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BonMallari
09-18-2012, 06:20 PM
Never thought it would happen to me...I thought I had a "cadillac" insurance policy...but I was at my cardiologist this morning for a routine bi annual follow up after taking an EKG and routine blood tests last month...after signing in the receptionist informs me that they no longer accept my Culinary Union insurance, but I could opt to pay the 250 office visit fee...WTH

Don't know if I should be mad at my union for not listing my doctor as an approved provider, my doctor for not agreeing to whatever my insurance pays....or the real culprit...the looming shadow of the Affordable Care Act...

had my cardiologist for almost 4 years...good thing that one of my brother's friend/classmates is the chief of cardio thoracic at one of the new hospitals and was able to get me a referral right away.....it raised my BP up a bit but luckily I just got those prescriptions renewed last month

has anyone else experienced this yet ( your physician dropping your insurance carrier)...our insurance carrier is the second largest in the state (next to VA) and my cardiologist is a member of one of the largest Health Care providers in the state...Guess this is what we all have to look forward to if they cant repeal Obamacare when Romney gets elected

gmhr1
09-18-2012, 06:31 PM
Surprise surprise hello Obamacare . My premiums just went up! I thought Obama said if you liked your Dr you could keep him nothing would change do you think he lied to us again?
Just found out today that two of our Drs have decided to quit.

charly_t
09-18-2012, 08:15 PM
I don't want to hi-jack this thread but.............docs here are just closing their office and going to work in a clinic somewhere else. Lost my health records that way. They got shipped to state office and stored ! Lady there refused to give any of them to me. I finally talked to a "legal being" and told her I had. She sent part of those records. Just a "heads up" grab your files before they travel.

gmhr1
09-18-2012, 08:19 PM
But Obamacare is supposed to be a good thing, nothing will change if you like your Dr keep him, if you like your insurance keep it, we are all in big trouble.

Franco
09-18-2012, 08:35 PM
Never thought it would happen to me...I thought I had a "cadillac" insurance policy...but I was at my cardiologist this morning for a routine bi annual follow up after taking an EKG and routine blood tests last month...after signing in the receptionist informs me that they no longer accept my Culinary Union insurance, but I could opt to pay the 250 office visit fee...WTH

Don't know if I should be mad at my union for not listing my doctor as an approved provider, my doctor for not agreeing to whatever my insurance pays....or the real culprit...the looming shadow of the Affordable Care Act...

had my cardiologist for almost 4 years...good thing that one of my brother's friend/classmates is the chief of cardio thoracic at one of the new hospitals and was able to get me a referral right away.....it raised my BP up a bit but luckily I just got those prescriptions renewed last month

has anyone else experienced this yet ( your physician dropping your insurance carrier)...our insurance carrier is the second largest in the state (next to VA) and my cardiologist is a member of one of the largest Health Care providers in the state...Guess this is what we all have to look forward to if they cant repeal Obamacare when Romney gets elected

Two years ago Blue Cross/Blue Shield was at odds with the my Cardiologist's group. It took them a while to settle as to what the doctors would accept and what Blue Cross would pay. All the while the Cardio group kept the co-pay at $60.

I was there two weeks ago for my bi-annual checkup and blood analysis. Everything luckily for me was in order; bad cholestrol was low, triglisirides(sp)good and blood pressure normal. That's what eating Boudin and Craklins for breakfast will do your you, clear the arteries.;)

I asked him about how Obama carewill affect me and my relationship with the Cardio Clinic. He said it wouldn't. Then he reminded me how much a stint procedure cost me in 05 compared to 2012, something we had talked about earlier. He said that another stint procedure, if I needed one in the future should cost less! I was in shock.

BonMallari
09-18-2012, 08:46 PM
Two years ago Blue Cross/Blue Shield was at odds with the my Cardiologist's group. It took them a while to settle as to what the doctors would accept and what Blue Cross would pay. All the while the Cardio group kept the co-pay at $60.

I was there two weeks ago for my bi-annual checkup and blood analysis. Everything luckily for me was in order; bad cholestrol was low, triglisirides(sp)good and blood pressure normal. That's what eating Boudin and Craklins for breakfast will do your you, clear the arteries.;)

I asked him about how Obama carewill affect me and my relationship with the Cardio Clinic. He said it wouldn't. Then he reminded me how much a stint procedure cost me in 05 compared to 2012, something we had talked about earlier. He said that another stint procedure, if I needed one in the future should cost less! I was in shock.


I am hoping that is the case with my Cardiologist, should have known my $27 co pay wouldnt last forever

I know for a fact that most if not all the procedures that are covered at my brother's practice are going nowhere but up..the bureaucratic red tape is unbelievable...He has been using state of the art cold laser and other frequency modulation machines that have still not been cleared for payment by insurance carriers, so many of his patients just pay the fees out of pocket....good thing the accupuncture needles are a low cost item...if they ever allow him to practice on the road at FT's he could probably pay for his weekends with his patient list alone

Wayne Beck
09-18-2012, 09:03 PM
Thats ok. I was just denied coverage by a new health insurance coverage. This was all based on info i gave them plus the info they already had since I went from a group policy to an individual policy. I think in the last 5 years ive been to the dr maybe 10 times. had the flu twice, a couple of sinus infections and a few physicals. im 37 in decent health.. My only major problems are this time last year i was 330 pounds and now i am 240(im 6'2).. i had a heel spur act up in april and last month i got hit in the face with a piece of wood that kicked out of the wood chipper.. Im perfectly fine.. In fact im in better shape physically now than i was when i was 18.. I called to find out why and they danced around the answer with the standard HIPPA crap.. They told me I had to request in writing, then they would write back, then i have to reply in writing to their nonsense.. Needless to say i said alot of 4 letter words today and cant wait to read their BS response,

JimmyD
09-19-2012, 07:09 AM
My wife's employer informed her effective Jan. 01, 2013 due to rising insurance premiums; The 100% employee health care plan will no longer be offered to employees. Those who wish to have insurance will have to pay $155/pay period($310/mo) for less coverge than presently offered and our co-pay is increasing from $10 to $25 per office visit and $1000/procedure.

Jason Glavich
09-19-2012, 08:17 AM
My wife went to the ER and we thought nothing about it and paid the copay. Several months later we get the standard bills for 10 or 20 bucks for random things the insurance did not cover. Then we get a bill from the Doctor that saw her at the ER for 800, I was like this must be a mistake. Called insurance, they informed me that the hospital accepts our insurance but the doctor has chose not to. How the hell was i supposed to know that this 1 doctor or maybe 2 did not take my insurance? I did not choose who we saw we went to the ER and were seen, no idea that a doctor employed at the hospital did not take our inurance that the hospital accepted.

No worries though the ER saw about 20 people with the sniffles before taking the guy who had a blood soaked bandage on his hand that had to be changed 5 times by the ER triage nurse lady. We were seen 4 hours later and got out 3 hours after we went in the back to be told call your General care Dr and see what he thinks in the morning here is some tylenol, that is what i paid 800 bucks!

Buzz
09-19-2012, 09:49 AM
My wife went to the ER and we thought nothing about it and paid the copay. Several months later we get the standard bills for 10 or 20 bucks for random things the insurance did not cover. Then we get a bill from the Doctor that saw her at the ER for 800, I was like this must be a mistake. Called insurance, they informed me that the hospital accepts our insurance but the doctor has chose not to. How the hell was i supposed to know that this 1 doctor or maybe 2 did not take my insurance? I did not choose who we saw we went to the ER and were seen, no idea that a doctor employed at the hospital did not take our inurance that the hospital accepted.

No worries though the ER saw about 20 people with the sniffles before taking the guy who had a blood soaked bandage on his hand that had to be changed 5 times by the ER triage nurse lady. We were seen 4 hours later and got out 3 hours after we went in the back to be told call your General care Dr and see what he thinks in the morning here is some tylenol, that is what i paid 800 bucks!


This happened to me about 10 years ago. I was informed that the ER docs don't work for the hospital, they are like independent contractors. They can take or leave your insurance even if the hospital is on your provider list. It sucks, but that is the reality that a lot of folks run into. I think it's total BS.

Bon, please explain how this is in any way related to Obama Care. When I first moved to South Dakota 10 years ago, I was getting injections for a trapped nerve in an incision scar from a surgery I'd had. I had to pay through the nose because the anesthesiologists in the state would not contract with BC/BS, there was a dispute about payments and it was statewide. So there was not a single doc in the state that I could visit for my injections that would take my insurance, and the injections were like $1200 per. Talk about rape. I would get prepped by a nurse, a doc walks in, gives the injection and walks out. Total of maybe 2 minutes. That'll be $1200. It was just a steroid injection for crying out loud. We are getting raped by the medical profession because we HAVE to go to them. Witch doctors are not an option...

gmhr1
09-19-2012, 09:58 AM
I was told my premium increase was because of the affordable health care act. I also expect my co pay to increase.

JimmyD
09-19-2012, 10:04 AM
BTW my wife works for the regions largest Hospital network in the region. ER visits are no longer covered unless you are transported by ambulance or Care Flight Chopper...and the insured is responsible for the first $1000

Ken Bora
09-19-2012, 10:39 AM
Bon,
I started a thread a year ago. My provider dropped my plan. 'Cause of upcomming changes. Had to shop round and ended with same provider with another plan. more per month and higher co-pay.
if we like our care we can keep it? my provider changed because if "IT" and told us so in the letter.
am I better off than I was 4 years ago? Hhhhhmmmmmmph!

Ken Bora
09-19-2012, 10:41 AM
.......Bon, please explain how this is in any way related to Obama Care. ...

Damn That George Bush!
:snipersmile:
um, that kinda don't work no more do it?
:rolleyes:

BonMallari
09-19-2012, 11:25 AM
This happened to me about 10 years ago. I was informed that the ER docs don't work for the hospital, they are like independent contractors. They can take or leave your insurance even if the hospital is on your provider list. It sucks, but that is the reality that a lot of folks run into. I think it's total BS.

Bon, please explain how this is in any way related to Obama Care. When I first moved to South Dakota 10 years ago, I was getting injections for a trapped nerve in an incision scar from a surgery I'd had. I had to pay through the nose because the anesthesiologists in the state would not contract with BC/BS, there was a dispute about payments and it was statewide. So there was not a single doc in the state that I could visit for my injections that would take my insurance, and the injections were like $1200 per. Talk about rape. I would get prepped by a nurse, a doc walks in, gives the injection and walks out. Total of maybe 2 minutes. That'll be $1200. It was just a steroid injection for crying out loud. We are getting raped by the medical profession because we HAVE to go to them. Witch doctors are not an option...

Strongly disagree...You are being raped by the doctor's malpractice insurance...the consumer(patient) bears the brunt of it..One of the reasons my brother changed specialties was because as a surgeon his malpractice insurance was astronomical...the insurance companies set the rates, not the doctors...there are many incompetent doctors and its because of them that you and I have to pay thru the nose, everyone tacks on their charges and in the end the patient pays

Brad Turner
09-19-2012, 11:39 AM
This is why we need legal reform on malpractice suits. I have no problem with a guy that loses the function of a hand due to an operation getting compensation, but a guy who has "mental distress" after butt cheek implants should not even be able to file suit.

Edit: this post was in reference to Bon's post above.

mngundog
09-19-2012, 12:19 PM
This is why we need legal reform on malpractice suits. I have no problem with a guy that loses the function of a hand due to an operation getting compensation, but a guy who has "mental distress" after butt cheek implants should not even be able to file suit.

Edit: this post was in reference to Bon's post above.
I hope things have gotten better for you lately, as for you getting compensation, I believe you deserved it after all you went through.

menmon
09-19-2012, 02:37 PM
My insurance sucks...the only good thing about it is I don't ever use it...and I don't use it when I should because of the pain of using it. Obamacare can not be any worse.

Please quit pretending that the system in place works well because it does not.

Raymond Little
09-19-2012, 03:13 PM
Thats ok. I was just denied coverage by a new health insurance coverage. This was all based on info i gave them plus the info they already had since I went from a group policy to an individual policy. I think in the last 5 years ive been to the dr maybe 10 times. had the flu twice, a couple of sinus infections and a few physicals. im 37 in decent health.. My only major problems are this time last year i was 330 pounds and now i am 240(im 6'2).. i had a heel spur act up in april and last month i got hit in the face with a piece of wood that kicked out of the wood chipper.. Im perfectly fine.. In fact im in better shape physically now than i was when i was 18.. I called to find out why and they danced around the answer with the standard HIPPA crap.. They told me I had to request in writing, then they would write back, then i have to reply in writing to their nonsense.. Needless to say i said alot of 4 letter words today and cant wait to read their BS response,

Wayne, you were declined due to your height/weight ratio only. Doesn't matter how healthy you are.
Nobody has mentioned that those of us who have insurance are paying the bill for all of those who don't. It's a vicious cycle; Pedro gets stabbed on Saturday night, ambulance picks him up, hospital saves his life, he is both illegal and indigent, NOBODY GETS PAID and our rates go up to cover Pedro. Now, let's add 20-30 million more uninsured folks to the mix under Osamma and you have Socialized medicine in 3-5 years.

gmhr1
09-19-2012, 04:57 PM
6 million people will pay the health care penalty under obamacare so enjoy.

ARay11
09-19-2012, 05:12 PM
Our Grand Welfare President (you know... the guy who is "in touch" with the workin class folks) creates a new law by which:

PEOPLE are mandated (read : Required by Law) to purchase an insurance product (or else pay the tax/penalty whatever sounds good to the scotus)

BUT

The insurance company is NOT mandated or required by law manage rates, co-pays, etc.

SO... (in my demented car-dealer brain)....

If I were an insurance company owner, this would be the greatest birthday present EVER!! I would have all the customers in the world, who cannot shop state to state, so I have a near monopoly and now the doctors are at MY mercy with no requirements on premiums OR coverage levels....

And yet this is somehow NOT crony capitalism and it's GOOD for the people?????? GIVE ME A BREAK!!!!

Let's dig in and see which insurance groups, funded by TARP and now supported by Obamacare donated to a SuperPac.


???????????????????????????????????????????And you say Romney is a bad guy??????????????????????????????????????????

This president has blatantly lied to the American people, subjected them to serfdom, is begging to remove our God and our guns, and wants to shove Mohammad down our throats.

I am so excited for him to have some flexibility "after" the election.

menmon
09-19-2012, 05:26 PM
No who ever told you the above lied to you

mngundog
09-19-2012, 05:30 PM
Our Grand Governor (you know... the guy who is "in touch" with the workin class folks) creates a new law by which:

PEOPLE are mandated (read : Required by Law) to purchase an insurance product (or else pay the tax/penalty whatever sounds good to the Governor)

BUT

The insurance company is NOT mandated or required by law manage rates, co-pays, etc.

SO... (in my demented car-dealer brain)....

If I were an insurance company owner, this would be the greatest birthday present EVER!! I would have all the customers in the world, who cannot shop state to state, so I have a near monopoly and now the doctors are at MY mercy with no requirements on premiums OR coverage levels....

And yet this is somehow NOT crony capitalism and it's GOOD for the people?????? GIVE ME A BREAK!!!!

Let's dig in and see which insurance groups, funded by TARP and now supported by Romneycare donated to a SuperPac.


???????????????????????????????????????????And you say Romney is a bad guy??????????????????????????????????????????

I am so excited for him to have some flexibility "after" the election.

Changed a couple words, yet it remains true.

caryalsobrook
09-19-2012, 05:30 PM
This happened to me about 10 years ago. I was informed that the ER docs don't work for the hospital, they are like independent contractors. They can take or leave your insurance even if the hospital is on your provider list. It sucks, but that is the reality that a lot of folks run into. I think it's total BS.

Bon, please explain how this is in any way related to Obama Care. When I first moved to South Dakota 10 years ago, I was getting injections for a trapped nerve in an incision scar from a surgery I'd had. I had to pay through the nose because the anesthesiologists in the state would not contract with BC/BS, there was a dispute about payments and it was statewide. So there was not a single doc in the state that I could visit for my injections that would take my insurance, and the injections were like $1200 per. Talk about rape. I would get prepped by a nurse, a doc walks in, gives the injection and walks out. Total of maybe 2 minutes. That'll be $1200. It was just a steroid injection for crying out loud. We are getting raped by the medical profession because we HAVE to go to them. Witch doctors are not an option...

No, the doctors don't work for the hospital. If they are on staff, they have to be on duty in the emergency room or on call a certain amount of time each month, mostly at night and on weekends. If the patient doen't pay them and there is no insurance and the gov. doesn't pay them, they don't get paid. I'm waiting for someone to tell me the last time they went to work and their boss told them that they might not get paid that day at all. Never mind that it might take 3-6 months before they will be paid if at all and you have to work under those conditions. You eveer work under those conditions? I doubt it.

As to having to go to a doctor here, have you tried Cuba, N. Korea, Greece just to name a few. It amazes me you think they are so dumb and make so much that I wonder why, if you are so smart, that YOU aren't a doctor. Just asking.

menmon
09-19-2012, 05:33 PM
Such hate being generated by something you don't understand to begin with...just have been told its bad for you

ARay11
09-19-2012, 05:46 PM
Changed a couple words, yet it remains true.

yes., it works for both ways for these two.

ARay11
09-19-2012, 05:47 PM
No who ever told you the above lied to you

So, the insurance industry has been regulated by the federal government as to the rates they can charge for healthcare and the copays, deductibles, etc are also government mandated? this is new....do tell....

DoubleHaul
09-19-2012, 06:05 PM
This is why we need legal reform on malpractice suits. I have no problem with a guy that loses the function of a hand due to an operation getting compensation, but a guy who has "mental distress" after butt cheek implants should not even be able to file suit.


Sorry to hear you are having problems with your 'work'. You do look fabulous, though!

murral stark
09-19-2012, 11:11 PM
This will probably get me pounced on. I believe if the govt is going to mandate insurance coverage, they should also tell the insurance companies that you can only charge this much for the bare minimum coverage, and this is how much you have to pay out for claims. If it is govt mandated to have insurance, the insurance companies should not be able to deny claims or charge exorbitant premiums with high deductibles and co-pays either. One problem I see coming is this. They cannot deny you coverage for pre-existing conditions, but there is no limit on what they can charge you for that coverage. that is what needs to be fixed. there's that evil word, "Regulate" the insurance companies and alot of problems will go away.

gmhr1
09-19-2012, 11:38 PM
Or the DR's can just leave like 2 of ours did today plus raise your co pay & premiums .

M&K's Retrievers
09-20-2012, 12:21 AM
this will probably get me pounced on. I believe if the govt is going to mandate insurance coverage, they should also tell the insurance companies that you can only charge this much for the bare minimum coverage, and this is how much you have to pay out for claims. If it is govt mandated to have insurance, the insurance companies should not be able to deny claims or charge exorbitant premiums with high deductibles and co-pays either. One problem i see coming is this. They cannot deny you coverage for pre-existing conditions, but there is no limit on what they can charge you for that coverage. That is what needs to be fixed. There's that evil word, "regulate" the insurance companies and alot of problems will go away.

aaarrrrrrggggghhhh!!! i CAN'T STAND IT.

JDogger
09-20-2012, 12:27 AM
aaarrrrrrggggghhhh!!! i CAN'T STAND IT.

Is that the sound an ox makes when being gored? JD

charly_t
09-20-2012, 02:14 AM
This will probably get me pounced on. I believe if the govt is going to mandate insurance coverage, they should also tell the insurance companies that you can only charge this much for the bare minimum coverage, and this is how much you have to pay out for claims. If it is govt mandated to have insurance, the insurance companies should not be able to deny claims or charge exorbitant premiums with high deductibles and co-pays either. One problem I see coming is this. They cannot deny you coverage for pre-existing conditions, but there is no limit on what they can charge you for that coverage. that is what needs to be fixed. there's that evil word, "Regulate" the insurance companies and alot of problems will go away.

When the government keeps regulating ( read: adds more and more regulations on a business ) it usually puts whatever the business is out of business. You really don't want the government to run the insurance business.

M&K's Retrievers
09-20-2012, 09:50 AM
Is that the sound an ox makes when being gored? JD

No, JD, I just made the decision a couple of years ago to stay out of the Obamacare discussions on POTUS. It's pointless and I have to do it enough in "real life" on a daily basis. As my predictions from past threads come true, "Aaarrrrrggggghhhh!!' is as close as I can come.

Told you so regards, :(

2tall
09-20-2012, 10:22 AM
When the government keeps regulating ( read: adds more and more regulations on a business ) it usually puts whatever the business is out of business. You really don't want the government to run the insurance business.
But it is perfectly fine for the insurance business to determine what health care you receive, how much you pay for it, can charge you more or drop you completely at any time? So it is better for the insurance companies to, in effect, operate "death panels", not pay Dr.'s what they want to charge for service, and the whole thing costing more in administrative fees and red tape than actual medical care?

M&K's Retrievers
09-20-2012, 10:28 AM
Aaaaarrrrrgggghhhhh!!

duckheads
09-20-2012, 11:29 AM
This will probably get me pounced on. I believe if the govt is going to mandate insurance coverage, they should also tell the insurance companies that you can only charge this much for the bare minimum coverage, and this is how much you have to pay out for claims. If it is govt mandated to have insurance, the insurance companies should not be able to deny claims or charge exorbitant premiums with high deductibles and co-pays either. One problem I see coming is this. They cannot deny you coverage for pre-existing conditions, but there is no limit on what they can charge you for that coverage. that is what needs to be fixed. there's that evil word, "Regulate" the insurance companies and alot of problems will go away.

That was done with Obamacare. So you got your wish.

The Affordable Care Act requires insurance companies to spend at least 80% of the premiums they receive on health care services or they must rebate a portion of the premiums they have received. No more than 20% may be spent on administrative costs such as salaries, sales, and advertising. This is referred to as the "Medical Loss Ratio" standard or the 80/20 rule.

Where does the govt intrusion stop? Wait till the govt comes into your business and tells you how much profit you deserve to make. I know, it would be great if the govt controlled everything in our lives because we are to freaking stupid to take care of ourselves! (sarcasm)

ARay11
09-20-2012, 11:54 AM
Numbers used for example only:

$200,000 in premiums (20%)= $40,000 for salaries, advertising, etc

$2,000,000 in premiums (20%) = $400,000

So the incentive to keep rates low for the individual is...?????

M&K's Retrievers
09-20-2012, 11:55 AM
But it is perfectly fine for the insurance business to determine what health care you receive, how much you pay for it, can charge you more or drop you completely at any time? So it is better for the insurance companies to, in effect, operate "death panels", not pay Dr.'s what they want to charge for service, and the whole thing costing more in administrative fees and red tape than actual medical care?

Your so right! How dare those evil, money grubbing insurance companies even think about making a profit. In fact, they are making so much money there are literally hundreds of insurance companies competing for you business.

Aaaarrrrggghhhhh! regards,

ARay11
09-20-2012, 12:02 PM
Your so right! How dare those evil, money grubbing insurance companies even think about making a profit. In fact, they are making so much money there are literally hundreds of insurance companies competing for you business.

Aaaarrrrggghhhhh! regards,

I see your point. 20% is not enough unless you are a HUGE company... and even then I don't see how salaries, admin costs, and advertising can all be paid out of the 20% (bigger you are, more you cost).... The 20% rule is new enlightenment for me and I am deeply appreciative of it. This is nuts.

So, now, there is no limit to what the individual can be charged, the insurance company MUST cover pre existing, birth control, abortion, well child care, and a host of other things.... and can only have 20% for operating expenses.

It appears as though the only one left operating will be the largest insurers. There would be no way for a small insurer to survive?

twall
09-20-2012, 01:44 PM
The biggest problem with healthcare is those in control do not have medical training. There was a day when doctors decided how to care for patients. Until our healthcare system reverts back to this model it will always be aweful!

Doctors are controlled by what insurance will pay for and what lawyers may sue them for if they don't order something.

And, we as a society, usually 'know' what is wrong with us and how we should be treated. If we don't get what we want, when we want it, we will go somewhere else to get it!

I see it everyday at work. Most of what we see and treat should be handled by the primary care physician. But, the patient can't get in because their PCP has to book solid because reimbursment rates are so low. Pretty soon the patient doesn't even try to go to their PCP because we treat them quickly without an appointment. But, insurance reimburses us at a higher rate so it costs more. It is a vicious circle.

Obamacare isn't going to improve anything. There aren't aren't enough doctors to care for everybody. You add to that more people who will have insurance. Plus, you cut the reimbursemnt rates, you end up with fewer people trying to care for more peolpe for less money. The only way to do that is to limit services.

Everyone will have insurance, but what will it cover? We currently accept most forms of medicaid. However, when we have to refer to a specialist these patients often have a hard time finding one that will accept medicaid.

It is only going to get worse! If you do not have a doctor, get estalished with one soon!

Tom

Franco
09-20-2012, 02:13 PM
The biggest problem with healthcare is those in control do not have medical training. There was a day when doctors decided how to care for patients. Until our healthcare system reverts back to this model it will always be aweful!

Doctors are controlled by what insurance will pay for and what lawyers may sue them for if they don't order something.

And, we as a society, usually 'know' what is wrong with us and how we should be treated. If we don't get what we want, when we want it, we will go somewhere else to get it!

I see it everyday at work. Most of what we see and treat should be handled by the primary care physician. But, the patient can't get in because their PCP has to book solid because reimbursment rates are so low. Pretty soon the patient doesn't even try to go to their PCP because we treat them quickly without an appointment. But, insurance reimburses us at a higher rate so it costs more. It is a vicious circle.

Obamacare isn't going to improve anything. There aren't aren't enough doctors to care for everybody. You add to that more people who will have insurance. Plus, you cut the reimbursemnt rates, you end up with fewer people trying to care for more peolpe for less money. The only way to do that is to limit services.

Everyone will have insurance, but what will it cover? We currently accept most forms of medicaid. However, when we have to refer to a specialist these patients often have a hard time finding one that will accept medicaid.

It is only going to get worse! If you do not have a doctor, get estalished with one soon!

Tom

That is what Dr Ron Paul proposed but he has been widely rejected by the right. In fact, he wanted to take it a step further to the prePPO days. But, this is not what the right wants. Conclusion is that the right likes insurance companies telling them what to do.

road kill
09-20-2012, 02:17 PM
That is what Dr Ron Paul proposed but he has been widely rejected by the right. In fact, he wanted to take it a step further to the prePPO days. But, this is not what the right wants. Conclusion is that the right likes insurance companies telling them what to do.

Who concluded that?

Franco
09-20-2012, 02:21 PM
Who concluded that?

As I said in my post, Dr Paul was widely rejected by the right. Romney, who pioneered government healthcare is clueless to the problems.

charly_t
09-20-2012, 03:40 PM
But it is perfectly fine for the insurance business to determine what health care you receive, how much you pay for it, can charge you more or drop you completely at any time? So it is better for the insurance companies to, in effect, operate "death panels", not pay Dr.'s what they want to charge for service, and the whole thing costing more in administrative fees and red tape than actual medical care?


Uuummm, not exactly what I meant. Trouble with government regs is that you have a bunch of people writing the regs who haven't a clue what is involved in that business. Lived long enough to have see it first hand :-)

M&K's Retrievers
09-20-2012, 06:05 PM
As I said in my post, Dr Paul was widely rejected by everyonet. Romney, who pioneered government healthcare is clueless to the problems.

Fixed it for you.

kjrice
09-20-2012, 08:43 PM
BC/BS hasn't been Cadillac since my dad last owner a Cadillac. They've been living off their old name for a while.

2tall
09-20-2012, 08:49 PM
Uuummm, not exactly what I meant. Trouble with government regs is that you have a bunch of people writing the regs who haven't a clue what is involved in that business. Lived long enough to have see it first hand :-)
Actually Charly, you and I might be getting close to a consensus! I agree that government does not know how to run a business. But to take it one step closer to my point, Insurance CEOs haven't a clue how to care for my health. Most businesses that expect to make a profit, provide a product or service. What does an insurance company produce or serve? Their goal is to guarantee that they come out on top on the premiums vs payouts. Wait.... isn't that what they do in Vegas?

kjrice
09-20-2012, 08:53 PM
Actually Charly, you and I might be getting close to a consensus! I agree that government does not know how to run a business. But to take it one step closer to my point, Insurance CEOs haven't a clue how to care for my health. Most businesses that expect to make a profit, provide a product or service. What does an insurance company produce or serve? Their goal is to guarantee that they come out on top on the premiums vs payouts. Wait.... isn't that what they do in Vegas?
I thought they provided a product and a service. I didn't know insurance wasn't a business instead of a charity. The odds are in their favor but most cannot afford a high-dollar bill. Roll your dice.

M&K's Retrievers
09-20-2012, 09:31 PM
Actually Charly, you and I might be getting close to a consensus! I agree that government does not know how to run a business. But to take it one step closer to my point, Insurance CEOs haven't a clue how to care for my health. Most businesses that expect to make a profit, provide a product or service. What does an insurance company produce or serve? Their goal is to guarantee that they come out on top on the premiums vs payouts. Wait.... isn't that what they do in Vegas?

It is not an insurance company's responsibility to care for your health. That's you and your doctor's responsibility. The insurance company is responsible for reimbursing catastrophic expenses incurred for expenses incurred for your health care. Yes, it's a little like Vegas They don't guarantee they will make a profit. They take a risk. Just like Vegas. It's called the law of large numbers.

2tall
09-20-2012, 09:56 PM
I promise, this will be my last comment here. Health care insurance is not like your local good neighbor from years past that helped you plan for your family's financial future. It is a mega industry built on actuarial tables with very, very little risk to the investors (stockholders). You can not "win". A small example is the case of a friend of mine. A self employed, hard working and conservative (financially) man, he paid premiums all his working life because he thought it the prudent thing to do. A few years back, he was diagnosed with cancer. After paying for the first treatment, the company, (one of the biggies) dropped him cold. What they paid did not even come to one year's worth of his premiums. He eventually received the needed treatment due to a caring Dr. And a great community of friends. It wiped him out. Now at 60 plus he is having to sell his home (very low mortgage) and take to the road to survive.
This is but one story out of thousands. You are right Mike. The insurance companies don't make medical decisions or provide health care. But they sure can kill ya. Ok, I'll go back to my silence.

M&K's Retrievers
09-20-2012, 10:44 PM
I promise, this will be my last comment here. Health care insurance is not like your local good neighbor from years past that helped you plan for your family's financial future. It is a mega industry built on actuarial tables with very, very little risk to the investors (stockholders). You can not "win". A small example is the case of a friend of mine. A self employed, hard working and conservative (financially) man, he paid premiums all his working life because he thought it the prudent thing to do. A few years back, he was diagnosed with cancer. After paying for the first treatment, the company, (one of the biggies) dropped him cold. What they paid did not even come to one year's worth of his premiums. He eventually received the needed treatment due to a caring Dr. And a great community of friends. It wiped him out. Now at 60 plus he is having to sell his home (very low mortgage) and take to the road to survive.
This is but one story out of thousands. You are right Mike. The insurance companies don't make medical decisions or provide health care. But they sure can kill ya. Ok, I'll go back to my silence.

Carol, one thing before you go. A Health Insurance Company can cancel for two reasons: 1. Non payment of premium or 2. Withdrawal from doing business in a state. If it was one of the "biggies", I doubt they completely canceled an entire block of business because of your friends claims. What state is he in? Do they not have an insurance department that handles complaints? Do they not have attorneys in that state? I grow weary of hearing BS like "thousands" of people getting screwed. You know one person who says he got screwed but I promise you don't know the details. They cannot cancel an individual for having claims nor can they "rate" a customer off the books. They can rescind coverage if the applicant lied about their health history on their application. I'm afraid I must quote Road Kill and call Bravo Sierra.

Aaaaaarrrgggghhhh regards,

kjrice
09-20-2012, 11:53 PM
I promise, this will be my last comment here. Health care insurance is not like your local good neighbor from years past that helped you plan for your family's financial future. It is a mega industry built on actuarial tables with very, very little risk to the investors (stockholders). You can not "win". A small example is the case of a friend of mine. A self employed, hard working and conservative (financially) man, he paid premiums all his working life because he thought it the prudent thing to do. A few years back, he was diagnosed with cancer. After paying for the first treatment, the company, (one of the biggies) dropped him cold. What they paid did not even come to one year's worth of his premiums. He eventually received the needed treatment due to a caring Dr. And a great community of friends. It wiped him out. Now at 60 plus he is having to sell his home (very low mortgage) and take to the road to survive.
This is but one story out of thousands. You are right Mike. The insurance companies don't make medical decisions or provide health care. But they sure can kill ya. Ok, I'll go back to my silence.

What were they built on in the good ol' days? I can't imagine a business based on math (odds) was developed without calculation.

Are you sure the big bad insurance company is what you say or do you think that the farce called managed care, reimbursement, policy limitations or related costs were involved? I don't personally know they answer, in your stated case, but not all policies are equal.

Gerry Clinchy
09-21-2012, 12:22 AM
2Tall, look at Medicare. The govt decides the compensation rates, and the fear is that with the govt contemplating reducing the compensation rates, more doctors will decline to take on more Medicare patients, since they can get better compensation via insurance companies.

Via Obamacare, eventually you end up with single-payer (govt) health insurance ... you might call it the universal Medicare and it will cost a bunch of $ to have that. What you "think" you are "saving" in premium v. what you pay now, you will pay the balance via income or sales taxes. The govt will have "administrative costs", just like insurors do. More govt employees with juicy retirement plans, and more members for SEIU who won't have to settle for the same health care program that everybody else gets (waivers, you know, for select groups). And if insurance companies are ornery to deal with, the govt bureaucracy won't be any better.

And right now people have sued insurance companies and won. Not likely to get many health care suits against a govt bureaucracy ... since the regulations that evolve for the law will not be "negotiable".

The UK's system is unravelling. Took a long while to work through the cycle, but the chickens are coming home to roost. The govt there is encouraging doctors to take "private" patients; and encouraging patients to take advantage of that. Waiting periods in Canada for important testing (from a friend whose wife is Canadian), can be life threatening.

I don't think there are any simple or easy answers to the questions about making health care more available and more affordable. Seems like a no-brainer to me that the govt could take some of that $ that we're giving to Russia and China in foreign aid and do a thorough, independent study to see how we can make it better. Certainly the Congressional process that produced Obamacare is NOT the way to solve the problem! It was mostly political and not pragmatic. I don't believe we can get it perfect, but at least better.