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Medicare rant - its getting bad

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DougK62

Diamond Member
Mar 28, 2001
8,035
6
81
All of these problems with Medicare and some people want the government to be MORE involved with health care? Yikes.
 

rudder

Lifer
Nov 9, 2000
19,431
82
91
Fine, and with that, seniors have been paying into medicare all their lives and most seniors are on it with a supplement. They don't even use private insurance because they don't work. It's rare to see a senior on 100% private insurance, though it happens.
And the supplement business is booming. AARP is a huge supporter of obamacare. You think AARP is a senior citizen lobbying group? No... they are in the business to make money from supplemental insurance. Almost half of AARP's income comes from royalties paid by insurance companies. And most of that income is derived from medicare insurance.
 

dmcowen674

No Lifer
Oct 13, 1999
54,908
44
91
www.alienbabeltech.com
Medicare rant - its getting bad

My wife works for a local doctor, the majority of the doctors business is elderly people on medicare.

A couple of days ago medicare sent the doctor a letter saying some of the procedures he did as far back as 2009 were unnecessary, and medicare wants their money back.

Before the procedures were done, someone from the office called medicare to get pre-approval. Medicare approved the procedures and the surgery was done.

The procedures in question were hip and knee replacements.

Think about that for a minute. Medicare approves procedure, 3 years later wants their money back. Why wait 3 years? Why not deny the procedures when they were pre-approved?

One of the ladies at the office is having to go through the records, and fax everything over to medicare to justify the procedure yet again. The office already did this when the patient was approved for the surgery.
Good

A step in the right direction towards destroying Republican opposition to Universal Healthcare for Americans.
 

Ausm

Lifer
Oct 9, 1999
25,215
13
81
This can only be one of two things:

a) Your doctor only a very small percentage of medicare patients he sees and limits the number of new medicare patients
b) or you just like making bullshit statements for the sake of making them.
What you can't wrap your tiny GOP mind around my post? You forgot the REAL answer..

c) I don't give a flying fuck if you agree with me or not.
 
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woolfe9999

Diamond Member
Mar 28, 2005
7,164
0
0
Private insurers do this sort of thing all the time. My wife got a botox injection for her migraine headaches. Because the procedure is generally used cosmetically, there often isn't coverage. However, the doctor submitted it to Blue Cross and got it pre-approved. They then denied coverage after the procedure was done. We're still fighting with them over it 9 months later. There should be some sort of law that once something is pre-approved, it cannot be later denied absent a finding of fraud. It should apply to Medicare and private insurance both.
 

shadow9d9

Diamond Member
Jul 6, 2004
8,133
1
0
Trust me, no one dies for profit here, its the other way around. I could give examples but I can't violate Hippa laws.
Anyone who is denied for pre-existing conditions or anyone of the 40 million uninsured will die instead of getting care.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,204
126
Good

A step in the right direction towards destroying Republican opposition to Universal Healthcare for Americans.
So the government does the inane and you're thrilled that the same people will assume control? Dude.
 

Texashiker

Lifer
Dec 18, 2010
18,812
192
106
Good

A step in the right direction towards destroying Republican opposition to Universal Healthcare for Americans.
Didn't hillary run on a campaign of universal health care?

But after the insurance companies donated enough money, she sat down and shut up. The democrats are a sell out just like everyone else.

http://www.nytimes.com/2006/07/12/nyregion/12donate.html?pagewanted=all

After enough donations, hillary changed her mind so that everyone would be required to buy insurance.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,204
126
Private insurers do this sort of thing all the time. My wife got a botox injection for her migraine headaches. Because the procedure is generally used cosmetically, there often isn't coverage. However, the doctor submitted it to Blue Cross and got it pre-approved. They then denied coverage after the procedure was done. We're still fighting with them over it 9 months later. There should be some sort of law that once something is pre-approved, it cannot be later denied absent a finding of fraud. It should apply to Medicare and private insurance both.
All insurance is a PIA at times. The difference is degree. If you talk with people in billing they cringe at private insurance but rant when a government entity is mentioned. It was so bad in NY that the state threw in the towel and farmed 3/4 of Medicaid claims to private concerns. Within a month the system was running better than ever.

Still, the system as a whole needs a lot of work but the consensus seems to be to impliment first and see what happens.
 

modestninja

Senior member
Jul 17, 2003
753
0
76
Anyone who is denied for pre-existing conditions or anyone of the 40 million uninsured will die instead of getting care.
No, they'll just fill up emergency rooms and make care that much more expensive for everyone that does have insurance.
 

modestninja

Senior member
Jul 17, 2003
753
0
76
All of these problems with Medicare and some people want the government to be MORE involved with health care? Yikes.
It's almost like they see the 20 or so countries ahead of the US with better overall health outcomes and notice that they all have UHC. Then they look a little further and see that those countries pay a fraction of the amount for their care that we do in the US and jump to the wildly invalid conclusion that it might work here...
 

woolfe9999

Diamond Member
Mar 28, 2005
7,164
0
0
All insurance is a PIA at times. The difference is degree. If you talk with people in billing they cringe at private insurance but rant when a government entity is mentioned. It was so bad in NY that the state threw in the towel and farmed 3/4 of Medicaid claims to private concerns. Within a month the system was running better than ever.

Still, the system as a whole needs a lot of work but the consensus seems to be to impliment first and see what happens.
Bear in mind that government agencies have two basic characteristics that can make them harder to deal with: the first is that they operate on hard-capped budgets and they don't necessarily have lots of people to staff phone banks. The second is that the rules they operate under are more likely laws than mere company policy. That gives them less discretion to bend their rules where it would seem to make sense in an individual case. That said, some government agencies are easier to deal with than others. The same is true with corporations. Ever try to get any sort of customer service from a company like AT&T or Comcast? The nightmare is indescribable.
 

shadow9d9

Diamond Member
Jul 6, 2004
8,133
1
0
No, they'll just fill up emergency rooms and make care that much more expensive for everyone that does have insurance.
Emergency rooms will not fix chronic conditions. They will die because they are not getting proper and regular treatment. However, what ER visits they do use will be paid by the taxpayer, so that part is correct.
 

modestninja

Senior member
Jul 17, 2003
753
0
76
Emergency rooms will not fix chronic conditions. They will die because they are not getting proper and regular treatment. However, what ER visits they do use will be paid by the taxpayer, so that part is correct.
Generally untreated chronic conditions result in at least one acute episode which ends up with someone in the emergency room (ie: untreated high blood pressure leads to someone in the emergency room because of a heart attack). Some will die before they get to the hospital, but a lot of them will end up getting expensive emergency treatment that the hospital isn't reimbursed for, the cost of which gets passed on to the insured patients.
 

Arglebargle

Senior member
Dec 2, 2006
892
1
81
To the OP, one of my last, commercial, health insurance plans did exactly the same thing: I would get procedures pre-approved, and they denied every single one of them, requiring me to hassle with their customer support in each individual instance.

I guess they'd figured out that the number of clueless, or really sick or dead patients who wouldn't dispute things in a timely fashion would add to their profit margin.
 

nanette1985

Diamond Member
Oct 12, 2005
4,211
1
0
Wwow. I'm fascinated that you-all know so many MD's that accept Medicare. Pretty hard to find one of them around here.
 

Matt1970

Lifer
Mar 19, 2007
12,321
2
0
My mom went to the Hospital a month ago (she is fine now) but the Ambulance ride with 2 Paramedics to the Hospital less than 2 miles away got billed to Medicare at $960. That is what is wrong with the system.
 

Craig234

Lifer
May 1, 2006
38,584
344
126
All of these problems with Medicare and some people want the government to be MORE involved with health care? Yikes.
Yes, private insurance is SO problem-free, cost-effective, free of corruption, providing what the country needs with 40 million uninsured, etc. With voters like you...
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,204
126
My mom went to the Hospital a month ago (she is fine now) but the Ambulance ride with 2 Paramedics to the Hospital less than 2 miles away got billed to Medicare at $960. That is what is wrong with the system.
So these trained people are collecting pay while waiting with an expensive vehicle and all it's gear waiting for someone to call and this service is available 24/7. So they spend what, an hour taking your mother to the hospital? Have you considered that these people aren't getting paid piecework?

Google says there are 8766 hours in a year and every one of them has someone waiting to save your mother's and others lives. You want them paid only when they are hauling people. Next time take a cab. Think of all the money you'll save.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,204
126
Yes, private insurance is SO problem-free, cost-effective, free of corruption, providing what the country needs with 40 million uninsured, etc. With voters like you...
How would Craig know anyway? He blocks out everyone he finds "unworthy" :D
 

TheVrolok

Lifer
Dec 11, 2000
23,269
2,536
136
My mom went to the Hospital a month ago (she is fine now) but the Ambulance ride with 2 Paramedics to the Hospital less than 2 miles away got billed to Medicare at $960. That is what is wrong with the system.
There is quite a bit wrong with the system.
 

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