Healthcare Survey

Take our Citizen Action healthcare survey to help us fight back against the big health insurance companies and healthcare providers (e.g. clinics, hospitals) that are hurting everyday people seeking care.

We need to hear about your experiences to help us shed light on just how many people are being treated unfairly and even in some cases, unlawfully. Many healthcare consumers don't know why they are receiving large bills after a medical appointment or procedure as the medical complex hides behind an intimidating system of billing, codes and approval protocols.

Citizen Action's Healthcare Co-op is a group of fed up consumers and community leaders many of whom work in the medical field,who decided to band together to help shed light on exactly how big of a problem this is. We plan to raise awareness of several issues and hopefully save some lives in the process.

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Contact Information

First Name Last Name

Postal Code City State/Province

Email Home Phone (Optional)

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(Optional)

Survey

1. How do you receive your medical coverage?
1. How do you receive your medical coverage? is required.

Through an employee sponsored plan

I purchased my own plan on the healthcare marketplace (ACA, OBAMACARE)

I am covered by BadgerCare or Medicaid

I am covered by Medicare (65 and older)

I pay out of pocket directly to provider as needed

if other, please explain. if other, please explain. (Optional)

2. Have you ever received an unexpected medical bill after a doctor's appointment?
2. Have you ever received an unexpected medical bill after a doctor's appointment? is required.

yes

no

3. Have you ever received an unexpected medical bill after a recommended preventative health screening ie. mammogram , colonoscopy?
3. Have you ever received an unexpected medical bill after a recommended preventative health screening ie. mammogram , colonoscopy? is required.

yes

no

4. Have you ever received an unexpected bill from your clinic or hospital and were told it was because one of the healthcare professionals did not have a contract with the hospital/clinic?
4. Have you ever received an unexpected bill from your clinic or hospital and were told it was because one of the healthcare professionals did not have a contract with the hospital/clinic? is required.

yes

no

5. If you answered yes, to the last two questions, please explain the circumstances of the unexpected bill. (Optional)

6. Have you ever delayed a medical appointment, medical follow up or a preventative screening because you were afraid of an unexpected medical bill not including your co-pay?
6. Have you ever delayed a medical appointment, medical follow up or a preventative screening because you were afraid of an unexpected medical bill not including your co-pay? is required.

yes

no

7. Have you ever delayed an appointment because of the co-pay?
7. Have you ever delayed an appointment because of the co-pay? is required.

yes

no

If yes, how much was the co-pay? If yes, how much was the co-pay? (Optional)

8. Have you ever been told you have dense breast tissue and in need of additional imaging during your mammogram? (Optional)
8. Have you ever been told you have dense breast tissue and in need of additional imaging during your mammogram? is required.

yes

no

9. Have you ever been told your breast cancer screening was considered diagnostic and not preventative because of a past medical history? (Optional)
9. Have you ever been told your breast cancer screening was considered diagnostic and not preventative because of a past medical history? is required.

yes

no

10. If you have had any other disputes with either your health insurance or health provider (e.g.clinic, hospital), not discussed or questioned in this survey, please tell us about them. (Optional)

11. What insurance company are you having issues with e.g. Blue Cross, Humana, United Healthcare (Optional)

12. What healthcare system are you having issues with? Ascension, Froedert, Aurora, etc. (Optional)

13. If you have insurance through your employer, is it self-funded? A self-funded is one in which the employer assumes the financial risk for providing health care benefits to its employees. Typically, larger companies self-fund. (Optional)
13. If you have insurance through your employer, is it self-funded? A self-funded is one in which the employer assumes the financial risk for providing health care benefits to its employees. Typically, larger companies self-fund. is required.

yes

no

I am not sure

14. What is the best way we can follow up with you?
14. What is the best way we can follow up with you? is required.

Email

Phone Call

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