Debates
- Thread starter BamaFlum
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Seems to me that you made several claims and offered zero facts to back up your claims. I merely pointed out that you are wrong. On every single count. Care to support your original claims? They are baseless in the first place yet you want me to support with facts the contradiction to something you can't prove.
If you're insured, doesn't matter how or where, your care is being rationed. It's a question of degree not a question of if. They just file it under "utilization review" or something of that nature.
I read all your post from page 7 or 8 on and still see no proof of your claims or evidence to support them.
There are a number of large differences in private enterprise within the scope of the law and the contract using accepted industry practices that are legal to lower spending vs the all-powerful government deciding who will get what care when - not that I'm fond of many of those tactics. But when insurance companies go too far people can choose another copmany or appeal or file suit to have the contract enforced. When the government decides you ain't gonna get treated then brother you ain't gonna get treated; and that's done with the full violent force of the law.
Nay. Ye have no water which ye have verily shown.
Like I said, you've made a number of claims but have offered zero evidence to support them. You're just plain wrong. And will never be able to prove otherwise. Which is probably why you are dancing around the issue worse than Obama tried to last night.
No, the majority of people cannot just choose another insurance company - their employer chooses for them (if you're in the individual market, you're playing with fire trying to change insurers due to underwriting and any other number of issues). Furthermore, if they do have a problem with the insurer, they must, by law, first go through the insurer's own internal appeals process before going to the regulator or court. You can guess the success rate of that.
The process is fairly similar in traditional Medicare, and actually better in Medicare Advantage because you get the above with the benefit of very pro-patient requirements on the plans' internal appeals processes.
When a treatment is denied, the big question is why and the differences are very important. In essentially all contexts, if your physician deems a treatment medically necessary, there are no comparable alternatives worth trying, and the treatment cannot be characterized as experimental or investigational, the treatment is almost certainly eventually going to be approved - and if it is a preauthorization you're waiting on, it will be approved in about 72 hours at the latest. As I said, this goes for just about every insurance context out there and most states I know of.
I find it interesting how many on here complain that Medicare should cover essentially all treatments, anywhere, however at less patient out-of-pocket costs than exists now at the same time they complain about what the program costs the federal government.
Health care services cost money. Less patient out-of-pocket + no limits claims authorizations = more cost to taxpayers and a bigger chunk of the federal budget.
Health care services cost money. Less patient out-of-pocket + no limits claims authorizations = more cost to taxpayers and a bigger chunk of the federal budget.
I'm not talking about wanting to give the patient the name brand and being forced to give them the generic for the same medicine (sorry I wasn't clear about that). I'm talking about when a patient is in need of a newer, more effective, medication in one class of drugs and being forced back into an older, now generic class of drugs. Perfect example in my line of work is wanting the patient to have Cymbalta (an SNRI with excellent mediation of pain pathways so it's good for depressed patients who also have neuropathic pain), but being unable to prescribe that and instead being told they need to take an SSRI like Sertraline, Citalopram, Fluoxetine, etc (no pain pathway mediation). With privately insured patients, I've had more success appealing the initial denial and managing to get approval for the preferred medication, but I've NEVER been successful getting Medicare to allow it.
It doesn't matter to me one iota what the reason is that the payments stop, it only matters that they stop and they have Medicare's name on them. If the government is entering into a contract with a private middle-man, then it needs to start demanding improved service. I'm sure the feds are giving those contracts to the lowest bidders, and they're getting what they pay for - a bad reputation. If I'm entitled to a Medicare reimbursement for the patients I see, I don't want excuses, I want the reimbursement in a timely fashion. As a Medicare provider, I'm not allowed to tell the patients "Medicare hasn't zeroed out your balance yet, so I can't treat you again until that happens." With privately insured patients I can say and do exactly that - and the bills get paid.
And you know if the govt. takes over the entire industry it will only get worse. My brother-in-law is a surgeon and his colleagues who are specialists are ALL dropping new Medicare patients. They all have signs saying no more Medicare patients taken. Truth be known they can't afford to keep the ones they are seeing. They are getting 33 cents on the dollar. They can't afford simple overhead. Many are now taking private retainers and setting a specific number of patients they will see much like it was in the past where the doc would come to your house, treat you and get paid. No D. C. Theoretician is going to convince business owners or docs that see this everyday that this is the best way to go.
I'm giving serious consideration to getting out of private practice myself. Sucks for my patients because I provide high quality care to an under-served area, but I can't continue bleeding money as I have for the past four years. Prior to 2008, at least the headaches were worth it. I count every penny that comes through my account and I'm seeing far too many patients and making far too little money for the amount of stress I'm under. Once I find a solid employed position, I'm going to make the move and let someone else deal with the business-side-of-medicine headaches that are sure to only get worse in the coming decades. If I lived in a less economically depressed area, I'd change over to fee-for-service only, but that would be unsustainable here. Many physicians are going to end up doing just that in the larger metro areas. Concierge medicine is also gaining traction. I applaud those physicians who can and will forge their own paths in the coming years. Their patients will get a higher quality of care and maybe, some day, the pendulum will swing in a better direction.
I know I will get tarred and featherd for this but, the real truth behind high medical costs is that lawyers add little or no value to the process but a tremendous amount of cost. This country needs TORTE REFORM. I think there should be limits on lawsuits and fines for frivalous suits. It will neer happen because most of our politicians are what?, lawyers....
I would love to see an actuary showing the true cost of health care in a world without legal action. I really don't believe that doctors spend their life dreaming up ways to hurt their patients and the mistakes that are made could be mitigated at standard rates to compensate patients. Now does this mean I can place a value on a life lost? No, but neither can a judge or jury. As sad as everyone is over these types of things money will not fix them.
I would love to see an actuary showing the true cost of health care in a world without legal action. I really don't believe that doctors spend their life dreaming up ways to hurt their patients and the mistakes that are made could be mitigated at standard rates to compensate patients. Now does this mean I can place a value on a life lost? No, but neither can a judge or jury. As sad as everyone is over these types of things money will not fix them.
Incorrect...this country needs to embrace the torte:
Wilford Brimley? Is that you?
Nope I read it as debates, therefore all my answers are totally un-related to the questions
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