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DavidH
Regular Member


Date Joined Dec 2008
Total Posts : 26
   Posted 12/10/2008 2:41 PM (GMT -7)   
Hi All,

I have a funny put sad question if it is true?

As you may know I am in Australia after reading allot of post were you take about insurance companies not approving ect. I like the movie “SICKO” which is a documentary on the American health system. For those who have watched it is this doco fact or a media bet up?

For example in Australia due to my injury happening at a sports clinic where I was helping coach with my son I hell thru the insurance cracks (Loss of income insurance does not cover because the injury is not bad enough, Sports cover does not cover due to I was playing the Sport, Workers insurance does not cover as I was not payed by the clinic, Public Liability does not cover due to no negligence) they what a crack LOL. What a crack.

Sorry I got off track. In Australia due to the above I am covered by the public system. What this means is the government pays all my medical tests and treatment if I use a public hospital unless my doctor refers my some were. For example I have a bad flare up and could not walk prior to epidural injection and my doctor organised an ambulance to pick me up and drop me off at the hospital and then take me home again (about a 2 hour trip each way due to where I live) the total cost for me was $0 because the government pays (We all pay due to TAX).

I can choose my doctors and surgeons and the government pays. I have to pay the prescription fee at the chemist what this means is due to my doctor writing the script with increased amounts which he rings to get authority for. I get three months of meds (A shopping bag full) for the total cost of $5.00 Australian (about $3 US)

My PT is payed you guessed it by the government again and I go twice a week. I do have pay of acupuncture but then by going to Medicare (the Government office) they reimburse me the full cost.

And due to not being able to work the government pays me sickness allowance it is not great deal of money about $450.00 per week. I am still able to work about 15 hours before they start to take dollar for dollar.

Is this system the same in America or is it like in the movie “SICKO” were they check your wallet first to ensure you can pay before they treat you?

If the movie “sicko” is correct. I can see why I live in the lucky country. smilewinkgrin We have allot of people talking about the sicko movie mainly people who are waiting in waiting rooms at PT due to you get to know the staff and other patients and I would lick to able tell them if it is true or not?

Thanks David
VIEW IMAGE sitting work away It's worth a look


Joie1
Regular Member


Date Joined Oct 2008
Total Posts : 376
   Posted 12/10/2008 3:32 PM (GMT -7)   
Um...havent seen SICKO yet. Too depressed to. When I had insurance, I didn't worry about the costs b/c back then, I had it under my mom's work. She had a PPO from a utility company so awesome coverage. Then I didn't have insurance and I thought I wouldn't ever need it again. I thought I'd been sick as a once in a lifetime sort of thing. Even afterward, I tried to get insurance and found it was super hard 'cause I had been sick so bad once upon a time. They made it unaffordable and unworth buying it. Then, I got sick again. I weigh ER visits because they always seem so much more expensive. I never use ambulances.

If I quit working I would be able to get social security disability insurance, maybe. I only been working 12 hours every other week. But I still make too much and that's at 11/hour. If I don't pay on all the hospitals bills that are coming in, even if its a dollar; within time, they can take me to court to garnish my and my husbands' wages. I look at how other countries seem to work better or worse health care and feel envy.
27/f/CD. 4 CD related surgeries: 2 resections, 2 JP drains, 3 NG tubes, many absesses (including the one my most recent surgery scraped off my ovary) and fistulas.
Currently trying to figure out hip and knee joint pain.
Have lost in these surgeries: appendix, 8 in. intestine, R fallopian tube, gallbladder, 10 in. intestine
Dx'd: February 2008.
Pentasa (and much mental screaming)


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/10/2008 3:57 PM (GMT -7)   
David,
Yes, it's sad but true. ER's have to treat you if it's life threatening, but all other providers check insurance first. And most all my doctors even make me pay my co-payment BEFORE I am seen by the doctor, although sometimes it's on the way out.

And yet the U.S. spends more per capita than any other industrialized country on health care. So whether it's in taxes or "hidden" in other ways, we pay, but we get a lot less.

PaLady

DavidH
Regular Member


Date Joined Dec 2008
Total Posts : 26
   Posted 12/10/2008 4:04 PM (GMT -7)   
Hi Joie,

I am sorry to hear that the movie seems to be true.

I do live in the lucky country as here we can do 15 hours at about $25 per hour. As my wife does not work and we have three kids she also gets paid and then we also get child support in round figures all combined about $1500 per week.

In Australia the government looks after it most vulnerable this also includes homeless and even visitors from other countries (Tourists ect)

I do heal for all of you as I know we have private insurance for medical in Australia and getting them to approve procedures is very hard as they are looking after the bottom the line (Their profit). It sad to think in what is meant to be first world countries that you can be treated so badly when you are at the lowest point of illness. And let’s face it is only due to companies wanting to make profit.

I know from the movie “sicko” the cost of medication was thru the roof. Here I get tramadol 200mg SR x 180 tablets, oxycodine x 90 tablets, panadine forte x 320 tablets, valium x 180 tablets, voltarine x 180 tablets, lirica x 320 tablets and some other for the grand total of $5 ($3 US)

You have to ask why different countries are so different. I have worked in the US and if I had got sick in the US the Australian government would pay as I am an Australian citizen and they have agreement with the US government. I think it is the same as if you came to Australia you would not have to pay in an Australia hospital who sick is that!!!!

I look forward to the replies as many people here do not believe the movie as we have nothing like this in Australia and cannot understand how it would be possible for the government to do!

Thanks and I hope you all have a low pain day

David
VIEW IMAGE sitting work away It's worth a look


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 12/10/2008 4:44 PM (GMT -7)   
 
 
 
Well, I had to go to the ER last night as a matter of fact...no insurance either.  I have recently signed up for TennCare (Tn medicaid) and I have to take some paperwork to them and then I'll be approved...but not as of last night.
 
So, after 5 hours,nine stitches, and a great deal of pain I was checking out and my bill was......ta da  $459.  But they discounted it since I don't work and so on...to $189.  That's a big difference.
 
Anyway, when I get approved it will be back dated so I won't have to pay at all.  If not, I have to pay $31/month for 6 months. 
 
Oh yeah, I was trying to open a box that got delivered in the mail and the knife slipped....3 inch laceration (pretty deep)on the back of my thumb....9 pretty blue stitches...Hooray for me... mad
 
Me.

 
 
spinal stenosis,degenerative disc disease,bilateral neuropothy.
lamenectomy L3,L4..spinal fusion L4-S1
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/10/2008 5:26 PM (GMT -7)   
David,
Do you have an extra room at your house? I think I may move to the land down under!

PaLady

ekkorose
Regular Member


Date Joined Jul 2008
Total Posts : 329
   Posted 12/10/2008 5:31 PM (GMT -7)   
Even haveing insurance here is pretty rough. I pay nearly 2500 a year for my policy and on top of that have to pay another 2200$ before I meet my out of pocket maximum. On top of that I have to pay 15$ everytime I go to my primary doc and then 25$ each time I go to a specialist such as my PM doc or physical therepy.
A quick run down for one year of just medical, not RX 
  • The doctors have charged my insurance 55k this year
  • The insurance has paid 23k this year
  • I have paid (out of pocket) 3k

Without insurance I would have been responsible for the 55k so for those without insurance, medical bills are nearly impossible to deal with. Next year I will pay about 900$ for my policy and will have to pay 3k out of pocket before they pay for anything.

 

Hysterectomy at 25

4 laproscopic surgeries since 24

Cervical stenosis in C3 & C4

_____________________________________________

 

Meds - percocet  3x day : nexium : xanax :

Supplements : calcium : magenesium :potassium : milk thistle : fish oil : B complex : vit E

____________________________________________

In the United States today, there is a pervasive tendency to treat children as adults, and adults as children. The options of children are thus steadily expanded, while those of adults are progressively constricted. The result is unruly children and childish adults. ~Thomas Szasz 


Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 12/10/2008 7:07 PM (GMT -7)   
I'm afraid I haven't watched that movie but I have to say that our health care is horrible here in the US. Even on Worker's Comp like I am on they look at my primary ins first which they should not even touch. Everything should (IS) covered under my WC claim! I have had them send me bills for 113 bucks for doctor visits or even when I had my very first fusion surgery on my lower back I got a dr bill from the hospital for a grand total of 119,003.47 which I found outrageously high!

Prescriptions too are way out of control and I cannot imagine having to pay out of pocket for my medications. One of my meds is called Topamax and I get 28 day supply each month. For 28 days its 389 bucks! My sister takes the same medication for her migraines and she has to pay out of pocket for hers so I know how much it costs for her to get hers and I think it is crazy that it is so much.

Anyway thought I'd put my two cents in.

Scarred
HEALTH ISSUES: Herniated discs at S-1-L5, L5-L4, L4-L3. Two level fusion (2000); one level fusion (2002); Revision at L4-L3 (2003). Diagnosed with Failed Back Syndrome, Permanent Nerve damage and Chronic Pain

Medications:

Kadian, Lexipro, Percocet, Temazapim, Lunista, and Robaxin.


DavidH
Regular Member


Date Joined Dec 2008
Total Posts : 26
   Posted 12/11/2008 7:56 PM (GMT -7)   
OMG it is true, why are all the people in the US putting up with this.

It is completely crazy to think you can leave people in pain and sick just because they cannot pay has the whole country gone MAD. In Australia we complain because as a public patient we get put on a waiting list for non critical surgery and depending on the type and how bad people may have wait up to 3 months. And every polly when there is an election runs saying they will reduce the wait!!

The nuts thing about this is if you go to another country the US government has agreements with other countries to perform surgeries at no cost in return for citizen of other countries getting the same treatment. And you do not have to be on the other side of the world, you can go to Canada and this rule applies.

I am shock to think it is true how can big business do this fellow humans for extra bucks and even with the just the super high cost of drugs, I had a looked up the non government rate for Topamax this means if I just went to the company and brought the drugs from them with no government assistance and they would cost me $68.75 (US$45.37) for a packet of 20. So how do these drugs cost US$389.00 (A$589.00) that is 857% more expensive if I brought them in the US.

I was hoping the movie was a media beat up. But sadly it looks like it is true. You should watch the movie it is not depressing (well not when you do not have to live with it every day) and it does give some great insight in to the US health system.

PaLady I wish I did have an extra room but I think my wife would kill me and start saying things like don’t you think I have enough to do!! Ect. And yes with me not working and 3 kids, 18 months, 4 Yrs, 8 Yrs and if you work it out I did my back when my wife was 7 months pregnant.

Thanks David
WERE I LIVE IS THE LUCK TRUELY THE COUNTRY
VIEW IMAGE sitting work away It's worth a look


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 12/11/2008 9:29 PM (GMT -7)   
David,
Please keep in mind that Sicko does take some artistic license. Yes, there are problems with the health care system here in the U.S. Yes, people fall through the cracks. Part of the problem is that there is no nationalized health care system. Free, or very cheap, public health care is dependent upon state & local governments. I live in a large city & pay plenty of property taxes & sales tax (the highest rate in the U.S. actually, though all of my overseas friends are exceptionally jealous of the "low, low taxes" they claim I pay). The public hospital in my city gives practically free health care. For example, my brother was injured & fell into a coma. His entire bill (no insurance) for the ambulance, 4 MRI's, meds, 4 specialists, ICU care for 4.5 days, plastic surgery, take home prescriptions (antibiotics & pain meds) & follow-up care was $300. The bill was actually paid by the person's property insurance where he was injured so he paid nothing, but in any case even if he himself would have had to pay it would have only cost $300 [I couldn't even believe it! We had to call to double check that there wasn't some kind of accounting error. At a private hospital in the same area the same care could have easily cost $30K]. We also have over a dozen free clinics available & people can get certain medications there for very cheap.

I wouldn't recommend anyone move here from anywhere else in the U.S. b/c you will pay a boatload of taxes. If you do not have a medical emergency, to get into a doctor at the same hospital I have seen people wait 3 months, even when they have fairly serious illnesses. They can get their maintenance meds for $3 a month no matter what it is, but getting into a doctor every month for re-fills is practically impossible so a lot of people do without their meds for weeks at a time. But I know in some sense we are very fortunate. I have met people from other states who weren't even permitted in the hospital to deliver a child unless their bill is pre-paid (in my state labor is treated the same as a medical emergency). At least here, there are some options & a lot of hospitals & doctors' offices, even the private ones, will work with people up to a certain point.

It can really be difficult for some people. I am blessed to work for an large corporation & have just about the best benefits money can buy, but even they are not without problems. They are constantly trying to convince me that I should be willing to accept substandard care as long as it is roughly (VERY roughly) similar to what my doctor recommends. It seems I have quarterly battles with them about this, but I keep reminding myself that at least I am able to battle with them & that is more than some people have.

Plenty of debates have been held over the last 15 years about how to change our health care system. The argument is often made that with socialized medicine people will not be able to go see their doctor whenever they need to. I've heard that is the case in other countries. Friends of mine from Canada & Germany say that often they have to wait for months to get in to see their pain specialists. Has that been your experience in Australia? Usually I can get into see my PM within 48 hours if I'm in a lot of pain. Just wondering how that works out for you.

-frances

mom9mom
Regular Member


Date Joined Sep 2008
Total Posts : 489
   Posted 12/11/2008 10:10 PM (GMT -7)   
David can me my husband and the four kids I have still at home come live with you.I have not seen the move but I will tell you about the last time I went to see my reg. DR. 2 years ago we got a little behind on are DR. bill.I was waiting for my tax return to get here.5 days before it came thay sent my bill to collections.When I got my check I went the same day and payed in full.We have used the same DR. for over 26 years.Now we have to pay for every visit before we see the DR. A few weeks ago I needed to go in and did not have any money but my insurance is paying my bills at 100% because I have meet my out of pocket expences for this year so I did not think it would be a big deal.When I went in thay spent 30 min. arguing with me even though 1.thay checked to see if my insurance was paying 100 % 2.Thay told me that since I have been paying each visit before the insurance money came through I had money on the books at this time. So thay would let me see the DR. but that next time I would have to pay before.That makes no since to me to make me so upset by arguing with me when thay know thay are going to get all of there money and that I have money on my account.But that gives you a idea how it works here.
Lost half of my small intestineJan.2008.Ilieostomy for 5 months then reverst in June 2008,Nerve damage to right leg,part of my right hip bone removed Jan. 2008,Cronic pain,hernia,infection in my back called discites,and depression.Gallbladder removed Nov,2008.Mother to 9 kids 7 boys 2 girls and 1 stepson.4 grandsons,9 grandaughters.4 of my grandkids I inherited from my twin sister who passed away 6 1/2 years ago from a blood clot after surgery.God has given me my life back after I almost lost it.Even though its a painful and sometimes hard road to walk I take it one step at a time and give thanks to god for every step I take.


DavidH
Regular Member


Date Joined Dec 2008
Total Posts : 26
   Posted 12/11/2008 10:15 PM (GMT -7)   
Hi Frances,

I am glad to hear it is not all bad!

In Australia we do pay a lot of tax but in return we get great benefits. Prior to my injury I was in the top tax bracket and yes everyone compares our tax system with other countries and up till I had my injury I did not fully understand how lucky we are.

As for seeing doctors I can use any doctor I wish and as my doctor who I have used for the past 15 years he is very good and compassionate and does not believe in swallow this pill and come and see in the morning attitude. But as he is a very good doctor I am not be able to get in to see him straight away this usually means I have to wait one or two days, this is due to he is very busy and has a good practice and I do not want to see another doctor that works at his practise. As for a NS I went to 5 different ones at different hospitals to get their options on what surgery I should have. I am now on the waiting list at the largest teaching hospital in Victoria and I have had the person who books in the surgery ring me yesterday and am scheduled to have surgery late January as they close down the operating theatres for maintance and emergencies only from late 23rd of Dec thru 15 Jan and they do not book surgeries in over this time, so even with this I will have to wait of about 8 weeks. And considering it is free who can complain. When I first did my injury I got an ambulance to the hospital due to not being able to walk and then they got me an ambulance home and had nurses and PT visit me at home every day for 3 – 4 months till I was able to bear weight without a frame. Then we started using the local PT that is ran by the local council twice a week to now. The only reason I have waited 18 months for surgery is that I did not want it and have tried every conservative treatment first. My doctor has a patient that had a discectomy with a month of the injury against my doctor’s advice but it shows if we want it we can get it.

We also have private insurance and from people I have met since my injury they regret having it as they are always fighting the insurance companies for different tests and treatment. And in Australia if you have private insurance you cannot use the public system without the insurance company paying.

In Australia we believe you gauge how good a government is by looking at the most vulnerable and this is why when USA is meant to be a superpower how can people be looked after so bad!

Especially now I would rather pay more tax than have to worry if any of my family got sick they would not be looked after.
Thanks

David
VIEW IMAGE sitting work away It's worth a look


DavidH
Regular Member


Date Joined Dec 2008
Total Posts : 26
   Posted 12/11/2008 10:21 PM (GMT -7)   
Hi MOM9MOM,

Why!!!!!!!

Why would you not move to the same state a frances just because it is less stress full and you would get better health care. This is some-thing that we cannot understand when we watch movies like SICKO.

I do feel for you all not only having to get better put fight the system as well.

David
VIEW IMAGE sitting work away It's worth a look


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/11/2008 10:30 PM (GMT -7)   
Frances,
I think the area where you live is the exception and not the rule. It took me over 2 months to get in for an initial eval. when I first when to see a pm doc a few years ago. Then the injections started, and while he would tell me to come back in two weeks after I received the injection, when I went to the front desk to schedule he had no openings for 6 weeks. So to get a few lousy injections, which didn't work anyway, took several months. The same happened with the other pm doc in my area who does injections. Neither of them prescribe meds.

I won't get into a discussion now as I'm too tired, but there's a middle ground between socialized medicine, where the hospitals are owned and doctors are paid by the government, and what we have now. That's what's being proposed; the development of some type of reasonable hybrid. Every system has its downside, but just in the past couple of days on this forum we've seen examples of good people without insurance, and that's plain wrong, IMHO. No, evveryone won't afford the same levels of care, but we all should be able to get needed meds and procedures even if we have to wait or use generics. I'd be witout insurance if my cousin wasn't helping to pay for my COBRA. When that ends I will either have no insurance or have to be on Medicaid, if I qualify. IF everyone is forced to be in the pool, that lowers rates for everyone, including employer costs. It's just the insurance companies and pharmaceuticals who don't want to lose their huge profits.

Ok, I'll stop my rant!

PaLady
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