My Health Insurance Sucketh

[SPKrazy]

It didn't use to. In fact it was pretty good. Now we have a prescription benefit, oooh sounds good. However the only things in their formulary are pretty much in $4 drug lists at Walgreens and Walmart from what I can tell, and they want $10 for the copay. Anything not 100 years old and generic, has to be "prior authorized", just another way to get physicians to prescribe cheap shit so they don't have to mess with filling out forms that take time that is unreimbursed.

Patient care went out the window back in the 80's. I know there are some here who work in the insurance industry. I'm sorry, but my opinion is that its time to overhaul this system and now!

Not everyone likes my occupation either, and I don't know that an Obama plan would pay for my services, but I do know that our country can't go on like this.

I pay for health insurance. My employer pays for it too. Instead of insurance paying for much anymore it seems more and more comes out of my pocket.

I know this is the freaking lounge. I'm just fucking pissed about it and don't care if anyone else cares or not!!!!

:patriot: :rant:

[TZ]

1. Oh I damn well understand

Yep. Our health care system needs a MAJOR overhaul. Unfortunately too many people in this country don't think so (see the RW) which makes true reform a difficult challenge..:banghead:

[MorningGlow]

2. Actually, that would be

"My health insurance doth suck."

Seriously you're absolutely right and you have every right to rant. Everyone in this country should. :(

I have a homeopathic m.d.--licensed medical doctor!--and I can't go to her because the HMO doesn't like the fact that she spends more than 1.5 minutes with her patients. Makes me :grr: too.

[SPKrazy]

3. that's terrible

of course, she could not charge for anything but a level 1 visit, but on the other hand, she's fighting to stay afloat too. Insurance companies, especially HMO's cut and contract and make the reimbursement pretty bad for physicians doing office visits. No wonder procedures are popular, even for family practitioners. More reimbursement. Office staffs have grown to meet the demands of insurance companies and Medicare included. HMO's for Medicare aren't saving Medicare any money, they are just making money off Medicare. Why not give all but 20% of what they save back to Medicare? :rofl: like that is going to happen. Medicare reimbursement is not so good either for lots of things.

In my state though, Medicaid pays like $10 for an ER visit? Yet there are companies that have set up and are making a killing doing day treatment with children and adolescents, and school based treatment. Good to treat the kids, but the reimbursement rate is what amazes me.

Where I work we get a daily rate from Medicare per person in the hospital (psych) We have to staff, provide the care, pay for everything then the rest is "profit" (a not for profit hospital can't really make a profit) We make our budget. We work short staffed because the reimbursement is not enough to pay for the staff you need. Each day a person is there the rate goes down. Acuity is taken into consideration only in the form of outliers like other diagnoses. The biggest reimbursement we get is the first day if they come through the ED. Now there are coders who are experts at reading through reports and paperwork to bill for everything that gets mentioned and get every penny from Medicare.

I asked a Medicare biller once in the past about our reimbursement rate, he said "I don't know" he said they just turned it all over to Medicare. Fox guarding the henhouse.

I digress and got way off track

okay yes we should be screaming for better insurance. I believe it is not only possible but would be cost saving and better than what we have if we paid taxes for our insurance instead of premiums. If everyone were covered, there would have to be limits and "rationing" (which we already have in the form of prior authorization and denial of coverage, and decisions made by third parties about what the treatment should be for a person)

I'm for a straight up not for profit one size fits all government run company. I know, flame away. Or not.

[lizziegrace]

4. And if you're uninsured

you get billed the full rate - not the negotiated rates the insurance carriers get.

[SPKrazy]

5. True, very true

and the full rate is usually jacked up high so that there is room to negotiate. Sometimes private payers can negotiate as well. I've seen discounted care be given for cash. Laws are so strict that they have to be careful to follow them carefully. For instance you can't just say "we'll take what insurance or Medicare will pay" for equipment or outpatient care. But, providers can bill someone and show a good faith effort to do so then write it off.

I've gotten money owed to providers discounted if I could pay it off at a point in time.

Also no matter what, if they agree to a payment plan, and the person is making payments, they can threaten all they want, but blood doesn't come from turnips and they can't really get it.

ER visits...all persons are entitled to a full medical screening regardless of ability to pay in a hospital that receives federal funds.

But overall you are right, its a dog eat dog world and I think the only answer is to cover everyone. Equally.

[Wapsie B]

6. I think corporate America will have to play a big part in the push for a plan that covers everyone.

Honestly I don't hold up much hope that Obama will change things significantly for the better in that regard. He may provide a step or two in the right direction but only something that could easily be undone by the next conservative administration.

[SPKrazy]

7. corporate America includes the insurance industry

who own congress

insurance companies blackmail companies by threatening to raise their rates if they speak up.

[Wapsie B]

8. Yeah I know. I thought of that as I wrote my reply.

But somewhere along the line the tide will have to shift against the insurance companies. There's gotta be a tipping point somewhere.