Access to hospitals and clinics and insurance coverage

**drz** · 11-04-2010, 07:31 AM

How many people have encountered difficulty getting access to a clinic, doctor, or hospital because of their insurance coverage? I read in news that Mayo was not taking Medicare anymore and know of some people on Medicare who were denied admission at Mayo, but also know some others who receive care at Arizona Mayo who are on Medicare.

I know many doctors won't take Medicare patients because of low rates of payment. Many insurance plans also have HMO plans or preferred provider networks and won't refer patients outside their network. I know of people who died because their HMO clinic wouldn't refer them to a specialist for better care. Both of these can be problems when we are seeking the best care for our Wegener's disease.

**Sangye** · 11-05-2010, 12:48 AM

JHU doesn't take Medicare Advantage, but does accept regular Medicare. They don't accept some other insurances, too. Fortunately even before I had Medicare they took my insurance. Mayo Arizona didn't, though, and I had to pay a huge amount each visit that was leftover from what my insurance would pay.

This isn't just a Weggie problem. Millions of people in this country are going without medical care or without the full care they need because of insurance issues. Don't get me started.

**marta** · 11-05-2010, 10:00 AM

That's just absolutely horrible. I can't even articulate how disgusting that makes me feel.

**freakyschizogirl** · 11-05-2010, 10:29 AM

Its the same in the UK, although we dont have to pay or sort out insurance.

**Jack** · 11-05-2010, 10:00 PM

Not sure I understand that post freaky. I've always had all the treatment I needed quickly and with no cost even though some of the drugs and treatments are frighteningly expensive. The only drugs that are difficult to obtain are the ones deemed to be ineffective by an independent body - NICE. This body has recently lost its power of drug withdrawal and it is now simply down to the doctor's decision.

I think you have had some particularly bad experiences with individual doctors, but the system itself provides a pretty good standard of health care.

(NICE = National Institute for Clinical Excellence)

**drz** · 11-07-2010, 07:17 AM

Part of the propaganda wars going on now about health care reform in USA allege that access in Canada to specialists is often hard to get since it requires a referral from a primary care physician and these allegations say that many Canadians can't find a primary care physician due to shortage of physicians so they can't get health care even though it is suppose to be available. Thus many Canadians come to USA for health care. Another claim is the Canadians don't wish to wait weeks or months for care when they can get in much quicker in USA if they have money to pay for it. We don't know how true these claims are or how much is exaggerated propaganda to argue for a certain view point.

**marta** · 11-07-2010, 12:08 PM

My personal experience with the medical system and this disease (and the few other medical things I've gone through) has been very positive to say the least. I have never had any problem getting a good GP, and the longest it took for a referal was for the ENT at the start and that took about three four weeks. The choice of ENT/specialist wasn't that great, but that could happen anywhere, anytime. I've never had to pull my wallet out through any of this - ever. And when proverbial poo hits the proverbial fan, I KNOW I will be taken care of no matter what. The system is taxed a little, but I have also learned that because there are so many people who abuse it when they don't really need it, that you just have to be your own best advocate and push if you see the ball getting dropped a little (which is what I did when the ENT referall went a little longer than I thought it should). I think that only the rich Canadians come down to the States to get stuff done if they don't feel they're getting done fast enough. I know I wouldn't be one of them, cuz rich is definitely not my normal descriptior. I know that politics is a no no on this site and I'm not sure how much of this flows into the land of politics, but I was sad to be watching the news from the hospital bed and watching some of the stuff that you mention above being said in the US and it makes me sad for the people who don't have the money. I think that it's people massaging words to push their own view and from my experience (and that of any of my family, friends, aquaintances) is very far from the truth.

Sorry if I've overstepped the boundaries of the forum, and I'll be happy to remove it if need be.

**Sangye** · 11-07-2010, 01:10 PM

(I'm okay with your post, Marta)

The argument about long waits for specialists and needing referrals doesn't hold water, since it takes weeks or months in the US to see most specialists, and it's common for insurance companies to require referrals to them. And we have a major PCP shortage. I've had real problems getting in to the PCP of my choice. In Arizona I had a great one who couldn't afford to stay in practice and went to work in the hospital. She had to make a personal call to get another great PCP to accept me as a patient, since her practice was full.

**Jack** · 11-07-2010, 09:05 PM

The whole subject of this thread will inevitably involve politics in general, but so long as it does not become an inter party battle I would think it is acceptable.

Personally I am a great fan of our own NHS system, but there are others who have had a bad experience with it. This seems to be very similar to the situation all over the world and has more to do with the qualities of the particular doctors involved than the system itself. In general, the medical systems are all so big that they have their problems and you really do have to push sometimes to keep things on track. It is a shame that this is required when you are feeling at your least able.

I have used the private health care system here in the UK to a limitted extent and the difference seems to be that you don't have to wait very long and you get offered coffee in a comfortable waiting room. The doctors are the same and the treatment is the same, but it hurts your bank account!