Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Need Info On Heart Related Issues With AS

Well, I have congestive heart failure which is pretty much just a nice way of saying when you retain water you have to take lasix to keep it off or it will start building up and it HAS to be taken off.

A couple of years ago I have been thru most tests from an ultrasound which showed I do have a thickness on 1 valve that causes pooling of blood at the bottom of my heart but was also told that this is not common but not that un-common.

I have about 70% usage of my lungs so I know that is also an issue but I do believe that something is going on...just not sure what..but in talking to different people about our stupid insurance (BCBS & Medicare) and our wonderful $5000.00 deductible and then Medicare it seems has like a $1000.00 deductible so it would basically cost me $6000.00 at this point to walk into the hospital and that's just not an option right now...so I just have to hope it isn't something serious.

$6000 is just shocking to read. This is where the Canadian system looks good and actually works well - you'd be admitted no questions asked for a heart problem. I worry about you Lisa. In a couple of years, your CHF might have changed... might need an increase in lasix or something... I really, really hope you find a way to get re-assessed. Sorry if I'm asking dumb questions, but is there a GP you could see rather than going to the ER? Can you deny a hospital admission, but do tests on an outpatient basis to avoid the big charges? Just thinking out loud.
I'm praying you're ok.

That explains why you're so cold-hearted to poor Miggins. Maybe you need a new battery.

Hi My Sunshine,

Already thought of that and it works the same way, say if a test was $1500.00 then that would be $1500.00 towards the $5000.00 deductible...it would be soooo easy just to go BUT someone has to pay for it and you know who that is and you know how that goes...so you see where I am.

Yes, my family is not happy with me but I imagine they will get over that also...

Right now I am just taking it an hour at a time and honestly hoping for the best, I guess we know what the alternative is..lol sometimes not sure that wouldn't just be a blessing!

I hope you are getting some rest.

Hugs,

Lisa

Lisa, you have to pay $1100 for days 1 - 60 with Medicare and your insurance picks up and pays on the difference after your deductible. Do you have a different deductible for hospitalization than office calls? $5000 is a lot of money. It is a blessing to have though in case of a catastrophe. I think that is what they call catastrophic coverage.

We are blessed with our insurance.....at least this year! Who knows where it is going year to year.

Whatever the cost, Lisa, if your heart is bothering you, you know you have to take care of it. That is nothing to mess with. I don't care if you pay them $10.00 per month.

Love you. You take care of yourself.

Possi

wow I can't believe it costs so much. I realy feel for you.
I am so lucky here it costs me nothing to go to the hospital for tests. I did go private for the cardiologist last year and including tests I cost me about $3000 but I got about $2000 back from the government so at the end of the day not too bad. I could have gone public and it would have cost me nothing but a little longer wait.

Huge hugs to everyone who has to pay so much. What a worry that must be.

Lisa, this will not help you right now with your current health situation. (... and I agree with the others, please get your heart checked out now - regardless of cost - the hospital will not turn you away.) This may sound like an odd question, but what benefit are you getting by having multiple insurance plans? It actually sounds like this is working against you instead of for you.

It sounds like you have family catastrophic coverage (BCBS) plus secondary Medicare for you due to disability. Your family coverage is currently acting as primary. Does it have to? I assume that this is group coverage through a large group health plan (LGHP) through your husband's employer. By law, you can reject the LGHP coverage for yourself, while your husband continues to carry coverage for himself and the children. http://www.ssdcservices.com/uploadedFiles/Shared_Content/Related_Links/OBRA%2093%20Regulation.pdf If you reject this coverage, Medicare would then become primary. (And you might save some money in premiums - some employers have different premiums for employee/spouse/children coverage then they do for employee/children coverage.)

With Medicare as primary, you would be subject to Medicare rules and restrictions, but would also only be responsible for the Medicare deductible / copay. Usually it is beneficial to have a private or group health plan as primary to Medicare because group health plan benefits are usually superior. However, your deductible is so high, that in this case it does not appear to benefit you. You may find that some of your doctors do not participate in Medicare (when it is primary), necessitating a change of physicians. But if you are not seeing them now anyway because of high deductibles, does it matter?

Generally, Large Group Health Plans only allow you to make a change in coverage during open enrollment periods. You should find out when this open enrollment is for your plan and carefully examine the insurance options offered. You need to compare total cost (premiums from paycheck and/or Social Security check, plus annual deductible(s), plus a reasonable estimate for copays) vs total benefits received. You may be surprised.

Something else occurred to me that may be of benefit to you now. Did you mention that you were part Native American, or am I remembering someone else? If you qualify as Native American, you should be eligible for Indian Health Services. http://www.coverageforall.org/pdf/matrix/OK_Matrix.pdf I have no idea what is available in your immediate area, but it might be worth while to travel a short distance to receive care.

Best of luck ... and please get your heart checked out.

Please don't take this as criticism as it is not intended to be. I am just clarifying a point.

You would also be admitted immediately into an American hospital for a suspected heart problem. You would receive the best of care and all necessary tests. You would not be placed on a months or years long waiting list for tests or procedures (other then highly specialized things like heart transplants, etc). After the bills are submitted to insurance and paid by them, you would then receive a bill for your portion. If you legitimately can not pay the bill, almost all major hospitals have charity care programs, grants, bill waivers or billing options available.

When things are urgent, Stormy, there are no delays here either. My mother was admitted at Christmas a couple of years ago for suspected heart problems. She was kept in and all necessary tests were done immediately. Luckily all was well so she was only in for a few days. There were no bills to pay.

Waiting lists are typical for non-urgent procedures and then the waits vary from province to province. To see a rheumy, my wait time has been between one and two months. I waited a similar amount of time for a non-urgent endoscopy. There were no bills to pay.

When my husband injured his eye, he was seen immediately, first by our GP and then sent to the specialist who fitted him in on the same day. He was then seen daily for almost three weeks by specialists who worked to save his eyesight. There were no bills to pay.

When I broke my leg in 1996, I was admitted to hospital immediately for surgery to repair it. Eighteen months later I went back in to have the plates and screws removed. There were no bills to pay.

I've had other non-urgent surgeries over the last ten years. The wait time was typically about six to eight weeks. There were no bills to pay.

This is just a clarification from personal experience.

I guess I should clarify.. In Lisa's situation, it would be better if she was in Canada with a questionable heart problem that landed her in the ER. An acute heart problem wouldn't put you on waitlists for anything here. Like you said, the best of care, etc. My dad nearly died in an accident 2 years ago, and they had to air evac him to a major centre, do tons of tests, surgery, rehab, the works. No waits. No bills either. It was one less thing to worry about in a very stressful time.

*All I meant was that she wouldn't have to be worried about deductibles and such. No bills here. That's not even a thought.*

I get the feeling if Lisa was covered by all the other hospital charity programs or grants, she woudn't have the massive hospital bills hanging over her head right now. Sucks when you make just a little too much to qualify for those things, and barely enough to pay off your bills.

But trust me, I don't want to start a big discussion on comparing systems here, there are pros and cons to both. (RIght now I think my move to the US will benefit me in this department.) Don't get me started on how the Canadian system treats CHRONIC problems - I just got dumped by another doctor here. Seriously. He showed me the door and said he didn't know, and wasn't about to take the time for figure it out. NICE. I can't get in to see anyone else. Dead end. I'm just supposed to take loads of morphine and live in a dark room for the rest of my life. Sounds like great fun. This is where the US system is much better - less wait times to see doctors, you can choose who you want to see, outpatient tests get done sooner, etc.

Anyway, the point is I hope Lisa is going to be ok..... worried....