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Why does the myth that Canadians flock across the US border to receive US health care persist?

I see one Canadian commenting about being forced out of hospital early and having to wait for some tests and treatments.My daughter (just 14 at the time) had to have open heart surgery in the US and fortunately we had health insurance to cover it. We were forced to wait until the 11th hour for the insurance company to “approve” the surgery which was an emergency…as if it was something we were doing just for fun. The people approving it were not medically trained.Then, after the surgery, she was forced, by the insurance company, out of the hospital less than 3 days later. I am not medically trained but was left in charge of her care at home. They gave me a telephone number to call in case I had questions. They had to give her morphine so that when they removed all the various tubes and needles inserted into various parts of her body it did not hurt her so badly. We wheeled her to the parked car and the medics lifted her into the front seat of my car which I put into a reclined position. I drove 20 miles an hour so as to not jostle her. She was too big for me to carry when we got home(plus we were not trained on how to carry a teenager safely) so she crawled on her hands and knees to her bed. I slept on the floor next to her bed for the next few weeks.I still feel weepy when I think of the worry we felt at the time.When my other daughter, at age 8, had to have an emergency appendectomy, the surgery was done around 3 am. That same day around 5 pm they sent her home—just 14 hours later. They force fed her jello to prove that her “system” was working. Again, the insurance company insisted upon this. We spent the next few weeks making daily trips to the doctor as she still had a fever and was in pain.When I was a little girl in Canada I had to have emergency appendectomy as did my daughter. That said, the appendix turned out to be fine and instead I had very painful (with 106 degree temperatures) peritonitis and a childhood kidney disease. While I did wish to be home, they had me there for 7 weeks while they worked to diagnose and treat my illness. (I am fine now.)When I was in a car accident in the US and was unconscious for 7 hours, the hospital was sending me home within 45 minutes of waking up. My insurance was not going to cover an overnight stay. As my husband rolled me out of the hospital, the medics who had taken me out of our totaled car looked at me in amazement, asking how in heavens name they were sending me home. It took me 3 years to recover from that accident and I was in excruciating pain. Despite my high deductibles and expensive monthly payments, my insurance covered only emergencies, so no follow up care was covered. One of the many problems I faced was my jaw out of place due to the sheer impact (I was t-boned). I had to learn how to put my own jaw back in place and did that many, many times. Many years later, after sleeping the wrong way or a after visit to the dentist, I still have to put it back into place again.When my mother, in Vancouver Canada, became ill, they took her into the hospital immediately at her doctor’s request. There was no profit-driven bureaucrat who had to give approval. It was the doctor’s decision. They did some surgery, and she was there for over two months while they tried to help her heal.Back in the US, once my daughter with the heart issue reached adulthood, she was without health insurance due to her pre-existing condition, until Obamacare kicked in that is. It was a life-saver when she lost the end of a finger in an accident.I would like to add that more recently my husband had to have a triple by-pass. The insurance seemed good…a $500 copay. Until after the surgery, when they claimed the hospital he had been approved for was not on their list of our EPO hospitals. As it turns out, there was not ONE hospital on their list who did bypass surgery. NOT ONE. They’ve been trying to get us to pay the $100,000 bill. Blue Cross/Anthem basically sold us an empty box. There was no nearby hospital on the EPO list that did after-surgery rehab either, so we had to forgo that.Choosing healthcare soon? Don’t make the mistake we made, of thinking that a Blue Cross/Anthem EPO will offer you all the usual hospitals and treatment centers. EPO stands for "Exclusive Provider Organization" And in our case, indeed it was exclusive..they excluded most hospitals and treatments centers. BEWARE!Meanwhile, we just got notice that in 2018 our health insurance will be $2,653 per month (almost $32,000 per year) with a 40% copay.Yes, like pretty much anything, the Canadian healthcare system likely needs some improvements. But how does it compare to, in the US, having our health care either not available at all due to the high cost of health insurance (or pre-existing conditions if Trump has his way) or having profit-driven companies determining what care we can have or how long we receive that care, I’d say it is pretty darned good. Canadians have the right to always ask for improvements in the system but unless they have lived in the US, raised a family in the US, paid the huge premiums etc, and had their care cut off or cut short, they have no clue how good they’ve got it.And yes, there is probably more of a wait in Canada for non-emergency treatment or tests. That’s because everyone is covered and there are more people, therefore, using the health system. In the US we don’t wait because a huge portion of the population is at home sick and possibly dying without insurance that will allow them to get treatment. When any American says they don’t want universal health care because they don’t want to wait in line at the doctor, what they are really revealing about themselves is that, they would rather a large portion of the population go without medical care so that they can get in to to see the doctor right away.For any Christians out there, whatever happened to “We are our brother’s keeper”?Galatians 6:2 - Bear ye one another's burdens, and so fullfil the law of Christ.I just received this news:California Fines Anthem Blue Cross $5 Million for Systemic Grievance System Violations.Here is an example they give in the article:One example of the numerous failures of the Anthem Blue Cross grievance system involved an enrollee who was diagnosed with a serious condition. Anthem Blue Cross provided pre-authorization for extensive surgical intervention and reconstruction to treat the enrollee. Anthem Blue Cross denied the claim when it was submitted by the provider. In an effort to resolve the issue, the enrollee, as well as the enrollee’s provider, broker, and spouse made 22 calls to the plan. Even after the 22 calls Anthem Blue Cross failed to recognize or resolve the enrollee’s complaint.Under California law plans are required to recognize an expression of dissatisfaction as a grievance, or complaint. Instead, calls to Anthem Blue Cross’ customer service system resulted in repeated transfers, as well as unfulfilled promises that the plan’s representatives would return calls. It was not until the enrollee sought assistance from the DMHC, more than half a year after the treatment, that Anthem Blue Cross finally paid the claim.Click on this link for the entire article: November 15, 2017

Which of the large US health insurers are best-positioned to grow operating profits during the Trump administration?

Health care costs affect the economy, the federal budget, and virtually every American family’s financial well-being. Health insurance enables children to excel at school, adults to work more productively, and Americans of all ages to live longer and healthier lives. The Affordable Care Act (ACA), has made substantial progress in addressing the uninsured Americans. Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of health care costs under control.There are several companies which provide health insurance to the US citizens under the ACA, which in-turn promotes Medicaid and Medicare government programs. According to these programs and their respective market shares, the best positioned health insurers are:-UnitedHealth Group Inc.Humana Group Inc.Anthem Inc.These insurers have been working in developing a high-quality, affordable and accessible health care system.In this answer, I will be assessing the progress these companies have made towards improving the US health care system and discuss how policy makers can build on that progress especially under the Trump administration.Medicare ProgramMedicare is a national social insurance program administered by the US federal government since 1966, currently using about 30–50 private insurance companies across the United States under contract for administration.UnitedHealth Group Inc. provides mainly three plans under the Medicare program.Medicare Part A (hospital)Medicare Part B (doctor and out-patient)Medicare Part C, a type of health plan ,also known as Medicare Advantage Plan. This plan combines the Medicare Part A and Medicare Part B, then provide additional benefits that contribute to improving your health and wellness.It also provides other Medicare Advantage plans which include prescription drug coverage (Medicare Part D). Enrollment in Medicare Part A and Medicare Part B is necessary to be eligible to enroll in this plan. It is necessary to continue paying your Medicare Part B premium to keep your coverage under this group-sponsored plan. UnitedHealth tries to offer coverage that is as good as Original Medicare. The government pays them a fixed fee for one’s care. UnitedHealth is required to handle the payments to doctors and hospitals.Humana Group offers the Medicare Savings Program (MSP) to Medicare beneficiaries whose income falls below $1,357 per month for single individuals and $1,823 per month for married couples.Humana offers several other plans under Medicare, one of which is the Humana Gold Choice plan. Humana Gold Choice is a Medicare Advantage private fee-for-service (PFFS) plan. Humana Gold Choice PFFS allows members to use any provider, such as a physician, hospital or any other Medicare provider in the US that agrees to treat the member after having the opportunity to review these terms and conditions of payment, as long as the provider is eligible to provide health care services under Medicare Part A and Part B or eligible to be paid by Humana Gold Choice PFFS for benefits that are not covered under Original Medicare.Anthem Inc. (Wellpoint Inc. Group) has been focusing on making sure that the needs of the people under the Medicare Program are addressed.Anthem has health plans that support those who are Medicare eligible by developing HMOs and PPOs specific to Medicare and providing Medicare Supplement plans to those who want them. They have been constantly working on expanding the tele-health options.Consumers’ costs concerns are addressed with Dual-Eligible Special Needs Plans (DSNPs) that are primarily $0 premium plans with $0 copays. They include dental and vision coverage and some even include coverage for over-the-counter drug costs. HMOs and PPOs specifically focused on accommodating the needs of the Medicare population are now available in targeted markets in 22 states. In specific markets in California and Texas, Anthem’s Medicare Select plans feature tight-knit provider collaboration. Also, convenient online doctor visits are available to most of Anthem’s affiliated Medicare Advantage plans through LiveHealth Online.Medicaid ProgramMedicaid in the United States is a social health care program for families and individuals with limited resources. Medicaid coverage is low cost or no cost to you. It is health care coverage for people with low incomes. Pregnant women, children, the elderly and people with a disability may qualify for the Medicaid Program.Medicaid Program discussed below is in reference with the state of Florida.UnitedHealth Group Inc. With growth in the Medicaid market, UnitedHealth took a vital step of launching a mobile app to better connect with people covered by the state-federal health insurance program.The new app called ‘Health4Me’ lets people in the state of Florida use their phones to more easily review their case history, track claims and find a doctor. The app also provides a digital health plan ID card, which has proved to be the most popular feature in early testing. It’s more about improving the way we share information than anything else when we decided to launch this for our Medicaid population.Expansion of Medicaid eligibility due to the federal health law has been a key factor in enrollment growth across the country, although some states have elected not to expand their programs. In 2014, about 5.1 million individuals were covered through Medicaid health plans at UnitedHealth and during the first half of 2015, the figure grew by 155,000.Humana Group has offered Medicaid services since 1970 in Florida. It is funded by both the state and federal governments and includes both capitated health plans as well as fee-for-service coverage. The Agency for Health Care Administration (AHCA) is responsible for administering the Medicaid program and to administer contracts, monitor Health Plan performance and provide oversight in all aspects of Health Plan operations. The state has sole authority for determining eligibility for Medicaid and whether Medicaid recipients are required to enroll in, may volunteer to enroll in, may not enroll in a Medicaid health plan or are subject to annual enrollment. The 2011 Florida Legislature passed House Bill 7107 to establish the Florida Medicaid program as a statewide, integrated managed care program for all covered services. This program is referred to as the Statewide Medicaid Managed Care (SMMC). In addition, Humana has the responsibility to ensure providers’ submission of encounter data is accepted by the Florida Medicaid Management Information System and/or the State’s encounter data warehouse.The Florida Managed Medical Assistance (FMMA) program focuses on four key objectives in order to support successful implementation:Preserving continuity of care.Requiring sufficient and accurate networks under contract and taking patients, allowing for an informed choice of plans for recipients and the ability to make appointments.Paying providers fully and promptly to preclude provider cash flow or payroll issues, and to give providers ample opportunity to learn and understand the plan’s prior authorization procedures.Coordinating with the Choice Counseling Call Center and website operated by the Agency’s contracted enrollment broker.Anthem Inc. has been investing significant time and resources to understand and serve the nearly 5.9 million plan members in state-sponsored programs across the country. While focusing on the needs of individual consumers, our plans are seeking out new and better ways to improve health outcomes with high-quality, cost-efficient programs that help society more broadly.Florida ranks first in the nation in the number of newly diagnosed HIV infections and second in the number of pediatric HIV cases reported. Clear Health Alliance, an HIV/AIDS Medicaid specialty plan offered by Simply Healthcare Plans, is addressing the special needs of those living with HIV/AIDS in Florida by offering bundled services tailored to their treatment requirements. Anthem is equipping consumers with the knowledge and support to better manage their health.Commercial Business ModelsUnitedHealth Group Inc.The UnitedHealth Group is a leading diversified health and well-being company that provides health benefits and health services through UnitedHealth and Optum business segments. UnitedHealth provides health benefits services to individual consumers, governments, and employers of all sizes. Optum offers health services to diverse stakeholder groups that include individuals, employers, governments, healthcare providers, payers, and life sciences companies.UnitedHealth Group Business Model EvolutionThe chart shown below is a one year stock market analysis till January 2017.The Insurance Company saw an enormous rise in the revenues and made a large operating profit.Humana Group Inc.Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. As of 2014 Humana has had over 13 million customers in the U.S. reported a 2013 revenue of US$41.3 billion and has had over 52,000 employees. It has been the third largest health insurance in the nation.Following is the Financial Highlights of Humana Inc. The results have been extremely supreme over the years!Stock market of Humana Inc. over the last year:Anthem Inc.Anthem Inc. is an American health insurance company founded in the 1940s, prior to 2014 known as WellPoint, Inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. It was formed when Anthem Insurance Company acquired WellPoint Health Networks, Inc. with the combined company adopting the name WellPoint, Inc. trading on the NYSE for the combined company began under the WLP symbol on December 1, 2004. On December 3, 2014, WellPoint changed its corporate name to Anthem Inc, and its NYSE ticker changed from WLP to ANTM.Financial Highlights of Anthem Inc. for the past years:Financial and Membership Highlights:(The information presented below is as reported in Anthem’s 2015 Annual Report.)Data Sources:How UnitedHealth Group Makes Money? - Revenues & ProfitsUnitedHealthcare launches Medicaid AppHumana Medicare and Medicaid InformationAnthem, Inc | Investor Relations | Annual ReportsAnthem Annual ReportMedicaid - WikipediaMedicare - WikipediaImage SourcesUnitedHealth Group Incorporated (UNH) Stock ChartGoogleGoogle Images2015 Annual Review UHC

What doesn't make sense to you?

Hi Maria,You asked, What doesn't make sense to you?Healthcare in America.What it costs to get insured, what the insurance covers, what doctors do when they see you - especially in an emergency room, and the sticker shock that patients regularly experience.Our $4000 storyIn the fall of 2017, my daughter graduated from college and started her first job in a small company.Really small company.The company did offer her healthcare and they told her, “It’s good, it’s Anthem Blue Cross HMO Gold plan.Before we even had had time to select a primary care provider, and look into the health care benefit, my daughter got sick.She woke up one morning with a terrible stomach pain.Since her insurance was so new, I didn’t know what to do.I made an online appointment for her at a private urgent care facility 4 miles away.Unfortunately, my daughter couldn’t wait till 9:00 a.m. when they would be open.She was in so much pain.I decided we would have to go to a hospital instead.I saw that Good Samaritan Hospital was one of the listed Blue Cross hospitals.We walked into the Emergency Room of Good Samaritan and all hell broke loose.The triage nurse took my daughter’s pulse and it was racing (a normal condition for my daughter).The triage nurse then called a Code Red or a Code Blue or whatever, and the next thing we knew, my daughter was in an ER bed hooked to an ECG.Later she was taken for a stomach MRI.She enjoyed the fuss and attention.A few hours later, a doctor discharged her and told us she had stomach flu.“Drink lots of fluids and here’s a prescription for a nausea medicine, in case the nausea persists”.It was a month later both she and me got really sick - when the bills started coming in.We received 4 different bills from 4 different providers - the doctor who had seen her first, the doctor who discharged her, the MRI place, the ER room - $4000 in all.For stomach flu.We tried to contest it with each of the providers, but nothing worked.My daughter said, “Mum, I’ll just pay it, but I’ve learned my lesson. I will never go to an ER again.”Meanwhile, there was another thing that made no sense.The so called nausea medicine.I went to the Rite Aid pharmacy next to my house.Oops, I said, when I got there.I had forgotten my daughter’s medical card.Oh what the hell, I thought. Maybe I will just pay cash.I handed the prescription to the pharmacy technician, “Can you tell me how much this is with and without insurance.”He looked at it and said, “Oh it will cost a lot. “He looked it up. “$80 with insurance (for 10 tabs), $280 without.”My jaw dropped.For what - a nausea medicine.Why this medicine?Nausea can be solved with Dramamine.I went back home without the prescribed nausea medicine.My daughter’s nausea had gone. She said if it started again, she would take Dramamine.Curious, I decided to check out the expensive medicine.It was called Ondansetron.It was not on the approved medication list of Anthem Blue Cross.Their website stated, it required special approval, except when it was prescribed for pregnancy nausea and chemotherapy side effects.I shook my head.Good Samaritan had not bothered to check what insurance we had and whether this medication was on the approved medication list for that insurance.A GoodRx ad suddenly popped up on my computer screen.“Are you looking to buy Ondansetron? You can get it for between $16 and $30 at different stores with our coupon.” said the ad.When I clicked on it, I was asked to enter my zip code on the GoodRx site to see nearby pharmacies where I could purchase Ondansetron for the Good Rx price.Target was $16, Rite Aid was $30, Costco was $20, Safeway was $16.I couldn’t believe my eyes . $16 vs $80 using insurance - that is, assuming the insurance would give us approval?I was totally disgusted.I thought about the poor caregivers of pregnancy patients and chemotherapy patients coughing up the $80 with their insurance cards.Such a rip off.I decided to fill the prescription to see if it was really true I could get Ondansetron at the GoodRx price.When I went to the Safeway pharmacy, they said, “Oh we will give it to you for $12.”And so with GoodRx, I paid $12 for 10 tablets, instead of $80 with my daughter’s insurance card.What’s this all about?Does it make any sense?

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