Do we dare discuss the Supreme Court decision re: Healthcare

[Lady's Human]

The thing that really bothers me is that they (the government) have made a royal mess of every program they control: Social Security, a mess; Medicare, a mess: Medicade, a mess; Welfare, a mess; food stamps, a mess, etc. Why on earth should we believe this new program will be any different when they can't even make those work?

Or maybe they plan on combining all those messes into this new Health care program for one gigantic ginormous mess?

And the current system is wonderful how?

It can't stay as is, billing is a labyrinthine mess. SOMETHING has to change. I don't see this as a cure all, but it may start a serious discussion, rather than a discussion with the various sides trying to score points for the PR Grist mill.

[Lady's Human]

BTW, as a political aside.....

Anyone who thinks Gov. Romney is going to repeal ACA needs to look at the man's history as governor.

First, this bill is largely based on the plan he enacted in Massachusetts.

Second, this is a man with no convictions whatsoever.

He was for health care reform, but now he's against something he fought for in MA?

He enthusiastically signed the Massachusetts Assault Weapons Ban, but now goes to the NRA convention as the keynote and speaks on second amendment rights?

His only conviction is that he belongs in the Oval office. Beyond that, the man has NO core beliefs.

[RICHARD]

BTW, as a political aside.....

Anyone who thinks Gov. Romney is going to repeal ACA needs to look at the man's history as governor.

First, this bill is largely based on the plan he enacted in Massachusetts.

Second, this is a man with no convictions whatsoever.

He was for health care reform, but now he's against something he fought for in MA?

He enthusiastically signed the Massachusetts Assault Weapons Ban, but now goes to the NRA convention as the keynote and speaks on second amendment rights?

His only conviction is that he belongs in the Oval office. Beyond that, the man has NO core beliefs.

Mexico has a new president.

I may move down there.

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I spoke to a friend (Yes I have friends) that works at a large hospital, It rhymes with Best Wirginia and she's not really enthused about the new act.

(Do they call it an act because it has a certain pretend factor associated to it?)

I am all for EVERYONE HAVING insurance, but what bothers me is the cost to everyone.

If you drive a Cadillac and you buy the cheapest insurance to drive it around?

Great. But if you need to take it in for service and your insurance company says you have to go to a Yugo dealership to have the work done?

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I had an accident on my motorcycle and the insurance company was adamant that I take it to the dealership where I purchased it.

I had to take my rice grinder to a Harley Davidson mechanic (The dealership was sold to an H-D group) and while they did a good job of fixing it?

When I showed up at the door, these guys didn't want to even touch the bike because it was Japanese. They also jacked up the price of the parts and labor.

The fix was more than the bike was worth.

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Everyone should be able to go to the doctor and 'be fixed'.

The same people who really want this law/act/initiative enforced are the people who have insurance.

They are also the people who do not want to be tracked by their shopping cards, emails or the government.

Yet, it's OK for the government to tell others they must buy insurance and they will tell you what plans they will subsidise so you can be in accord with the law?

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Go check out what the prices are just to see a doc, then go to another and another.

Yugos, Volkswagons and Mercedes prices are what you are going to see.

Instead of setting guidlines against gouging the system and setting prices for basic services?

We get a totally screwed up law put into effect that people are already trying how to figure out how to scam it.

Look at Medicare fraud.

The FBI broke up a So Cal gang that scammed 100 MILLION dollars from the FED/MEDICARE system.

100 million is a drop in the bucket compared to the yearly amounts spent for healthcare.

But think of the lives that could be impacted by that amount of money.


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Look past the "Affordable Health Care Insurance".

Why not "Affordable Health Care" or "Health Care Cost Initiative"?

You can get all the insurance, affordable insurance you want.

That does not guarantee you will get good care.

HC guarantees you will be seen or have access to a physician.

It does not mean he/she will be able or willing to give you the best possible care. Access to costly tests/exams are going to determine exactly how you are treated.

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It going to be a giant party where the word is going to be "Free Liquor".

People will flock and when they come inside they'll see that some people will get beer, the good stuff will be served in the back, where not all of us are welcome.

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The MIttster probably isn't the best bet for running the US, I'd much rather have someone with the idea or would try to reform the system first and not to try and push everyone into an elevator car that has strict load and occupancy limits.

It ain't going to work.

[momoffuzzyfaces]

And the current system is wonderful how?

It can't stay as is, billing is a labyrinthine mess. SOMETHING has to change. I don't see this as a cure all, but it may start a serious discussion, rather than a discussion with the various sides trying to score points for the PR Grist mill.

Never said it was wonderful, quite the opposite. They are going to take something already a mess and make it worse.

[smokey the elder]

I don't know if this is directly related to the ongoing debate, but one big problem with medical care is: try getting a quote for something you want done. Say, a knee replacement. GOOD LUCK! Every other product or service I can think of has the prices transparent. I reckon if people knew what they were paying, they could decide if they are getting what they pay for. If someone wants to buy a Kia and sees a Cadillac price, they know right away something's not OK. No such "common lore" exists, AFAIK, in health care prices.

[Cataholic]

I don't know if this is directly related to the ongoing debate, but one big problem with medical care is: try getting a quote for something you want done. Say, a knee replacement. GOOD LUCK! Every other product or service I can think of has the prices transparent. I reckon if people knew what they were paying, they could decide if they are getting what they pay for. If someone wants to buy a Kia and sees a Cadillac price, they know right away something's not OK. No such "common lore" exists, AFAIK, in health care prices.

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

[Randi]

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

Of course the charge should be what the charge will be, not what they can "get out of it"! Anything else sounds like a banana republic.

[RICHARD]

Ind. woman accused of embezzling $300K from pet insurance firm
THE ASSOCIATED PRESS
First Posted: July 04, 2012 - 4:01 am
Last Updated: July 04, 2012



JEFFERSONVILLE, Ind. — A southern Indiana woman faces dozens of forgery and theft charges alleging that she embezzled more than $300,000 from a pet insurance company.

Christina Heaven of Jeffersonville has been charged with 59 forgery and theft counts accusing her of embezzlement from PetFirst Healthcare. Her trial is scheduled for November.

The Courier-Journal of Louisville, Ky., reports (http://cjky.it/O25Yra ) the 35-year-old Heaven was an administrative worker at the Jeffersonville company. She's accused of using her boss's social security number to open a secret checking account in the PetFirst name with a credit card account in 2010.

Heaven allegedly deposited checks from PetFirst customers totaling $314,723 into that checking account and then withdrew $293,703.


Brandon Smith, one of Heaven's attorneys, urged the public "not to rush to judgment before the evidence is available."


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This would NEVER happen to a human insurance company.....

[Karen]

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

Unless you have some really obscure plan, the person who handles the billing ought to be able to tell you that right away, or with a quick search on his or her computer! Sheesh!

Just today, I was on the phone with an insurance company. In May, as you know, I ended up having my gall bladder removed. Good riddance. But part of that was, my primary care's office suggested I go to a nearby Urgent Care place, as they didn't have anyone who could see me that afternoon. So I dutifully looked up where it was, went there, and briefly saw a doctor, who told me they didn't have any ultrasound available there, so it was most likely my gall bladder, but I would go to the Emergency Room at the hospital. They had taken all my information, and said they'd call, and let them know to expect me. Before I left, I said, "Now, before I leave, don't I owe you a co-pay?" I was in pain, yes, but still had the presence of mind to inquire. "Na," I was told, as we couldn't really do anything for you, so go on ahead, you don't owe anything." I asked if they were sure, they said yes, and onward I went.

This week, more than a month later, I got a bill for $15. That's my copay, I KNOW that amount. I had no problem paying it, just would have preferred to get it over with while I was there the first time! Instead, they had to wait, generate paperwork, bill my insurance company for the whole amount, figure out there was $15 the insurance didn't pay, and send me a bill for that. And have someone available to answer the phone when I called to ask, "What the heck?" Talk about a waste of everyone's time and money!

[Edwina's Secretary]

Unless you have some really obscure plan, the person who handles the billing ought to be able to tell you that right away, or with a quick search on his or her computer! Sheesh!

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

[Lady's Human]

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

This in a nutshell, is a huge fault with the current system.

It's why people wind up in bankruptcy for medical bills, hard to plan when you have no earthly idea what your expenses are going to be beyond some very, very vague guidelines, further exacerbated by the contractor shell game. (Well, yes, all our staff are PPO for your insurance, however, Dr XYZ isn't part of our staff, he/she contracts with us through Dewy, Screwem and Howe, and therefore aren't part of our PPO group. hat do you mean you didn't realize what you were agreeing to while you were in excruciating pain? We have your signature, it's valid.)

[cassiesmom]

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

I learned something very interesting when I worked for a company that paid its own claims. The claims are generally paid in the order they arrive. So if a big bill gets to the carrier and you haven't met your deductible, they will apply it toward your deductible. Then the next one that comes in might be paid because you met the deductible with the previous huge one. It was a bugger for people who were reaching their policy maximum because the providers who got their claims in first got paid, and the ones who dragged their feet got denied because the member had met their policy maximum. I've also worked for two Fortune 500 health plans and I can say with certainty that it's a huge help if you are familiar with your plan - deductible, co-pay, out of pocket and all that stuff. Someone from the physician's office can call the 800 number but they frequently have to plow through a lengthy menu of phone prompts to get the information they need.

I had a high-deductible health plan for a little while. It was expensive but relatively easy to manage- I paid for everything and submitted claim forms. I think the Affordable Care Act is going to have more people confused and uncertain about their coverage and benefits for awhile until the payors and providers figure out what the laws require, and it all gets sorted out.

This in a nutshell, is a huge fault with the current system.

It's why people wind up in bankruptcy for medical bills, hard to plan when you have no earthly idea what your expenses are going to be beyond some very, very vague guidelines, further exacerbated by the contractor shell game. (Well, yes, all our staff are PPO for your insurance, however, Dr XYZ isn't part of our staff, he/she contracts with us through Dewy, Screwem and Howe, and therefore aren't part of our PPO group. hat do you mean you didn't realize what you were agreeing to while you were in excruciating pain? We have your signature, it's valid.)

This is how we used to coach patients to respond to the contractor shell game. Say to the provider: No no no no. That was emergency department care. Payable at in-network level under prudent layperson rule. I want Dr. XYZ's care to continue to be paid at the in-network level for continuity of care purposes. What do I have to do to make sure that's done? What else can you do to help me get that done?
Then call your insurance. If you contact the payor yourself they might send the claims back for reprocessing at the higher level. The squeaky wheel gets the oil, so squeak!.