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October 21, 2009 – Comments (3)

DeniseCAHeathcare Status: Employer Insured

Our daughter was born with congenital heart defects and had the best of care when we lived in the Bay Area, however, we could only afford an HMO and learned we would have to fight to gain access to the top specialists for our daughter's care.

A couple years ago our daughter was diagnosed with a rare, life-threatening illness for which there is no cure and few treatment options, far fewer options for her because she is also a heart patient. Once again, we have to fight for access to a specialist in another state due to the lack of specialists in California. Our insurance company expects us to accept the fact that because we can only afford an HMO we are restricted to specialists at the only children's hospital in our city that almost killed our daughter in August 2007 because of their lack of expertise on her illness.

I find it appalling that 50% of health care costs go toward administrative costs and representatives, with no medical background whatsoever, are making life and death decisions! You need to realize you DO have a voice in the quality of care you receive. Insist on speaking with a Supervisor or Case Manager and bypass the representatives and do not be afraid to file appeal, after appeal, after appeal.

If you have to, go to the media with your struggle; we had to do it back in 1991 in order to bring to light the difficulty of changing health insurance companies when you are dealing with pre-existing conditions.

The actual amount of health insurance dollars that goes toward administrative costs is 35%. 25% on the insurers end and 12% in the doctors office.

3 Comments – Post Your Own

#1) On October 21, 2009 at 11:46 PM, Option1307 (29.68) wrote:

 we could only afford an HMO and learned we would have to fight to gain access to the top specialists for our daughter's care.

Who deserves the top specialist? Everyone?

lack of specialists in California.

Really, what specialist were they seeking?

Do you have a link for the article Devoish, I'd like to read more about it if you do. Thanks.

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#2) On October 22, 2009 at 8:17 PM, devoish (98.36) wrote:

Option,

It is not an article. It is just a letter. And yes I agree. Nobody is so special that they deserve better care than everyone else.  Especially not based upon income.

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#3) On October 23, 2009 at 10:53 AM, Option1307 (29.68) wrote:

Where did you get the letter?

I don't agree with most of your ideas about healthcare reform, but I appreciate your thoughts b/c they usually seem honest and I can usually see you rtrain of lgoic that brought you to your conclusions. Every once ina  while though, you throw out blogs like this that are way off base...

 we could only afford an HMO and learned we would have to fight to gain access to the top specialists for our daughter's care.

Think about that for a second. These people are complaining because they can only see a docotor at childrens hospital. Wtf? I have no idea which childrens this is because they didn't specify in their letter, but having access to a childrens hospital is usually far superior than most people are fortunate to receive. They should feel blessed not pissed off. 2nd, everyone cannot see the "top specialist". That is simply a logistically problem. It simply can't happen from a numbers standpoint. There is only one "top specialist" he/she can't see everyone. So it's ridiculous for these people to complain that they can't see the top specialist only because they are poor, yadda yadda, they have bad insurance, etc. Not everyone is going to have the best doctors, that is simply not possible.

3rd, this is more of a question. Under HR676, will everyone be able to see the "top specialist"? Would this family be happier under your proposed system in your opinion? I find it hard to belive that they would get the "top spcialist" under your system, and therefore would still be upset.

So what is the point of this letter?

1) This family is getting better care than most simply because they have access to a large childrens hospital

2) B/c they are at a childrens hospital they are getting treated by specialists

3) They are upset b/ they can't see the absolute besty best doctor in the world...Really? Is this a valid complaint? If so, how do you propose everyone gets access to the "top specialitsts"?

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