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Any recommendations for a good/affordable health insurance in the US?
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Lateralus
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Feb 28, 2011, 11:19 AM
 
I've been traveling abroad for a while but will probably be returning home soon. And before traveling, mostly due to the invincibility of my youth, I never paid much attention to whether or not I was insured. But thanks to a few 'told you so' moments while traveling, I've decided that I'd rather not be without insurance again.

And since I'm not planning on being immediately employed with benefits upon disembarking the plane, I was considering just buying 6 months or whatever or insurance on my own to get me through until I line up some stable employment.

Does anybody have any suggestions for something that doesn't suck is fairly affordable?

Thanks peeps.
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bstone
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Feb 28, 2011, 01:11 PM
 
Until the new laws take effect you are still subject to the whims of the insurance companies. Age, health, weight, previous history etc are a major factor. You might end up paying a lot for very little.

A friend who is a health care consultant said that if you can't get approved for a major medical plan then at least get a catastrophic plan. Those plans aren't much money and will cover you from ruin. Also, if you do end up having to pay huge sums of money it will be less than if you didn't have insurance due to the company negotiating lower rates with the hospitals.
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Thorzdad
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Feb 28, 2011, 01:26 PM
 
You can get "good", or you can get "affordable". You cannot get both.
We've been in the private insurance market for the past six years and done a ton of shopping. It's pretty depressing, especially if you have a family (like us.)

You will be tempted to fall for those dirt-cheap, "use any doctor, no co-pays, no network, only pennies a day" plans. Those things are chock full of loopholes and gotchas. For instance...ask whether the plan allows balance-billing on the part of the provider. That's the practice where the provider bills, for instance, $15,000 for an emergency appendectomy. The insurance will allow (and pay) only $8,000 (including your deductible). However, the provider will then bill you directly for the remaining $7,000 balance. This isn't allowed under a normal policy. Many, if not most, of those dirt-cheap plans allow balance billing. This is because they don't actually negotiate payment with the provider. They just set a cap for what they will pay on anything.
     
bstone
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Feb 28, 2011, 01:44 PM
 
Balance billing is evil. I think a court in NJ or CA recently ruled it was illegal (state court, only applies there).
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Big Mac
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Feb 28, 2011, 02:10 PM
 
eHealthInsurance.com is what I recommend for individual policy shopping. It's only major carriers, not TV advertised scams. Some of the plans are essentially instant acceptance.

On a related note, if you currently have had an individual plan for quite some time you should use ehealthinsurance to compare plans now popular because the insurers commonly introduce more competitive plans while raising rates on existing policy holders as time goes on. If you find a plan that's more competitive offered from your current insurer, call up their customer service and find out how to switch to it. (Don't just apply for a new plan using the site.)

PM me if you need small business group health insurance advice (including if you've been denied individual coverage due to preexisting conditions, a practice which I think is generally being phased out because of ObamaCare).
( Last edited by Big Mac; Feb 28, 2011 at 09:35 PM. )

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olePigeon
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Feb 28, 2011, 02:14 PM
 
Originally Posted by bstone View Post
Balance billing is evil. I think a court in NJ or CA recently ruled it was illegal (state court, only applies there).
California. ERs can't charge for the difference in costs of going through the ER and standard hospital, or for fees charged by the ER but not HMO.

I'm on a the fence about that, and would have appreciated a non-blanket ruling. People use the ER for all sorts of non-emergency crap, and they should be billed for emergency care for stuff they could easily have been covered by simply making an appointment with their general care physician.

For people in genuine emergencies, I agree, there shouldn't be any discrepancies in charges between services provided by the ER and HMO.
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olePigeon
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Feb 28, 2011, 02:15 PM
 
Also keep in mind that PPOs are generally more expensive than HMOs. However, even within an HMO, you can change doctors, it's just more tedious and you have to have a legitimate claim that the physician isn't meeting your needs.
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stumblinmike
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Feb 28, 2011, 02:32 PM
 
Where's Ebuddy when you need him? He pays next to nothing for a FAMILY plan! I'm sure he could steer you towards something affordable....
     
Thorzdad
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Feb 28, 2011, 02:54 PM
 
Originally Posted by Big Mac View Post
eHealthInsurance.com is what I recommend...
That's a great place to start and get a general idea of what the market offers. The thing to remember about places like that is that the prices they aggregate are best-case teasers. The prices they show are very rarely the price you end up with. You will have to go through underwriting before you will get an actual price.

For instance, I just plugged-in my family information and the price I got back from my current insurer (same deductible, copay, etc) is about 1/3 what I'm actually paying right now. But, if you DO get a great rate, expect it to last only a year. Then comes the price hikes. I think our first year hike was in the 20-30% range.
     
Big Mac
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Feb 28, 2011, 03:13 PM
 
Yeah, that's true they are prime, best case rates, but it gives you a good baseline.

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Athens
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Feb 28, 2011, 03:39 PM
 
You could also get out of country insurance from where you are now to cover you for 6 months and skip the American system totally until you are employeed with a package. Im sure Quark can hook you up with some uber fedeation insurance lol. Seriously though Insurance companies in Canada and im sure in most countries can quote you on travel/extended out of country medical coverage and I have seen 6 months plans and I currently carry a 1 year plan because I travel to the US often enough. It might be cheaper to use a non American insurance provider for that period you need coverage for.
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Big Mac
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Feb 28, 2011, 03:45 PM
 
That's a great point too. Your in-state insurer won't cover you if you go out of the country. Thankfully travel medical insurance is pretty affordable.

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Lateralus  (op)
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Feb 28, 2011, 04:15 PM
 
I'm currently with CareMed for my travel medical. And as I recall, they only allow you to buy travel insurance for the US if you are not an American citizen. I was told that is fairly normal.

I don't really know what I'm looking for in a plan, but basically my travels will end with my returning home a tinnitus sufferer. I'd mostly just like to know I can duck into an ENT doctor during any flare ups. I also have high blood pressure, and will either be stocking up on medications here in Germany out of pocket or checking in with a GP for a prescription when I get back.

But I'm more worried on the tinnitus front.

I'd had a big scare last year (which I posted about) regarding my blood pressure and what might have been causing it as well as what damage it might have already done to my system. Long story short, I've since gone through a full workup here and there's absolutely nothing wrong with me; kidneys are perfect, blood is clean, cholesterol is 116, heart is great, nothing wrong with my adrenal gland... Just naturally high (very) blood pressure.

But yeah, just stuff like clinical visits (the ENT) and medication is really all I'm gunning for with any insurance I'd pick up.

Thanks for the suggestions thus far guys. Sounds kinda grim though... I'd hoped a few of the more protective measures from last year's reform had kicked in by now. Guess it's still just as bad as it was when I started traveling back in '09.

Keep it coming.
( Last edited by Lateralus; Feb 28, 2011 at 04:23 PM. )
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Big Mac
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Feb 28, 2011, 04:23 PM
 
There have been some positive changes instituted at insurers as a response to ObamaCare (I can admit that), but it didn't completely change the way insurers operate and conduct business.

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Thorzdad
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Feb 28, 2011, 04:46 PM
 
Originally Posted by Lateralus View Post
I don't really know what I'm looking for in a plan, but basically my travels will end with my returning home a tinnitus sufferer. I'd mostly just like to know I can duck into an ENT doctor during any flare ups. I also have high blood pressure, and will either be stocking up on medications here in Germany out of pocket or checking in with a GP for a prescription when I get back.
I would definitely stock-up on meds in Germany, if you can get them back into the US with no hassle. Without prescription coverage, blood pressure meds can cost you a fortune, depending on what they are. Even generics can sometimes be pricey.

You can certainly see an ENT without insurance coverage. You'll just have to pay out-of-pocket for the visit and any tests/labs they run. Some docs offer a discount for uninsured patients, but it's still a lot more than a copay. My doc's office visit is billed at around $110. I think they knock that down to $80 for uninsured patients. That doesn't include any in-house labwork. With your blood pressure, any new doc you go to, is going to want to run a few tests to see what he's dealing with.
     
Lateralus  (op)
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Feb 28, 2011, 04:47 PM
 
Originally Posted by Big Mac View Post
There have been some positive changes instituted at insurers as a response to ObamaCare (I can admit that), but it didn't completely change the way insurers operate and conduct business.
Good to hear. I don't pretend to understand it all myself, but it's nice to hear that there's something afoot.

A pre-emptive request for everybody that we not make this political, it's wasn't my aim but I've suspected from the moment I created the thread that this subject was at a high risk for derailment.

That said, even creating this thread is a reminder for myself of the fact that I'm now an adult. I remember just a few years ago I overheard somebody, maybe a comedian, joke about how from 25 onward problems just... start. I laughed at the time and didn't give it much thought. But I'm now heading toward 27 and I've had more doctor's visits in the past 12 months than I'd had in the 25 yrs prior (partly because I never had anything other than poor-kid Medicaid when I was growing up). From little chronic issues, some hereditary, that are either festering in a noticeable way or are the type of things that I now need to actually keep an eye on over time... to colds, flus, headaches, upset stomachs... things that now seem to be both more intense and longer lasting than I ever remember them being as a teenager.

Had my first cavities this year as well. My vision is now teetering on the point of my needing glasses to read street signs before I actually arrive at the intersection.

A year ago I honestly couldn't have given a shit about health care one way or another. Now I'm honestly scared of going anywhere without it. My issues thus far have all turned out to be be 'small', fairly manageable, and luckily mostly covered. But it's been enough of an experience(s) that I really have developed an empathy for people battling issues far more severe, whether they had any control of their coming into being or not, who are simultaneously worried frantically about whether or not their insurance will cover (and how much) and fighting the conditions.

Fun stuff.

I don't know, I just don't want to dick around. And really, insurance companies should encourage people my age to be on the ball, even if it results in a good number of visits to a GP because the alternative is that people ignore their issues and they snowball into things that cost far, far, far more to remediate later in life. And even when the insurance companies don't pick up all of the tab in those instances, the amount they do wind up covering would usually represent a higher figure than the cumulative cost of GP visits and the accompanying preventive-prescriptions earlier in the process.
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Lateralus  (op)
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Feb 28, 2011, 05:06 PM
 
Originally Posted by Thorzdad View Post
I would definitely stock-up on meds in Germany, if you can get them back into the US with no hassle. Without prescription coverage, blood pressure meds can cost you a fortune, depending on what they are. Even generics can sometimes be pricey.

You can certainly see an ENT without insurance coverage. You'll just have to pay out-of-pocket for the visit and any tests/labs they run. Some docs offer a discount for uninsured patients, but it's still a lot more than a copay. My doc's office visit is billed at around $110. I think they knock that down to $80 for uninsured patients. That doesn't include any in-house labwork. With your blood pressure, any new doc you go to, is going to want to run a few tests to see what he's dealing with.
I'm on the fence with the meds. The stuff I've been put on now here in Germany isn't your standard beta-blocker (it's something called Losartan) and even buying a bulk 3-month package of generics cost me 60 Euros out of pocket last week, which I guess isn't really that bad given... that it was out of pocket. And technically my travel insurance covers prescriptions, but I've hit them with a few thousand Euros worth of bills from tinnitus treatment to my blood pressure-cause workup (neither of which I' know for sure they'll be covering), and I really don't feel like pushing my luck further by sending them receipts for prescriptions.

I have no idea what Losartan costs in the states, but when I had proper health coverage back in the day, my beta-blocker of the time was only running me around $5/mo out of pocket.

I'll be checking a heavy wheeled suitcase on my flight back, with locks, so I assume the medications wont be a problem - particularly if I retain my prescription for them and receipts.

Bah. If only this shit grew on trees.
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Laminar
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Feb 28, 2011, 07:16 PM
 
Originally Posted by Lateralus View Post
I'll be checking a heavy wheeled suitcase on my flight back, with locks, so I assume the medications wont be a problem - particularly if I retain my prescription for them and receipts.

Bah. If only this shit grew on trees.
I'm not sure how Germany works, but in the US they warn your not to lock the bag or it will get cut. I'm assuming you'll have to go through US customs at some point and they'll typically scan your bag.
     
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Feb 28, 2011, 07:23 PM
 
I suggest calling your local hospital to see what insurance providers they will work with. As has been said here, some of those smaller health insurance providers will sell you stuff, but these packages are fairly useless if they are out of network with the hospitals you'll be hauled to with your gaping head wounds.
     
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Feb 28, 2011, 07:29 PM
 
And this assumes tinnitus and high blood pressure are not considered 'preexisting conditions' — which often means your application will be denied or be prohibitively expensive.
     
ebuddy
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Feb 28, 2011, 07:43 PM
 
Originally Posted by Lateralus View Post
I've been traveling abroad for a while but will probably be returning home soon. And before traveling, mostly due to the invincibility of my youth, I never paid much attention to whether or not I was insured. But thanks to a few 'told you so' moments while traveling, I've decided that I'd rather not be without insurance again.

And since I'm not planning on being immediately employed with benefits upon disembarking the plane, I was considering just buying 6 months or whatever or insurance on my own to get me through until I line up some stable employment.

Does anybody have any suggestions for something that doesn't suck is fairly affordable?

Thanks peeps.
As others have mentioned, without access to healthcare coupled with an employer or a larger pool of insureds, the premiums can get real pricey. The laws and minimum coverage requirements, rates, and providers can all vary considerably from state to state and you may want to check first with the small business administration office of that state. If you were going to be "lone-wolfing" it more longterm I'd suggest an HSA and compatible plan, but since you intend on seeking an employer, discriminating employers' benefits packages will likely be part of your final decision.

If you're presently self-employed, it sounds as if BigMac may have some options he's more intimately familiar with and to pool yourself with others would be a good way to go to keep costs lower if you can.
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Feb 28, 2011, 08:07 PM
 
Originally Posted by Lateralus View Post
I have no idea what Losartan costs in the states, but when I had proper health coverage back in the day, my beta-blocker of the time was only running me around $5/mo out of pocket.
Losartan (US Brand name Cozaar) just lost its patent protection at the end of 2010, which means it is now available as a generic. Expect the price to come down as more generic manufacturers start making it.

But, assuming you haven't already tried it (or one of its cousins) and it didn't work, when you get back to the States and if the cost of even generic losartan is still too high for you, you might want to ask your doctor about lisinopril as a potential replacement, since it is one of the $4 generics at the places that do that (Walmart, Target, Kroger, etc).
     
Athens
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Mar 1, 2011, 03:12 PM
 
Originally Posted by Thorzdad View Post
I would definitely stock-up on meds in Germany, if you can get them back into the US with no hassle. Without prescription coverage, blood pressure meds can cost you a fortune, depending on what they are. Even generics can sometimes be pricey.

You can certainly see an ENT without insurance coverage. You'll just have to pay out-of-pocket for the visit and any tests/labs they run. Some docs offer a discount for uninsured patients, but it's still a lot more than a copay. My doc's office visit is billed at around $110. I think they knock that down to $80 for uninsured patients. That doesn't include any in-house labwork. With your blood pressure, any new doc you go to, is going to want to run a few tests to see what he's dealing with.
Or live close to the Canadian border for access to cheaper drugs. If your on a lot of Meds and worried about a possible major medical event, you might be better off camping in Canada near the US border like in Vancouver, Windsor or Niagara and using Travel insurance here until you get your stuff sorted out in the US so your employeed and got good medical coverage. But if your going back and forth between Canada and the US a lot and something happens in the US, not sure the travel insurance would cover you in the US like your German insurance. Prob same rules.
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Mar 1, 2011, 03:15 PM
 
can you em... sort of buy a canadian passport?
     
Athens
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Mar 1, 2011, 03:22 PM
 
Originally Posted by Laminar View Post
I'm not sure how Germany works, but in the US they warn your not to lock the bag or it will get cut. I'm assuming you'll have to go through US customs at some point and they'll typically scan your bag.
I've had locks broken both times on my flights to NY. Both times my bags where a total mess. My third trip I didn't bother putting a lock on the bag and it looked like nothing was touched inside. Dont bother locking. And whatever you bring declare it and have the prescription with it otherwise you might get looked at as a trafficker and could end up going through a TON of BS to prove you’re not. My be best not to put all your eggs in one basket either. Ship half of the pills by mail and bring the other half with you on person.
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Athens
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Mar 1, 2011, 03:22 PM
 
Originally Posted by Sealobo View Post
can you em... sort of buy a canadian passport?
Why?
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Mar 1, 2011, 05:10 PM
 
Originally Posted by Athens View Post
I've had locks broken both times on my flights to NY. Both times my bags where a total mess. My third trip I didn't bother putting a lock on the bag and it looked like nothing was touched inside. Dont bother locking. And whatever you bring declare it and have the prescription with it otherwise you might get looked at as a trafficker and could end up going through a TON of BS to prove you’re not. My be best not to put all your eggs in one basket either. Ship half of the pills by mail and bring the other half with you on person.
I use one of those "TSA locks" on my luggage and I never have any issues flying domestically or internationally. Besides, I never pack anything I can't afford to lose in my checked bags so even if it does get trashed I'm not out much. Anything of value stays close to me in carry on luggage.

Also, my father goes to Greece every year for 4 or 5 months and he always stocks up on his pills before coming home. He's never had a problem coming back to the U.S. Except for that one time when his Green Card expired while he was in Greece. He had to get some "emergency travel papers" from the U.S. Embassy and I ended up waiting at the airport for almost 3 hours after the plane landed while the immigration agents grilled him. He got a new Green Card and no problems since.
     
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Mar 2, 2011, 02:24 AM
 
What is the ENT doing for your tinnitus?

If you can avoid seeing an ENT (or any specialist), you can usually save some money, especially if it can be handled by a primary care doc, although it is sometimes hard to get into one that has a full practice.

Another option is to go to an "urgent care/non-emergency care" office. It's for illnesses/conditions that don't require ER level of services. Many charge the price of a regular doctor's visit, as opposed to the cost of an ER visit.

Where do you plan to visit? That may make a difference in the type of care that is readily available.
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Mar 2, 2011, 07:22 AM
 
Is there really a treatment for tinnitus? I have had to just manage mine-avoiding "silent" locations, avoiding aspirin and excess caffeine, that sort of thing...

And in my experience, primary care docs have problems with biomechanical issues. I have honestly seen primary care providers refer people to occupational therapy for "carpal tunnel syndrome" because they had numbness in their pinkies...as if the provider never bothered to read the definition of CTS. This is probably due to high volumes of patients in situations I've experienced as both a patient and therapist (military/Tricare), but my fellow OTs have voiced very similar experiences.

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cjrivera
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Mar 2, 2011, 07:32 AM
 
Originally Posted by ghporter View Post
Is there really a treatment for tinnitus? I have had to just manage mine-avoiding "silent" locations, avoiding aspirin and excess caffeine, that sort of thing...
That's why I was wondering what an ENT is doing for tinnitus...
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Mar 2, 2011, 07:39 AM
 
Ruling out external or internal pressure? A distended eardrum can make it worse by reducing hearing acuity.

Oh, and there's a very small chance that it's a brain tumor-just before I retired from the Air Force I was told "we're going to do an MRI because in some cases tinnitus is a symptom of a tumor." For the record (and because it's about the only time I can use this quote), in my case "it's not a tumor."

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Mar 2, 2011, 10:09 AM
 
Originally Posted by ghporter View Post
Is there really a treatment for tinnitus? I have had to just manage mine-avoiding "silent" locations, avoiding aspirin and excess caffeine, that sort of thing...
It really depends on the cause. In some cases (like tinnitus caused by certain drugs), it goes away once the cause is treated. But for a lot of sufferers, there really is not an effective treatment available.

And in my experience, primary care docs have problems with biomechanical issues. I have honestly seen primary care providers refer people to occupational therapy for "carpal tunnel syndrome" because they had numbness in their pinkies...as if the provider never bothered to read the definition of CTS. This is probably due to high volumes of patients in situations I've experienced as both a patient and therapist (military/Tricare), but my fellow OTs have voiced very similar experiences.
Seriously? I'm pretty sure we're taught in medical school what the definition of carpal tunnel syndrome is and what it affects (thumb, index, and half of the middle finger)...

Perhaps it's my osteopathic medical training, but as a primary care internal medicine physician I am able to recognize the difference between carpal tunnel and a possible ulnar nerve problem, and refer to Physical/Occupational Therapy appropriately. I just wish I could convince all my patients to consider physical therapy for their carpal tunnel syndrome. I've seen more patients helped by it than not. Then it gets aggravating when they insist on seeing the orthopedic surgeon and what does he do? Send them to PT!
     
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Mar 2, 2011, 10:42 AM
 
I got my tinnitus back in November while wearing headphones. I'd been watching a video in VLC that had been encoded with really low volume for some reason, so I'd set VLC up to around 200% to compensate. Following the video, I mindlessly browsed the net for a bit before opening up a song in VLC without having closed the application, so it started to play at the 200% volume level.

The whole experience was maybe a second long, but it was enough.

After weeks and weeks and weeks of either injections, acupuncture or medications I have 'wonderful' hearing again according to my ENTs here - I test at peak pretty much across the board in both ears during my hearing tests. And the ringing has come down a lot in intensity, but it's still there.

The main problem for me is that things still seem to be extremely sensitive and set off easily. More specifically, the ringing in my right ear had gone away completely within a week of my initial headphone accident. But a few weeks ago I was walking around Munich taking photos and came across a loud political rally, and made the mistake of standing there for about 5 minutes to get photos. Almost as soon as I walked away I'd noticed that my right ear was ringing. By the end of the night, I was in absolute hell as both ears were on the fritz.

I'm just terrified at the moment. If the tone were stable and less affected by external shit, I could more easily learn to deal with it. But it feels like I'm constantly walking on egg shells in a society that has a fetish for loud noise. I still can't wear headphones, even at low volume, without settings things off. I took a cab ride home last week late at night, and I'm fairly sure that the decently loud music the driver was playing was responsible for the massive hissy fit my ringing threw in the middle of that night.

Every time it happens, I take a fair dose of something called pentoxifylline and it works within hours. It's something that I get prescribed here.

Also; there seems to be a different perception of tinnitus here in Europe. Because from what I've read, it's very quickly deemed permanent in the US. But my doctors here said there's every chance it will go away in months since there doesn't seem to be any corresponding damage or permanent hearing loss.

I have no idea what to believe though. I've told my doctors not to bullshit me, and they swear they're confident in their cautious optimism about the long term.

I don't know. It's just hell. Ambient noise takes the edge off, obviously, but that doesn't help when you put your head to your pillow at night.
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