Whether you live in the U.S. or elsewhere, tell us about your medical coverage. Do you have insurance? If you live in the U.S., have you ever used Medicare or Medicaid? What was the experience like? Is your health coverage adequate? Have you ever been denied coverage or found it impossible to see your doctor?

For a rundown of my own experiences, see Brenda's description of her sinus problems on the other health care thread. That was almost exactly my situation, except I eventually gave up, and as a result I don't hear very well out of my left ear. I am currently looking into purchasing private insurance because I am so unhappy with Kaiser (although the sinus issues all happened when I was with Foundation, where my assigned primary care physician sent me home with Darvocet for chest pain instead of determining that I had bronchitis and mono).

Share your stories.

-- Anonymous, June 30, 2000

Answers

Beth::: looking into HIPC [Health Insurance Plan of California] aka PacAdvantage. Allows organizations/small comapnies, etc. to aggregate as insurance groups, thus getting group rates and coverage. They offer a choice of 11-15 carriers, and since it's group coverage, no worry about age or pre-existing conditions.

-- Anonymous, June 30, 2000

I'm lucky. I work for a large company and had a choice of various plans from HMOs to the kind where you see anybody any time you want. I pay something like $15 a month (I think - anyway, it's not a lot.)

I have various chronic conditions I need to keep under control, like asthma. I've had some other problems like foot pain that I needed to see someone about for a limited time.

I chose a managed care method because it's worked for me in the past. I picked a primary care doctor at a large teaching hospital clinic & see other doctors in that group. I've seen him a couple of times & don't have any problem getting referrals. Usually I talk to his secretary, she talks to him, and then calls me to tell me the referral is in place the same day. The insurance company required the referral. If I'm sick, I can call the secretary or the clinic for advice or an appointment. In case of an emergency, I can call the clinic and get their okay to come in (required, again, by the insurance).

The only problem I've had was when she was on vacation and I spoke to another person about getting a referral to a gyn for my yearly check up, and that person insisted the primary care doctor could do it. I was dubious about that just because I always assume a specialist is better, and the clerk was patronizing and annoying. When I did see the doctor, I complained about this and he apologized and told me that I could see a gyn if I preferred. I decided to have the exam with him and see a gyn if I need more advice in a couple of months (I'm going to start a new bc pill.)

I've since found out that California has a law that allows women to see a gyn in addition to their primary care doctor if they want. But you have to insist.

I have a plan that covers my prescriptions and I pay $5 or $10 for each. That's pretty good.

-- Anonymous, June 30, 2000

I'm covered by the British National Health Service, and I don't have any complaints about my health coverage...yet. My birth control is free (as are any and all doctor's appointments), I pay only #6 of any prescription and I can get into my GP's office on very short notice. The doctors (there are four at my local surgery, and I've seen three of them) are very direct and frank, mostly because they don't have time to waste, but they're happy to discuss any issues over which I may be concerned, no matter how unrelated to the main purpose for my visit they may be.

If I needed an operation and had to go on a waiting list, I'd be annoyed, but the peace of mind of not having to pay for surgery and a hospital stay (both free) would make it worthwhile. If it was something I absolutely didn't want to wait for, I could go private and get it done quickly.

All in all, pretty great.

-- Anonymous, June 30, 2000

I am very lucky with my health insurancen (Nippon Life for the curious). In the past 3 years I have had some pretty serious medical problems where I have racked up quite a few major medical bills (from a colonoscopy to a week stay in the hospital and quite a few visits in between) and all I have had to pay was a grand total two hundred dollars. I also do not have to pay my deductible which is taken care of by the company. See I may work for the devil (tobacco) but at least they provide good health insurance. But then again they have to.

-- Anonymous, June 30, 2000

For a long time my company had a great health plan. Very low deductibles and copays, all the doctors in town were in it. Three weeks before I was to have a vasectomy we changed companies.

The newer plan still has most of the docs, but it has higher copays and doesn't cover vasectomies! Damn capitalist overlords! Makes me want to hang a picture of Karl Marx in the office.

Now I have two choices:

1) Go to a civilian doc, pay up front. Because I'm retired military the service would pay me back for about 40% of it (80% of what they consider a fair price, and their "fair price" is about 70% of what the market charges), and I have a supplemental policy that would pay about another 45%. These are paperwork nightmares, and there is every chance that I'd get nothing, and a chance they'd pay for everything. Every claim is a spin of the wheel.

2) Go to San Antonio and have it done for free at the Air Force teaching hospital. There is a good chance that the surgeon would be a student. A student cutting on my little clinton. Hmmmmm

So far I am paralyzed with indecision.

-- Anonymous, June 30, 2000

When my world came crashing down in 1998/1999, I turned to United Behavioural Health... My God, they suck! I needed someone who could seriously help me deal with my mother & my family (for those of you not in the know, the charges against her, my mom, were assualt, extortion, terroristic threats, & telephone harrassment), the court systems, and what was happening to my body (it was turning against me - I was always sick, I ended up in the hospital with asthma attacks from the stress TWICE!). I'd had years of abuse and coupled with the latest development, everything went to shit. And to boot, I later would find what was happening to my body was the effects Post- Traumatic Stress Disorder.

I freaking needed help in a big fat way. So here I am in the worst situation I could imagine, trying to do all the 'right' things, and my insurance wouldn't help me at all...

--they DON'T publish the names of mental health providers. You have to call them, wait on hold, get authorization, and THEN they'll give you the names of 5 people you can call. If none of those work, are too far away, have too many patients, OR can't deal with your issues, you have to call back and get 5 more names. --they only cover 5, and later 10, visits at a time. --they referred me to the world's biggest quack! She once told me, in the middle of therapy FOR NO REASON AT ALL SHE LAUNCHES INTO THIS TANGENT about how, as a woman, I should always drink out of a straw because woman enjoy that sucking motion! --They try to analyze you on the phone. You know what? My freaking problems sent me into fits of uncontrolled crying. I don't want to discuss my fucking issues with you on the damn phone you nosey ass person. I'm not going to tell me insurance I've got an ear infection before I go to the dr., I'm sure not going to tell you my mother tried to kill me!

I finally got someone to seriously help me by using the suggestion of a friend - "If you don't find someone who can deal with me, then I'll check myself into the hospital and we'll find someone that way!" I could go on forever. There is MUCH to be said of the arguement for mandating mental health coverage the same way as your other healthcare coverage... They are related! See aforementioned hospital visits for asthma.

Plus the United plan is a over zealous control freak.

-- Anonymous, June 30, 2000

p.s. Beth - I've also heard of other people's terrible experiences with Kaiser. Thankfully we don't have them here in TX!

-- Anonymous, June 30, 2000

I've been really lucky with my insurance, generally. As I said on the other healthcare thread, I pay *very* little and, at least hypothetically, get a *lot.*

My problem with healthcare has always been finding a good physician, not with insurance. Luckily, I've finally found a fantastic doctor: the first to put my symptoms of the last 23 years together and come up with a diagnosis.

As I'm just launching into a period when I'm going to be racking up some serious medical bills for the very first time, I may be feeling differently about it in the near future. I couldn't find reference anywhere in my policy literature to sleep studies or narcolepsy treatment. I'm hoping to be guided through the process by the neurologists. I certainly hope that I don't end up paying for the sleep study myself (it's supposed to be covered, but I'm afraid of some snafu) because I can't really afford $2000+ right now. I'm also a little nervous that I might have a hard time getting insured in the future. Has anyone had any experience with pre-existing conditions? Any advice? E-mail me if you'd like!

-- Anonymous, June 30, 2000

I have Healthnet -- an HMO. My son had nearly constant ear infections from age 4 months on, with a few breaks when he had tube surgeries. At age 3, it became apparent that all those periods of hearing loss were affecting his speech and he needed speech therapy, just to be understood in basic life situations.

I was told by the insurance company that they wouldn't cover speech therapy for him, except for a few months even though the speech problems were caused from a documented medical problem and I had two speech therapists, an ENT and a speech pathologist saying that he had severe speech delay. (For example: His name is Russell...he went to Sunday School and told them his name was Ruh-huh and they called him Roger for the whole hour.)

I raised hell with the insurance company and got them to cover a lot of speech therapy the summer before he was to attend Kindergarten to try to get him better prepared for school and it certainly helped, in that he moved from having a severe speech delay to having a moderate speech delay. He gets a small amount of speech therapy at school, which I supplement at home, but he's still somewhat hard for strangers to understand, though recently, he got separated from us in a store and got the store clerk to call "Wendy" to get "Russell." No thanks to the insurance company, though!

Another problem I came up against was with my diabetes. When I was pregnant, I had to take insulin. Part of taking insulin, is that you have to measure your sugars several times a day to make sure you're taking enough insulin, and this means you have to use test strips in your glucometer. The insurance company put a rule in place that if you used generic drugs, your co-pay was only $5, but if you used a namebrand, you have to pay $10. However, they would only allow diabetics to use one particular brand of insulin and one particular brand of glucometer and one particular brand of test strips. So monthly, I was paying $60-$80, when realistically, I should have been paying half that. I know it would have been more expensive retail, but if I'm paying them $330/month, you'd think they'd do better. And as a diabetic, I was really at their mercy because I had to have insulin and test strips, but I certainly didn't feel I had to have any particular brand. They did.

-- Anonymous, June 30, 2000

Jim - it's really unlikely you would have a student operating on you (alone) even in a relatively minor surgery. (in fact it probably violates policy)

However, it might be likely that you will see a medical student or junior medical officer in an initial consultation.

I would recommend the brand new Brooke Army Medical Center over Wilford Hall. (many of the air force physicians rotate through there anyway -- with the joint training and all, and it's basically just a nicer and more up to date facility).

BTW, I am retired Air Force -- nothing wrong with Wilford Hall though if you prefer it --

-- Anonymous, June 30, 2000

I have insurance with Oxford. I believe they only cover New York, New Jersey, and Connecticut. I have to use doctors within their network in order to qualify for the co-pay, otherwise they pay, I think, 80% of what they deem reasonable and customary. Unfortunately, reasonable and customary doesn't go very in New York City, so I opted to use a primary care physician and gyn within their plan.

I have been very, very lucky. I had a stroke and open heart surgery, that required tons of physical and occupational therapy and extended hospital stays. All told, I racked up roughly 100K in hosptial bills. I paid maybe $35 out of pocket.

Of course, I had to follow all of their rules, get referrals to specialists, report emergency hospital visits within 24 hours. Once this nightmare started, my primary care physician approved all referrals pertaining to my case by rote, rather than making me come in to see him each and every time.

However, it bears saying that I believe the reason he did this, smoothed the way, was because I had been to see him 3 times with heart palpitations that he misdiagnosed as stress. He retired six months after I stroked out. I'll never know if these two events were related, but I do know that he never once looked me in the eye after he found out about my heart.

Win some, lose some.

-- Anonymous, June 30, 2000

Cory: I had a knee operation at Willford hall, and it worked out great, in fact it's the ONLY time I've ever been cured of anything by a doctor. A friend had a vasectomy there that went bad, so who knows? I'd have to take more time off work to go to San Antonio, and that could be an issue.

I talked to a bunch of doctors and nurses and found they all agreed on the same urologst as the best in Austin. I was really hoping to use him. His name (I swear this is true): Dr. Richard Chop.

-- Anonymous, July 01, 2000

Beth,

I had Kaiser when living in Davis, which entailed going to Sac for anything but basic office visits. Kaiser North sucks badly--never had even one good experience. The weird thing is that Kaiser South was excellent; my years in the Kaiser system in San Diego constitute the best experience I've ever had with an HMO. Not problem-free, but generally good on all accounts. (The sinus problem thing happened after I had to give up my Kaiser coverage for a different HMO.)

-- Anonymous, July 01, 2000

I work for a Fortune 500 company which provides health insurance.

I chose the option where I can choose my primary care physician, who will refer you to a specialist.

I had a skin cancer, and he sent me to a dermatologist, who removed it. My co-payment was $10 per office visit.

I added Brenda to my insurance when she was between jobs. Good thing, too, because she is between jobs now. I pay $40 a month for the coverage and the company pays $300.

In the past, when she had insurance, and I didn't, she added me.

We like our doctor. I had a cyst cut out of my back, at the same time I had the cancer removed, and he told me to say it hurt, so the dermatologist wouldn't consider the procedure cosmetic.

We're both healthy, but getting old. I'd hate to try to get insurance on the open market. I had high blood pressure once, and that information follows you around.

Also, Brenda manages her sleep disorder/depression with prescription drugs, and needs a doctor to discuss her history with and write script. (She also uses diet, exercise, and over-the-counter herbs from health food stores.) She takes hormones, and needs a doctor to advise her about drug interactions, there.

There's an EAP program at work, and I think mental health/substance abuse are covered separately. I know they can refer you to a specialist.

I don't have a drug or alcohol problem but my writing borders on the obsessive/compulsive, to the point where it interferes with my job performance.

I think that's a personal problem. Go to the chaplain and get your t.s. card punched.

Once, I went on sick call, with the crabs, and the corpsman told me I had a supply problem, not a medical problem. Go and get a bug bomb. DDT.

"How come I have the clap and he has nonspecific urethritis?" "He's an officer and you're an enlisted man." "But I got it from his wife."

I worked with a guy who always wore a coat and tie, when he went to see the doctor. He said they treated you better.

I know the quickest way to commit suicide is to check into Bay Medical without health insurance. They wheel your gurney out in the hall and let you catch pneumonia.

-- Anonymous, July 02, 2000

I am Canadian. Oddly enough, I haven't read any other contributions from Canadians in this or the reform thread, so I guess it's up to me to provide some background on our health care system, along with my personal experience.

The dry info: The Canada Health Act ensures that universal medicare is available to every Canadian. Transfer payments from the federal government are distributed to each province (who also levy provincial taxes to fund health care - this can amount to as much as 60% of the entire provincial budget. The province then dictates administration of the funds within the regulations of the Health Act. This means that while it's universal, it's inconsistent throughout the country. For example, Ontario levies a payroll tax while BC charges premiums to individuals. ($36/month for me)

Right now our system is undergoing some serious problems, the biggest being understaffing (nursing shortages) and health care availability in rural areas. Patients in small northern Manitoba community have to fly 400 miles to Winnipeg for dialysis - some have to leave their families and relocate when their conditions worsen, which is a vivid example of poor distribution of services.

A few weeks ago in Prince George, BC, specialists staged a strike; resigning their hospital priveleges for over a week (leaving residents with only trauma care) demanding funds to attract doctors and nurses to the community to alleviate understaffing. (They won.) And in Ontario, the premier made severe cuts and closed down dozens of hospitals without providing proposed community-based care - creating horrendous backlogs at emergency rooms and contributing to nurse burnout and migration to - guess where - the US, where salaries are much higher because your systems are not non-profit.

You don't often hear Canadians complain about our system in an international forum (though there's much protest at home) since we are proud of the principles of universal health care, as well as the many excellent aspects of our system.

I've never had to wait to see my GP - I can get in the same day if needed. Hospital emergency room waits have been a few hours at most if I'm there for a minor complaint (like stitches) but when I had a life-threatening problem I received immediate attention - quick ambulance service and a trauma team waiting when I arrived. In between the extremes, when I have had serious asthma attacks I've always been seen right away by an ER doctor.

I've had free elective surgery that I only had to wait 2 1/2 weeks for. I know there are waiting lists for geriatric elective surgeries (mostly hip/joint replacements), but I'm not personally affected. My grandmother has had about eight orthopedic surgeries - she had to wait but she's never complained about it, or the quality of care. The surgeries were completely successful.

Medical research in our universities is every bit as good as that in the US. Recently doctors in Edmonton announced a new treatment protocol for diabetes - very nearly a cure - a major breakthough hailed internationally.

So, that's the good news. We have a great system which is undergoing some disintegration, but will likely be restructured and improved. There's been some discussion of privatization of some aspects of care but it's been fiercely debated and largely rejected. We don't want to be like America. No offence.

But then there's the mental health care system, which completely sucks (though not quite as bad as in America, where the seriously mentally ill are condemned to homelessness and/or prison), and I could rant about it for pages and pages, but I'll spare you. There are plenty of details in my journal.

There you go, a Canadian perspective.

-- Anonymous, July 02, 2000

Like Javina, I'm the beneficiary of universal Canadian health care. I pretty much never have to wait to see my doctor, have had but small waits to see specialists, and have even had elective surgery- all for free. Ditto trips to the emergency room, ultrasounds, endoscopy, and other fairly invasive tests.

Most people working for large companies also have extra coverage provided by their employers, paid through payroll deductions. This would be to cover things like prescriptions, eyeglasses, dental care, and other things not covered under Health Care. My fiancé recently got a job at such a place. Unfortunately their health insurance options are limited. He can get Single coverage for about $25 per month, or Family for about five times as much. Like, every family is going to include passel of kids all needing tons of orthodontia...

At his last job, he was able to get coverage for just the two of us at a nominal fee. I got in exactly one dental appointment before he changed jobs. Oh well!

-- Anonymous, July 02, 2000

My experience is the same as Jackie D's, although my doctor is senile and crazy and really wants me to get pregnant now, while I'm young.

I also get healthcare through PPP as a company perk, and I wouldn't take a job now that didn't offer this - so that should take care of any waiting lists if I ever need an operation.

-- Anonymous, July 03, 2000

This past spring I was really grateful for my insurance. In the past five years, I haven't used it for more than the yearly gyn appointment and a couple of mammograms and an ultrasound (oh, and I now take Allegra for my allegeries). But I have been having a lot of problems with my back since mid-March, and I have gotten muscle relaxers and pain killer prescriptions for only a few dollars, I have gone to physical therapy appointments and paid nothing for them, my doctor referred me for a series of massage therapy and I only had a $15 copay and I got an MRI. Without insurance I would not have been able to do all this.

-- Anonymous, July 03, 2000

i have fairly basic health insurance-- which still costs me $110 a month. and since i'm over forty, it'll only get worse. i have to work for an employer that provides serious health (inc. eye and dental) coverage as soon as I finish law school.

my coverage-- it may be of some value if i have a heart attack or need major surgery, but it's useless for anything everyday. a broken arm, serious sinus infection, anything like that-- the deductibles will leave me unable to go to a doctor, and i can't afford prescriptions at all.

needless to say, i long for Euro-style universal health coverage.

-- Anonymous, July 05, 2000