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RE: Kicka, part 3 - 3/13/2008 11:53:51 AM
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TammyIsBlessed
Posts: 1478
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Bubbles - of course you can chat the topics!! Even if you don't read it all 
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I am only one, but still I am one. I cannot do everything, but still I can do something. I will not refuse to do the something I can do. Helen Keller
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RE: Kicka, part 3 - 3/13/2008 12:17:43 PM
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paulsbride
Posts: 1683
Joined: 5/19/2005
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quote:
That's why a lot of places won't take military insurance....in them taking it they are saying they will receive whatever their system sets as the price, not what the dr wants out of them for that procedure.
I know! I have had Doctors tell me that Tri-care is the most ridiculous insurance out there and that they wish "they" (tri-care people) would smarten up and treat the soldiers better.
I have no complaints about it, I am very grateful for the free treatments we do get, and the Doctor has found ways around the system to get me the things she feels I need, but I do wish that Tri-care wasn't so looked down upon by the medical world!
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-Jessica-
<--- 25 weeks
MY BLOG
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RE: Kicka, part 3 - 3/13/2008 12:51:29 PM
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Bubbles5
Posts: 859
Joined: 4/12/2005
From: Wisconsin
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Thank You For The Warm Welcome Tammy
Please call me Barb...
Let me introduce myself alittle:
I am a SAHM that does daycare. I am the mother to five children, three grandchildren, with two more on the way. Been married to my wonderful husband for almost 30 years now. Three of my children are married and out on their own, my fourth child is in her first year of college, she come's home on week-ends, and my "baby" is a freshman in high school.
I see we are talking about insurance. My husband's company changed our insurance three years ago. I in turn had to find a new family doctor. I was'ent to happy with that. I had been going to this clinic and doctor for over 25 years. In our network, in my area, their was only TWO doctors to choose from. This "new" insurance signs contracts with these two doctors and my hospital to pay a certain amount for a procedure or a check-up. I just have to pay a $20 co-pay. The problem is to make sure everyone I see is in my "network". I was going to my hospital for blood tests, and paying around $200 every six months. (This is for high cholestrol checking) I finally called the hospital (in my network) and questioned the high cost. They informed me the hospital is in their network...but not the lab!!! I now have to drive 45 minutes away, to another hospital, that has a lab in our network. They really know how to mess with your brain 
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My granddaughter Isabelle
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RE: Kicka, part 3 - 3/13/2008 12:53:37 PM
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Nicole_Michelle
Posts: 2660
Joined: 8/22/2007
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Welcome Barb!
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~Nicole~
<---Genevieve tried to escape but got stuck! She's a crazy, hyper hamster!
For the love of photography - my blog
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RE: Kicka, part 3 - 3/13/2008 5:11:28 PM
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lexie
Posts: 2959
Joined: 6/27/2005
From: Toronto
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quote:
Do you ever see any kind of (not a bill) but any kind of summary of what services you received or any paperwork mailed to you at all?
We don't receive anything. When you show up to the doctor they swipe your health card and hand it back. They then send all of the information to the government, and we never see a thing. If you actually have to pay for something and send it in to your insurance, then you get something but I've never encountered that. As well, I'm sure I can ask for paperwork saying what I've had done if I really wanted it.
Supplemental insurance here often covers drug plans, private hospital rooms, eye care, elective procedures, etc.
There is a standard level of care they provide through the government and anything above it you have to pay for, unless the hospital can't provide it to you. For example, when we had Akeelah we did not have supplemental insurance so I asked to be put in a standard room (free, with 3 other women). By the time Akeelah came along all of the rooms were full, so they gave me a private room and they did not make me pay the $200 per day for it, OHIP had to cover it.
Jessica - They can't refuse emergency medical help without proof of insurance (besides emergency medical help is covered by OHIP anyways.) Basically, OHIP completely covers things that are medically necessary (doctors appts, needed surgeries, emergency medical care, and most specialists). I'm sure they can refuse things that aren't covered by OHIP like cosmetic surgery if you don't pay first, but I think that's rare. You'll never show up to the emergency room or doctor's office and be refused care though.
One thing that is being encountered now is OHIP card fraud, so a lot of places will charge you a fee if you don't bring your card with you to the appointment, to cover the cost of the appointment if your card does not go through.
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RE: Kicka, part 3 - 3/13/2008 5:30:43 PM
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paulsbride
Posts: 1683
Joined: 5/19/2005
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quote:
Jessica - They can't refuse emergency medical help without proof of insurance (besides emergency medical help is covered by OHIP anyways.) Basically, OHIP completely covers things that are medically necessary (doctors appts, needed surgeries, emergency medical care, and most specialists). I'm sure they can refuse things that aren't covered by OHIP like cosmetic surgery if you don't pay first, but I think that's rare. You'll never show up to the emergency room or doctor's office and be refused care though.
But what about people without OHIP? How does that work?
Because I know that in order to get the OHIP card you need to be a resident for 6 months before you can apply, and there are TONS of immigrants! Do you know how that works?
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-Jessica-
<--- 25 weeks
MY BLOG
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RE: Kicka, part 3 - 3/13/2008 8:10:01 PM
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lexie
Posts: 2959
Joined: 6/27/2005
From: Toronto
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Immigrants are covered as long as they have applied for landed immigrant status, permanent residency or refugee status and they get a form when they enter the country saying you have met the medical requirements for landing.
As well, if you are here only on a temporary work permit you can get OHIP if you will be here for more than 6 months.
You have to wait three months from when you've established residency to get your OHIP card, and in that time they say you should have other insurance. (or hope you don't get sick). (BTW..if you're pregnant, you don't have to go through the 3 month waiting period.)
To keep your OHIP, you have to be in the province for 6 months a year.
I can't find anything that says you can be refused medical treatment if you are uninsured and can't pay for it (I've read through the Health Regulation Act, but that's a big document!)
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RE: Kicka, part 3 - 3/13/2008 8:53:05 PM
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paulsbride
Posts: 1683
Joined: 5/19/2005
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Thanks Lexie for clearing all that up!!
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-Jessica-
<--- 25 weeks
MY BLOG
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RE: Kicka, part 3 - 3/13/2008 10:23:52 PM
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RepentanceIsRequired
Posts: 1103
Joined: 9/14/2005
From: Home is where the heart is.
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quote:
ORIGINAL: peculiar_lady2
Our insurance doesn't pay what they request a lot of the times though...so it's weird. That's why a lot of places won't take military insurance....in them taking it they are saying they will receive whatever their system sets as the price, not what the dr wants out of them for that procedure.
I can see how military ins is good for the patient, but for the dr or facility Tricare pays lousy. There were many accounts at the hospital where I would write off over half the hospital bill because Tricare paid all that they would, and we were not allowed to bill the patient for the remaining balance. Occasionaly there would be a cost share on the patient's part, but it usually was not much.
quote:
This "new" insurance signs contracts with these two doctors and my hospital to pay a certain amount for a procedure or a check-up. I just have to pay a $20 co-pay. The problem is to make sure everyone I see is in my "network". I was going to my hospital for blood tests, and paying around $200 every six months. (This is for high cholestrol checking) I finally called the hospital (in my network) and questioned the high cost. They informed me the hospital is in their network...but not the lab!!! I now have to drive 45 minutes away, to another hospital, that has a lab in our network. They really know how to mess with your brain
I've seen this happen to many people, and would have many a conversation with patients about their plans. What it boils down to is knowing your plan. The first thing I do when I receive a new ins plan is read my benefits booklet (several times) and if something is unclear I call.
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--Nicole--
"We all have our blinking and beeping and flashing lights to deal with." Buck Murdock (as played by William Shatner) in Airplane 2.
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RE: Kicka, part 3 - 3/14/2008 12:21:29 AM
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peculiar_lady2
Posts: 8768
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quote:
ORIGINAL: RepentanceIsRequired
quote:
ORIGINAL: peculiar_lady2
Our insurance doesn't pay what they request a lot of the times though...so it's weird. That's why a lot of places won't take military insurance....in them taking it they are saying they will receive whatever their system sets as the price, not what the dr wants out of them for that procedure.
I can see how military ins is good for the patient, but for the dr or facility Tricare pays lousy. There were many accounts at the hospital where I would write off over half the hospital bill because Tricare paid all that they would, and we were not allowed to bill the patient for the remaining balance. Occasionaly there would be a cost share on the patient's part, but it usually was not much.
considering how much the dr or facility overcharges on things and makes their own prices, I am glad there is an insurance that actually stands their ground and doesn't let anyone push them around. Not that many would do that, esp these days. If these dr's don't like it, then they have the option of dropping their contract with them. I have heard a lot of dr's say though that they LIKE tricare, because while they won't pay outrageous fees, they actually DO pay...and in a timely manner...whereas other insurance companies put them through the ringer for forever sometimes to get a simple thing paid. Unfortunately it's a love/hate relationship with tricare...either you love them or you hate them...there really is no middle ground. I personally love them. They don't charge us a huge amount that we wouldn't be able to afford and they cover everything we have ever needed done. Considering what the gov't pays soldiers these days it's something small that I think helps out tremendously. Most people can't imagine what our soldier go through for the pay they receive...it's insane...esp before these last few years before the increases every year. It has gone up 3% every year for the past few years, and that has made it a little better...but to me and IMO it's still not enough for what they go through (not that I am complaining...our bills are paid and we look to God to provide money, not the Army....but I still don't think it's enough when you consider their jobs)
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Be alert - the world needs more lerts.
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RE: Kicka, part 3 - 3/14/2008 1:31:06 AM
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ThursdaysChild
Posts: 344
Joined: 1/18/2006
From: The Arabian Gulf
Status: offline
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Hi, ladies.
With all this insurance talk, I can tell you I sure like living overseas! In Lebanon the kids and I just had hospitalization because a doctor's visit, to a regular internist, was $20. Not a co-pay...the cost of the visit itself. When our doctor had to make a housecall (they still do that) it cost about $30-35. After E's appendectemy (sp?), we paid about $20 for our share.
Here in Kuwait you can see a doctor you choose and pay whatever. It's been a while so I don't know what it costs. But once we got our civil ID's we just started going to the clinic and paying 1KD (3.5 USD) to see the doc, get meds, tests, etc. I did go to a dentist this winter. Just got cleaning, no X-rays. It cost 20 KD (70 USD). I'm going to hate that part of moving back to the States...messing with insurance, etc.
Well, we're moving this weekend. Hopefully we can get things taken care of this weekend. We've been moving all week but around our work schedules. Last Saturday night we didn't do anything at all because DH had a horrible headache and it caused his BP to go up to 152/106. He called the dr who said he was more worried about the headache. Get rid of it and the BP should go down. I gave him my pills from the clinic and half an hour it was almost gone. He wanted me to go get more. LOL (This from a guy who hates taking drugs even when they're absolutely necessary.) DH has to go apply for the phone line to be moved so unless I'm back over here for a bit I won't be online much until I'm back at school on Sunday.
Have a nice weekend, ladies.
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Live your life in such a way that every morning when your feet hit the floor...Satan shudders and says..."Oh No...she's AWAKE!"
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But having lived there, no, I never received any statements on the services received. 
