dmcowen674
No Lifer
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Blue Shield Won't Pay NorCal Mom's Cancer Treatment
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LunarRay
Diamond Member
The patient in this case should argue that the hospital charge the Ins Co. the rate for the one procedure and she be held for the difference, if any.
There is a difference in the procedures even if it is only the side effects... The MD selected her best choice... that is the criteria for treatment at end of the day.
How is it that the Insurance Co. can argue 'my way or the highway'...
The economic value to the hospital is based on how it amortizes the assets... the time value of the procedure... the after care aspects and the like.. The economic value to the Insurance Co. is only the cost differential for one versus the other.. they agree one is needed...
There is a difference in the procedures even if it is only the side effects... The MD selected her best choice... that is the criteria for treatment at end of the day.
How is it that the Insurance Co. can argue 'my way or the highway'...
The economic value to the hospital is based on how it amortizes the assets... the time value of the procedure... the after care aspects and the like.. The economic value to the Insurance Co. is only the cost differential for one versus the other.. they agree one is needed...
That's great. As long as you pay for the correct coverage and the insurance company doesn't suddenly turn tail after they find out you cost more then you are paying them, you are just dandy. I mean she specifically chose to get that type of cancer and had more then 3 brain tumours which was 1 brain tumour too many as told by Blue Shield. Poor her, next time she should chose her diseases a little more carefully and go in when she has 2 brain tumours or whatever number is covered until you actually go and ask for the treatment.
And yes UHC does cover gamma knife treatment in Canada. It's a fairly new system available to Canada and probably a long wait, but it is available. The US system is also avialable to Canadians too if they are willing to pay, not wait and cross the border.
It's funny, you have posters stating how the US healthcare system has been failing them, and in ATOT, yet here we always have defenders pretending those issues never exist, and always have extreme examples from UHC systems in hand to prove why they are bad for the US. I have no idea why they can even defend such a ridiculously flawed system
Hayabusa Rider
Admin Emeritus & Elite Member
But will it do so in the US under all circumstances where the physician recommends it, and how do you know it to be so?
That's what many of us want to know before endorsing it. If the idea is to bring this up as an example of why we need government run health care, but then those doing so can't say if it would be any different, well we just don't buy it. We've learned long ago that promises given by politicians were made to be broken. In fact we have one member who believes that lying about health care is perfectly acceptable if it gets UHC in place.
Why am I supposed to believe that which no one will show me?
I wasn't finished posting for one, and show where Canadians on ATOT have pointed out that the Canadian healthcare system have been failing them. An american talking about a friend needing knee surgery in Yellowknife, and a past Canadian as a kid now American citizen talking about some story he heard doesn't count.
theeedude
Lifer
The only one that is relevant to here is automotive insurance, and that one is not a necessity, if auto insurance company refuses to fix your car properly, you aren't DEAD, like this woman will be soon because BCBS refused or at least delayed treatment her doctor deemed appropriate.
The other ones provide actual products, not financial ones. Health insurance company is placing bets on your health care costs, that is its business. If it loses, it should pay up, not try to tell you you don't really need this stuff when your doctor says you do. It's outrageous that someone with a blatant conflict of interest like insurance company paid doctor gets to decide whether a person this company insured lives or dies.
The Canadian provincial governments has on many occasions paid for service in the US that was not readily available within Canadian borders when life or death situations arise. This is often used as a talking point by anti-UHC spokespeople to show the weaknesses of the Canadian healthcare system, but is actually a sign why the healthcare system works. Even under circumstances that Canada itself does not have the necessary means to properly treat a patient, it will cover the cost to be treated elsewhere. That patient will never get a 100,000$ bill or be denied coverage because they have 3 brain tumours instead of 2 or less.
The point about government run healthcare is you turn a for profit business meant to provide as much value as possible to stock holders, into a system with only one non-profit business who's goal is to offer healthcare at the most cost effective price and value to its members, the taxpayers. Each province in Canada has their own healthcare system, but must abide by federal legislation. Government run healthcare does have accountibility, and that's to taxpayers who can vote a party out of power. A party would never be allowed to bring a healthcare system in ruin, it would be voted out well before they could try.
Canada used to be a country with a very similar system to the US less then 50 years ago and Canadians had this huge very similar debate quite some time ago. Why are countries going the UHC route, and not the other way around into a 'free market' route if it was so great? If the quality of UHC was so poor, no government would ever survive with such a system and democracy would take over. Democracy is talking now, which is why there is so much talk about healthcare reform in the US. As a conservative, I want to have my own money that I work for go further for me, and it goes further in a properly managed government healthcare system.
Hayabusa Rider
Admin Emeritus & Elite Member
For me Firebot, I realize we are going to have UHC, but we here are not Canada, or Germany or any other country. Right now the emphasis is on pushing something through. We're going to have to take it, and we have no say and no idea of what it is. You mention a properly managed system. That's what I want! Yet, when many who want the same try to find out more than slogans or vague ideas of what should be, we're told some quite impolite things.
Until the Democrats stop diverting the issue with cries about disinformation and actually provide facts, I can't support it. I'd be a fool to sign a contract without knowing the details, and I'd be likewise to take on faith something hidden.
Until the Democrats stop diverting the issue with cries about disinformation and actually provide facts, I can't support it. I'd be a fool to sign a contract without knowing the details, and I'd be likewise to take on faith something hidden.
I dont disagree at all. The US is not Canada, and the idea of offering healthcare to illegal immigrants would disgust me. In Canada they have the right to emergency healthcare, but get a bill and a deportation ticket right after they come into the hospital. The Democrats are no better then Republicans when it comes to lobbyism and underhandedness, they just have different clients they cater to.
UHC at heart though is a better system then the current system the US has in place (and yes I know communism at heart 'sounds' good, but you get the idea).
quest55720
Golden Member
No it is not I would rather have our broken system right now than some shitty UHC. We forget this governments track record when it comes to entitlement programs. How are social security and Medicare doing again? Oh yea they are a few years away from being bankrupt. I do agree we need reform but not government controlled health care. Let the government first fix SS and Medicare before it gets a shot at my health care. There is plenty of reform that can be done that can bring down costs that keeps the governments hands off health care. This country has by far the best medical care in the world. You think guys like Dodd, Kennedy are going to Canada to treat their cancer?
As someone intimately familiar with radiation oncology, BCBS is making the right choice. Standard of care for that many brain mets is not stereotactic radiosurgery, but whole brain radiation. The article tries to pull at your heart strings by saying she is going to die without the treatment. Unfortunately, she is going to die no matter what we do. Why waste the money when the gamma knife procedure has not shown any survival benefit compared to WBRT, but costs 10 times as much?
Pliablemoose
Lifer
This example is BS, she has freaking 15 tumors in her brain, she should receive palliative therapy only, and IMHO, the whole brain irradiation therapy is a massive waste of $.
UHC won't fix this woman's problem, but it highlights the issues that patients are unrealistic in their expectations of outcomes, and that physicians are nearly as unrealistic as the patients.
If UCSF Medical Center feels that she should receive this therapy as part of a research program, then they should foot the bill, or pay the difference between the whole brain radiation treatment and the gamma knife irradiation.
I'm a supporter of UHC, despite the fact that it'll likely affect my personal income, I've worked in health care nearly 30 years, and the gov will likely not pay us for shit if UHC is implemented, but we have to do something, ER's have become clinics, the hospital beds are full.
In manufacturing ~85% capacity is what they shoot for, health care has become a 100% capacity nearly 100% of the time issue for hospitals, the beds never get a chance to cool off. In a field where there should be no mistakes, running everything at 100% capacity is just asking for trouble.
UHC won't fix this woman's problem, but it highlights the issues that patients are unrealistic in their expectations of outcomes, and that physicians are nearly as unrealistic as the patients.
If UCSF Medical Center feels that she should receive this therapy as part of a research program, then they should foot the bill, or pay the difference between the whole brain radiation treatment and the gamma knife irradiation.
I'm a supporter of UHC, despite the fact that it'll likely affect my personal income, I've worked in health care nearly 30 years, and the gov will likely not pay us for shit if UHC is implemented, but we have to do something, ER's have become clinics, the hospital beds are full.
In manufacturing ~85% capacity is what they shoot for, health care has become a 100% capacity nearly 100% of the time issue for hospitals, the beds never get a chance to cool off. In a field where there should be no mistakes, running everything at 100% capacity is just asking for trouble.
TheSkinsFan
Golden Member
Implement limited reform (read: regulations) that will specifically address (read: prevent) the denials of enrollments and treatments such as those described in the OP. Believing that we need a completely new healhcare system to address such specific issues is epic fail.
/thread.
/thread.
dmcowen674
No Lifer
But but but we have the best health care system in the world remember?
Are you saying it isn't?
IndyColtsFan
Lifer
We need to start with specific, limited reform. Cost containment should be the first objective of such a plan. I have presented many facts and links detailing these issues, and only trolls like Nobodyknows (who, true to form, sent me an insulting PM and then "ignored" me like the true simpleton he is) don't acknowledge the numbers -- but his refusal to directly address the facts shown to him just shows he has no factual rebuttal.
As mentioned, cost containment should be the first priority. We also need to do something about pre-existing conditions -- either through legislation which bans insurance companies from excluding those people or from dropping them, or through another method. Finally, I do acknowledge that we need some sort of catastrophic coverage for ALL Americans.
Fingolfin269
Lifer
You guys need to find a much better example for why UHC would be better than our current system. Then again watching you argue for it using this as your platform is actually quite amusing so please forget my suggestion. 😉
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