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Crohn's Disease Forum » General IBD Discussion » How do Americans pay for their Crohn's healthcare?


07-23-2017, 02:19 PM   #1
Idiom
 
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How do Americans pay for their Crohn's healthcare?

I heard Trump lost a vote to reform healthcare.

It sounds complicated, so how do you Americans pay for your Crohn's treatment and are you satisfied with what you get?

I understand there is health insurance, but I don't see why an insurance company would cover someone with a chronic illness.

(I live in the UK).
07-23-2017, 05:32 PM   #2
cmack
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American healthcare, or lack thereof, is a very heated and controversial subject. You have NHS and we have a similar system in Canada. Ours is awesome in comparison, however flawed our systems may be. I'm no American, but I know we have it way better than down south.
07-23-2017, 08:41 PM   #3
Crispix73
 
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I'm very fortunate that I have a great insurance plan through my husband's job. I haven't had any problems with them covering procedures and medications. I currently take lialda and pay $30 a month. I've never had any problems with the pre-existing condition because I've never had a lapse in my insurance. I went right from my parents insurance, to my own insurance, to my husband's insurance plan.

I'm most likely going to have to go on a biologic in the next few months, so I guess I'll see if I run into any trouble with them approving it, and what the copay will be. Hoping it will be manageable for me.
07-23-2017, 08:53 PM   #4
Jabee
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In the UK and Canada taxes pay for health care. Here in the US (ridiculously) we buy health insurance through our employers. Basically, insurance companies profit because more people buy insurance than use it (in theory). So the insurance companies earn more than they spend. Some insurance companies are non-profit but most are for-profit. The insurance is expensive, though, and smaller companies often don't offer it. Individual plans are available not through an employer but their cost is prohibitive and they often limit coverage and don't cover chronic illnesses (since they are a "pre-existing condition"). As a result many people don't have health insurance so they either don't get needed medical treatment or pay enormous bills (the cost of medical care is another issue that the US needs to address). People over 65 are covered by a government program (Medicare) but need supplemental insurance (which is often provided by their employer) to ensure all treatment is covered.

While I have a rudimentary grasp of how the ACA (Obamacare) works, I am not the best person to explain it! Suffice it to say that more people are covered by health insurance (and can therefore get health care) than before. The new "plan", or lack thereof, under the Trump administration, would take health insurance away from people.

The bottom line is that everyone in the US should be able to get affordable health care. The ACA is the first (essential) step toward providing health care for all US citizens.
07-24-2017, 04:42 AM   #5
Beach
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I don't have Crohn's. I have a type of colitis. With the health care system though, as you have likely heard ours is much more costly. Approx. 18% of our GDP goes toward health care expenditures while other western countries pay around half that, 9% and even sometimes less than that.

Part of the reason for the increased costs is due to a lack of shopping around. Prices for procedures and drugs can vary greatly from hospital to hospital it has been reported frequently over the years. As an example:

Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences

http://www.huffingtonpost.com/2013/0...n_3232678.html

excerpt:

When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.

Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.

Americans have long become accustomed to bewilderment and anxiety when confronting health care bills. The new database underscores why, revealing the perplexing assortment of prices for medical care, with the details of bills seemingly untethered to any graspable principle.

Even within the same metropolitan area, hospitals charge prices that differ by staggering degrees for the same procedures. People without health insurance pay vastly higher costs for care when less expensive options are often available nearby. Virtually everyone who seeks health care winds up paying inflated prices in one form or another as these stark disparities in price sow inefficiencies throughout the market.

While this basic picture has emerged as the consensus reality among health care experts, their evidence has been primarily anecdotal. Hospitals have protected their price lists — documents known as charge masters — as closely guarded secrets.

Their prices are secret no more.

The database released on Wednesday by the federal Centers for Medicare and Medicaid Services lays out for the first time and in voluminous detail how much the vast majority of American hospitals charge for the 100 most common inpatient procedures billed to Medicare. The database — which covers claims filed within fiscal year 2011 — spans 163,065 individual charges recorded at 3,337 hospitals located in 306 metropolitan areas.

The Obama administration shared the data in advance with The Huffington Post, The New York Times and The Washington Post. What emerges through a preliminary analysis is a snapshot of an incoherent system in which prices for critical medical services vary seemingly at random — from state to state, region to region and hospital to hospital....
07-24-2017, 08:50 AM   #6
mtseeg
 
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Unfortunately the Senate may still push through a vote to fully repeal the ACA this week. Last I heard, they're going to take a vote just to get the senators on record, though at least three Republicans have stated they'll vote no (which is enough to kill it).

The ACA isn't perfect, but a full repeal with nothing replacing it would be a disaster. One side hates the other side while everyone who wants good healthcare is caught in the crossfire. It's crazy.
07-24-2017, 10:42 AM   #7
Scipio
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The US has a mixture of health insurance options that range from outstanding to nonexistent. Most people, including me, get their health insurance through a group plan offered by their employers. Currently, insurers are required by law to cover a long list of medical conditions, and I'm pretty sure IBD is on that list. Often employees can choose between a Preferred Provider Organization (PPO) option and a Health Maintenance Organization (HMO) option.

In a PPO the patient can choose their own doctor and can go straight to a specialist if they so choose. But they are strongly and financially encouraged to choose doctors and hospitals that are “In plan.” Which is to say they have signed a contract with the insurance company to provide services at a discounted price. If you choose a doctor or hospital that is “out of plan” then the percentage of bill the insurance company will cover is sharply reduced. So there is strong financial incentive to stay “in plan.” I live in San Diego and the quality of the medical care available here is quite high. I have a PPO that offers many In-plan choices, and I am generally happy with it.

In an HMO there is less freedom of choice for the patient. You cannot go straight to a specialist but must first work your way through a series of triage nurses, GPs, and other screeners. Same for drugs. The HMO may have rules requiring the doc to first prescribe older, cheaper drugs before moving up to the fancy and costly new ones. HMO insurance is significantly cheaper for the patient than PPO, but you pay for it with more limited choices and greater bureaucratic headaches. For expensive non-emergency procedures (an MRE or CT scan for a Crohn’s patient for example) both HMOs and PPOs will often require a pre-authorization process in which the doc justifies the need for the expense.

For very poor people there is government provided insurance called Medicaid. It’s a sort of government run HMO. The waits to see doctors are often long and choices very limited. This is because the government reimbursement rates to the healthcare providers are so low that most doctors can afford to accept only a very limited number of Medicaid patients. Some accept none at all. Much of the current political debate centers on increasing or decreasing the funding of Medicaid and enlarging or shrinking the group of people who qualify for it.

For the millions of people who are employed by small companies that cannot afford to offer group insurance plans there are the options of either buying a private insurance policy or going without any insurance. Traditionally, a private policy was very expensive, so most people who fell into this category simply went without insurance and relied on Emergency Department care for the times when they got really sick. This however is very inefficient since ER medical care is the most expensive medical care there is. This is the gap that the ACA (ObamaCare) sought to fil by providing both the carrot of financial subsidies and the stick of penalties to induce people without insurance to get one of these policies. This program has been a success but an uneven one. Twenty million more people have insurance now than had it before ObamaCare, and that’s good. But the program is faltering as some insurance companies have bailed out of the program and others have raised rates, and that’s bad. Plus the law is unpopular because many Americans resent being told by the government that they must purchase something, even when it may be in their interest to have it. Whether to repeal this requirement to buy insurance is also a key part of the current political debate. However, economists and insurance companies warn that without this requirement it is likely that many healthy people who do not have employer provided insurance will stop buying insurance, leaving mostly sick people in the pool of policy buyers. This will drive up prices even further and will eventually cause the system to collapse - the so-called "Death Spiral."

By contrast in the UK the system is much simpler. They have NHS – which is basically one big HMO for the entire country. And it has all the same advantages and drawbacks that most US HMOs have but on a much larger scale, and with a dose of government bureaucracy and political pressure thrown in.

There is no one best answer. Healthcare funding is a kind of a zero-sum game. Any money spent on one function or service is taken away from somewhere else. So it all depends on the priorities and choices any given society makes. The UK system provides decent but not great care for everyone. The US system provides the latest and very best care in the world to those who have the money or good insurance to pay for it and somewhat less for those who don’t - ranging down stepwise to those who have no health insurance at all.

Last edited by Scipio; 07-24-2017 at 10:57 AM.
07-24-2017, 12:41 PM   #8
Beach
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That is something I hope any new health care law is able to fix, Emergency Room visits. In theory it was thought that the ACA would decrease expensive ER visits. Instead the opposite happened. More people are going to the ER. A little on that issue can be seen here:

More evidence expanding Medicaid increases emergency room visits

https://www.washingtonpost.com/news/...=.7d082d314aec

excerpt:

...Ezekiel Emanuel, a top White House health policy adviser during Obama’s first term now at the University of Pennsylvania, said that the best way to reduce emergency room visits would be to change how health care is paid for. He pointed to a program in Seattle in which home health care workers faced an increased copay for using an emergency room, compared to urgent care.

Changing payment systems, he argues, can incentivize doctors and patients to act differently. Right now, those incentives don't exist and the system is built so that the path of least resistance may be the emergency room for many patients.

Emanuel was especially struck by a quote in the study from a patient who was sent to the emergency room by a doctor: "Your blood sugar is way too high. It’s going to take us hours to get it down. So you need to go to the ER," the patient reported being told during a regular office visit.

"We have a system that hasn’t actually changed, both on the physician side and on the patient side and I think that’s what we’re seeing here," Emanuel said. "We know we can change emergency room practices, but it’s not the kind of thing where just giving someone insurance or a primary care doctor is going to do it."

I mention, as I recall reading an ER doctor complaining about now seeing a surge in Americans suffering from and seeking treatment for constipation. He felt this was an issue that could be best taken care of by Americans eating more fiber most likely for most, to visiting a drug store and buying a laxative, or seeing a GP in severe cases, not visiting an expensive and busy ER.
07-24-2017, 02:10 PM   #9
Cross-stitch gal
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My work has better insurance than my husbands so I stick with that. I end up paying a little out of my paycheck every week for it since I get paid once a week. My Pentasa they changed so I'm given 3 months worth for $300. But, before I saw this GI my first GI had me taking too much medication. So, my 3 months worth is actually 6 months. So, that means I'm paying about $50 a month. Even though I'm paying $300 up front.
__________________
Diagnosed:
Ulcerative Colitis/IBD 1996, Iritis 2001, Ulcerative Proctitis 2013, Indeterminate Colitis 2016, Remission 2017, Hand Eczema

Current Meds:
Pentasa 1000mg 2xday or Mesalamine DR 1.2gm 2xday, Canasa Suppositories (when needed) 1000mg 1xday, Tylenol 3 with codeine 300-30mg (when needed)

Non-Meds:
600+D Calcium 2xday, Multivitamin, 65mg Iron 1xday, Fish Oil 1000mg, Vitamin D3 5,000 I.U., Eye Drops 2xday


UP Support Group http://www.crohnsforum.com/showthread.php?t=68350
07-24-2017, 02:49 PM   #10
aypues
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I'm self employed so an employer plan is unavailable to me. I purchase my plan through the California exchange, and since I make too much to qualify for a subsidy I end up paying $628/month for a Blue Shield Platinum plan which is great. Because of my Remicade infusions I meet the annual out of pocket max of $4000 within a few months, and I pay none of it practically because of Remistart. There is no deductible. I feel I am lucky to be able to afford it but what if I wasn't making as much? It would still be very expensive even with a subsidy. I just plan to allow about 10k/year in medical expenses, although this year will be less around 8k.
07-24-2017, 03:02 PM   #11
Scipio
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One thing that the ACA (Obamacare) did away with that is of particular important to Crohn's patients is lifetime caps. Prior to that law many insurance companies would stop paying benefits once you hit a certain limit for total health care expenses, say $1 million or $5 million or some such number.

Since many of us take expensive biologics or other medicines for years on end, it can be very easy for us to exceed these caps in a few years should they return. There has been talk and speculation during the congressional debates of the various healthcare reform bills that whatever finally final comes into law may allow for the reinstatement of lifetime caps as a way of controlling costs. Boy, I hope not. That would be sword hanging over the head of anyone with an expensive, incurable disease.
08-02-2017, 01:43 PM   #12
Idiom
 
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Thanks for all your answers. Really interesting stuff.

I feel for you guys who have to stress about the cost of healthcare.
08-05-2017, 06:14 PM   #13
chuckmya
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My private insurance in Maine is Blue Cross Anthem..... the monthly premium is $1200 just for me with a $1000 deductible & $2500 out of pocket max! How can anyone afford that???? Something hasta be done to allow EVERYONE to be able to have a reasonable rates! I DON'T GO TO THE ER unless I'm on my deathbed literally! I dunno how much longer any of us can sustain pay such high premiums??? Something hasta give!!!

08-05-2017, 06:25 PM   #14
chuckmya
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The US has a mixture of health insurance options that range from outstanding to nonexistent. Most people, including me, get their health insurance through a group plan offered by their employers. Currently, insurers are required by law to cover a long list of medical conditions, and I'm pretty sure IBD is on that list. Often employees can choose between a Preferred Provider Organization (PPO) option and a Health Maintenance Organization (HMO) option.

In a PPO the patient can choose their own doctor and can go straight to a specialist if they so choose. But they are strongly and financially encouraged to choose doctors and hospitals that are “In plan.” Which is to say they have signed a contract with the insurance company to provide services at a discounted price. If you choose a doctor or hospital that is “out of plan” then the percentage of bill the insurance company will cover is sharply reduced. So there is strong financial incentive to stay “in plan.” I live in San Diego and the quality of the medical care available here is quite high. I have a PPO that offers many In-plan choices, and I am generally happy with it.

In an HMO there is less freedom of choice for the patient. You cannot go straight to a specialist but must first work your way through a series of triage nurses, GPs, and other screeners. Same for drugs. The HMO may have rules requiring the doc to first prescribe older, cheaper drugs before moving up to the fancy and costly new ones. HMO insurance is significantly cheaper for the patient than PPO, but you pay for it with more limited choices and greater bureaucratic headaches. For expensive non-emergency procedures (an MRE or CT scan for a Crohn’s patient for example) both HMOs and PPOs will often require a pre-authorization process in which the doc justifies the need for the expense.

For very poor people there is government provided insurance called Medicaid. It’s a sort of government run HMO. The waits to see doctors are often long and choices very limited. This is because the government reimbursement rates to the healthcare providers are so low that most doctors can afford to accept only a very limited number of Medicaid patients. Some accept none at all. Much of the current political debate centers on increasing or decreasing the funding of Medicaid and enlarging or shrinking the group of people who qualify for it.

For the millions of people who are employed by small companies that cannot afford to offer group insurance plans there are the options of either buying a private insurance policy or going without any insurance. Traditionally, a private policy was very expensive, so most people who fell into this category simply went without insurance and relied on Emergency Department care for the times when they got really sick. This however is very inefficient since ER medical care is the most expensive medical care there is. This is the gap that the ACA (ObamaCare) sought to fil by providing both the carrot of financial subsidies and the stick of penalties to induce people without insurance to get one of these policies. This program has been a success but an uneven one. Twenty million more people have insurance now than had it before ObamaCare, and that’s good. But the program is faltering as some insurance companies have bailed out of the program and others have raised rates, and that’s bad. Plus the law is unpopular because many Americans resent being told by the government that they must purchase something, even when it may be in their interest to have it. Whether to repeal this requirement to buy insurance is also a key part of the current political debate. However, economists and insurance companies warn that without this requirement it is likely that many healthy people who do not have employer provided insurance will stop buying insurance, leaving mostly sick people in the pool of policy buyers. This will drive up prices even further and will eventually cause the system to collapse - the so-called "Death Spiral."

By contrast in the UK the system is much simpler. They have NHS – which is basically one big HMO for the entire country. And it has all the same advantages and drawbacks that most US HMOs have but on a much larger scale, and with a dose of government bureaucracy and political pressure thrown in.

There is no one best answer. Healthcare funding is a kind of a zero-sum game. Any money spent on one function or service is taken away from somewhere else. So it all depends on the priorities and choices any given society makes. The UK system provides decent but not great care for everyone. The US system provides the latest and very best care in the world to those who have the money or good insurance to pay for it and somewhat less for those who don’t - ranging down stepwise to those who have no health insurance at all.
Its not just the poor that cant afford the premiums.....My private insurance in Maine is Blue Cross Anthem..... the monthly premium is $1200 just for me with a $1000 deductible & $2500 out of pocket max! How can anyone afford that???? The middle class such as myself & others that cannot buy insurance as part of a large group needs help too! Something hasta be done to allow EVERYONE to be able to have reasonable rates! I DON'T GO TO THE ER unless I'm on my deathbed literally! I dunno how much longer any of us can sustain paying such high premiums??? Something hasta give!!!

08-06-2017, 12:21 AM   #15
mtseeg
 
Join Date: Jun 2017
Location: Ohio
Canadian Journalist Ali Velshi says it best:

https://twitter.com/SenSanders/statu...35042096103424

"There is no actual 'free market' health system, and that's because no profit making company would ever choose to willingly insure a sick person or an old person. They just don't it.

"So the only way this works is as a risk pool. Now, the only way to cover as many people as you can with a risk pool is to do what most modern countries have done, and that is a single-payer health care system."
The United States has stubbornly shied away from a single-payer system.
Instead they've stuck to this idea that we can work this out with for-profit health insurance companies and for-profit health care providers and it just won't work. And that's because of what the "Adam Ruins Everything" guy best explains in his video:

https://www.youtube.com/watch?v=CeDOQpfaUc8

"American health care is NOT the best in the world. But despite that,
we spend more per person annually on health care than any other developed nation. And a big part of the reason for that is that American hospitals overcharge patients massively.

"After the rise of insurance companies, hospital billing got complicated,
in part because these gigantic corporations demanded gigantic discounts.
So to please these powerful insurance companies, hospitals cooked up a plan. They'd make up a really high, 'fake price' and then give insurance companies a discount off that."
And the problem with THAT, of course, is that if someone doesn't have insurance, they're also charged that overly inflated, "fake" price.
08-06-2017, 10:08 AM   #16
Bufford
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The Canadian system does work, but it is far from perfect with many procedures that are not covered. Things like dental and going to the eye doctor are not covered. A dental bill can be very high, and my teeth are awful. I have to choose between paying my taxes or going to the dentist. So if I am to keep a roof over my head, i had to trade off my teeth. Taxes are very high in this country, and in recent years essentials such as hydro have risen dramatically and are now taxed as well.

The other thing are the wait times for connecting with doctors and for getting procedures done. It took me several years to connect with a family doctor after my old doctor retired. Its not much fun waiting for hours in walk in clinics when one is not well. In the case of our regional hospital located in Thunder Bay, its too small and the ER is often swamped. Many of the sitting areas with in the hospital had to be converted into make shift wards, and there often are times when patients overflow and have to be placed in hallways for a lack of beds.
08-06-2017, 01:01 PM   #17
mtseeg
 
Join Date: Jun 2017
Location: Ohio
Hi Bufford: That does suck about the dental. I don't have dental coverage either here in the U.S. because my employer chose not to offer it. So I paid about $2500 last year for a root canal and other related procedures.

I pay $165 a month in health insurance, deducted from my paycheck. My insurance has a $3000 deductible. After that, I have to pay 30% for any procedure up to the maximum yearly out of pocket of $5500. There are also many procedures and drugs that my health insurance often chooses not to pay, and that's not counted here. All elective procedures need pre-authorization from the insurance company.

As for wait times, they've been notoriously long for elective procedures or for seeing specialists here in the States. My first GI appointment, which I'm still waiting on, will have been over a month wait just to get my first consultation. Other specialists have wait times of 6 months or longer, easy.

Many would blame the Affordable Care Act, but it isn't at fault here. Before the Affordable Care Act, I also had to worry about lifetime limits or being denied coverage due to preexisting conditions. And deductibles and wait times were already notoriously high before the Affordable Care Act. I do understand that since the ACA was passed, deductibles have risen at a slightly lower clip overall, but it doesn't feel like it.

Still, what we have now is loads better than what any of the last (failed) three Senate GOP bills proposed.

Universal health care may have its own set of problems, but I think overall, it's the best form of coverage for everyone, everywhere. If it weren't, 58 countries on earth wouldn't have adopted it.

Last edited by mtseeg; 08-07-2017 at 09:09 AM.
08-06-2017, 08:05 PM   #18
emilyt804
 
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At present, my husband pays for my health care. We are low-income right now (because I am not working d/t Crohn's and he is only working part-time because he also goes to school part-time).

So, we get a ACA waiver that the government pays to our insurance company (which is Anthem), and that lowers my premium to about $50/month.

I am trying to apply for both disability and Medicaid because in case I can't work (which has, in fact, been the case for approx. 2 years now), it would be better for my overall health/well-being for me to get a disability allowance from the government every month and to be on Medicaid, which is the government insurance plan for people in extreme circumstances (low-income + permanent disability...or low-income + pregnant).

I am 32 years old and married and have no children yet.

The thing that weirds me out about US healthcare is that if I lost my ACA waiver due to Trump successfully repealing the ACA, I could get health insurance back immediately and not have to pay a dime to do it...I'd just have to get pregnant first!

If I got pregnant, boom, Medicaid! No one would blink twice. And I'd get WIC, which stands for Women, Infants, and Children, which would allow me a certain amount towards my grocery bill from the time my application was approved during my pregnancy through my child's fifth birthday.

The Medicaid would go away - for me, at least - shortly after the baby's birth.

But, and here's the kicker...

It would be best for me to have my Crohn's treated, like to have a small bowel resection, or to have very serious drugs like Remicade, while I am *not* pregnant. Good for me; good for Baby.

However, if I really, really needed treatment for my Crohn's right now (like, if I wanted surgery and couldn't wait any longer, but it wasn't exactly an emergency...) I could just get pregnant and then the Medicaid would cover my "semi-elective" Crohn's surgery.

We have a separate law, called EMTALA, which stands for the Emergency Medical Treatment and Active Labor Act. I believe EMTALA was passed under the Clinton administration (mid-90s). Before EMTALA passed, hospitals would let patients give birth and/or die in hospital parking lots if they knew full well that the patient would not be able to pay. For instance, if the patient had outstanding, unpaid medical bills to that hospital, the hospital could refuse to treat.

I got my last bowel resection done under EMTALA. I lost my health insurance when I graduated from law school (in retrospect, it would have been wise for me to fail one class on purpose so that I could maintain my health insurance, but I was full of pride, and I wanted to graduate with my class!), so I'd had student insurance through my school, but I'd developed my "pre-existing condition" during the course of that school year.

Because I graduated, I was no longer eligible to continue my student coverage, because I was not a student any longer.

OTOH, I was not allowed to buy *any* health insurance plan on the open market. Insurance companies are not stupid. They know that folks with serious Crohn's are likely to lose them money. Ergo, no insurance for me. My grandmother tried everywhere. Everywhere! We even had an insurance agent who attended our church who knew my grandmother personally, and his hands were tied.

And, then, I could not work, because my Crohn's was too debilitating, so I could not get coverage through an employer.

But, in order to get disability in America, you have to prove that you have not been able to "work" for the prior eight months, plus a whole slew of other requirements, so I was not really eligible for disability/Medicaid at that time either.

Basically, America has a complicated system, and I fell through the cracks. The American health system pre-ACA simply did not work well for folks with chronic illnesses, especially illnesses like Crohn's, which can strike at any time in the life cycle.

I hadn't planned on getting sick as a 24-year-old law student, but that's what happened.

Heaven knows if I had known when I would get ill, I would have spent the prior 2.5 years doing something more enjoyable than spending my time in a law library! I might have joined the Peace Corps or been an au pair or something. I like advocacy, and I like little children, and I like doing charity work, so I really would not have wasted my time preparing for a career that (in reality) is probably going to be too much responsibility and too stressful to manage alongside my current symptoms, which have been on full blast for the last two years.

I am really, really and truly jealous of you British folk, who can just rely on the NHS to cover at least the majority of your medical needs, whenever the demon we call Crohn's strikes you.
08-06-2017, 08:11 PM   #19
emilyt804
 
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One thing that the ACA (Obamacare) did away with that is of particular important to Crohn's patients is lifetime caps. Prior to that law many insurance companies would stop paying benefits once you hit a certain limit for total health care expenses, say $1 million or $5 million or some such number.

Since many of us take expensive biologics or other medicines for years on end, it can be very easy for us to exceed these caps in a few years should they return. There has been talk and speculation during the congressional debates of the various healthcare reform bills that whatever finally final comes into law may allow for the reinstatement of lifetime caps as a way of controlling costs. Boy, I hope not. That would be sword hanging over the head of anyone with an expensive, incurable disease.

My student insurance as a law student had a $50,000 annual cap, which I killed in about six weeks (appendectomy + MRSA infection + complete bowel obstruction w/ NG tube + PICC line + other fun stuff). I had to declare a Chapter 7 bankruptcy due to medical reasons even though I was properly insured at the time that I began to be ill.

In retrospect, the American Bar Association had a better student health insurance plan at the time. However, the premium per year was also about $500 more than the student plan offered through my law school. $500 is a lot of ramen noodles when you are a student! So, I just figured I'd use my student plan for a Pap smear and birth control and maybe, you know, a broken arm or something.

I had no symptoms either my first or second year of law school. If I'd been symptomatic, since my mom has Crohn's, I assure you I would have bought the big plan.

IMHO, single payer is the only thing that makes sense.
08-06-2017, 08:20 PM   #20
emilyt804
 
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[QUOTE=Beach;983910]That is something I hope any new health care law is able to fix, Emergency Room visits. In theory it was thought that the ACA would decrease expensive ER visits. Instead the opposite happened. More people are going to the ER. A little on that issue can be seen here:

More evidence expanding Medicaid increases emergency room visits

https://www.washingtonpost.com/news/...=.7d082d314aec

excerpt:


For zip codes who have an urgent care facility (Patient First, Concentra), why not require Medicaid patients to have an urgent care doctor determine whether or not they need ER treatment before referral to the ER?

Obviously, you'd have to list the conditions requiring this special clearance...in a car accident, I'm just going to catch an ambulance, and urgent care can go stuff themselves.

I routinely go to the Patient First before I go to the ER with Crohn's. It's far cheaper for them to, say, run a CBC w/ differential to determine whether I am likely to have an abdominal infection before I bother my ER with fever + abdominal pain of indeterminate origin.

I don't like people who obviously just need to get over a hangover/detox hitting up my local ER. It makes me feel unsafe. Surely urgent care could give them a IV w/ fluids and/or do a referral to rehab.

I've been to the ER more than most people I know, and there *has* to be some pre-ER screening so that the people who really need to get seen get a stretcher.

In Rhode Island Hospital, the night before I had my appendix out, they had me on a stretcher in the hallway for several hours. I didn't mind, as they'd chosen to station my stretcher directly in front of the nurses desk, so I could just roll over and ask for a warm blanket or more morphine as desired. I told them I could be the last patient in the hallway (there were others!) that they put back in a room, b/c I did not care where I was located, as long as I was getting appropriate medical care.

The staff appreciated that.

However, this is America; we should not have a shortage of ER beds.

The night before I had abdominal surgery in Virginia, my nurse was consistently distracted by the guy down the hall, who was obviously drunk/stoned/drugged out of his mind, and she had to keep yelling at him to cooperate with her. I also really feel that giant, young, strong, angry male patients ought to be assigned a male nurse when possible.

My female nurse was tiny.

She was doing her best to control the situation, but I was worried he'd hit her or something because he was so out of it.

There are many, many things with regards to Emergency Rooms that ought to be corrected. Any hospital administrators reading this board: I am happy to speak with you about the patient experience!
08-06-2017, 11:52 PM   #21
cmack
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Join Date: Aug 2014
Location: British Columbia

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Hey Em,

I appreciate your experiences with the American health services. That is a real eye opener for sure. I hope, if your new president can only do one thing right, it is to fix that horrible situation you folks have to endure for medical bills.


God bless you,

Chris
08-07-2017, 08:45 AM   #22
mtseeg
 
Join Date: Jun 2017
Location: Ohio
emilyt804: To be going through this disease, on top of law school, on top of starting a family, on top of the struggles with the U.S. health care system....you're kind of a superwoman!
08-08-2017, 10:19 AM   #23
Bufford
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Join Date: Dec 2015
Location: Northwestern Ontario

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· Stoma
It becomes ridiculous when cut backs to healthcare involve this;
http://www.cbc.ca/news/canada/new-br...aper-1.4237506
Cut one administrative position and there would be more than enough for the essentials patients need. Its not that there is any shortage of paper in this county, but rather values, compassion and common sense.
08-09-2017, 08:25 AM   #24
teeny5
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Location: California

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I had insurance through my employer that was about $600/month. After I was laid off I had to convert to an individual plan since my husbands employer does not provide an insurance option that was good. We now pay about $700/month for insurance with less coverage than the employer plan (that is for both of us). Not terrible, but still expensive. Now I'm looking for work again...even part time could at least help pay for my healthcare! Our medical insurance is with Kaiser Permanente which is an HMO. We did not get dental to save money, but will add it once I am employed again. Vision is included.

Yes the insurance is expensive (there were cheaper options with higher deductibles), but my fear is always what if I flare and have to get stronger meds or even surgery. Something like that could easily put us into an unreal amount of debt. My Colazal (generic) has a price of around $200 and with my insurance I pay $30. Just to have prescription coverage is a must with this disease.
__________________
Currently on: Colazal, Prilosec, multi-vitamin, probiotics, total EFA's, glucosamine.

Previous meds: Sulfasalazine, Asacol, Rowasa, Pentasa, Entocort.


"Adopt the pace of nature: her secret is patience. -Ralph Waldo Emerson"
08-10-2017, 09:35 AM   #25
Beach
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Join Date: May 2011

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[QUOTE=emilyt804;985047]
That is something I hope any new health care law is able to fix, Emergency Room visits. In theory it was thought that the ACA would decrease expensive ER visits. Instead the opposite happened. More people are going to the ER. A little on that issue can be seen here:

More evidence expanding Medicaid increases emergency room visits

https://www.washingtonpost.com/news/...=.7d082d314aec

excerpt:


For zip codes who have an urgent care facility (Patient First, Concentra), why not require Medicaid patients to have an urgent care doctor determine whether or not they need ER treatment before referral to the ER?

Obviously, you'd have to list the conditions requiring this special clearance...in a car accident, I'm just going to catch an ambulance, and urgent care can go stuff themselves.

I routinely go to the Patient First before I go to the ER with Crohn's. It's far cheaper for them to, say, run a CBC w/ differential to determine whether I am likely to have an abdominal infection before I bother my ER with fever + abdominal pain of indeterminate origin.

I don't like people who obviously just need to get over a hangover/detox hitting up my local ER. It makes me feel unsafe. Surely urgent care could give them a IV w/ fluids and/or do a referral to rehab.

I've been to the ER more than most people I know, and there *has* to be some pre-ER screening so that the people who really need to get seen get a stretcher.

In Rhode Island Hospital, the night before I had my appendix out, they had me on a stretcher in the hallway for several hours. I didn't mind, as they'd chosen to station my stretcher directly in front of the nurses desk, so I could just roll over and ask for a warm blanket or more morphine as desired. I told them I could be the last patient in the hallway (there were others!) that they put back in a room, b/c I did not care where I was located, as long as I was getting appropriate medical care.

The staff appreciated that.

However, this is America; we should not have a shortage of ER beds.

The night before I had abdominal surgery in Virginia, my nurse was consistently distracted by the guy down the hall, who was obviously drunk/stoned/drugged out of his mind, and she had to keep yelling at him to cooperate with her. I also really feel that giant, young, strong, angry male patients ought to be assigned a male nurse when possible.

My female nurse was tiny.

She was doing her best to control the situation, but I was worried he'd hit her or something because he was so out of it.

There are many, many things with regards to Emergency Rooms that ought to be corrected. Any hospital administrators reading this board: I am happy to speak with you about the patient experience!
I agree. Many areas with how we use and run ERs should be updated. Along those lines I read this article today concerning a study that examined high ER costs. It provides ideas on how to help improve that issue.

Medical emergency: ER costs skyrocket, leaving patients in shock

https://www.cnbc.com/2017/08/10/medi...-in-shock.html
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