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From: ocean_dancer2001 (no email)
Date: Mon Dec 01 2003 - 20:16:58 EST
B Geres,
Thanx for the input, and some good info for sure. I'll go out on
a limb here and say that I suspect you worked for Blue Cross/Blue
Shield at one time? Perhaps thats why you think their insurance cards
are like gold in the medical profession? I've never known that to be
true, but really off the point anyway.
And I don't think any insurance carriers today are worth squat, for
the very reasons you point out...they will, and do interrpret
exclusion clauses in any way to suit themselves, because heaven forbid
that they have a client that may actually NEED their services.
Also..as for "commercial" insurance ...nope...we don't have that
anymore. Back in "the days" we all had insurance thru our employers,
and whenever we had ..lets say...a hospital stay...our insurance
companies would pay the bill, based on actual charges. Thats what
they paid to the hospital. Now, thats not true. They reimburse the
hospitals now based on what they call DRG's..or diagnostic related
groups..whereby the insurance co. pays a flat fee to your hospital
based on your admitting diagnosis. Thats part of the reason hospitals
rush you out the doors anymore...its because they know up front that
they will ONLY get that small, flat fee pymt from ANY of the insurance
carriers. What a mess! People being discharged way too soon from
hospitals because again, as I stated previously, insurance companies
dictate health care today. Period.
As for the other issue you mention regarding living wills.
Yes...a good idea, but I will say this. As a nurse for many years
now, and having worked in any and all types of clinical areas, and
based on what I've seen in those years...remember this when making out
your living will. What we think, when we are enjoying good health,
is most often different than what we feel or believe when it gets down
to life and death. In other words, you can easily say now that you
would not chose to support your life with tubes and by artificial
means, BUT, the human instinct to survive is far stronger than you
know. And when faced with the choice of either dying, or taking a
chance to live, even if by some artifical means, MOST people will
chose to take the chance on living. And so I would strongly advise
you to really think your answers thru when you are considering filling
out that Living Will.
Also you mention getting in good physical condition prior to an
extended trip. Thats very good advice. But...advising someone to
have a healty appendix removed, or going on blood pressure medication
as a precautionary measure...is downright scarey. Why not cut off a
perfectly good arm just in case it might get injured on your trip?
Sorry, but thats just really BAD advice.
Good idea tho as you said, to get routine things done like eye
exams, dental work etc. And medical history and any pertinent
paperwork, also good.
And again, I've gone on too long...theres just so much involved in
this topic. Sorry if anyone finds it not useful, just tell me when to
stop!...:)
Cheers to all!
Ocean_Dancer2001~
-- In , B Geres <bgeres at y dot dot dot > wrote:
> Lisa:
>
> If "sanctioned event" is the key, then I suspect some
> companies might see to it that (for example)
> participants in Steve Black's Caribbean 1500, the
> Atlantic Rally for Cruisers (ARC), and the Nova Scotia
> Adventure Cruising Rally, etc would find their care
> excluded. In my experience (over a decade on the
> underwriting and case management side of the business)
> I've found companies interpret exclusion clauses quite
> broadly when its to their financial advantage. You
> have to remember these companies benefit financially
> when they take in more premium than they pay out in
> claims - its their job to see this simple equation
> balance in their favor. Before you say "but if they
> enforce clauses like these aggressively, their
> customers will become dissatisfied and switch
> companies" you need to understand that this is part of
> the strategy. Insurers like nothing better than to see
> sick people leave the pool.
>
> My advice? First off, think long and hard about how
> you want to see your life out. The vast majority of an
> individuals medical expenses are in a subjects last
> days, as they pursue extreme and in many cases
> experimental therapies in an attempt to squeeze a tiny
> bit more time out.
>
> I not only have insurance experience; I've worked as a
> hospital administrator. And I'll tell you quite
> frankly - quality of life during the last days of
> people pursuing extreme measures suck. Personally, I'd
> rather just go quietly than have tubes protruding from
> every orifice, pickled and wigged out on various meds.
> What am I saying? Think the issues through and make
> yourself up living wills (and healthcare directives)
> in a form considered legal by the States/Countries in
> which you intend to cruise.
>
> Secondly, before you take your retirement or extended
> holiday from work to cruise, take full advantage of
> your employers group medical policy (and your cash
> flow) to get yourself in tip-top condition. Have your
> appendix out if its not already (even if it seems
> okay). Get your lasix proceedure done. Get on blood
> pressure/cholesterol meds (and/or make lifestyle
> adjustments) if your numbers are even slightly
> elevated. Start working out as if you were in training
> (you are!). You want to go on your cruise just as
> healthy as you can be.
>
> You may want to shop for and initiate the healthcare
> policy you'll use while traveling BEFORE you go -
> especially if theres a pre-existing clause to deal
> with. Paying premiums for coverage that's only
> secondary to your employers policy is expensive, but
> you may find its cheaper than dealing with
> unreimbursed care while cruising.
>
> Once "out there" you need to take on the role of
> primary care coordinator. Since for someone traveling
> continuity of care can be an issue, you need to be in
> charge. Before you depart, get hard copies of your
> medical records and carry them. Its up to you to put
> them in the hands of doctors you see along the way and
> inform them (in detail) as to what your care is all
> about. You also need to fully inform docs that you are
> transients and follow-up care might need to be
> delivered in another city (or country) so get records
> from that visit before you move on and add it to your
> stack.
>
> Be religious about preventive care. Most people get
> into trouble because they neglect routine care (exams
> or maintenence medication) and wait until a small
> problem festers into a crisis. many times they do this
> because they are trying to save a buck or two ("penny
> wise, pound foolish"). Jump on small health problems
> the same way you would hop to fix a tiny tear in your
> best sail. Many cruisers take far better care of their
> boats than they do themselves (just as most "dirt
> people" take better care of ther cars than their
> bodies.
>
> If lack of funds stands in the way of proper care you
> may find you qualify for some degree of charity care
> through the network of free clinics that exist in many
> medium and large cities in the States. Now I'm out of
> the commercial side of healthcare I donate my time to
> one such clinic locally. We see lots of transient
> cruisers there. These clinics are not just funded by
> churches, as one might expect... they are funded
> through donations by employers who can no longer
> afford medical insurance (free clinics serve the
> "working poor" who fall through the gap between
> Medicaid and commercial insurance)... and they are
> also funded by grants from local hospitals who know
> that without the clinics, these same patients would
> clog their emergency room with routine care. Think you
> would qualify? Look in the phone book and you'll most
> likely find a free clinic.
>
> What else might I add... well, at point of service,
> brand name is still very important. Flash a Blue Cross
> Blue Shield card to doctors staff and you're good as
> gold. You might be surprised to find that many
> physicians who say "not accepting new patients" really
> mean "not accepting anything except traditional
> comp/major/med funded patients, preferably BCBS).
> Bring in some crappy off-brand insurance card and you
> might be shown the door.
>
> Speaking of off brand... be very careful as there are
> many many people being scammed these days by fake
> medical insurance they bought off the net or from a
> local shiester. It looks real and the doctor might
> admit you with it, but when they submit claims, only
> small ones are paid and the large ones pile up (its a
> Ponzi scheme). Before buying, ALWAYS check with the
> department of insurance to make certain that company
> exists and that your salesman is a licensed agent for
> that company. Don't just say "I've heard of the
> company so its okay". Scammers often create names very
> similar to those of actual companies.
>
> Sorry I rambled off a bit here... know I probably lost
> a few of you early on. But hopefully there was some
> useful meat in there ;-)
>
> ------------
>
> Lisa wrote: [snip] as best as I can determine, it
> appears that the operative word here is 'sanctioned".
> [snip] Also, you mention having been employed in the
> health insurance business in the past, what further
> info can you share with the group that I may be
> missing?
>
>
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