How can anyone dealing with health insurance not want reform?

I had an MRI last November. My insurance company has still not paid for it or for the doctor's visit when it was ordered.

It's been 9 months.

Finally this weekend I got a letter from a company that was hired by my insurance company to investigate fraud. They want to know why I needed the MRI.

Here's where that letter got creepy. It said they had searched accident insurance and workman's comp claims and can't find that I reported an injury.

If I don't respond and tell them why I needed the MRI, my insurance company won't pay for it.

The doctor's order for the MRI, which explained why she was ordering it, isn't good enough. The hospital record, which also explains why they did the MRI, is not good enough.

They want MY explanation, in my own words.

NINE months later.

A co-worker is also dealing with this same insurance company over their refusal to pay for an MRI because it was negative.

So I guess there is a problem with people getting MRIs for the fun of it? Do they think I woke up one day, decided there was nothing better to do than go to my doctor, lie about an illness and get her to order an MRI? Then go to the hospital, wait for a long time, and lie in that creepy machine for the MRI just because I wanted to see if I could fool my insurance company?

How can anyone not see that these insurance companies need to be reigned in???

Even though the status quo is unsustainable they are quite happy with their medicare so they fear the uncertainty of change even though it bankrupts the country for everyone else. They will be long gone by then so they don't care.

Of course it's a little more complicated because they are also being brainwashed by Faux + Insurance industry and a lot of them fear a black man in the whitehouse. Faux + Insurance industry are all too happy to exploit those fears and redirect the anger. It all comes back to old people who can't deal with change and always resist it.

They fear change.

no one knows more than they that they are about to get fucked..or i should say already have..


CMS may cut up to 44% of Medicare payments for cancer treatments....
according to Bay News 9 in Tampa. Here we are talking about health care reform, and the Centers for Medicare and Medicaid Services are talking about huge cuts in cancer treatment for Medicare patients.

This will affect many millions of seniors.

From BayNews9:

Doctors: Reimbursement cuts may affect cancer treatment


BAY AREA (Bay News 9) -- The U.S. Department of Health is proposing a major reduction in reimbursement for cancer treatments. Recently the Centers for Medicare & Medicaid Services announced they're planning on cutting reimbursement rates for radiation cancer treatment -- in some cases by 44 percent.

"The radiation oncology community was shocked," said Dr. Robert Miller with Wellspring Oncology Cancer Center. "At the time our cost have gone up higher and higher, they were going to cut the reimbursement by almost in half."

Last year Wellspring spent more than $2 million to by a TomoTherapy machine. It targets only cancer cells while leaving healthy cells unharmed. Doctors fear with a cut in reimbursement rates many people will not be able to afford the best treatment possible.

"We are hoping that, there probably will be some cutback, but we are hoping more realistic -- 5 percent, 7 percent -- but not a dramatic 44 percent," Miller said.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx


Sun Aug-30-09 10:07 PM
Cardiologists Crying Foul Over Obama Medicare Cuts

" Aug. 28 (Bloomberg) -- An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a backlash that’s undermining the president’s health-care overhaul.

While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a “tooth and nail” fight against a separate initiative to boost the pay of family doctors, and cut fees for cardiologists and oncologists. The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care, from pacemakers to chemotherapy.

The proposal by Medicare, the government insurer for the elderly and disabled, is an effort by Obama to focus U.S. medicine on preventive care. The fight by physicians who work with the most expensive patients is weakening support for Obama’s broader goal, legislation to remake the health system, said Mark B. McClellan, 46, a former Medicare chief.

“If you can make the health-care debate all about moving slices of the pie around, it’s very easy to generate opposition and very easy to get derailed,” said McClellan, a physician and analyst at the Brookings Institution, a policy research center in Washington, in an interview."



They have already cut Medicare until it is squealing.

more aware of this shit going on right under their noses!
while they have a damn donut hole that is killing them..and maybe, just maybe they understand what is being lost more than you fucking do!
Maybe they are damn sick and tired of seeing money wasted like this while their friends and family die from lack of medical care and they don't want any more stripped from them!

Seems the seniors have been around a damn lot longer than the youngun's and they know damn well what these cuts are that are coming, than the Ipod generation..they paid for and worked a lifetime for medicare..and they damn sure are not going to let some snotty noses take it away without a fight!
They already watched Howard Dean marginalize senior women..they get it damn well what is going on!
I live in Fla , the home of seniors..and i can tell you they are the most aware voters in this country..they damn sure know what is going on with medicare and their health care!

www.chicagotribune.com/news/chi-tc-nw-rum-0831-0901sep01,0,5601382.story
chicagotribune.com

British distiller gets billions for rum

By Tom Hamburger and Peter Wallsten Tribune Newspapers
September 1, 2009

http://www.chicagotribune.com/news/chi-tc-nw-rum-0831-0901sep01,0,2726096,print.story


WASHINGTON - -- Yo-ho-ho and a bottle of rum.

With little fanfare, a deal is moving forward to direct billions in U.S. tax dollars to an unlikely beneficiary -- the giant British liquor producer that makes Captain Morgan rum.

Under the agreement, London-based Diageo PLC will receive tax credits and other benefits worth $2.7 billion over 30 years, including the entire $165 million cost of building a state-of-the-art distillery on the island of St. Croix in the U.S. Virgin Islands.

Virgin Islands officials say the arrangement complies with the letter and spirit of tax law and will help the islands' sagging economy. The islands are a U.S. territory.

Captain Morgan is now produced in Puerto Rico, a U.S. commonwealth, and critics say the subsidy for the new distillery in the Virgin Islands, along with the other benefits, are so generous that they practically guarantee a profit on every gallon of rum produced there by Diageo, the biggest distilled spirits maker in the world.

"The U.S. taxpayer is basically being asked to line the pockets of the world's largest liquor producer," said Steve Ellis, the vice president of Taxpayers for Common Sense, a nonpartisan watchdog organization.


but make sure you read this as well..........

Bailout of Wall St. could fund rum ads

http://www.swamppolitics.com/news/politics/blog/2008/10/bailout_could_fund_rum_ads.html

Little noticed beneficiaries of the Emergency Economic Stabilization Act of 2008, commonly known as the $810 billion bailout bill, are the liquor companies Diageo (producers of Captain Morgan) and Bacardi.

A Taxpayers for Common Sense (TCS) analysis has found that both of these liquor conglomerates benefit from a program renewed in the bailout bill. This program, known as a "cover over," rebates excise taxes charged on rum imported from Puerto Rico or the the U.S. Virgin Islands back to the territorial governments. The governments in turn provide as much as 35% of the rebated revenue back to the distillers to help market rum in the U.S. - to teach Americans to "do the mojito"and find out if they "have a little Captain" in them.


This may explain a scene I witnessed at the Democratic National Convention. There was a guy dressed in a Captain Morgan outfit accompanied by a couple of mini-skirted women holding signs that said "Captain for president." Not unexpectedly, he made something of a scene as he strolled near the Pepsi Center and stopped to talk with delegates and the otherwise curious.

I don't think the guy in the pirate suit was lobbying necessarily. But there's nothing like making sure your brand has top-of-mind awareness as you try to get a taxpayer subsidy to pay for marketing your rum and building a new distillery.

and use our public system. It was weird because she was so bent on keeping the plan despite the fact that THEY NEVER DID ANYTHING for him but get him kicked out of the hospital before he was stable.

They can ALL go straight to hell as far as I'm concerned. :grr:

Not paying for an MRI because it was negative? Congratulations, you don't have cancer! Now you can celebrate by paying for your own MRI!! :rofl:

Geezus.

people agree on parts of the bills even the GOP

The ONLY reform the GOP want's is reform the insurance industry wants. It is NOT real reform. It is ONLY reform that benefits the insurance industry. I am quite certain that Obama would threaten to Veto if that's all they got!

And if they all go under, I will cheer.

caused by an accident, more than likely your insurance is the not the responsible party. They want to know if it was an accident and if so, was it on the job or automobile? That is not new - they ask for this information and I remember being asked it for simply years.

Until they get the answers they won't pay the claim. If they do and an automobile insurance is responsible or workers comp it will cost them to recoop the money.

the insurance company. :crazy:

won't get you anywhere but sued for the bill, eventually. Did you have an accident or not? It's a simple yes or no.

Some investigation! LOL

The injury was 16 years ago.

paid.

They knew 16 yeas ago. The doctor detailed it in her report in November and so did the hospital. This is just about the insurance company hanging on to every penny and not paying a claim for as long as they can get away with it.

the doctor's "word" for accident status.

Same insurance company paid for my treatment when I had the injury 16 years ago. Same policy. Same plan. Same company. It's a chronic injury that flares up every couple years. I will have to deal with it for the rest of my life.

So hiring an investigator is a waste of money. All they needed to do was look at their own records.

who actually LOOK back 16 years in your record???? You've got to be joking. These people are warm bodies that make eight or ten bucks an hour and everything is automated. They check their brains at the door!

A claim comes in and automatic triggers say how it is handled. Now you can be stubborn but it won't get you anywhere but not having your bill paid. It's up to you.

I had permission to go "out of network" for my transplant and on the same day they PAID a claim, they would refuse one for being "out of network". Medicare the same. On the same dates I got EOB's on paid claims from Medicare, they refused other claims saying they thought "Medicare wasn't primary".

Insurance companies are staffed by legions of practically automated people. They won't even HIRE people to answer the phone which is why you have to go through 14 levels of who you are, etc every time you call them. Yes it's stupid, and yes it shouldn't be that way, but that IS the way it is.

for profit institutions.

They have to find ways to keep down the medical cost ratios. And those employees have to find ways to justify their jobs.

But as to your question, many people don't make claims all that often. And then there is the "ownership effect." (see Surowicki's column in last week's New Yorker -- for example, a group of students was randomly awarded tickets to a Duke basketball game, while some others did not win the tickets; the students who won the tickets were willing to part with them for, on average, $2100 while the students who did not win them were willing to pay, on average, $175 or similar. When you own something you tend to overvalue it.)

rightfully be paying for neglect. Their doctors will agree to or not ask about the lie because they don't care.

If you are injured by your brother or son's neglect at their house their homeowners police is liable for part if not all of your medical care. To protect all of the policy holders from fraud something that looks like it could come from an accident is going to be investigated. Government health programs do these same investigations.

Although I must say private insurance is much better at investigating fraud, that is part of how medicare keeps it's overhead low, they allow for a lot of fraud.

And your doctor agreed to the timing of payments when there is an investigation, so she or he can not complain they signed a contract with the provider that they would wait on payment until all benefit recovery operations were completed.

What happens to the average Joe if he doesn't pay his bills for nine months?

nothing happens to him.

The doctor signed a contract agreeing to allow for benefit recovery, I know doctors don't think contract law applies to them, but it does.

we have in getting health care paid for. Very good argument for single payer you give there. Single payer would even lower homeowner's and auto insurance rates wouldn't it? The medical payment part of the premiums would no longer be necessary.

Edit: I'll bet the insurance industry has considered this, even though I've never heard any advocates for single payer talk about it.

Edut 2: As far as neglectful parties go, there are other ways to handle that, rather than through insurance.

who would be responsible for that accident. If it were on the job, Worker's comp is responsible and not your health insurance. If it were automobile, and you have health through your policy or the person who hit you does, it is their responsibility.

This has been the case for years. From what he said, they think he had an accident, all he has to do is tell them.

them. If they were to roll up tomorrow bankrupt, I would break out a bottle of bubbly.

They have NO PLACE in health care if we are to treat all for a reasonable amount. NONE.

lets face reality.
single payer is, sadly, not going to happen

If it was under 5K, or if you had the family plan 10K, you would of had to pay for it out of your pocket anyway to meet the deductible of hr3200.

My policy covers MRIs (supposedly). I have a $50 copay.

a few years ago. She was in a stable cleaning out one of the horse's stall. Big horse backed up and step on her foot and she went to the ER for x-rays to see if anything was broken. Everyone at the ER was told this narrative, however a few months later came the same form letter. Did this happen in a car or a car accident? I just thought this was a way for insurance companies to stall payment. It's what insurance companies are good for, the stall. Had to fill out that stupid form, no horse and child weren't joyriding in a car when this happened.

triggers in the paperwork cause the letter to be sent. It's a minor inconvenience. Has happened to me about a zillion times.

which undoubtedly causes health care costs to rise.

And it is despicable, IMO.