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Thread: Health Insurers' Move to Drop Child Policies Draws Criticism

  1. #21
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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by sokpupet View Post
    Health Care and the Tragedy of the Commons - Adam Wernick - Open Salon
    ~snip


    We need to embrace preventative medicine, nutritional counseling, local free gyms. we need to think out of the box and change how we think of healthcare. Everything we do should not be seen as a means to make a fekin' buck.
    Nice snarky response there buck. Impressive.

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by Harry Guerrilla View Post
    Preventative mandates largely killed the emergency/surgical only plans.
    Where before you paid out of pocket for visits and insurance covered emergency/surgical care.

    From what I remember, the plans cost around $100 a month for the average person.
    1)Those plans were sold to low income households. The companies aggressively denied claims, knowing the low percentage of low income people that would seek legal representation. Or could afford it.

    2)State mandates? If you want to go state by state, mandate by mandate... or just give some specific examples of how a state mandate 'eliminated' something that was a valuable insurance product.


    Wellchild care mandates, preventative screening mandates, all those things are not included with a surgical/emergency insurance plan.
    They are affordable out of pocket.
    The regs vary state by state. Certain types of insurance like supplemental health insurance, short term coverage or international travel coverage - are exempt from those requirements.

    Regs are there to insure quality service and coverage.

    There is no such thing a perfectly symmetrical information, not even with the government.
    With government, they make aggregated choices.
    Choices on the average, as we know there are always exceptions and such many people get left out in the cold.
    Fair enough.

    But minimizing those left out is the point.

    Private insurance offered more choice and flexibility.
    They have moved toward offering a limited number of choices once you're in the plan. Competitive pricing is still not there.

    Courts exist for any breach of contract.
    Fine print is a bogus argument, you can read the document before you sign it and if you're really worried it would cost you little to have it reviewed by a lawyer.
    Insurance company bean counters have this down to a science -- they budget for a certain number of legal claims. And they can figure out which type of claims are easiest to deny, which type of client is least likely to hire an attorney, and which type of legal action is least likely to be successful.

    And you missed my point about 'fine print' -- when a claims rep in some other state is making a final decision on treatment, there is no fine print. And to the extent those decisions are based on profit and not reasonable, ethical honoring of the contract, government must regulate that.

    Few claims as possible means that they deny invalid claims and not claims covered by the agreed upon contract.
    That's a very ignorant statement not backed up at all by practices over the last 3 decades.

    If you didn't read what was covered, it's your fault, not the insurer.
    Again, extremely naive.

    Companies sell insurers computer programs and claims management protocols designed to reject as many legitimate claims as possible. Also keep in mind, that for many, once a claim is rejected, the process of an appeal is so daunting and overwhelming, that many of these claims go unpaid. This is part of the business model of the insurance industry.

    A significant number of claims denials are related to medical necessity, or the lack thereof. The health plan is essentially saying that the physician or medical provider that treated you did so without a justifiable medical reason, or that it was cosmetic, experimental, or investigational. Or when a patient goes to a hospital which is contracted with their health plan and feel everything was taken care of, but then they receive out of network bills from the anesthesiologist, pathologist, radiologist, assistant surgeon and so on, which are reduced in payment due to "Usual and Customary".



    People should be buying plans outside of their employer.
    Government shouldn't be creating incentives for employer plans but they have been for quite some time.
    Employers can get better group rates.

    But if a coal mining company is buying into an insurance plan that doesn't cover lung disease... That's were gov comes in.

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    that's nice, but here in reality under the reform that has exhausted for lifetimes any futher efforts of reform, ER visits steeply INCREASE, med advantage is GONE, the m&m's are simultaneoulsy EXPANDED massively and DEFUNDED drastically, and all 50 states are facing what dem gov of tennessee phil bredesen (speaking for bill richardson of new mexico, christine gregoire of washington, bill ritter of colorado and brian schweitzer of montana, once progressive superstars all) called THE MOTHER OF UNFUNDED MANDATES

    read

    it's YOURS!

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by sokpupet View Post
    Health Care and the Tragedy of the Commons - Adam Wernick - Open Salon
    ~snip


    We need to embrace preventative medicine, nutritional counseling, local free gyms. we need to think out of the box and change how we think of healthcare. Everything we do should not be seen as a means to make a fekin' buck.
    Where the hell's the fun in that?!? I can't buy a new boat, unless I spend a majority of my time making a friggin' buck.

    It's called, "making a living", and if more people engaged in it, the economy would be better off. Or, let me say, if the government would get out of the way, then more people could engage in it and the economy would be better off.

    One way of, "getting out of the way", would be to throw this piece-a-**** healthcare bill in the toilet and start over with a plan that makes actual sense.
    Quote Originally Posted by Top Cat View Post
    At least Bill saved his transgressions for grown women. Not suggesting what he did was OK. But he didn't chase 14 year olds.

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by hazlnut View Post
    1)Those plans were sold to low income households. The companies aggressively denied claims, knowing the low percentage of low income people that would seek legal representation. Or could afford it.

    2)State mandates? If you want to go state by state, mandate by mandate... or just give some specific examples of how a state mandate 'eliminated' something that was a valuable insurance product.




    The regs vary state by state. Certain types of insurance like supplemental health insurance, short term coverage or international travel coverage - are exempt from those requirements.

    Regs are there to insure quality service and coverage.



    Fair enough.

    But minimizing those left out is the point.



    They have moved toward offering a limited number of choices once you're in the plan. Competitive pricing is still not there.



    Insurance company bean counters have this down to a science -- they budget for a certain number of legal claims. And they can figure out which type of claims are easiest to deny, which type of client is least likely to hire an attorney, and which type of legal action is least likely to be successful.

    And you missed my point about 'fine print' -- when a claims rep in some other state is making a final decision on treatment, there is no fine print. And to the extent those decisions are based on profit and not reasonable, ethical honoring of the contract, government must regulate that.



    That's a very ignorant statement not backed up at all by practices over the last 3 decades.



    Again, extremely naive.

    Companies sell insurers computer programs and claims management protocols designed to reject as many legitimate claims as possible. Also keep in mind, that for many, once a claim is rejected, the process of an appeal is so daunting and overwhelming, that many of these claims go unpaid. This is part of the business model of the insurance industry.

    A significant number of claims denials are related to medical necessity, or the lack thereof. The health plan is essentially saying that the physician or medical provider that treated you did so without a justifiable medical reason, or that it was cosmetic, experimental, or investigational. Or when a patient goes to a hospital which is contracted with their health plan and feel everything was taken care of, but then they receive out of network bills from the anesthesiologist, pathologist, radiologist, assistant surgeon and so on, which are reduced in payment due to "Usual and Customary".





    Employers can get better group rates.

    But if a coal mining company is buying into an insurance plan that doesn't cover lung disease... That's were gov comes in.
    Why didn't those low income households seek help from government funded healthcare that already exists?
    Quote Originally Posted by Top Cat View Post
    At least Bill saved his transgressions for grown women. Not suggesting what he did was OK. But he didn't chase 14 year olds.

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by apdst View Post
    Why didn't those low income households seek help from government funded healthcare that already exists?
    I would also like to see the statistics that surgical / catastrophic type plans had a higher rate of denials on legitimate plan covered claims. I really have my doubts about that.

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    Quote Originally Posted by buck View Post
    I would also like to see the statistics that surgical / catastrophic type plans had a higher rate of denials on legitimate plan covered claims. I really have my doubts about that.
    Its simply a good talking point, nothing more.

    .

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    Re: Health Insurers' Move to Drop Child Policies Draws Criticism

    yes, and any "talking point" by the party still in power which contains the words "health care" does devastating damage to the dems

    just like "stimulus," just like "global warming," just like "cap and trade..."

    it's simply the lay of the land

    5 weeks and 4 days are all that remain

    carry on, chin strokers, pose

    we republicans will remain real

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