Medicare rant

[nitrah55]

On reflection, it has occurred to me that of all the people I have heard say the United States has "the best medical system in the world," not one has ever added, "And, by the way, the US medical system is good."

Medicare Part B pays most of the cost of 100 days of skilled nursing care after a qualifying hospital stay. In my mom's case, that 100 day period ended January 16. For benefits to begin to be paid again (another 100 day period), Mom would have to be out of the system for 60 days.

We paid Mom's costs of nursing care out of our own pocket through April 3. She spent one day in assisted living, then had a kidney stone attack on April 4. Went to the hospital, now in skilled nursing/rehab since April 21. Should get out in a couple of weeks.

We figure we have the 60 day period covered (1/16-4/4). We don't. The clock on the 60 day period starts from the final day Mom got skilled nursing care- regardless of whether Medicare paid for it. In Mom's case, that date was February 8, because she received antibiotics for a week. 2/8-4/4 is less than 60 days.

So, we are once again paying her rehab at retail prices.

Before I mentioned this, did any of you (not medical professionals or people who've been through this) know about this? Because I didn't. And the medical professionals at Mom's original rehab place never mentioned it to us.

And if I, a reasonably well-educated guy with some spare time on my hands can get flummoxed by this stuff, what confounding things are happening to folks who don't have the wiles and wherewithal to track down what's going on? If this is the best system, the rest of the systems must be really awful.

Mom's getting better. My condition deteriorates daily.

[peacock2121]

I did not know this.

I am sorry you are caught in this mess.

[PlacentiaSoccerMom]

All I know is that because of the many uninsured people in California, including illegal aliens, and the low rate of reimbursement by Medical and Medicare, many emergency rooms are operating in the red.

Here is an article that was in the LA Times this weekend.

The guy is blue is Jeff's boss.

http://www.latimes.com/news/local/la-me ... 5836.story


It seems to me that if the Federal Government is doing nothing to shore up the borders, then they should pay for the cost of services (schools and healthcare) that these people are using. Basically, it's unfair for the border states to pay for these unfunded madates by the Federal Government. Next year there will be many cutbacks in California schools and it really sucks.

[nitrah55]

I did not know this.

I am sorry you are caught in this mess.

Thank you.

[gsabc]

Basically, it's unfair for the border states to pay for these unfunded mandates by the Federal Government.

It's unfair for ANY states to be paying for ANY unfunded mandates, but that has been Congress's and the Administration's MO for years. You name the state or local goverment department, it's struggling to pay for some federally required regulation that was passed without the funding to carry it out.

[Spock]

I cant't wait till we have full socialized medicine and no other choices. Boy, that will be pure utopia. All such problems as you describe will then be magically solved.

[Appa23]

All I know is that because of the many uninsured people in California, including illegal aliens, and the low rate of reimbursement by Medical and Medicare, many emergency rooms are operating in the red.

Here is an article that was in the LA Times this weekend.

The guy is blue is Jeff's boss.

http://www.latimes.com/news/local/la-me ... 5836.story


It seems to me that if the Federal Government is doing nothing to shore up the borders, then they should pay for the cost of services (schools and healthcare) that these people are using. Basically, it's unfair for the border states to pay for these unfunded madates by the Federal Government. Next year there will be many cutbacks in California schools and it really sucks.

The article really oversimplified the federal law (which may have been because of a lack of space). In actuality, a participating hospital (which nearly every hospital is, except for Shriner's and military hospitals) only is required to treat, stablize, or otherwise transfer patients who have an "emergency medical condition," not every patient who shows up at the emergency room.

I also read something interesting the other day. Many, if not all, of the states claiming to have "balanced budgets" are playing fast and loose with the facts. In actuality, the budgets only are balanced because of federal funds being given back to the states, above and beyond money given to cover some mandates. Otherwise, without these billions and billions of dollars, the federal budget looks much better, and the state budgets look much worse.

[dimmzy]

The health care system is a mess, but it's so complex that there are no easy solutions. I sympathize with your family--and your willingness to pay!

Here are some of my ideas:

1) Give incentives to people who have their medical papers in order (Do Not Resuscitate etc.)

2) Require WRITTEN COSTS in advance of routine procedures (my Blue Cross refuses--saying it's not their practice to do so) Yet, you can be blindsided by unexpected bills for procedures you THOUGHT were covered. Require insurers to provide WRITTEN DOLLAR AMOUNTS of what they will pay. My routine mammogram? $700 out of pocket. Why? BC will COVER a mammogram but they only PAY $99!!

3) Bonuses to doctors and patients who develop healthy practices.

4) Cancellation of health policies if you DON'T have medically advised tests.

I could go on forever, so I won't.

[ne1410s]

Wonder how many hospital bills we could pay with the two trillion dollars we are pissing/pissed away in that clusterf_ck known as Iraq?

I'm just sayin'...

[PlacentiaSoccerMom]

Wonder how many hospital bills we could pay with the two trillion dollars we are pissing/pissed away in that clusterf_ck known as Iraq?

I'm just sayin'...

I'd like to see it divided up between healthcare and schools.

[Bob Juch]

All I know is that because of the many uninsured people in California, including illegal aliens, and the low rate of reimbursement by Medical and Medicare, many emergency rooms are operating in the red.

Here is an article that was in the LA Times this weekend.

The guy is blue is Jeff's boss.

http://www.latimes.com/news/local/la-me ... 5836.story


It seems to me that if the Federal Government is doing nothing to shore up the borders, then they should pay for the cost of services (schools and healthcare) that these people are using. Basically, it's unfair for the border states to pay for these unfunded madates by the Federal Government. Next year there will be many cutbacks in California schools and it really sucks.

There are two doctors in blue; I guess you mean the medium blue.

There's a lot more to the problem than MediCal and Medicare payments; it's private insurance companies too.

[PlacentiaSoccerMom]

All I know is that because of the many uninsured people in California, including illegal aliens, and the low rate of reimbursement by Medical and Medicare, many emergency rooms are operating in the red.

Here is an article that was in the LA Times this weekend.

The guy is blue is Jeff's boss.

http://www.latimes.com/news/local/la-me ... 5836.story


It seems to me that if the Federal Government is doing nothing to shore up the borders, then they should pay for the cost of services (schools and healthcare) that these people are using. Basically, it's unfair for the border states to pay for these unfunded madates by the Federal Government. Next year there will be many cutbacks in California schools and it really sucks.

There are two doctors in blue; I guess you mean the medium blue.

There's a lot more to the problem than MediCal and Medicare payments; it's private insurance companies too.

There was an article in the newspaper about two weeks ago about how HMOs are not paying for their patients.

Say I have a HMO insurance, which mandates that I go to certain doctors.
I have a true emergency and go to my nearest hospital and a specialist takes care of me. Say it's a surgeon who doesn't have a contract with the HMO.

From what I understand, the surgeon can bill the insurance company, but many of these HMOs refuse to pay more than they would pay one of their contracted HMO doctors. The doctor is not allowed to bill the difference to the patient. So, even though the doctor does not have a contract with the HMO, he is forced to accept the HMO's going rate of reimbursement.

[Bob Juch]

There was an article in the newspaper about two weeks ago about how HMOs are not paying for their patients.

Say I have a HMO insurance, which mandates that I go to certain doctors.
I have a true emergency and go to my nearest hospital and a specialist takes care of me. Say it's a surgeon who doesn't have a contract with the HMO.

From what I understand, the surgeon can bill the insurance company, but many of these HMOs refuse to pay more than they would pay one of their contracted HMO doctors. The doctor is not allowed to bill the difference to the patient. So, even though the doctor does not have a contract with the HMO, he is forced to accept the HMO's going rate of reimbursement.

I don 't see why he couldn't then go after the patient directly. Every doctor I've seen has had me sign a contract agreeing to pay the difference between what the insurance company pays and what they charge. Of course, my insurance company has a contract with the doctors I see that they will accept whatever the insurance company says they will.

[PlacentiaSoccerMom]

There was an article in the newspaper about two weeks ago about how HMOs are not paying for their patients.

Say I have a HMO insurance, which mandates that I go to certain doctors.
I have a true emergency and go to my nearest hospital and a specialist takes care of me. Say it's a surgeon who doesn't have a contract with the HMO.

From what I understand, the surgeon can bill the insurance company, but many of these HMOs refuse to pay more than they would pay one of their contracted HMO doctors. The doctor is not allowed to bill the difference to the patient. So, even though the doctor does not have a contract with the HMO, he is forced to accept the HMO's going rate of reimbursement.

I don 't see why he couldn't then go after the patient directly. Every doctor I've seen has had me sign a contract agreeing to pay the difference between what the insurance company pays and what they charge. Of course, my insurance company has a contract with the doctors I see that they will accept whatever the insurance company says they will.

In California, balance billing, or trying to collect the amount that insurance companies refuse to pay, is against the law.

[Appa23]

There was an article in the newspaper about two weeks ago about how HMOs are not paying for their patients.

Say I have a HMO insurance, which mandates that I go to certain doctors.
I have a true emergency and go to my nearest hospital and a specialist takes care of me. Say it's a surgeon who doesn't have a contract with the HMO.

From what I understand, the surgeon can bill the insurance company, but many of these HMOs refuse to pay more than they would pay one of their contracted HMO doctors. The doctor is not allowed to bill the difference to the patient. So, even though the doctor does not have a contract with the HMO, he is forced to accept the HMO's going rate of reimbursement.

I don 't see why he couldn't then go after the patient directly. Every doctor I've seen has had me sign a contract agreeing to pay the difference between what the insurance company pays and what they charge. Of course, my insurance company has a contract with the doctors I see that they will accept whatever the insurance company says they will.

In California, balance billing, or trying to collect the amount that insurance companies refuse to pay, is against the law.

Unless I am mis-reading the following article, it is not yet illegal in California. There was a court case upholding balance billing, Gov. Arnold asked for regulations to ban such billing, and there have been negotaitions on the terms of the regs for two years.

http://tinyurl.com/5txldc

[Bob Juch]

There was an article in the newspaper about two weeks ago about how HMOs are not paying for their patients.

Say I have a HMO insurance, which mandates that I go to certain doctors.
I have a true emergency and go to my nearest hospital and a specialist takes care of me. Say it's a surgeon who doesn't have a contract with the HMO.

From what I understand, the surgeon can bill the insurance company, but many of these HMOs refuse to pay more than they would pay one of their contracted HMO doctors. The doctor is not allowed to bill the difference to the patient. So, even though the doctor does not have a contract with the HMO, he is forced to accept the HMO's going rate of reimbursement.

I don 't see why he couldn't then go after the patient directly. Every doctor I've seen has had me sign a contract agreeing to pay the difference between what the insurance company pays and what they charge. Of course, my insurance company has a contract with the doctors I see that they will accept whatever the insurance company says they will.

In California, balance billing, or trying to collect the amount that insurance companies refuse to pay, is against the law.

I wish is was! I have a black mark on my credit due to a billing dispute from six years ago. They're not trying to collect, but won't remove the disputed amount either. Not a huge deal and it will roll-off in less than a year.

[etaoin22]

as absolutely atrocious at many levels the Canadian system is in terms of funding, organization and devolution to the state of what should be solved at the local level, little compares to this.

worst I remember is "I cant alter my asthma meds now (May); I wont be eligible for travel insurance next winter". Even then, I wasnt sure this was an over-reaction.

the waste engendered in running a system filled with nonsense such as described is almost certainly enough to fully fund a single-payer national system. In fact,just the economic damage done by tying insurance tightly to employment is such that if relieved, a fully-funded national system would pay for itself by increased economic growth.

[PlacentiaSoccerMom]

I don 't see why he couldn't then go after the patient directly. Every doctor I've seen has had me sign a contract agreeing to pay the difference between what the insurance company pays and what they charge. Of course, my insurance company has a contract with the doctors I see that they will accept whatever the insurance company says they will.

In California, balance billing, or trying to collect the amount that insurance companies refuse to pay, is against the law.

I wish is was! I have a black mark on my credit due to a billing dispute from six years ago. They're not trying to collect, but won't remove the disputed amount either. Not a huge deal and it will roll-off in less than a year.

This is a law that was recently passed.

[ontellen]

Our system isn't perfect but save me from this! I've had 2 knee replacements and have absolutely no idea what they cost. Sure I had to wait for 6 months to get the surgery and the food sucks big time, but it got done without bankrupting my family.

I had to pay for rehab - 20% only because our extra health coverage paid the other 80.

I have no idea how Americans deal with this. I have NEVER seen a bill for what my medical care costs. I've also had 2 carpal tunnel surgeries - bunion surgery - 2 kids - ectopic pregnancy and have no idea what they cost.

This is Canada and I love it.

[mrkelley23]

Nononono, Ellen and etaoin. You obviously are confused. Talk to any red-blooded, lapel-pin-wearing Amurrican and they'll tell you that everyone -- EVERYONE in the world is envious of our health care system and wants to come here to live so they can take advantage of our health care system.

nitrah, I"m sorry for your hassle. I have often felt the same way, on a much smaller, less personal level, about our tax code. Each of these messes seems to me to be a way for those who don't produce anything to suck a bunch of dollars up, while those who do produce something (including doctors and other medical care professionals) get the shaft.

[Sir_Galahad]

I cant't wait till we have full socialized medicine and no other choices. Boy, that will be pure utopia. All such problems as you describe will then be magically solved.

I didn't see your sarcafont.

[peacock2121]

I cant't wait till we have full socialized medicine and no other choices. Boy, that will be pure utopia. All such problems as you describe will then be magically solved.

I didn't see your sarcafont.

teehee

[nitrah55]

Our system isn't perfect but save me from this! I've had 2 knee replacements and have absolutely no idea what they cost. Sure I had to wait for 6 months to get the surgery and the food sucks big time, but it got done without bankrupting my family.

This is Canada and I love it.

In the interest of fairness, I should mention that the food sucks in the US, too.

[mellytu74]

Nitrah -

Sorry you are caught up in this mess.

Hugs from here.