Parenting: 2-Year-Olds Community

Well, I'm an expat....a US citizen living abroad. The problem I'm having is the difference in opinions in healthcare. A dr wont even see a child here if he/she hasnt had a fever for over 3 days. They dont agree with meds, and infact, really dont have any but Paracetamol (Tylenol). They dont give antibiotics unless you are practically dying. And the BIGGEST challenge is the language barrier.

Linz, our pedi won't see a child unless they have symptoms other than just a fever or the fever lasts more than 3 days. They say it isn't worth risking them catching something worse in the office when they're probably just fighting a virus

Expensive crappy coverage. Very high deductibles. In fact, I still owe on my delivery (yes and my DD is 3) because I had to pay 20% of the charges after insurance. I was in the hossy for almost a week. 20% of that is insane!!!!!!!!!!!

Trying to convince our employer that vision coverage would be more beneficial and worth the higher premium than massages, a nutritionist or podietry... grantedthey pay half our premium, but shouldnt we have a say in what we want/need covered?

I work in an office setting and spend my day looking at a computer screen...I may be one of the only employees left not wearing glasses, but my eyes are exhausted at the end of the day! ... (and they laugh at me for the large print on my screen) ...but it helps!

From working in the health insurance industry, the biggest challenge I see for our customers is not understanding what their policy covers and does not cover - or not caring enough to try to educate themselves before they seek treatment then complaining when something isn't covered. FYI folks - breast implants are NOT covered unless you've had mastectomy surgery!!

We were very lucky to have "Cadillac Coverage" for a very long time. My DH is in a union and the coverage they have used to be second to none.When I had DD, I paid nothing. He also did not pay anything for family coverage. Over the past three years, things have changed, and we pay a small amount weekly for family coverage and now have more co-pays and deductibles that we just are not used to. It is still great coverage, I don't know many people who only pay $12/week for family coverage, but when you are used to paying for nothing and when the union guys took basically no wage increases in their previous contracts to try and offset the medical costs, it has hit us where it hurts.

I really can't complain though about the cost. I am happy to pay something for our coverage. What gets me is the time I have spent, over the past three years, arguing about what should be covered with them. Our insurance is thru Anthem, but everything goes thru the union's welfare fund, which is good and bad. At least they are local, but I know almost everyone of the girls who work there since I average a call there about once every two to three weeks. And why is this the case? 1) It takes FOREVER for a claim to be paid. Like for example, my DH had a minor surgery in May 08. They just finished paying their part in July of this year!!! 2) People at Dr's offices and labs we frequent are pretty much idiots. They submit EVERYTHING wrong. Date of birth, our subscriber ID, you name it, they screw it up. Then I get an outrageous bill saying denied claim, have to waste my time calling the union, calling the dr office, etc. etc. 3)The way insurance companies, doctors offices, the whole medical field in general operate is a joke to me. Why in the hell does it cost $3000 on my bill to have an ear, nose, and throat specialist follow up my DH's surgery by looking up his nose with a scope? Yet the doctor will never see that money. They automatically contract a certain amount with the insurance company, usually less than half. Then I have to argue with the billing department because they have screwed up the amount we truly owe, and after trying to politely plead your case, you resort to getting really fed up and finally just write some more off. Why do I have to get nasty before they will listen to me??? Grrr!!

Sorry for the long rant, the whole health care system rubs me the wrong way!!

My biggest problem is not wishing I could reach through the phone and tyrign to strangle anyoen who works at my insurnce company ANY time I have to speak to them.

Depite beign a large, international company, they are the worst. They process every claim incorrectly and will tell you anything as an excuse. They lie, lie, lie and treat every caller like they are dumb and retarded. Too bad I work in the healthcare industy, know how to read a policy and love to write complaint letters to all federal and state insurance regulatory agencies!!

Being co-pay'd to death also sucks!

Shena,
Lie to the idiots on the phone when you want an appointment. Only the pedi needs to know the truth- there is no reason for some person with no medical training to tell you not to come in if you are really concerned. You know when your child needs to be seen.

Oh yeah, I forgot-
just took DS to the dentist. we have dental insurance, but its so crappy that hardly any pediatric dentist will take it-I didn't have enough time to even seek out one within a reasonable distance of where we live. if PREVENTION is so important, why isn't dental insurnace better- EVERYONE has teeth!!!!!!!!!!!!!!!!!!

DD has had to have a lot of testing over the past 2 years. Not one test or appt has been done correctly billing wise. I call ins and they say it's the hospital. I call the hospital and they say it's the Dr. I call the Dr and they say they have nothing to do with billing and I start all over again. Nothing like fearing your child has soemthing seriously wrong with them and getting thousands and thousands of dollars worth of bills that ins. says they're not covering even though they should.

I just wish that I could get an answer the first time and not be passed around, just because someone doesn't want to do their job.

BTW I do take the time to know what's covered and what I need to do in advance to make sure things get covered, so it's even more frustrating when I get a denied claim

My biggest problem is that I don't have insurance. My DH is out of work and obviously with no income, we can't pay $700 a month for COBRA. We have to take DS to Emergicare if something is going on with him. That said, I don't want the rest of America paying for me to have healthcare. I just want to find some affordable plans for my son.

I purchase individual coverage. It isn't the best coverage. $5000/deductible, $40 copay for office. I am fortunate however to have coverage. Recently though I tried to get a different policy. I had no pre -ex placed on me but my children did for Ears, throat even though they only averaged 2 sinus/and or ear infections a year. It was a 2 yr clause. I told them I will wait until the health care bill kicks in because they won't be able to place pre ex on my children. I will say though having an individual coverage it doesn't cover chiropractor, it doesn't coverage mental health coverage nor medications for mental health, it doesn't cover my birth control pills (even though I am strictly on them for medical reason only) so there is a lot excluded.
Also in my area of the country companies that offer individual coverage is growing thin! United Health care is pretty much buying them all which reduces the ability to have any other type of coverage. That is very frustrating /challenging to deal with. I did find out one other company is getting into individual coverage. At least I have one other choice to try.
I have also noticed that the "negotiated contract discounts that the ins. companies have with the doctors /hospitals are not as good as they used to be.
I had gallbladder surgery last year and with my Ded/copay for hospital I had to pay over $5500. However I did ask for help and since it was at University hospital and due to my income circumstances they offered charity payments and took down my balance a lot. I should have it paid by Dec.
My premium went up $50/month so that is substantial for a bare bones type policy.
But through all of this I am so grateful to have coverage.

Unlike most people, I have always had pretty good coverage through an employer. I did not have a "Cadillac" plan, but I had copays or lower deductible options that have always been okay with me and I have never had a 100% coverage either. I never had a problem with pre-exisiting either, so I have been lucky.

On the flip side, I work in the health insurance industry, so I understand how it works and why it works the way it does. The main problem is that people do not understand or try to educate themselves on coverage, like pp said. They choose a plan, then get mad at the insurance when something happens and they chose a $2500 deductible plan. People also think that they should not have to pay anything, that we should let them pay $200 and we just pay and pay out on them...uhm, it don't work that way. People have to take some responsibilty in their own health and health care, and that is where deductibles and copays come in.

Anyway, I am blessed to not have had any major health problems, and what problems my family has had, have always been covered as they should. The main challenge now, is to get people to understand that while shortly your kids pre-existing may be covered, but the rates are going to be much higher, and you will have to pay out more for the coverage than before, which is what customers are already experiencing in some areas of the industry.

We live in Canada, so I really can't complain about our healthcare. We can walk into our family doctors office whenever we need to, and referrals to a specialist are easy and quick. Our biggest problem right now is our insurance, which covers things like physiotherapy and psychologist appointments. My DH needs both of these things... but since we have to pay upfront and get reimbursed later, it's a pain. Each therapy session is at 50-150 dollars. At 2 or 3 sessions PER WEEK, that's a lot of money to be putting up front.