Medicare. I pay $105/month for Medicare Part B, and $205/month for the Medigap F supplement. Plus, because the payment is based on your age when you signed up (not year by year), my rates won't go up for the rest of my life, except for small increases based on inflation. I'll always receive the lowest rate on the chart because I signed up at 65.

Neither my husband nor I have to worry about networks any longer, as long as the doctor or facility accept Medicare. I can't tell you what a relief that is. United Healthcare covers the difference between what Medicare pays and what is due, but they have NO freedom to decide if it is allowable. If Medicare covers one penny, they have to pay the balance. Medicare controls how much providers get reimbursed. They may bill $5,000 for some service, and if Medicare pays $500, that's what they get. But they know that going in. They like it, because Medicare pays more quickly and more reliably than any of the insurance companies. Why they initially bill these crazy inflated charges is something I don't understand. But the kicker is that if you don't have insurance, your bill really is for the $5,000, because the negotiations that Medicare or insurance companies create with providers doesn't apply. If you don't pay it, your credit will be ruined or they can sue you for everything you own. The majority of bankruptcies in America are related to medical bills.

I know more about this than most people do because life has made us heavy "consumers" of medical care, even though my husband is super-responsible and does everything humanly possible to take good care of himself. He is only the second male in 5 generations in his family to make it to the age of 60, because of hereditary coronary artery disease. He has benefited from every advance made in modern medicine. He is a walking, talking miracle, and I could not be more grateful for all the care and help he has received, which has enabled us to reach our 24th anniversary. The honeymoon lives.

But there are elements of our healthcare system that truly need to be fixed. So much of the cost is because of the layers and layers of expenses built in for reasons described above, and others. Millions of people can't get care or insurance no matter what, and they just die. These are not lazy people who don't want to work for a living and are just "takers." These are hardworking, decent people who just can't find a way to get the care they need under our system.

No system is "free." Everything has to be paid for one way or another. In America, we are afraid of "rationing," but we already have "rationing." Some people are rationed out of the system entirely. Others are rationed by the insurance issues described above. The United Kingdom and Canada ration by means of waiting lists and all kinds of restrictions.

I would like to see a more thoughtful and sustainable system that allows everyone to be covered. Everyone would have to pay -- nothing is free. How to solve this is enormously complex. In addition, it is so hard to understand that it is near impossible politically to get anything to happen. What we now call "Obamacare" represents the first time in nearly 100 years that the US has managed to pass something to provide expanded access, though it won't really be universal. There have been so many compromises that I don't know whether it will work as intended. Most people are scared of it even though they don't understand what it is supposed to do or how it will work. Changes will definitely be made to it, but even with all the problems I have to think it is a huge step forward.

When Medicare was enacted in 1965, the American Medical Association opposed it and said it was "socialized medicine." Lots of people were as terrified of Medicare as they now are of Obamacare. Not too many people want it ended now. It is one of the most treasured features of our political/social system.

I have two master's degrees and most of a Ph.D. (all but dissertation). I've invested massive amounts of time learning about all these billing and insurance issues, partly through my education, mostly through necessity. And yet I still run up against new and unexpected surprises. Most people can't wade through 1,000 pages of fine print to determine what is really available to them, and what the choices they make really mean.

This has been such a long posting, Randy. I am not trying to pressure you into changing your views on anything, just sharing some thoughts. A central question that all countries try to answer is, "What is the good society? What kind of world do we want to live in, to create?" The United Kingdom, Canada, Australia, and most other advanced nations believe that includes some form of universal access to medical care. We have not joined that group of countries yet. I wouldn't want to have to live with some of the restrictions those systems impose, but I think that there has to be a better way to provide and pay for healthcare than what we have now. It should preserve the strengths of the American system, while addressing some of the flaws. Everybody wants that, but it is super-hard to get agreement on what that means, what should be done, etc.

Enough for today!

 

[BeckyR]

Hello, friends,

Kind of a fun day today. Took my first shower - no more sponge baths - and it was pure ecstasy. My husband changed my dressing, and we both lost track of time while he ensured that every inch of me was patted dry. He took photos of my incision -- now exactly one week out from surgery -- and I've attached two so you can see what the SuperPATH incision looks like. It is 3 inches long -- not two inches -- but it is really just a hairline right now, after a single week. The "stab wound" is where my surgeon inserted the camera in a catheter to guide the surgery. This is as "minimally invasive" as a hip replacement can be, I think. It was black-and-blue (dark purple) after the surgery, but has faded to green and yellow now, as the bruising clears. No stitches, staples, or tape -- it was closed with glue -- so there is nothing to remove. It is basically healed now, because the large band-aid that covered it came off totally clean.

I'm posting this here instead of on the special thread for scars because there isn't a thread yet for 2013, and I know that some members are interested in the SuperPath technique.

Cheers!

 

[zauberflöte]

BeckyR finally got here-- you sound wonderful! I love your first shower experience....

Thanks for the photos, too-- very interesting technique, isn't it? Your bruising is very decorative

 

[BeckyR]

zauberflöte, Thank you, darling Zauberflote. I have missed you, though I've followed some of your postings. It does have a kind of abstract art greatness to it, doesn't it? A little bit like Jackson Pollock? (Hope I spelled his name correctly.)

Hugs!

 

[randy62]

Ah the first shower, Woo hoo yeah that is a great feeling, and afterwards the massage with the oil. Make sure he massages your feet that is the best part. Peace be with you

 

[BeckyR]

randy62, I left out the part about the feet, but we did do that. He put lotion on my feet, and then put on bright red socks -- the kind that don't slip. It is an arresting look, overall.

 

[zauberflöte]

BeckyR I get so frustrated that I can't keep up now-- I'm enough more active that the time for reading and posting here is just not available unless I want to give up, say, sleeping LOL.

Jackson Pollock, maybe? I was more thinking "my two year old with his crayon box".... I had long, impressive bruises down my leg, but was disappointed that they were out of my view-- my neck and back don't twist quite that far! I avoided white pants for a couple of weeks....

 

[randy62]

Yeah it just does not get any better then this. I know for a fact that I owe my Sue big time after this one. May even have to take her out for a meal and an overnight to one of our fav cities. Think McDonald's and a cardboard box is over doing it a bit? Lol. Prob end up taking Sue to Chicago for dinner and a meal from Graham Elliot. We are big time foodies hmm will have to research what shows are going on in the next month. Peace be with you

 

[BeckyR]

zauberflöte randy62,

Magic Z -- you didn't get to be a Supremo by accident. It is good that you are now so busy with other things that you can't keep up with every single posting on the site.

Randy -- I think that Sue deserves something a little better than the Golden Arches. Maybe a blank check letting her pick out the restaurant and vacation spot?

 

[Jojool]

BeckyR Where, exactly, is your scar? Just curious where mine will be. And, what is the oil that Randy is talking about? What is it for?

 

[Goody2Shoes3]

So great to hear that everything has gone well. I appreciated your encouragement when i joined the site last week!

 

[BeckyR]

Jojool, The scar is kind of high up on my butt. I don't sit on it, so there's no pressure on the incision from sitting. Randy was just joking about the oil...not any special kind, just saying it's good to have fun after the surgery and pamper each other. Nylsor Poppet and some other BoneSmarties have posted about a special oil that they use -- Elmore's??? -- and they may want to share with you about it.

You are going to be fine, and will be so happy with the results. Dr. Chow is supposed to be one of the best surgeons in the country and he uses the exact same technique as Dr. Grandic (my surgeon). They probably know each other very well.

Better times ahead!

 

[BeckyR]

Goody2Shoes3 How are you doing? It is so good to hear from you! What is happening?

 

[Goody2Shoes3]

BeckyR Thanks for asking Becky. Well I called the docgood care of yourselftor and asked her to send my referral in so I am waiting to hear when my appointment will be. The difficulty about this whole thing is that I have two people who depend on me hugely so I have to make some kind of arrangements for them in addition to the arrangements for myself. One is my mom with bone cancer and the other is my son who has Down Syndrome and is autistic. It looks rather daunting at the moment, but I need to go forward somehow as I can feel it is getting worse. There are days i think maybe i should wait longer but then other days when I feel it would not be wise. I am rather torn because I want to be here for my mom. Her mind is great, she has always been there for me and I don't know how much time she has. She is stable but with multiple myeloma the cancer is in your infection fighting cells so more people die from infection than from the cancer unless they have a transplant.....not a option tho if your body is unable to take the dose of radiation you would need to accept the stem cells. So that's where things stand at the moment. Take good care of yourself and love your new outfit!
(I just want to add that if anyone wants to comment on my post please do it on my thread because I don't mean to inadvertently take over Becky's thread with my issues....thx )

 

[BeckyR]

Goody2Shoes3 I am so sorry that you are struggling with such difficult issues. I have quite a few students with Asperger's in my classes, because I like and enjoy them, so the school assigns most of them to me. I have some sense of how hard it must be for you to not be there, even temporarily, for your son. And your mom's time is limited. You are part of what is called "the sandwich generation," caught in the middle. Still, you need to take care of yourself, or you will not be able to be as effective with either your mom or your son. On an airplane, they tell you that if something goes wrong, you should put on your own oxygen mask first, or you'll be unable to help anyone else. Maybe the social services people at the hospital where you will have your surgery done can help make some arrangements. You won't need to be away from either your mom or your son totally, for more than a few days at the very most, but you will need support with a lot of your responsibilities once you return home. And there will be much more of yourself to share with them, even during your recovery period, because you won't be experiencing this devastating and debilitating pain, etc. Please keep me and others on the forum posted. We want to be here for you!

 

[BeckyR]

Jojool, I thought (after my last post to you) that it is actually quite hard to explain exactly where an incision is made. It is more on the side of the butt -- above the leg joint -- and not where I sit, but I can't explain it better than that. It is sometimes referred to as "Northern Exposure" surgery because the incision is made high up. What you want to keep in mind, though, is that the incision is really nothing to worry about, and will heal 1-2-3.

Jojool, you are 15 years younger than I am, and are undoubtedly much more athletic (horseback riding, etc.!). I suspect you will do even better than I did after your surgery. I've always had a problem with balance, and I still have a knee problem that will have to be dealt with at some point. (For now, I have a brace I will start to use again tomorrow to keep my leg straight.)

You are going to be amazed at how well you do, and you will realize, when you look back, that it is natural to be anxious ahead of time, but that the reassurance others have been giving you is genuine.

Keep the faith, Hipsta!