Hi,

we pay a huge part of our salary for the health insurance, but their service and what they cover like medizine and stuff is getting less and less. (Per sample since one year I have to pay my spray for asthma myself)

On 7th of october both of my kids will have a surgery. Both will get removed the ardenoids (?? right word) in nose. My daughter even worse, she will have surgery on her ears as well, because she hears bad (some luiquids is in the inner ear and they have to open the grommet (or tympanostomy tube ??, found the words with translator). She also has very big and swollen tonsils and they plan to remove the half of them with laser surgery. They do it many years this way, just to keep the organic function, which is very important for young kids, they are an immun protection.

I just have received a letter from our health insurance that they don't pay the surgery, because this kind of surgery is not listed for covering the costs in the catalog for health insurances.

How stupid is that? The new laser surgery is ambulant and she can leave the hospital on the same day, but instead they would pay a complete removement of the tonsils, which is more dangerous, the important function of the tonsils would be gone and if she stay 1 week in the hospital (which is of course much more expensive than ambulant surgery).

Well, I'm fighting now with doctors with healthinsurance and people of the union of all health insurances. So far the doctor is really very helpful and try to change the bill to keep our costs lower, but he can't do much official.

I don't know how to come up with the funds to pay the sugery. I have not expected this! I don't know for what we still pay insurance??? Do they pay, if we come with our head in our arms into the hospitals?

Sorry for venting, but it is getting really ridiculous!! Hubby and I pay both a huge part of our salary into health insurance.

Oh, by the way, my son's jaw need to get corrected, he got a head belt and has to wear it each night. Guess what, I had to pay 100 Euro for it, insurance won't cover the costs!! If I would know how it has to look like, I would have made this belt myself, the construction looks very simple!!

It will be very stressful anyway that both kids will have the surgery at the same day. Not sure how I will manage that, but much more I'm not sure how to come up with the funds now!

Life is getting so unfair and so expensive! Even health is not for free!

Hugs
Monika

I know in this country we moan about the health service but I think we're really lucky. We can pay private to go in when we want and where we want and I know there's some things not covered by the NHS but on the whole we get really good treatment. It's not "free" to most people, we pay in tax for it but it's free at time of need and if you weren't able to work you'd get the same treatment as someone who did. They don't check your insurance policy at the A&E doorway. I thought Germany had a National Health system? We're always told by certain media and polititians how every other country has a better system than ours......... makes you wonder

I agree that it sounds ridiculous, my dear friend - I feel so sorry for you and how should you know!?! I also thought that you paid for hospitals and free hospitalization via your income tax!?!

OMG that is awful for the insurance not to pay...what is wrong with these people? It should be case by case if it is not listed...come on, like you say it will cost MORE the other way!

Even worse is the fact that your dear children have to goi through this and both on same day! Bless them. PLEASE keep us updated so we can follow along...I will send them both strength and good thoughts! How awful.

Will they BILL you, or do you have to pay first? If you need help paying the bill, please PM me and I will try to find a way to chip ion some for the kids. This is important and I want them and YOU not to have to worry about the $$ when you should just worry about them. bless you all, I am so sorry!

Hugs

Elisabeth

We in Germany have National Health insurance and there are many different insurances to choose from. (like companies). If we run our own business we have to pay private health insurance. The service of both is absolute different, the private ones get a much much better service than the national one. Per sample our insurance won't cover any medical bills if you have a cold only. Of course you don't pay the doctor, but you have to pay the precribtion.

Most of the prescribtion we have to pay ourself at the pharmacy.

The national health insurances treat you like crap sometimes and cover only standard options (or lets say the "cheapest options), only the private insurances cover the best treatments available. It has always been like this, but it is getting worse every year! Of course private insurances are more expensive..

But it simple does not make sense that they would pay the traditional kind of surgery like removing the tonsils completely, let the child stay in hospital for 1 week and has more pains and more risk. The modern medicine says only to downsize the tonsils, they don't "cut" with the lasers where the nerves and the vains are and close the wounds with laser so there is no much bleeding and not many pains, the child can leave the hospital after some hours.

Elisabeth, we have an appointment with the doc who will do the surgery on monday the 6th of october, than I will have to pay him, completely. He already changed the bill and lowered the amount we have to pay, I don't think he did it the legal way and put more on the bill, the part the insurance would cover. But they won't cover the surgery on the tonsils, the other surgeries on nose and ears yes.

If I would do a separate surgery, it would be much more expensive, because I would have to pay the anesthesia as well plus the time and work for the surgeon!

Edited to add, OMG Elisabeth, I just read your absolue generous offer! What a sweat and kind lady you are! I will find a way first that insurance will cover everything, I have an appointment with a lawyer next week. THANK YOU SO MUCH!!!

This is no beauty-surgery, it is effecting indeed their health, Sophie often has infections like angina and earinfections. The result is, she needs speech teraphy, because we simple did not know first that she has problems with her ears and doesn't hear well, because the Ped who has less equipment than the Ear/nose-specialist, said always that everything is fine with her ears.

I am so sorry, Monika. It's SO frustrating!!!

I hope you can get the insurance to cover everything like they should.

Oh dear Monika, you are having a tough time of things lately.
You must be stressed out as we all want the best for our kids don't we?

We moan about our NHS but having just had first hand experience of it (gallbladder removal) I have to say the care was exemplary.

My sister lives in Jersey and I thought she was badly done to there compared to us ..but your situation seems worse.

Fingers crossed you get a good outcome

Linda
xx

Hi sweetie!
I just saw this! First of all hugs!! I realize how stressful surgery is on little kids :(
I will pray everything goes smoothly with the surgery itself and the kids will have minimum pain etc.

As far as healthy insurance IT SUCKS!! I know!!
I can't believe they won't pay for adenoid removal!! It's ridiculous! It's not a cosmetic surgery!!!
Can you look into private insurance? It's pricey, we pay 1700 Euros a year PER CHILD for it but they cover EVERYTHING even exams.
(except teeth unless it is surgery)
I really hope you can work this out :( I wish I could help too...
You are in my prayers!!!!
And call me if you need to vent/chat!!!
Hugs
Tina

Thank you so much for your kind words!

Tina, it's the downsizing of the tonsils they won't pay, the ardenoid removal they will pay. The surgery on the tonsils is with laser technics, they do this method for some years now, just to keep up the important function of the tonsils.

So why they would pay for the old way?

We can't afford a private health insurance, it would cost much more than in Greece, Tina! Germany is one of the most expensive European countries, but salaries getting low now.

I will have an appointment next week to talk to our health insurance again.

I agree at some point that of course we probably have a better health care in Germany, because EVERYone has a health insurance. There are only a few exception of rich people who have their own business and don't pay a private health insurance, but that is their own risk.

But the service is getting worse and since last year the prescribtions for kids were free up to 18 years, now we have to pay almost everything for them as well.

We have to pay a lot out of our own pocket now and it's getting much more every year.

The bad thing is, I also have to fight with our house insurance, some pipes broke and they won't pay a replacement!! Tomorrow we get everything done and it will be a bill around 2000 Euros.


I have no idea for what the insurances are still for???

Hugs
Monika

Monika, i really feel your frustration . It is bad enough having 2 children needing surgery on the same day - that in itself is very scary and something you need to cope with emotionally. But to have to pay a huge amount too for this
I sincerely hope you can come up with the funds somehow. Very best of luck for your childrens surgery -at least they will be able to sympathise with each other - it will help them feel closer I'm sure.
Love and best wishes
Becky xxxx