i have no doubt that insurance companies have doctors. and since you work in insurance, i just have a question for you. if a doctor is getting paid from the insurance company don't you think that maybe they might side more with the people who pay them? i don't know the answer to that and hope you can answer that. for me there seems to be a conflict of interest there.
Couldn't your same question be applied to mandated insurance that is handled by the government? Wouldn't it just put the government in the place of the insurance company as the payor?
i have no doubt that insurance companies have doctors. and since you work in insurance, i just have a question for you. if a doctor is getting paid from the insurance company don't you think that maybe they might side more with the people who pay them? i don't know the answer to that and hope you can answer that. for me there seems to be a conflict of interest there.
Couldn't your same question be applied to mandated insurance that is handled by the government? Wouldn't it just replace the insurance company as the payor with the government?
no, as was mentioned before, i believe that any decision about your health should be decided by only you and your doctor. the government or the insurance company should not have a say it what you decide.
Coming from Canada.. I know that it just doesn't happen like that up there. Their system isn't built around wringing as much money from people as they can.
You are right about that, as well. They can't - Government fixes prices. And that's why I think the providers are misguided in pushing for that. They won't like that very much.
BUT, has the Government managed anything effeciently? So, what makes us think these fixed prices would be the best you could get? They could have a draconian system that basically scares any semi-intelligent person away from med school. But, that's no good either. Who CAN'T envision when the Gov't will overpay for everything and drive insurance rates (taxes) through the roof?
And in Canada, some of the best doctors simply opt out and create a premium driven private plan for rich folks.
your also correct here. the government here in Canada does set the prices on what a doctor can charge for things. but to be honest, i know many doctors and they are not just scrapping by.
My family Doctor drives a benz and lives in the nicest/trendiest area of the city, he's doin alright!
Believe me, when I was growin up, I thought the worst thing you could turn out to be was normal, So I say freaks in the most complementary way. Here's a song by a fellow freak - E.V
i have no doubt that insurance companies have doctors. and since you work in insurance, i just have a question for you. if a doctor is getting paid from the insurance company don't you think that maybe they might side more with the people who pay them? i don't know the answer to that and hope you can answer that. for me there seems to be a conflict of interest there.
Well, obviously, they look at things from a different perspective. But, all Medical Directors (the doctors at the insurance company) must be licensed in the State they are "practicing" and carry malpractice insurance like any other doctor (though it is cheaper).
They also must follow the clinical guidelines of the organization which must be submitted for review to the regulating (State or Federal) entity. These guidelines must cite source and relevance. There are 2 or 3 "standards" that are out there for general stuff, but most of these guideliness are based on AMA or specialty specific professional organizations that are populated by many more doctors that are "practicing" physicians than "insurance" doctors. All "denials" must be documented with reasons and source. They are "eligible" to be appealed and then have 3rd party review. It's a lot of work for an insurance company to deny something. So, this concept that they are denying for petty things is ridiculous. Yes, some poor decisions get made from time to time. And, there are checks and balances for that, also.
I know my organization denies very little (you'd be amazed at the %'s). Most times, our doctors will talk to the requesting physician and the requesting physician will withdraw/cancel the request. Now, you can look at that in some nefarious way. But, what happens many times it the requesing physician does not have all the information the insurer has. Or, the service isn't really necessary and just by asking a few questions the requesting physician admits as much. Or, doctors are just "caught" doing dangerous (there's no other word for it) things thinking nobody is watching.
One classic example is we track the history of GI scopes - we've had doctors request a 3rd or 4th colonoscopy on some poor guy within a single year. We bring this to their attention and they go - oh! I had no idea! We let them off with that when this very same doctor was the same one that did the 2 or 3 before. I don't know all the clinical details, but at some point, if it's not working, you gotta try something else.
Most good providers don't mind the oversight. They are confident in what they do, and answer the questions and move on with their lives.
Sorry. The world doesn't work the way you tell it to.
your also correct here. the government here in Canada does set the prices on what a doctor can charge for things. but to be honest, i know many doctors and they are not just scrapping by.
No doubt.
I will say this - in the US we could solve a lot of problems with 1 very simple fix - tort reform. I understand folks need remuneration when a doctor messes up. But, they don't need them and their progeny to be set for their and their future family's life b/c of a mistake. The damage should be covered. Punishment should be paid. But, enough is enough.
There are OB/Gyn's that basically spend 80% of their year paying their malpractice insurance b/c if 1 child gets born with some deformity and everyone must pay.
If we fixed tort reform and the premiums being paid on malpractice we'd see a significant drop in health care costs (and remove the lame excuse of defensive medicine that some weaker providers try to play off of).
Sorry. The world doesn't work the way you tell it to.
your also correct here. the government here in Canada does set the prices on what a doctor can charge for things. but to be honest, i know many doctors and they are not just scrapping by.
No doubt.
I will say this - in the US we could solve a lot of problems with 1 very simple fix - tort reform. I understand folks need remuneration when a doctor messes up. But, they don't need them and their progeny to be set for their and their future family's life b/c of a mistake. The damage should be covered. Punishment should be paid. But, enough is enough.
There are OB/Gyn's that basically spend 80% of their year paying their malpractice insurance b/c if 1 child gets born with some deformity and everyone must pay.
If we fixed tort reform and the premiums being paid on malpractice we'd see a significant drop in health care costs (and remove the lame excuse of defensive medicine that some weaker providers try to play off of).
Can we have tort reform, and with the costs apparently lowered, then pay for a universal system.
I guess what I don't understand about the USA is why people have no problems paying to bomb the shit out of another country, but balk at having to pay so their neighbour won't go bankrupt if he gets sick.
Believe me, when I was growin up, I thought the worst thing you could turn out to be was normal, So I say freaks in the most complementary way. Here's a song by a fellow freak - E.V
Can we have tort reform, and with the costs apparently lowered, then pay for a universal system.
I guess what I don't understand about the USA is why people have no problems paying to bomb the shit out of another country, but balk at having to pay so their neighbour won't go bankrupt if he gets sick.
Specious argument. Whether I agree with the war(s) or not is irrelevant. If we never spent another dime on foreign soil, I still don't think government run health care is the right way to go. One has nothing to do with the other. Just because I save money on the war effort doesn't mean I have to spend it on ineffecient government run health care.
Now, I guess I should clarify - when folks talk about universal coverage, they generally mean a government run health care system. If you wanted to pay for everyone and then have mandated managed care or something NY State Medicaid does this), then maybe. But, I'm guessing that's not what most folks intend. They just want plain old - I go to a doctor and I want someone (else) to pay for whatever I get type coverage. Which is NOT what Canada has.
Sorry. The world doesn't work the way you tell it to.
but balk at having to pay so their neighbour won't go bankrupt if he gets sick.
Most "uninsureds" could afford "sleep at night" coverage if they so desired. That is, high deductible, major medical style indemnity coverage. Nobody goes bankrupt because of a $5,000 deductible which quite frankly, most facilities would waive if they had a large enough hospital stay being paid for. But, folks decide not to. They can afford concert tickets, but not medical insurance to cover a catastrophe.
Sorry. The world doesn't work the way you tell it to.
sorry man, re. 'theres details missing here' i hope your joking.
re. the employer base HMO coverage, that was irrelevant, my wife was (at that time) a private contractor/1099 as are millions of other americans in the same boat. they gotta shop for a privately insured plan. sure there are catastrophic plans (which she did for 1 year), boy those are really fkd up.
I'm sorry. I didn't mean to offend. That just sounds odd to me. Is there a history of smoking? Family history of diabetes? Is there any other mitigating circumstances?
I'm not saying you are lying. I've just never heard of someone that young (assuming she gave birth such a short time ago) being denied coverage simply for high blood pressure. I guess I may have learned something new. So, thank you. My bad. And I certainly wrote it in the worst way possible.
Sorry. The world doesn't work the way you tell it to.
i have no doubt that insurance companies have doctors. and since you work in insurance, i just have a question for you. if a doctor is getting paid from the insurance company don't you think that maybe they might side more with the people who pay them? i don't know the answer to that and hope you can answer that. for me there seems to be a conflict of interest there.
Well, obviously, they look at things from a different perspective. But, all Medical Directors (the doctors at the insurance company) must be licensed in the State they are "practicing" and carry malpractice insurance like any other doctor (though it is cheaper).
They also must follow the clinical guidelines of the organization which must be submitted for review to the regulating (State or Federal) entity. These guidelines must cite source and relevance. There are 2 or 3 "standards" that are out there for general stuff, but most of these guideliness are based on AMA or specialty specific professional organizations that are populated by many more doctors that are "practicing" physicians than "insurance" doctors. All "denials" must be documented with reasons and source. They are "eligible" to be appealed and then have 3rd party review. It's a lot of work for an insurance company to deny something. So, this concept that they are denying for petty things is ridiculous. Yes, some poor decisions get made from time to time. And, there are checks and balances for that, also.
I know my organization denies very little (you'd be amazed at the %'s). Most times, our doctors will talk to the requesting physician and the requesting physician will withdraw/cancel the request. Now, you can look at that in some nefarious way. But, what happens many times it the requesing physician does not have all the information the insurer has. Or, the service isn't really necessary and just by asking a few questions the requesting physician admits as much. Or, doctors are just "caught" doing dangerous (there's no other word for it) things thinking nobody is watching.
One classic example is we track the history of GI scopes - we've had doctors request a 3rd or 4th colonoscopy on some poor guy within a single year. We bring this to their attention and they go - oh! I had no idea! We let them off with that when this very same doctor was the same one that did the 2 or 3 before. I don't know all the clinical details, but at some point, if it's not working, you gotta try something else.
Most good providers don't mind the oversight. They are confident in what they do, and answer the questions and move on with their lives.
thanks. and i agree with you that doctors make mistake and will order the same tests a couple of times. happen to my mom here in Canada when she had cancer. i just have met to many people who have been deny some type of test that may have saved their lives but wasn't approved as the insurance company didn't believed that it was needed.
thanks. and i agree with you that doctors make mistake and will order the same tests a couple of times. happen to my mom here in Canada when she had cancer. i just have met to many people who have been deny some type of test that may have saved their lives but wasn't approved as the insurance company didn't believed that it was needed.
Sorry about your mom.
And the last part is unfortunate. Again, I would implore anyone with that situation to question their doctor as to the necessity of such a test. And then fight if that's what you need to do. Folks at insurance companiers are human, too (believe it or not). Yes, it's unfortunate that the few have to work harder due to the transgressions of others who have abused the system. Nobody is trying to reduce the quality of care to anyone (well, I can't speak for EVERYONE). I truly believe that is not the goal. It is easier to approve care than to deny it.
My saying to all our new employees is this: The right care at the right time at the right place is always best for the patient. If you follow that - the finances will take care of themselves.
Sorry. The world doesn't work the way you tell it to.
Specious argument. Whether I agree with the war(s) or not is irrelevant. If we never spent another dime on foreign soil, I still don't think government run health care is the right way to go. One has nothing to do with the other. Just because I save money on the war effort doesn't mean I have to spend it on ineffecient government run health care.
Now, I guess I should clarify - when folks talk about universal coverage, they generally mean a government run health care system. If you wanted to pay for everyone and then have mandated managed care or something NY State Medicaid does this), then maybe. But, I'm guessing that's not what most folks intend. They just want plain old - I go to a doctor and I want someone (else) to pay for whatever I get type coverage. Which is NOT what Canada has.[/quote]
i actually think the government run health care is actually a scare tactic mostly from the right (sorry). most people think that the government is going to tell them what they can do which is further from the truth. as i have said before, the best system in my eyes is the more based on a Canadian and other countries health care system. where through your taxes, the government pays the health care bills but does not dictate care.
i have no doubt that insurance companies have doctors. and since you work in insurance, i just have a question for you. if a doctor is getting paid from the insurance company don't you think that maybe they might side more with the people who pay them? i don't know the answer to that and hope you can answer that. for me there seems to be a conflict of interest there.
Couldn't your same question be applied to mandated insurance that is handled by the government? Wouldn't it just replace the insurance company as the payor with the government?
no, as was mentioned before, i believe that any decision about your health should be decided by only you and your doctor. the government or the insurance company should not have a say it what you decide.
Ok, I wasn't exactly sure at what you were getting at with your question. I agree with your thinking on this; it definitely should be between you and your doctor.
i actually think the government run health care is actually a scare tactic mostly from the right (sorry). most people think that the government is going to tell them what they can do which is further from the truth. as i have said before, the best system in my eyes is the more based on a Canadian and other countries health care system. where through your taxes, the government pays the health care bills but does not dictate care.
It's not a scare tactic to me.
I know what could work. Remember - businesses pay for a large chunk of the medical insurance bill in the states right now. GM was it's own health care carrier. This is also why Bush was brilliant in his design of Medicare Part D (prescription drugs). Now, folks complained about the donut hole. That is debatable, but that was put there for affordability reasons. But, again - debate away.
The truly brilliant part is he said to employers that were already footing the bill for their retirees (and keeping them off the government's dime) that the Feds would pay employers 2/3rds of the Federal Prescription drug plan cost if they provided Medicare eligible retirees with a prescription drug plan AT LEAST as rich as the Federal Plan. Now, critics argued that Bush was giving money to big business. And he was - to avoid the alternative - those same companies dropping coverage, and the Feds winding up with 100% of the cost of those retirees! It was sheer brilliance. Now, you could again argue if 2/3rd was too much, or what the exact amount was that would keep the employers in the game to keep providing this benefit. But, basically, he was saving the gov't (i.e. taxpayers) 33% on every retiree that kept their employer based retiree coverage and could thus afford to offer more benefit with less tax dollars. And employers liked it b/c they could keep that benefit to attract employees (and unions loved it even more b/c they are the ones that had this type of coverage the most).
That is the type of gov't funding we should look into - don't kill the golden goose (employer coverage and private insurance) - enhance it. And then you could fund an increasing number of uninsureds. Continue to close the gap while encouraging employer based funding for coverage.
Sorry. The world doesn't work the way you tell it to.
i actually think the government run health care is actually a scare tactic mostly from the right (sorry). most people think that the government is going to tell them what they can do which is further from the truth. as i have said before, the best system in my eyes is the more based on a Canadian and other countries health care system. where through your taxes, the government pays the health care bills but does not dictate care.
It's not a scare tactic to me.
I know what could work. Remember - businesses pay for a large chunk of the medical insurance bill in the states right now. GM was it's own health care carrier. This is also why Bush was brilliant in his design of Medicare Part D (prescription drugs). Now, folks complained about the donut hole. That is debatable, but that was put there for affordability reasons. But, again - debate away.
The truly brilliant part is he said to employers that were already footing the bill for their retirees (and keeping them off the government's dime) that the Feds would pay employers 2/3rds of the Federal Prescription drug plan cost if they provided Medicare eligible retirees with a prescription drug plan AT LEAST as rich as the Federal Plan. Now, critics argued that Bush was giving money to big business. And he was - to avoid the alternative - those same companies dropping coverage, and the Feds winding up with 100% of the cost of those retirees! It was sheer brilliance. Now, you could again argue if 2/3rd was too much, or what the exact amount was that would keep the employers in the game to keep providing this benefit. But, basically, he was saving the gov't (i.e. taxpayers) 33% on every retiree that kept their employer based retiree coverage and could thus afford to offer more benefit with less tax dollars. And employers liked it b/c they could keep that benefit to attract employees (and unions loved it even more b/c they are the ones that had this type of coverage the most).
That is the type of gov't funding we should look into - don't kill the golden goose (employer coverage and private insurance) - enhance it. And then you could fund an increasing number of uninsureds. Continue to close the gap while encouraging employer based funding for coverage.
the major issue that i have with this is as you can see today, jobs are few and far in between. like here in Canada i have health coverage from my work for things that we must pay for. even thought we have UHC that doesn't mean that everything is paid for. for example, i take many pills in a day, these pills are paid for by my own insurance. the government doesn't pay for them. however, my insurance will not pay for other things that the government will pay for. however, if i lose my job only a portion of my health care is gone but not the whole amount. in America if you lose your job you also lose your coverage unless you can afford to keep it.
sorry when is a scare tactic what i mean is that most people still have a belief that it is the government who approve certain things and not others. that why that whole death panel came around.
Comments
Couldn't your same question be applied to mandated insurance that is handled by the government? Wouldn't it just put the government in the place of the insurance company as the payor?
no, as was mentioned before, i believe that any decision about your health should be decided by only you and your doctor. the government or the insurance company should not have a say it what you decide.
Well, obviously, they look at things from a different perspective. But, all Medical Directors (the doctors at the insurance company) must be licensed in the State they are "practicing" and carry malpractice insurance like any other doctor (though it is cheaper).
They also must follow the clinical guidelines of the organization which must be submitted for review to the regulating (State or Federal) entity. These guidelines must cite source and relevance. There are 2 or 3 "standards" that are out there for general stuff, but most of these guideliness are based on AMA or specialty specific professional organizations that are populated by many more doctors that are "practicing" physicians than "insurance" doctors. All "denials" must be documented with reasons and source. They are "eligible" to be appealed and then have 3rd party review. It's a lot of work for an insurance company to deny something. So, this concept that they are denying for petty things is ridiculous. Yes, some poor decisions get made from time to time. And, there are checks and balances for that, also.
I know my organization denies very little (you'd be amazed at the %'s). Most times, our doctors will talk to the requesting physician and the requesting physician will withdraw/cancel the request. Now, you can look at that in some nefarious way. But, what happens many times it the requesing physician does not have all the information the insurer has. Or, the service isn't really necessary and just by asking a few questions the requesting physician admits as much. Or, doctors are just "caught" doing dangerous (there's no other word for it) things thinking nobody is watching.
One classic example is we track the history of GI scopes - we've had doctors request a 3rd or 4th colonoscopy on some poor guy within a single year. We bring this to their attention and they go - oh! I had no idea! We let them off with that when this very same doctor was the same one that did the 2 or 3 before. I don't know all the clinical details, but at some point, if it's not working, you gotta try something else.
Most good providers don't mind the oversight. They are confident in what they do, and answer the questions and move on with their lives.
No doubt.
I will say this - in the US we could solve a lot of problems with 1 very simple fix - tort reform. I understand folks need remuneration when a doctor messes up. But, they don't need them and their progeny to be set for their and their future family's life b/c of a mistake. The damage should be covered. Punishment should be paid. But, enough is enough.
There are OB/Gyn's that basically spend 80% of their year paying their malpractice insurance b/c if 1 child gets born with some deformity and everyone must pay.
If we fixed tort reform and the premiums being paid on malpractice we'd see a significant drop in health care costs (and remove the lame excuse of defensive medicine that some weaker providers try to play off of).
I guess what I don't understand about the USA is why people have no problems paying to bomb the shit out of another country, but balk at having to pay so their neighbour won't go bankrupt if he gets sick.
Specious argument. Whether I agree with the war(s) or not is irrelevant. If we never spent another dime on foreign soil, I still don't think government run health care is the right way to go. One has nothing to do with the other. Just because I save money on the war effort doesn't mean I have to spend it on ineffecient government run health care.
Now, I guess I should clarify - when folks talk about universal coverage, they generally mean a government run health care system. If you wanted to pay for everyone and then have mandated managed care or something NY State Medicaid does this), then maybe. But, I'm guessing that's not what most folks intend. They just want plain old - I go to a doctor and I want someone (else) to pay for whatever I get type coverage. Which is NOT what Canada has.
Most "uninsureds" could afford "sleep at night" coverage if they so desired. That is, high deductible, major medical style indemnity coverage. Nobody goes bankrupt because of a $5,000 deductible which quite frankly, most facilities would waive if they had a large enough hospital stay being paid for. But, folks decide not to. They can afford concert tickets, but not medical insurance to cover a catastrophe.
I'm sorry. I didn't mean to offend. That just sounds odd to me. Is there a history of smoking? Family history of diabetes? Is there any other mitigating circumstances?
I'm not saying you are lying. I've just never heard of someone that young (assuming she gave birth such a short time ago) being denied coverage simply for high blood pressure. I guess I may have learned something new. So, thank you. My bad. And I certainly wrote it in the worst way possible.
thanks. and i agree with you that doctors make mistake and will order the same tests a couple of times. happen to my mom here in Canada when she had cancer. i just have met to many people who have been deny some type of test that may have saved their lives but wasn't approved as the insurance company didn't believed that it was needed.
Sorry about your mom.
And the last part is unfortunate. Again, I would implore anyone with that situation to question their doctor as to the necessity of such a test. And then fight if that's what you need to do. Folks at insurance companiers are human, too (believe it or not). Yes, it's unfortunate that the few have to work harder due to the transgressions of others who have abused the system. Nobody is trying to reduce the quality of care to anyone (well, I can't speak for EVERYONE). I truly believe that is not the goal. It is easier to approve care than to deny it.
My saying to all our new employees is this: The right care at the right time at the right place is always best for the patient. If you follow that - the finances will take care of themselves.
Now, I guess I should clarify - when folks talk about universal coverage, they generally mean a government run health care system. If you wanted to pay for everyone and then have mandated managed care or something NY State Medicaid does this), then maybe. But, I'm guessing that's not what most folks intend. They just want plain old - I go to a doctor and I want someone (else) to pay for whatever I get type coverage. Which is NOT what Canada has.[/quote]
i actually think the government run health care is actually a scare tactic mostly from the right (sorry). most people think that the government is going to tell them what they can do which is further from the truth. as i have said before, the best system in my eyes is the more based on a Canadian and other countries health care system. where through your taxes, the government pays the health care bills but does not dictate care.
Ok, I wasn't exactly sure at what you were getting at with your question. I agree with your thinking on this; it definitely should be between you and your doctor.
It's not a scare tactic to me.
I know what could work. Remember - businesses pay for a large chunk of the medical insurance bill in the states right now. GM was it's own health care carrier. This is also why Bush was brilliant in his design of Medicare Part D (prescription drugs). Now, folks complained about the donut hole. That is debatable, but that was put there for affordability reasons. But, again - debate away.
The truly brilliant part is he said to employers that were already footing the bill for their retirees (and keeping them off the government's dime) that the Feds would pay employers 2/3rds of the Federal Prescription drug plan cost if they provided Medicare eligible retirees with a prescription drug plan AT LEAST as rich as the Federal Plan. Now, critics argued that Bush was giving money to big business. And he was - to avoid the alternative - those same companies dropping coverage, and the Feds winding up with 100% of the cost of those retirees! It was sheer brilliance. Now, you could again argue if 2/3rd was too much, or what the exact amount was that would keep the employers in the game to keep providing this benefit. But, basically, he was saving the gov't (i.e. taxpayers) 33% on every retiree that kept their employer based retiree coverage and could thus afford to offer more benefit with less tax dollars. And employers liked it b/c they could keep that benefit to attract employees (and unions loved it even more b/c they are the ones that had this type of coverage the most).
That is the type of gov't funding we should look into - don't kill the golden goose (employer coverage and private insurance) - enhance it. And then you could fund an increasing number of uninsureds. Continue to close the gap while encouraging employer based funding for coverage.
the major issue that i have with this is as you can see today, jobs are few and far in between. like here in Canada i have health coverage from my work for things that we must pay for. even thought we have UHC that doesn't mean that everything is paid for. for example, i take many pills in a day, these pills are paid for by my own insurance. the government doesn't pay for them. however, my insurance will not pay for other things that the government will pay for. however, if i lose my job only a portion of my health care is gone but not the whole amount. in America if you lose your job you also lose your coverage unless you can afford to keep it.
sorry when is a scare tactic what i mean is that most people still have a belief that it is the government who approve certain things and not others. that why that whole death panel came around.