Effin Healthcare

[Shamis]

I think part of the reason for requiring people to have health insurance is that people without health insurance go to the ER all the time and then don't pay the bills. If hospitals were allowed to send people without health insurance straight to the dumpster out back I think it would probably work a lot better.

[mike_a_lafontaine]

How about simply making health care companies actually required to provide the service you pay for? Everyone is worried about the uninsured, but having insurance is no guarantee that you will not go broke paying medical bills. How about simplifying insurance codes? Take the decision making steps out of the hands of the insurance company and into the hands of the physician and patient!

Simple Insurance: You pay for insurance. You have a deductable and a co-pay. If the physician determines you need something, the insurance company pays their part. Period. No 15 pages of rules and shit. No denials because of some stupid-ass loophole that allows them to skip out if their consultant that has no information on the patient decides it is unnecessary. My wife was having tightness in her chest and difficulty breathing. Her GP thought it prudent for her to take a stress test. The insurance company denied it. It is covered by our policy, but because she is younger than 40, she is not in the high risk catagory, so they deemed it unecessary, despite several consulting docs thinking it was necessary. Despite a family history of heart disorders. Despite a personal history of mitral valve defect. So we had to pay out of pocket. Fuck that.

And the shit we've had to fight to get propper care for our son...

Health insurance companies really answer to nobody. The laws governing their business practices are made by people that are getting shit-loads of money from health insurance lobbyists. That is corruption waiting to happen...except it already is happening.

[bcombs]

Why would you want to take the power away from the gigantic private businesses and put it in the hands of an institution that is supposed to be designed to represent the people?

Medco and Blue Cross called me earlier today. They asked for my vote on who should be on their board. They said if I didn't like their policies I could vote in another direction in just two short years.

[dollyjn]

There are many facets to the healthcare movement:
The healthcare cost impact
The healthcare quality/safety impact
The healthcare availability impact
Objective analysis and planning is required to overhaul this system. What a concept, removing everyone's agendas for the greater good rather than isolate favor to one or two silos.

[clif]

i have a hit on my credit record elevating the interest rates i'd be approved for otherwise because of an outstanding medical bill.
as a former NC state employee with full medical insurance benefits and no cap on expense, only the exclusionary clause of 'usual, customary, and reasonable'

so, following my spinal fusion surgery at the Fine and Distinguished University of Kentucky Medical Center, my insurance provider saw fit to take my 2500 in copays and deductibles and then declare me derelict for the other ~70,000. apparently, the Doctors in Lexington provided an unnecessary, or unusual, or unreasonable procedure.

so, government is the problem, clearly.

[dustonian]

Is that sarcasm? Your medical insurance was provided by a private, unregulated corporation who saw fit to violate you as they pleased. It's irrelevant that the state of NC was paying the premium.

[clif]

yeah man. the politics is so far gone i'm surprised you took note. and it was me paying the premium.

[dollyjn]

Your prior authorization would have told you how much insurance was to cover and how much you would be responsible for when the surgery was performed.

[clif]

"prior authorization" was not a concept in any contract or agreement i was party to. is this an insurance idea? and, what makes oversight of medical intervention by private non-transparent proprietary committees more acceptable than government "death panels"?

wtf. what a bullshit front. no. that's exactly my point. it was discussed long before the surgery. and it was 2500. and, do you really endorse the idea that discussing the details of insurance coverage are in the moments when one is hours before surgery?

are you an insurance salesman or lawyer?

[dollyjn]

Not understanding the process does not make a person exempt from responsibility.
The process is the surgery would be scheduled after the doctor's office received prior authorization from insurance.
This information is sent to the patient.
We are advocates in our own health care as we are in the decision in which insurance to purchase and which physician to go to.
Yes, depending on the health plan you may have a list of physicians to choose from but researching or asking others about asking others about which docs are good is a great way to go and advisable.