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Quietstill

Pay attention.

43 posts in this topic

2 hours ago, Linda Garren said:

Hi, NN.  When you say providers are refusing Medicare patients, do you mean they will not see them?  Or do you mean that they "don't participate in Medicare" (which just means that they accept Medicare's payment for their services, but that the patient must pay the balance that Medicare did not cover)?

It is against the law for a doctor to accept Medicare payment, then require the patient to pay more.  If a doctor accepts a Medicare patient, they must accept the Medicare payment as payment in full for the service. There are doctors who won't accept Medicare, but in my experience with myself, DH, mother who is 103, two sisters and a brother, we have only come across two doctors who wouldn't accept Medicare.  My brother's family doctor switched his practice to no insurance at all and a yearly fee, then he would see you as many times in that year as needed.  The other doctor was a neurologist whose practice was so large he didn't need to take Medicare patients.

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Hi, genden.  My internist at Hopkins "does not accept Medicare."  However, her secretary submits the bill to Medicare for me.  I get a full bill from my internist and put toward the total costs whatever Medicare has reimbursed ME toward the bill.

I hope this is clearer.  If not, I'll try again!  :-)

 

Edited by Linda Garren

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2 minutes ago, Linda Garren said:

Hi, genden.  My internist at Hopkins "does not accept Medicare."  However, het secretary submits the bill to Medicare for me.  I get a full bill from my internist and put toward the total costs whatever Medicare has reimbursed ME toward the bill.

I hope this is clearer.

 

2 minutes ago, Linda Garren said:

Hi, genden.  My internist at Hopkins "does not accept Medicare."  However, het secretary submits the bill to Medicare for me.  I get a full bill from my internist and put toward the total costs whatever Medicare has reimbursed ME toward the bill.

I hope this is clearer.

Interesting.  If Medicare is billed out of this doctor's office, this is problematic.

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18 hours ago, Quietstill said:

Be angry at honest and respectful dialogue?  Never.

:-)

 

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6 minutes ago, genden69 said:

 

Interesting.  If Medicare is billed out of this doctor's office, this is problematic.

I stand corrected.  A doctor can register as a nonparticipating Medicare provider and Bill more than Medicare allows.  This is called balance billing, but the amount over the Medicare allowance is restricted.  The article I read said only 4% of doctors do balance billing.  Patients must be told up front before services are provided of this practice.

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14 minutes ago, Luke said:

puke what??

You know what?  That is so funny you should ask.  I wondered the same thing about your LOL!  I finally decided it must be a laugh at the ridiculousness of our whole political situation (and hopefully not a laugh at me).  The "puke" was meant in the same vein--how horrible, awful, terrible, shameful our political situation is.  It is indeed laughable and nauseating at the same time.

The main reason I posted that site was because it had so much information supporting the possibility that Trump would either withdraw soon or be impeached or perhaps be sent to jail.  And how about the IRS head (Koskinen) still being in his position!  Hmmm...could it possibly be something to do with Trump feeling he might be exposed re: his tax returns should a new person be appointed to that position?

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1 hour ago, genden69 said:

I stand corrected.  A doctor can register as a nonparticipating Medicare provider and Bill more than Medicare allows.  This is called balance billing, but the amount over the Medicare allowance is restricted.  The article I read said only 4% of doctors do balance billing.  Patients must be told up front before services are provided of this practice.

Thank you for the info, genden.  In the case of my internist, she more than earns whatever she gets.  Truly.  She saved my life for one of the medical problems I have (and follows me for my whole medical situation).  Many other doctors would probably not have known about what she suspected as to why my blood lab readings were so high.  Polycythemia vera, which is what she suspected, is most often fatal if not controlled.  It's like cancer, only different in that it replicates itself but does not spread to other organs.  Without control, it can lead to strokes, embolisms, etc.  It "just happened" that Hopkins had leading researcher physicians to whom she sent me who were studying this condition and took me under their care.  I was told that many hospitals/doctors would not know much about the condition or even not know of it at all.

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55 minutes ago, Linda Garren said:

You know what?  That is so funny you should ask.  I wondered the same thing about your LOL!  I finally decided it must be a laugh at the ridiculousness of our whole political situation (and hopefully not a laugh at me).  The "puke" was meant in the same vein--how horrible, awful, terrible, shameful our political situation is.  It is indeed laughable and nauseating at the same time.

The main reason I posted that site was because it had so much information supporting the possibility that Trump would either withdraw soon or be impeached or perhaps be sent to jail.  And how about the IRS head (Koskinen) still being in his position!  Hmmm...could it possibly be something to do with Trump feeling he might be exposed re: his tax returns should a new person be appointed to that position?

Well that says volumes about you, that you took my post in a negative manner.  I could have said LOL because I agreed with you and thought your post was funny.  On the other hand, I could have said LOL because I thought it was total hypocrisy on your part for polluting a thread about health insurance with your personal ideology.  Either way, you polluted a thread.

Not far in the past, you started a thread on Christian Faith that was polluted by a few non-believers.  You didn't take it well, and I didn't think it was necessary either.  What does impeaching Trump have to do with Healthcare questions?  CNN, MSNBC, Fox and many others have political threads.  Let your frustrations out there.  Here's a hint:  Nobodies minds will ever be changed.  And yes, our political situation is in dire straits, but I didn't think this board was where I would have to encounter the endless blabber I see everywhere else!

If you want to start a personal, political dialog, feel free to message me so it stays off this board.  If you want to start a Christian dialog about judging others or casting the first stone, I'd also be happy to entertain you.....Keep it fair and civil regarding the intent of the thread.  Is that so hard to ask?

Edited by Luke
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On ‎4‎/‎6‎/‎2017 at 1:29 AM, ellaangel2 said:

Trump is all you said Linda and more.......immature, spoiled, erratic and a narcissist!  Very poor qualities for a leader of our country!

and later, I'll tell you how I really feel!!  Lol!

 

Quite the contrary, Trump is the first president in modern history to do exactly what he promised during the campaign.  I think that he's doing GREAT!  The only way that health insurance will ever work is for the government to get out of it completely and let market forces work.  Ditto for healthcare!

Homeowner's insurance would not work if people could wait to buy insurance after their house burnt down.

Car insurance would not work if people could wait to buy insurance after their car was destroyed in an accident.

Health insurance does not work if people can wait to buy insurance after they have a serious illness.

 

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Luke,

With all due respect, politics unfortunately does have a lot to do with healthcare.  Politics lately has a lot to do with incivility.  I have always believed that words matter.  Facts matter.  Civility matters.  I refuse to believe that we are no longer able to discuss important issues because it might go against one person's world view of caring fro our brothers and sisters.  If you have any thoughts on the current state of healthcare (policies, programs, attitudes), please feel free to join in.  We need many voices.  However personal attacks are neither welcome or helpful.

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3 minutes ago, PatriotM said:

Health insurance does not work if people can wait to buy insurance after they have a serious illness.

 

I couldn't agree more with this sentence.  But young people do feel they are invulnerable.  What do we do if someone gets hit by a bus without insurance?  Say 'oops.  You just thought nothing could happen!' and let them die?  Or let them bankrupt first their parents and then the community hospital?  But you are right, health insurance without an element of personal responsibility does not work well.  And young people across the world are often stupid, and should be allowed to live through that period.

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The other big problem with health insurance is that it is being used for routine care, which is not what insurance is intended to be.

Does your homeowner's insurance pay to fix a leaky faucet?

Does your car insurance pay for an oil change?

Why should your health insurance pay for a routine doctor's office visit?

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Today insurers are just one part of the medical corporate state.They are basically the collectors for medical establishment.Its one giant pool of money of which most of it is invested in the stock market like other insurers.The last thing they want is government control.

On a personal note I have two insurances now .But having insurance doesn't equate that you will get good care.If I hadn't taken charge in my care I would probability be much worse off like others i know. 

maybe this is a little critical but without critics where would we be.

 

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3 hours ago, PatriotM said:

The other big problem with health insurance is that it is being used for routine care, which is not what insurance is intended to be.

Does your homeowner's insurance pay to fix a leaky faucet?

Does your car insurance pay for an oil change?

Why should your health insurance pay for a routine doctor's office visit?

The discussion should be had, but the comparison of home owner's insurance, car insurance, and insurance for healthcare isn't quite the same.  I can, in most instances fix my own leaky faucet and other routine home repairs myself.  I can't fix a broken arm myself or a bladder infection.  For many people, these routine health issues that require a doctor would be financially devastating without insurance.  I understand your point Patriot and it is worth discussing and thinking about.  When we come to a concensus about what insurance should cover in healthcare, then how to pay for that insurance, we will have the problem solved.

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I realize my comments will take us slightly off subject but feel compelled to make them.  Recently a close relative of mine ( I'll call him Mr. X ) voluntarily went into a drug and alcohol rehab facility.  At the time those folks at the facility told us in their professional opinion the best results were achieved with a 30 day committal.  Mr. X has a gold rated insurance plan purchased through the Obamacare program.  Supposedly these medical services were covered and we were feeling more than a little relieved and bless to have such good insurance.

What we now know is the coverage is not worth the paper it is written on.  And, if anecdotal experiences told by other patients is true, this is a common experience.  A few days after checking himself in, the facility put in a claim.  The insurance company informed us they would cover four days and then the patient would be best treated by extensive outpatient therapy.  This was not what those at the facility who knew and were treating Mr. X were recommending.  The claim was sent to a third party for approval and was suppose to take into account best practices and common treatments.  When you take into account the cost/share and deductible, the insurance company will only pay for a little more than one day and any days beyond the 4 days are totally up to the patient to pay.

Here are some problems with this.  To begin with, the deductible was such that BCBS (Blue Cross Blue Shield) has agreed to pay a little over one day while Mr. X will be responsible for most of the remainder.  Most alcoholics are barely out of detox after 4 days, let alone have made many strides in long term  rehabilitation.  The third party that BCBS consulted with is owned in partnership with by BCBS and other insurance companies.  There is absolutely no incentive for this third party to be fair or above board in their recommendations as they are essentially getting paid to deny claims.  If they don't then I assume the insurance companies will look to sell their portion of the company or go looking for another company to do their dirty work for them. 

The third party claims the results of extensive community based therapy is as effective and naturally more cost effective despite whatever the professionals at the rehab center might say.  The thing of it is, most of the patients look at the price tag and feel they can't afford to pay the entire cost of the 2 or 3 weeks remaining in their recommended stay and leave the facilities.   In effect, it is a self fulfilling prophesy, most patients don't stay a month and go into outpatient treatment but not because it is more effective but  because they can't afford to do otherwise.  Sadly the third party would have you believe otherwise.  While Mr. X was there, there were many patients who had several commitments so obviously outpatient rehab hasn't been all the successful but I don't think getting the patient well is really the point - getting more money for insurance companies is.

Yes, the denied claims can be appealed but there is no guarantee it will go through.  In addition one must realize that most folks who have reached the point of going to a rehab facility are struggling and very likely have hit rock bottom.  Money, jobs, and financial security are an iffy proposition - making the prospect of fighting a big insurance company or trying to find the funds to pay for treatment on their own more than a little daunting, if not down right impossible.

My point is I personally am not going to let rhetoric about how awful it is going to be if the big bad republicans take away coverage for mental health or drug rehab because I know the truth of the situation.  Yes, currently you are told you have coverage for these things, but the truth is you DON'T.  It is just empty words and not worth the paper or website it is written on.  They can't take away what you really never had.

    

     

Edited by lahdedah

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Lahdedah,

i certainly sympathize with Mr. X.  If Mr X had insurance with his employer, the results would have been the same.  It doesn't matter if the insurance is Obamacare, employer insurance, or self pay insurance.  The problem is how insurance companies pay for addiction treatment and mental health.  If Mr. X had been treated for cancer or injuries from an accident, the best practices care would have been paid for.  The state agencies who regulate what these policies pay for can make those changes.

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