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Post by frankcor on Apr 25, 2009 5:33:25 GMT -5
I agree with everything you say about the law, Dave. It is a very complicated matter. The laws, and thus the people, of New York are generous, indeed. From appearances, Oneida County is more generous than others.
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Post by dgriffin on Apr 25, 2009 23:00:29 GMT -5
I agree with everything you say about the law, Dave. It is a very complicated matter. The laws, and thus the people, of New York are generous, indeed. From appearances, Oneida County is more generous than others. That's not my impression. But as homeowners and taxpayers, the county personnel are probably more worried about provider fraud and exorbitant amounts charged than old people trying to preserve what little money they have left. A third of NY's medicaid money is spent on nursing homes, priced near the highest in the nation, and much of it was at one time paid by insurance companies after collecting premiums from a patient for decades. Railing at the families and calling them despicable and criminal as they honestly pursue legal remedies is a lot like blaming the victim. |
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Post by dgriffin on Apr 25, 2009 23:21:13 GMT -5
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Post by Clipper on Apr 26, 2009 9:33:45 GMT -5
It is not just in NY and it is not just medicaide providers Dave. I recently paid $232 for my portion of the cost of a back brace. The brace cost about $1700 total. That is why our private health insurance rates are so high also, not just medicaide and medicare. The damn brace is a 10 inch wide piece of fabric with a rigid plastic insert in the back, and some elastic and velcro closures. Other than molding the plastic insert, Kathy could have made the damn thing for about $50 and a couple of hours on the sewing machine.
Healthcare costs and usurious charges by providers is a national problem that effects all, whether on medicaide or not. It is about provider coding when they bill ANY insurance. They don't look at what they actually did as much as they look at the list of codes and determine HOW MANY of those codes they can charge for. The thing that pisses me off the most, is when I pay for a doctor and see a Nurse Practitioner or Physician's Assistant. An office visit should be billed at a rate commensurate with the level of skill of the person that attended to you.
I hate it when I am told "take this and if the condition doesn't improve by Thursday, call and we will get you in to see THE DOCTOR." Duh, that is what I came here for to begin with dumbass.
Medicaide, medicare, self paid insurance, and overall medical care costs are simply way out of control. Doctors have us by the balls, and we pay what we have to to see one. There is a shortage of doctors in rural areas because they can't bilk the poor out of millions or see 3 patients for every 15 minute appointment block. Some is legitimate cost, and some is just plain old fashioned American Greed and thievery.
When my dad was alive and living in the nursing home, they had a physician that came to the home on a scheduled basis. He would see a huge number of patients or residents in a short time. I was there on many occasions when he visited my dad. I wrote down the dates to see if the visit was billed. He would stop in the room, listen to Dad's chest with his stethoscope, ask him how he felt, and leave. It was billed as a nursing home visit and they charged $70. He would "visit" about 100 patients in a short period of time, and make $7000 in a couple of hours. I oft wondered how many of those that he billed for, he actually visited.
Some might call it "free enterprise" but I call it legal "extortion".
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Post by dgriffin on Apr 26, 2009 10:07:06 GMT -5
There must be two sides to this issue, but as you suggest, it's hard to not see anything but the greed on the part of providers and insurance companies.
And yet, I remember seeing a credible story one night (TV News anthology series, can't remember name) where a rural doctor was getting pushed to the wall so far by insurance companies that he was planning to take a part time job working for one of his patients in the landscaping business.
I, too, remember the physician who would breeze the nursing home, piling up "visits" on his scorecard, careening down the hallway from room to room. Stepping into his path would have risked a nasty collision.
And Doctor Punjab, or whatever his name was, who was detailed by the hospital to monitor my stress test a few years ago. He pulled back the curtain and did two of us at the same time, later sending a bill for the 3 minutes work for $750. My insurance company paid him $110, and he had to take it. Had he not been contracted to do so, he would have billed me the difference.
(This practice doubly screws the people who can't afford it in the first place, those without insurance.)
What can we do about it? That's the rub. I don't know what we can do about it. So, when they tout "competition" as the secret ingredient of new health coverage proposals, I sit and wonder how that will help.
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Post by Clipper on Apr 26, 2009 10:42:22 GMT -5
Providers also have a legitimate story to tell, as you describe with the doctor having to take a part time job.
I had noticed that some of the explanations of benefits that arrive STILL, long after my father's death, are for services provided over a year ago.
I don't know about you, but if I provided a service, I don't think I would be able to wait for a year to be paid. My doctor has told me that it sometimes takes as much as 6 months to a year to be paid for a simple office visit.
Seems ironic that if you don't pay your premium on time, they have their ass covered with the ability to cancel your policy after 60 days, but THEY can take up to a year of more to pay a claim, haha.
On the subject of Medicaide, Tennessee in the last year or so cancelled completely their Tenncare program, and revamped it. They started over essentially with stricter requirements to qualify, and they have made sure first and foremost that children and the elderly are not left without care. When they started over and required re-qualification, they automatically lost a lot of people that were not actually qualified, or that had been defrauding the system.
I think that this is where most states are at this time. They are at a point where they need to stop, renegotiate the entire program, and start over.
Sure the program is leaner, and doesn't cover as many or as much, but it has been revamped to do away with some of the rife misuse and abuse.
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