Obama violating rights...STRUCK DOWN!

gimmesometruth27 · August 2011

EdsonNascimento wrote:

gimmesometruth27 wrote:

i absolutely know what i am talking about, and i am going to call bullshit right here.
annual physicals and well visits are not covered. and if they are, they are not covered at nearly the same reimbursement rate as a sick visit. even for school aged kids who have to have an annual physical for school, and for those that need a preparticipation physical for sports. i have to tell them when they call that an annual physical is not covered by their insurance and if they want to submit it to insurance they can, but if it gets denied it costs $168. sometimes they call their insurance company to ask them to cover it, and they get maybe $20 paid and sometimes they don't. all i know is i have to track down deadbeat parents to get the money for their kid's physical that the insurance did not cover. so yeah...

i dunno, 25 year olds need annual physicals all the time. in case you have not looked around, we have a lot of obese people in their 20s. obesity is the leading cause of chronic illness. these are people with hypertension, high cholesterol, thyroid problems, diabetes, etc and they all require yearly checkups, and most of them require refills on their maintenance medications, and this is normally done at the annual physical. if they are asymptomatic and are not sick they are called well visits. if they come in while sick it is not a well visit, so that is when it is typically covered..

well visits are covered under medicaid and medicare. and mind you medicare covers not only elderly, but those on disability.

Those obese visits you're talking about are not well care. Obesity is a recognized illness, and pcps get them covered every time.

As for well visits, they are covered to pcps. Not to specialists. What kind of provider are you? Im guessing not Im or fp or ped.

i am telling you they are still billed as annual checkups/well visits if there are no new complaints or symptoms. why do you think they ask if you are sick or if you have a problem when you call to make the appointment? i get an annual physical and i owe about $120 every year because insurance does not cover it. it covers my lab work and $40 of the visit and that's it.

no we are not fp or im. we are orthopedic mds. we see all ages, peds to elderly. i think in the five years i have been there we have seen a 1 year old all the way to a 98 year old. and we are the only one in a 30 mile radius that takes medicaid. not because they definitely pay, but because it is the right thing to do, because somebody has to see those people. we are in a group of 30 docs and the im guys are always complaining in meetings that they are not getting paid by the private insurances. hell we are specialists and we get pennies on the dollar for some services. fracture care for one. fracture care is an umbrella code that includes all of your visits, copays, x rays, casting, splinting for 3 months. a fracture code bills insurance about $900. we are lucky to see 60% of that from insurance and the patient ends up owing a lot of money.

RFTC · August 2011

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.

pjfan021 · August 2011

to focus on just the individual mandate...don't people realize that those who are uninsured in this country are already getting their bill picked up by the rest of the country? Mandating that everyone has insurance doesn't really change anything except people might actually cut down on ER visits when they have access to a doctor on a more regular basis...and i guess since I view myself as more of a progressive I'm ok with us covering uninsured people...kinda makes some sense to make sure people are healthy when we can spend around 700 billion a year on defense against nuclear weapons and terrorists but can't spend on our own health. we have a very good health system for some and a kinda shitty system for a lot. this bill isn't perfect by any means but i think it's a great starting point to build on.

keeponrockin · August 2011

I would much rather, as a society, pay for 'unnecessary' tests than not pay for necessary ones.

EdsonNascimento · August 2011

keeponrockin wrote:

I would much rather, as a society, pay for 'unnecessary' tests than not pay for necessary ones.

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

Because we don't live in a perfect world. Who decides who is necessary and what is not? At the moment, it's the health insurance companies that won't pay for tests until they know that the patient is terminal. So they don't have to pay for treatment. They wait until you're sick enough that you won't get better... Is that the kind of system you really want?

EdsonNascimento · August 2011

Prince Of Dorkness wrote:

EdsonNascimento wrote:

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

Because we don't live in a perfect world. Who decides who is necessary and what is not? At the moment, it's the health insurance companies that won't pay for tests until they know that the patient is terminal. So they don't have to pay for treatment. They wait until you're sick enough that you won't get better... Is that the kind of system you really want?

You are misinformed.

bgivens33 · August 2011

pjfan021 wrote:

to focus on just the individual mandate...don't people realize that those who are uninsured in this country are already getting their bill picked up by the rest of the country? Mandating that everyone has insurance doesn't really change anything except people might actually cut down on ER visits when they have access to a doctor on a more regular basis...and i guess since I view myself as more of a progressive I'm ok with us covering uninsured people...kinda makes some sense to make sure people are healthy when we can spend around 700 billion a year on defense against nuclear weapons and terrorists but can't spend on our own health. we have a very good health system for some and a kinda shitty system for a lot. this bill isn't perfect by any means but i think it's a great starting point to build on.

The focus is on the individual mandate because the Federal government doesn't have the authority to mandate citizens to purchase a product. Everything else you typed is irrelevant if the bill itself isn't constitutional. That is why the focus IS on the mandate.

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

Prince Of Dorkness wrote:

EdsonNascimento wrote:

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

Because we don't live in a perfect world. Who decides who is necessary and what is not? At the moment, it's the health insurance companies that won't pay for tests until they know that the patient is terminal. So they don't have to pay for treatment. They wait until you're sick enough that you won't get better... Is that the kind of system you really want?

You are misinformed.

Well no. I'm not. And the sad thing is that the health insurance companies have convinced you otherwise. They pour millions into the campaigns of politicians who'll say things like "death panels" and "pull the plug on gramma" and the sheep all follow.

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

You are misinformed.

Ok I'll give you this... If a person has great coverage, they often DO get tests they don't need because e doctors know the insurance will pay for it.

But that's a lot less common than you're lead to believe. What's more common is people not getting tests until it's too late. My grandfather died because although his doctor knew he had cancer, he couldn't get the proper tests approved until it was way too late to do anything about it.

fife · August 2011

Prince Of Dorkness wrote:

fife wrote:

completely agree that the playing field is more even. i was just saying that if you are a rich person in canada you can always go to America or somewhere to get faster services. the people with the greatest health coverage in canada are the Hockey players.

Meh... I'm "rich" (-er than the average American) and live in America and I still got better services in Canada when I was making 40K a year.

Yes, I have an amazing personal doctor who answers my emails at 6 AM, but I also have a PPO that costs more per year than most people make in two months.

My last motorcycle accident when I went to an emergency room... I laid there for 3 hours begging for morphine before I even saw a doctor. The health care down in America... ain't so great.

sorry went away for the weekend and didn't have internet there. Don't get me wrong, i love the Canadian health care system even with it faults. but i do have to say that depending on where you are in Canada you might wait 3 hours or more in the emergency room. they base entry on how important your issue is.

fife · August 2011

EdsonNascimento wrote:

keeponrockin wrote:

I would much rather, as a society, pay for 'unnecessary' tests than not pay for necessary ones.

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

i understand what you are saying but like i said before. who should have the power to determine that?

also sometimes what is considered unnecessary test are necessary. i remember back in the 80's and early 90's many women where not being test for HIV cause most people believed that it was just a gay man issues. i think we all know now that this is not correct.

Prince Of Dorkness · August 2011

fife wrote:

sorry went away for the weekend and didn't have internet there. Don't get me wrong, i love the Canadian health care system even with it faults. but i do have to say that depending on where you are in Canada you might wait 3 hours or more in the emergency room. they base entry on how important your issue is.

True.

But one of the performers I work with had a severely broken collarbone AND not only waited the 3 hours to be seen, once they found he didn't have insurance, they gave him a few x rays, a bottle of pain killers and a cloth sling, sent him home without the surgery he needed and sent him a bill for $30,000.

He's quite deformed because of how bad the bones healed.

That never would have happened in Canada.

Yes, in some places you have to wait a long time for care in Canada butbat least you get it.

fife · August 2011

Prince Of Dorkness wrote:

fife wrote:

sorry went away for the weekend and didn't have internet there. Don't get me wrong, i love the Canadian health care system even with it faults. but i do have to say that depending on where you are in Canada you might wait 3 hours or more in the emergency room. they base entry on how important your issue is.

True.

But one of the performers I work with had a severely broken collarbone AND not only waited the 3 hours to be seen, once they found he didn't have insurance, they gave him a few x rays, a bottle of pain killers and a cloth sling, sent him home without the surgery he needed and sent him a bill for $30,000.

He's quite deformed because of how bad the bones healed.

That never would have happened in Canada.

Yes, in some places you have to wait a long time for care in Canada butbat least you get it.

holy fuck! i should send this post to many people in Canada who complain about our health care system. I also broke a collarbone and was in a lot of pain. it was a Saturday night and really busy in the emergency room. i think i waited i think about 10 minutes but i think it was also because i was a falling down alot due to what i found out was a concussion.

EdsonNascimento · August 2011

fife wrote:

EdsonNascimento wrote:

keeponrockin wrote:

I would much rather, as a society, pay for 'unnecessary' tests than not pay for necessary ones.

Why can't we pay for necessary ones and NOT unnecessary ones?

And some unnecessary ones are detriments to your health.

i understand what you are saying but like i said before. who should have the power to determine that?

also sometimes what is considered unnecessary test are necessary. i remember back in the 80's and early 90's many women where not being test for HIV cause most people believed that it was just a gay man issues. i think we all know now that this is not correct.

Doctors should determine what is necessary and what is not. Who wouldn't think that?

And who thinks insurance companies don't have DOCTORS doing that? That's the misinformed part. The media here has folks believing CFO's are. That is 100% incorrect. The insurance companies are regulated and must file all medical protocols with CMS (For Medicare) or the State (For Medicaid and Commercial/Individual). There are also stringent appeal rights, third party reviews, etc.

If they made decisions not based on medical criteria, they would be put out of business.

Are they perfect - no. But, anyone who thinks their pesonal doctor is - well - there's a bridge in Brooklyn I have for sale.

As for the HIV testing - that was not insurance protocol - that was common misconception. It happens all the time in life. And that "conventional wisdom" changed for the better.

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

And who thinks insurance companies don't have DOCTORS doing that?

Wow.

And you called ME "misinformed."

Although yes... I suppose a few doctors rubber stamp the paperwork, the jobs of those people are "find evidence of pre-existing conditions so we can cancel their claims now that they're sick."

EdsonNascimento · August 2011

Prince Of Dorkness wrote:

True.

But one of the performers I work with had a severely broken collarbone AND not only waited the 3 hours to be seen, once they found he didn't have insurance, they gave him a few x rays, a bottle of pain killers and a cloth sling, sent him home without the surgery he needed and sent him a bill for $30,000.

He's quite deformed because of how bad the bones healed.

That never would have happened in Canada.

Yes, in some places you have to wait a long time for care in Canada butbat least you get it.

Here's the (not so) funny part of this story - you blame the insurance company for this. When, in fact it was the facility that acted poorly. You are right about waiting times in ER's. It is abhorrent at some places. And legally, they are required to provide treatment regardless of insurance. You should have reported them if you believe they provided sub-par service. They could lose their license for that.

But, look at the bill he got - $30,000! Do you think the service he got (let alone the service he should have gotten) was worth $30,000? I certainly hope he didn't pay that. What you describe is less than $1,000.

Now, let's say we have this perfect world Universal Coverage you seek - would you like your tax dollars to go up b/c the Feds are paying $30,000 for a $750 service? And would your friend have had a problem not being covered by insurance if they billed him appropriately rather than artificially inflating the bill so they could negotiate based on a % discount off billed rather than based on the actual value of the service?

What other industry do we allow producers/providers to do such a thing?

EdsonNascimento · August 2011

Prince Of Dorkness wrote:

EdsonNascimento wrote:

And who thinks insurance companies don't have DOCTORS doing that?

Wow.

And you called ME "misinformed."

Although yes... I suppose a few doctors rubber stamp the paperwork, the jobs of those people are "find evidence of pre-existing conditions so we can cancel their claims now that they're sick."

Have you gotten a clue yet that I work at one of these "evil" companies? And, I am not a doctor. And, I know who makes the decisions here and how they make them. I also know the inner workings of several other large insurers, how they work and the legal requirements we are all under.

So, yes, I can confidently say you are misinformed.

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

Have you gotten a clue yet that I work at one of these "evil" companies? And, I am not a doctor. And, I know who makes the decisions here and how they make them. I also know the inner workings of several other large insurers, how they work and the legal requirements we are all under.

So, yes, I can confidently say you are misinformed.

Ah yeah... "legal requirements."

That's just a way of saying "let's see how we can get this around the laws."

If you work for one of the companies, you know about how many people have paid for years and then had their coverage cancelled once they needed because someone - doctor or otherwise - was able to find a legal loophole and a "pre-existing condition."

Prince Of Dorkness · August 2011

EdsonNascimento wrote:

Here's the (not so) funny part of this story - you blame the insurance company for this.

Oh... no, I don't.

I blame the entire system that's meant to make money and not make people well. This isn't an insurance company's fault.

And legally, they are required to provide treatment regardless of insurance. You should have reported them if you believe they provided sub-par service.

They did "treat" him. They gave him a few x-rays, some drugs and a sling.

But, look at the bill he got - $30,000! Do you think the service he got (let alone the service he should have gotten) was worth $30,000? I certainly hope he didn't pay that. What you describe is less than $1,000.

Agreed. No, of course he didn't pay it. He's 21 with a part time job and no insurance. He makes 30K in about 2 years.

Now, let's say we have this perfect world Universal Coverage you seek - would you like your tax dollars to go up b/c the Feds are paying $30,000 for a $750 service?

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.

Obama violating rights...STRUCK DOWN!

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