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  • No Relief for Chronic Kidney Stones

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    Old 12-01-2012, 07:22 PM   #16
    gmak
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    Re: No Relief for Chronic Kidney Stones

    Hi t girl, Thank you! I saw something about it & of course knew about the college kids staying on parents plan til age 26, but didnt know the particulars. When I had kidney stone i was in hosp, 2dr visits & no one could find what was wrong. One 5am day it moved, WOW, now i am in pain deluxe, sicker than sick. By the time the stone showed itself it had been 12 weeks & 1 1/2"'s of my ureter was gone! Urine was pouring into my body. The whole time i was sick but NOT in pain!!! So, im very concerned for argyles to get admitted to hospital when she has a stone. No matter how often. Modern medicine does not ,imo, send people home without finding the stone, retreiving it by scope, instrumentation, or lithotripsy. And, even if genetic the dr gives medicine or diet changes to make the Ca oxalate, cystine or uric acid stones etc not form. Thanks, gmak


    Ps. My urologist told me lemonade. But then i read that some hereditary kidney disease where you make too much oxalate that too much vit c
    makes the stones worse.

    Last edited by gmak; 12-03-2012 at 06:53 AM. Reason: ps

     
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    Old 12-01-2012, 07:40 PM   #17
    Argyles
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    Re: No Relief for Chronic Kidney Stones

    The support and advice is very much appreciated. Sometimes it just helps to vent about your frustrations too It definately helped in making the decision to go to the ER. I am very happy to have immediately recieved something for pain and (most importantly) nausea. I've developed this fear of seeing doctors for this problem because of the times I haven't received the help I needed.

    I was very shocked when my insurance denied payment on a CT because I have a history of Kidney Stones; thus, making this a pre-existing until July of next year. I wasn't even aware that it could be a pre-existing condition. It would be a problem if I didn't have a gap where I wasn't covered by insurance. ER visits have been paid in full before, so it's about the only affordable way for me to see a DR right now. It's also cheaper without any snags in the insurance. The co-pay covers it all, imaging tests, doctors, and medications. If I go to a urologist, I have the office co-pay, have to pay for the CT if deductible isn't met (plus the reading of the test).

    I believe that the majority of the problem has to do with the town I live in. Who knows, but again, I appreciate your opinions and help. I wold probably still be suffering right now instead of going t the ER.

     
    The following 2 users give hugs of support to: Argyles
    gmak (12-02-2012),Manatee31 (12-03-2012)
    Old 12-02-2012, 11:26 AM   #18
    Ilovemycutedog
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    Re: No Relief for Chronic Kidney Stones

    Appreciate you sharing more...

    Could you explain a bit how your insurance works where they cover all the ER visits but won't cover a visit to a Urologist or Nephrologist? I've never heard of this before because the ER is about the most expensive care out there....Every single thing from the Drs, nurses, and all the tests on an "emergency" basis are close to ten times the amount that a regular Dr. and facility will charge.

    So you are saying when you contact your insurance company...they tell you that you can't see the Urologist and you have to go the ER for care?

    I'm just really curious about this as it seems so backwards for someone who has insurance..

    As mentioned...I'm glad that you have gotten medical care...I was just concerned about any possible previous actions to where I didn't want you to get into trouble.

    Hope you are doing well..

    Last edited by Ilovemycutedog; 12-02-2012 at 03:24 PM.

     
    Old 12-02-2012, 03:10 PM   #19
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    Re: No Relief for Chronic Kidney Stones

    I believe that they won't cover preventative care for a pre existing condition, but will cover emergency care for any issue. I could see that they could audit and decide that the lack of preventative care for the pre existing condition led to the need for emergency care though. I agree its ridiculous they are paying so much more that way, but I've definitely heard of it before.

    I don't think the insurance would have said anything about going to the ER...I assume they said that any office visit which was coded for kidney stones wouldn't be paid as they were considering it pre existing (usually defined as a condition you were treated for in the 6 months prior to the new coverage). Sorry to hear about your lapse in coverage and the problems its is causing, but glad to hear that you can at least get emergency care.

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    Even for a non pre existing condition, under certain plans, it can be cheaper to go to the ER. You may have a high ER co pay, but that often covers everything (as long as you aren't admitted). Otherwise you pay the office visit copay + cost for tests (deductible + percentage coinsurance) + medication copay.

    This is a good example of our ridiculous system. That is why high deductible plans are now being pushed by insurers and employers...it puts the choice of costs on the consumer, when they will pay full price until their deductible, then a percent until their max out of pocket. They encourage folks to seek preventative instead of emergency care, and shop around for providers which offer the best value. There is also a push to offer free preventative care and increase costs for emergency care.

    For most folks those high deductible plans are actually a good deal. They are combined with a health savings account (non taxable) and the money rolls over to use down the road. However, I figured out I am an odd one out due to my high number of costly prescriptions...they are at a high cost with these plans (usually a percent instead of a copay) and you have to pay for them even after you reach the max out of pocket for the plan. Best wishes.
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    Old 12-02-2012, 03:21 PM   #20
    Ilovemycutedog
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    Re: No Relief for Chronic Kidney Stones

    I guess I've just not heard of this previously as I have quite a few friends who have chronic issues with kidney stones and see a Nephrologist (they are a medical kidney disease specialist). Their insurance companies cover all the visits and they have no problem getting treatment or any tests needed.

    So...that must be one terrible insurance company that pushes a patient to see the ER so often in that it is covered there but not for a specialist...

     
    Old 12-02-2012, 04:28 PM   #21
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    Re: No Relief for Chronic Kidney Stones

    Yes its unfortunate an insurance can exclude coverage for a pre existing condition if you've had any gaps in coverage. Sometimes folks don't have an option though, as they had a break between jobs and couldn't afford COBRA coverage (which is the full cost the employer was paying plus an admin fee), or even just couldn't afford the premium for coverage previously.

    Excluding preventative care for a pre existing condition unfortunately is common with all insurance companies, but yes the unusual fact is that they would pay for an ER visit for the same condition...You'd think they would catch that in the coding quite easily and deny it same as they would do for an office visit. If it was just one previous ER visit I would have guessed it slipped through the cracks, but it seems like this happened more than once.

    I think some of the problem is there is so much emphasis on billing codes and computer processed claims. Its unfortunate. These increased costs eventually get pushed back to everyone else in the way of raised premiums. However, I can say that if I was in Argyles' shoes, I would also go to the ER vs. paying out of pocket. Plus, often stones happen outside of doctor hours or you can't wait days for an appointment. Best wishes.
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    Old 12-02-2012, 04:48 PM   #22
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    Re: No Relief for Chronic Kidney Stones

    I guess I still don't see how they would still cover it through the ER as a pre-existing condition as it's not always a "life or death" situation with a kidney stone so it seems the insurance company would know that someone is playing the system by going all the time to the ER instead of going to a Dr.

    I guess I misunderstood the situation that she has had this insurance for awhile and it wasn't about pre-exisiting but the yearly gap with co-pays and out of pocket expenses...

    I haven't had insurance for 6 years as I have pre-existing conditions and the insurance company wanted to charge me close to $2000 a month for my premium...So..I know all the reasons behind the "why" someone would have this issue...I just am saying I don't see how this makes sense to an insurance company to keep paying and be ok with multiple ER visits...

    But thanks for explaining things..

    So

     
    Old 12-02-2012, 08:25 PM   #23
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    Re: No Relief for Chronic Kidney Stones

    I'm not really sure why they do not cover the CT scans or visits to a urologist, but cover the ER visit. My job went away last year and because they are a non-for profit, they did not have to offer me Cobra and my husband's company wouldn't add me until open enrollment came around again.

    When I spoke with the insurance company last, they said anything related to UTI or kidney stones was under pre-exhisting until July 1 2013. I didn't ask about ER visits and I probably should call and clarify that. They never give me CT scans. It used to be that when I went to the ER I would have a CT immediately, but now I might have a KUB, ultrasound, or nothing if they can find blood in my urine. It might be a cost cutting measure since CTs are very expensive and if a person without insurance dosen't pay, the hospital has to write it off.

    It is much cheaper to go to the ER with a stone. My only concern right now is how many scans I've had and keeping my exposure to radiation down. Most ER doctors I've encountered have actually suggested I don't have any type of tests because of my history. It just depends on who I get

     
    Old 12-12-2012, 07:10 PM   #24
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    Re: No Relief for Chronic Kidney Stones

    Wanted to say a quick thank you to everyone who helped me out and let me vent my frustrations. I passed the stone last week. I have contacted the hospital where I received services and met with a case manager to try and help me with the problems I'm having with them.

    You guys are awesome, have a happy holiday season!

     
    Old 12-12-2012, 07:27 PM   #25
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    Re: No Relief for Chronic Kidney Stones

    Quote:
    Originally Posted by Argyles View Post
    Wanted to say a quick thank you to everyone who helped me out and let me vent my frustrations. I passed the stone last week. I have contacted the hospital where I received services and met with a case manager to try and help me with the problems I'm having with them.

    You guys are awesome, have a happy holiday season!
    Dear argyles, Thank you for the update! Soo happy that you have found help with finding a dr to unravel this horrid dilemma that has been caused you so much suffering. God speed in your recovery, gmak

     
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