Health Care/and hurt child | Arthritis Information

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It's hard to believe that a health group, gets to tell you, what is an emergency.  You have to get  their permission to go to an ER or you have to pay 100%.  I can see on colds and the likes, that some go for...but a real emergency,  how can a scare parent of a child, that has falling and they can't wake him up, not be an amergency?  With Obama's plan it will get worse ( but then again I didn't get to shake his hand)  There is no way that a nation that is already in trouble, going to get enough money to give health care to everyone.  The money is not there and more and more people are losing thier jobs which makes less money and more needy people.  where are they going to cut next? Where is the money coming from?  I may be wrong, wouldn't be the first time.

 
Now for why I'm typing this.  My great-grandson fell off the bleachers at the church ball game, about 4 1/2 feet down on cement, landing head first.  he was crying, she took him to bathroom, where he started throwing up and fell over,  they rush him to ER, they found out if they didn't get an ok from their med. group that they would have to pay.   they took care of him,  just warm the parents.  The father spent about 20 mins. on the phone, they put him on hold,  he got the ok.  But why should a father have to stand and wait on the phone, instead of being with his son.  His insurance group is 38 miles away in the city.  they have to go there for any kind of medial care and then it's very poor care.  Most doctors around here are joining groups because of the high price of office space and insurance.
 
Little Trent is going to be alright, thank God.  He has a bruise brain, large bruise on back of head and a concusion.  He's only 3,  very active, mother was right behind him,  he fell between the foot rest and the seat.   Very scary night, we were down there most of night.
rusty2009-08-25 12:32:51 [QUOTE=rusty]
 
I hope he feels better really soon.
Oh my goodness!! I'm so glad Trent is ok!! I can only imagine the fear that came with it. Give him lots of hugs and kisses for me. It tears me up when kids get hurt like that. Is he just on bed rest with meds or do they want you to keep waking him up every hour? Poor baby. I'm so sorry your family had to go through this.
 
As for the insurance - yikes! What company are they going through that requires prior approval for emergency situations?? It's an EMERGENCY!!! 
I would check to see if this is something the insurance company imposed themselves or if it is something the employer requested. A lot of times the insurance company only adminsters the benefits and it's the employer who chooses how/what/when/where/why. Either way, it may be time to switch.
 
thanks for replys.  they were told that the cat scan come back good, so they didn't need to worry, to bring him back if he started throwing up again or couldn't stand or walk or acted funny.
They have Kaiser insurance, thur this enployment.  They have to drive all the way to Roseville to even get a presription filled.  I think now that its over,  Im letting my feeling come out.   My husband and I worked most of our lives and pay insurance and took care of our children.  Our children and grandchildren do the same.  We got enough money to get by on and a little left over,  now with the high cost of living we just get by.  we have medicare and i had to fight hard to get extra help from state when we could  no longer make it.
With a California med-cal card, I can go to any ER or any Doctor that takes medicare.  I have more choices them the working people.  The working people paid the price and that will never change.   Its just not right.
rusty2009-08-25 13:17:43most insurance policies have emergency rules.  If possible you should get advanced permission but in the case of an acute emergency they have something like 24-48 hours to get the authorization.  Everyone needs to understand the rules of their insurance companies. 
 
The parents should have called an ambulance..head injuries that involve vomiting is a true emergency and the child should have had monitoring on the trip to the hospital but I am glad he is doingbetter now
[QUOTE=buckeye]most insurance policies have emergency rules.  If possible you should get advanced permission but in the case of an acute emergency they have something like 24-48 hours to get the authorization.  Everyone needs to understand the rules of their insurance companies.  [QUOTE=rusty]It's hard to believe that a health group, gets to tell you, what is an emergency.  You have to get  their permission to go to an ER or you have to pay 100%.  I can see on colds and the likes, that some go for...but a real emergency,  how can a scare parent of a child, that has falling and they can't wake him up, not be an amergency?  With Obama's plan it will get worse ( but then again I didn't get to shake his hand)  There is no way that a nation that is already in trouble, going to get enough money to give health care to everyone.  The money is not there and more and more people are losing thier jobs which makes less money and more needy people.  where are they going to cut next? Where is the money coming from?  I may be wrong, wouldn't be the first time.
 
[/QUOTE]
 
I'm just so glad we don't have to worry about anything like this.  We can go to the ER whenever we feel the need.  I'm sorry this happened to your great grandson and glad he's going to be ok!

Whew, what a frightening thing to happen.  I really feel for you guys.  So glad he turned out okay.  Bleachers have always scared me, for just that reason!

I'm  just glad he's alright. 
I just can't see why something like that would have to have advaned permission, what parent is thinking  about calling an isureance co.  They paid for it. it should be there when needed.  the insurance has 24/7 phone service.  My daugther works for one. she said they would have to paid it, when it is life or dead. 
rusty2009-08-25 17:38:33I am so sorry to hear this.  I have a 3 year old also and things can happen so quickly even when you are standing right there.  Bleachers are so dangerous, I live right next to our high school football field and whenever we are at a game I am so nervous because they are so dangerous.  I am so glad that your little guy is ok, I hope you and his parents are ok as well.  I'm glad the little guy is okay.  Accidents can happen so quickly.  My family had a similar scare, not quite as bad, but my grandnephew had a bike accident and had to go to ER for stitches.  Luckily, the ER doc was a Dad of 3 boys, so he was very good with my grandnephew, so it wasn't very traumatic for him.

So you are in California.  So am I.  I'm familiar with Kaiser, I had that insurance at one time and I have several friends and relatives that currently have it -- they have been treated for cancer, heart disease, and have been very satisfied with the care.  It is an HMO system, so you have to see their docs, go to their labs and hospital (ER), get prescriptions from their pharmacy.  Many people choose this insurance plan because premiums and copays are more affordable than a PPO.  For people that live in the cities where Kaiser facilities are located, restriction to these medical facilities/services isn't too much of a problem because Kaiser has several satellite offices and in my area, has 3 hospital centers.  For people though, that live in rural areas, especially in the case of emergencies, this may pose some problems. 

I would suggest getting more familiar with Kaiser's out-of-network policy, so that should a situtation like this occur again, you don't have the stress of figuring out Kaiser's rules at a time when one needs to be with their family member.   Reading/understanding one's health insurance policy booklet is not fun, can be a headache, but these days, with the cost of health care, we need to be aware of what our plans cover and what their rules/requirements are, to avoid the surprise of being billed for something we thought was covered.

Good to hear Trent's ct scan was okay, and hope he recovers quickly from his fall, and his family too.  [QUOTE=Joie]I'm glad the little guy is okay.  Accidents can happen so quickly.  My family had a similar scare, not quite as bad, but my grandnephew had a bike accident and had to go to ER for stitches.  Luckily, the ER doc was a Dad of 3 boys, so he was very good with my grandnephew, so it wasn't very traumatic for him.

So you are in California.  So am I.  I'm familiar with Kaiser, I had that insurance at one time and I have several friends and relatives that currently have it -- they have been treated for cancer, heart disease, and have been very satisfied with the care.  It is an HMO system, so you have to see their docs, go to their labs and hospital (ER), get prescriptions from their pharmacy.  Many people choose this insurance plan because premiums and copays are more affordable than a PPO.  For people that live in the cities where Kaiser facilities are located, restriction to these medical facilities/services isn't too much of a problem because Kaiser has several satellite offices and in my area, has 3 hospital centers.  For people though, that live in rural areas, especially in the case of emergencies, this may pose some problems. 

I would suggest getting more familiar with Kaiser's out-of-network policy, so that should a situtation like this occur again, you don't have the stress of figuring out Kaiser's rules at a time when one needs to be with their family member.   Reading/understanding one's health insurance policy booklet is not fun, can be a headache, but these days, with the cost of health care, we need to be aware of what our plans cover and what their rules/requirements are, to avoid the surprise of being billed for something we thought was covered.

Good to hear Trent's ct scan was okay, and hope he recovers quickly from his fall, and his family too.  [/QUOTE]

My experience with HMO's - even those with very restrictive network policies - is that in life/limb-threatening emergency it doesn't matter if you go to (or are taken to) an out-of-network hospital.  It's covered at the same rate.  I used to work for a California-based company.  Our california-based associates had a Kaiser HMO option and those were the "rules."
[QUOTE=JasmineRain]
 
My experience with HMO's - even those with very restrictive network policies - is that in life/limb-threatening emergency it doesn't matter if you go to (or are taken to) an out-of-network hospital.  It's covered at the same rate.  I used to work for a California-based company.  Our california-based associates had a Kaiser HMO option and those were the "rules."
[/QUOTE]

You are right, and I would think the insurance booklet would indicate that.

I think this hospital would have treated Trent regardless, but I think they were informing the parents that should their insurance not cover treatment, they would be billed for it  -- but given the nature of the injury, it was an emergency and therefore would be covered.

I have insurance, but everytime I go to a new doctor, I have to sign a form saying I'm responsible for costs my insurance doesn't cover, but most of the time my insurance covers most of the expense, except for my copays.

The fall of this little boy was very stressful for the family, and I'm sure this additional stress about having to deal with insurance matters at such a time added to their stress.  I feel very badly for them.  I have been in hospital emergency situations with family members and its not a time when you want to worry about one's insurance.
 

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