When your medical insurance status made a difference in the treatment you got.

In My Humble Opinion
1

I have three personal anecdotes, from both fully-insured to non-insured.

1: Uninsured, mid 1990s. History (2 ER visits) of miscarriages. Went to doc because of pain, suspected pregnant, doc suspected ectopic pregnancy and sent me toot sweet to the ER. Ultrasound done there confirmed ectopic pregancy. Doctors and nurses swirl into action. During the doctor’s explanation of what they’re going to do (D and C, basically, then ten weeks of no lifting blah blah, you will die if you don’t do as we say) I stop him and point out this is not an option: I have no insurance and am putting (now-ex) husband through school. I must work. “Oh! Then here’s the morning after pill, expect massive bleeding and pain, don’t call us we’ll call you, but it should be done with in a day or three…”
It was messy and unhappy, but I survived. Was the D and C a completely unecessary procedure that an insurance company would have been dinged for, or was I given the morning-after pill because I was a second-class, indegent citizen?

2: Uninsured, a couple years later, knee injury with massive swelling that went on for weeks before I saw a doc.
“Aha! You have a torn anterior cruciate ligament. You need surgery otherwise you’ll be crippled for life.”
“Not an option. I’m the only one bringing in income right now, I have to work.”
“Oh. OK. Here’s some muscle relaxants. Have a nice day.”
I’ve been totally fine, and quite active, since. Knee is fine, it’s been about 20 years.
Was I underserved by not having ACL surgery because I had no insurance, or would my insurance company have been charged with unecessary insurance?

3: Full coverage insurance:
Weird, all the sudden I start coughing with a non-productive cough. Of course, since I have great insurance, the docs are like fucking vultures. It is determined that I have eosinophilic granulomas and this excites the doctors at National Jewish (hospital in Denver) because it’s not that common. They think it may alsi be lung cancer but they’re not sure.
So, I am booked and scheduled and get a lung biopsy, which is not the least bit of fun for me but apparently the doctors are chuffed because I may have something rare and here’s the clincher: it’s paid for by insurance!
Turns out to be absolultely fucking nothing but a garden-variety case of bronchitis that could have been treated with a short course of antbiotics, and I’ve been fine since (I was offered no treatment) but because I have gold-plated insurance at the time, I was tossed into needless and I assure you really fucking uncomfortable surgery. As anyone who has had a lung biopsy will attest to. Also my family was scared shitless for no good reason, because 15 years ago they were told I had lung cancer - I didn’t then and I don’t now.

So - based on my own short history in the U.S.A. I got slipshod or haphazard health care (depending how you look at it), or completely unecessary procedures (ditto) for really no good reason. I understand that medical providers have to both shield themselves from lawsuits and protect and serve their corporate medical overlords but damn: shouldn’t there be some sort of over-arching care standard for patients?

2

I have not once had an insurance carrier who was willing to pay for the number of diabetes test strips that my doctor prescribed for me. (6 per day.)

Edit: Hm, you seem to be looking for anecdotes of unnecessary medical procedures done solely because you have good insurance. I do not have any stories like that.

3

Either way, really. I only offered up three anecdotes.

I’ve spent about equal times in the U.S. having good, comprehensive insurance as having little or none. No agenda, except it does seem to me that one way or another, medical care is at least somewhat dependent on the type of insurance one has.

4

Follow-up question: for the knee story, were you seeing a specialist/an MD outside of the ER?

Our system incentives more expensive (ie. usually invasive) procedures, not necessarily better procedures. The lawsuits wouldn’t really be an issue in terms of recommending treatment, because in the first two instances, you were told the “expert” recommendation and then opted for something less. Also, there’s much less chance of something going “wrong” with the less invasive procedures- another basis for a malpractice claim. It’s much more that in example 1, you refused the “recommend” D&C and in example 2, the MD wanted to be paid.

5

I posted this in a thread about sonograms in November:

6

Regular MD for the knee thing (no health insurance = difficult to get to specialist level. If you’re used to having insurance, you may not realise this. I fell between indigent and able-to-afford at the time, which means zero community/taxpayer funded health care.)

I did not refuse the D&C recommendation in #2. I did say it wasn’t an option (it wasn’t; see above) and as I stated I don’t see that it would have made much of a difference. It wouldn’t have. Except I would have owed the hospital for a D&C plus a few days of care, which apparently weren’t necessary.

Also: Show me where I said the MD didn’t get paid? In each instance, they most certainly did!

Also #2: where did I mention malpractice claims? Oh right, I didn’t.
To make it crystal clear for you: When I have had medical care, I’ve paid for it. Also, I have never even considered a malpractice claim, for anything.

Thanks for playing.

7

No one is accusing you of not paying for anything. Please calm down. You mentioned lawsuits as reason for providers acting a certain way, which are almost universally malpractice claims. I was trying to show you why the doctors motivation in all of these cases was almost certainly not lawsuits, but almost certainly pay, as you had already mentioned yourself.

If you’re going to argue semantics saying that telling a doctor that something is not an option is not refusing treatment, then you clearly are not going to engage in reasonable dialog on this topic. I think most people would agree that some phrasing of “that’s not an option” is understood as a refusal. My point was, you refused the standard of care treatment that they issue in the ER. So you got the alternative. Much cheaper, obviously, for you. And they only made the money of your ER visit.

The MD did not get paid because you didn’t have the surgery.

8

Yes, we agree, then. Not lawsuits, but certainly pay.

I’m not arguing semantics. When I told the doc is wasn’t an option, I meant: NOT AN OPTION. As in, back then, I was the only income provider, we had no savings to carry us for six weeks of my “recuperation”, I meant, at the time literally, it was not a realistic option.

Also - I already responded to your question but I guess you missed it so again just for you: This was not the ER. The doctor in question was a regular GP, and he got paid accordingly for my visit, at the time of the appointment. The ER probably would have been cheaper. They’re used to treating (and not being paid by) indigent patients. Again: I did not go to the ER.

Got it, now? Good. :slight_smile:

Again - did you read my responses? At all?
In scenario 3, I did indeed have surgery. Surgery with a surgeon, three days in hospital, for which he was, I assume, adequately compensated, between my insurance company and my co-pay. Last I checked, having a lung biopsy is indeed an in-patient surgery. And: THE MD GOT PAID. (In case you missed that part.)
And again, you may have missed this part too: It is highly questionable whether I needed the surgery at all. Isn’t that a hoot!

Seriously I am not trying to be difficult but your responses are bizarre, and give no indication at all that you actually read anything I posted. It’s not like I’m asking you to grasp the theory of relativity, or advanced calculus or anything. Just, please read and comprehend before responding. Thank you. :slight_smile:

Jesus Christ I hope you are not any sort of medical professional who has to read, comprehend and follow written instructions, Amasia. Because if so I certainly don’t want you on my team.

9

Seriously, why are you being so combative? You started this thread, they’re asking questions about your situation, you’re being pretty bitchy in your responses. If you didn’t want commentary, why open the thread at all?

10

I never responded to number 3 at all. In fact, I specifically said

[QUOTE=Amasia]

and in example 2, the MD wanted to be paid. .
[/QUOTE]

And if you communicate in a rude, inappropriately aggressive way, you can expect people to disengage with you, despite the fact that you bring up an interesting and important subject. Which may have been what was happening in the first two examples, and is certainly what I am going to do here.

11

Except for a recent six-month period, I’ve always had pretty good insurance. Over the years I have learned that I can stop a lot of things from happening by asking what would happen if I didn’t take the treatment. For example, when I went to a doctor with all the symptoms of strep throat–

“We will send you in for a strep test…”
“If I do or I don’t have strep throat, will the treatment be any different?”
“No.”
“Okay. I’d like to decline the strep test.”

Or, after taking a flying fall and landing on my kneecap on cement,

“We can sign you up for eight weeks of physical therapy for this.”
“What happens if I don’t take the physical therapy?”
“You will heal. It will just take longer.”
“I’d rather not do physical therapy, then.”

I always felt that the doctors were being proactive in order to protect themselves from lawsuits, rather than run up insurance. The one time I really did get a bee in my bonnet about insurance fraud was in this past six months, when we had only a high-deductible plan. My daughter’s four month vaccinations cost us $438. You bet that for her six month appointment, I took her to Public Health for those vaccinations… and they cost $28. I understand that the shots cost some money and PH is government funded, but dang, there were NOT $438 of shots there, no way no how.

12

I think I have had some kind of invasive testing done merely because I had good insurance at the time, but it’s hard to tell–possibly if I’d been paying, they would have made the same recommendations as a CYA kind of thing.

I also had a “not an option” thing, also with a knee. I turned it down because I have a rule, based on years of working for a hospital (not as a medical/clinical person), and that rule is, “No elective surgery, ever.” And by elective surgery I mean anything I am conscious enough to consent to. (Exception made for c-section because that wasn’t for me.) Dr. shrugged, said “Try some PT then,” and in fact the PT fixed it.

But a friend of mine took her 8-year-old to the ER. A few hours before the kid had been walking the dog, the dog bolted, and the kid did what my friend thought was going to be a face-plant, only she somehow flipped sideways, hit her temple on the surface of the street, and lay there motionless for a few seconds, then she got up and said, “Wow, I saw stars.” My friend checked her pupils, decided she was okay, and took her inside to look for some kind of lump on her head. A few hours later the kid said she had a terrible headache, so off they went to the nearest ER.

Where they waited. For six hours. And then were told, “You need to go to X hospital, it’s for indigent patients.”

Friend was between jobs at the time and had no insurance. However, she didn’t need it, as she could have written a check for anything they did, up to and including a head transplant, and pulled the necessary funds out of her trust accounts. She did amble over to another hospital, and she wrote a letter to various people that got the original ER hospital into some hot water, but the fact is, even with a lot of money her daughter got BAD CARE because she didn’t have insurance. And if you don’t think that’s bad care, consider the ramifications if the headache was caused by internal bleeding. It wasn’t, and the kiddo was okay, but also consider how seriously unpleasant it is to spend six hours in a hospital ER waiting room with a child with a really bad headache that you suspect might be a brain injury.

Okay, OP, though, back to you, saying “That’s not an option” is basically the same as refusing the treatment, but either a D&C or a morning-after pill sounds wrong to me as treatment for an ectopic pregnancy, and the whole 10 weeks of no lifting sounds wrong, too.

13

I went to the ER with a kidney stone once. I had to call 911 because I couldn’t drive, it was 2am, and because I had just moved, I didn’t know anybody to ask for help (except my mom who lived 35 minutes away, and I couldn’t wait that long). I was insured, but I didn’t have my card on me. So they treated me like an uninsured person. I was shunted out the door of the ER within the hour, still woozy from the intravenous pain meds (and clutching a barf bag because the pain was so bad it made me projectile vomit on the paramedics). Thankfully my mom answered my phone call and drove me home, otherwise I suppose I’d have had to call a cab (since I took an ambulance I didn’t have a car there, although I wouldn’t have been able to drive anyway).

That was a terrible experience. I make it a point to carry my insurance card on me all the time, now.

14

Good insurance: In my 40’s, no history of heart disease, had mild palpitations one day at work, mentioned it to the plant nurse who sent me to the clinic, where I was referred to a specialist, who did an EKG and then put me on one of those monitor things. I thought it was overkill.

Injured at work (fell and broke hip): Excellent care (employer paid) except that I still have the rods and pins in the hip. When I asked about having them removed, the company doctor said it wasn’t necessary, and that it would involve another surgery (duh). I don’t know if it’s standard practice to leave the metal inside, so maybe that was okay, or maybe the doc was saving my employer some money (and me some risk).

Uninsured: Cholecystitis and gall bladder removal, with x-rays, a CT scan, and a colonoscopy just to be sure. Excellent care, and the doctor and surgeon knew I had no insurance. The clinic was antsy about being paid but the hospital was more than willing to accept payments. An uninsured friend recently had the same thing – the bill was $16K and the hospital is happily accepting $100 a month from her.

My experience doesn’t show a pattern.

15

When my insurance was of the HMO type when my primary care physician had to approve any referral to a specialist or it wouldn’t be paid for, I had tried for many months to get her to refer me to a neurologist to formally diagnose me with migraines. I had told her time and again about the excruciating headaches on one side of my head, above my left eye, and the uncontrollable vomiting, and the sensitivity to light and sound, and she was adamant that I had a chronic sinus infection. She sent me for x-rays and told me I had a minor deviated septum, not bad enough to do anything about. She just kept giving me antibiotics for my phantom sinus infection, while I pleaded to go to a neurologist.

Then I got “lucky” enough to have a migraine at a time when my then-boyfriend, now-husband picked me up at work, drove me in to the HMO and demanded help for me. My regular doctor wasn’t there but the one who saw me wrote the magic word on my chart. I would have spelled it for him if I could have opened my mouth without puking on his shoes. “Yes, doctor, it’s ‘M-I-G-R . . .’”

After that, I got the referral.

16

Sure, once people’s bodies all react predictably and exactly the same, that’ll be easy.

It’s quite possible that your average person might have been crippled for life with the same ACL injury but you got lucky/you’re a superhuman being when it comes to your ACL.

When I broke my wrist, two different sets of initial x-rays (done at the ER and then again a few days later at the orthopedist at a completely different hospital, because the disc from the ER was flawed/scratched) failed to show that the end of the break went diagonally up and out the end of the radius where it met the wrist bones. That part was caught at the follow-up x-rays a few weeks later. This caused lots of extra pain during the healing process due to all the rubbing on the broken end of the bone by the wrist motions. If the disc had been fine and thus we didn’t need another shoot, I might have wondered if the ER was incompetent at their imaging; instead, we had my report of what I saw and the printed x-ray report, plus a set of x-rays taken only days later, which all seemed to agree until the visit weeks later showed what had really been going on. My orthopedist said that sometimes, the full extent of a break simply does not show up on x-ray until later.

When I showed up in the ER, the staff didn’t discuss insurance with my husband and I until after the x-rays; they asked my husband to come out with them to finish that up. Since all I got were the copies of their reports and images, a splint on my wrist, a prescription for a painkiller, and a referral to a local orthopedist if I didn’t have one in mind, I’m pretty sure they didn’t treat me differently. For the orthopedist - well, with insurance I was able to afford weeks of physical therapy to get full range of motion back in my dominant hand in a nicely guided and coached fashion, so I did appreciate not having to deal with that myself.

17

I had always heard that an ectopic pregnancy was when the fertilized egg implanted in the fallopian tube. IANAD, but cannot imagine how a d&c or morning-after pill would help. Every other account I’ve heard about ectopics involves major surgery and is pretty much mandatory as an alternative to potentially bleeding to death. If I am wrong in this recollection, please explain.

18

Yeah, *neither *of those are safe options for the treatment of an ectopic pregnancy, so the OP either misunderstood what was going on, or is conflating it with a different story in her mind. Whatevs, it’s still an interesting topic.

“That’s not an option” means you’re declining what is, indeed, a medical option. It may not be a GOOD option, it may not be a PRACTICAL option, it may not be a POSSIBLE option because of what you’ve got going on in your life, but it is a medical option that was explained to you.

But yes, doctors don’t explain options well, whether you have insurance or not. They know what they want to do, based on their experiences with other patient in your condition, based on what they think you’ll be compliant with (no sense mentioning PT to a patient who won’t do it), and based on what your insurance will pay for. And really, can you blame them? If you can’t pay, do you really want to know about the $1200 a month pill that could be used for your condition?

It doesn’t always go the way you think it will, though. One time when my SO (older man, history of heart attack) went to the ER with chest pains, they did all the right tests and admitted him for observation. This was on a Friday. They told him he’d be in for observation over the weekend, and a cardiac catheterization on Monday when the lab opened. Why did he have to stay? *Because *he had no insurance. If he had insurance, he’d be sent home and told to return on Monday for the test. But then it wouldn’t be part of his Emergency admission, so he’d have to pay up front, cash. By keeping him admitted, the doctor could order the test and the hospital would do it and *then *try to collect money for it, because he came in through the ER.

19

Years ago my husband needed an emergency bypass operation, as an angiogram showed that his main coronary artery was mostly blocked (thus explaining the chest pain he’d been having for months, which he kindly shared with no one, making this emergency a complete surprise to one and all, but that’s another story). I dutifully called his insurance company to tell them about it. The hospital was not in-network, but the treatment was approved because it was an emergency.

However, much later, the insurance company said they weren’t going to pay any bills after the first 24 hours because that was all the time covered for emergency treatment. “He should have transferred to an in-network facility at that time.” Excuse me? At the 24 hour mark he was still in intensive care, IIRC having a machine breathing for him! It took two entire years before the finances were sorted out.

The hospital and doctors, however, did not alter their treatment one iota as far as I could tell; he certainly received excellent care.

20

I’m not sure what the OP is getting at. In the US, at least, every single medical issue will involve will involve whether you have insurance or not. Sometimes the choice is one treatment option or another based on what you can afford, sometimes it is getting no treatment at all because it’s too expensive, and sometimes it involves looking for some charity that subsidizes medical care for the poor.