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Insurance requires you to correctly diagnose yourself to get paid for services

jaeger19 said:
I don't lie..

What I find astounding is how much you liberals lie when it comes to healthcare and healthcare insurance.

In all likelihood. the person;s "elderly mother".. has medicare.. a GOVERNMENT insurance.. and the reason that she was sent home was because her insurance.. the GOVERNMENT insurance would not pay for her being admitted for a week to the hospital.

And our medicare.. is far and above better than almost any government insurance in single payer countries.

I have personally proved this on this board over and over.. .to you no less.. and yet..... you don't want to believe the truth.
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You can argue by hypothetical until you're as red as a tomato, but it won't change the fact that you're engaged in a logical fallacy, asserting your unjustified speculation as meaningful.
 
Absentglare said:
I'm not really sure why we don't allow people to opt-in to medicare or medicaid, even if it ends up being slightly more expensive than what some private insurers can offer.
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I have suggested that would make the perfect "public option" - perhaps designate the premiums as a fixed percentage of gross income based on self (8%?), self + spouse (15%?) and self + family (20%?).
 
Absentglare said:
You can argue by hypothetical until you're as red as a tomato, but it won't change the fact that you're engaged in a logical fallacy, asserting your unjustified speculation as meaningful.
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nope.. I am not arguing hypothetically.

The lady was on GOVERNMENT insurance. a government insurance that is actually BETTER than most single payer medical insurances (again not hypothetical.. our medicare tends to pay for many more things than many other single payer government insurances.. AND it tends to have less authorization and wait times). And it was done because its a cost saving measure.

So you explain why another system.. whose insurance covers less.. and that gets MORE savings... would be better. .
 
Absentglare said:
I'm not really sure why we don't allow people to opt-in to medicare or medicaid, even if it ends up being slightly more expensive than what some private insurers can offer.
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Because it would financially crush medicare..

and few people would want Medicaid. not if they could afford what private insurers offer.
 
ReverendHellh0und said:
They also sent a letter to these people about going to urgent care, etc. if more people did that than the emergency room there would be less need for this. Anthem is wrong here and I'm suprised the appeal was denied as the symptons indicated a serious medical emergency. I wont be surprised that this will get fixed and no one will notice as we move on.
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Funny. My son was taken into the ER for a seizure a few weeks ago and there was no one there, at all. Thursday morning as we were getting ready for school, and not a single person waiting in the ER to be seen when we were leaving. (They had one patient besides my son being treated in the ER when we arrived.) So where are these lines exactly? I live in a pretty big city (for NC).
 
roguenuke said:
Funny. My son was taken into the ER for a seizure a few weeks ago and there was no one there, at all. Thursday morning as we were getting ready for school, and not a single person waiting in the ER to be seen when we were leaving. (They had one patient besides my son being treated in the ER when we arrived.) So where are these lines exactly? I live in a pretty big city (for NC).
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Thursday morning is typically low. Friday night, Saturday and Sunday are usually busy because people have put off going to see the doctor during the week and then its worse on the weekend. then the accidents from the weekend warriors and the issues with the weekend partiers.
 
roguenuke said:
Funny. My son was taken into the ER for a seizure a few weeks ago and there was no one there, at all. Thursday morning as we were getting ready for school, and not a single person waiting in the ER to be seen when we were leaving. (They had one patient besides my son being treated in the ER when we arrived.) So where are these lines exactly? I live in a pretty big city (for NC).
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It all depends on how good, and where you are. I hope your son is ok. that's the important thing here.
 
ReverendHellh0und said:
It all depends on how good, and where you are. I hope your son is ok. that's the important thing here.
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He's been diagnosed as epileptic now, so we are working on controlling the seizures and adjusting lives around it but it's being managed, even if causing a lot of stress.
 
Threegoofs said:
Yep. This one is just brilliant.

Anthem is now refusing to pay the cost of ED visits to people who use the ED inappropriately.. meaning they didnt get the diagnosis they thought they might have.

This story is how a woman presented to the ED with abdominal pain because she suspected it might be appendicitis. After a workup, it was determined to be painful ovarian cysts.

So the insurer rejected the $12,000 claim and is making her pay for it.

https://www.vox.com/policy-and-poli...emergency-room-coverage-denials-inappropriate



When you hear people say that the US has the 'greatest healthcare in the world' because its the 'greatest country in the world', and that all we need is a little capitalism and free market to fix our healthcare system... just think of this story.
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Trump supporters dismantle Obamacare, then act surprised at the consequences.
 
jaeger19 said:
And our medicare.. is far and above better than almost any government insurance in single payer countries.
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Wait a second...
So, you're saying that "the government better keep their hands off our Medicare?"
 
jaeger19 said:
The lady was on GOVERNMENT insurance. a government insurance that is actually BETTER than most single payer medical insurances
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I don't think you are clear on how this whole thing works.
Single payer plans ARE government, because the government collects the tax revenues that pay for the program, and they become "the" single payer.

They are paying doctors and hospitals that treat people with all kinds of coverage, not JUST Medicare.
Under a single payer system, EVERYTHING would be the equivalent of Medicare, except that in most single payer countries, elective surgeries and procedures continue to be privately insured or out of pocket, therefore a boob job for strictly cosmetic enhancement is not covered, just as one example.
 
Checkerboard Strangler said:
Wait a second...
So, you're saying that "the government better keep their hands off our Medicare?"
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Nope.. pointing out that our medicare.. is substantially better than most government single payer in other countries.

In fact our MEDICAID is substantially better than most government single payer in other countries.

SO.. if you want to go to a single payer system like Canada.. be prepared if you have medicare or Medicaid.. to have a decrease in your insurance.
 
Checkerboard Strangler said:
I don't think you are clear on how this whole thing works.
Single payer plans ARE government, because the government collects the tax revenues that pay for the program, and they become "the" single payer.

They are paying doctors and hospitals that treat people with all kinds of coverage, not JUST Medicare.
Under a single payer system, EVERYTHING would be the equivalent of Medicare, except that in most single payer countries, elective surgeries and procedures continue to be privately insured or out of pocket, therefore a boob job for strictly cosmetic enhancement is not covered, just as one example.
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umm.. I understand how this works exactly.

no.. under a single payer program everything WOULD NOT be the equivalent of medicare....

for example in Canada.. single payer Canadian insurance does not pay for medications on an outpatient basis.

Medicare and Medicaid.. do cover it.

In Canada.. out patient physical therapy is not covered under Canadian single payer

Medicare and Medicaid do cover it

In Canada.. out patient occupational therapy is not covered under Canadian single payer

Medicare and Medicaid in the US do cover it

In Canada outpatient speech therapy is not covered under Canadian single payer

Medicare and Medicaid in the US do cover it.

In Canada, home health services are generally not covered under Canadian single payer

Medicaid and Medicare do cover home health.

Many devices like braces and prosthetics and orthotics as an outpatient are not covered under Canadian single payer.

They are covered under Medicare and Medicaid.

Just as several examples.
 
jaeger19 said:
Nope.. pointing out that our medicare.. is substantially better than most government single payer in other countries.

In fact our MEDICAID is substantially better than most government single payer in other countries.

SO.. if you want to go to a single payer system like Canada.. be prepared if you have medicare or Medicaid.. to have a decrease in your insurance.
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I suspect you're implying that the quality of care is lower in a system like Canada's.
 
jaeger19 said:
umm.. I understand how this works exactly.

no.. under a single payer program everything WOULD NOT be the equivalent of medicare....

for example in Canada.. single payer Canadian insurance does not pay for medications on an outpatient basis.

Medicare and Medicaid.. do cover it.

In Canada.. out patient physical therapy is not covered under Canadian single payer

Medicare and Medicaid do cover it

In Canada.. out patient occupational therapy is not covered under Canadian single payer

Medicare and Medicaid in the US do cover it

In Canada outpatient speech therapy is not covered under Canadian single payer

Medicare and Medicaid in the US do cover it.

In Canada, home health services are generally not covered under Canadian single payer

Medicaid and Medicare do cover home health.

Many devices like braces and prosthetics and orthotics as an outpatient are not covered under Canadian single payer.

They are covered under Medicare and Medicaid.

Just as several examples.
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"Repeated surveys have shown that cost-related non-adherence to prescribed treatments is common in Canada and high by comparison to other countries—with the notable exception of the United States, where gaps in coverage are even greater than in Canada."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094297/

In addition, there are significant caps on how much prescriptions are covered under Medicare and Medicaid, with Medicaid recently being hit with disastrous cutbacks in the last couple of months.
In addition, take a look at Canadian pharmaceutical prices and please note the astronomical difference. Canadian drugs are significantly cheaper.

Many devices like braces and prosthetics and orthotics as an outpatient are not covered under Canadian single payer.
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Medicaid recently got hit with several Trump administration cutbacks that have literally gutted services for the disabled.
American Medicare services for the disabled is a veritable racket, overrun by grift, waste, fraud and abuse and Medicare is hamstrung when it comes to resources to fight it.

Last but not least, what bankrupts the typical American consumer are surgeries, ER visits, catastrophic illnesses, basically almost any bill that comes from a hospital.
I don't think that there are enough medical bankruptcies to count in Canada.
 
Checkerboard Strangler said:
"Repeated surveys have shown that cost-related non-adherence to prescribed treatments is common in Canada and high by comparison to other countries—with the notable exception of the United States, where gaps in coverage are even greater than in Canada."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094297/

In addition, there are significant caps on how much prescriptions are covered under Medicare and Medicaid, with Medicaid recently being hit with disastrous cutbacks in the last couple of months.
In addition, take a look at Canadian pharmaceutical prices and please note the astronomical difference. Canadian drugs are significantly cheaper.



Medicaid recently got hit with several Trump administration cutbacks that have literally gutted services for the disabled.
American Medicare services for the disabled is a veritable racket, overrun by grift, waste, fraud and abuse and Medicare is hamstrung when it comes to resources to fight it.

Last but not least, what bankrupts the typical American consumer are surgeries, ER visits, catastrophic illnesses, basically almost any bill that comes from a hospital.
I don't think that there are enough medical bankruptcies to count in Canada.
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Well, you are right.

And it has been a burden.

However the current government is preparing a program and will like be rolled out in 18 months to two years.

That's what we numbskulls in Canada call "progressive"


I forgot to mention that there is "pharmacare" available for most drugs to those whose incomes are below a certain level.
 
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Checkerboard Strangler said:
I suspect you're implying that the quality of care is lower in a system like Canada's.
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Nope.. man you really try to make up stuff don't you.???

I am stating that the quality of their government insurance.. is lower.. i.e. covers much less than Medicare or Medicaid in the US.
 
Checkerboard Strangler said:
"Repeated surveys have shown that cost-related non-adherence to prescribed treatments is common in Canada and high by comparison to other countries—with the notable exception of the United States, where gaps in coverage are even greater than in Canada."
.
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For people that don't have insurance in America? sure. for people that have insurance in America? Some. but medicare and Medicaid. Which is what I was talking about? No.

so for people without health insurance.. roughly 10 % of americans? A Canadian style government single payer will be good.

for the other 90%,.. not so much.

In addition, there are significant caps on how much prescriptions are covered under Medicare and Medicaid, with Medicaid recently being hit with disastrous cutbacks in the last couple of months.
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Still cover pharma while Canada government insurance does not.

In addition, take a look at Canadian pharmaceutical prices and please note the astronomical difference. Canadian drugs are significantly cheaper.
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Yep.. but if you don't have coverage? Its why Canadians have to go and purchase separate pharma coverage.

As we age, we’re increasingly likely to develop chronic conditions, many of which need meds, sometimes indefinitely. Between the ages of 65 and 74, 20% of Canadians have at least three chronic medical conditions. By age 85, it’s up to 36%. “Because of this, it’s not uncommon for a senior to be taking 10, 12 or even 14 drugs in a day,” says Dr. John Puxty, associate professor and chair of the division of geriatric medicine in the department of medicine at Queen’s University in Kingston, Ont. “In Canada, there really is no uniform drug coverage,” he says. “Provincial programs like the Ontario Drug Benefit Plan may cover a number of medications, but some are not included, even though they may be indicated for some diseases.”

it’s not uncommon for a senior to be taking 10, 12 or even 14 drugs in a day

The average senior household spends $500 each year on prescription drugs. But that doesn’t account for the cost of some very pricey treatments for serious illnesses. In the case of cancer treatment, for example, the government covers the cost of drugs administered in hospitals and clinics. But half of the newer cancer drugs are taken at home and become the responsibility of the patient. A 2009 report by the Canadian Cancer Society pegged the price tag for a full course of these newer drugs at $65,000. Some, but not all, provinces have established high-cost drug insurance to protect patients. Even with a private insurance plan, the provider usually requires a 20% co-payment, which amounts to a $13,000 cost in the case of a $65,000 drug. Those plans, too, often have lifetime or annual spending caps, maxing out with less than one round at this price.
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American Medicare services for the disabled is a veritable racket, overrun by grift, waste, fraud and abuse and Medicare is hamstrung when it comes to resources to fight it.
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Yawn.. bull. Tell you what.. put up an article or something so I can debunk it. Medicare for "the disabled".. is pretty much awesome. In fact.. Medicare is so good that the rich love it.

Last but not least, what bankrupts the typical American consumer are surgeries, ER visits, catastrophic illnesses, basically almost any bill that comes from a hospital.
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nope.. what bankrupts a person is not medical bills. what bankrupts them is the loss of income from a medical problem. In most bankruptcies citing medical reasons.. medical bills were actually something like around 6-10% of their actual debt.

I don't think that there are enough medical bankruptcies to count in Canada.
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Wrong again.

As for the notion that greater government involvement in health insurance will reduce bankruptcy, it is helpful to compare personal bankruptcy rates in the United States and Canada. Unlike the United States, Canada has a universal, government-run health insurance system. Following the logic of Himmelstein and colleagues, we should therefore expect to observe a lower rate of personal bankruptcy in Canada compared to the United States.

Yet the evidence shows that in the only comparable years, personal bankruptcy rates were actually higher in Canada. Personal bankruptcy filings as a percentage of the population were 0.20 percent in the United States during 2006 and 0.27 percent in 2007. In Canada, the numbers are 0.30 percent in both 2006 and 2007. The data are from government sources and defined in similar ways for both countries and cover the time period after the legal reforms to U.S. bankruptcy laws in 2005 and before the onset of the 2008 economic recession.

.
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