Discussion in 'Phoenix Rising Articles' started by Phoenix Rising Team, Jun 28, 2012.
From Thom Hartmann:
That's a good point. I don't think most do. (Dr. Peterson is a standout in that he actually takes Medicare!) but I don't think that means patients can't get reimbursed by insurance; I think it means they have to give the doctors bills to their insurance companies directly. Does anybody know? Its been a long time since I saw a doctor for ME/CFS...
Drs. Enlander and Natelson in New York accept Medicare too.
Yes, that is correct.
Drs that "don't take insurance" simply don't bill directly to the insurance. The patient has to pay up front, submit the bills to their insurance company and get reimbursed directly by the insurance company. It does not mean the insurance company doesn't pay. The resources necessary for a clinic to bill directly to insurance are very high. It is expensive to the clinic in terms of manpower and paperwork and therefore adds to the cost of services from the clinic. It also takes quite a long time for a relatively new clinic to get the paperwork in place to be able to bill insurance directly, which is one reason some of our ME/CFS doctors don't have that capability (yet).
This can be very difficult for patients without a good cash flow because you have to have enough money to pay the bills up front. Even if you get reimbursed later, you are without several thousand dollars for many months. If you don't have that kind of cash to play with, you don't get to see the doctor you need.
This kind of arrangement is not a problem for well-to-do Texas Tea-Partiers, since they have money to throw around, and they don't care about the rest of us middle-class schmucks who either can't work because of our illness, or have to try to survive in this conservative-created middle-class economic crisis while paying for, say, the medical bills (including supplements and expensive not-covered-by-insurance off-label meds) for multiple family members with ME/CFS.
My experience with MDs that don't bill the insurance companies directly but rather present you with a superbill to submit is that the insurance covers 10%-20% max. of the bill, and that is if you're lucky. While theoretically the MDs have not opted out of insurance, practically they have, and there is only one reason for it, and that is that they make more money, and even more important, they get their money faster (cash-flow!) because they don't have to wait for the insurance companies to approve.
My experience is similar but I find the reimbursement rate is generally less than 10%.
I have been able to negotiate cash discounts often with doctors and labs that have saved me a lot of money. The amount they bill insurance is usually at least three times higher than what they will accept as payment in full. It's a pain to call and deal with the billing office but totally worth it in most cases as the savings can be significant.
I don't disagree with this overall. My experience, however, is that insurance has paid no less (so far) than 80% of the bill. I suppose that depends on your insurance company. The whole medical industry is terribly inconsistent.
It doesn't follow that universal healthcare increases costs. I believe that the US spends around 17% of GDP on healthcare which is just about the highest in the world. This compares with 9.6% for the UK in 2010 of which I believe 8% is spent on the NHS and 1.6% on private provision.
With Medicare, I don't think you can send them the bill yourself if the doctor doesn't accept Medicare. Seems to work differently from private insurance.
I think health care in the UK is very good, although getting worse due to recent budget cuts and reorganisations.
If anyone is really interested in comparisons there is a lot of data on:
As a famous baseball player said, it's hard to make predictions, especially about the future. But I'm not optimistic about the results of the new law. Extremely poor people who live in states governed by actual human beings will likely benefit from Medicaid coverage. I certainly hope that includes Merry. But I live in Maine, where the foot-in-mouth governor just rammed through a law to dump FORTY THOUSAND people off Medicaid. It's not likely his handlers will allow him to change his mind and accept the new program. He's too busy cutting the state income tax rate for the highest earners.
We can be assured that the insurance companies will benefit. This law is for them, not us. The fact that some working class people might benefit is a happy accident. It's important to remember that the US, like most of the world, is a subsidiary of the FIRE sector - Finance, Insurance, Real Estate. We exist to serve them. Until the FIRE sector completely wrecks the economy (shouldn't be many more years) no substantial structural changes will happen. They will just keep piling bricks on a foundation of sand.
I have never seen or heard any discussion of just what the premiums will be. That is remarkable. Presently we have no idea whether or not working people will be able to actually pay for these policies. I predict many will not. So not only will they continue to not have real access to the medical industry, they will be assessed penalty 'taxes' for being poor. As usual.
How many of the new Medicaid patients will be able to find a doctor that will accept Medicaid? I have see no discussions of this. In Maine, most Medicaid patients are dumped into an HMO-type plan. They literally have to get permission to change providers. Fortunately I have Medicaid due to disability, so I don't have these restrictions. My biggest problem is that I can not see out-of-state providers, so I will never have the oppurtunity to see a real CFS specialist.
Someone mentioned the fact that insurance companies prefer to sell insurance through employers, and really stick it to individual policy holders. There is a simple reason for that: one has to be relatively healthy to keep a job; these are the customers the insurance companies want.
The last time I bought individual insurance in Maine, there was only one company, Anthem, selling those policies. All the others dropped their customers, including me. I have seen nothing that suggests this will change, just a lot of blather about 'insurance exchanges', in other words, a web site listing phone numbers to call and wait on hold for hours.
As always, the devil is in the details, and in the bureaucrats that interpret the regulations that no one can understand, and whether those bureaucrats expect to leave 'public service' for a cushy job in the insurance industry. God I hate being so cynical all the time. There really is bliss in ignorance.
It doesn't last long if people are not informed. That is how all of this began.
Part of the act was to fund a website with information and facts about the plan. A good place to start for information.
It might also depend on how you look at it...My insurance was *meant* to pay 80% out of network. But that was only 80% of what they considered reasonable and customary and not 80% of the actual bill. So in actuality that 80% coverage ended up being about 10% of the total charge.
But of course, as you say, experiences vary as widely as the policies.
It's a racket any way you slice it.
Amen. I did post in this thread ... and would like to hit undo on that. Politics gets, err, odorous.
The only real reason we don't have universal healthcare is that our politicians have to raise fantastically large sums of money, increasingly so every year, and creating a bill did nothing for the profits of those who fund their campaigns -- big HMOs, big Pharma, etc. -- is basically impossible for the Democrats or the Republicans because their jobs depend on giveaways to their funders.
That's why I vote Green Party, which takes no corporate donations. The Green US presidential candidate is Dr. Jill Stein, a Harvard-trained physician and a leading advocate for single-payer Medicare for All who twice ran against Romney in Massachusetts
Here's what she had to say about the Supreme Court decision on her website:
Stein noted that "Obamacare is based on Romneycare, and as with so much else, Obama implemented a Republican scheme to impose mandates that are a regressive tax on working people. The Roberts Court may call it constitutional, but the mandate is still bad news for our suffering millions. Romneycare has meant that the working poor have seen a health cost increase ten times that of the wealthy. As a physician, I've seen Romneycare in action in my home state of Massachusetts. Forty percent of the people who need health coverage find that it's still too expensive for them. And a quarter of the people who seek payments get denied by their private insurers. It has failed to control costs, and as a result they are raising co-pays and attacking public employee health plans. It's a fiscal and administrative nightmare which has gutted public services in Massachusetts. Schemes developed by health industry lobbyists to enrich themselves will never take care of our real needs.”
When Jill debated Romney during the Mass Governor's race, the Boston Globe described her as "the only adult in the room." -- http://www.c-spanvideo.org/program/173128-1
A racket indeed.
I suppose I'm either fortunate in my insurance or in my choice of physicians. I'm also not in an HMO, which may be beneficial in this case.
However you slice it, though, the medical industry is making money hand over fist and patients are suffering for it.
I live in one of those "other countries", and things are quite good here. My insurance after getting sick now costs half of what it did in the US prior to getting sick. It's a very similar situation to Obamacare - there are private insurers that are required to offer certain services. No one can opt out, people that can't afford it are covered, etc.
I'm not sure what horrible things you think are happening in Europe and elsewhere. Waiting times here to see doctors about the same, as is appointment length. All doctor visits and prescribed meds are fully covered. There's a "deductible" of something like 100 euros for the entire year, except it's actually in the form of a refund if it isn't used. No one takes out their checkbook or debit card in a doctor's office, or a drug store, or a hospital. It's an amazing and safe feeling.
The money to pay for the system comes from all the lucky, currently healthy people, who are also forced to pay into the plan. Then one day they'll be the old sick people, and younger folks will be helping keep their rates low.
So what, exactly, is bad about any of this?
I don't think that many people in the UK would swap our system for anything else either, and definitely not for the US system.
Sure, it's not perfect, and we complain about it a lot, but overall it really does look after us from birth to death when we really need it.
Personally, I think it's the best thing about our country, and I hold it in very high regard.
Yes, CFS patients are neglected, but I think that's more of a social-care issue and a political corruption issue rather than a health care issue.
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