Health Insurance

Parent Cafe
81

<p>“Or contiinually telling posters they’re not giving you the whole story, like you know better.”</p>

<p>gar, you know if you follow those questions it does come out that the services were paid for via taxes, so they weren’t “free.” Initally it was mistakenly implied they were free services given to US citizens in Canada and the UK… If that were so, I be at the border crossing over for my elective free surgeries, wouldn’t you? Travel agents would have a booming business.
wouldn’t they? </p>

<p>" you like those kinds of passive aggressive confrontational tactics. But you are right, I’ve got better things to do then get drawn in."</p>

<p>Well, sorry you’ve implied inconviences, not “problems” as you’ve made them out to be and I called you on them. Yea, I’d be mad at me too…:wink: but it doesn’t make me wrong does it?</p>

82

<p>Opie, why are you ranting against all of us and why are you so angry??</p>

<p>Can’t we have a reasonable discussion?</p>

<p>Why did you assume the requirement for the implanted teeth was cosmetic? It was actually functional.</p>

<p>Why did you assume the four hours to clear up the anesthesiologist charge was only insurance company time? It includes patient time, benefits manager time, insurance company time, doctor staff time.</p>

<p>You’re making an awful lot of assumptions and really getting hot under the collar. Single-payor doesn’t necessarily mean government-paid, as I’ve said on other threads dealing with this subject. Single-payor means no one cares which plan is responsible for the cost, because it’s all one big plan.</p>

<p>Enough already. I’m outta here too.</p>

83

<p>What scares me the most about single-payer is the perceived lack of choice and opportunity to get several opinions and weigh all the alternatives before making major medical decisions. </p>

<p>When my D needed foot surgery, we talked to 3 orthopedic surgeons, and there was only one doc within 500 miles of our home who had ever performed the particular procedure. As it was, we had to wait 6 weeks for an opening in his surgery schedule. Meanwhile, D was in a cast. Our insurance at the time refused to cover his services, so we paid the $15,000 out of our pocket rather than go to a preferred provider who had no experience with this injury.</p>

<p>With a single-payer, would we have had the choice of docs? What if the gov’t did not approve this particular procedure, could we get it done anyway? Would we have had the option to pay our own way? How long would we have had to wait?</p>

84

<p>“Why did you assume the requirement for the implanted teeth was cosmetic? It was actually functional”</p>

<p>Didn’t assume, it is the natural question on the decision tree based on your information. don’t care what the outcome is or was, it is the question that will always be asked no matter who is paying… that’s my point. It’s not a valid complaint for or against a payor single or multiple. it will always be asked no matter who is calling the shots. K? </p>

<p>“Why did you assume the four hours to clear up the anesthesiologist charge was only insurance company time? It includes patient time, benefits manager time, insurance company time, doctor staff time.”</p>

<p>didn’t say that, said normally it’s 15 minutes done preop by hospital/dr staff. I didn’t say it was all insurance. I was telling you if it takes that long, complain. It simply shouldn’t. It should be a quick phone or email or log in for authorization and an authorization number is given and neener neener it’s done… :slight_smile: </p>

<p>Claims are just data put into a computer system with parameters. The auth code or number is simply attached to anthesiologists billing (diagnostic code)and it’s processed. </p>

<p>“You’re making an awful lot of assumptions and really getting hot under the collar.”</p>

<p>My collar is quite cool thank you…:slight_smile: </p>

<p>They aren’t assumptions, they’re questions. I have 20 years experience in this field so yes, I do call some folks out on things. that not anger, that’s just pointing out the bs… I have spent waay too much time fixing claims and do you know what the number one problem is? </p>

<p>transposing numbers in diagnostic code. A gynological visit becomes a vision exam if you transpose one number… (true story) and leads to a rejected claim if vision isn’t covered. But last time I checked nobody sees from there… that won’t change in any system… </p>

<p>Claim are simply punched in as quickly as possible patient name, identifer, date of service, provider and diagnostic codes press enter and onto the next one… it hits the parameters of the plan and if the data entry is good, it processes and check is printed and mailed. The only claims reviewed after data entry are large dollar ones (threshold used to be 10k) by human eyes.
What fails most people is that there are simply millions of claims processed everyday. </p>

<p>" Single-payor doesn’t necessarily mean government-paid, as I’ve said on other threads dealing with this subject."</p>

<p>Actually what we are working towards are regional players… that’s why the government isn’t saying no to all these buyouts and mergers… it is in the govs best interest to let the private sector build the regional player system and then when we throw the switch to uhc, the means to handle it will be in place. Our own blackwater of healthcare… That’s what I see coming, uhc ran by four or five giants who will have the structure in place so the govt will not have to spend years reinventing the wheel. And yes, that kind of makes me angry because it won’t be the best providers it will be the biggest. the aetna, the united healthcare, the anthems… all mega giants that don’t provide good service now and will not later under a single payor… </p>

<p>“Single-payor means no one cares which plan is responsible for the cost, because it’s all one big plan.”</p>

<p>no body cares about cost? :slight_smile: hmm OK? Again you’re assuming cost won’t be a factor and uncle bucks won’t say NO to anything… just like they do now :wink: </p>

<p>I’m not angry at all, but insurance is math wrapped around by emotion. Most statements being made here and elsewhere are emotional ones, not mathmatical. Insurance is math at the end of the day. And cost is important. As this started out about free healthcare in France are you willing to have a 49% tax bracket starting at around $70,000 a year to support it? That’s the math of it. It is isn’t angry, it isn’t emotional, it’s the math. </p>

<p>When we look around at where a single payor is in play we find a much, much higher tax bracket. We are magical, so what really makes anyone think we can do more for less than the rest of the industrialized nations? </p>

<p>I sat with a legislator once who basically told me we can do the canadain system with better benefits for less cost than the canadians how? “because we’re smarter than the canadians.” was his answer. Gee, I don’t really know if that is the most compelling arguement to ignore costs.</p>