posted
There have been several discussions here concerning our U.S. health-care industry. Ironically our local Ventura County Star newspaper just ran an article this week that fits right in to what we've been debating.
It's worth the time to read what's being said. The article does a good job of providing both the pros and cons of the issue.
The bottom-line is that several local doctors have decided to no longer accept any health insurance. They will be operating under a totally "fee-for-service" method of payment.
They will also be offering yearly memberships to their care. At any rate, it makes for interesting reading and some thought.
Enjoy.
Posts: 681 | From California | Registered: Oct 2005
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posted
Great for the doctors that they no longer have to hassle with insurance cos, but not so great for the patients who are paying for the insurance. Hardly anyone who is really sick is using just one doctor. So you have to have insurance for the ones that take ins, and pay out of pocket for the docs who don't take it. The worst of both worlds.
The reason people get insurance is because healthcare costs can ruin a family financially. I am not happy with this trend for docs to opt out of insurance plans; it sure doesn't help the patients. If docs don't like the way it works, maybe their groups should join patient groups and work toward a system that serves everyone better.
Posts: 8430 | From Not available | Registered: Oct 2000
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just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
I guess IF we had to wrassle with insurance companies constantly like docs do we would opt out too.
Long gone are the days of writing what you did on a piece of paper and they send you a check. Now days you have to speak code
,,,then they screw it up five times before anything gets done,,,and thats the GOOD part!!
It IS a tremendous waste of time and money to go thru if you have alternatives.
About they get all the codes right they say that your fee exceeds reasonable and normal,,,which means higher than the 'average'.
So if you cant exceed average where can you go?? Insurance wastes twice the amount they pay,,,just trying NOT to pay!!
I can see the problem,,,just NOT the solution. I guess for those docs you can file your own claims I guess.--just don--
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
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posted
I think it is horrible. There are thousands of people who go out of this country for health care because it is tons cheaper and the quality of care is the same.
What does it say about this country who tries to rip off the sick and inflicted? And yes, that is what is happening!
Boo Whoo to doctors who want their $300 for a simple 15 minute, "I got the sniffles" appointment and don't want to settle for the $100 the insurance thinks should be allowed.
And here I am, paying $1000 month for insurance and still LLMD's don't take insurance causing my costs to rise higher than a the Empire State building!
Now, don't get me wrong, insurance companies are out for just themselves and can screw, even the best of us, over.
The whole system is a total wreck! It's sickening to say the least!
Posts: 94 | From Greenville, Tx | Registered: Apr 2007
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RoadRunner
Frequent Contributor (1K+ posts)
Member # 380
posted
quote:Originally posted by Allison Smith: I think it is horrible. There are thousands of people who go out of this country for health care because it is tons cheaper and the quality of care is the same.
What does it say about this country who tries to rip off the sick and inflicted? And yes, that is what is happening!
Boo Whoo to doctors who want their $300 for a simple 15 minute, "I got the sniffles" appointment and don't want to settle for the $100 the insurance thinks should be allowed.
And here I am, paying $1000 month for insurance and still LLMD's don't take insurance causing my costs to rise higher than a the Empire State building!
Now, don't get me wrong, insurance companies are out for just themselves and can screw, even the best of us, over.
The whole system is a total wreck! It's sickening to say the least!
I agree great post.
RR
-------------------- "Beep Beep" Posts: 2630 | From ct | Registered: Nov 2000
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bettyg
Unregistered
posted
hi Dad/others,
i was going to start my own post or add on to existing one telling about my long-standing fight with iowa's wellmark/bcbs, but i'll just add this to yours since you have an article about the BS going on to patients like me/other lymies, etc.
UPDATE from IOWA'S BCBS about my over $3900 out of pocket they REFUSE to pay for my lyme appts., body lab testings she did, and $1,000 supplements for 1 month !
I got a letter 2 days ago from them.
OPTED OUT OF MEDICARE! how timely on this one!
my 2nd LLMD in S. Minn. had me sign this FORM for her services; I did NOT understand it all well since this was in my 3 hr. session with her but signed anyway.
she said i could submit it to my bcbs, which i did 4-06.
15 months later, I finally get a letter with the following NOT verbatim since I'm typing this in the dark while hubby sleeps nearby.
OPTING OUT OF MEDICARE DOES NOT REPLACE MEDICARE'S FORM! why did it take 15 months to be informed of this??? BS!
You need to submit medicare's NORMAL form to them; then they will decide whether to reimburse or not. Since I could NOT give a form I never got; AUTOMATICALLY DENIED !
They will pay for my COMPOUNDED RX meds, but not shipping/handling which is NON-MEDICAL expense.
3 of these bills were submitted by pharmacist to wrong pharmacy handling bcbs's drug bills! so i need to resubmit on proper forms to person writing letter!
they will NOT reimburse for any SUPPLEMENTS except the written RX compounded ones!
you've exhaused your administrative choices; your only choice left is going to federal/civil court!
If I want, to write them for a copy of what they used to determine these things. YOU BET I'M GOING TO WRITE THEM !
IOWA INSURANCE COMMISSIONER'S OFFICE, MARKET BUREAU REGULATION ATTORNEY, JOHN LEONHART letter today!
They enclosed everything BCBS furnished them recently so I learned a lot from that which her letter to me did NOT state!
John's investigation of my case is NOT done yet; still in process; he'll keep me advised.
In bcbs's letter to him, she stated I could not talk to her personally since I involved him in Nov. 06; she was advised in Dec. 06; that's when it became an APPEAL vs. normal handling. She didn't mean to "offend" me by not taking my calls to her! What do you call it yet?
I'm going to followup with an email to him about a few things in her letter to him for him to consider in their investigation!
BEWARE! Also, watch what you send bcbs/your insurance co...they will use it against you! ."
Guess I had some type of form in there stating to submit bills to your insurance company IF they can be paid. "We can't guarantee that these will be paid."
So she knew then good chance of our NOT paying reimbursements to her on lyme expenses since LLMD OPTED OUT OF MEDICARE!
that's all I can remember at this late hour. Bettyg, Iowa
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I understand your frustration. We've been through several of these same types of bureaucratic "Catch 22"s in the past.
I'm really torn on this issue, health insurance doctors vs fee-for-service doctors.
With all we've been through trying to get our daughter's insurance to pay for her health care, I can't imagine what the doctor's offices go through when they try to get paid by these same insurance companies.
We live, thank God, in a free market economy and at times I have a hard time blaming the doctors for wanting to cut their overhead and make a decent living.
I guess the best thing to pray for is the cure of this awful disease. I wouldn't be so intimately involved with all of this nonsense then.
Hey, stay strong! Frustrations and stress certainly don't help in the healing.
LymeDad
Posts: 681 | From California | Registered: Oct 2005
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Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Betty,
I know you are frustrated. But I have never heard of an insurance company covering supplements.
If you have prescription coverage, they should cover prescribed medications according to your plan. There may be limits on brands, or even overall dollar limits.
But prescription coverage never covers non-prescription drugs (over the counter drugs) or supplements.
The only way I know of where supplements may be covered is if they are provided intravenous, like a Meyer's Cocktail.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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trueblue
Frequent Contributor (1K+ posts)
Member # 7348
posted
Here's another scenario.
Our internist had a Medicare only practice. He was toying with the idea of the Concierge service. Instead he decided to take only a specific Medicare HMO. I believe it's Humana Gold Plus, if I remember correctly.
So, all of his patients got letters saying (paraphrasing here) If you want to join this HMO I will continue to be your doctor...
This was entirely unexpected.
He dumped his entire patient load that didn't want to or couldn't switch to this particular HMO. He now will get a flat rate for as many patients as he has signed up, monthly, whether he sees them or not. Nice to have a paycheck you can count on to be the same every month. I completely understand that. And much less insurance hassles.
But... we're out of a doctor now. Great
-------------------- more light, more love more truth and more innovation Posts: 3783 | From somewhere other than here | Registered: May 2005
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and I'm puzzled as how we can think of doctors having the ability to provide us with health, only God Himself can do that.
My daughter is quite ill and she's been to every known specialist in southern California and a couple in northern California and at least four different General Practioners.
Doctors don't provide health, doctors provide a service. Doctors are no different than lawyers, accountants, engineers, they just provide us with the benefit of their education and training.
Why do we think they are bound to provide other people with any service without making a profit.
Do you expect your lawyer to provide his service for free if you're being charged with a major crime?
Finally the quality care my dauther is receiving is coming from a physician who is strictly a fee-for-service doctor.
He's not a millionaire, but he is doing well for himself and his family. I personally don't want to send the people I love to a doctor who isn't doing well in his practise.
We're back that discussion concerning entitlements. "Society owes us good health care".
We're not entitled to anything in this country except life, liberty and pursuit of happiness.
I can't find anywhere in the U.S. Constitution, the Bill of Rights or even the Bible where it says we are owed the right to be healthy or to be entitled to be taken care of by our society.
It's a nice concept, but it just isn't reality, at least not in a society that is based on individual freedoms.
Posts: 681 | From California | Registered: Oct 2005
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bettyg
Unregistered
posted
Nim, my friend, big favor to ask; would you break up your solid block text into short paragraphs as this neuro lymie can't comprehend/read them as is ... a friendly reminder
to edit, click the PENCIL icon to right of your name which opens up subject line if you initiated it and body text. now please break it up and hit the enter bar twice after EACH paragraph to help us all out. BIG THANKS! *******************************
lymedad and aniek
thanks for your comforting words.
in MY copy of hubbies health insurance policy it states that supplements can be covered IF PRESCRIBED, and llmd did this. I covered that in my detailed appeal to BCBS and iowa insurance commission attorney.
disgusting we pay $700/month for both of us on medicare/bcbs!
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I do pray for my daughter's health everyday. In fact I'm convinced the reason she's showing the improvement she is is because God has led us to our current doctors.
We pray for all the people on this board every day and for others with these types of diseases.
Again, we're stuck on entitlements. We've become an entitlement mad society. Society owes me a living, society owes me health, society owes me freedom without cost.
I'm not sure we'll survive as a free nation as long as we continue assuming we're entitled to everything without a cost.
Doctors can't give us health regardless of whose paying, doctors provide us with health care. There's absolutely no guarantees that their care will give us health.
This entire website and discussion group is the primary example of that fact. We've got the biggest hospitals, the best research, the best education and Lyme is still a huge problem.
I'm curious as to how you feel doctors should be motivated.
Should young people choose to become doctors based solely on the desire to help their fellow man?
Should doctors strive to find effective treatments for Lyme because the government is going to provide them with a liveable wage?
What should a person's motivation be to be willing to spend up to 8 years in college and another 2 to 4 years in training before they can reap the benefits of their efforts?
Hey, I don't have the answers to this health care problem. As a family, we're almost broke because our health insurance won't pay for the majority of my daughter's treatment.
I just don't blame the doctors for our society's problems. Maybe there's an opportunity for this group of "Lymies" to formulate an answer.
Maybe a combination of fee-for-service and free-enterprise incentives for physicians and research doctors.
A "flat-tax" like fund that provides doctors with tax incentive benefits if they do pro bono work for those who can't afford treatment.
There are large numbers of people who visit and write on this forum who are a lot smarter than I am who might be able to contribute to a movement to help solve this problem.
I just don't want "Big Brother" or his relatives making those decisions for us and certainly don't want to have my family's health dependent on our government.
Posts: 681 | From California | Registered: Oct 2005
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quote: From Lymedad: Should young people choose to become doctors based solely on the desire to help their fellow man?
_____________________________________
Um, YES!!!! Teachers teach for the love of it and the children, not how much money goes into their pockets. Many people, do things and jobs not for the money of it. Well educated and well rounded individuals.
Placing money at the forefront of your desire to do something will just pervert the goal of what you are trying to acheive.
If you are a doctor just in it for the money, my question is...are you doing these tests, giving me this medicine, or treating me in the way I should or the way that will give you more money?
Now there are doctors who are out there not because of money, and I praise them for that. However, this free-enterprise stuff that keeps getting yelled at us is bogus and is just an excuse to let people rip other people off.
Posts: 94 | From Greenville, Tx | Registered: Apr 2007
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bettyg
Unregistered
posted
What upsets me about my above example of what happened to me this week is this:
why when LLMDS or any other MD OPT OUT OF MEDICARE can't we submit our bills to our 2nd health provider, example, bcbs?
That's the part that is NOT FAIR to me!
I don't deny the llmds for getting FULL PAYMENT for their services; I just resent the fact that their decision effects 2 HEALTH CARE PROVIDERS!
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trueblue
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Member # 7348
posted
quote:Originally posted by Allison Smith:
quote: From Lymedad: Should young people choose to become doctors based solely on the desire to help their fellow man?
_____________________________________
Um, YES!!!! Teachers teach for the love of it and the children, not how much money goes into their pockets.
Ummm... Yes, too!
-------------------- more light, more love more truth and more innovation Posts: 3783 | From somewhere other than here | Registered: May 2005
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posted
I think you may have missed my point or maybe I didn't express it well.
My question was,
quote:Should young people choose to become doctors based solely on the desire to help their fellow man?
I don't think that's a reasonable thing to expect. I was writing in response to Nimzovitch where he stated:
quote:in the U.S. the whole purpose of studying medicine is to become millionaire.
I just thought that his statement was a little over-the-top and I was rebutting his point.
It would be a great thing if all of our doctors were motivated purely on their desire to help mankind. I just don't find that to be reality.
Doctors, as are most of us, are motivated by their desire to succeed. Some, and probably most people, measure their success by the size of their paychecks.
That's not being cynical, that's just reality as I see it.
Don't forget I'm not a doctor, nor have I ever been one. I'm a retired Senior Master Sergeant, USAF. If money was my motivation, I was definitely in the wrong business.
I just get a little weary of all the U.S. bashing that goes on throughout our world today. We don't have a perfect country, but we've got the best in the world.
There's a lot we can do to improve our way-of-life without tearing it down. I've lived in several countries where free enterprise, freedom of religion, freedom of speech and freedom to choose how we spend our lives wasn't afforded the citizens of that country.
I didn't like it and I doubt most who utilize this forum would like it either.
Good Night
Posts: 681 | From California | Registered: Oct 2005
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posted
I have Medicare and Anthem BC/BS also. As I understand my policy, if Medicare does not cover a service then BC/BS will not cover it also. It is a supplement to Medicare not an addition to Medicare coverage.
I hope this helps.
Hugs, Perplexed
PS Our whole Insurance and Health Care Industry needs to be revamped and greatly improved. Something is drastically wrong in this country and will be getting worse if something is not done soon. Posts: 324 | From Lexington, KY, USA | Registered: Dec 2001
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