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Topic TMS only covered by Blue Cross Federal Go to previous topic Go to next topic Go to higher level

By lurkingforacure On 2009.08.13 11:06
I posted yesterday about TMS, an FDA approved treatment for depression. I made some calls, and learned that the course of treatment usually runs 8-10K, and that's discounted. Even though FDA approved, Medicare and Medicaide do NOT cover it. Indeed, I learned that no insurance covers this, EXCEPT blue cross blue shield federal, which is the health insurance for federal folks. No wonder Obama and Congress want to keep their federal plan for themselves, it covers everything. I'm really disgusted.

By karolinakitty On 2009.08.13 14:57
Yeah they have an awesome plan ..... covers everything the restr of their lives too, and we pay for it..... yet can't afford our own.... by the way....
There's a retired general in Florida who is running a campaign for the federal government to include our vets and wounded warriors in the federal program.
Now since I know a lot of wounded warriors due to our love for cat fishing and taking out these guys on the water.... hearing their horror stories on health care would curl most of your toes.... They've served our country, got hurt or lost limbs and sometimes half their bodies and they are left to basically fend for themselves on health care. It has taken a friend of mine 4 years to get a surgery to get the feeling back in his hands, through the VA( which isn't all that grand)....PLUS .. they have to fight for Social Security disability benefits just like you or me. While they get a disability from the military it is on a percentage basis and on the pay they received when active...

Oops... sorry i ranted but it just gripes my butt..

By WitsEnd On 2009.08.13 15:55
Don't apologize. Getting federal government benefits is a pain for everybody and our veterans do deserve better. I wouldn't have my dog in some of the VA hospitals much less someone who risked his life to fight for me and my country.

I also agree with Lurkingforacure....carve outs to make unions and federal employees (including the people who are trying to change the world for everybody else) is hypocritical at least and corrupt at worst. It is disgusting.

By jsmitch On 2009.08.14 07:53
That's not quite a true picture.

Yes, the Fed (through the Office of Personnel Management) has Blue Cross - Blue Shield available. Federal civilian employees can also choose from nine other plans.

The reason these programs are considered off limits is they are already in place and working. Just as there are hundreds of insurance options out there for the general population that won't be affected by any new legislation.

Those opposed to healthcare reform are spending over a million dollars a day to put doubt and fear into the citizens of this country. If everybody just stuck to the facts, this discussion and similar ones would have little to fuel.

Now, because a drug or treatment is approved by the FDA does not automatically qualify it for payment by insurance companies. It just means it can be used on humans for specific indications. Formulary boards comprised of pharmacists and physicians determine if and when something is covered. Most insurance companies are reluctant to approve something that has had little peer-review and has not shown marked efficacy.

Remember Vioxx? FDA approved and paid for by insurance. Ever heard of Trasylol? It was approved by the FDA in '93 -- pulled from the market. The list of drugs and procedures that have received the OK from the FDA and then found to cause harm is not a short one.

By lurkingforacure On 2009.08.14 08:32
The measly million dollars (and I seriously doubt it is that much-where is the source for your data?) pales in comparison to the 150-200 million pledged to be spent in a media blitz supporting the plan in the few weeks before Congress reconvenes.

And Congress' plan is very unlikely to be affected by any healthcare reform, while my plan can be reduced in coverage, made much more expensive, or my insurance company may opt out of health insurance altogether (or worse). This is really not any concern for them, but is for the rest of us.

My plan is in place and working, same as what you say for Congress. So why can't my plan be "off limits" too? Or why doesn't Congress join the ranks of those they serve and be part of the program we all have to live with? They know what is going to happen, and they are proactively protecting themselves by exempting themselves from this proposal.

If Congress had stuck to some simple reform points rather than trying to overhaul the entire system (and throw in a bunch of other stuff that has no place in healthcare to begin with) AND made themselves subject to the same thing everyone else has to live with, I think a whole lot of folks would have been much more comfortable.

Congress cannot guarantee me that my insurance won't change (be more expensive, or coverage be reduced), or go out of business, if this plan goes through. So no, you can't tell me that "there are hundreds of insurance options out there for the general population that won't be affected"-this is a common defense to this plan and no one buys it. Put a guarantee in the bill that my current coverage won't change in any way, and I might be more interested. But I am looking at VA, social security, and medicare, all three programs run by the fed and are a mess and OUT of money. That's three programs, three strikes. Why in the world are we thinking they can "get it right" this time with a program that is even larger than the other three combined?

By Newcaregiver On 2009.08.14 08:40
Mitch: thank you for your reasoned reply. I think the worry for everyone is whether we will be better off with a new healthcare standard. We won't be if everyone won't stop all the bickering based on false information. We must stick to facts and then debate those facts that are in the 3 proposed healthcare plans before Congress. If everyone continues confusing issues by throwing out untruths (i.e. death panel talk) then it insures that we will not move forward on proposals before Congress. The question should not be "do we need healthcare reform", but "what sort of healthcare reform is best for all". there was information on the news last night about a team of doctors that have been traveling around the country providing free healthcare to those in need. they used to travel to 3rd world countries. Now they travel almost exclusively in the U.S. They are seeing many, many people. the surprise is that most of the people have jobs. They are not street people. the are not indigent. They are people who cannot cover their non-covered expenses with their pay checks. If a person has good healthcare - that is unusual. And, if they do today -- they may not tomorrow without some reform to our current system. Are the proposed plans good? will they work? I don't know, but we won't find out unless we try to work on them and stop the bickering.

By jsmitch On 2009.08.14 10:38
Lurking -- Why do you think the FEDS are going to mess with whatever insurance plan you have now? Is it in any of the pieces of proposed legislation?

By WitsEnd On 2009.08.14 10:53
As one of my old bosses used to say "the devil is in the details". The fact is that nobody seems to be able to nail anybody down on the specifics of what I would call "the problem statement". A bunch of people keep throwing out "we need healthcare reform" the same way they would throw out "we need world peace". That makes for a good publicity op for President Obama but it doesn't really do anything to solve anything.

IF the problem is health care costs are too high--you don't fix it by increasing bureaucracy. (Check out Rep. Brady's chart at the House web site.) Where's the details? What exactly costs too much and why? We are a free market society. If you want to reduce costs you have to affect either supply or demand. That's the way it works. Reducing demand means people who get current services lose some of them or stop using them. The people who use them the most today are older Americans, chronically ill Americans and terminally ill Americans plus a few that aren't Americans at all or even here legally. (Hospitals don't turn anyone away for inability to pay.) Yes, people are using inflammatory words such as "death panels" because people are scared and worried and mad. The fact is that there are provisions in the proposals that sparked this. It's not somebody making it up. With the rhetoric gone is the base proposal sound? It sure sounds like the base proposal is to restrict or reduce care to the people who use it the most--including a good chunk of Medicare folks as they are talking about REDUCING the Medicare budget.

Now the government could be working on the supply side of the equation. They could be funding medical education by providing scholarships to increase the number of doctors and funding research to help offset private companies who do that independently now. In rural areas some doctors have their medical educations provided with the stipulation they return to the town that paid for it and practice. These types of proposals aren't what's on the table though at least that I've seen.

It seems that everytime somebody brings up an issue about what exactly IS the SPECIFIC problem that is trying to be fixed here--nobody gets a straight answer or the target keeps moving. Throwing these humongous proposals out there that include everything from educating parents to heaven only knows what isn't the solution. Each individual proposal needs to be segregated out, matched with a specific problem, and a rational discussion held. How does that saying go? How did the boy eat the elephant? One bite at a time. Obama's trying to cram a whole elephant down everybody's throats isn't productive and frankly he needs to be focused on the economy right now anyway.

If the goal is to give everybody health care--then specifically who and how is it going to be paid for. The program that provides health care for one of the highest users in our society (Medicare) is currently are in financial distress. Give me specifics. How much would taxes have to go up to get the current program funded? How could that tax burden be spread out? Once you get that answer--then how much more would taxes have to go up to pay for everybody else? How could that tax burden be spread out? Details. Specifics. The government started the rhetoric and the web sites and the publicity campaigns--and Obama used his office to get free air time. I don't want to hear what he's for or against (which if anybody noticed seems to fluctuate depending on how public polls are handling one of his ideas at any given point). I want to see the details. The specifics. How is it going to impact me and my loved one? I'd love to see the facts. I wish somebody coming up with these grandiose ideas would put them out there for me to see.

By lurkingforacure On 2009.08.14 12:25
Does anyone doubt private healthcare policies will change if a government plan is put in place?

If you do, talk to small business owners, call your own private insurance company, talk to folks in the actual industry instead of political pundits who will say anything to prevail (both sides have members who do this, I'm not picking on any candidate or party).

The minute an insurance company is told that it MUST cover folks with pre-existing conditions, as Obama has said from day one and every proposal on the table mimicks that, rates will go up. There is no way an insurance company can cover risks it previously did not include in its statistical analysis to set rates without adjusting those rates. More risk = higher premiums, simple as that. If you are in crappy health, you cost more to insure because the odds are higher that you will have claims than someone who is in better health. We all know this, why are people so unwilling to acknowledge that mandating coverage for previously uninsurable, uninsured, or simply unhealthy, people will not result in drastic private healthcare premium increases?

A government plan will be funded with a virtually unlimited supply of tax dollars-no private insurer can compete with that. The best a private insurer can do is raise rates and/or cut coverage...or go out of business. Like I said, if the feds were willing to guarantee that my coverage won't change in cost or benefits currently in my plan, I'm all ears.

By WitsEnd On 2009.08.14 12:50
Not I. All of the proposals will have some impact. Government involvement in free enterprise ALWAYS has consequences of some kind.

I would suggest reading up on income policies a/k/a wage and price control policies. These policies tend to be more general (not just focused on health care)--but essentially they work the same. Here's a good link on that topic: http://en.wikipedia.org/wiki/Incomes_policy. This article references a number of historical examples in a number of countries and a number of points in time. The references on government mandates generally usually include the same conclusion: Unsuccessful.

By annwood On 2009.08.14 14:31
Lurkingforce - I continue to follow your posts because I believe that you are right on the money. There is just NO way the government can cover everyone. It just doesn't add up. I will be paying my premium, possibly taxes on it in addition to covering the uninsured. Where do people think all of this money is going to come from?? The emphasis will have to be on the young and I continue to believe that those with chronic illnesses will not have much in the way of benefits. None of this will work unless there is some tort reform. This is rarely mentioned because all of the legislators are attorneys. No way that is going to happen despite the fact that it is a major player in the escalating health care costs. (Not to step on your toes).
Keep on posting.

By shakydog On 2009.08.14 14:40
So everyone here has a great insurance policy that pays for everything under the sun and wants to keep that policy intact. I have to assume that this insurance is provided as part of your employment. What happens if you no longer have the job that provides this insurance? Which company would you go to to replace your insurance policy?

I've had parky for 11 years and have been able to continue working and using my employer provided health care policy. With a little luck and a lot of accomodation from my employer, I can continue working and using this insurance for a couple more years. But at 53, I am a long way from Medicare. Which insurance company would you suggest that I approach for coverage for the rest of my life? Or until I am 67 and eligible for Medicare and Social Security?

Reform means providing cost effective coverage for all.

By lurkingforacure On 2009.08.14 22:06
We actually had to get out of my husband's company plan because it had become very expensive, lots of folks in bad health (mostly preventable, by the way, like smoking and obesity (not saying it's easy to take those pounds off, but I know how some of these folks were eating every day and let's just say it was not conducive to health)...I shopped it and we left the company plan and now our family is on our own, a family plan I guess you could call it. Lots of insurers offer single member or single family plans, you just have to call to see what is available in your state. Our savings the first year (what we would have paid for company-issued plan versus going off on our own)...over eight thousand bucks. I only wish we'd left the company plan sooner, we'd have saved even more, which we could then turn around and use for PD!

Unless you work for a company composed primarily of really young and healthy folks, if you are in pretty good health you might be better off going off on your own. Do the research, and see what you find. Also, our policy is ours: wherever we go in Texas, whoever either of us works for or for however long, that policy follows us, it's like car insurance.

I think the reason that you lose your insurance if you are part of a company plan is because your health (and corresponding risk of claims) is calculated as part and parcel of the health of everyone in your office that is also on the plan...if you leave that group, and join a new group, the health of each member of the new group is different, the numbers are correspondingly all different, and have to be recalculated to fit in with the insurer's actuarial requirements, which makes sense.

Most folks I know believe healthcare needs some reform, including at a minimum tort reform. It's just that we believe the reform should be highly targeted, and if it were, most of the complaints/concerns I am reading about might be put to rest, IMHO.

By shakydog On 2009.08.14 23:22
Wait a minute............

The reason I will loose my health insurance is that I will no longer be able to work.

You were able to get a private health insurance policy? And you saved money? Where did you find an insurance company that would cover an existing condition such as Parkinson's Disease?

In the past, I have been turned down for insurance because I had a prescription for Prozac (a pre-existing "mental condition requiring treatment"). How am I supposed to get insurance when I have something like parky?

The actuarial calculations are the same for me and everyone who has an existing medical condition..... we are uninsurable. Without a reform of the entire system, those who are healthy will have insurance and those who are sick are going without.

ShakyDog

By lurkingforacure On 2009.08.15 08:30
Shaky,

We got our private policy before my husband was dx'd, which I realize was incredibly lucky. They cannot kick us off now, although they do raise our rates (every year, but everyone gets rate increases every year).

On the money saving, remember we were in a pretty unhealthy group...we were probably helping lower the rates for everyone else! Folks had all sorts of illnesses, and those raise the rates for everyone, everyone but us, and then ironically, we get off the company plan, and later get dx'd with PD-which is worse than what anyone in the company had, it's crazy.

If/when my husband quits working, as long as we pay our premium, we still have our insurance. One more thing- I'm pretty sure we have to stay in Texas, since insurance companies are licensed state by state-although I wonder if our company were also licensed in our new state if our policy could transfer across state lines.

I know you can get it, though, because my husband just got life insurance, all three companies we got quotes from, no one nixed us, although the rates were much higher obviously because of the PD. It might be harder to find a company willing to offer health insurance for someone with PD, and of course it will be more expensive, but since we got life insurance (and had several offers for it), I can't help but believe one could'nt get health insurance as well, even with PD. Just be prepared to answer a zillion questions and they will scrutinize your medical records like crazy. Good luck.

By jsmitch On 2009.08.15 09:19
An affordable insurance plan that is portable, doesn't exclude pre-existing conditions, eliminates "state" underwriting and is available to everyone. Wow what a concept.

Ah, but then healthcare reform is a bad thing.

By lurkingforacure On 2009.08.15 13:19
jsmitch,

If you read my post, I was clear that we got our insurance BEFORE dx. I am pretty sure we would have a much harder time now, and it would be much more expensive. But we could get it.

I think most folks would be OK with portable insurance....but there is no way you can madate coverage for pre-existing conditions for everyone without all the problems that would create, this has already been covered extensively on this forum as well as other places. And why would we want to eliminate state underwriting? I like regulation being at the local level, just like car insurance, and homeowners, and property. Different geographical regions have different risks, also.

The "available to everyone" is a problem for people like me who believe we should not be rewarding people here illegally with even more freebies. That for me, in and of itself, is a non-starter. Gosh, if we took out providing care to illegals, it would probably more than offset how much care we soon-to-be seniors who have paid taxes all our lives will need. I'm guessing that there are more illegals here in the US than there are tax-paying seniors and disabled folk. Charity begins at home: care for our citizens first.

And no one said reform was bad, it's the total overhaul that's the problem. Like someone said, the devil is in the details. Sure would love to see some details...

By jsmitch On 2009.08.16 09:35
So wait for the details.

By WitsEnd On 2009.08.18 12:19
Annwood,

I agree. If the government can't afford to cover the people they do today under Medicare, etc....how can they afford to add more people? It just doesn't make sense.

The state issue is important. If you change states, even carriers like Blue Cross want you to change from Alabama's Blue Cross to Texas' Blue Cross. Rates go up when this happened. I did not change dad though because we had that problem with Texas Blue Cross on the part D coverage. I managed to make it several years without changing, but I was worried every time I got the letter about "if you've moved......" Insurers should make policies portable across states. Negotiating with the insurers should make this happen I would think.

Cobra coverage exists which also helps. An extension of Cobra would be helpful. That means if you are covered under an existing policy and you end your employment you get to keep your coverage even though you have to pay for it. I think that is for 18 months or something like that now. Extending that would be helpful. My dad worked until he was 70 so he could keep mom in insurance because she was younger than he was and wasn't eligible for medicare when he was. She was on Cobra at the end.

I thought that you could get medicare when you are first eligible--you didn't have to wait until you full retirement date of 67 or whatever? Is that right?


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