Roche Diagnostics Out of Network

[catwoman]

I had to wait from August to the following March to have my AVR. In Canada, my mom's neighbor started at the same time and got his AVR in half the time. Some things are a shorter wait, some are longer. ALL of it in the U.S. is horrendiously bureaucratic and much more expensive. But that goes with the culture, The NHS or Canada's health system would never work here, just as the American system would never work there.

Perhaps it was the red-tape of your insurance carrier coupled with having to wade through the agility course of diagnostics, doctors' schedules, etc., that caused a wait from August to March for you.

I had an echo on 4/15/03, saw cardio on 4/29, who said I needed surgery ASAP & wanted me to go to the Mayo or Cleveland ASAP for repair. I found another cardio in another city (Dallas), saw him in early early June and had MVR on 6/24/03. Had to wait for surgeon to return from vacation and I wanted to spend Father's Day with my dad before surgery. Because of timing, I had heart cath on 6/23, was admitted overnight, then had TEE in the operating room during the surgery.

On prices of medical equipment:
I believe that is triggered largely due to the FDA's rules, policy-making, etc.
I have not been across the border (i.e., Mexico) in years, so laws may have changed since then. However, at one time I was able to go across the border from San Diego, Calif., and Laredo, Texas, and purchase enalapril, amoxicillin, tobramycin, prednisolone, clavamox (veterinary form of Augmentin), many other items for my cats at farmacias for a fraction of what I would spend in the U.S. -- all w/out having to produce an RX. And these products were made by the same pharmaceutical company as the counterpart product I purchased in the U.S. Seems like you do have to have an RX form now in Mexico, but those are easy to get. Don't know about the border crossing procedures now. Haven't been across the US-Mexico border since February 2001.

 

[catwoman]

The US healthcare system is working for me. I'm getting the home kit and won't have to pay a deductible, all because of competition in an open market. It's the threat of my taking my business elsewhere that has kept the price down for me.

Perhaps it's more related to terms of your particular health insurance policy. Some provide 100% coverage of DME, some cover a set percentage of the cost -- which may not be a straight percentage, but only a percentage of "usual and customary" or some other similar wording.
My first monitor was covered at 100% of the charge. My 2nd one was at 80% (I think 80%) of the "usual and customary charge." That translated into 60% of what I paid for it. I paid cash, which saved me $1,000, then filed for reimbursement. As it turned out, 40% (my portion) of $1700 (including case, charger, strips and monitor) was cheaper than 40% of $2700 if I had gone straight through insurance. Why the $1,000 difference? Time and money the supplier saved by not having to wait for payment from Aetna, plus savings of company employees' time on doing paperwork.
Yes, it's a crock, but that's the way it is. There was no getting around it.

 

[Garserin]

I had to wait from August to the following March to have my AVR. In Canada, my mom's neighbor started at the same time and got his AVR in half the time. Some things are a shorter wait, some are longer. ALL of it in the U.S. is horrendiously bureaucratic and much more expensive. But that goes with the culture, The NHS or Canada's health system would never work here, just as the American system would never work there.

I agree that medical care is more expensive in the US, but I had did not have to wait very long for surgery. I found out that it was time for surgery on a Wednesday, had tests on Friday, talked with the surgeon on the following Tuesday and had surgery four weeks later. I could have had surgery two weeks after my surgeon's appointment but needed more time to get used to the idea. Mayo is very efficient!

 

[carolinemc]

They forbade you because they need the insurance money to stay in business. Heaven forbid you do will with self-testing. That is the way they are these days. Hugs for today.

 

[Protimenow]

I'm assuming that you were responding to my statement that the Anticoagulation Clinic forbade me from using my own meter, but I'm not convinced that, in this case, the reason was related to insurance. This clinic handles a lot of uninsured and underinsured patients. Many of the patients are getting their medical attention paid for by the government. I don't think that insurance payment was the issue.

What I really think, regarding this particular clinic, was that they believe that THEY are the only ones who should be involved in anticoagulation management for their patients. ANY involvement in testing or questioning of dosing from the patients is unwanted and discouraged. If they can't be responsible for the entire management process, they'd rather not be involved. (From a pure legal liability standpoint, this sort of makes sense -- if there's a patient who may not follow their advice, they don't want the liability of having this patient that they can't control).

FWIW - the values on my InRatio have been far off the blood draws the last couple tests. I'm getting a bit concerned with my meter's accuracy -- or, perhaps, with the lab's techniques.

 

[wcasey5]

the clinic I used to go to suggested a home meter and said they may have a pilot project. I thought great, they promised to get back to me. When I asked the next time I was in, they told me no. Because they didn't want to lose the revenue. So now instead of getting less revenue from me, they get none. ZERO.