|
|
|
|
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 7:13:14 PM | I too could go on all night about the subject including the 2 checks I just wrote the State & Federal Government. Let's just say I could have bought a low end BMW or a Harley and a new Honda Accord in cash! Insted I will be sending my cash to be pissed away in some wasteful manner!LOL! Italmost made me sick when I saw the bills fromthe tax lady. Plus $515 to prepare the taxes! Damn!
I too believe there should be more stringent welfare to work enforcements. Our children those of working tax paying citizens are being ripped off by the Education system. ( i paid another $5200 in real estate taxes for them to sink in to entitlements). What infuriates me is the whole system is being ripped off. Hell the guys by my old home living in Section 8 housing were driving nicer cars than me.
Physicians are far from being ripped off. Anesthesiologists for instance AVERAGED over $200K in income amd they generally only supervise RNA's. I do agree that family docs get the shaft and something needs to be done. As far as copays on Medicaid HA! Never stick! The whole medicaid system needs thrown out. If you have more babies, they shouldn't get increases. I say mandate welfare recipents who are long term be implanted with Norplant after second child. I gotta stop my head is starting to hurt! | |
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 8:20:10 PM | Family docs do get the shaft, and Internal med is not far behind. With the upcoming P4P for Medicare, they are really going to be in a world of hurt.
And as far as the Medicaid recips having more babies for increases, did you know that if they are not married to whomever they are living with, the amount of assistance increases as well? It's perpetuating more babies by different fathers, and no marriages! bah! | |
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 8:32:55 PM | "" Isn't there some plans to regulate these companies? I know the Insurance Commission is supposed to be doing this, but I don't really know what good they do.""
Bingo.............you hit on part of the problem and probably did`nt even realize it.
You basically have a hodgepodge and here is the reason why..........there is absolutley no federal regulation in the US of insurance companies.I wont go into the reasons why this is,but suffice it to say,but thats the way it is. Medicare as an example is under federal control as to what they{the government}are going to pay for certain procedures{thats called control},yet a private company{assuming they meet that states minimum coverage requirements}can offer coverage better or worse than the federal governments mandate {outside of the reach of the feds}.on the other hand if you pick up a private carrier for your Medicare coverage you sometimes pick up better benefits.As an example private carriers in a lot of cases leave old folks high and dry when they decide they are losing money in a certain geographical area and pull the plug because there ai`nt enough left in the pie,so then it is back to the "old standard medicare"and the cycle goes on.If this all sounds confusing,its because it is confusing.Insurance companies thrive on confusion and dont hold your breath while the insurance company lobbyist allow control on a federal level{they like it just the way it is}.So we end up with a "fractured"
health care system and the solution is "probably" single payer such as medicare,but there is lotsaaaaaaa opposition to fix it in that manner,after all who in the hell in this country has more money than the insurance industry?
Pack | |
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 8:39:52 PM | | Oh I totally know all that you are talking about...and it chaps me. Medicare HMO's are new to my area, but we have had so many companies with so many beneficiaries just pull out because West Michigan is an unhealthy population. What the hell....they paid their premiums, now the ins. co. has all that money...and they invest in real estate (no lie). I do think that the Medicare HMO's are good for a lot of MC recipients, because they get pharmacy and preventative coverage, which has long been a dicey thing at best for them. But most of them require higher premiums on top of the Medicare premium. These poor old folks...they don't know what hit 'em. The one thing you can count on in healthcare is that nothing stays the same for very long, but when is it going to be the best changes for all? And with the baby boomers reaching Medicare 'status'....we are really going to have some crap on our hands. It frightens me for them. (Good job security for me, though). | |
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 10:02:49 PM | SimmahDahnNah, our system is very different from yours. Frankly it does seem that the local politicians are bent on switching to American Style healthcare and they seem to be bound bet and determined to repeat your mistakes instead of objectively learning from them, then applying the better parts of it while discarding the nonsense.
Here in essentially in terms that would relate to you, every single individual is on a "form of medicare/medicaid). Forgive me if I mess up any terminology I really do need to learn more about the exact way this is done there. But that means that since we all pay to support this program we are all have coverage for essential services. This worked very well for a long time, but like anything the government gets involved in there was a lack of fiscal responsibility, and of course instead of addressing the cause of the problem the politico's prefer to play a blame game. It still is a case for citizens that if you have a heart-attack or your child develops cancer they are treated, and you are not bankrupted trying to care for them. The games played and finger pointing seem to have made actual delivery of services less efficient IMHO here to say the least. And the babyboomer issue has forced the problem to light aswell, here they also have subsidized prescriptions for retirees (a couple bucks co-pay per Rx I believe). | |
|
| Illogical medicare/provincial health plans.
Posted: 4/16/2007 10:35:20 PM |
How can we regain control of these systems and make them reasonable as the once were?
absolutly this thing has become another political football with the worker bees getting droned.
i honestly get a good vibe off this Smitherman guy...he's gone around the Province, he's held public forums, he's looking hard for some answers...but much like a lot of things...there's hidden agendas it seems everywhere...a lot of it makes no sense at all, while we should still count our blessings for some of the systems in place...I'm hoping he's as tough as he is thorough
but when we know there's spare beds here and there, but hear about chronic bed shortages it just leaves you scratching your head...
the cost over-run fiasco in our own cancer centre again is an example as to why i could never figure out why i don't just throw my tax payments out on the street for all the good it seems to do sometimes...
the doctor situation is atrocious and it gets scarier the farther north you go...from Thunder Bay on westward, any sick kid is doomed unless the folks load up and book a motel in Winnipeg where there is just an outstanding kids hospital...but not everyone can do this...and kids are getting sicker and sicker all the time...i'll write a long post on that one sometime, but i hinted at it in the forum on kids this generation living shorter lives than their parents...it's really going to get nasty
the boomer generation and the medical situation are headed for a trainwreck...it's only a matter of time now...part of my post-grad thesis was on this very subject back in 1981, but people listened back then about as much as they do today
but, i think of my aunt over in England who's now blown pretty much the last of her substantial nest egg paying for treatments to help try to get her second husband back on his feet from cancer...it's a scary number the pounds that woman' spent in the last 24 months...she's pretty much tapped now...so we do still have to work and improve on what we have here...we cannot throw the baby out with the bathwater...we just have to clean the bathwater again
ps..lady from London...excellent post on smokers...i feel good once again about lighting up a ciggie...t'anks | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 11:25:13 AM | MEDICAL INSURANCE EXPLAINED
Q. What does HMO stand for?
A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye .
Q. I just joined an HMO. How difficult will it be to choose the doctor I want?
A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. The doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan . But don't worry, the remaining doctor who is still in the plan and accepting new patients has a diploma from a third world country, and an office just a half-day's drive away.
Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.
Q. Can I get coverage for my preexisting conditions?
A. Certainly, as long as they don't require any treatment.
Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.
Q My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do?
A. Poke yourself in the eye.
Q. What if I'm away from home and I get sick ?
A. You really shouldn't do that.
Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his/her office ?
A Hard to say, but considering that all you're risking is the $20 co-payment, there's no harm in giving it a shot .
Q Will health care be different in the next decade ?
A. No, but if you call right now, you might get an appointment by then.
Close to the truth? | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 11:56:58 AM | without going into my usual passionant rant
i,d say the problem is the same in britain everyday i see idiot laws and systems in all areas of life
i think its a way of control
to try and create a feeling that there is not enough and make us think things cost more than they do which can create distraction and fear and the excuse not to put money into others areas and to foward centralization. time and time again in britain public services get privatized each time things get worse each time people say dont privatize but it happens whose pushing this whose gaining. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 12:01:48 PM | | Just a quick update for you. Autism funding now carries on until the 19th birthday. Apparently it then magically cures itself, as there is no support for Adults on the Autism Spectrum. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 1:07:06 PM | | Count yourself lucky to be on the "Wet" coast if you are caring for someone with autism Stilldancing. The cut parents off here at either age 6 or 7 :--S. Maybe we have something in our water that "cures" it faster? | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 7:25:53 PM | | Loony, if you want to know how these things work feel free to email me. I love talking about it, but beware, I kind of subscribe to a conspiracy theory on how the private insurance companies do their business. lol Any time a claim is delayed or incorrectly denied...I say "They just don't want to pay! Those jokers...how do they sleep at night!" | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 9:56:30 PM | Simm,
I have to laugh. It is funny to hear the other side of the coin. I alternatively look at a surgeon's bill and there are 4-5 procedures billed totalling $50K and you read the operative notes and it was a three hour surgey! LOL! We both have some stories I am certain. Honestly though when claims are denied incorrectly it is usually human error either in handling the claim manually or programming the system incorrectly. However, most of the "incorrectly" denied claims I see and review come from the billing being done incorrectly. LOL! Just kidding of course! You know I had to! Just having fun! | |
|
| Illogical medicare/provincial health plans.
Posted: 4/17/2007 10:04:02 PM | Packleader,
I don't know what type of HMO you had, or have, but the ones I had were very good. There was a wide range of Primary Care Physicians to chose from, if you weren't happy with the Primary Care Physician you chose you could switch to a different on with no problem, there was no problems getting referred to specialists, my pre existing condition was covered, no problem getting x rays, lab tests or any other type of test the PCP ordered. And I found that there was an emphasis on preventive health care, regular check ups, blood tests, mammograms, those types of things. You were covered when you were away from home, and I found that the Primary Care Physicians encouraged their patients to seek a specialist when needed, physicians don't want to take a chance of being sued for mal practice.
My ex husband had some very serious health problems and he received top rate medical care which the HMO paid for. Physical therapy and rehab services were also covered.
With most prescription plans the generic form of the drug has to be used in order to get the lowest co pay. And I agree that most HMO's don't cover alternative forms of medicine.
My experiences with HMO's were very positive, totally different than yours. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 12:33:15 AM | Singlemaninmd....oh man, I didn't know you were the enemy!!! I'll tell you what...if you'd like to have a fun excersize in patience with the 'incorrectly denied' claims, try dealing with Humana Gold Choice once...just once....I dare you. A Medicare HMO that is supposed to follow MC guidelines. You'll file a claim with 6 CPT codes for the same DOS, and trust me, I make damn sure these are clean claims when they go out. They'll pay 2 lines at the wrong allowed amount, reject one for not medically necessary-in error, charge copays for CPT's that do not require copays-in error, and possibly one line on these claims is paid correctly. Then we as billers must call them to have them take a look at it. Now this plan is 2 yrs old, so the growing pains should be all worked out one would think. It takes me 20 minutes.....PER CLAIM LINE.....to have this claim looked at/corrected by customer service....partly because the person is not using English as their primary language. Then we must wait 30-45 business days for reprocessing....and 9 times out of 10 instead of being reprocessed, the claim is rejected as a duplicate....and we have to call again. It is enough to drive a gal to drink. Not to mention if the patient actually pays attention to the piece of mail they also get regarding the same DOS, and is understandably confused, we're spending another 10-30 min on the phone there too, usually yelling, cause let's face it, we're talking about Medicare people and they can't hear us! (Bless their hearts, I love them the most out of all). So if you think that my conspiracy theory is unfounded, I'd love you to come job shadow me for a day. lol (And yes I know there are plenty of claims that come through incorrectly billed, and I feel for you on that. There is talk of mandated certified coders on site in the future much like offices are supposed to have at least one RN on site...don't know what direction that will take though).
With that said, I really do love my job. Fighting tooth and nail for payment from insurance carriers, and finally getting the claims paid...correctly.....even if it's a 2.68 payment from Medicaid that I've been fighting for over 6 months, makes me do a dance of joy! | |
|
e-wok
|
Joined: 9/25/2006
Msg: 40 | |
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 1:19:41 AM | Just a quick update for you. Autism funding now carries on until the 19th birthday. Apparently it then magically cures itself, as there is no support for Adults on the Autism Spectrum.
There's no cure for autism ever.....it's just one big fancy and expensive daycare for
adults. This is exactly why there are wait times in other sectors of
our medical services plan....limited resources being allocated to
non benificial patience. It's a complete waste of time, IMO. In England the
autism is starting to skyrocket and the limited services are being hurt
with already 500k patience.
Like I said before......stop the progression...everything is out of control and
we are running out of funding. Nobody is gonna afford the cost for medical
services if taxes keep going up to cover the ever expanding birth
defects. People complain NOW of wait times....we suppose to throw another
400,000,000,000 - to what end? I can't afford to raise kids myself because
of crippling taxes....so screw that idea, and it's no bloody wonder Canada
wants to bring more immigrants in, it's because immigrants are young and
replace the Canadians that won't exist because of the taxes to pay for
people who KNOWINGLY bring into the world with severe and appalling
birth defects. Wholly smokes - it's a right to bring in a damaged and suffering
child into this world? It's damn selfish. Parenting is suppose to be the most
UNSELFISH act you can possibly accomplish - many are proving to be otherwise. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 1:30:10 AM | Too bad that British "Health Minister" didn't look at his own health-care system before opening his big mouth. Britain, along with Canada, have a terribly-long waitlist for almost any procedure. Look at the OECD reports. In Canada the more we spend, the longer the waitlists grow. (I don't know how that happens but it does)
In the US, you get what you pay for. They don't have a problem with people dying on waitlists. Plus most people have medical insurance so payment isn't an issue. | |
|
e-wok
|
Joined: 9/25/2006
Msg: 42 | |
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 1:53:03 AM | It's getting ridiculous........I want to opt out because I'm tired of the amount
of taxes I'm paying. Sooner or later people will revolt. I'm tired of
hearing the seniors complaining......their generation shouldered the
debt on us and they should be the last to ****......the good old days?? Yeah, no
kidding.....racking up the taxpayer credit card and then when the bill
comes in they want us to foot it. Sick of this. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 4:46:15 AM |
Too bad that British "Health Minister" didn't look at his own health-care system before opening his big mouth. Britain, along with Canada, have a terribly-long waitlist for almost any procedure. Look at the OECD reports. In Canada the more we spend, the longer the waitlists grow. (I don't know how that happens but it does)
I suspect he did. I suspect you haven't looked at the stats on the UK experience with privatization. It hasn't been beneficial to anybody but private healthcare companies and the super rich.
E-wok, you need to look at how other systems function before you can compare it to your own. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 5:27:53 AM | Charlesesdm
I have looked at our it works - I want out too. I don't want HMO's , I don't want nationalized health care. I want to pay some amount of taxes to ensure that the children all get what they need until age 18 - after that - I want to be able to approach a doctor and pay him directly.
Once I am paying for a service directly, I can be sure that my doctor is working for me and not Big Pharma! Once I am paying for a service directly, I am going to be looking for a competitive price and I am going to be careful about paying for services I don't need and don't want.
The Canadian Health system works great - as long as you are NOT sick! Once you get sick - its a dud.
And the cost of health care will only continue to grow as long as the taxpayer is footing the bill!
Michelle | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 6:22:44 AM |
Once I am paying for a service directly, I can be sure that my doctor is working for me and not Big Pharma! Once I am paying for a service directly, I am going to be looking for a competitive price and I am going to be careful about paying for services I don't need and don't want.
Some problems with this, namely what happens if you get cancer? Are you a multi millionaire? Cause if not you're screwed.
Also, lets say their is a SARS outbreak, do those other over 18 year olds not get treated? If they dont, wont the outbreak spread like wildfire?
We don't get to pick and chose, you can no more opt out of healthcare in this country, then I can opt out of paying my education taxes because I don't have kids. We all benefit from the programs, even if in just a secondary manner. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/18/2007 9:36:40 AM | I am sorry Charlesd - yes there are risks that come with freedom but those who would trade freedom for security will end up with neither!
The health taliban does not merely want my money (which I would be willing to give). People like you believe that in nationalized health care - not only should the state be able to collect money in exchange for medicare- it is now believed that the state owns my person. That I have a duty to be healthy for the state! The only lifestyle choices I am now allowed to make but be approved by the state!
A case of lung cancer costs about $24,000 to treat (US dollars) - that is approximately what I pay each year in health care taxes, sin taxes for being a smoker, health care premiums.
So I can pay for my own health care and own my body. All I have to do is set aside fear - fear of getting sick and fear of dying. Guess what - I have no such fear left in me. The truth is that most Canadians have about 65 years of disability free life. We don't need much in the first 65 years - there is plenty of time for the majority to save for catastophic illness. Yes - some will suffer. But if society wants to exclude me and treat me as a leper - why the hell should I care?
Nationalized health care is a nice benefit to living in a civilized society but it is not a benefit I am willing to have anybody hold over my head! It is the natural response to the health talibans instructions that smokers should be denied health care, employment, the right of association, and even the right of housing. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/19/2007 3:47:49 PM | We feel that it is not enough to say "this is the way things are;" instead, we should assess and say "this is the way things should be." Each state program has been evaluated in terms of four categories: eligibility, scope of services, quality of care, and reimbursement.
Our findings indicate that nationally, the state Medicaid programs are severely challenged.
The state-by-state breakdowns reveal marked disparities between and among states.
Enacted over 40 years ago, Medicaid has evolved with changing demographic, technological, and health needs; political priorities; and fiscal realities. The program has been called many things: the cornerstone of the nation’s health system, a safety net for the neediest, a workhorse that goes into action when help is needed, and an inflexible and flawed system, among others.
Whatever its shortcomings, Medicaid continues to grow, reflecting and refracting many of the trends affecting health care as a whole. At present, the program
covers approximately 55 million Americans;
accounts for one out of every five health care dollars spent in the nation;
pays for 41 percent of all U.S. births and 50 percent of all long-term care costs;
supports tens of thousands of health care providers throughout the country; and
represents the largest source of federal grant support to states.
Purpose and scope of study
While there are abundant data on Medicaid, these tend to avoid making value judgments. This report therefore seeks to fill the existing gap. We feel that it is not enough to say “this is the way things are;” instead, we should assess and say “this is the way things should be.”
Almost 20 years ago, the Public Citizen Health Research Group published a report on Medicaid, Poor Medicine for Poor People, ranking state Medicaid programs. The current report seeks to update that report. But because programmatic mandates have changed and states now have considerably more latitude in how they run their programs, the indicators are different, as are the sources of data. As a result, there is greater variety among states, as well as greater differences within states.
Each state program has been evaluated in terms of four categories or criteria: eligibility, scope of services, quality of care, and reimbursement. These were in turn measured by 55 indicators, and the resulting scores were weighted according to the relative value given to each category by experts. The ranking system gives a state a score for each category as well as an overall score.
Major findings
Nationally, the state Medicaid programs are severely challenged: even the best state scores only 646.2 points on a scale of 1000. And the worst state rates a score of only 318.1, i.e., less than a third of the total maximum points.
The state-by-state breakdowns reveal marked disparities between and among states. The top 10 states, ranking #1 to #10, tend to cluster in the Northeast but also include three states in the Midwest and two in the Northwest. The following states occupy the first 10 ranks, in descending order: Massachusetts, Nebraska, Vermont, Alaska, Wisconsin, Rhode Island, Minnesota, New York, Washington, and New Hampshire.
The 10 most deficient state programs have overall scores ranging from between 318.1 and 379.8 of the total 1000 points. The worst, in order from 50th to 41st, are in Mississippi, Idaho, Texas, Oklahoma, South Dakota, Indiana, South Carolina, Colorado, Alabama, and Missouri.
The overall score of top-ranked Massachusetts is more than twice that of bottom-ranked Mississippi. A breakdown of scores by category further highlights the existing disparities: the scores vary 2.5-fold for scope of services, and more than threefold for eligibility. In the remaining two categories, which have fewer indicators and are therefore more volatile, variations among states are even more dramatic: in quality of care, the difference is more than 17-fold; in reimbursement, it is more than 20-fold.
The overall ranks are followed by state-specific summaries with the breakdown of scores by category. This allows states to pinpoint their areas of weakness, and to more successfully target their interventions. It also highlights states that have achieved success in one or more areas and can therefore serve as models for other jurisdictions.
The full report on Medicaid can be found at citizen.org/medicaid and its interesting.
Pack ....PS,Somb,you will be delighted to see your state falls in the top ten. | |
|
e-wok
|
Joined: 9/25/2006
Msg: 48 | |
| Illogical medicare/provincial health plans.
Posted: 4/23/2007 12:03:44 AM | It is estimated that lack of health insurance causes 18,000 premature deaths every year in the United States.
Some of those people were at one stage in their lives doing very well but
for whatever reason....downsizing, outsourcing or what have you, they
have gone into a path they never anticipated.
18,000 deaths per YEAR.
Universal health care has wait times but the number of deaths for
people waiting? Come now. | |
|
| Illogical medicare/provincial health plans.
Posted: 4/23/2007 10:06:12 AM | e-wok
It is very very easy to quote statistics but without putting them in perspective - they mean nothing
You said "18,000 people die per year because they don't have health care" that is in the United States with a population of over 300 million?
That is 0.006 % of the population that die because they don't have healthcare.
In Canada with a population of just 32 odd million " it is estimated that 24,000 people die per year because of doctor error, infections from hospital stays ect"
"that is 0.075 % of the population dying cause they DO have health care."
Michelle | |
|
| Illogical medicare/provincial health plans.
Posted: 4/23/2007 6:06:37 PM | | About a year ago I was going through some issues with my health. (major burnout) I knew full well that going through the public system would end in sheer frustration. I am far from being wealthy. In Quebec my income as a single person is in the middle class range. (as a SINK single income no kids I pay through my butt in income taxes) Anyway, to avoid frustration I went to the Private clinic that opened up about two years ago here in Montreal. It cost me 300.00 the first visit. Then I had 3 more visits which totalled about 100.00 per visit. Grand total of about 600.00 more or less. It was worth every penny! (my private insurance took care of my wages while I was on sick leave) With issues like burnout, if you don't have a family doctor, you're pretty much screwed. Too bad though that I have to pay so much in income tax, because rather than have any doctor taking care of my women's issues when I "drop in" to a clinic once a year, I would actually always go through the private system. I figure my tax dollars should be doing something for me. | |
|
|
|
Home
login 
