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Thread: Personal experience with government health care

  1. #1
    Senior Member Smurf-Herder's Avatar
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    Default Personal experience with government health care

    Hey, my ex got my daughter the state program; not sure if it's SCHIP. It covers full medical, dental and eyecare.

    She needs to have infected wisdom teeth removed. And it has to be done in the hospital, by an oral surgeon.

    So after two weeks of her being on antibiotics for the procedure, guess what.

    The insurance won't cover it.
    "I am not a number. I am a free man!"

  2. #2

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    Ive been on Medicare for 5 years, and I see 3 Specialists, plus my General Physician, and a Chiropractor, and Ive never gotten turned down yet

    The only problem Ive had was with my Plan D insurance..Ive been on 8 different meds, and only got rejected on one

    I know people that have Blue Cross that get rejected more often for less

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    Senior Member Smurf-Herder's Avatar
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    Quote Originally Posted by slowhand
    Ive been on Medicare for 5 years, and I see 3 Specialists, plus my General Physician, and a Chiropractor, and Ive never gotten turned down yet

    The only problem Ive had was with my Plan D insurance..Ive been on 8 different meds, and only got rejected on one

    I know people that have Blue Cross that get rejected more often for less
    What bothers me is, everybody thought my daughter's procedure was to be covered, or they wouldn't have put her on antibiotics (that made her sick) for 2 weeks.
    "I am not a number. I am a free man!"

  4. #4

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    Quote Originally Posted by Smurf-Herder
    What bothers me is, everybody thought my daughter's procedure was to be covered, or they wouldn't have put her on antibiotics (that made her sick) for 2 weeks.
    Pretty sure she'd need the antibiotics anyway...especially if her condition got so bad there's an infection.

    It wasn't covered because it was a dental issue?

    I wonder what she would've paid for those pills out of pocket?

    12 years ago, my insurance was crappy, and I wound up paying 4 bucks each for antibiotic pills.

    Around here, there are plenty of dentists who also do extractions. It shouldn't cost more than $300.00/tooth.

    As opposed to the thousands the hospital would charge.

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    I've gone through my story here before. The care I received in the military was horrendous.

  6. #6

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    There is quite often an issue when a "dental" problem is treated in a "medical" setting.

    My late wife had pretty good private coverage , but-when an oral surgeon began treating her for a medical problem, both medical and dental component of her plan balked, and she wound up paying out-of-pocket.
    meangenes

  7. #7

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    Quote Originally Posted by Smurf-Herder
    What bothers me is, everybody thought my daughter's procedure was to be covered, or they wouldn't have put her on antibiotics (that made her sick) for 2 weeks.
    That sucks, and I can certainly understand your frustration

    The one drug that my Part D insurance rejected was the one drug that provided the best quality of life for me

    Your Mom had Parkinsons, so maybe you are familiar with some of the pd meds

    I was taking generic Sinemet CR 50/200 3 times a day, and last Sept it stopped working, so I took more..I was up to 900 mg per day to take some of the edge off..Sometimes I didnt have the strength to push my arm through a shirt sleeve

    So I finally, had to make an earlier appointment with my neurologist

    He checked me out and gave me some samples of Stalevo 200 mg, and told me to try it, that it should get me back on my feet..I tried it, and I felt as normal as one can feel with pd..It felt like a dose of speed, and 3 x 200 mg doses lasted all day and all night

    Then when I ran out of samples, my Dr called in an Rx for Stalevo..and the insurance rejected it..They said I had to try Comtan and generic Sinemet instead first..Same drugs, but in 2 pills instead of one

    At first it wasnt as good, but good enough to function..Then I developed dyskinesia and dystonia in my right leg a couple of months later..It started to get worse, so I tried the Contan with brand name Sinemet, instead of the generic, and the dyskinesia got so bad, that my right leg never stopped moving for 3 days 24/7, and I could feel my right arm getting ready to join the parade, inspite of the fact that I was taking the maximum dose of 400 mg of Amantadine to address the dyskinesia..It was driving me bonkers, so I cut my meds in half to make it stop, cuz I knew that dyskinesia is a side effect of the Levadopa in the Sinemet..It stopped it from going all day and night, but it didnt stop it completely, and now I was under medicated again

    I called the Dr and got some more samples of Stalevo, and the dyskinesia stopped completely, and instead of taking 600 mgs per day, I found that I can actually get by on 375 mgs

    When I run out of samples, my Doc is gonna re-submitt the Rx and see what the insuance company does this time

    Drugs are expensive as hell, and if I have to, I will be forced to pay what I can out of pocket, and bug my Dr for more samples..Hard to do when you are on SSDI and can only work part time

    That is why I am so passionate about healthcare..I would much rather be working, but this is my reality, and my reality is a blessing compared to the reality of alot of other people who are faced with greater health and financial challenges

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    Senior Member Revere's Avatar
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    Government rationing of health care is their ever shrinking reimbursement to providers.

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    Quote Originally Posted by mrmeangenes
    There is quite often an issue when a "dental" problem is treated in a "medical" setting.

    My late wife had pretty good private coverage , but-when an oral surgeon began treating her for a medical problem, both medical and dental component of her plan balked, and she wound up paying out-of-pocket.
    I had a similar problem in my family. I think it's a matter of disclosure.

  10. #10

    Default Medicare is USA's golden standard of medical insurance

    Quote Originally Posted by slowhand
    Ive been on Medicare for 5 years, and I see 3 Specialists, plus my General Physician, and a Chiropractor, and Ive never gotten turned down yet

    The only problem Ive had was with my Plan D insurance..Ive been on 8 different meds, and only got rejected on one

    I know people that have Blue Cross that get rejected more often for less
    Slowhand, my wife and myself share your experiences with federal administered Medicare.

    All acquaintances that mentioned the subject to me tell of similar experiences. Iím sure that someone is dissatisfied with Medicare services but I've never encountered them.

    Respectfully, Supposn

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