Anyone beside me having issues with the Cleveland Clinic? Cancelling my surgery

[carolinemc]

Reading the experiences of US posters here, what strikes me is the massive administration burden placed on hospitals and patients. Fighting to get every test and procedure approved for insurance coverage prior to, must be frustrating and exhausting.

I live on the West coast of Canada and we don’t have that hurdle, if your doctor says it is medically needed, you get it. If It Isn’t emergent you may wait longer than you want, the system is by no means perfect, but my experience is you get what you need. And you are not billed for anything in hospital. Maybe a TV in some hospitals lol. Surgery is stressful enough with out worrying that it will bankrupt you so I am grateful. There still be some costs, drug Coverage is means tested (a Higher income means an higher deductible for drugs but most of us have a plan for that through our jobs)and peri medical like massage and physio are not always covered.

One of the draw backs is less choice to pick your Hospital or doctor. You are pretty much stuck in your home province as each province administers their own health care, though all must provide care to the same general standard. I live just over an hour from one of the best heart hospitals in the country, so for me it wasn’t a problem. If I had wanted to have surgery in a different hospital, I think my cardio would have obliged by referring me there, but I would have had to travel and maybe wait longer.

I think it’s also more challenging in smaller and remote communities to get quality care and needed diagnostics. Canada is a large country with a small population it can be challenging to service remote areas to the same standard.

A question for American folks; is the CC really that much better, or is it hype and marketing? There must be tones of other great hospitals and surgeons in the country? Though if I lived in Arkansas, given their ranking, I would also be concerned.

Our system faces challenges for sure and it’s never prefect and it does result in higher taxes. I can see Americans have more choice and may not wait as long as Canadians, but on balance I wouldn’t trade you. I just can’t imagine having to make health care decisions for my family based on finances Instead of need.

To let you know we do not live in Providences, we live in Cities and States. And we are not stuck in our cities or states to get medical care. Some of us are able to travel to where there is better medical facilities. It is just medical insurance in America limits the coverage at certain facilities and where we can go for better care. It is harder when we are at the mercy of the Health Insurance big wigs. They control wat can be covered and where.

 

[erricojj]

Reading the experiences of US posters here, what strikes me is the massive administration burden placed on hospitals and patients. Fighting to get every test and procedure approved for insurance coverage prior to, must be frustrating and exhausting.

I live on the West coast of Canada and we don’t have that hurdle, if your doctor says it is medically needed, you get it. If It Isn’t emergent you may wait longer than you want, the system is by no means perfect, but my experience is you get what you need. And you are not billed for anything in hospital. Maybe a TV in some hospitals lol. Surgery is stressful enough with out worrying that it will bankrupt you so I am grateful. There still be some costs, drug Coverage is means tested (a Higher income means an higher deductible for drugs but most of us have a plan for that through our jobs)and peri medical like massage and physio are not always covered.

One of the draw backs is less choice to pick your Hospital or doctor. You are pretty much stuck in your home province as each province administers their own health care, though all must provide care to the same general standard. I live just over an hour from one of the best heart hospitals in the country, so for me it wasn’t a problem. If I had wanted to have surgery in a different hospital, I think my cardio would have obliged by referring me there, but I would have had to travel and maybe wait longer.

I think it’s also more challenging in smaller and remote communities to get quality care and needed diagnostics. Canada is a large country with a small population it can be challenging to service remote areas to the same standard.

A question for American folks; is the CC really that much better, or is it hype and marketing? There must be tones of other great hospitals and surgeons in the country? Though if I lived in Arkansas, given their ranking, I would also be concerned.

Our system faces challenges for sure and it’s never prefect and it does result in higher taxes. I can see Americans have more choice and may not wait as long as Canadians, but on balance I wouldn’t trade you. I just can’t imagine having to make health care decisions for my family based on finances Instead of need.

There's more choice here because there's more competition. Where there's competition, there's more availability, innovation, and incentive for quality. Marketing and "hype" are just an indication that competition is taking place.

IMO, in most cases where government controls the supply chain, quality and availability suffer. I prefer to have my healthcare provided by a free enterprise system as opposed to a socialized one. Nonetheless, we don't have a pure free market here in the U.S. since it is a highly regulated industry, but many of the principles of free choice still prevail.

My story is an example. Once my cardio determined that I had a BAV, he stepped up my echocardiograms to 6 months frequency. The time elapsed from when the echo which showed that I had entered the "severe" phase to the date of my SAVR was 61 days. I had no symptoms and no damage. I was able to move quickly along the path of testing and consultations with my providers before the surgery. Yet, it was not a "rush job" and I had ample opportunity to ask questions and consider alternatives where possible. Had I been a subject of a socialized healthcare system, I doubt that would have happened.

We agree on at least one thing...I wouldn't trade with you either.

I wish you good fortune and continued satisfaction with your country's chosen system.

 

[Lynn]

was able to move quickly along the path of testing and consultations with my providers before the surgery. Yet, it was not a "rush job" and I had ample opportunity to ask questions and consider alternatives where possible. Had I been a subject of a socialized healthcare system, I doubt that would have happened.

In fact, it does happen, my family has never not gotten what they need. Once diagnosed with severe AS my surgery was completed within a couple of months. Excellent surgeon, excellent facility, very timely care. I had complete choice in the type of valve, and the surgical team went to great length to make sure my questions were answered and I had the info I needed to make my choice. So it sounds like we had similar experiences despite our divergent systems.

I disagree with The idea that only free enterprise results in good care. Public or private. Either system is capable of delivering both good and bad care. Having spent my life working in the “free enterprise system” for large corporations, I can tell you that the idea that corporations always do everything better than governments does not hold water. Every time I have to deal with my cell phone provider, my bank, my automobile dealership, every time I go to the supermarket I am reminded of that. Every time I submit a claim to my private plan that covers prescriptions and dental I am glad they are not making my most important health care decisions.

Is there room for improvement in the Canadian system, absolutely! Does a public system have its challenges, yes it does. Does a private system have its challenges, yes it does. I believe In ”free enterprise” however, I also believe every society must decided what aspects are to important to be left to the private sector alone. Capitalism works, unfettered capitalism, in a very short time, begins to resemble feudalism . But that’s propabably a different discussion lol.

I can see the advantages of the US system, particularly for folks with unlimited resources or top of the line insurance, so I am glad it works for you. In Canada the system has many ”private enterprise“ element, so the idea that the government controls the entire system is somewhat misleading,. But yes, it is “single payer” so we are not dealing with different insurance providers for primary care.

Worth a read is this detail article in the New York Times dealing with the consolidation in US Health Care.

https://www.nytimes.com/2023/05/08/health/primary-care-doctors-consolidation.html
A couple of quotes: “Many doctors say they are becoming mere employees. “We’ve seen this loss of autonomy”

“Envision exercises profound and pervasive direct and indirect control and/or influence over physicians practice of medicine,”

“You don’t become a physician to spend an average of seven minutes with a patient,”

 

[atlantadoug]

My ins. denied coverage. CC did an urgent peer-to-peer appeal. CC called when the urgent appeal was to be completed, said it was denied and ins. co. won’t respond again until 11/2, surgery is 10/24. So we’re in the 2nd level of appeals. CC said my case was submitted to the powers that be and they would go ahead and do surgery and deal with the ins. on the backend. CC also said that they were going to except what the ins. pays and I only need to pay $275 and I wouldn’t be liable for anything else. Said they were a non-profit and this is what we do to assist when needed.

It didn’t seem right, I was very doubtful. I talked to the drs. office the next day about the surgery being off. The assistant had the managing NP call stating the same thing about the limited charges to me.

So thing are moving along and I start to hear little tidbits of info. from various people that conflict with what I’ve been told regarding coverage and that the urgent appeal was never filed.

I’m supposed to fly to CC this Sat. Yesterday I received 14 requests for info for pre-op tests and these requests include payments I’m to make before testing. There’s also a doc. to sign that says I will be 100% liable if ins. denies coverage or any and all amounts that ins. doesn’t pay. This was not what I was told.

I just received a partial estimate for surgery, $278,840, that doesn’t include the anesthesiologist, any other drs. or personal involved.

I asked for additional estimates. I received a partial again of $21,000 for some of the pre-op. On the hospital stay I was told, “we don’t do estimates on that because we don’t know what the charges will be”. Huh, CC doesn’t know how much they charge for rooms in their own hospitals? I did see on their site that ICU and cardiac rooms are $6,200 a day. 5 days would be another $32,000 plus I would assume much greater charges for all that goes along with that.

Today 2 different people read to me the original agreement that I mentioned at the start. When I asked for a copy, one kept saying no, and the other said it was illegal! When did it become illegal to document the terms of an agreement between parties?!

Known charges are $330,000, my guesstimate is charges may be $450,000. (10 yrs ago I had a craniotomy at the Mayo Clinic for a leaking brain aneurysm that was $100,000. That’s a 35% increase every year to get to $450,000.)

Kinda feels like bait and switch. So, at this late date I now have no protection if the ins. continues to deny coverage. The CC could decide not to proceed with challenging some or all of the denials. Then it all falls on me.

The CC didn’t follow through on the ins. appeal in the past… they may not in the future when they have another funding source…me. Lost my trust in the CC, I’m going to cancel my surgery.

That's unfortunate. You experience is clearly not common. CC is known as the finest heart felicity in the world. They did me right 11 years ago. Best of luck yo you Karen.