Silicon Investor (SI) -- The First Internet Community

STOCKTALK

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor. We ask that you disable ad blocking while on Silicon Investor in the best interests of our community. If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.

Politics : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?

To: Road Walker who wrote (378957)	4/19/2008 12:06:50 PM
From: i-node	Read Replies (1) \| Respond to of 1578294

Many many millions of people are underinsured, because that is the only thing they can afford or that is all that is provided by their employer. You may feel comfortable with a $5K deductible but for a lot of folks $5K can put them in bankruptcy. This is nonsense. While nobody in his right mind would file for bankruptcy protection over a $5,000 debt, let's assume, arguendo, that you are correct. We (the nation) simply cannot take responsibility for someone who cannot handle a few thousand in medical expenses. I'm sorry, it just isn't our responsibility. I know of no medical facility, ANYWHERE, who would deny service to someone over the deductible on their health insurance policy. Universal coverage is a fine goal, and should be pursued. And it can easily be done with socialization of the payment system. If you take the bloated insurance companies out of the system, then you could adequately insure everyone and still reduce the costs towards the European system, at about 50% of our system. The side benefits would be to eliminate the adversarial relationship between insurer and insured (where insurance workers are actually paid commissions to deny claims) and streamlined claim requests and subsequent lower overhead for doctors, clinics and hospitals. As someone who makes his living in this specific industry, I cannot begin to convey to you how little you understand about this subject. Insurance companies are not motivated to be "bloated". United Healthcare, for example, totally eliminated its precert program because they found it was not productive FOR THEM and was a waste of healthcare provider's time in the process. I do not believe your remark that commissions are paid to DENY claims. I'm sure some companies pay bonuses for efficient processing, but that isn't "denying". If you have a link I would be interested in reading about it -- still, I doubt the reliability of such a story as I do not think this practice exists, at least not with any reputable insurance company. The simple truth is that private enterprise, with all its problems, is far more efficient than government. While state BCBS programs process payments within 10-14 days, Medicare requires twice that. Another example is the NPI implementation required by HIPAA -- a law established in 1996 under the Clinton administration. We've known NPI was coming for 10 years. So, the final implementation is May 23, and Medicare is a mess because of the lack of communication with providers on the issue, and almost every state Medicaid program has been unable to get compliant in time for the test phase that began in March. Practically every commercial insurance is now accepting NPI-only claims. Commercial insurance effectively subsidizes Medicare & Medicaid programs. These programs would not be able to do what they do without commercial insurance because they do not pay sufficiently to adequately compensate providers. It is not unusual for a commercial insurance company to pay twice (or more) what Medicare pays for a given procedure. For example, for a level 4 office visit (99214) Medicare allows $82, while Qualchoice (not even one of the better paying plans) allows $119. If a provider does not have a sufficient number of commercial insurance patients, he literally cannot make ends meet. Medicaids are worse, as they often deny ANY coverage for certain procedures. Medicaid here pays $1100 for the global fee for delivering a baby -- that includes five monthly visits, the delivery, as well as a follow up visit. And I know of no OB/GYN who refuses this work, even though OB/GYN malpractice insurance is among the most expensive (I actually had one OB/GYN client who literally closed his doors when hit with a $300,000 annual malpractice premium). Liberals want to bash the health care business, but in all, it does a pretty excellent job. Once again, I just think that most of you lack the capacity to look a little more analytically at the problem. I'm not saying there isn't room for imporivement, but changes to the system must come in the form of tweaks not major legislative changes (like HIPAA) which provide little benefit while corrupting an existing system that has worked well in the past.