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babylonsister Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:10 PM
Original message
How health insurers secretly blacklist those with certain ailments.
HEALTH COVERAGE BLACKLIST

Insurers shun those taking certain meds
How health insurers secretly blacklist those with certain ailments.


BY JOHN DORSCHNER
jdorschner@MiamiHerald.com


Trying to buy health insurance on your own and have gallstones? You'll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers' practices is available on the Web -- if you know where to look.

What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won't be rejected for insurance.

It's especially timely because growing numbers are looking for individual health insurance after losing their jobs. On top of that, small businesses, which make up the bulk of South Florida's economy, are frequently finding health policies too expensive and are dropping coverage, sending even more people shopping for insurance.

The problem is, material available on the Web shows that people who have specific illnesses or use certain drugs can't buy coverage.

''This is absolutely the standard way of doing business,'' said Santiago Leon, a health insurance broker in Miami. Being denied for preexisting conditions is well known, but when a person sees the usually confidential list of automatic denials for himself, ``that's a eureka moment. That shows you how harsh the system is.''

more...

http://www.miamiherald.com/323/story/973158.html
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dysfunctional press Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:12 PM
Response to Original message
1. ANOTHER problem that can be solved with single-payer universal coverage...
is there anything that single-payer CAN'T do???
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patrice Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:13 PM
Response to Original message
2. Risk management has many dimensions. nt
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47of74 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:17 PM
Response to Original message
3. Obama and the Democrats need to tell these pigs
That the people of the United States are in charge, and the people are going to get the health care system they deserve. And if they don't like it they are more then welcome to go peddling their shit in Iran or Saudi Arabia.
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MagickMuffin Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:30 PM
Response to Original message
4. If the drug companies didn't charge an arm and a leg for medications
Edited on Sun Mar-29-09 03:32 PM by MagickMuffin
perhaps this wouldn't be such an issue. However, they can get away with charging out the ass for their medications, all the while advertising thru the media to just ask your doctor for their products.

Something really needs to be done to over haul our health care system. I have been without health insurance for decades. I think I'm fairly healthy except for an allergy that I don't know how to treat effectively. Trying to figure it out on my own, but if I had coverage I wouldn't hesitate to go and find out what is causing my legs (below the knees) to break out in a rash and swelling after eating certain foods. I believe the food part of it is due to Frankenfoods. :shrug:

I really don't see anything getting done though, because both parties get huge funding/contributions ( just look it up on the FEC website) from Pharma and Insurance companies. And Pharma and the Insurance Lobbyists will MAKE sure nothing gets done to help Americans have good health care. :grr:


:kick: & RRRRRRR


Edit: typo

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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:32 PM
Response to Reply #4
5. metformin is $4 a month
My insurance doesn't pay for it.
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MagickMuffin Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:39 PM
Response to Reply #5
9. Well that is reasonable, however, there are other drugs that ARE way to expensive
My MIL goes over her alloted amount the government provides, then she has to pay out of pocket for her medications. My SIL just got out of the hospital and was given a new experimental antibiotic and she said that for less than twenty pills she had to pay over $200 for the prescription, and that was her cost the insurance company picked up the rest of the cost.


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sandnsea Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:51 PM
Response to Reply #9
12. I meant med costs aren't always a good excuse
Not that meds aren't outrageously expensive. They deny anybody for just about any reason they can find, the use of the medicine is just how they target people they don't want, that's all.
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Atman Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:35 PM
Response to Original message
6. Basically, you are denied if you have any condition for which you'd be covered...
...if you hadn't been denied. What a racket. How do I start an "insurance" casino?

.
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gristy Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:35 PM
Response to Original message
7. The whole idea of private health insurance is that you buy it before you get sick
I certainly don't blame an INSURANCE company for not wanting to insure someone after they are sick, or even after showing by the meds they take an increased likelihood of getting sick. They're an INSURANCE company, and the way INSURANCE companies work is that folks who aren't sick and are never going to get sick ARE SUPPOSED TO pay the same amount as the folks who do get sick.

That said, we need single-payer

http://www.pnhp.org/facts/what_is_single_payer.php


What is Single Payer?

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.
Access and Benefits

All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures.

Care would be based on need, not on ability to pay.

Payment

Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses—a “global budget.” A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.

Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.

Financing

The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0 percent payroll tax and employees would pay 2.0 percent, essentially converting premium payments to a health care payroll tax. 90 to 95 percent of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax.

Administrative Savings

The General Accounting Office projects an administrative savings of 10 percent through the elimination of private insurance bills and administrative waste, or $150 billion in 2002. This savings would pay for providing medical care to those currently underserved.

Cost Containment

The Congressional Budget Office projects that single payer would reduce overall health costs by $225 billion by 2004 despite the expansion of comprehensive care to all Americans. No other plan projects this kind of savings.
Different Perspectives on the Benefits of Single-Payer

Patients

Each person, regardless of ability to pay would receive high-quality, comprehensive medical care, and the free choice of doctors and hospitals. Individuals would receive no bills, and copayment and deductibles would be eliminated. Most people would pay less overall for health care than they pay now.

Doctors

Doctors’ incomes would change little, though the disparity in income between specialties would shrink. The need for a “wallet biopsy” before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy.

Medical endorsements include PNHP (9,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women’s Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student’s Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, American Nurses Association, the Nurses’ Network for a National Health Program, and the D.C. chapter of the American Medical Association.

Hospitals

The massive numbers of administrative personnel needed to handle itemized billing to 1,500 private insurance companies would no longer be needed. A negotiated “global budget” would cover operating expenses. Budgets for capital would be allocated separately based on health care priorities. Hospitals would no longer close because of unpaid bills.

Insurance Industry

The need for private insurance would be eliminated. One single payer bill currently in the House (H.R. 1200) would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

Business

In general, businesses would see Single Payer limit their health costs and remove the burden of administering health insurance for their employees.

Congress

Single payer would be the simplest and most efficient health care plan that Congress could implement.
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patrice Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 09:05 PM
Response to Reply #7
14. There is a reason why MEDICAL SCHOOL STUDENTS WANT SINGLE PAYER health care.
Not only will they be able to go into practice more easily, but they will be able to devote more of their resources to CARE rather than administrative services.
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SoCalDem Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:38 PM
Response to Original message
8. THIS is what "computerized" medical records is really about.
This is also carried into the workforce, when HR "checks" on prospective employees.. The medical coverage "offered" is a valuable bargaining chip, so of course applicants "authorize" background checking..

It's illegal to ask ages, but the "medical-age" of someone is easily ascertainable by looking at which meds the doctor's prescribing and the patient is taking..

A 35 yr old who got meds to stop smoking, and who takes Plavix, could mean "costly" problems ahead..
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MagickMuffin Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:45 PM
Response to Reply #8
10. I don't think "computerized" medical records should EVER be allowed in the Work environment
However, if it was just between hospitals and doctors then I could see the benefit. I don't know how many times when my In-Laws were sick and hospitalized that filling out paperwork was always so time consuming, and if you weren't sure about the medications they were taking could be deadly. Several times the hospital were giving them medications that they should not have been given.


But No way, No how, should Employers be given this information.


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SoCalDem Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 07:49 PM
Response to Reply #10
13. Insurance companies are the conduit
They deal with ALL parties. the hospital, employer, pharmacies, the patients..

Once the fox is in the henhouse, promises to "behave", often fall on "dead: ears:)

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liberalhistorian Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 03:48 PM
Response to Original message
11. My totally repuke senator's representative is coming
to my tiny town this week for a "people's forum" (the man doesn't actually care about any people except for those with big bucks, but he likes to pretend otherwise). He's in the pocket of insurers and Big Pharma and the corporate wing of the medical industry and has voted against any health-care-related bill that's patient-oriented, claiming it's, and I quote, "harmful to private insurers." I can't wait to print this out and demand from his rep why he's so much more concerned with these insurance companies who are harmful to US, his alleged constituents, and obstructing Obama, instead of ordinary Americans who are being screwed by these companies and who are relying on Congress to assist them. Can't wait to hear what she has to say.

I'm also gonna ask her to ask her boss and his repuke cronies why THEIR federal health insurance isn't socialism. They pay 35 bucks a month for FULL COVERAGE OF EVERYTHING, with NO pre-existing condition bullshit, no worries about denials, huge co-pays, etc, courtesy of the very taxpayers their support of insurance companies helps to screw over, and many of whom do not have coverage, can't get coverage, or have to deal with huge premiums and constant denials of care. Matter of fact, we should ALL ask our congresscritters of BOTH parties that very same question.
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patrice Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Mar-29-09 09:36 PM
Response to Reply #11
15. We also need to ask them what they expect the perfectly legal treatment choices/decisions will be
Edited on Sun Mar-29-09 09:39 PM by patrice
for those who are difficult/expensive to treat, without system reform that REALLY gets the costs down. When insurance companies are making the decisions by looking at databases instead of human beings, don't you think the rational thing to do will be to put expensive data/patients on a track out of the system, PERMANENTLY, as soon as possible? It's called risk management.
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