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Post by nitetimeritetime on Mar 31, 2009 14:24:15 GMT -5
Well, justmeg, you are the first healthcare person I've heard say that BC/BS is easier to deal with than Medicare. But given your experience in the business, I wil concede that point to you.
And consider yourself lucky that you were able to choose your insurer based on which doctors they covered. Millions and millions of Americans do not have that choice. Word of advice: don't get cancer.
Nitetime, thanks for answering. I've worked all sides of healthcare...managed care, insurance broker and employer. I was just curious as to whether you had an especially restrictive plan (eg. some employers are now contracting directly with practices and negotiating their own rates...running their own managed care operations, if you will).
The advent of managed care has indeed lessened our choices, but I still prefer a private system after speaking with friends in other countries.
As to the issue of not having kids, that is a choice, buut what are you gonna do force abortions on people who have an income below 18k a year? Children to a certain extent belong to a society as a whole because they represent our future. I may not like the choices and actions others have made, but I will never have a problem trying to take care of children in the best way possible.
I am by no means advocating a law. I'm libertarian, and pretty much no matter the subject, I want the government to step off. I just don't want to be forced to pay for other people's mistakes. I understand pregnancies happen and have friends in that situation. I have no problem helping them out, or donating clothes and food to charity. My problem is the government decides how the (tax) money is spent (whatever's left of it after it trickles through the system), and too much of it ends up in the wrong hands.
Nitetime, thanks for answering. I've worked all sides of healthcare...managed care, insurance broker and employer. I was just curious as to whether you had an especially restrictive plan (eg. some employers are now contracting directly with practices and negotiating their own rates...running their own managed care operations, if you will).
The advent of managed care has indeed lessened our choices, but I still prefer a private system after speaking with friends in other countries.
Private has to be the way to go. Anyone living in Massachusetts, that wants the inept people in charge of our roads and bridges, and public transportation, to be responsible for our healthcare, has rocks in their head.
Everyone doesn't deserve healthcare?? You really believe that?
edit: I'm not against helping others by any means. I just think taxing people (above what is done currently) isn't the way to do it. Fundraisers for people in the community who are sick, donating to charities, charity walks, etc are much better ways of doing things. People can help the people they love, and causes that are closest to them, directly, rather than having that $$ dragged through all the government red tape.
note:karma starting at 27.
amen to this. as for what doctors are in a particular insurance's network, that is really up to the doctor. its the doctor who chooses what insurances he wants to accept. the doctor will the then go through the credentialing process (which takes forever). then, the insurance company can then decide if they care to work with that particular doctor. my dad's clinic tried credentialing with bc/bs, but they denied us, due to being credentialed with another doctor down the road. is it fair to the patient? no. but what can the doctor do at that point?
meg, that is awesome for you and bc/bs. however, i know "some" who have the same insurance are not as lucky.
first, it is not about having kids in poverty or choosing to do well for your self... Many people go into poverty after an illness occurs. My wife and have children and her MS started later. We have had over 400000 in medical bills because of crappy insurance. As far as the survival of the fittest bull sh it....... Using what we have is survival. We can reason and make new ways to survive...So I just decide, oh someone else cannot get a doctor my wife should just die and I watch her... We fought to have medicare and medicaid for my wife, in indiana it pays for a lot and keeps her alive and walking. I pay into the medicaid under a new program for disabled people who are under insured for her.
much of this discussion comes down to a disagreement about the value and importance of money.
between my gf and i, we pull down a sizable chunk of change each year. maybe it's easy for me to be so free with my money because i have enough to not worry about it. i dont need to check the price of a can of soup if i want it. but im not rich, nor will i be retiring at 40... i've just made choices in my life that resulted in this situation.
my logic for healthcare is "well, im paying for medical coverage already, if it went national, i probably wouldnt be paying any more than i already do - and everyone wins!"
i dont have kids, not sure that i will, but i pay for schools. that's okay with me - keeps society and the country going. my federal taxes might pay for some development in a part of the country i will never visit, but that's okay - it's helping the people there.
first, it is not about having kids in poverty or choosing to do well for your self... Many people go into poverty after an illness occurs. My wife and have children and her MS started later. We have had over 400000 in medical bills because of crappy insurance. As far as the survival of the fittest bull sh it....... Using what we have is survival. We can reason and make new ways to survive...So I just decide, oh someone else cannot get a doctor my wife should just die and I watch her... We fought to have medicare and medicaid for my wife, in indiana it pays for a lot and keeps her alive and walking. I pay into the medicaid under a new program for disabled people who are under insured for her.
Clato, you and I both know that I am not talk about a situation like this. I hope everything works out for you and your family!
I am talking about the healthy americans who have kids and choose not to work!!!
^^^ but this is exactly the situation to be concerned about.
you could get sick. your insurance company could deny you coverage. the small minority of freeloaders that exploit the system will always exist, regardless of the system in place.
I pay over 2000 a month for bills, and why should my earned money go to someone who doesn't try to work.
Why should your money go to a war you don't want to fight? To public transportation if you never take a bus? Volcano monitoring if you don't live near a volcano? My point is that your tax dollars go to lots of things. Not everything is going to be something that you use directly. Of all the things that you can complain about, it has to be about your taxes (which you were going to pay regardless) going to sick people who need help?
my logic for healthcare is "well, im paying for medical coverage already, if it went national, i probably wouldnt be paying any more than i already do - and everyone wins!"
i dont have kids, not sure that i will, but i pay for schools. that's okay with me - keeps society and the country going. my federal taxes might pay for some development in a part of the country i will never visit, but that's okay - it's helping the people there.
^^^ but this is exactly the situation to be concerned about.
you could get sick. your insurance company could deny you coverage. the small minority of freeloaders that exploit the system will always exist, regardless of the system in place.
^^^ Exactly, our system has to take all of the situations into account. There are always going to be people who abuse the system, but if we throw it out based on those people, then the ones who really need it aren't going to get the help they need.
^ How is it fair to me to take care of someone else's children?
I made a choice to do better in life, they made a choice to bring a kid into poverty.
As a society we collectively monitor and protect children as a whole. This is why DCS can take them from you if society feels you are doing an inadequate job. Your taxes already take care of children, and I doubt it is any cheaper to put a child in a orphanage/foster home, than it is to provide financial assistance to the mother. As to bitching at people who have too many kids, what are you gonna do? Personally I am not into the government regulating sex, abortions, or sterility.
Nitetime, thanks for answering. I've worked all sides of healthcare...managed care, insurance broker and employer. I was just curious as to whether you had an especially restrictive plan (eg. some employers are now contracting directly with practices and negotiating their own rates...running their own managed care operations, if you will).
The advent of managed care has indeed lessened our choices, but I still prefer a private system after speaking with friends in other countries.
Nope, my plan isn't especially restrictive; it's normal. My point was just that the issue of "choice" and "bureaucracy" in this regard is a red herring.
Kelaroo, I know you dont, but the problem is when we toss out general ideas without considering the faces it harms more people. We like to blame individuals in this country in a general way "they". We also tend to forget about the the money behind health care. Not the md but the the pharmaceuticals. As I said early ONE of my wife's medicine cost 35000 a year. It cost the company 1000 to make it, per their own admission.
Over 1/3 bankruptcies in America are do to medical bills-This is a national crisis and many start up companies fail because providing insurance to their employees can be expensive.
Back to what the Obama plan what is wrong with providing tax cuts to companies to provide insurance. The original plan was up to 5000 a person. This is enough to help the companies out then provide more persons with insurance. Then have standards of what insurance will have to cover and then federal support for people who go over PRE-determined limits. This is not socialist it is allowing you to keep tax dollars to provide for your own private insurance.
as for what doctors are in a particular insurance's network, that is really up to the doctor. its the doctor who chooses what insurances he wants to accept.
...can end with this idea...
my dad's clinic tried credentialing with bc/bs, but they denied us, due to being credentialed with another doctor down the road. is it fair to the patient? no. but what can the doctor do at that point?
meg, that is awesome for you and bc/bs. however, i know "some" who have the same insurance are not as lucky.
Well if nobody had insurance the Doctors would be forced to treat people at a reasonable rate. The disparity between charges to an insurance company, and those to someone without insurance is almost 200%. This is what shuts people out of healthcare.
I used to have catastrophic health insurance. Which means that my insurance wouldn't pay anything less than $10k I believe (I forget the exact dollar amount). I had an MRI a couple of years ago and when I told the hospital that I wouldn't be going through insurance and instead pay with my credit card they cut the bill in half. I don't know if this is what you're talking about, but it seems like doctors/hospitals have no problem porking the insurance companies for extra $.
I admit - I am lucky - because I have Federal BC/BS and I am sure that is where the difference is. I have also been on the not so lucky list with insurance when all we had was insurance through Boz - it sucked and I am still paying on over $5,000 in medical bills that insurance would not cover.
My dental insurance sucks - I just put out $1400 last week AFTER insurance paid because they would only pay at 40% instead of 50% because I did not go to a provider in their network because there is NOT a freakin' oral surgeon covered by them in Mississippi because they pay out so crappy. But I have to feel lucky that they covered 40% of it.
Any physician who participates with any type of managed care (HMO, PPO, etc.) is paid a discounted, negotiated rate based upon reasonable and customary charges for that type of practice, in that particular area. So long as the doctor/hospital participates, there's no "porking" for extra dollars...unless they're just throwing extraneous charges in there for the hell of it.
^Well negotiating a deal is not the same thing as what I am talking about. If they cut it in half, they probably charged you what they would have charged an insurance company. The fact of the matter is the insurance companies have negotiated lower rates for service. This means they have to have a higher rate for people without insurance, and personally I have always found it unfair.
I admit - I am lucky - because I have Federal BC/BS and I am sure that is where the difference is. I have also been on the not so lucky list with insurance when all we had was insurance through Boz - it sucked and I am still paying on over $5,000 in medical bills that insurance would not cover.
My dental insurance sucks - I just put out $1400 last week AFTER insurance paid because they would only pay at 40% instead of 50% because I did not go to a provider in their network because there is NOT a freakin' oral surgeon covered by them in Mississippi because they pay out so crappy. But I have to feel lucky that they covered 40% of it.
Hey Meg, you need to appeal that dental claim. If there isn't an oral surgeon in the network, you should not be penalized.
Post by rooconteur on Mar 31, 2009 15:33:35 GMT -5
My problem is that people view medical assistance as a right. It's not. We as a society contribute, and in our times of most need, should have access to it. But, we are not entitled to it. People don't give a fuck that the $$ that's paying their bills is coming out of other people's pockets, while they spend their money on booze, weed, cigs, etc. This is alot more prevalent than people want to believe. But it's a sad truth. Again, I'm not saying the system shouldn't be there, or that it doesn't help tons of worthy people. Just don't tell me it's your right to have medical care, because nobody is entitled to that. There are people in 3rd world country's dying of diseases that could be cured with something simple as penicillin. Where are their rights?
I know I take insurance from private providers and self pay along with federal and state grants. Depending on the private most reimburse more then what I charge clients (by my I mean my workplace) but we are small and it is easier to work with clients. The insurance companies however make it impossible to get the money. They will approve a certain number of sessions after you call and make a case for it. Then after you summit the bill many try to deny they approved then we fax the paper work over they sent us on approval and a year down the line they send us a check.. For small not for profits like my company it cost more money to chase the money...A few insurance we will not take because they are to difficult....
Yeah, that's a whole other can of worms...reimbursements for mental health/substance abuse and the sad joke of parity laws that were passed a few years back.
i guess my point was, after reading my own post didnt make too much sense, if you think the pool of physicians in an insurances network is small now, wait until the healthcare system changes. also, it is no wonder that a report i read says that physicians are discouraging their own children to follow in their footsteps. the reason is, the way things are going there is no incentive to go into medicine. you make more, you get taxed more. also, the govt will tell physicians what they can charge. getting into medicine is a very costly career, and it seems to not dish out what it used to.
as for the case of making college available to everyone--why do we have to pay for people to go to college. grants, loans, and scholarships for those that cant afford it, and out of pocket for those that can. that is the way it has been done for decades. what is so wrong with that.
on another topic, why is it that the obama administration is deciding not to call terrorists terrorists? why are we no longer allowed to use the phrase "war on terror"? now, its man-made catastrophes. i guess that means 9/11 wasnt an act of terror, but rather a man-made catastrophe. i guess the whole 9/11 commision report will have to be rewritten now.
i guess my point was, after reading my own post didnt make too much sense, if you think the pool of physicians in an insurances network is small now, wait until the healthcare system changes. also, it is no wonder that a report i read says that physicians are discouraging their own children to follow in their footsteps. the reason is, the way things are going there is no incentive to go into medicine. you make more, you get taxed more. also, the govt will tell physicians what they can charge. getting into medicine is a very costly career, and it seems to not dish out what it used to.
as for the case of making college available to everyone--why do we have to pay for people to go to college. grants, loans, and scholarships for those that cant afford it, and out of pocket for those that can. that is the way it has been done for decades. what is so wrong with that.
on another topic, why is it that the obama administration is deciding not to call terrorists terrorists? why are we no longer allowed to use the phrase "war on terror"? now, its man-made catastrophes. i guess that means 9/11 wasnt an act of terror, but rather a man-made catastrophe. i guess the whole 9/11 commision report will have to be rewritten now.
Maybe we should subsidize their educations then. If they do not have 500,000 in student loans it might seem more attractive.
I admit - I am lucky - because I have Federal BC/BS and I am sure that is where the difference is. I have also been on the not so lucky list with insurance when all we had was insurance through Boz - it sucked and I am still paying on over $5,000 in medical bills that insurance would not cover.
My dental insurance sucks - I just put out $1400 last week AFTER insurance paid because they would only pay at 40% instead of 50% because I did not go to a provider in their network because there is NOT a freakin' oral surgeon covered by them in Mississippi because they pay out so crappy. But I have to feel lucky that they covered 40% of it.
Hey Meg, you need to appeal that dental claim. If there isn't an oral surgeon in the network, you should not be penalized.
OH trust me - I am doing everything I possible can at the moment to get more money out of them - the only reason I stayed with them when it was open season was because I was at the end of the 24 month waiting period for orthodontic coverage and the 11 year old needed braces
I admit - I am lucky - because I have Federal BC/BS and I am sure that is where the difference is. I have also been on the not so lucky list with insurance when all we had was insurance through Boz - it sucked and I am still paying on over $5,000 in medical bills that insurance would not cover.
My dental insurance sucks - I just put out $1400 last week AFTER insurance paid because they would only pay at 40% instead of 50% because I did not go to a provider in their network because there is NOT a freakin' oral surgeon covered by them in Mississippi because they pay out so crappy. But I have to feel lucky that they covered 40% of it.
This is exactly what I'm talking about. When you have to actually USE your insurance, you find out that it is either inadequate (thus $5000 bills and no oral surgeon in your network), or you find that the insurance company tries to falsely deny claims, claim that you had procedures that aren't covered when they are supposed be covered, and take every other opportunity they can to screw you over.
They do this because they can. Because they know thay we do not really have a choice (no, deciding between crappy insurance and no insurance isn't really a choice). Some people are lucky enough to choose which insurance company to do business with; many others are not so lucky. And many others have to go without insurance (and health care) altogether.
Obama's plan offers us a choice. Under his plan, we could keep our private insurance if we wanted to, or we could use the nationalized system.
If insurance companies knew that people can simply cancel their coverage -- if that was actually a choice, which it really is not right now -- then they would have to be responsive to their customers' needs. This is something any free-market conservative would tell you. When customers have choices, companies whose business model is basically to screw their customers over will eventually fold.
Plus, if insurance companies had to compete with a nationalized plan, I bet it would be a lot easier for doctors to be included in their networks.
When insurance companies have to offer better service than they do now to stay in business, the customer wins. And they will offer better service if the alternative is going out of business. They'll make sure that their service is better than the nationalized plan, or customers will stop paying them.
Denied claims, "lost" paperwork, claiming that things aren't covered when they are, shutting doctors out of their network: all of this would stop if insurers had to compete with a nationalized plan for our business.
on another topic, why is it that the obama administration is deciding not to call terrorists terrorists? why are we no longer allowed to use the phrase "war on terror"? now, its man-made catastrophes. i guess that means 9/11 wasnt an act of terror, but rather a man-made catastrophe. i guess the whole 9/11 commision report will have to be rewritten now.
Am I just being too simplistic here when I say 'who the hell cares?' I mean... it's just a name. A terminology. A euphemism, if you will. It's not like they're banning the word "terrorist" and anybody who is caught speaking of such heresy is arrested and thrown in jail.
Personally, I kinda like the ring to man-made catastrophe. It sounds way more devastating than acts of terrorism... atleast to me
You know it really gets me when people make exceptions to the the rule, as the rule, and make stances on that. I would like to leave you all with this sports analogy...last year the Toronto BlueJays had the best pitching, the Los Angeles Angels of Anaheim had the most wins, and the Chicago Cubs had the best hitting, yet it was the Philadelphia Phillies who won the world series, why, because the sum of the parts is what makes champions. Sure we might not have the best healthcare system, or the best education system, or the best political system, but the sum of Americas parts makes us the greatest country on earth.
I'm the opposite of moderate, immaculately polished With the spirit of a hustler and the swagger of a college kid Allergic to the counterfeit, impartial to the politics Articulate but still would grab a ni**a by the colla quick