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Old 11-21-2016, 03:37 PM
 
Location: Living rent free in your head
31,116 posts, read 13,636,147 times
Reputation: 22162

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Quote:
Originally Posted by thinkalot View Post
When you have catastrophic you do not pay the uninsured rate. you pay the rate agreed upon with the insurance company. If you go to the ER and the insurance company agreed to $700 and the price is $2000 the fully insured pay nothing, catastrophic policy holders pay $700, and the uninsured pay $2000. How many families make several ROUTINE visits to the doctor in a month? Maybe in a year. We need to stop having people run to the doctor for every ache and pain.
And if you don't have $700? What then, just suck it up and make sure you don't die on the sidewalk so as to impose an inconvenience to those who have insurance and might have to step over your body?

 
Old 11-21-2016, 05:37 PM
 
Location: Wisconsin
21,543 posts, read 44,068,928 times
Reputation: 15160
Quote:
Originally Posted by TuborgP View Post
Isn't that a private sector v public sector difference? Profit is the core private sector motive and the reason people risk capital
Which is exactly why for-profit PRIVATE insurers should NOT be administering public benefits - i.e., Medicare Advantage or, by extension, Medicare Modernization. For-profit PRIVATE insurers ("risk capital," to use your words) bottom lines are directly dependent on denial or obstruction of benefits - which they do - all the time.

Only one, of many, cases in point:
Quote:
Minnesota Attorney General Lori Swanson is asking the federal government to investigate Humana's Medicare Advantage policies after uncovering what she said were "significant problems" reported by Minnesota patients and medical providers.

Affidavits gathered from 25 Minnesotans showed a pattern where Humana denied claims for medical services required by law, overcharged for co-payments and coinsurance, and failed to disclose the providers that are in the network, she said. Swanson's office also found that Humana didn't follow procedures laid out by federal regulations for patients to appeal their cases.

"They were stringing people along, taking months to get back to people," she said. "Oftentimes, it took the intervention of our office — and oftentimes we had to write multiple times."

Humana, based in Louisville, Ky., is one of the nation's largest health care insurers in

Medicare Advantage, a private policy that covers seniors and those with disabilities. Humana has been doing business in Minnesota for more than 10 years, and provides insurance coverage to more than 100,000 residents through various types of Humana Medicare Advantage plans, including a plan for prescription drugs, according to a company official.

Dawn Kern, a business office manager at Bigfork Valley Hospital Clinics and Community in northern Minnesota, has not had a top-star experience. Her staff spent two years and "countless hours" trying to get Humana to pay for two claims for home care services that are worth $7,000 and $1,700, she said.

The hospital made more than 25 phone calls, sent letters and supporting documents and still hasn't been reimbursed for the 2011 services, Kern said in her affidavit. The insurer also has denied payment for routine screening procedures, such as mammograms, and hospital stays for observational care that exceeded 24 hours, both of which are covered under Medicare.

"Humana has been a nightmare to work with due to its frivolous denials, horrible customer service, and lengthy and often fruitless appeal process," Kern said.

This is the first action the attorney general's office has taken against Humana, according to a spokesman, but the company has come under fire in the past from the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees Medicare.

Swanson asks U.S. to investigate Humana over medical claims - StarTribune.com
 
Old 11-21-2016, 05:42 PM
 
Location: Living rent free in your head
31,116 posts, read 13,636,147 times
Reputation: 22162
Quote:
Originally Posted by Ariadne22 View Post
Which is exactly why for-profit PRIVATE insurers should NOT be administering public benefits - i.e., Medicare Advantage or, by extension, Medicare Modernization. For-profit PRIVATE insurers ("risk capital," to use your words) bottom lines are directly dependent on denial or obstruction of benefits - which they do - all the time.

Only one, of many, cases in point:
I agree, the fiduciary duty of a corporation is to maximize returns to shareholders, the best way for a private health care company to do that is by denying benefits.
 
Old 11-21-2016, 06:51 PM
 
6,649 posts, read 3,761,413 times
Reputation: 13726
Quote:
Originally Posted by jim9251 View Post
Just give me back the entire amount I've paid into SS since I was 13 years old and I'm good. A lump sum would be fine.
Your contributions are just half. Your employers contributed the other half. And you didn't have financial institution fees withdrawn from it. The fees have been very low, the SSA benefiting from the economies of scale.

Any middle class person who thinks he'll do better with privatization is unfamiliar with 401ks. What an employee contributes to SS is small. Once you put it in a 401k and take Merrill Lynch fees out of it, and have limited investment choices, they'll end up with not much.

When Ryan and others say you'll make more...they're talking about the stock market. Which is not "secure." (It's called Social "Security," after all.)
 
Old 11-21-2016, 08:09 PM
 
1,014 posts, read 579,437 times
Reputation: 1368
He's not even in office yet. Let's see what he does then. After all, he could be gone in 4 years and if you're not 61, then this really does not matter as much.
 
Old 11-21-2016, 08:16 PM
 
26,024 posts, read 33,040,777 times
Reputation: 32264
Quote:
Originally Posted by thinkalot View Post
When you have catastrophic you do not pay the uninsured rate. you pay the rate agreed upon with the insurance company. If you go to the ER and the insurance company agreed to $700 and the price is $2000 the fully insured pay nothing, catastrophic policy holders pay $700, and the uninsured pay $2000.

How many families make several ROUTINE visits to the doctor in a month? Maybe in a year.

We need to stop having people run to the doctor for every ache and pain.
Well most people don't do that. Not sure why you think they do.
 
Old 11-21-2016, 08:18 PM
 
Location: Living rent free in your head
31,116 posts, read 13,636,147 times
Reputation: 22162
Quote:
Originally Posted by jteskal View Post
He's not even in office yet. Let's see what he does then. After all, he could be gone in 4 years and if you're not 61, then this really does not matter as much.
I think that Paul Ryan expects us to just wait and see what he does...but once it is done it will probably be too late and might be difficult or impossible to undo. I won't sit back, I will watch this very carefully and donate money to those who seem to be representing the interests of seniors.
 
Old 11-21-2016, 11:00 PM
 
Location: Eugene, Oregon
9,179 posts, read 3,019,420 times
Reputation: 13865
Quote:
Originally Posted by jasperhobbs View Post
So true. There would such a public outcry if they tried to making sweeping change.
Quote:
Originally Posted by TuborgP View Post
Why? When they made it perfectly clear what they intended to do and people then elected them to do it.
The kind of people who voted for him, don't pay much attention to details.
 
Old 11-22-2016, 12:43 AM
eok
 
6,684 posts, read 3,175,988 times
Reputation: 8464
Quote:
Originally Posted by Deelighted View Post
Don't be so fast to judge another until you've walked a mile in their shoes!
Bad idea. Don't let Republicans walk a mile in your shoes. You will need new ones.
 
Old 11-22-2016, 01:40 AM
eok
 
6,684 posts, read 3,175,988 times
Reputation: 8464
Quote:
Originally Posted by stevek64 View Post
deferred plans, private savings/investments allowed us to retire in our early 40's comfortably
When people do well, it's always because of their brains. When they do poorly, it's always because of bad luck. It's the way people are.

"You gotta know how to catch, you gotta know how to throw." -- Peter, Paul, and Mary
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