Been watching an reading only some issues on this lately. Seems to draw some concerns also. First is, it didn't make the Presidents desk. Then even if it did pass and was signed, it wouldn't start for 4 years or more later. Well, that would mean 4 years or more waiting. But, it has been talked about, that if and when it does go into effect, that Medicare just might get dropped. Thus causing problems then for many that need Medicare.
I had been checking a State which is Indiana, They now have a program going on for health care for needing people. Where many States have just Medicaid, Indiana is using Blue Cross Blue Shield to perform this task but they do require the person only pay a small amount for this policy. I've been told only $30.00 a month. Now even though that may hurt some to pay that, it's not at all bad if one needs medical. Now it's my opinion, from what I am learning this is also done for those denied Social Security. If they do obtain SS, they then can use it as a supplement insurance. And it is a program they have to help people get back to work on their feet again. With many churches helping in other ways with food, and money to pay important bills like electric and water and such.
Several years ago, Illinois had a program for people seeking medical and food stamps. It was required these people enter in and then start with the program to get back to work and all. Only the program was talked about, instead of the people of State working on it properly. Making it very unfair to the tax payers.
It's only my opinion, is that as I look at what Indiana is doing, that if all the States would do just that, there would be little need to even have a health care reform issue.
Now, I also been looking over some medical facts. A hospital billing $5,000.00 for an item they purchase for only $700.00, a surgeon bills $13,000.00 for services, but the hospital turns that into $140,000.00 bill. Now these are only examples, but in order for health care to be reformed, medical billing needs to be reformed along with it. Or the tax payers are still going to take it in the rear.
When a Doctor signs up to accept a Insurance Carrier, such Doctor then aggress to accept their Co-pays, and payment proposals. But, it doesn't seem to appear that hospitals have to comply with these issues.
Hospitals negotiate reduced rates with insurers all the time. If you have insurance, look at the EOB or Explanation of Benefits you receive after you have been in the hospital. You will see a substantial difference between the amount originally billed and what the insurance company paid the doctor. My wife had surgery a few months back that probably totaled well over $20,000, but our insurer paid just over half of that.
As for the health reform that is coming down the road at us, ask your Congressman why they will not have to be covered by the same plan.
I served on my Congressman's Health Care Reform Task Force about 10 yrs ago.
I spoke at a town hall meeting about the struggles my family was going thru with our medically fraigle daughter.
It cost our family $850.00 a month for health insurance and the cost was being increased to $2,500,00 a month. Our family was faced with going without health insurance because we could no longer afford it.
A couple of local tv stations contacted our family and interviewed me, then contacted Blue Cross & Blue Shied for their story. A week later I received a phone call from the insurance company saying they had found a way to help us keep our health insurance.
Katheleen Sebilus, is a part of the presidental administration and former governer of Kansas is leading the current helth care reform. She is former Insurance Commisioner of Kansas.
ADMIN, I uderstand what your saying also. But, I even seen a pre-approval for a surgery take place with an insurer. yet only afterwards to deny payment due to over inflating the bill. These things do happen, and way too much.
As what I'm seeing take place in Indiana though, seems to be a faster sultion to health care reform. from what I am learning also, the State lined up very good hospitals and doctors also. One would not be forced to a State hospital like they are in Illinois then neither. All for a low $30.00 a month.
If you are saying that there are better solutions than what they are trying to do out of Washington, I agree with you 100%.
As for the health reform that is coming down the road at us, ask your Congressman why they will not have to be covered by the same plan.
Simple...it's much like the short order cook who says, "I ain't going to eat this SLOP I'm cooking!"
ADMIN, yes, I do think there are way better solutions than what they are trying to do out of Washington. As I am for some sort of a program, I just don't like what I have been reading as to how they wish it done. It just might cripple States such as South Dakota by as much as $45 Million dollars or more. As their program is not being well thought out, but only being shuffled around is all.
Taking the example from what I'm seeing done in the State of Indiana, if other States would simply follow the same program, there then would be no need for health care reform.
ADMIN also, the hospitals I talked about, with Pre-approvals are also in the State of Indiana. Where the Insurer approves, the later denies the payments. It's a true fact that I have been following. Even surgeons have been speaking on this matter. As it's only my opinion, hospitals inflate or over inflate their medical bills to help pay for the bills that others can not pay for. Being so, that right there is then a form of health care reform. But, it just might be better to panel doctor's, surgeon's and hospital's, into the health care reform act, to maybe come up with a much better plan of action.
This is a wonderful discuss and of course as most of you know one that is very dear to my heart. first I am hearing about a program that provides some sort of insurance to the underinsured in Indiana which sound really good. I guess for me I would like to read more about that insurance to agree that is should be taken to all states. I would agree that I have recieved enough infomration to believe that it does a better job of providing healthcare for those that do not have healthcare than what it looks like is happening with the Federal Government.
Next I am hearing about hospital billing and medical cost and so forth. Most of what I am hearing is 100% correct. There is a long history behind medical billing and how we got to where we are today. My back ground of course is mostly in Long term care when it comes to billing, however, I have had the pleasure of working for and being a patient in a civilian hospital. As a nurse who has a graduate degree in nursing, we learned a lot about medical billing mostly to help us understand budget cuts which mostly will include decreasing your hours per patient day (HPPD's) which of course is cutting nursing positions and giving them more patients to be responsible for.
The history is very simple. In the 60's -mid 80's the hospitals charged under what was called DRG's. DRG's stand for Diagnosis Related Groups. What this meant is that a board of doctors predetermined how long a person would stay in the hospital for each diagnosis such having a baby by C. section or vaginally etc. AT that time Medicare was a program that was just launching and so were most of our medicaid state programs. I find that for the most part, most people confuse the purposes or populations served by medicare and medicaid. Medicare services a population over 65, people who are under 65 with disabilities, and people who are in poverty and are able to collect SSA. Medicaid is a state paid for but supplemented by the federal government to provide medical services to people on welfare or who are in proverty status. Mostly welfare is for the children the the medicaid program extents its services to the adults as well. In terms of hospitals, I can't speak to this, but in terms of long term care, the services are documneted through a program called Minimun Data Sheets and then sent to the states for payment.
With medicare there is a part A, which is automatic with all served populations, a part B, and now since about 2003 a part D. Part A pays for inpatient care only. However, I believe it was in 2002 changes were made as to how this was going to be paid and what they were going to pay for. For instance, in the past Medicare A paid for the pretermed old time system that was under the DRGS. If a person was going to be in the hospital for a particular disease then it paid for those days, all the ancillary tests connected with that stay, medications given etc. Then doctors were paid in addition as an outside bill part of a person's hospital stay. In 2002, that changed to say that Medicare will pay so much per day to a hospital and it would be all inclusive which means that the hospitals could no longer bill for labs, medications, Xrays separtely. The big push on this was when the MRI's started and they are very expensive as I am sure most of you know. This was a great concern for the hospitols becasue they could not always control what the doctors would order. At first they put more people in the quality control departments to do chart audits, give doctors the ok to order a test and so forth. They found that this did not work. Consequently they took their own labs etc..all the ancillary departments and made them their own sub business. What this meant is that medicare is now paying the higher daily rate to cover all of the expenses but Medicare B is being billed for the labs, and all ancillary components of a hospital stay.
I will come back to talk about what happen with civilian insurance in terms of HMO's etc. and the billing for the supplies etc. Sorry this is very long..if not interested, just skip through it...my hands are not working now..so I got to end this Red
Great discussion Badboy...
I may not have an opinion at this time, But I am interested in this subject, and would like to hear more, As you all know I am now retired and receiving Medicare , As alot of others are also.
Thanks Bx4, Admin and Red. and all the others posting to this thread.
