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If you break your arm, and the procedure codes involved says that $500 is the payment the insurance company has to pay for a cast.. How does the fact that the guy next to you paid $0, mean that the $500 is more than the $500 that the insurance company had to pay?
IT DOESNT..
Its similar to paying someone to cut your grass.. If the quote is $40 to cut your grass, and the neighbor gets his grass cut, and stiffs the lawn company, you dont have to pay $80.. You still pay $40.. Dont you?
the ones who DO have to makeup the cost, is those who pay the BILLED rate, and thats ONLY the cash payers, because again, the insurance companies DO NOT PAY THE BILLED RATE..
The lawncare company would have to increase the billed rate on the grass cutting job, but those with a contract already would STILL pay $40, while those without, would have to makeup the difference.
Why is it, so many people, dont have a dam clue how it works?'
Your 2nd link actually confirms this to be true, without realizing it, because it gets into discussing rationing.. If the insured, and government has the burdeon of picking up the tab, the rationing wouldnt have to take place, would it? And since the ACA actually increased costs, (i.e. through things like taxes), then clearly the ACA is responsible for "rationing" even more, correct?
No, BILLED rates to the insured are raised but PAYABLE rates are NOT.. They absolutely positively are not.. The rates are established in November/December OF THE PRECEEDING YEAR..
You better talk to your husband because you clearly dont know what the hell you're talking about..
Maybe reading your own link will help you? Try the first paragraph.
Did you thinK i wasnt going to go back and read it?
The phrase “usual, customary, and reasonable” (UCR) refers to the base amount that third-party payers (including insurance carriers and employers) generally use to determine how much will be paid, on behalf of an enrollee, for services that are reimbursed under a health insurance policy or health plan.
YES? Its a PREDETERMINED about, which is paid to a hospital, REGARDLESS OF HOW MANY OTHER PEOPLE ARE PAYING...
What exactly is your point, or did you not comprehend what you read?
Did you thinK i wasnt going to go back and read it?
The phrase “usual, customary, and reasonable” (UCR) refers to the base amount that third-party payers (including insurance carriers and employers) generally use to determine how much will be paid, on behalf of an enrollee, for services that are reimbursed under a health insurance policy or health plan.
YES? Its a PREDETERMINED about, which is paid to a hospital, REGARDLESS OF HOW MANY OTHER PEOPLE ARE PAYING...
What exactly is your point, or did you not comprehend what you read?
Did you miss "As a result, the enrollee will be responsible both for the remaining 20 percent and for the difference between what is charged by the provider and what the plan considers UCR".
As I look thru your last few posts in response to how the cost are passed on to the consumer, I think the above is relevant.
Did you miss "As a result, the enrollee will be responsible both for the remaining 20 percent and for the difference between what is charged by the provider and what the plan considers UCR".
As I look thru your last few posts in response to how the cost are passed on to the consumer, I think the above is relevant.
Haha, you cant read..
Thats 20% OF THE UCR RATE.. Once again, NOT THE BILLED RATE.. You are now quoting things thats say I'm correct.
For example, if the plan covers 80 percent of UCR charges and the enrollee is responsible for the remaining 20 percent, the plan will actually pay 80 percent or less of what is charged by the provider. As a result, the enrollee will be responsible both for the remaining 20 percent and for the difference between what is charged by the provider and what the plan considers UCR.
Have you ever fricken looked at a hospital bill? Here, I'll give you an example
When I fell and broke both of my wrists, the billed rate by the hospital was about $35,000
Thats 20% OF THE UCR RATE.. Once again, NOT THE BILLED RATE.. You are now quoting things thats say I'm correct.
For example, if the plan covers 80 percent of UCR charges and the enrollee is responsible for the remaining 20 percent, the plan will actually pay 80 percent or less of what is charged by the provider. As a result, the enrollee will be responsible both for the remaining 20 percent and for the difference between what is charged by the provider and what the plan considers UCR.
Have you ever fricken looked at a hospital bill? Here, I'll give you an example
When I fell and broke both of my wrists, the billed rate by the hospital was about $35,000
Amount paid $6K.. The other $29K got paid by who?
I suppose, if you pretend you don't know how the cost of uncovered people gets passed on, you will be able to continue to pretend it doesn't, huh?
Out of the estimated 2.1 million people who enrolled in coverage, only 420,000 bought unsubsidized coverage. Since we know that 2.4 million people completed applications on the website and discovered that they weren’t eligible for financial assistance, that translates into 17.5 percent of eligible enrollees opting to pay for coverage out of pocket. More than 8 in 10 saw the prices on offer, but didn’t buy.
In short, enrollment is very heavily skewed toward subsidized coverage. And it’s likely even more heavily skewed towards the low-income population, because the gap between enrollees receiving subsidies (1.7 million) and subsidy eligible applicants (2.7 million) – means that 1 million people who are eligible for subsidies haven’t bothered to enroll in a plan yet. That’s nearly 4 in 10 (37 percent) people for whom the subsidy wasn’t significant enough to get them to enroll.
Yes Im sure the hospitals just eat the costs and wisp their wand around and magically make those loses just disappear. No, the insured don't get charged extra because of uncompensated care.
First, thank you for at least presenting some articles. Most Left-Wingers don't have the guts.
Second, you slit your own throat by using biased sources instead of neutral sources.
Third, your article prove nothing, and in fact contain propaganda and disinformation.
[SIZE=2]Alicia suffers from Multiple Sclerosis and is uninsured. She has two children (ages 10 & 12) who take care of her at home. She is confined to a wheelchair and can't afford home care.[/SIZE]
PBS? Please, you'd do better using the International Comintern.
Alicia is 100% disabled and therefore on Social Security Disability and therefore covered by Medicare.
That makes PBS a bunch of goddam liars.
If Alicia is not on Social Security Disability and covered by Medicare, then her medical support network, social support network and family support network have failed her. We pay payroll taxes for OADI for people just like Alicia who are struck down in the prime of life. She ought to be on SSDI, and if not, then as I said, the entire support network failed her.
The average U.S. family and their employers paid an extra $1,017 in health care premiums last year to compensate for the uninsured, according to a study to be released Thursday by an advocacy group for health care consumers.
There are enormous misconceptions about the "uninsured" and those misconceptions start here.....
The term “emergency medical condition” means— (A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in— (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part; or (B) with respect to a pregnant woman who is having contractions– (i) That there is inadequate time to effect a safe transfer to another hospital before delivery, or (ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
EMTALA definition of ‘stabilized’ To provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B) [a pregnant woman who is having contractions], to deliver (including the placenta).
Make sure you read the case law associated with EMTALA that even more narrowly defines the definition of "emergency medical condition."
So we have this bizarre unfounded prejudicial belief that people show up at the emergency room for any little thing and get free treatment, when in fact, that is not even the reality.
The second issue is that because your hospitals are organized as monopolistic cartels, you have no idea what the real costs of medical treatment are.
That fact is hampered by the incredibly large number of stupid people who don't understand the US has 1,539 separately functioning economies/markets and the fact that they don't understand that it's an appendectomy, not the #2 Combo Meal at McDonald's.
Would you shop at Sears, Wal-Mart, Krogers, Meijers, Target, Albertsons (until they close), Dillards, or Macy's without knowing the prices of the goods sold?
You're going to put a bunch of stuff in your shopping cart and just hope you can afford to pay for it?
The funny thing is that's exactly what you do when you "shop" at your monopolistic hospital cartels.
Worse than that, you're at Wal-Mart throwing things into your cart hoping you have enough money to pay for it. When you get to the check-out lane, the customer in front of you has many of the same items you have. But you are shocked when the previous customer was charged $4 for an item and you are charged $27 for the exact same item.
Why would you tolerate that? Because you are tolerating it....that's exactly how your monopolistic hospital cartels operate.
We all go to the same hospital where I get charged $750 for a 30 minute MRI scan, you get charged $1,940 for a 30 minuted MRI scan and another person gets charged $2,250 for a 30 minute MRI scan.
You don't see a problem with that?
Quote:
Originally Posted by cxr89
..... because, our govt. is so beholden to these special interest groups.
American Hospital Assn
HEAVY HITTER The American Hospital Association represents 37,000 individual members at more than 5,000 hospitals and health care systems. With one-third of the nation’s hospitals in the red, the association’s primary focus is lobbying against any reductions in Medicare payments. Read more...
View totals for other cycles:
CONTRIBUTIONS
$2,383,767 ranks 137 of 20,981
LOBBYING
$19,251,200 (2012)
$20,823,341 (2011) ranks 5 of 4,368 in 2012
OUTSIDE SPENDING
$1,912,675 ranks 47 of 296
The American Hospital Association gave....
$779 Million to Obama for America 2008
$260 Million to DNC 2008
$428 Million to RNC 2008
Just some history on your healthcare system: the American Hospital Association --who created the "Out-of-Network" clause to stifle competition and drive non-member hospitals out of business in order to gain monopoly control -- incorporated the first health insurance company -- the Blue Cross --- in 1946.
The American Hospital Association's Blue Cross ultimately took over and gained control of the American Medical Association's Blue Shield, and now the American Hospital Association, in addition to having monopoly control over hospitals, is gaining monopoly control over health plan providers....
That is a misunderstanding of how price negotiation works.
I don't have time to explain that here, but if you are interested, then look at the formulary for the VA hospital system, and then go to fedbiz.gov and look at the bid specs, bids and contracts.
Quote:
Originally Posted by cxr89
EVERY other country has a lower cost of care BECAUSE of the govt., via massive bargaining power the govt. has due to being large in size. This bargaining power allows for the same care for cheaper prices.
That is not true, and that is a misunderstanding of how Euro-State healthcare systems operate.
In order not to trigger penalty payments, the KBV devised an Emergency Programme which would, in effect, ration drug prescribing for the rest of the year.
The Emergency Programme proposed five steps:
1. Waiting lists for prescription drugs and other prescription treatments (Heilmittel, which include physiotherapy, acupuncture etc.) except in life threatening or medically essential circumstances
2. Postponement of innovative therapy to the following budget year
3. Radical switching of prescriptions from brand to the cheapest generic
4. Prior authorisation of expensive therapies
5. In the event of budget being exceeded, ‘emergency prescriptions’ to be issued temporarily, for which patients would have to pay out-of pocket and personally claim reimbursement (in Germany, unlike France, patients pay only user charges out of pocket)
Source: Why Ration Healthcare? Page 86
So....how's that working for everyone?
Quote:
Originally Posted by cxr89
Ill keep asking over and over again, if govt care has raised the price of healthcare, why do countries where there govt. is MORE involved have lower health care prices?
They don't have lower prices.
Virtual budgets are also set up at the regional levels; these ensure that all participants in the system—including the health insurance funds and providers— know from the beginning of the year onward how much money can be spent.-- Franz Knieps German Minister of Health (2009)
You have confused spending less with costing less.
Your mortgage is $1,800 per month. You collect enough in income to pay $1,200.
You are $600 short.
"In the past 20 years, our overriding philosophy has been that the health system cannot spend more than its income." -- Franz Knieps German Minister of Health (2009)
Suppose the cost of health care is $2.4 TRILLION.
Suppose you only collect $1.9 TRILLION in taxes under a single-payer scheme to pay for healthcare.
What happens to the sick/ill people who need that $500 Billion you failed to collect?
The gov't doesn't have the slightest clue as to haw many people ACTUALLY have gotten ObamaCare.
They can spot out anything they want and it is NOT based on ANY real info.
I watched the hearing the other day and the guy ahead of CSI, I tink that is the initiaLs, when asked a direct question stated that the SYSTEM DOES NOT HAVE THE ABILITY TO KNOW WHO PAID, THEREFORE THEY DO NOT KNOW HOW MANY PEOPLE HAVE INSURANCE UNDER OBAMACARE.
Everything Obama and his minions say about how many people are covered is pure B.S.
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