RE: Kicka, part 3 (Full Version)

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peculiar_lady2 -> RE: Kicka, part 3 (3/13/2008 10:09:27 AM)

Jeanie....I know you didn't ask me, but.......our insurance pays 100% at MTF's (Military Treatment Facilities)....and at non MTF's they pay nearly that (for all emergency or referral work). Basically all we have ever had to pay is hospital stay fees ($11 per night plus meals....so with each kid born in a MTF it's been something like $35-50). We get a summary of costs statement though....and sometimes we get bills that we have to turn over to the insurance office to take care of (esp if it's not an MTF).



paulsbride -> RE: Kicka, part 3 (3/13/2008 11:31:51 AM)

I know you didn't ask me either [;)] But having lived there, no, I never received any statements on the services received.
My dad didn't have insurance so some things weren't covered by the government (mainly vaccines for traveling overseas.) The two times I had to get them done I just paid cash and was given a receipt for it - I never got anything in the mail.

Maybe Lexie can shine more light on this - but I believe in Canada, or Ontario anyway, they can refuse care if you cannot pay upfront. Most people have OHIP (health insurance) so it's not a normal encounter to have people that need to pay.
I *think* that is illegal down here to refuse medical services, right?

When I was at my parents for six weeks during my pregnancy with Judah I had to see a doctor twice and both times I had to pay cash or credit for the services at the time of service. (because you need to have 6 months of residency before you can use the health care system - so even though I am still Canadian, and in fact still have my health insurance card, I couldn't morally use it.)


And right now being military I am being seen at a civilian hospital but I do not get statements on what things would've cost.
I wish I did though - I'm very curious what this baby costs! I know what Judah costs as we were on State insurance for most of the pregnancy and they mailed me statements.



Bubbles5 -> RE: Kicka, part 3 (3/13/2008 11:39:49 AM)

Hi Everyone [sm=wave.gif]
I usually don't venture out of the community daily chat thread, but I needed to find Twin. [;)]
I must admit to starting to read this thread..and find it intresting so far.
If you don't mind (when I get it all read) I might come on over to chat the topics?
In the meantime, I hope you don't mind me posting something for Twin.

Twin, could you PM me??



TammyIsBlessed -> RE: Kicka, part 3 (3/13/2008 11:53:51 AM)

Bubbles - of course you can chat the topics!! Even if you don't read it all[:D]



peculiar_lady2 -> RE: Kicka, part 3 (3/13/2008 12:14:13 PM)

quote:

I *think* that is illegal down here to refuse medical services, right?

yes...in an emergency situation. Not particularly in a non-emergency way though....for instance, an elective surgery.

quote:

And right now being military I am being seen at a civilian hospital but I do not get statements on what things would've cost.

yeah our statements do not list what it would have cost...only what was paid by our insurance. 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.



paulsbride -> RE: Kicka, part 3 (3/13/2008 12:17:43 PM)

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!



peculiar_lady2 -> RE: Kicka, part 3 (3/13/2008 12:27:12 PM)

quote:

ORIGINAL: paulsbride

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!

yeah. I think they get a bad rap on things. Problem is, other companies pay whatever, which ups the prices even more....but tricare sticks to their guns...they make people live up to the contract they signed with them...and a lot of medical people don't like that. They WILL pay....they just won't pay ridiculous overpriced charges for stuff. I know a lot of easier insurance's that simply won't pay...that's not tricare's policy though...they will pay for just about anything (if it's covered...and just about everything is covered)....and they won't really put the patients through what other insurance companies will with their patients.....instead they make the dr's live up to their word though and some don't like that. I would much rather have it then some other insurance companies though.



Bubbles5 -> RE: Kicka, part 3 (3/13/2008 12:51:29 PM)

Thank You For The Warm Welcome Tammy [:D]
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 [sm=eek.gif]



Nicole_Michelle -> RE: Kicka, part 3 (3/13/2008 12:53:37 PM)

Welcome Barb!



peculiar_lady2 -> RE: Kicka, part 3 (3/13/2008 1:02:09 PM)

HI BARB!!!! Welcome to this side of the forums!!!!



Bubbles5 -> RE: Kicka, part 3 (3/13/2008 1:46:05 PM)

Thank You Nicole

Hi Sarah,
Mother to almost five. Welcome to the club [;)]



peculiar_lady2 -> RE: Kicka, part 3 (3/13/2008 1:49:48 PM)

quote:

Hi Sarah,
Mother to almost five. Welcome to the club

LOL...yeah it's an "elite group" isn't it!!! We aren't sure if we will have more then five or not....medically I am not sure if I could handle another pregnancy (and my dr, who loves big families...came from a six kid family and has four of her own...agrees with that)...plus there's the having to get a bigger vehicle then what we have, and what we have is paid off fully (YAY!!!)....so we are not sure yet, but we might be done when this one comes. We are still praying about it. That's such a hard thing to decide....kwim?



Bubbles5 -> RE: Kicka, part 3 (3/13/2008 2:08:24 PM)

Sarah,
It's a personal choice.How many children one wants, or can handle.
We had our three older children within our first four years of marrage. One daughter and two sons. Then we thought we were done. But seven years later we had our daughter and our son came three and a half years after that. I was 35 years old by then. I decided after that I was done. We needed to add on to our home (more bedrooms) and get a bigger vehicle. Funny..we even had to buy some more kitchen chairs. LOL
We both feel SO BLESSED. I LOVE a large family. Now with the grandkids comeing my house gets pretty full when everyone come's home. [sm=heart.gif]



lexie -> RE: Kicka, part 3 (3/13/2008 5:11:28 PM)

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.



paulsbride -> RE: Kicka, part 3 (3/13/2008 5:30:43 PM)

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?



ChelseaRae -> RE: Kicka, part 3 (3/13/2008 7:14:58 PM)

Geepers!!! I have been waiting and waiting for Kicka 3 to start so I could jump in and you ladies are already at nine pages! Is it still okay if I jump in? I am very much missing grown up talk and you guys have such interesting discussions in here! If no one minds I am going to jump in.[:)]



paulsbride -> RE: Kicka, part 3 (3/13/2008 7:25:12 PM)

[:D] Good! Welcome Chelsea[:)]



lexie -> RE: Kicka, part 3 (3/13/2008 8:10:01 PM)

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!)



paulsbride -> RE: Kicka, part 3 (3/13/2008 8:53:05 PM)

Thanks Lexie for clearing all that up!!



RepentanceIsRequired -> RE: Kicka, part 3 (3/13/2008 10:23:52 PM)

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.



TwinCityGirl -> RE: Kicka, part 3 (3/13/2008 10:30:46 PM)

Hey, my friend BARB showed up!

Hi, Barb!!! [sm=wave.gif]

Hello, and welcome Chelsea! (Yes, come ANYTIME!!! Doesn't matter how little or how often you stop on by -- everybody is welcome!)

Welcome also to:

Kim
Tonya
Myka
Nicole (RepentanceIsRequired) (You're the 3rd Nicole here with Nicole/CAN and Nicole/AUS!)
Laura
Tammy

I hope I haven't forgotten to greet everybody! I am so glad to see so many women come over and add their 2-cents whenever they feel like sharing. Thank you all for stopping by! [sm=wave.gif]

Jeanie



peculiar_lady2 -> RE: Kicka, part 3 (3/14/2008 12:21:29 AM)

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)



ChelseaRae -> RE: Kicka, part 3 (3/14/2008 12:40:41 AM)

Thank you for the welcome! I don't know all of you that well, I will introduce myself.

My name is Chelsea, I am a 22 year old sahm. I have been married for a year and a half and have a 9 month old dd. I am totally in love with staying at home and being a mom but some adult conversation about something other than Mary is desperately needed around here!

All of this insurance talk is making my head spin! I know some of you have said in the past that you like the system but I sure like what we have up here in Canada. I am so glad I don't have to worry about what is/isn't covered, it sounds like a big pain to me. In nursing I heard that people loose their houses and life savings over medical bills, that is insane!



ThursdaysChild -> RE: Kicka, part 3 (3/14/2008 1:31:06 AM)

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.





Bubbles5 -> RE: Kicka, part 3 (3/14/2008 8:58:49 AM)

Hi Everyone [sm=wave.gif]

Chelsea, Thats why I come online...for that ADULT conversation.
If there is anything I miss with working outside my home it's that. I have been a SAHM for 19 years now. After I gave birth to my fourth child, I could no longer afford daycare for all them kids. I was paying out more per hour than I was makeing. But I do MISS the adult conversation daily tho. Now I am watching my neice's children and my grandchildren. My kids friends are comeing to me for daycare for their kids. Goodness..sure does make one feel old [;)]

Nicole,
I TRYED reading our new policy. It went right over my head [sm=crazy.gif]
Altho I am being more responsible in calling ahead of time to see if a procedure is covered. My mamogram was suppose to be covered 100%. But after 3 months I got a bill. I called my ins. company to see what happened. After about a half an hour purshing this number, and that number, and being put on hold. I FINALLY got to talk to a real person!
They assured me the check is being sent out soon to the hospital. Same thing happened when I got my cholonosopy (sp?) I don't know if they paid that or not. Altho they said they would cover it 100%. Guess I should call the hospital and see if they ever got their check.
See, my last insurance company never had me do all this checking.

Twin..my friend
I came onboard to have you PM me. Could you please do that?
But while over here I have decided I like this thread. The folks here are so nice, and the conversation is intresting [:)]



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