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Woman skips mammogram because she cannot afford it and insce company refuses coverage. Breast cancer survivor. Doctor ordered. [cbsnews.com]cancer-survivor-fights-with-insurance-company-over-annual-diagnostic-mammograms/

ToolGuy 9 Dec 4
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Just becsuse the Dr orders something doesnt make it right. Im not about to claim im a breast cancer expert, but i have known several other cancer survivors and all their surveillance imaging was CT or PET. Why should the insurance be on the hook if the dr is ordering unneded tests?

@ToolGuy a little of all three. The insurance companies have drs too, and they arent quacks. Theres also tons of regulations they have follow, including very detailed standards of care they have to follow. That doesnt mean bad things don't happen, but out of about 275k new breast CA cases per year, and a high survival rate, there a millions of women getting the follow up care they want/ the care ordered by their Drs. Some media warrior finding a couple women with sob stories for xmas, hardly counts as evidence of anything. Its completely possible their drs are not doing their jobs, just as it is an indictment of insurance companies not wanting to pay for crappy care. We don't know, were just being fed soup by the media.

@ToolGuy yes i have. An6 follow up is much more frequent than every 5 years. My point is that the diagnostic mammogram may not be the right test. Maybe she needs something else, or her dr doesnt know how to explain him herself. Theres no reason to assume this is obviously a case of insurance company abuse

@ToolGuy you gave an example of something that heppens millions of times a year (follow up care for breast CA) and how it went wrong for a couple people. Your surmised the mechanism and the cause, with no evidence, made some always statements about a system you have no experience with, based on click bait propaganda thats designed to inflame. You completely lack credibility here.

@ToolGuy I'm attacking your ignorance. Not understanding decision making, cost control, risk management, resource allocation, and payor/payee relationships is what's killing US healthcare now. The primary decision makers are bureaucrats and politicians, not health care experts. People who read articles about statistically insignificant events and use that to espouse for their political platform, are hindering the change we ultimately need.

There are some huge commonalities between the US and Canada. I'm sure you know plenty of people who have had frustrating or unfair experiences there too. One advantage Canada has is that the Drs themselves have far fewer choices and a more formalized payor/payee process, so it's much harder for them to "do it wrong". The US process is by nature adversarial, plus theres always a way for the hospital or clinic to turn around and bill the patient (which doesnt happen in Canada?). If the woman got an unneeded or incorrect test (say she needed an MRI not a mammogram) in Canada the patient wouldn't get billed. In the Us they might. Neither if those things are an indictment of insurance companies. You're jousting at windmills.

So in a sense I am defending them. The govt here has allowed costs to spiral out of control, rebuffed attempt after attempt to regulate big pharma, and doubled down on the employer employee taxation system to the point that our health care sector has simply become too big to fail. Insurers have tried to control costs, even though the publicity is horrible. Trying to mandate medical evidence, not using the latest expensive drug, limiting the advertising power of large hospital systems, promoting value based reimbursement.. to do those things, insurers need to put limits on the way drs practice, and on the things patients feel they deserve. Its ugly, but all those things are part of daily life for all nationalized systems. In the US we have the odd case if a private sector who performs functions the govt should be performing, a health care industry that is all about payment or write offs (bankrupt the patient). Ita not fair to blame the insurance industry to for that, nor is it fair to base opinions about political reform on your experiences with a fundamentally different systeem.

I'm writing this in the dark kn a train, sorrybif it's full of typos

@ToolGuy that has nothing to do with insurance companies in the US or the article you posted. Good update overall, though

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"Diagnostic" procedures are commonly used by insurance companies in the U.S. to get out of paying. I haven't had cancer, and I get my annual exam and mammogram in my doctor's office, but last year he saw a spot on the films he wanted another look at, so he sent me to an imaging center. My insurer concluded these were now "diagnostic" instead of"preventative" mammograms, and not covered the same, so I paid a lot out of pocket for them. It's a criminal system.

Damned if you do, damned if you don't (get the tests).....

@TomMcGiverin

Pretty much so. 😊

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Yup, the good ole US healthcare system. Either they bleed you dry financially and then you die, or you are too poor to begin with to afford healthcare, so you get to die sooner...

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Mammogram found mine while still at stage one. It was so deep it would have killed me before being felt in a lump. We paid nothing more than our Blue Cross coverage, & I had 5 years of pills after mastectomy, & chemo, & we were out of pocket for none of it.

@ToolGuy Just part of it. I have diagnostic mammos every year now, & do not pay. Its been more than 14 years.

@ToolGuy Yes, I did see the $900 & that is an outrage. We're not perfect, but I'll take our medical coverage over them any day.

@ToolGuy The US.

@ToolGuy No, I knew it was the US, I know what CBS is!

Why do you think I'd say I like OUR medical even though its not perfect? I'm not that well educated, but I didn't think my English was that bad.

@ToolGuy Yup, born here, parents born here.

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