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Message
re: article detailing the lengths health insurance companies will go to deny coverage
Posted on 2/2/23 at 11:26 pm to Zappas Stache
Posted on 2/2/23 at 11:26 pm to Zappas Stache
quote:
My Dad is on Medicare and has had several health issues the last 8 years including 2 cancers and he has been well taken care of. He has been able to choose what oncologist he wanted which is more than I would get with my private insurance. Overall, medicare for he and my mom has been very good
Same here with my mother. We have FAR more issues with the Dean Care that supplements Medicare as far as what doctors and other health care providers she can use. Been a huge headache the past 6 months.
0
Posted on 2/2/23 at 11:41 pm to tehchampion140
quote:
I don’t know how anyone could read this and not feel totally disgusted and angry. Imagine this guy’s life if he didn’t have smart parents with an abundance of resources to fight his case, and imagine what’s happening to tons of other patients every day across the country who can’t fight for their healthcare like this one could. Our system is so buried in greed and broken beyond repair and I don’t think we will see any significant enough reform in our lifetimes to make a difference.
Only way to bypass it is to develop cures for diseases instead of multi-step treatments that only treat symptoms.
Posted on 2/3/23 at 1:08 am to tiger91
quote:
Our inpatient rehab people get kicked out by their “advantage” Medicare
Managed Medicare/Medicare advantage/Medicare ppo patients get denied routinely for inpatient rehab, or you have to jump through hoops with peer-to-peer review to even get admitted to inpatient rehab, even despite a compliant diagnosis (60% rule) like a stroke. Even with multiple medical comorbidities. If they are approved for rehab, their approved are typically less than recommended by the IRF-PAI. They never get approved for SNF/subacute rehab if needed after a course of acute inpatient rehab.
Not to mention the prior authorization/jumping thru hoops for outpatient imaging like an MRI, or a medicine like a DOAC (must showed that they failed warfarin treatment before approved).
They give people a free $20/month gym membership, but deny them necessary medical interventions costing thousands of dollars.
I recommend “regular” Medicare A+B) to all of my older relatives.
Don’t know of many doctors who don’t take Medicare, except the concierge type groups. I think the previous poster is confusing Medicare and Medicaid.
Posted on 2/3/23 at 1:41 am to tehchampion140
quote:
I don’t know how anyone could read this and not feel totally disgusted and angry. Imagine this guy’s life if he didn’t have smart parents with an abundance of resources to fight his case, and imagine what’s happening to tons of other patients every day across the country who can’t fight for their healthcare like this one could. Our system is so buried in greed and broken beyond repair and I don’t think we will see any significant enough reform in our lifetimes to make a difference.
Ahhhhhh nothing like some good ole capitalism
Posted on 2/3/23 at 6:50 am to greygoose
quote:
Insurance companies? Ask anyone who is the worst insurance to deal with. 9 outta 10 are going to say "Medicare"! Those SOBs deny for no reason, then make you jump thru hoops for months. A lot of times, it takes going as far as pushing the claim all the way to an administrative judge. At the end of the day, they know a lot of companies will just give up......and that claim just doesn't get paid. The difference is, with private insurance, the patient is ultimately responsive. With Medicare, not so much. There's a reason why a lot of docs are not accepting new Medicare patients
Medicare > Private Insurance
Posted on 2/3/23 at 6:58 am to tehchampion140
Let's also remember, you could pay for insurance for your whole life, and it wouldn't cover the cost of 1 major operation, then u have a second.
Health insurers depend on healthy people to pay for the sick people.
Untill some one finds a better system, it is what it is.(Canadian health care is shite)
Health insurers depend on healthy people to pay for the sick people.
Untill some one finds a better system, it is what it is.(Canadian health care is shite)
Posted on 2/3/23 at 7:13 am to tehchampion140
Medicare is the most abused, frauded and overused healthcare system in the world and medical providers LOVE it mostly for that very reason. It's the wild wild west and more of an honor system than anything else. Original Medicare puts up the least resistance when it comes to payment for services, whether they are truly needed and in the patient's best interest or not. Their retrospective reviews only catch a very very small portion of the illegitimate services and charges. They know they cannot manage care which is why they pay private companies to do it for them.
There are tons of studies out there that all sow different evidence but most of them will show that Advantage plans produce overall healthier outcomes although and provide more services (ESPECIALLY for those on Medicaid who struggle to find providers) than original medicare.
That being said, there are certain individuals, with certain health issues and comorbidities in certain financial situations that can do better on original medicare.
Anyone saying that one or the other is purely better is not doing so based on your best interest, only their viewpoint.
Anyone with questions on what might work best for them in Louisiana should reach out to SHIP
There are tons of studies out there that all sow different evidence but most of them will show that Advantage plans produce overall healthier outcomes although and provide more services (ESPECIALLY for those on Medicaid who struggle to find providers) than original medicare.
That being said, there are certain individuals, with certain health issues and comorbidities in certain financial situations that can do better on original medicare.
Anyone saying that one or the other is purely better is not doing so based on your best interest, only their viewpoint.
Anyone with questions on what might work best for them in Louisiana should reach out to SHIP
Posted on 2/3/23 at 7:20 am to greygoose
quote:
Ask anyone who is the worst insurance to deal with. 9 outta 10 are going to say "Medicare"!
Medicare is the easiest to deal with. You’re thinking of Medicaid, and even that varies from state to state.
Posted on 2/3/23 at 7:23 am to tiger91
quote:
Our inpatient rehab people get kicked out by their “advantage” Medicare e programs but straight Medicare people get up to 100 days.
Medicare is much more easily abused/defrauded that MA plans for this very reason.
Posted on 2/3/23 at 7:30 am to greygoose
Traditional Medicare is fine. Managed medicare (People's, Humana, etc...) denies all the time. They're terrible to deal with
Posted on 2/3/23 at 7:31 am to chRxis
quote:
of course not... the alternative is constantly mischaracterized as socialism, so yeah, our healthcare system ain't changing no time soon... as long as insurers are beholden to their shareholders and not their clientele, we will continue to be fricked
Couldn’t agree more.
Posted on 2/3/23 at 7:37 am to tehchampion140
The cost of my penis pump was unbelievable. My wife says it was a rip off.
I am happy with it.
I am happy with it.
Posted on 2/3/23 at 7:40 am to tehchampion140
When I got diagnosed with cancer I was scared of not only having to go through treatment, but having to deal with the insurance. Had a couple of minor hiccups, but otherwise BC/BS Highmark did an fantastic job - one of the main reasons why I went back to work for the same trucking company after our drama this past summer.
Posted on 2/3/23 at 7:47 am to Ric Flair
Ric is 100% right. My experience has been the same as his.
Please understand that managed medicare companies hold themselves out to be the guardians of Medicare dollars. They've successfully framed themselves as protecting the system against fraudulent expenses.
The opposite is true.
They're given a block grant from Medicare every year based on the number of enrollees (see why they're so aggressive with narketing?). Any dollar of care denied is not reimbursed to the government--they keep it.
Please understand that managed medicare companies hold themselves out to be the guardians of Medicare dollars. They've successfully framed themselves as protecting the system against fraudulent expenses.
The opposite is true.
They're given a block grant from Medicare every year based on the number of enrollees (see why they're so aggressive with narketing?). Any dollar of care denied is not reimbursed to the government--they keep it.
Posted on 2/3/23 at 7:48 am to tehchampion140
I have had multiple surgeries, and without BC/BS my parents would have lost their house due to the debt.
Posted on 2/3/23 at 7:53 am to tehchampion140
2 years ago it seemed my insurance covered anything. Now half the time they don’t cover shite. Went to clinic with congestion and sore throat the other day and I got a prescription for Ed a Hist. They didn’t cover the script because they said it’s over the counter medication. Even though you have to get a script for Ed a hist. It’s bullshite and this is BCBS
Posted on 2/3/23 at 8:01 am to SeeeeK
quote:
Let's also remember, you could pay for insurance for your whole life, and it wouldn't cover the cost of 1 major operation, then u have a second. Health insurers depend on healthy people to pay for the sick people.
True to an extent and if you look around there are less and less healthy people in this nation. Too many obese people
Posted on 2/3/23 at 9:14 am to Eli Goldfinger
quote:
Medicare is much more easily abused/defrauded that MA plans for this very reason.
YES but not everyone stays 100 days .. they still need to have need for skilled care BUT with the managed plans, we've had to d/c stroke patients and just patients who truly weren't ready to go home. It's sad in many cases.
Posted on 2/3/23 at 9:49 am to tiger91
Usually Medicare patients discharge from acute rehab to SNF if they can’t safely discharge home after 2-3 weeks, depending on diagnosis. Never had one stay for 100 days. It’s the Medicaid pending patients that stay 90+ days because no SNF’s will take them until their Medicaid is approved.
Posted on 2/3/23 at 10:05 am to SeeeeK
quote:
Health insurers depend on healthy people to pay for the sick people.
And medicare or other government-paid coverage doesn’t?
There is no system where it’s “free” for everyone where it’s also affordable for those that pay.
There is no “system” where “someone else” pays for everyone. It’s magical thinking.
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