Who pays for your meds?

For once, not a question for V…
With all the discussion about healthcare in the US, I’m curious…
Who pays for your treatment?
Do you have co-pays?
Does your insurance cover everything?
Most things?

Here, in France…
Normally people covered under the French health care system have what is rcalled ‘top-up’ insurance, which covers the gap between the French system of 70 - 90% and actual cost, bringing coverage up to 100% for all medical and drugs. No co-pays or dedudctibles.
As soon as V was diagnosed with diabetes he was moved to 100% paid category under the French system for everything, including medical taxi service to drive him to and from his doc visits - making the top-up unnecessary.

For this coverage we pay about $400 per year to the French system and another $1800 for the top-up.

That is the entire cost - both employee and employer, if you will.

With or without insurance a doctor visit to a GP is $25 and to a specialist, like my GYN, $32.00.
Just thought i’d toss that into the health care fray…

I can only speak for our situation. I cannot say how the other Provinces’ and Territories’ Health Care is applied/supplied in Canada.

My Hubby’s work Group Insurance totally covers our medications. He pays $35. every January. They used to cover pumps/supplies also but since our Government covers them, the Insurance only pays the $600. extra fee.

If he lost his job, I would be able to get Disability and drugs paid for, since I have another chronic, life-threatening disease. Disability provides the basic drugs however. Since I am past using all the basic drugs for my other chronic disease, another Provincial Program that we have would cover the costs of the more expensive drugs that I have been on for some years.

If a Person has Diabetes, they do not pay for any Doctor’s appointment. Non-Diabetics have to pay a small fee for their Eye Dr. appointments. We do not pay for ER visits, tests, Hospital stays, surgeries, treatments, etc. This is all covered by our Health Insurance Plan. People who are employed pay taxes off their cheques for Health Insurance. These taxes are used to cover the worker, their families, People who do not have a job, etc. We also get a tax deduction for certain costs due to having Diabetes.

There are supposedly elective surgeries and treatments that are not covered. We honestly do not know anyone who has paid for any treatments/surgeries. Gall bladder surgery has been mentioned, as an example… Well, if a Person is in so much pain due to their gallbladder the Surgeon will take it out, no charge. My Sister and Friend both had theirs removed.

We do pay $45. if we call 911 for an Ambulance/Paramedics.

When I was employed with a corporation before, the company was paying for my health care. Any pre existing conditions (I had asthma) was covered since we are insured as a group. When I got married and had to quit my job, I had to pay for my own health care. Since it is with another company, I am required to go through a "one year contestability period where all pre existing diseases and those illnesses predisposing from it are not covered.
When I was first diagnosed with diabetes, I was without any health care. Yep, it sucks since we had to pay for EVERYTHING! In the Philippines were I was raised most of my life until I got married, a national health care system is non existent (nor a government priority). But you can avail of it as a private individual shouldering its cost. (not very many individuals can afford that there). The cost depends on one’s age and pre existing conditions. Mine is costing me about $ 220 per quarter or $880 a year. It also increases yearly depending on one’s usage. The health care companies there too does not cover any medicines, equiptments, procedures, gadgets, etc. once you are already an out patient, only during confinements. As out patient though, they will cover all check ups and laboratory proceudres. So all medicines I take for my diabetes are paid for by myself including test strips and lancets. It costs me about $250-$300 a month.
I have not attempted to apply for health care yet in the US (defying my husband’s constant nagging and prodding…) Im afraid that they might deny me. Maybe in the near future.

I pay for it all myself out of pocket and I am pretty sure that I will be denied by any insurance company that I try to go with it has happened way too many times and then you just cannot get any help period . the economy in the united states is really bad and unemployment is really high . I have been out of work almost two yrs . it is terrible . My husbands insurance does not want to cover me at all and we cant afford it anyway . It costs too much and it is picky what it will cover so there you have it .

I live in the U.S. and am a private contractor (self-employed) and even though I have steady work and the ability to pay, my only option for insurance is to be covered under my husband’s plan. I joined a trade organization to try to get benefits through them and was laughed at over the phone and told there was no way they would cover a diabetic. I applied for what they call “private insurance” that my conservative friends tout as the free-market, competitive solution, filled out about 50 pages of questions and medical history and received letters back stating “We cannot cover you on the basis of: DIABETES.” It was infuriating. They did not care about my ability to pay or my good control and health.

My husband has to choose a plan with a high deductible that we have to pay - close to $1,000 (an amount that has to be met each year from your own resources before the insurance plan kicks in their portion) because I have to see specialists. Healthier Americans can pick lower cost plans from their employers if they just expected to be covered for their GP and any unforeseen emergency care. Our particular co-pay is 20% of the total for all visits, pump supplies, Rx’s, and procedures, and we pay roughly $400-500 a month, additionally, for our monthly insurance premium. In a good year (no lapses in coverage, no hospital visits), not including what we spend in paying our monthly insurance premiums, we generally spend an additional $4,000-5,000 out-of-pocket on doctor visits, pump supplies, lab fees, and prescriptions. 99% of that is me. My husband might see a GP once a year.

Also, while now, coverage for pumps is fairly ubiquitous, there was a time when you had to fight a lot harder to be approved for it because it was experimental. I am facing this battle anew now that I wear a CGMS (continuous glucose monitoring system). The insurance company considers it a costly experimental treatment and often refuses coverage, while simultaneously setting unrealistic quantity limits on test strips. It is cheaper for them, long run, to risk my complications or end-of-life needs later (when they hope I’ll be under Medicare or some other employer’s plan) than it is for them to keep me healthy now - part of the problem with employer based coverage…they hope you won’t be under them when you need something big later.

I’ve experienced 4 different versions of health care since learning I had Type I back in 1994. I was an active duty soldier then and not one thin dime came out of my pocket. On that day, I saw an LPN in my unit and gave him my symptoms. He sent me next door to see a PA-C, who in turn sent me to a GP, who then forwarded me to see an Endocrinologist who’s been treating George and Barbara Bush. All of that, plus meeting a CDE and nutirtionist within the space of 4 hours. They even had a system (way back then) where my doctor at Walter Reed Medical Center could enter a prescription in a computer and I’d pick it up on my way out of the hospital. I’ve held every instance of care up to that standard.

I was discharged from the Army 9 months later and was put into the Veterans Affairs health care system. More about that later.

A couple of years later I had private health insurance when I worked for the federal government. As a condition for having access to federal employees, insurers were not allowed to prohibit coverage for pre-existing conditions. I was quite happy with it, and the nominal copays for doctor visits and medicine of $20-25 did not seem unreasonable to me.

When I left the government and went to work in the private sector, my new insurance also covered my diabetes. After a few months, my PCP opted out and started a ‘concierge’ practice. He set it up so that patients paid $1,000 per year for unlimited coverage, including a full and very comprehensive annual exam. He limited his practice to 200 patients and guaranteed that each appointment would last not less than 30 minutes. I was completely satisfied not only with his care, but more importantly with the impression that his goal was NOT to get to the next patient as soon as possible. If I had the resources, I’d go back to him in a heartbeat. I left his care when I became too ill to work and lost my job. At that point I went back to the VA system.

In the current health care debate, Veterans Health care is held up as a model of efficiency, particularly with respect to computerized health records. My experience with them has been pretty hit or miss.

On the plus side, some of the physicians (particularly in CT and NC) are affiliated with top shelf medical schools such as Yale and Duke. They have been purely fantastic. Most are interns in training, although they are closely supervised by faculty of both. ON the other hand, some of the nursing staff and administrators are quite poor since they are not as accountable as their peers in the private sector. In addition, prescription refills can be requested online and are mailed for free. Copays are required for meds not required to treat conditions that are not associated with the disabilities identified by the VA as connected with the conditions I was discharged for.

On the negative side, there is no choice in selecting any doctors. You get who they give you. The automated record system is not as seemless as some believe. When I moved from CT to NC I thought that I’d pick up my treatment where I’d left off. Nope. In fact, I had to wait 3 months to get an appointment to review my records with an RN, and another 3 months for a PCP assignment and appointment. PCP appointments typically involve a 2 month wait, and specialist appointments take 3 months.

It is worth noting that I had a continuous glucose monitor when I had private insurance, with the insurer picking up the cost. Under the VA, they will notr cover it, nor provide any formal assistance. If I want to get back on Dexcom, I’ll have to find a private doctor to write the scrip, and pay for everything out of pocket. Given that it is life of death for me due to hypoglycemia unawareness, I have little choice.

I hope this is informative.

I should add two things:
First, in France we are responsible for physical medical records. We have them all, x-rays, scans, etc. And we take them with us to whatever doc we are seeing, They have computer records, but anything physical we have.
Second, we both worked in ‘health care’ in the US., working with businesses to provide less expensive (to them) but better health care for their employees - not less health care. We worked to set-up wellness programs, pro-active plans and alternative courses of treatment. Then the HMO’s took over and we were out of it.
I know we don’t hear all of it but I don’t understand why the US people seem to be against National Health Care. I know why the gov and insurance co. are against it…

Thanks for sharing Katie. Good to know first hand what is offered in other countries. Here in the US, I have Aetna PPO that will not cover pre-existing for 1 paid year (that means meds for and treatment and almost anything can be related to diabetes), then I pay 20% of all costs for treatments (but, at least insurers negotiated price = less than if I paid 20% of full price!). I have a cap on meds at $1,500/year and that is calculated on what would be my cost w/o insurance. I have more coverage if “in network” (only 20%) than “out of network” (40%)…this could be huge if hospitalized. I typically pay $80+ for my internist’s visit and well over $100 for my endocrinologist’s visit. I go 2x/yr to internist and 2x/yr to endo. With better insurance…I had lower copays ($20-25 a few years back) on visits and meds ($10-20) and as a result…I went 4x/yr to endo and had better coverage of testing supplies, etc. I tried to get a new pump (mine was 8 years old when it started malfunctioning) through my insurance and found out my durable equipment limit was $1000/year…so, no chance of getting. I got a pump (MM522) on Craig’s List…seems to work ok and only 1 year old…MM wants $495 to transfer the warranty. The reason I have this type of coverage is that I was downsized from a job of 12 years and to keep insurance coverage, started back to graduate school in a different field. It is the best I can get right now…continue to look for a good job/benefits to keep while going to school 9 hrs. I have had T1 since childhood…30 years…knock on wood…no complications until I get a better job!

I too, would emphasize that the new healthcare system we are wanting to envision should not copy any existing programs that are fraught w/ both inefficiencies and inadequate care. Care should be based on best practices and quality outcomes…especially in the case of chronic illnesses. This is a little more complex than creating just a payment system. Tom, thanks for sharing your insights into care in the military. My dad has also used the VA system…and in treating his Alzheimer’s…they have been subpar, but to have access to generous medication coverage and access to an excellent nursing home facility, should he need it later…you have to be their patient. We get around that by taking him to the teaching hospital docs 2x/yr and filling scripts that way:)

I don’t necessarily agree that the U.S. people are against national health care. Some in the more conservative areas are afraid of anything which smacks of “socialism” which is imho a left over of the cold war. I am definitely for national health care. I’m actually one of the lucky ones, but know that many many people are not. I have always worked for non-profits which don’t pay too well but seem to have better insurance. I have NEVER paid a premium. I do have a $500 a year deductable but office visits aren’t included in that; I pay $20 for office visits. I pay either $10 (generic) or $25 (non-generic) for three months of medications on my mail away program. (more if I get them at the pharmacy). I pay 20% of labs and I believe hospitalization; I’ve never had to use the latter but I know that could add up. I worked for a county for five years before I retired in order to receive California retirement benefits including this insurance for the rest of my life. Like I said, I consider myself lucky.

On the other side of the fence in my work in Mental Health I saw how much we were hampered by Medi-Cal (Medicaid) requirements and how managed care impacts health. I saw this as well when I used a HMO. I now use a PPO which isn’t as bad to me.

There is certainly a lot of debate in the U.S. as to what form the health care reform takes, but there is no doubt in my mind with so many people uninsured, underinsured and making decisions on healthcare vs feeding their family/paying their mortgage, that something has to give. I think it is shameful that the richest country in the world doesn’t take care of its own people.

Interesting… a neo-political argument, a.k.a “tea party” on this forum? I am still looking at the proposed National Health Care plan, and there are reasonable arguments on BOTH sides.of the debate.Mind you dears, I am not telling anyone what to write, just proceed with Caution…, This could be a Tudiabetes Landmine…
God Bless,


About government run health care in America, let me share some of my horror stories from my experiences with Veterans Affairs.

1995: I had an 8:00 Endo appointment in Brooklyn. It took me 2 hours to get there. When I arrived, there were 14 other people who also had an 8:00. Seems it was easier for them to schedule everybody a the same time, and to see them in the order they arrived. Oh, and don’t leave the waiting room because if they call your name and you are not there, they move on to the next patient and reschedule you for 6-8 weeks later. Well, at 4:30 they closed and I never saw a doctor. I mae a new appointment for the Bronx VA.

I went to Bronx VA (arrived at 5:30 a.m.) and by the time they started seeing patients, there were 9 other veterans. I did a quick inventory: 10 people, 16 legs and 3 white canes. The doctor advised me not to let my BG fall below 200 since I live alone. Thankfully, they now schedule ACTUAL times.

This Tuesday I finally went to a podiatry appointment that I’d been waiting on for the last 5 weeks. I drove 63 miles to get there. Hooray - my feet have been killing me, and I was dying to get some relief. I saw a nurse (no doctor) and in the end I found out it was to get my toenails trimmed. No exam, but it was a nice pedicure. My feet still hurt, but I now have an appointment to see a doctor - in September.

Last month I had a consult to see a CDE at Duke University. She was great and taught me new tips about making my pump work better. I told her I was having trouble with passing out, and she sent me across the street to the VA Emergency Room. After checking in, I was told that if it was an emergency, I should go to the Fayetteville medical center, and not the one in Durham (where I was). Stupid me - I did what I was told, and walked across the street instead of driving 85 miles to Fayetteville. Anyway, I had to beg to be seen. I got an intern (his first week on the job). He said that I should be hooked up to an event monitor, and to get one at their EKG clinic. I went there, and found out they would not do that until after I’d seen a cardiologist. Fine. That appointment is at the end of September, and until then the problem is the same.

Another time I was hospitalized in CT. The nurse came by to give me a shot of insulin before dinner. She hadn’t yet checked my BG, but was going to give me the shot anyway. I asked how many carbs were in the meal - she had no idea. I asked if she could find out before giving me the shot. She said she’d call the nutirtionist from the kitchen. When she came by, I asked the same question, and she said simply “you are getting the diabetes meal.” I asked how many carbs, and she didn’t know. After all that, I gave up, took the shot, ate dinner and naturally had a nasty low. After all that, I found out later that the nurse labeled me as “uncooperative” in my electronic medical record.

Oh, and one other thing: it is free (and I appreciate that). But as the old saying goes, if something is free, you get what you pay for.

I forgot the most important thing: the bureaucracy. When I first applied to get health care benefits for the diabetes that caused my discharge in 1994, it took 3 1/2 months for them to issue a decision. In VA terms, that is warp speed.

About 2 years ago, I repeated that claim process to get the complications that have come up since then. I am still waiting for a decision. But for the last 9 months, I’ve been told every time I ask that the decision will be done in another couple of days.

Oh, and if you don’t like a VA decision, you can always appeal. Hooray, you say? Not so fast. Currently, the average time from when you submit an appeal until the decision is finalized is FIVE (5) YEARS.

So before you start thinking that Government health care will help you to live a healthier and more stress free life, think again. And start getting used to the idea of paying for your CGM, since the governemtn still considers them to be “experimental.”

I do not recall giving a viewpoint as to pro or con , sweetie. I said I was considering both sides of the National Health Care debate. Check my post, kind sir. I am not advocating neutrality, just pro-active rather than reactive discussions. That’s all.

God Bless

Here in the right wing part of Canada. I get an Endo and ophtalmologist visit paid for each year. And a few GP (family doctor) free per year. Drugs and dental work we were kidded off Blue cross by doubling of our premiums so about $7000.00 per year out of pocket for my wife and I. She does not take any pills but needs hearing aids occaisionnally. So far so good we can afford this. We may get a very small income tax reduction from this expenditure.

I’m American, so my insurance is through my employer. I have had employer-based insurance for the last several years, and I now owe tens of thousands of dollars in medical bills because of it. I’m not sure how much my insurance covers. Not a lot. Or maybe they cover 80% and my doctors just charge a lot. No clue.

I think we know each other well enough to freely express differing opinions when it comes to hot political topics like health care reform. We after all come together over only one thing, being diabetics, and represent widely ranging demographics other than that. Strong feelings of all kinds are understandable. What I am a bit uncomfortable with is when someone says “The American people feels this way” when I, as an American person, and many other American people I know clearly do not feel that way. Perhaps what would work best is if we each speak for ourselves.

Here in the UK the state (read: National Health Service, commonly referred to as NHS) pays for ALL my medical care. In fact, all medical care for all citizens is free at the point of delivery. All my prescriptions are free too (diabetics are holders of what are known as “medical exemption certificates” and this includes medication unrelated to diabetes). Diabetics also get free check-ups with high street opticians, but we have to pay for any new lenses and frames. The only other thing we have to pay for is dental treatment. The majority of people (including non-diabetics) don’t take out private insurance for eye/teeth check-ups – in fact, the majority of people don’t have private health insurance full stop.

The NHS came into being on 5 July 1948, so we’ve had it for six decades. A measure of how significant the NHS is in the UK is reflected in what Nigel Lawson, a Chancellor under the Thatcher government, said when he made the comment that the NHS is the closest thing to religion in Britain. I think that if any government were to propose dismantling it, there would be revolution.

What puzzles me about some of the entries in this post is the fear of a socialised health care system. Since when was the UK a hotbed of socialism with reds under the bed, because that’s what this bizarre fear boils down to? Don’t get me wrong, our system is far from “perfect”, but it would seem that neither is your insurance-based set-up.

I nod vigorously in agreement. Embrace socialism!

Not only is there a strong anti-socialism sentiment, but nothing proposed up to this point is even close to the socialism I would actually, in theory, support. Government extending help to the poorest, sickest, and oldest and leaving the wealthier, working, and healthy under a private run system is so far from socialism. People are calling those who would see the pre-existing condition clause obliterated “Nazis.” I think we’ve officially jumped the shark here in the states.

Many Americans often complain about the post office and the department of motor vehicles and compare healthcare to those programs, but they rarely seem bothered by the fact that our fire departments, police departments, public school systems, state university systems, and interstate highways are all operating under a government-state-city-funded system. My father is a firefighter and a paramedic. He performs first aid and rescues homes and people from fires and accidents regardless of their ability to pay or the insurance they hold on their property. If it were suggested here that, unless you had fire insurance and paid hefty premiums, the fire department would let you burn, people would be outraged.