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Health Reform and the Polls


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Posted

I consider myself as a lucky person. I have health care benefits through my job with the State. But I go into the doctor for some test about my heart and they tell me the Insurance Company has to pre-approve me for the test. That even if I get pre-approved they still might not pay.

 

So I asked based on what? Based on a chart that tells them if I need the test. Not a doctor but a Chart. My doctor says I need the test but their chart might say something different.

 

Tell me what is wrong with this? Maybe I won't send in my premium this month based on my chart.......

 

There are problems with health care and this is just an example of a few.

Posted

Most insurers require preapproval for lots of things. I was turned down once. I contacted my insurance company and disputed the decision. They had me go to another doctor who said I needed the procedure and then agreed.

 

Insurance companies use accuarial norms for things. If it is outside the norm they may ask for more proof. It really is an attempt to keep health care costs down by not doing unnecessary tests.

 

It is amazing how many people try to hide various unneeded testing and cosmetic stuff as necessary.

 

In your case it is your heart and if your doctor says you need it then they should pay for it and probably will, but they may make you jump through a hoop because, for whatever reason, you don't fit the norm.

Posted

I think that, in most cases, it's a good thing that all procedures/tests/drugs are not approved carte blanche. It seem like every week or so there's an article about some physicians? scamming the MedicareMedicaid system. The latest that I read was the Houston clinic that was dispensing "arthritis kits" which contained some cheap orthotics, over-the-counter medications and a heating pad. The clinic was billing and collecting from medicare about $4000. per kit. Maybe this wouldn't have happened if the "arthritis kit" had to be pre-approved. As an aside: maybe the gov should have to pre-approve the "clunkers for cash" program as well

Posted
I think that, in most cases, it's a good thing that all procedures/tests/drugs are not approved carte blanche. It seem like every week or so there's an article about some physicians? scamming the MedicareMedicaid system. The latest that I read was the Houston clinic that was dispensing "arthritis kits" which contained some cheap orthotics, over-the-counter medications and a heating pad. The clinic was billing and collecting from medicare about $4000. per kit. Maybe this wouldn't have happened if the "arthritis kit" had to be pre-approved. As an aside: maybe the gov should have to pre-approve the "clunkers for cash" program as well

 

Then why are people worried about the government being the middle man instead of the insurance company who is still worried about making a profit?

Posted
Then why are people worried about the government being the middle man instead of the insurance company who is still worried about making a profit?

 

Besides the inefficiencies that non-profits- government included- have, also because our government has no money. The deficit is huge!

Posted
Besides the inefficiencies that non-profits- government included- have, also because our government has no money. The deficit is huge!

 

Except the argument most of the time is not about the money but about some government bureaucracy making MY medical decisions, when we all know that WE do not make these decisions now. I would rather the government which is not looking at the bottom line to do instead of a profit seeking white collar individual.

Posted
Except the argument most of the time is not about the money but about some government bureaucracy making MY medical decisions, when we all know that WE do not make these decisions now. I would rather the government which is not looking at the bottom line to do instead of a profit seeking white collar individual.

Because they have done wonders with your retirement.

Posted
Except the argument most of the time is not about the money but about some government bureaucracy making MY medical decisions, when we all know that WE do not make these decisions now. I would rather the government which is not looking at the bottom line to do instead of a profit seeking white collar individual.

 

 

If I'm in need of some very expensive tests, I would rather the company that makes a profit and actually has money, my doctor and me decide whether or not I get the tests...Not a government that is flat broke and going deeper in debt by the second.

 

Which one would more than likely approve the tests...The one that actually has the money to pay for it, or the one that can't pay for a AM Radio subscription?

 

If a "profit seeking white collar individual" wants to stay in business he will satisfy customers. If the government wants to stay in business they will just keep borrowing/making money and taxing you and me. You're right the Government has no bottom line.:rolleyes:

Posted

It really doesn't matter how great we (or more accurately those who have insurance) currently have it. The current healthcare system is not sustainable and will bankrupt the nation.

 

My problem is that I don't think most people attacking the current reform efforts have an appreciation for the cliff we are about run off of.

Posted

Years ago I worked for a company that reviewed hospital bills for insurance companies. An IV bag of fluid might cost $5.00 and the hospital would charge $150.00! We would adjust the bill and pay $25.00. Usually the hospital accepted payment. I was amazed at what hospitals charge.

Unfortunately the man who ran the company was unscrupulous himself and we went out of business.

 

Why cant there be some type of review to make sure prices are reasonable?

 

Of course, any review would have to include that the patient doesnt have to pay the difference.

 

I dont want any government official telling me what medical tests I can and cannot have, but by reviewing the costs of certain things, perhaps the cost of care can be reduced.

Posted
It really doesn't matter how great we (or more accurately those who have insurance) currently have it. The current healthcare system is not sustainable and will bankrupt the nation.

 

My problem is that I don't think most people attacking the current reform efforts have an appreciation for the cliff we are about run off of.

 

I think it's just the opposite, I don't think most people pushing the current reform efforts have an appreciation for the cliff this will take us over.

 

I believe change is needed, just not to the extent being discussed.

Posted
If I'm in need of some very expensive tests, I would rather the company that makes a profit and actually has money, my doctor and me decide whether or not I get the tests...Not a government that is flat broke and going deeper in debt by the second.

 

Which one would more than likely approve the tests...The one that actually has the money to pay for it, or the one that can't pay for a AM Radio subscription?

 

If a "profit seeking white collar individual" wants to stay in business he will satisfy customers. If the government wants to stay in business they will just keep borrowing/making money and taxing you and me. You're right the Government has no bottom line.:rolleyes:

 

Or that white collar profit seeking individual can simply deny your claim/test/procedure to keep cost down, profit margin up and share holders happy by increasing dividends. He doesn't have to worry about satisfying customers because most people have no choice with whom there coverage is provided by, myself included.:idunno:

http://sickforprofit.com/

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