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Doctors dropping insurance

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strmrdr

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I havent decided on this issue.
On one hand injured patients deserve to recover reasonable damages on the other hand if no one can afford medical services or insurance it isnt good either.

Iv been looking for health insurance for a while now and it isnt easy to get nor affordable.
For our small group at work we are quoted 800-1200 a month per family and basicaly nothing is covered the first year for a couple of us because of pre-existing conditions.
 

mike04456

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What they don't tell you when blaming malpractice lawsuits for skyrocketing premiums is that the average malpractice settlement has barely kept pace with inflation over the past decade or so. What has happened is that many insurance companies lost their shirts in the stock market like everyone else. The only way to make up the loss is to hike premiums.




What few people realize is that insurance companies make their money by investing the premiums they get. The premiums themselves are not income--they are required by law to bank that money against possible claims.




That said, going without malpractice insurance is actually a good tactic to avoid lawsuits. It's often said that insurance money is the mother's milk of litigation, since there is no point in suing people who can't pay a judgment.
 

Jaded Gem

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Dec 23, 2003
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Dear Strmrd,
Hey my dad can sympathize with you. If you read another thread called "Unemployment" then you may get a clearer picture of what I mean. Basically, my parents own their own restaurant which they run themselves with family help. With the downward economy, my parents just couldn't keep up with the over 1K expense of basic coverage for just my mom and dad. Their business was affected by neighboring businesses closing shop, relocating, or just going bankrupt. So they lost some customers during these changing times. They just adapted by choosing to let go of a personal cost which was their health insurance coverage. I thought it was a bad idea, and I had offered to help them pay for any health coverage for them especially since I know my father has heart problems. He declined my help. Around this past Thanksgiving, my father had to have surgery. He did not have medical insurance. As a result, he is paying a lot of money out of his own pocket for that cost. He wouldn't tell me how much it was since he said that I didn't need to worry about it. I'm sure it is somewhere in the five figures if not more. I still encourage him to buy insurance for himself and my mother, but he says it's not financially reasonable to do so at this moment. He won't have any of his kids help either. I don't know if it is his pride or what. I guess it depends on what you think are the pros and cons of having insurance. I didn't have medical insurance after I lost my job. When I moved into the city that I am living around now, I got into a terrible car accident shortly after. The car was totalled. Nothing was left of the car. Fortunately, I had my seat belt on, and my air bag was deployed. I walked out of the car with just a minor scratch on my hand. I was stunned for about five to ten minutes, and I didn't even know what happened or where I was for a little bit. My boyfriend, now husband, was so scared that he would lose me or have me face an incredible amount of debt if I was hurt had then reconsidered where he stood in my life. (We knew each other for almost ten years and dated for about half the time.) We got married five months after the accident, and I am now insured under his medical coverage. If your company doesn't subsidize the health insurance costs, it does seem a lot to pay for premiums, but I still think it is better than not having some type of policy. I know there are co-pay and deductible fees on top of the insurance preminum, but I still think it's worth it. It's that or playing russian roulette with your life. Regardless of your decision, I wish you and your wife good health. I hope nothing bad ever happens.
 

strmrdr

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Jaded Gem,
I sorry to hear about your dad.
Its tough out there for small business owners right now.

Indevidual insurance coverage for just myself without a group would cost more than I make a month so it isnt an option.
Im trying to get coverage before I get married but I dont know if that is going to happen.
 

strmrdr

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LawGem,
You raise some good points and hit it on the head.
Im not sure I like doctors being judgement proof because they do mess up at times and there needs to be help available for the affected patients.
 

derekinla

Shiny_Rock
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Sep 7, 2003
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467
Doctors certainly need to be held accountable for negligent behaviour but outrageous settlments and payouts do not necassarily ensure high quality care and certainly do not make healthcare costs any more affordable to the end consumer. I am not an expert on medical malpractice economics but I would suspect that limiting caps on malpractice awards would probably lead to lower malpractice insurance rates, and lower overall insurance premiums and costs for the consumer. As a practicing physician I can tell you that the constant fear of litigation has also increased the cost of healthcare in the form of "CYA" medicine ("Cover Your Ass" medicine) in which extraneous tests, hospitalizations, and procedures are commonly ordered in the remote chance that something might be missed and therefore might come back to haunt you. These extra costs are passed back into the system and we all end up paying
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Matata

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Derek,

I thought that California passed a law to cap malpractice awards. Is that so and if so has there been a statistically significant decrease in lawsuits? My SO is a pediatrician in Oregon and there is some talk about capping awards here.

I agree, without question, that physicians who are incompetent or who deliberately cause harm should be punished and their victims compensated.

I think it is tragic, however, that so many physicians are being forced to stop speciality practices because of the potential for lawsuits. In my community, more and more obstetricians are refusing to deliver babies. We're down to the bare minimum on neurosurgeons. I've listened to reports on National Public Radio over the past two years that stated there are portions of some states (usually rural areas) that lack coverage by a doctor. The identified causes for the losses are the costs of malpractice insurance and the increase in malpractice lawsuits.

Some thoughts to add to the overall discussion: I suspect we expect doctors to be perfect. Sometimes things happen that have tragic results but are not caused by negligence. All eventualities cannot be predicted and there is a limit to what skill and technology can accomplish. As our medical achievements increase, so do the risks associated with them. Lawsuits based on the public's rising expectations that medical miracles are daily occurances also threaten the medical system as do frivolous lawsuits.

I apologize for the ramble.

M.
 

derekinla

Shiny_Rock
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Very insightful comments Matata,

Yes, California does have laws in place that cap awards in malpractice lawsuits. I do believe that malpractice insurance costs are lower here in California relative to other states that do not have such caps in place.
 

mike04456

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Yes, California has capped non-economic (i.e., pain, suffering, and the like) damages for malpractice suits at $250,000 since the 1970s. Incidentally, that cap has not been changed nor adjusted for inflation since its enactment.




We live in an overly litigious society--I will freely admit that, having been a litigation attorney some years ago--but the malpractice problem is a lot more nuanced than most people realize. Spectacular multi-million-dollar verdicts are the exception. The average award is typically far less, and in fact, most malpractice trials end in defense verdicts.




Malpractice suits are among the most expensive types of litigation because of the necessity of expert testimony, and for this reason, the attorneys who do plaintiff-side med mal have to be extremely careful about the cases they take. One malpractice attorney once told me that he rejects around 90% of the cases that come through his door. You need clear damages and a slam-dunk on liability to even think about pursuing the case. The insurance companies know that juries in general sympathize with the doctor (which is in large part responsible for the poor success ratio for plaintiffs noted above), so the typical practice is fight every case to a jury verdict rather than settling.




I don't know what the solution is--I think it's tied up with the general problems of high cost of medical care in this country. Capping awards does hold down the cost of insurance, but at the cost, in many cases, of denying fair recovery to injured patients.
 

pqcollectibles

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Feb 22, 2003
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We used to live in Indiana. Our medical costs were the lowest in Indiana of any state we've lived in. The State has limits of liability on medical malpractice and the insurance savings are passed on to consumers. When we moved from IN to Missouri, the rate for a routine doctor's office visit jumped $15. We were used to being charged $20 in Indiana, and it jumped $35 when we moved to Kansas City.
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There are other things to consider also. The huge medical system/insurance bureaucacy. My mother was in the hospital back in October. The doctor suggested several other tests that needed to be done after she got out of the hospital. I asked why they didn't just do the tests while she was in the hospital. I got a lesson from the doctor in Admissions Diagnosis and Medical Pharmacopoeia. According to the diagnosis my mother was admitted under, only certain tests and proceedures were deemed allowable and coverable. The doctor could order the other tests, but the hospital would have to eat the charges. If the hospital eats too many charges from a doctor, the doctor looses his priviledges to practice at a hospital. Without basis, he could not just order a bunch of additional tests. The doctor said that wouldn't stop him from ordering anything absolutely necessary for my mother's care. If she had a change in condition, he would respond accordingly by adjusting the "Admit Diagnosis". The insurance red tape would not prevent him from treating my mother appropriately for her condition, but she could not have the additional tests as an inpatient.
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I can only imagine your father's bills, Jaded. From October thru December of 2003, my mother ran up quite a bit in medical bills. She spends an average of $150/month out of pocket for medications anyway. The bill for her 3 day hospital stay was $6000. She had a colonoscopy/endoscopy that cost over $3K. She had an abdominal ultrasound that cost $1500. And there was a MRI with contrast that cost another $3K or so. That doesn't even count the Kidney Specialist, the Gastro Enterologist, biopsies and labs, and the Radiologists' bills. It is mind boggling. Thank goodness my mother has MediCare and a coinsurance for hospitalization. She couldn't afford all the bells and whistles on the coinsurance. She bought a catastrophic type of coverage to hedge against huge bills and the premium is around $200/month for 1 person. It pays a small amount on her prescriptions, a portion of her doctors' bills, and covers 100% of what MediCare does not pay on hospital stays after she meets a deductible. Because the bills go to MediCare first and then her coinsurance provider, we still don't know what her total out of pocket will be for all the testing and doctor's visits.
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I don't envy you, Strm. You are young and less likely to need care, but I would hate to be without insurance. Been there done that when we were younger. We were lucky to not get ill or injured. God had to be looking out for us. May you be as blessed, even after you get insurance.
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strmrdr

Super_Ideal_Rock
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I’m not looking for sympathy just sharing my experience on medical costs.
When I was in the hospital for pneumonia 3 years ago the bill was just over $23000 for 6 days not counting doctors fee’s, which was another $3000 or so.
In 96 11 days in the hospital for dvt and pe was just over $30000.
Sleep apnea sleep tests run $2500 each.
Asthma testing/lung function test $600-$800
ER visits when my asthma acts up $1000 + ct costs of $1200 because they wont let me go without one to check for another PE.
Er visit and ultrasound when my leg acts up from after affects of the dvt $3000.
Asthma meds: advair 145 a month abuteral $50-$75 depending on how much I use.
Rental on an oxygen machine for the sleep apnea $475 a month.
It adds up in a hurry.
 

Jaded Gem

Shiny_Rock
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Dec 23, 2003
Messages
199
Hey Strmrdr!
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You wrote "I’m not looking for sympathy just sharing my experience on medical costs." Hey, I sympathize with you regardless of you not asking. Medical insurance and/or medical care is a very expensive thing. My parents don't want to get it because they don't feel they want to pay over $1,500 a month. My dad has heart problems and with his age and all the medication he has to take, the insurance would see him as a "heavy cost to them and their establishment." I don't know the logic to why my parents just don't get insurance even after having to pay for a very expensive surgery on their own.
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I know that getting any type of surgery and any nights at the hospital all add up. I think they charge like $500 for only the Tylenol alone or any other type of generic pain reliever that they give you, and then they charge an arm and a leg for the nurse who gives it to you since she is a "distribution aid." I don't know why they need to charge for every little small thing. Only my sister got to look at my dad's bill eventually since he couldn't understand why everything had cost him so much. She asked for an itemization of the bill, and she said that my dad got charged these rediculous fees for minor things outside of the operation. I think the patient's outfit also cost like a rediculous amount. I have no idea why it is so expensive.
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And I guess that's why I thank God that I am insured under my husband's medical plan. The first HMO I went to back in the late 1980's tried not to charge any of its patients any type of co-pay, but the wait was at least an hour long and they eventually didn't make much money so they folded. The second HMO I went to in the 1990's also had a long wait, but they charged like $5-$10 copay for the general generic services. The current HMO I am enrolled in also has a long wait, but the copay is around $15-$20 for the general generic services. Obviously, if the patient had some type of operation or hospital stay then the co-payment would cost more. Yes, we, as consumers, feel the preminum hikes too, but I still think insurance is better than not having any since it is rediculously expensive to have anything done at the doctor's office for what the average consumer would consider a relatively reasonable amount. I hope to see your health improve. Take care Strmrdr! Hopefully you will never get into my dad's rut.
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derekinla

Shiny_Rock
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Sep 7, 2003
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467
Medical care is expensive in this country for a variety of reasons but the disturbing fact remain that MOST hospitals in this country are teetering on the brink of financial disaster. Major academic medical centers have been hemorrhaging from cutbacks in medical reimbursements and more and more headlines about hospitals "closing up shop" are popping up on the local evening news. UCLA Medical Center, for example, was in the black by ONLY a few million dollars last year. The cost of medical care will ONLY continue rise in the coming years and consumers/patients will soon start assume more and more of those costs in the form of higher co-pays and higher premiums. The supermarket strike affecting Southern California supermarkets highlights this trend in the shifting of healthcare costs to the end consumer.
 

pqcollectibles

Ideal_Rock
Joined
Feb 22, 2003
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I know you didn't ask for sympathy, Strm. I just really feel for anyone without insurance. Medical costs are so outrageous these days.
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