Health and Medical Insurance in Washington - Observations (Seattle, Bellevue: health insurance, house)

[DallasYankee]

I have lived in Washington for nine months and find myself increasingly frustrated by an insurance system which restricts, limits, controls, and denies access to sports medicine treatments readily available in most other states.
While I am pursuing other avenues of care to resolve an ongoing, nagging sports injury that happened since my relocation and is related to my chronic neck/shoulder issues, it appears both ordinary and ART-trained chiropractors are stumped and clueless as to how to correctly treat this condition. Yet I have been charged $80+ (Renton-area) and $118 (Tukwila- area) for additional time (more than 2 regions at the Renton location) and (non-effective) automated roller-bed and laser therapy(Renton) and Storz magnet "PT" treatments (Tukwila) from these two offices.
In Colorado (where I lived for 12 years and where most of my chronic conditions began), dry-needling (an off-shoot of acupuncture), cupping, Graston and ART could all be provided by a single practitioner. In Wahington by contrast, you must seek out the rare acupuncturist who does offer dry-needling, a massage therapist, PT (are they even allowed to?) or acupuncturist( ?) for cupping, and a chiropractor for ART and Graston. The regulations involving such "special and unusual" care are maddening and mean I have to travel to Bellevue for acupuncture/dry needling and to Redmond for a highly recommended PT (who will actually spend time treating the injured area with myofascial release and manual manipulation and not just "give me a bunch of exercises to do by myself" (as is customary here).
Has Washington health insurance always been this abysmal?
Is it modeled on the controversial Canadian system? (Of which I know little.)
Are the big tech companies like Amazon to blame for this low-level of permitted care and coverage?
I am surprised these doctors haven't recommended marijuana yet for pain management instead of me seeking alternative modalities since it's totally unregulated and freely available to anyone who desires it, LOL!

[Hemlock140]

I haven't had your particular ailment, but when I had severe shoulder pain and complained to my primary (Swedish) physician, he referred me to a orthopedic surgeon at Proliance Orthopaedics & Sports. After an exam and xrays it was determined to be an impingement of the rotator cuff. I was referred to G2, a Sports & Physical Therapy place just down the hill from my house. I went there for an hour twice a week for 6 weeks and have been fine since. My insurance (thru my employer) paid for most of the PT, just a $20/visit co-pay.

[DallasYankee]

Thank you Hemlock140. I'm glad your shoulder pain turned out to be no big deal and required only a few low-cost PT visits and that you haven't had any difficulties since.
I have dealt with orthopedic surgeons before and was certain I would need to obtain their permission before I could get any real PT treatment. Luckily, The Premara BlueCross insurance my husband has through his company allows 6 PT visits before the medical insurance stops treatment pending a go ahead to continue care. If I do need X-rays or MRIs (Which I had in Colorado before both cortisone injections (i.e., left deltoid and right subacromial) then I'm sure this PT will refer me to a sports specialist or hopefully help me find a decent PCP (which I don't yet have and probably will need) in order to see such a physician, per local insurance.)
Dry needling worked before even when the rotator cuff was involved and a semi- impingement was diagnosed. I really should have tried these alternative routes before but knew it would be a long trek for quality care. (We currently live near the run-down area of Fairwood where such things are just not offered.) It may be I will need a cortisone shot in one the shoulder/ blade bursas due to the delay in a proper diagnosis.
Most orthopedic surgeons want to do invasive procedures, and I have been told by many different providers that my chronic conditions require complex and varied modalities that not every doctor is privy to (especially where such treatment is deemed suitable only for Olympic athletes, LOL! )

[Glenview94602]

Originally Posted by DallasYankee

Thank you Hemlock140. I'm glad your shoulder pain turned out to be no big deal and required only a few low-cost PT visits and that you haven't had any difficulties since.
I have dealt with orthopedic surgeons before and was certain I would need to obtain their permission before I could get any real PT treatment. Luckily, The Premara BlueCross insurance my husband has through his company allows 6 PT visits before the medical insurance stops treatment pending a go ahead to continue care. If I do need X-rays or MRIs (Which I had in Colorado before both cortisone injections (i.e., left deltoid and right subacromial) then I'm sure this PT will refer me to a sports specialist or hopefully help me find a decent PCP (which I don't yet have and probably will need) in order to see such a physician, per local insurance.)
Dry needling worked before even when the rotator cuff was involved and a semi- impingement was diagnosed. I really should have tried these alternative routes before but knew it would be a long trek for quality care. (We currently live near the run-down area of Fairwood where such things are just not offered.) It may be I will need a cortisone shot in one the shoulder/ blade bursas due to the delay in a proper diagnosis.
Most orthopedic surgeons want to do invasive procedures, and I have been told by many different providers that my chronic conditions require complex and varied modalities that not every doctor is privy to (especially where such treatment is deemed suitable only for Olympic athletes, LOL! )

I really hate evicore....

[DallasYankee]

I had to look that one up Glenview as I never heard of them before. (My previous insurance providers were Cigna and United Healthcare (in Colorado).
I am certainly aware that Premera/BCBS offers very limited care for physical therapy; this is why I delayed going that route for this sports injury. A lady with whom I have taken yoga classes told a horror story about Premera denying her more than 6 visits even after the PT told her she would greatly benefit from longer - term access but since they would not relent on terminating her treatment and she couldn't afford to continue her visits as a cash patient, she just had to accept it and live with her condition.
I am determined to find a way around this awful bureaucracy and not learn to accept what can't be changed here like traffic or having to live in a remote location with few amenities.
Since dry needling is allowed here only in acupuncture offices, that is where I am going in tandem with the highly recommended PT.
I am allowed 12 acupunture visits per year; after that I am financially able to continue as a cash patient and would actually prefer that - Premera and Evicore then would have no say in how many needles can be inserted, the location/ area that can be treated, the frequency of sessions, etc.
I hope I will not need to see a PCP and orthopedic surgeon for MRIs and xrays.
IMHO, avoiding protracted and possibly unnecessary medical costs and multiple provider visits is the wisest course, particularly when I have experience with proven methods that worked for me in the recent past.

[rkcarguy]

There is a reason WA scored 48th out of 50 states for its healthcare in a recent "Money" report.

[Ruth4Truth]

OP, health care providers in WA say BCBS is the worst, in terms of reimbursements. They take forever to reimburse, and they're miserly about it, when they do finally pay providers. Some Urgent Care facilities in Seattle flatly refuse to accept BCBS patients. Insurance companies in WA were forced to add acupuncture coverage by a mass patient lawsuit.

[MechAndy]

I hope the wife and I never get sick here on the Olympic Peninsula.
It’s one of the main reasons I keep a house in the Bay Area.

We get either free Kaiser or a PPO that would cost us $175 per month from my retirement contract.
That is a $2,100 difference per year I’d rather keep, especially since the health care here is not really the best.

I have heard that lots of doctors don’t want to work here because the money insurance (Medicare) offers them is just not enough, and there is a real lack of doctors here because of this.

[87112]

Originally Posted by Ruth4Truth

OP, health care providers in WA say BCBS is the worst, in terms of reimbursements. They take forever to reimburse, and they're miserly about it, when they do finally pay providers. Some Urgent Care facilities in Seattle flatly refuse to accept BCBS patients. Insurance companies in WA were forced to add acupuncture coverage by a mass patient lawsuit.

What about the rep of United Healthcare? This is my new Health plan, use to have Aetna.
I will say Aetna has great customer service, no clue if they reimburse well to either DR or patient.

[Transmition]

Originally Posted by DallasYankee

In Colorado (where I lived for 12 years and where most of my chronic conditions began), dry-needling (an off-shoot of acupuncture), cupping, Graston and ART could all be provided by a single practitioner. In Wahington by contrast, you must seek out the rare acupuncturist who does offer dry-needling, a massage therapist, PT (are they even allowed to?) or acupuncturist( ?) for cupping, and a chiropractor for ART and Graston. The regulations involving such "special and unusual" care are maddening and mean I have to travel to Bellevue for acupuncture/dry needling and to Redmond for a highly recommended PT (who will actually spend time treating the injured area with myofascial release and manual manipulation and not just "give me a bunch of exercises to do by myself" (as is customary here).
Has Washington health insurance always been this abysmal?

You're after coverage for a lot of different treatments that are not currently accepted by the wider medical community due to a shortage of things like "evidence they work". I don't know who told you that you needed all of them, but I guess they made bank while you were in Colorado. Given the number of crunchy woo people with money in this state, I'm equally surprised they aren't more commonly available, but I'm glad my insurance money isn't going into the pockets of every placebo seller. Higher standards don't make it abysmal, the shortage of qualified practitioners however leads a lot to be desired.