WHAT IS WRONG WITH OUR MEDICAL SYSTEM

So ive been flaring for the last couple months, pred isnt working, i just got a new doc THAT IS AWESOME cause i moved to a new city, my new doc did colonoscopy last tuesday and even before that procedure he had made up his mind he wanted me on remicade, im extremely sick right now and i have to wait for medical insurance to go through before i can get medicine that could quite possibly start to heal me within a few days or atleast make my qulity of life better........AND I HAVE TO WAIT????? what is wrong with our medical system!!!!!!! nobody should have to wait at home and suffer when the meds are available and there is no question i need remicade, ive been on alll the other drugs over the past 12 years!!!!! i live in Canada too!!!!

I live in the US and am concerned, with our health care changing to what you have, that folks like us with chronic illness will suffer the same fate. I saw my GI and the same week I was in with an infusion for Remicade...at that time it was still experimental for UC.
Now I did pay 10% ($750 at that time; the cost has come way down since) of the costs. I understand that Canada and UK folks get everything for "free" (or government funded through tax dollars) is that right?

yeah, it sucks. When I started Remicade, I was told it usually takes 3-4 days for approval, but for some reason I had to wait 3-4 weeks.

Not quite the way it works in Canada, some things are not covered by our insurance, especially newer expensive drugs and our insurance is seperate from our "health care system" as well, we don't pay to see docs out of our pockets and the insurance companies don't have anything to do with paying docs either, our health care system covers paying docs that we see, so we can see any docs and all the docs we want, but there are some limitations through out health care system as well, for example a person is only covered to have one "physical" a yr, if you have more than one "physical" then the health care system may not cover it (and since I've never had more than one a yr I don't know what actually happens (who pays for it or how) if you do).



Overall it is a better system compared to the US, we don't actually pay for any surgeries unless they're cosmetic and you've 18yrs old or older. Our dental and eye care is covered strictly through our insurance (if you have it either through your job, spouses job or under Blue cross) and that is also payed for by you independantly. For example my hubby pays 40.00 each pay cheque for his insurance and that insurance covers 80% of RX (remicade might not be covered at all, I've never checked, or it might only be partially covered, but likely less than the standard 80%, and eye RX only cover 300.00 per person per every 2 yrs for adults, and every yr for dependants (kids). If you go over the covered amount then you have to pay the extra out of pocket...same with the dentist, nothing cosmetic is covered (except for braces for kids but they only pay 2500.00 per life-time for each kid and braces usually rung between 4 thousand and higher, so it helps some but it's not all free.



So it's not a perfect system and it is very unafordable for many even if they have insurance but it's better than some other systems.



:)

I also should have mentioned that it varies from province to province as well (I'm sure this includes insurance either private, like Alberta Blue cross or through one's job)...For example, we live in Alberta and my son (16yrs old) has the option of getting his jaw aligned because it's very slightly off, well in Alberta where we live, we'd have to pay 3-5 thousand dollars for it (and that's completely out of our own pocket), but in Saskatchewan it's covered...and I believe in Saskatchewan they pay for their provincial health care through their property taxes, where in Alberta we used to pay for it seperately out of pocket, 88.00 a month for a family of 4 and now we no longer have to pay that (or get directly billed for it, but when we used to get billed for it, some people had the option of it going through their companies, only in the sense that the company you work for would deduct it off your cheque and pay it directly to ABHC for you, you still payed but it was more for convienence). They've waved our premiums here in Alberta but we are obviously paying for it one way or another, in time the truth will come out about exactly how.

:)

Nope, the drug is approved for RA so it would likely be covered at the regular % that one's insurance company pays for so you'd only have to pay the portion that wasn't covered, like if your insurance pays 80% you only pay 20% out of pocket...and as for using it for IBD, your doc simply fills out a form stating that it's required for an IBD patient and then the insurance company will cover the max that they cover (eg 80%) and I'd pay the 20%...so definitely I definitely would not be expected to pay 4 grand. Anyone in Canada that had to pay 4 grand out of pocket doesn't have insurance (either through their job or private provincial insurance) and that would be why but with insurance you wouldn't pay that kind of money for it.

There are some braces here that only cost 2500.00 (or even less) as well but it depends on the severity of the condition the teeth are in and what we paid was the cheapest we found.

:)

That's the thing...we don't pay out of pocket for MRI's or any other tests for that matter, nor do we pay for surgeries or hospital care...we also don't have a "patient advocate" because we don't need one, in Canada the insurance companies don't run the health care system the way it does in the states and it's not a big money profit maker because in canada they don't have everyone by the nuts, they are not in control of our health, our government is and the nice thing about that is, it's all seperate from province to province and if we don't like how our provincial government is "running" our system then they are at risk of being voted out the next election. In Canada, the insurance compaines are very low on the totem pole, we can choose if we want blue cross, or we go through who ever our employers go with and they're basically all the same so there's not much in the way of competition that way either. And in many families if both spouses are working and get insurance from their companies they can use both and end up paying nothing for RX and other things like dental and eye care. No, not perfect (what is?) but a heck of alot better than some other countries...England is a another country that has excellent health care, same with many places in europe.

:)

I live in Ontario Canada and I don’t agree with everything pb4 is saying. Some of the differences could be the differences between Alberta and Ontario. The federal government sets the basic rules and minimums for all provinces to follow. It is then up to each Province to administer their own public health insurance plan to meet the minimum requirements. If a Province wants to provide more or better insurance than the minimum then that is up to them. Here in Ontario most dental and eye care is not provided for most people. Prescription drugs are only provided by our public health plan for hospital inpatients, even for Remicade. Private insurance is available to cover anything that is not covered by the provincial health plan. Ontario does provide some extra insurance for seniors and low income people. Private coverage varies considerable between companies and different plans. Most people get private coverage through their employers. I have excellent coverage from my employer and pay no deductibles or co-pays for prescription drugs. In fact they pay 100% for many over the counter drugs and some minerals and vitamins. When I first went on Remicade it took me about one week to be approved and it cost me nothing. I am currently waiting for approval for a dental implant. I had a front tooth extracted a few weeks ago. At first the dentist did not want to submit the request for approval because he has never seen an insurance company pay for it before. I checked my plan at work and it is covered. I must first get pre-approval because of the cost ($4000.00). My plan will pay 85 % because it is considered cosmetic.

NOTAR is probably dealing with a private company for his Remicade just like in the US and not a provincial public health plan.

I think this thread just highlights that there is no perfect health care plan! I'm grateful to have the coverage that I do, because I know it's a lot better than what most have. One thing my employer is committed to is having good health care coverage for employees, including dental and vision.

Eva Lou, I completely agree. Most Americans are very happy with their private healthcare and would prefer that the government would focus its attention on addressing the kinks and not try to overhaul the entire system. I'm concerned that a public option will quickly turn into universal healthcare because it will be cheaper for companies to drop their private healthcare providers and instead pay the fees to the government because the government can charge less for everything since they don't have to make a profit.