why does mainecare pay for surgery?

I just need to gripe.... My husband pays $150 a week for our insurance coverage through BCBS, yet I have to pay approx $1600.00 for deduct. and so on for my surgery. Though people who do not work nor pay for their insurance don't have to pay a cent. I know I'm going to get a lot of crap for this, but I just want to understand. Am I the only one who feels this way?

I understand your frustrations, but it is not the people that have MaineCare who is to blame. It is the insurance companies or the employers. I believe that just because they do not have a job like us or our spouses does not mean they are not entitled to the same care we are. Of course there are always those out there that "work the system" that make a bad name for the ones that are trully justified to be on Maine Care. Those are the people that I get short about. I just know that if I did not have insurance I would be very greatful to have MaineCare and I would have gotten wls with it. Many surgeons do not accept Maine Care because it reimburses so little. We are lucky that some of the surgeons at EMMC do take it. I know I had to pay a bit out of pocket, though I do not think quite as much as you and at the time I was not working because I was staying at home with my 4 children. It was hard, but DH and I both felt it was something that would improve our lives and my health. If I could not have had the surgery because of the portion I had to pay, then I might have been upset, but still hope I would have seen it in an objectionable (is that a word ) light. Just my opinion of course. Theresa

Well, I know for a fact that I would LOOOOOOVE to have a job and work as all the "normal" people do. But, I have a disability that prevents me from doing so. I am glad I have insurance at all, as a lot of people don't. And I have to jump through hoops like pre-authorization, and plus, a lot of medications that some folks NEED on MaineCare are just not covered, and they do not get the priviledge of getting them. Imagine knowing that a certain medication would make you better, but the State just says, "Nope, sorry, we don't cover that." I understand your frustration, but please don't get angry at the people who are covered by MaineCare. Most of us would rather pay the money and have a job we can call our own. Or maybe that is just me, I don't know. Plus, we are threatened all the time to have services taken away from us at the drop of a hat, because the State doesn't deem them necessary. Just a couple of the ones that they tried to pull were brain injury rehabilitation, and funding for an entire facility that helped people who were mentally ill. Plus, not every doctor takes MaineCare, so we don't have the luxury of picking our doctors. It is very complicated, but once one sees both sides, it is easier to come to the conclusion that both MaineCare and other insurances both have their drawbacks, but both have their pluses. Hope this helps...

The previous poster was right. It's the insurance companies that you should be cranky with. It's wonderful that you & your family are able to have health insurance w/o 'living on the state', as I call it. When I had my surgery, I also had an insurance where I had a substantial co-pay. But somehow I managed to come up with it, sucky as it was. I knew people who had MaineCare, and they got their surgery 'for free'. Some of them even got a panni 'free'. It doesn't seem fair, but it's not their fault. The state says they qualify for MaineCare, and our insurance companies say we still have to pay. Sometimes I get cranky about it too, but then I stop. I'm too busy to waste my time thinking about things that I can't change. I don't want to make the MaineCare people start paying when they can't, and I know I'll NEVER change the insurance companies.

Tracey, It's funny to yet another person who passes judgement before knowing what they are talking about. MaineCare is not provided to only "people who do not work", it is provided do people who do. Have you ever heard the term working poor? Or maybe someone you know has been laid off from work, since it seems more companies are leaving Maine than coming in. Or my guess is that you don't. Or maybe you don't know that it is not only offered to single parents either. You might also not know that you are damn lucky that MaineCare covers the surgery. Recently when Baldacci proposed that MaineCare cut the surgery out of it's benefits it could have set off a chain reaction where other "regular" insurance companies would follow their lead. And yes you possibly may be the only other person who feels this way here. Or the only one who would take the time to "gripe" about it. Since the last I knew this was a supportive message board, where in my time posting here I have never seen someone post something such as this. We all care about eachother here and support eachother in this "journey". I am quite offended that you would try to stir up trouble by complaining about things that are actually just your problem. Maybe you could look into a better insurance? I will never try to justify my life situation or explain to you why I have MaineCare because, quite frankly, it is of course none of your business. But think about this, should I not be sitting here writing to you because right now in my life I do not have the 30,000 to pay for surgery? Looks to me that you don't either. Goodluck on trying to find happiness in your life, instead of finding faults in others. Casey

OUCH. You are right. I do not know everything about Mainecare as I do not have it. I am not passing judgement. Where in my statement did I do that? I understand that some people need and deserve the assistance. I am very happy in my life, thank you, and feel as though you did not read my posting as it was written. Your's was the only response that was hateful. I have a right to be upset that there are people out there that take advantage of the system. I have the right to gripe. I have given a lot of support on this site, as well as gotten a lot. I did not understand your point in your last statement about, "should I not be sitting here.....". All that I can say is that I work a full time job, take care of my 2 children, and I don't go beyond my means. Everything that I have I pay for. Maybe you can assist me in finding a less expensive insurance. I'd be very interested in that! Tracey

Tracey, I in fact was not hateful in any manner. Where exactly do you get hate from what I wrote? Of course you have a right to your opinion as does everyone else, yet I find it odd someone who is happy would take the time to gripe and try to hurt others feelings overwhich something you have no control. I honestly meant that I do hope you find happiness with your life, often that means accepting where you are in life and where others are. Also not thinking stereotypically about people who need certain programs that are offered to them based on income levels. My point about not being here was based on morbidly obesity...something we all share/d here. Which I would not be a part of all this had I not come to the "last chance" surgery we share. By the way I am surprised you had been approved for surgery without having "tried smaller portions and healthier foods first". But I guess the screening isn't as stringent in other areas of the state. About the insurance, if what you have doesn't meet your needs fianancially wouldn't you shop around to find a better price? I mean after all you sound like an intelligent woman. As you said, you knew you would get "crap" for what you wrote. I have just as much a right to reply as you do to gripe. Casey

This will be the last time that you hear from me. Where do you get that I didn't try smaller portions, or healthier foods first? You know nothing about me, nor is it any of your business. I paid for what I got, not taxpayers. You have the nerve to say that BCBS doesn't screen their clients enough? I PAY FOR MY INSURANCE AS WELL AS YOURS. It's too bad mainecare doesn't screen their clients. I would question why so many of them can afford computers, and multiple children. Tracey

Tracey, I got that from a previous post of yours. I'll post it here: (RE: Question, please? Response from Tracey Libby at 7:17 PM EST on 04/26/2004 Buxton, ME - RNY (02/26/2004) Hello, I had open surgery on 2/26. I was in the hospital for 5 days w/ no complications. I would strongly recommend sleeping in a recliner if at all possible. I came home to my children, ages 4 and 2, and had no problem at all. The only regret that I have is that I didn't try harder on my own to lose weight. I was right at 40 bmi. I miss food. I'm still going through the "brain hunger". I loved going out to eat, and now go and have a small salad....not the same. Yes, I am 40 pounds lighter, but I should have tried smaller portions and healthier foods first. Good luck to you! Tracey) You know nothing about me either and it isn't any of your business about MaineCare. I pay for what I have as well. As you know some form of insurance is needed for medical coverage. Who can pay that out of pocket? Who said I have multiple children? In case you need to know...my husband is a straight A college student, who we are putting through school right now on loans. We can afford what we need. Again though that is none of your business. Have a good one! Casey

Many surgeons are not accepting patients with MaineCare as it's not lucrative for them and they are losing $$ on the procedures. I am a single mother and pay $85 per week for insurance for me and my son so I understand your frusteration. Anthem is my insurer and they have been making me jump through hoops to get approval.