Government run health care

[pomtzu]

So I hope that answers your question and if not well it's how I feel and that is that.[/FONT]

No - it doesn't answer what I asked, but I'll not pursue it further.

[Cataholic]

But that is true with "private" insurance as well. My Explanation of Benefits show the "full price", the discount price my carrier has negotiated, the amount they will pay and what I must pay.

The difference and there is always a difference - is "lost" as you say.

When I see my PCP doctor my copay is a percent of what the insurance covers. As the doctor does not know how much this is...I pay nothing at the time. My doctor send the bill to the insurance company - they decide what they will pay - send that back to my doctor and them he must send me a bill for my percent of the bill.

I have tried to pay something at the doctor's office but it cannot be done that way. I must wait...and so must my doctor!

We switched, once again, health plans. LOL, same deal- way less coverage for much higher premiums. They pay the first $2000, I pay the next $3000. Yeah, I was at that $3000 figure by May. May! Anyhow, I went into my doctor for what I KNEW was a sinus infection. Knew it, knew it, knew it. Of course, antibiotics were prescribed. As I left, I asked for a copy of my bill, so that I could maintain my own records at home as to the $3000 payments. The clerk said she had NO IDEA WHAT THE CHARGE WAS! I was stunned. I just had a service at an established doctor's office and they couldn't tell me what my bill was ? WTH? I stared at her, and she said just what ES said, and that I would get a bill within 8 weeks. LOLOL. CRAZY!

[Edwina's Secretary]

Her is an example of how my employer provided - yet still expensive insurance works. We have met our deductible (we must each pay the first $500 of expenses.) This doctor submitted a charge of $104.27. Cigna discounts that to $64.97. Coverage is 80% so Cigna pays $51.98. I am responsible for $12.99.

Who pays the $39.30 between what the doctor charged and what Cigna and I paid?

Don't know. I could be cynical and say the doctor's charge was higher knowing there would be a +60% discount applied but I don't know that.

But the situation Grace described with her diabetes supplies is the standard operating procedure of PPO coverage.

[sasvermont]

Although I have never worked in a doctor's office, my best friend manages an office of a surgeon. Yes, they (the doctorS) submit a number for reimbursement, assuming they will get a portion of the amount billed. Each insurance company has their own little payment schedule as to how much some service is worth. So, yes, the doctors pad their bills, knowing they will get less. Not much different than car dealers starting at a higher price and taking what they get in the end.

I also know that the different insurance are noted for rejecting claims by doctors... giving them a hard time....but in most cases, after contacting the company, the payment is made to the doctor. Cigna has the worst reputation for rejecting doctors' and patients' claims.

I don't think the doctors misrepresent what they have done, as much as they bill the max and hope for the best.

I also know that the doctors' medical malpractice insurance carrier audit the doctors for billings, note taking, procedures, etc. I am not sure how often Medicare/Medicaid does audits.

I would like to believe that doctors are not so guilty for padding bills - hospitals and nursing homes are another story.

All that said, I really don't have any first hand information. Just second hand.

[Edwina's Secretary]

Cigna and Aetna are two I would rather not have. I am sure they differ across the country but they still would not be my choice.

However, I don't really get a choice. It is what my employer or my husband's employer decides to offer.

And...as Cataholic points out - that can change. I have a client that has BCBS right now. A 12% increase this year so the broker is getting quotes from other carriers. If it changes - it is possible covered employees and their families will have to change doctors as well. Especially if it is a different HMO.

[Miss Z]

Please explain that sentence.

I am sitting here, stunned.

And give me an example-I'm stripping my brain thinking about this.

Stunned? It's medical fact. Not like it's my opnion, or anything.

To echo ES, I don't understand how you don't know this if you indeed worked in a medical environment, but I'll explain it for you anyway.

Pathogens, bacteria in particular, undergo mutation in a number of their population. The change in their genotype may give them an immunity to the effects of a drug. Most of the time, it doesn't. But sometimes it does.

Under normal circumstances, i.e. without the presence of drugs, the typical strains and the mutated, resitant organism live alongside each other, in the ileum, for example. The strains compete with one another to survive. In these conditions, the resistant organism have no advantage over the typical strains, and it is highly likely that the resistant organism will die out. Thus, it's resistant gene is lost.

However, introduce a drug into the environment. All the typical strains are destroyed, but the resistant organism remains. It now has no competition and is able to reproduce quite happily, each of it's daughter cells carrying this saving grace gene. The drug administered is rendered useless against the pathogen. The pathogen spreads to other people and now we have nothing effective to fight it.

That is how natural selection works - a change in the environment favouring a particular genotype, causing extinction and evolution.

The more drugs that are being exposed to the pathogens, the better conditons we are providing for much more dangerous strains. Plus, many bacteria are able to exchange genetic information via plasmids, or indeed their own DNA, to other species of pathogen, so the resistance genes are not limited to only one condition.

An example? Staphylococcus aureus! S.Aureus is present in your respiratory system and on the surface of your skin right now. Occasionally, it will cause a mild throat infection. At first, we treated it with penicillin, as pencillin was the wonder, cure-all drug at that time. Before long, penicillin no longer worked. At that time, no one really knew why.

Then this condition was treated with methicillin. It was oversubscribed as people wanted to keep popping these pills everytime they felt a bit hoarse. So we get methicillin-resistant staphyloccocus aureus. The first MRSA.

So then we're in a bit of trouble, and combat MRSA with vancomycin. We can't find anything else to administer but vancomycin. The inevitable happens. Now the most dangerous form of MRSA is Multiple Resistant Staphylococcus aureus.

So, again, it is practically and morally wrong to oversubscribe drugs.

[Edwina's Secretary]

It makes you wonder, SAS, who pays rack rate or whatever the non-discounted rate is called. The uninsured? Those with the old style indemnity plans?

I looked at a new product - high deductible - sounds like Jo has a version of this. Like the concept but couldn't get comfortable with it...will people with this type of plan pay rack rate?

And imagine a doctor's office trying to keep track of all these different plans ahd how they work and what they pay!

Must be a nightmare.

[RICHARD]

Stunned? It's medical fact. Not like it's my opnion, or anything.

To echo ES, I don't understand how you don't know this if you indeed worked in a medical environment, but I'll explain it for you anyway.

Pathogens, bacteria in particular, undergo mutation in a number of their population. The change in their genotype may give them an immunity to the effects of a drug. Most of the time, it doesn't. But sometimes it does.

Under normal circumstances, i.e. without the presence of drugs, the typical strains and the mutated, resitant organism live alongside each other, in the ileum, for example. The strains compete with one another to survive. In these conditions, the resistant organism have no advantage over the typical strains, and it is highly likely that the resistant organism will die out. Thus, it's resistant gene is lost.

However, introduce a drug into the environment. All the typical strains are destroyed, but the resistant organism remains. It now has no competition and is able to reproduce quite happily, each of it's daughter cells carrying this saving grace gene. The drug administered is rendered useless against the pathogen. The pathogen spreads to other people and now we have nothing effective to fight it.

That is how natural selection works - a change in the environment favouring a particular genotype, causing extinction and evolution.

The more drugs that are being exposed to the pathogens, the better conditons we are providing for much more dangerous strains. Plus, many bacteria are able to exchange genetic information via plasmids, or indeed their own DNA, to other species of pathogen, so the resistance genes are not limited to only one condition.

An example? Staphylococcus aureus! S.Aureus is present in your respiratory system and on the surface of your skin right now. Occasionally, it will cause a mild throat infection. At first, we treated it with penicillin, as pencillin was the wonder, cure-all drug at that time. Before long, penicillin no longer worked. At that time, no one really knew why.

Then this condition was treated with methicillin. It was oversubscribed as people wanted to keep popping these pills everytime they felt a bit hoarse. So we get methicillin-resistant staphyloccocus aureus. The first MRSA.

So then we're in a bit of trouble, and combat MRSA with vancomycin. We can't find anything else to administer but vancomycin. The inevitable happens. Now the most dangerous form of MRSA is Multiple Resistant Staphylococcus aureus.

So, again, it is practically and morally wrong to oversubscribe drugs.

WTF, do you think that I would say I didn't understand the "natural" albeit drug "engineered", pathogens?

Duh, I could have given you the "Pathogens are for Dummies" spiel.


I was looking for YOUR spin on the morality and "practically" of over PRESCRIBING of drugs.


Do you mean it's practically immoral?


If it's immoral and unpractical to overprescribe drugs that cause mutating pathogens, next time you go to the doctor, tell him to shove the prescription.

--------------------------

I wonder what immorality and 'practically' the physician, who gave my mom chemo therapy in a last ditch effort to keep her alive, was trying to perpetrate on her being. As our esteemed president alluded to before?
He may have wanted to keep her alive so he could make more money.


One thing that people are very shy and ignorant about is asking what meds they are give post-office visit. The physician will ask you about what you are allergic, what meds you already take and then he will prescribe you a med as he sees fit.

Yes, some doctors will prescribe front line meds because they are wont to give out the generics bcause the pharm companies have them in their pockets.

LOLOLOL,

Ask a physician/doctor/surgeon how many people do not give a flying shiat about WHAT they are given to take for their ills.

Some of them ask about the cure/meds they saw on House or Scrubs.


You say Toe may toe, I say flesh eating bacteria, "Doctor, save my life".

[Miss Z]

Oh goodness – here's the dummy back, I think you must have thrown it out your pram.

You know, RICHARD, I used to love your posts, as witty and as crazy as they were. You had such a way with words.

Now, when every other word is “shiat”, “crap”, “arsed”, “turd”, “BS” and a hundred and one other abbreviations that make trying to understand what you’re actually saying verging on the impossible, half the time I can’t be bothered to waste my energy on them.

Perhaps if you’d been clearer with your question, I could have answered it for you in the manner you desired. Evidently, I wasn’t the only one who didn’t understand what you were asking, as ES also took it to mean that you didn’t get the science behind superbugs.

Do you mean it's practically immoral?

No, obviously, that’s why I put an ‘and’ in between.

• Practically – in practice.
• Morally – well, if a medic has morals, then s/he works for the prevention of suffering due to disease. That doesn’t mean they dispense everything from flucloxacillin to fairy dust just to keep the patient happy. For yes, that is immoral.

If it's immoral and unpractical to overprescribe drugs that cause mutating pathogens, next time you go to the doctor, tell him to shove the prescription.

Pfft. Get over yourself. That wasn’t what I was saying and you’re blatantly aware of that.

If you need treatment, then you need it, no two questions about it. But, if people visit the doctor and expect to be prescribed something, then THAT is where the problem lies.

Gah, I thought you said you understood this. Drugs don’t cause mutations in pathogens. They’re happening all the time, regardless of what is happening around them. Drugs provide ideal environments for mutated strains.

Well, even if you didn’t need the biology lesson, it did me good. I’m applying for Vet. Med. this winter. At least I got a revision session out of it.

[lizbud]

It seems to me you won't have a bit of trouble with your future studies.

[Edwina's Secretary]

You know, RICHARD, I used to love your posts, as witty and as crazy as they were. You had such a way with words.

Now, when every other word is “shiat”, “crap”, “arsed”, “turd”, “BS” and a hundred and one other abbreviations that make trying to understand what you’re actually saying verging on the impossible, half the time I can’t be bothered to waste my energy on them.

You forgot "AH" "FW" "effing" "Effs" Really likes "Eff"

and my new favorite..."POS". I had to ROLFLMAO on that one. Most people that means Point of Sale.

For the life of me I cannot figure out FW.....

[RICHARD]

Oh goodness – here's the dummy back, I think you must have thrown it out your pram.

You know, RICHARD, I used to love your posts, as witty and as crazy as they were. You had such a way with words.

Now, when every other word is “shiat”, “crap”, “arsed”, “turd”, “BS” and a hundred and one other abbreviations that make trying to understand what you’re actually saying verging on the impossible, half the time I can’t be bothered to waste my energy on them.

Perhaps if you’d been clearer with your question, I could have answered it for you in the manner you desired. Evidently, I wasn’t the only one who didn’t understand what you were asking, as ES also took it to mean that you didn’t get the science behind superbugs.




No, obviously, that’s why I put an ‘and’ in between.

• Practically – in practice.
• Morally – well, if a medic has morals, then s/he works for the prevention of suffering due to disease. That doesn’t mean they dispense everything from flucloxacillin to fairy dust just to keep the patient happy. For yes, that is immoral.

Pfft. Get over yourself. That wasn’t what I was saying and you’re blatantly aware of that.

If you need treatment, then you need it, no two questions about it. But, if people visit the doctor and expect to be prescribed something, then THAT is where the problem lies.

Gah, I thought you said you understood this. Drugs don’t cause mutations in pathogens. They’re happening all the time, regardless of what is happening around them. Drugs provide ideal environments for mutated strains.

Well, even if you didn’t need the biology lesson, it did me good. I’m applying for Vet. Med. this winter. At least I got a revision session out of it.

So, you cut and pasted your answer about pathogens?

Look,

If you want to talk about bio/physio and anatomical stuff o.k.

If a medic has morals? That's pretty much a slap in the face of all docs out there. THey have to deal with morals more times than I would or could.....
Your mileage may differ.

I've had fairy dust, but the flucloxacillin I'd have to check out the PDR to see what that is-either that or pick it off of a website or school paper. Psst, do they teach pharmacology in regular school.


Drugs don't cause mutations?

Why do pathogens mutate and become resistant to the compounds in medicines?

Here's another question.

THINK about this one.

Drugs are ideal enviroments for mutated strains, but they are not the cause of mutated strains?

So, if you go into a lab with an MS and you add a drug to it, It will grow larger?

Wouldn't the strain have to mutate to feed or grow in the "ideal enviroment"?
And why would a moral physician give a compound that would help a pathogen grow in this ideal enviroment?

Dude,

I was over myself a while back, apparently you are way more mature than I am, so pardon me whilst I go back to my meager existence.
If I have get over myself, I'll lend you my high jump pole. The women's record is 6.6 meter and was set last month.

Read up on the published writings of Dr Leonard Kokintz.

[Edwina's Secretary]

apparently you are way more mature than I am,

Finally...you post something with which I agree!

[Marigold2]

You are correct it can be a nightmare to keep track of all the claims, rules etc. It's what I do for part of the day.
Why do Dr's in Ohio like Medicare because they pay the Dr well? They are one of the highest paying plans, and you have a year to submit claims where with United Health you have 90 days to collect your money.
Here in Ohio Medicare patients have no copay, most that I talk to love their insurance. Most here have a secondary I would say 97% do, either AARP, Medicaid, BCBS etc.
Knowing what your insurance covers is important.
I do not understand however how the office staff could not know what you were billed for, it's all coding which is universal throughout the US and. 367.1 means you are near sighted. 365.10 means gluacoma no matter what state you are in.
And yes we do have to wait for the insurance company to process the EOB, on it is the following info. Your copay, your deductable, the allowed amount, the amount to be written off, why it might have been denied and YES you should also recieve a copy from the insurance company with the same info. If you have questions, pick up the phone and call the insurance, you pay for it and it is there to protect you.
It is not the Dr's responisbiltiy to know your deductable or your benefits, it is yours. There are thousands of companys out there and each is a bit different.
However things are now changing and we will soon be able to look on-line at your info before you walk into the office. If you have not met your deductable and the office visit is $200.00 you will be expected to pay that up front or to make arrangements for a payment plan. Dr's have a hard time collecting from many people and this will change that. You cannot go into a grocery store or gas station and get the products and say bill me, soon you won't be able to do that at the Dr as well.
I hope Obama gives all Americans decent health care no matter how you slice it we all deserve that. I also hope that we take better care of ourselves if possible so that we may avoid or slow down heart disease, diabetes, high blood pressure and many other illness that come with a not so healthy lifestyle.

It makes you wonder, SAS, who pays rack rate or whatever the non-discounted rate is called. The uninsured? Those with the old style indemnity plans?

I looked at a new product - high deductible - sounds like Jo has a version of this. Like the concept but couldn't get comfortable with it...will people with this type of plan pay rack rate?

And imagine a doctor's office trying to keep track of all these different plans ahd how they work and what they pay!

Must be a nightmare.

[Miss Z]

So, you cut and pasted your answer about pathogens?

Oh, how you must underestimate my intellect so! You cannot revise by cutting and pasting. Google my words, if you so desire, you will find that they are my own.

As for the next bit...

Psst, do they teach pharmacology in regular school.

A little. But, because I am just curious like that, I often do a little reading around the topics we're given simply to pass exams.

Drugs don't cause mutations?

Why do pathogens mutate and become resistant to the compounds in medicines?

Here's another question.

THINK about this one.

Drugs are ideal enviroments for mutated strains, but they are not the cause of mutated strains?

You say that you could have given me a 'Pathogens for dummies', and yet you don't know how this works?

No. I have read of one obscure protozoan responding directly to drug treatment, though.

Mutations arise as a fault in copying of the DNA the vast majority of the time.

An organism cannot think 'Hang on, these conditions are kind of killing me today, better mutate fast!' It dies. IF a mutation has arisen that gives the organism an advantage, it may well survive.Again, natural selection driving extinction and evolution.

You cannot stop it happening, but you can decrease the occurences by administering less medication.

If you don't believe my biology, that's cool. All I can say is that I managed to score in the top ten points in my AS level, and I was able to get on a course, specifically on this kind of stuff, of the top twenty or so young biochemists in the country - so somewhere along the lines, I must be doing something right!