"Genevieve" #23

She said she still doesn't understand how Medicare works, but she bought a Highmark plan, and they worked well together until she got denied for the first time two weeks ago. "I still don't understand how Medicare works. I bought a High Mark plan, but together they're like peanut butter and jelly. They work for me. They may not work for someone else.... The only glitch that I've hit in the last five years with Medicare and Highmark was two weeks ago. I went to have a procedure done. [The] lady says this code came up, ABH code or ABN code. She said they denied you.... I just made a thirty-five-mile trip to come to do this procedure, and I can't do it.... But I was thinking, what happens if I was a cancer patient and I had to do that?... What if I had a heart condition, or I had cancer, and that procedure was like a life-saving thing for me? Or I at least had it in my mind that it was. I would have been devastated."

"Jason" #17

Insurance will only cover a certain number of physical therapy appointments. "That's not the way it should be. It should be, my life plan is to get back on my feet. And if I can walk, that's fine. If I can't, that's fine too. But I at least want to be able to get in my wheelchair, stand up without sliding and doing all this baloney, you know."

"Jessica" #22

"How much do I trust [the government/healthcare systems]? Actually, when I commit to something, I have to trust it. Like, when I joined Blue Cross Blue Shield, whatever they say I have to follow along with it.... I personally feel like they treat it as a business, right? They aren't really considering how much benefit you receive or how much you utilize."

"Kate" #07

"UH owns our hospital system. And they only refer you to UH doctors. Well, that's fine if that's the best doctor for this problem that I'm having. But if he isn't the best... I want you to refer me [to] who's going to take the best care of me. You know me. You know what... my needs are. I want to be able to have that, you know, I know this guy, he's good. He'll be the one that takes the best care of you, not because the system that I'm in told me I had to refer you to somebody in this system."

"Konnor" #16

"We live in a capitalist society, and that drives everything. Healthcare is now not a non-profit, it is a business. And there are pluses to that and there are minuses to that. As I said, UPMC and the universities here have been [at] the forefront of some incredible technologies. And so, for that, I'm grateful. In my best interest, I don't think I enter into the equation. I think if progress is profitable, then I'm a beneficiary, I guess is the way I look at it."

"Melanie" #26

Insurance will not approve a preventive medicine she has found helpful. "This year, on [my insurance's] formulary, they have a preventative drug. My doctor put in, I don't know how many prior authorizations to get approved. I trialed it with my doctor, she gave me samples for a month in April of '22, I believe. And it worked.... They will not approve it. They say I have to trial other ones. They give you a list to trial. I looked up those other drugs. I do not have asthma or cataracts. I don't need the antidepressants that are on there, right? They have a lot of side effects. I'm like if I trial [one] that worked for my doctor... and she put it on how many prioritizations, you keep denying them, why? Because you don't want to pay for the $2,000 now?... I had [to] fight for that again this past year when I called. And I told the woman, my voice was raised, and I said, I don't want you to take this personally, but let me explain. And she said, 'Well, you probably have to do another prior auth or an appeal again.' I have talked to so many people who've had the same problem. They do it and I think they do it on purpose a lot of times because they want to get you so frustrated and so tired you give up. You say, forget it. I'm paying you a premium every month out of my measly poverty salary, but yet you don't want to approve a drug that could help me."

"Sherrie" #17

"It's the doctors and hospital. It became a money thing. Way back in the day aspirins and all that wasn't costing what it cost now. If you need something, and your doctor felt like you really need it, you could get it. Now the insurance is the one that comes in and makes that decision. I think that's wrong. I think it's wrong that the insurance is trying to save money to profit over the help of people."

"Dennis" #18

"They have transportation. But you gotta schedule the week in advance, and... if it was just 1 or 2 trips to Biloxi and back, probably not a problem. But I'm looking at 20 surgeries. 20 trips there, first to biopsy, then 20 trips for surgery, then trips to have stitches taken out. That's a whole lot of trips, you know. If... look at the logistics of it all, and it [takes] one week to schedule transportation over there and back for an appointment? I'll never get it all done. I'll never get... it over with. It's mathematically impossible. You know? I mean, It won't work."

"Yingtong" #06

"Those without Medicaid have to pay out of pocket for most medications. So many retired people don't have much money, right? So, when everything costs money, many people just avoid going to see a doctor if they can, right? They just endure it or take some medicine on their own. For us, the elderly.... it causes delays, so it's not very good. If the government can provide more support so we don't have to bear all the costs ourselves, then if anything happens, they would at least want to get it checked more often. This would be beneficial for their health by catching issues early."

"Yvonne" #27

"[Healthcare systems could better support me if they would] lower the cost of the bills.... Just being able to catch up on paying the bills that I have not paid on the health care. I don't like being overdue like that. Like, I'm a person that wouldn't pay and then it may end up going to collections. Then it's like it's getting to the point [where] you're gonna have to be forced to pay otherwise. You may go to court, or whatever, or it goes against your credit. You try to get your credit better so you can have a better standing in life for things that you may want to go forward with where your credit does count for something."

"April" #14

"UnitedHealthcare doesn't cover my needs.... I'm talking about the dental thing now. That's a huge thing for me is to get my teeth extracted. I don't think it's gonna cover that plus dentures.... And if it doesn't, I'm just gonna go ahead and get my teeth extracted, and then just not be able to get dentures... They're giving me $1500 this month $1500 in January. And I think that's only going to take care of the extractions.... I'm pretty sure it won't take care of dentures. I've looked at prices online and stuff. So, I'll get the extractions. I might even have to pay a little of my emergency money towards that."

"Bonita" #03

"One struggles with medicine here because they prescribe something that insurance doesn't cover. So you end up just going to the appointment, but you don't get the medicine because it's not covered. So you're stuck in the same situation. It's not like when you have good insurance, where you have everything."

"Christine" #04

"I can't hear sometimes, but... hearing aids [are] $5,000, $6,000. That's ridiculous.... Well, now, with my new policy, they'll pay I don't know how much out of it. But... this [is a] coal mining area, so guys can't hear. They've been in mine all the time and different kind of hearing aids. It's like $5-6000. It's a booming business. Booming."

"Dennis" #20

"I'm 30-something dollars over the threshold of qualifying to receive Medicaid...I could get my teeth fixed.... I got 11 cavities that I haven't been able to address. So what's going to happen? I'm going to lose all those teeth. I can't afford to have them filled.... I don't see why, you know, the VA will treat you for anything and everything unless it's dental. When we all know that we're all needed, that doesn't make any sense. You served the country, you offered to give your life. And in old age, when you got your teeth falling out, you should be able to get somebody to help you."

"Donna" #12

She has Humana (Medicare Advantage), with most copays set at $15. She receives doctor's bills by mail and doesn't pay a premium. She switched plans last year; previously, she was with UnitedHealthcare (UH). One of her agents advised her that she would get a better deal with Humana. "One of them agents told me they thought I would get a better deal with Humana.... The dental insurance, my vision insurance, because they would only pay for new glasses every two years.... Last year I had to get glasses every six months because I've got the macular degeneration. And I had to get glasses. And I had enough, you know, left on my flex benefits to get my new pair of glasses. They're ready now, but I don't have a way to go get them.... [Dental] they pay like $5,000 and I need new dentures. I've been needing new dentures. But I didn't have enough coverage to [afford] $1,400 some of them told me. I went to one [place and they talked] to me about the implants and I could apply for a grant. And he wanted $7,500 and it had to be paid upfront. I said, well, thank you... I didn't go back.... [And Humana] there's some things they're cutting. Like, they won't pay for my insulin needles anymore."

"Melanie" #05

"Half the time, if you try to get the equipment you need, medical equipment... you don't get it 'cause you have to go to a Medicaid doctor to get it. Then there's other stuff that Medicare won't pay that I could surely use. It's like, forget it. Just forget it. Don't give it to me. I'll just have to make do with what I have. It's frustrating. And then you, you have no time to relax and de-stress yourself, because there's always something coming up."

"Melanie" #13

"Medicare... doesn't pay for eye or teeth. I had to pay a dentist and he told me I should get braces again because I have an overbite and... that could be, I don't know, it could be contributing to the migraines.... He said I'm biting on just my back teeth. He said that's not healthy for you. He's urging me to see an orthodontist. I can't afford an orthodontist.... He said it's not for cosmetic reasons... it's for your health."

"Miguel" #11

His insurance does not cover all of his needs. It covers his doctor's appointments, but it doesn't cover the dentist. He is missing teeth, but can't afford to go. "It only covers for the doctor, things... for emergencies. That's it. But for... like I told you, since I don't have teeth anymore either, I tell you, it doesn't cover my teeth because I can't afford it, I don't have money. It's a lot of money. No, it doesn't cover it. Oh well, you have to manage like that.

"Sandra" #09

"Okay, I'm going to tell you what annoys me as an older adult. There's an emphatic thing about, you need to go get your eyes examined, you need to go to the dentist, you need to do the this, you need to do the that. But your basic eye exam... when they determine whether you need glasses, they don't cover. What is up with that?... Or like you don't even have any coverage in most of your medical, unless you do an advantage, for any dental work that you get done. Even a basic cleaning. Come on already. And I ask myself, who's making these decisions and what do they do for themselves? How does it impact their lives or their own relatives?"

"Sarah" #07

"Most of the time [my insurance covers my needs].... I just have to make a big copay every time. And that's what irritates me because then I have to, like, decide if I'm gonna buy this or pay for my medicine.... Most of the time I let the medicine go. I'm supposed to be on medicine, but I don't pick it up and I don't take it.... I have to pay [for my prescriptions]. I have to pay $10 and $15 for every one. So, I don't always have it, so I've decided I don't want to take medicine. I want to live as long as I can without it. So, I don't take the medicine. [I buy] food and stuff."

"Yvonne" #21

"Just like the glasses that I need. I haven't got them yet, because the price they were trying to charge was pretty steep. And maybe because it was the kind of glasses that I wanted, but I figured if I'm going to wear some glasses, I want them to be [the one] I want... so I still haven't got them yet. So I'm trying to get them at a cheaper source, but the same kind of glasses that I want." Unfortunately, her health insurance does not cover the cost of her glasses. "Well, they only cover them to a certain amount, but I got to forfeit the rest of the money. So, I just... put that on hold until I can find a cheaper source."

"Arthur" #03

"I do have a PCP. I haven't been there for a year. My insurance covers it. I probably should go once a year. But, I don't really need to because I'm a member of the Pitt Men's Study. So Pitt Men's Study is every six months and Allies is every six months and they're staggered. So really every three months I'm seeing somebody. Pitt Men's Study is the best thing because I get my blood work done, they check my liver, they check my kidneys, they have the memory test, they have the cognitive test, they have the emotional test and it's all there. Free. So, I'm really blessed that I've been a member of the Pitt Men's Studies since 1985, and I've been getting this free service... I haven't been billed once. Because they get funding through the National Institute of Health or something. And furthermore, it's associated with Pitt. So, because I've been a member in good standing for so long, they've enrolled me in three lung studies, three heart studies, [and] three bone studies. So, I'm getting all these tests every several years. Just making sure that everything is good and that's all free. I'm providing them with valuable data and they're also providing me with valuable feedback. So, yeah, I'm really, I feel blessed."

"Jessica" #01

"[There is a] genetic predisposition for cancer in my genes, so my family has a strong history of it. My older sister, younger sister, and younger brother all have had cancer.... I have as well. So this is something in our family; there's no helping it. It's been confirmed through DNA testing that we have these genes.... If I were in Hong Kong they say you should get checked every 2 years, but actually, I would get tested every year. But [in the United States], because of the insurance, they won't allow you to get tested every year, so you get it done every three years which they think is already a lot. So your insurance wouldn't cover you to do this every year, that's how it is.... I go back to Hong Kong for [colonoscopies]... because I am part of a genetics study at Queen Mary Hospital in Hong Kong.... It's very cheap for me to do colonoscopies there, just 100 Hong Kong dollars."

"Sandra" #03

"I have Medicare, and I have original Medicare, so I have a Medigap. A lot of people try to push the Advantage, but I'm not comfortable with it for two reasons: My mother had it, and whenever we needed to get something done, it was always, 'Well, we don't think...' or 'We're not going to approve it.' And I remember saying to someone [from my insurance], do you have an MD behind your name? And they were, no. I said, so how do you make the decision that the doctor's recommendation is not acceptable?... That experience was really difficult. Then the other experience I had with it, I had a similar type plan. I was self-employed for a period of time and I had to have an MRI. And they told me that I couldn't have it. Same thing, wasn't a doctor who was saying it. The insurance just didn't want to pay for it. And, the lesson was I was the first person who had signed up for the plan because they had just introduced it for small businesses. I called the provider and they spoke to the insurance company and I was able to get it. But... I don't want to deal with that no more, you know. It costs more upfront, but I believe in the long run, it is beneficial for me."