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  1. #31
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    Quote Originally Posted by BetteDavisEyes View Post
    Quite simply, I don't want the government determining what healthcare I receive, which doctor/s I can see, when I can see a particular physician/specialist, etc. My dad was Canadian (became U.S. citizen in his early 20s). Had many Canadian relatives and heard a lot about universal healthcare growing up. Not all of it was good.
    Health insurance determines what services you will receive. That is the way it is now and has been for years and years, Didn't you ever have your doctor call to see what can be done? And how a procedure is coded determines if something will be paid.

  2. #32
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    Quote Originally Posted by rain88 View Post
    But the alternative is "for profit" heath care companies to determine what healthcare you receive
    They do not have to be for profit to determine what you get.

    Blue Cross Blue Shield is not for profit. They pay their CeO some outrageous amount of money plus perks such as golf club membership. All legal because it is in the benefits package. Then there are the nice buildings and furniture you pay for.

    Why do we need to pay insurance companies? I am at a loss .

  3. #33
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    Special provision in repeal and replace

    http://www.latimes.com/business/hilt...307-story.html

  4. #34
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    BetteDavisEyes is offline "Fasten your seatbelts. It's going to be a bumpy night."
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    Quote Originally Posted by human View Post
    Health insurance determines what services you will receive. That is the way it is now and has been for years and years, Didn't you ever have your doctor call to see what can be done? And how a procedure is coded determines if something will be paid.
    No. Physicians know up front what my insurance covers. Never been denied any type of test or treatment. If there is a copay for test and/or treatment, I pay the difference.
    Last edited by BetteDavisEyes; 09-23-2017 at 04:22 PM.

  5. #35
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    Quote Originally Posted by BetteDavisEyes View Post
    No. Physicians know up front what my insurance covers. Never been denied any type of test or treatment. If there is a copay for test and/or treatment, I pay the difference.
    What happens if you get cancer and cannot work? Does your employer still have to keep paying your health insurance?

  6. #36
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    Quote Originally Posted by BetteDavisEyes View Post
    No. Physicians know up front what my insurance covers. Never been denied any type of test or treatment. If there is a copay for test and/or treatment, I pay the difference.
    That is so interesting as there are so many different types of policies with different rules.

  7. #37
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    Quote Originally Posted by Jennifer17 View Post
    What happens if you get cancer and cannot work? Does your employer still have to keep paying your health insurance?
    I would imagine COBRA kicks in which I think gives you 18 months where you can use the employer health insurance with you paying the premiums.

  8. #38
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    BetteDavisEyes is offline "Fasten your seatbelts. It's going to be a bumpy night."
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    Quote Originally Posted by human View Post
    That is so interesting as there are so many different types of policies with different rules.
    My doctors (and office personnel) know what my insurance covers. I don't know if all physicians/office staff know this information about each patient, only that mine do. When I see a specialist like my allergist or ophthalmologist, they know that I have a $50 copay, so that's what I'm charged. Any tests performed during the office visit are covered by insurance (Medicare and/or BCBS supplemental plan). Similarly, when DH and I see our dentist twice annually for cleaning and checkup, the receptionist knows that we have dental insurance that covers these services.

  9. #39
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    BetteDavisEyes is offline "Fasten your seatbelts. It's going to be a bumpy night."
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    Quote Originally Posted by Jennifer17 View Post
    What happens if you get cancer and cannot work? Does your employer still have to keep paying your health insurance?
    Sorry. I can't speak to that as it hasn't happened to DH or me.

  10. #40
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    Quote Originally Posted by BetteDavisEyes View Post
    My doctors (and office personnel) know what my insurance covers. I don't know if all physicians/office staff know this information about each patient, only that mine do. When I see a specialist like my allergist or ophthalmologist, they know that I have a $50 copay, so that's what I'm charged. Any tests performed during the office visit are covered by insurance (Medicare and/or BCBS supplemental plan). Similarly, when DH and I see our dentist twice annually for cleaning and checkup, the receptionist knows that we have dental insurance that covers these services.
    I can understand a standard thing. For instance, medicare gap policies cover complete physicals, but different kinds.

    With hundreds of patients, there is no way anyone can keep track of what insurance offers.


  11. #41
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    Quote Originally Posted by human View Post
    Health insurance determines what services you will receive. That is the way it is now and has been for years and years, Didn't you ever have your doctor call to see what can be done? And how a procedure is coded determines if something will be paid.
    This is the point. Insurance companies decide what medical services you receive. It's about insurance codes, not patient needs. It's about a relationship between doctors and third party billers where doctors have to ask the third party what you can have, not a relationship where doctors and patients decide, and the doctor verifies the need to the insurance company, who is a payment source, not a medical manager.

    This is not improved by single payer/universal coverage (which is not 'care'). Medicare and Medicaid are limited programs with rationed care. Medicaid nursing home residents, for example, have even less access to care because of how Medicaid pays out (or doesn't) for medical needs under long term care. Rehabilitation services (PT/OT/ST) under Medicare are stringent and leave people with gaps in care.

    It's one thing for an insurance company to decide the scope of policies where you know that scope when you purchase, in a market where there are other options. It's another thing altogether for insurance companies to pick and choose/require permission/refuse to pay for doctor recommended or ordered care within the scope of a policy because they don't want to pay for it.
    “The louder he talked of his honor, the faster we counted our spoons.” - Ralph Waldo Emerson

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  12. #42
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    Quote Originally Posted by jillycat View Post
    This is the point. Insurance companies decide what medical services you receive. It's about insurance codes, not patient needs. It's about a relationship between doctors and third party billers where doctors have to ask the third party what you can have, not a relationship where doctors and patients decide, and the doctor verifies the need to the insurance company, who is a payment source, not a medical manager.

    This is not improved by single payer/universal coverage (which is not 'care'). Medicare and Medicaid are limited programs with rationed care. Medicaid nursing home residents, for example, have even less access to care because of how Medicaid pays out (or doesn't) for medical needs under long term care. Rehabilitation services (PT/OT/ST) under Medicare are stringent and leave people with gaps in care.

    It's one thing for an insurance company to decide the scope of policies where you know that scope when you purchase, in a market where there are other options. It's another thing altogether for insurance companies to pick and choose/require permission/refuse to pay for doctor recommended or ordered care within the scope of a policy because they don't want to pay for it.
    Maybe not in the US but the countries that have universal health care, don't have this.

  13. #43
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    Quote Originally Posted by jillycat View Post
    Health care reform and health insurance mandates are two different things. ACA had impact on the insurance industry and made it federal law to have insurance. This did nothing to 'reform' care, how its administered, or its quality. Americans were spending more on medical services before ACA, with less return on health than other nations. We did not change that by a federal mandate to carry insurance, or by government trying to control a market that was out of control for reasons that have nothing to do with 'waspy' people, privilege, or actual costs of products and services.

    The problem with the health insurance industry is doctors and medical institutions eliminated the patient consumer from the equation and created a quid pro quo to get fat and happy together. And now doctors are servants to the insurance company - herding patients like cattle for 10 minutes at a whack, and spending more time charting and justifying their actions and prescriptions, and running interference on referral for specialty services, than being a doctor. And now they're stuck with having you fill out a form about how many times a week you feel sad or don't enjoy activities.

    I had a spot on my skin a year ago and called for a referral to a skin clinic. Nope, I had to come in and talk to the doctor first to, essentially, get permission. But he couldn't see me for over a month. So, I was offered an appt. with the PA. Ok. So I got there and had to fill out their special mood questionnaire. I was honest and noted/circled one of the options for sadness. I had lost my mother several months prior and my precious son 5 weeks later. So the PA comes in and says, "So what's this about, pointing to the question and answer sheet. I told him, and was tearful at having to mention my son, and he started asking me if I was suicidal or homicidal.

    ?

    I asked how bereavement was related to either and he said, "Well, you're depressed and sometimes people can think things...", and he pointed to his head and asked, "How are things here?"

    ?

    I told him grief over child loss is not "depression" or a psychiatric issue and if I was going to kill myself or someone else, he'd be the last person I'd tell." He kept pushing his agenda. I told him he was the bridge to a skin clinic not a grief management specialist, and I didn't need armchair head shrinking for a skin spot. The MA later said that the insurance companies mandate these questions because if a patient kills themselves or someone else after leaving a doctor's office, there's a burden of liability.

    ?

    I asked what happens if someone expresses these feelings and she said the police are called. What a way to build confidence in your doctor-patient relationship.

    So, I spent a morning that I will never get back in a senseless and costly rodeo with an unqualified person trying to manage my non-existent psych problem, so he could decide whether to call police, as a knee-jerking agent of an insurance company. I finally got a referral to the skin clinic that was not recorded so the clinic wouldn't schedule me. After having to call back to have my doctor's office correct the mistake, a year later, still haven't been to the skin clinic because despite multiple calls, they never called back to schedule me. I saw my doctor later for my annual and he said the spot was not suspicious anyway. But he did offer me medication for my grief which I declined since grief is not a medical problem.

    I've since told my doctor's office that in the future, it can anticipate a smiling answer of 'I feel fine' to any and all questions about my mood no matter what I'm really feeling. And any dishonesty on my part is the price of the off course mission of the insurance company to get inside my head when I need a skin spot looked at. And if I say I'm there about my skin or my arm or my toe or whatever, that's all I'm there for and that's all we're going to talk about.

    We have a long way to go before we're sensible enough to 'reform' health care.

    As for coverage and how affordable the federal government thinks it can make it, how many mornings like mine are getting funded with no advantage to the patient? Given our record of paying more than anybody for less health, I suspect a whole lot of mornings.
    Jillycat, this is so well said, and covers so many bases. Here's what makes me very sad, the number of outstanding physicians who have given up their practice because they can't keep up with the liability and insurance requirements. That 10 minute, actually 6 minute in NJ has severed the patient - doctor relationship. The fact that an insurance company usurps a patient's need and a doctor's opinion is the workings of a profeetering industry that has little to do with the needy or the hipocratic oath.

    Transient culture is a big issue, Imo. For instance, I grew up in one town, had the same pediatrician my whole life, he was actually a very special doctor as he saw all his kids until he retired when I was 28! I was heartbroken but of course understood. Still, I was rudderless. When a doctor knows your history from 6 to 28, the conversation, the diagnosis, the treatment, the healing, is organic.

    The are the amazing young doctors and nurses who go out into the poorest regions of America to fulfill the crisis of those in need without basic care. They set up tents, the lines are miles long.

    Working in small business I have a high deductible/ health savings insurance plan. Ok, I feel I won't lose my house if something catastrophic happens, but last year I got shingles on my left arm... So I went to a CVS clinic (drug store east coast), was diagnosed, given meds and advice, and was on my way for $90 dollars. I cannot imagine what my ordeal, or cost would have been had I tried to navigate my insurance!

    Perhaps it is the sage advice of my beloved pediatrician who once told me; "one more strep throat and I'll have to remove your tonsils!" --That, along with many other antidotes, and very rarely prescribing antibiotics, have made me very mindful about my own care.

    I am one of those carry me in on a stretcher peeps. I couldn't care less about profiteering "guidelines". I care that I won't lose my house or bankrupt my family should something catastrophic befall me. In the 1990's I was able to get (as a single payer) Heath insurance policy that covered the basics for a couple hundred dollars a month through Amerihealth...

    That vanished in the Bush years, and tripled. I don't count on the republicans for anything having to do with fair market and healthcare...


  14. #44
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    McCain kills Obamacare repeal for a second time despite Trump's threats

    http://www.wsaz.com/content/news/CAM...436784883.html

    Guys this is one of the largest and best hospitals in my General area...this is what is really happening. I don't care if you have insurance or not these hospitals are cutting services and without them ...insurance isn't going to help you at all!


    Always My Own Opinion

  15. #45
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    Quote Originally Posted by WVWoman View Post
    http://www.wsaz.com/content/news/CAM...436784883.html

    Guys this is one of the largest and best hospitals in my General area...this is what is really happening. I don't care if you have insurance or not these hospitals are cutting services and without them ...insurance isn't going to help you at all!


    Always My Own Opinion
    Yeah, agree, looks pretty grim...


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