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ROSIE, i have heard of that happening where my mom lives.

Posted : May 14, 2012 7:48 pm
A Davis
Trusted Member

i will have to find more, but i do not believe the medicaid cuts have anything to do with what you are calling "obamacare" (the affordable health care act).

it may have to do with paul ryan. please read this excerpt, then the entire article at( http://www.forbes.com/sites/joshbarro/2012/03/26/how-federal-medicaid-cuts-will-squeeze-states/ )

Currently, Medicaid is a joint federal-state program, with the federal government paying for 57 percent of the program’s budget. Paul Ryan’s Republican budget plan turns the program into a block grant—the federal government would send a lump of cash to the states, and the states would pay for 100 percent of any costs above that. By limiting the growth of the block grant, Ryan aims to save $810 billion in federal spending over ten years.

The key word in that last sentence is federal. By forcing states to pay 100 percent of Medicaid cost increases at the margin, this plan is likely to achieve some restraint in the growth of total Medicaid spending. But the plan will also shift much of the cost of Medicaid from the federal budget to state budgets.

as for medicare, see this article also on paul ryan's actions: http://www.huffingtonpost.com/2012/04/01/paul-ryan-budget-attack-ads-medicare-cuts_n_1394939.html

WASHINGTON -- Democrats are not waiting long to use Rep. Paul Ryan's federal budget proposal for next year as a campaign billy club.

Last week, the House passed the Wisconsin Republican's $3.5 trillion budget plan, complete with measures to switch Medicare to a private system, slash more than $700 billion from Medicaid, and cut programs such as food stamps.

Posted : May 14, 2012 8:26 pm
Trusted Member

Interesting Miss Davis. At the risk of exposing my self a bit more than I would like, I am disabled and on Medicare and Medicaid. I recently got a new doctor and dentist with no problems, and also saw an oncologist because I was suspected of having cancer. I have had no problems with either Medicare or Medicaid with ongoing health issues.

I have no cancer, but the bone marrow biopsy is the second most painful thing I have gone through in my life. I actually gasped three times during the procedure.

Posted : May 14, 2012 8:34 pm
A Davis
Trusted Member

i am so glad that you have not been affected by these cuts which appear to happen at the federal level, with repercussions at the state level. i have a feeling that experiences may vary from state to state or from doctor to doctor. even happier that you came through your tests with flying colors!!! (tu)

i just wanted to offer some more information on why perhaps that person had an issue, and to check for myself whether this was a result of what everyone is content to call "obamacare"...

Posted : May 14, 2012 9:07 pm
Trusted Member

Well, thanks to Obamacare my OB/GYN is no longer taking Medicare patients. Offered to pay cash and was told that that was against the law!!! Called every doctor's office in this county of about 25K and none were taking new Medicare patients and were phasing out all together Medicare patients that they have been seeing. So, what good is having the govt. insurance if no one will see you???? For the doctors to be not allowed to take cash is just plain insane, but, once you are identified as a Medicare patient, they are not allowed to take your cash.
Change of subject, but, Lasik surgery has never been paid by insurance as it is elective procedure. Just a few years back it was 5K and now some eye doctors charge only $500. and better care. The free market works and works well. But, let the govt get involved and the price goes up. Or, you can get no care at all.

A physician who participates with Medicare cannot take your money because it violates the contract they signed with Medicare. Not sure if it's actually against the law or not. But since Medicare is a federal program, I wouldn't be suprised.

As far as Obamacare being the culprit, I wouldn't be so quick to blame. This article is a bit old. But I'm pretty sure not much has changed: http://www.forbes.com/sites/rickungar/2010/09/25/does-obamacare-really-cut-medicare-benefits-to-senior-citizens/ . Basically, it explains that the payment cuts that make serving Medicare participants less lucrative were started during the Clinton administration. And the shortage of doctors began at the same time when the government failed to increase the number of Medicare internships (the major finding source for turning out new doctors.). One of the big complaints about Obamacare is that it did nothing to increase the number of physicians that would be needed for all those new insured.

About the Lasik. I had mine done on both eyes 11 years ago for $2000. The price has come down because there are more trained doctors to perform it, and the cost of the equipment has gone down, as manufacturers have recouped their research and development fees, and sold higher quantities. Insurance has nothing to do with it. CAT scans and MRI's are far cheaper than they were years ago for the same reason. And they are mostly covered by insurance.

Posted : May 15, 2012 3:43 am
Trusted Member

Union leaders are now hearkening back to what Obama repeatedly said starting in 2009: "If you like your health care plan, you can keep your health care plan."

Joe Hansen, president of the United Food and Commercial Workers International Union, wrote in a recent op-ed that that scenario “is not going to be true for millions of workers now" and the realization “makes an untruth out of what the president said.”

“makes an untruth out of what the president said”. Did he just call the President a liar? Maybe some of our Big Government friends are finally catching on. Promise them what they want but give them what we think they need.

Posted : May 25, 2013 9:41 pm
Active Member

Healthy food for thought (relevant to the dialogue):

- Providers are prohibited from taking cash -- whether it's for TriCare, VA Benefits, Medicaid, Medicare or commercial plans -- if they are contracted as an in-network provider. They also cannot balance-bill.

- Technically, they also cannot waive a copay / co-insurance payment if they are a contracted in-net provider with your plan. And, the provider is contractually obligated to collect that payment at the time of service. Seriously!

- Please do not confuse and/or compare the office of a private practitioner (physician, mental health, allied health, optical or dental provider) with an agency or hospital when considering charges or billing ... They are very, very different.

- Insurance has used the Sherman Antitrust Act (July 2, 1890, ch. 647, 26 Stat. 209, 15 U.S.C. §§ 1–7) to prevent providers from disclosing or even discussing insurance reimbursement rates. So providers never can really determine if the Usual and Customary Rate (UCR) is statistically valid for their discipline in the region where services are rendered. Remember - the UCR is typically set by the commercial third-party payers ... and that's the same groups that prevents open discussion! Federally managed plans; however, make this info available to the public, in general.

- Expect most providers in private practice to only be reimbursed 25-30% of what they would actually would earn in a region based her/his typical training, licensure, education, continuing education and experience (with the exception of regions identified as a Health Profession Shortage Areas http://hpsafind.hrsa.gov/). But wait, they cannot discuss the UCR, so hmmm ... guess they cannot get accurate data to see if they have been duped by big business! That's one reason why providers who accept insurance also see more patients ... And why some stop accepting insurance all together. Financial lust may not be driving the car ... the provider actually may be treading water to stay afloat.

- And some (Medicaid) plans just don't pay or they even go broke, which means a provider needs to conduct a feudal risk assessment. If the Medicaid plan is "going under" (Wash DC, 5/17/13: http://www.bizjournals.com/washington/blog/2013/05/chartered-health-plan-still-owes.html?page=all), then the provider must balance risk, financial reality, obligation to keep a roof over their family, etc. Rest assured, there is a common concern about many district, territory, state and commonwealth managed plans. USVI probably isn't alone on this note (hey, see the link above). This situation isn't the case with Fed plans, they tend to e reliable, timely and solvent. Perhaps DC Medicaid needs emergency FEMA funds, just not from the era managed by "Brownie" (sorry, I couldn't help myself!)

- Even if a patient states they do not have insurance and the provider offers a reduced fee-for-service as an act of good-will... but then the patient later discloses they actually *did* have insurance and they submit a self-claim (aka, the patient seemingly lies and makes an unethical choice to submit a claim seven years after the date(s) of service) a provider will likely be required to repay that amount (income) and possibly with interest, if its in the contract ... Or face possible charges of fraud.

- And yes, in the scenario above, that provider would have already paid 100% of their own self employment taxes which would not be recouped. And no, private practices cannot "write off" bad debt the same way an agency or hospital does.). One may better appreciate - yet not necessarily approve of - the reason why a provider may be reluctant to accept third-party reimbursement *and* concurrently offer services to someone who self-reports they don't have health insurance.

- For some providers, reimbursement rates from insurance has actually *dropped* during the past decade while overhead has drastically jumped. Not fun having a job without a cost of living raise after ten years of employ, eh?

- Any idea how much your doc / provider must pay per unit for telephone answering that's compliant with HIPAA? Please remember, they ought not use regular cell phones and standard voice mail (except for emergencies) because those methods are not secure. Indeed ... cell phones, regular voice mail and unencrypted email are now taboo under health privacy laws. Insurances does not cover this expense. Nor do they cover most reports produced by health care providers.

- Govt plans (TriCare, VA, Medicare) are IMHO generally well-managed, they pay timely and are far more cost effective that other options for many medical and allied health disciplines. (Medicaid is harder to describe because it depends on the direct management or carve-out contracts offered by the state, jurisdiction, territory, or commonwealth ... it's not directly managed by the Feds). Imagine you've rendered a professional service and then you must waiting six months to seven years to get reimbursed! It's as though we, as patients, are given an interest free loan and the provider pays the interest while waiting to make an income. Still gotta pay WAPA, rent and their staff in the meanwhile... So who do you think sometimes goes without a salary?

- And providers can typically expect to loose money for accepting a new patient. Not intended to be a value judgment, just a hard fact. The practice prepares the for the first visit, conducts a courtesy call to insurance on behalf of the new referral to verify coverage (that process can take up to two hours on the phone trying to talk with a real, live person who often cannot give the provider all the required data anyway), etc. The health care provider pays a significant expense up front "hoping-against-hope" the new referral actually comes to the first appointment! A remarkable percentage of new clients/patients don't cancel a first appointment and often just don't show. Insurance, workers comp and employee assistance benefits do not pay if a client/patient no shows.

- Providers who can only see one person at a time (psychologist, dentist, optometrist) who then has a new referral fail to show will loose both an hour of income *and* upfront costs. Most people wouldn't be happy going to work and then, out of the blue and on a regular basis, discover that they're docked an hour of pay. Yet, that's exactly what health care providers do and we generally expect them to do it with a smile. Perhaps that's why lawyers, accountants, plumbers and other service providers (a) invoice at the time of service, (b) bill hourly for the work of para-professionals and assistants and/or (c) require retainers ... and that's why more providers are giving super bills for services that we've always expected them to cover (as a courtesy), yet the provider can no longer absorb. Start looking for super bills that look like a statement from your lawyer or accountant. And it's not compelling to peg this on "Obamacare" ... That's far too simplistic. It's a growing concern that has existed for decades and we've long past the tipping point.

- Regretfully, health insurance isn't like homeowner insurance ... I suspect most people reading this post already have wind, hurricane and other riders for home policies. Health insurance doesn't offer rider protections for uncovered services. Imagine not being able to get coverage for wind damage? I'd sure look for a better home owner policy if it wouldn't offer needed coverage. So why not use similar logic when getting health insurance? Do I just expect a provider to take responsibility for the costs I should really cover (multiply this cost by the overall number of patients to whom your provider offers professional services. Yikes!)

- The "new" referral dilemma (described above) is one reason why wait times in a docs office are getting longer ... And it's partly why allied health providers (if you're lucky to find any still accepting insurance) tend to place more and more of the responsibility on the client/patient to verify their own benefits in advance of the appointment. Some practices require up to a $100 benefit-check fee or first appointment security deposit to foster personal accountability and responsibility. Obviously, this would be waived in many circumstances and is not the norm ... but it happens and there is a reason why it happens.

- Remember, commercial insurance is a contract between the consumer/client/patient and their insurance company. The provider can get only accurate and real-time benefit info from govt plans, but ... Providers typically cannot receive the same info for someone with commercial third-party coverage.

- Does anyone know how much your provider pays annually for her/his own health insurance? Or liability insurance, business insurance? Professional license(s), board certification(s) and post-graduate continuing education / development / specialization fees?

Food for thought ... Perhaps one may think positive thoughts when next seeing a provider. Sometimes, an oath by a provider to do no harm to others often means that same provider seemingly takes on a greater risk of harm to her/himself and family. The biopsychosocial, cultural and economic variables are just different.

The typical issues about health care are less about providers and "big" government than one may surmise.


Posted : May 26, 2013 2:32 am
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