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"For every problem, there exists a simple and elegant solution which is absolutely wrong."
- J. Wagoner, U.C.B. Mathematics
The doctor my daughter saw in the ER after an accident at a gymnastics meet wasn't "in-network", so we had to pay for his care. At the time, we didn't know there was an appeals process. This accident took place about 25 miles from our home, BTW.
In all seriousness, I hope your daughter is OK.
The fact is you have a policy. You get a new copy every year. Everyone should read it.
The old saying goes, ignorance of the law is no excuse.
Aren't you one of those touting about a college eduction? College educated people are much smarter than people without the sheepskin?
Like I said before, you have a contract. The error was your fault, not the insurance company.
You made a claim that you were denied coverage as if the insurance company was some evil ogre only out for profit. Then we find out it was your fault not the insurance companies. You grossly exaggerated your situation.
I agree. We have a healthcare problem,....and the federal government caused it. When the federal government artificially sets the reimbursement for goods and services ,.....certainly the costs are held down for that particular age group.
So, if the government caused it, why is it that every other industrialized nation (that have far more government involvement) covers all their citizens at half the cost of the U.S.? YOu would think that "if government caused it" government would have caused it there too.
The fact is you have a policy. You get a new copy every year. Everyone should read it.
The old saying goes, ignorance of the law is no excuse.
Aren't you one of those touting about a college eduction? College educated people are much smarter than people without the sheepskin?
Like I said before, you have a contract. The error was your fault, not the insurance company.
You made a claim that you were denied coverage as if the insurance company was some evil ogre only out for profit. Then we find out it was your fault not the insurance companies. You grossly exaggerated your situation.
Why is this "my fault"? When we needed an ER, we were supposed to ask if the one doctor on staff at the ER that night was "in network"? When the answer was "no" (something that didn't occur to us to even ask at the time of an emergency), we were supposed to take our injured child to another ER that had a doctor "in network"? It was just a way to get some money out of us. We actually had numerous claims denied when I was pregnant with our second daughter, many of which were adjudicated in our favor. I am not some ignoramous and your constant personal attacks make you look small.
So, if the government caused it, why is it that every other industrialized nation (that have far more government involvement) covers all their citizens at half the cost of the U.S.? YOu would think that "if government caused it" government would have caused it there too.
.........this is not "every other industrialized nation". I don't care what other nations are doing. I don't live there.
Most "other industrialized nations" don't have the illegal immigration problem there that puts a tremendous burden on the healthcare system, costing untold millions to taxpayers, strains the healthcare facilities, and contributing to the spiraling costs.
Many other nations are struggling to pay for their socialized medicine programs, or have limited access or long waiting lines for treatment. I don't see that happening here.
You tout "other industrialized nations" so much,....why do their citizens want to come to the United States for major operations? Why do Canadians cross the border for healthcare they can't readily get in their country? Why do world leaders always end up in the United States when they have a serious heath problem? At some juncture healthcare becomes equivalent to gasoline/fuel,......it really makes no difference what it costs as long as you can get it. You may be different, but in my many decades of living, I've NEVER known someone who died because they were denied healthcare in the United States. I've known some uninsured people who ended up with thousands in debt, but that was their own fault in most cases.
Our healthcare professionals are second to none, and in fact train most of the physicians who practice all over the world. If you cannot/will not see what the government has done to our healthcare system with its endless bureaucracy and endless redtape, then you haven't been paying attention. The rules/regulations governing Medicare is 100,000 pages,..........100,000 pages. The bureaucracy alone must take thousands to administer.
If you prefer the government to run your life, then that's your business. I prefer to exercise my own rights as a human being.
Why is this "my fault"? When we needed an ER, we were supposed to ask if the one doctor on staff at the ER that night was "in network"? When the answer was "no" (something that didn't occur to us to even ask at the time of an emergency), we were supposed to take our injured child to another ER that had a doctor "in network"? It was just a way to get some money out of us. We actually had numerous claims denied when I was pregnant with our second daughter, many of which were adjudicated in our favor. I am not some ignoramous and your constant personal attacks make you look small.
Because that person wants to defend corporate greed by for-profit Insurance conglomerates.
From my neighbor who works at the ER in my region:
Fact: Our hospital administrators will tell our ER doctors what to order on certain patients. Meaning they will set protocols.
If the patient has Medicare and comes in with chest pain, we will get paid for these test. Even if the patient does not need all of those test, they will get ordered. Even though Medicare doesn’t pay for everything, and the patient will have to pay a ton out of pocket.
I have seen elderly patients come in not running fever. ER nurse or doctors falsify saying there were running fever so we could run and charge blood cultures x2. Medicare pays for it if they are running fever. It cost our lab around $2 and we charge $183.00 a set. So there is $366 - $4 = 362 pure profit. Now like I said Medicare does not pay all, so you can bet the patient will pay about $100 out of pocket. They still do this even though the WBC count is normal showing no infection, which is what Blood Cultures test for.
Let’s do a breakdown of cost for just lab for a common er visit for feeling bad, say flu symptoms.
TEST Our Cost Our Charge Profit
CBC $3.00 $144.50 $141.5
CMP $3.00 $197.00 $194.00
UA $2.00 $65.59 $63.59
BCX2 $4.00 $183.00 $179.00
($2.00 Per Set)
Total Profit = 578.09
IF YOU SAID SHORTNESS OF BREATH THEN WE WILL ADD.
Coags
PT $2.00 97.40 95.40
PTT $2.00 138.24 136.24
D-dimer $5.00 148.00 143.00
We will also run cardiac enzymes if you are on medicare or have insurance
CK $2.00 104 102
Trop 4.00 163 159
Mg 2.00 107 105
Oh and don’t forget the flu test if its flu season, and now cause of H1N1 we will test for flu year round.
FLU 5.00 183 178
If it’s a kid then you can add strep. If it’s a baby then add strep and rsv, but take away the cardiac enzymes----most of the time, lol.
This is not counting the EKG, x-ray, respitory breathing treatments or blood gas, er charges, doctor charges, iv charge, drugs given charge, anything else they can possibly think of charge.
Of course this depends on insurance. I can go into an er room and tell by the orders and complaint if they have Medicare, good insurance, bad insurance or no insurance.
Our doctors are told to order based on this. OF COURSE THEY GET BONUSES FOR DOING SO.
Now some actual ER Certified doctors (Meaning did their residency in Emergency Medicine) won’t play this game and large hospitals have to use actual ER certified docs.
INSURANCE MANDATES MEDICAL CARE HERE, WHICH IS WRONG. when they can circumvent medical professionals with ethics, they do it at any cost.
So why is it that every other industrialized nation covers all their citizens at half the cost of the U.S.? It's really only a crisis here.
If it's the government's fault, why is it that Medicare costs have grown slower than private costs?
Here’s the raw fact, from the National Health Expenditure data: since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%. The rise in Medicare costs is just part of the overall rise in health care spending. And in fact Medicare spending has lagged private spending: if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.
We don’t have a Medicare problem — we have a health care problem.
got any examples of these "smart employers?" Most firms interested in attracting and retaining valuable employees provide health plans.
My point too. Companies like WALMART and McDonalds depend on the government to provide Health Care for their employees while pocketing the cost. The only way to cut Health care is to Nationalize it, as long as the Insurance Companies and for profit hospitals are in the mix cost will be at least double what they should be.
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Guarantee you they do....
