re: 7 in 10 Louisiana children are on Medicaid

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paying millions even with insurance

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I could be wrong but I believe the out of pocket maximum is not in the millions.

Healthcare is broken though, and government broke it.

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It’s a testament to how fk’d up our system is that the words “paraplegic” or “paralyzed” aren’t enough.

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It is the reason I was asking about it. Those words are more than enough. My guess is there was a work credits issue as a result of the stated date of disability and it was simply getting kicked out because of that. This is something that could be cleared up with an attorney (or some research) at the reconsideration stage or at least at the hearing stage. If he didn't have the work credits at the legitimate date od disability then he should have been filing for SSI instead of SSD. The filing every year means he probably did not file for a reconsideration much less a hearing (because the process usually takes longer than a year). Unfortunately, it is likely he was making the same "error" year after year and never got proper help in fixing it. While SSD has actually gotten harder to qualify for over the last 30 years there is still zero issue for a quad to get SSD if if they have the work credits to qualify and the paperwork is properly filled out.

My firm has a very strong pro-bono program and back when I was an associate I did a lot of SSD/SSI work, primarily SSI because the way the fees are handled made it difficult to get a disability attorney to take the cases because you had to consider it pro-bono because you might have gotten paid for 1 out of 100 cases you won. Losing a quad case where the person was SSD qualified would likely mean I committed some sort of malpractice like being Cooter Brown drunk at the hearing.

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What an absolute failure of the adults in our state, that so many of them need the government to provide health insurance for their kids.

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daddy?

Many couples don’t marry so they get all these extra benefits. So much tax dollars being stolen by dishonest citizens.

Not naming any names but there is a billboard lawyer in the northern part of the state that has his kids on Medicaid. Its just another abused program with too many loopholes.

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There are contracted rates for each charge, but the hospital only has one fee schedule, they aren't going to charge BCBS one amount and Medicare another amount. They are going to charge them both the same, knowing that BCBS's negotiated payment for that charge may be lower than what the charge is, and that Medicare's allowable will also be lower. But, United Healthcare may pay more than the BCBS contracted rate. They are going to charge all of them the same amount, but in order to not miss out on $$, they have to set the charge at the highest negotiated rate they have for any insurance carrier for that charge.

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This is the thing that blows my mind about medical billing more than anything. The practice of “bill everyone the same” makes zero logical sense. In any other industry, the vendor (hospital) would bill the customers (insurance companies) at their individual agreement rates, and the customer would reject that invoice if it didn’t match the agreement. I can’t think of another industry where standard practice is to invoice at, effectively, a list price and then have customers come back and say “this is what we will pay.” I’m not saying it doesn’t exist elsewhere, but it’s certainly not the norm.

I suspect this is largely driven by some sort of requirement (either in the insurance agreements or Medicare/Medicaid requirements) that prohibits hospitals from charging more than they would to any other customer. But it’s an asinine model when nobody pays the same amount anyway.

I've posted it like 5 times now...but here we go again -

I'm going to point out(like i do in every universal healthcare thread) that we ALREADY pay for the young that can't afford healthcare and the old(most expensive) in our current medicare/medicade system.

Who doesn't benefit from that system? The people paying for it....you and me. So yeah, let's keep throwing money at the private for profit insurance companies that stand between us(the people paying for everything) and health care.

This is really a no brainer folks....it actually astounds me that no one on this message board can do simple math.

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an indication the tide is changing.

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Middle class working people are getting squeezed harder than ever. More and more people are falling out/dropping out of the middle class, leaving us (and probably the rich one percenters but idk any of them) paying for ourselves plus more and more others. I’m no baller but make close to $90k and have health insurance through my employer. My kid was hospitalized 3 days and my out of pocket was $5000 (the total bill was, idk, 40k maybe.) I’ve had health insurance through my previous employers, too, and with all of them, had significant out-of-pocket costs. “Just get a job with insurance.” And yes, i always select the one with the highest premium and most coverage, but it doesn’t cover what it should. Probably all the other kids on the hospital wing were covered by medicaid paying nothing (it was BR.)

One of my good friends is a pharmacist in NYC.. a fairly prominent rapper who often is showing excesses in jewelry and money and cars and things comes into his store often and gets meds for his baby and baby momma… of course on New York Medicaid

Infuriating and whenever I see this person I tv, I just laugh at him

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This is the thing that blows my mind about medical billing more than anything. The practice of “bill everyone the same” makes zero logical sense. In any other industry, the vendor (hospital) would bill the customers (insurance companies) at their individual agreement rates, and the customer would reject that invoice if it didn’t match the agreement. I can’t think of another industry where standard practice is to invoice at, effectively, a list price and then have customers come back and say “this is what we will pay.” I’m not saying it doesn’t exist elsewhere, but it’s certainly not the norm.

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There are thousands of charges in the system, it would be way too much upkeep to have a separate fee schedule for every contract that you have as an organization. Keep in mind these contracts can change on a yearly basis.