Cimarron29414

Do you want to rent it from NetFlix?

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...how about BlockBuster?

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Apology accepted.

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"Here lies The_Jazz: Killed by an ambitious, sparkly, pink butterfly."

dippin

Well, maybe because a sign that talks about watering trees with blood is a direct call to assassination, whereas a movie that imagines what would happen in the event of an assassination, and in no way paints it as a triumph or as something leading to desirable outcomes (quite the contrary) is not...

aceventura3

Currently in Medicare there are medical practitioners that opt into Medicare and there are some that opt out. There are some that accept the Medicare "usual and customer" payment and some who don't. Medicare has standard protocols for common treatments that they reimburse or pay based on that national standard. If an individual's treatment involves a doctor who has opted out, or bills more the "usual and customary", or goes outside of the standard treatment protocol for common conditions, the cost has to be paid by the individual. This forms one of the basis' for the "death panel" concern.

__________________
"Democracy is two wolves and a sheep voting on lunch."
"It is useless for the sheep to pass resolutions on vegetarianism while the wolf is of a different opinion."
"If you live among wolves you have to act like one."
"A lady screams at the mouse but smiles at the wolf. A gentleman is a wolf who sends flowers."

dippin

Except that the movie in no way portrays the outcome of the assassination as positive or desirable... that is akin to saying that "red dawn" was a call for a communist invasion...

---------- Post added at 12:48 PM ---------- Previous post was at 12:45 PM ----------

how is that in any way a "death panel?" First, if it's something already in place then it can't be a feature of the proposed reform. Second, how is this a "death panel?" Third, so is she advocating that doctors be forced to take medicare?

roachboy

yeah, see this is what i was referencing when i talked about the degenerate state of political debate, particularly around this topic.
which is compounded in my view because obama is simply not going far enough fast enough in advancing a clear, coherent plan.
the problem seems to be tactical on his side: build consensus around the general proposition that the existing system is not sustainable/workable.

as for the right, it really appears that they have no coherent position from which to argue against the plan but a clear tactical imperative to appear to be politically viable by mobilizing their demographic to stop such debate as there is by generating a level of noise that simply grinds it to a halt. what's depressing within this is that to do this, they seem to have tapped into the same demographic that was running to buy up as many guns as possible when obama was elected---so what you've got, it seems to me, is an opportunity for far right petit bourgeois being-aggrieved as the center of a position regarding health care. which is absurd, and a pretty clear indication of the strategic debacle that the right now finds itself trying to work a way out of.

this isn't to say that all conservative opposition is like this--but it's pretty hard not to see in what the right is doing en bloc much beyond a reflection of total disarray.

so the right has found itself backed into a position where their strategy is to say everything and anything to grind the debate to a halt, as if by doing that there's anything possible beyond a pyrrhic victory.

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

dksuddeth

I found some interesting comments from some people here.

http://www.tfproject.org/tfp/tilted-...ed-panned.html

__________________
"no amount of force can control a free man, a man whose mind is free. No, not the rack, not fission bombs, not anything. You cannot conquer a free man; the most you can do is kill him."

Cimarron29414

I didn't watch the movie, so I couldn't say what it portrays. This guy had a sign and a gun. I don't know anything else about him, he was peaceably assemblying and breaking absolutely no laws. We are all looking at him through our political filter and trying to judge his intent. I'm not giving him the benefit of the doubt, I am pointing out that to suggest that others didn't think about assassinating Bush is simply disingenuous.

As to the "Death Panels", I believe the verbage that gives people pause is section 1233. Personally, I just think it is really poorly written and opens itself up to fear mongering. To me, this section is simply evidence that idiots are writing these laws - how could you write something so vague regarding something so important to people? I don't think there will be death panels to "go before" and plead for your life - but why write it so that it could even be open for (albeit ridiculous) interpretation.

How about this: An organization will be created and made available to the public which will help individuals arrange their affairs in the event of their death. This organization will be available to people of all ages but will focus on outreach to the elderly. Services available will include "How to write a living will" and "How to write a state specific will", as well as state-specific information on hospice and probate. There ya' go. Easy - Peasy.

__________________
Gives a man a halo, does mead.

"Here lies The_Jazz: Killed by an ambitious, sparkly, pink butterfly."

Martian

I've been mostly a silent participant in these discussions so far, but I have to say that as an outsider I find it bizarre that so many people are opposed to something so basic and fundamental as universal healthcare. Perhaps other non-US members have different opinions, though.

I find myself wondering how opinions break down in terms of immigrants or US citizens who've spent time living abroad. Y'know, people who've experienced such systems in action.

Also, I miss Ustwo. It's been a long time since he's told me that the healthcare system I rely on is in a perpetual state of near-collapse.

As for the sign, not being an American citizen and being only passingly familiar with your history, I had to look up the quote in question. What I found was this:

Taken in the context of some of the rhetoric swirling around President Obama, this seems like a pretty clear message to me; I doubt he's calling for the blood of patriots to be spilled. Adding the gun in that context is a bit of an odd choice on his part -- perhaps he was hoping that the secret service agents would be as poor history students as I am.

The whole thing is merely an aside, though.

__________________
I wake up in the morning more tired than before I slept
I get through cryin' and I'm sadder than before I wept
I get through thinkin' now, and the thoughts have left my head
I get through speakin' and I can't remember, not a word that I said

- Ben Harper, Show Me A Little Shame

roachboy

my sense is----but this is only my sense----that the opposition to universal health care from the right plays to the same logic that informed opposition to programs like welfare. the source of it is the usual sense of conservative-as-victim, the upstanding horatio alger type who did everything with no help from anybody or anything, pure gumption and will and all that, who is not being persecuted for real or imaginary financial success by being required to participate in evil programs that redistribute wealth. programs that fashion systems for killing other people in large number are just fine--but redistribution of wealth for some larger socio-political goal--well that's just bad. behind that probably lay class and/or status anxiety, but framed in such as a way as to stand it on it's head.

so the opposition is pitched more toward a kind of shared sensbility or demographic than toward the actual issues involved with this particular proposal.

i think while my exact sense is of course my own, the tactical choices being made by the conservative establishment are pretty clear.

__________________
a gramophone its corrugated trumpet silver handle
spinning dog. such faithfulness it hear

it make you sick.

-kamau brathwaite

connyosis

I agree with you. I keep reading that universal healthcare is the most horrible thing ever invented. Why is it so horrible? Really? I've lived with it for almost 30 years now and I still have not seen any death panels around. Maybe I'm just lucky though...

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If atheism is a religion, then not collecting stamps is a hobby.

scout

If there is no coherent plan how can there possibly be a coherent response?

I'm with you, I think {Obama} jumped into this thing without any real plan other than to rally everyone around "we have to do something" rather than having a real plan with real solutions and I think it's a tactical misstep. If Obama had come out and said he was going to offer every legal resident the same plan our elected representatives are enjoying there wouldn't be near the outcry. He made some serious mistakes with this debate from the very beginning.

People are getting real sick of politics as usual and I think some of that is spilling over into these town hall meetings as not all the frustration is centered upon healthcare. People are generally mistrustful of their elected representatives and the government as whole.

__________________
"The beauty of the second amendment is that it will not be needed until they try to take it."
Thomas Jefferson

Derwood

I also agree. Part of the reason that there is little to no reasoned, rational debate is because there aren't enough details to debate about

Rekna

Don't the insurance companies already decide to not cover certain things or perform recission? It seems to me like the insurance companies are the death panels.

rahl

I think part of the outrage is that the bailouts didn't seem to sit well with most americans because it was rushed and didn't have many stipulations and the proposed healthcare bill seems to be more of the same

---------- Post added at 07:06 PM ---------- Previous post was at 07:03 PM ----------

Insurance companies don't decide not to cover someone based on a "death panel". If a procedure or condition isn't covered it is stated clearly in the policy that is issued.

ratbastid

That's so interesting. I have a bunch of questions about that, if you'd be willing to flesh this out a little for me. The only other person I've seen lay it out so plainly like that is Rush Limbaugh, and he's not available for my questions. I really don't mean these questions as point-scoring questions. It's just that this statement is so unfathomable to me, I'm really interested in getting where you're coming from about it.

Do you consider yourself a patriot? If so, how does hoping for the failure of the President of the United States square with that?

See, I think if the president fails, the country fails. I think we failed for almost the entirety of our last administration, as a result of that administration failing. Are you really saying you want more of that? Or, perhaps you want us to fall down the other side of the mountain instead? OR perhaps you reject my assertion that if the president fails the country fails?

What does "fail" mean, in this context?

Will "Obama failing", whatever that means, restore the America you know and love?

What will "Obama failing" produce, exactly? What would his failure be useful for?

As opposed as I was to Bush, I always hoped he'd turn things around. All I really wanted from the guy was for him to not be such a miserable disappointment. I never would have said I hoped he'd fail. I observed his actions and interpreted them as failure. But I think that's different. I don't quite know what my question is related to that... something like: your thoughts?

---------- Post added at 07:45 PM ---------- Previous post was at 07:42 PM ----------

What about rescission? People are finding themselves being dropped the minute they come down with expensive conditions that are supposed to be covered, for any minute and sometimes even fictional reason the insurance company can find.

Tully Mars

I can't speak about death panels because, well that just sounds like BS to me. But I call BS on "If a procedure or condition isn't covered it is stated clearly in the policy that is issued." I had the same procedure 10 or 11 times on my spine, nerve block, in an attempt to repair nerve damage in my leg. This was clearly covered in my policy. My insurance, Cigna, covered the first, kick back the second without reason, paid for the four and fifth and then paid for, I think, the eighth. Now these procedures weren't questionable, three doctors told me this was the correct course of action. The insurance folks used excuses like incorrect coding, non preapproval etc... All of that was Bull Shit. They fought tooth and nail not to pay for the ones they rejected. I had to hire an attorney to get them to pay. I was lucky. I had the cash to hire legal help, lots of folks don't.

So to think that "insurance companies don't decide not to cover someone" that it's all in the policy, it's cut and dry. No they try to get out of every out pay they can. I had one lady at the insurance company literally tell me they'd been told to reject X number of claims and that their pay was increased (by bonus) if they successfully rejected a certain number of claims.

These health insurance companies that are spending major cash lobbying and getting this "Astroturf" movement moving are doing so out of fear they'll lose the option of bilking billions out of their policy holders. They want no part of a public option because they know to complete with it they'll have stop feeding at the trough.

__________________
I used to drink to drown my sorrows, but the damned things have learned how to swim- Frida Kahlo

Vice President Starkizzer Fan Club

ratbastid

Bottom line, right there.

Fortunately, enough members of congress are getting pissed off about this bullshit that they're looking to take action.

Rekna

Ever heard of rescission? Look it up.

rahl

While your circumstance is a terrible one this is not general practice across the board. There is shady practices in insurance no question, but there is in virtually every business because those businesses are run by PEOPLE. I can't speak for cigna or the people that work there since I'm not employed by them, but with my company, we will deny a claim based on a few very specific reasons: a)was the policy in force at time of incident? b) was the injury or loss specifically excluded in writing on policy? and c) was the injury or loss intentional or occur during the process of a felony?

---------- Post added at 08:18 PM ---------- Previous post was at 08:10 PM ----------


rescission has nothing to do with denying a claim. It has to do with cancelling a policy, which is limited to very few specific circumstances. One being lieing on an applicaiton

ratbastid

Really? Nobody goes back to look and see if the insured left their middle name off the application, when that multi-million dollar diagnosis comes in? Because insurance companies in general are doing that like crazy. If yours doesn't, then either you don't know about it (because really, who would tell the whole staff about your evilness?), or your company is the one saint in the cesspool.

rahl

That's really unfair. I already said that there may be some instances that people employed by insurance companies may act unethically. Show me a single industry that this isn't the case. Does the insurance industry AND medical industry need some tune ups? Absolutely. But you can't lay the blame entirely on Insurance companies. Just like you can't lay the blame for the financial crisis in this country entirely on the banks.

Charlatan

As an outsider, I am simply (and continually) amazed at how your nation manages to even function with such division over such basic ideas (and ideals).

__________________
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- Old Man Luedecke

Tully Mars

I call bull shit yet again. I spent a lot of time in waiting rooms over a two and half year period. I've heard so many people tell so many stories, many almost exactly like mine, that I in no way believe insurance companies don't spend a good deal of time and money simply making it difficult for people to get their claims processed. "This codes wrong, should be out patient.... denied" "Forms states patient is female, insured is male... denied." Form states procedure preformed on right shoulder, pre-approved for left... denied." And on and on. Once it's denied getting it not denied is like putting toothpaste back in the tube. Like some circle jerk from hell. "Oh, yes we'll just change the code." "Oh, that? That's an obvious mistake we'll change it. Don't worry about it." Two months later you're getting a letter and call from a collection agency. I used to see the same people in the waiting room so often we'd trade "war stories" about the insurance and collection agencies. I got to where I had a three inch thick file of names, conversations, dates and times. Really helped once I had to hire an attorney. I highly recommend keeping detailed notes if you find yourself in this situation. I have no doubt you'll be told "this" by person "A" and "that" by person "B." Or person "B" will have no idea what person "A" said or who they were.

I talked to a guy who must have been 55 or so and he was in tears because he didn't know how to get the insurance company to pay for his wife's care and the hospital was refusing to proceed without payment. After listening to him I think the good people at the insurance company were just playing a waiting game and figured dead people don't need care.

__________________
I used to drink to drown my sorrows, but the damned things have learned how to swim- Frida Kahlo

Vice President Starkizzer Fan Club

rahl

Like so many arguments in these forums, your personal experience or experiences of a few people you know can not and do not prove anything, other than the fact that you had a bad experience. There are proper procedures for filing any type of paperwork and if things aren't filled out properly they are void. If you write a check on 08/11/2009 but dated it 10/11/2009 and try to cash it before then the bank will say no way. Is the bank some evil corporation trying to steal your money from you? Of course not. Even though you made an honest mistake, perhaps like that of the person coding your claim, you can't circumvent procedure.

Tully Mars

Yeah, I just happen to run into 20 or 30 people who were having the same type problems as I was over a 30 month period solely by random. Obviously a complete anomaly.

And if an industry, as a whole, makes the process so confusing and difficult to follow half or more of customers' claims get denied it's the customers fault for not understanding it.

Credit card companies are doing the same thing. What used to be a two page contract any high school kid could understand has become a thirty page, fine print, bunch of legalese most people can't comprehend. Oh, they comprehend the gist of it once they're 5 days late and get hit with a $50 late fee and an 15% interest increase.

People are pissed off at these industries for a reason. They treat many of their clients the same way con men treat a mark. And until recently they had little to worry about. Most people have few options when it comes to their HI, they take whatever their employer is offering. If a public option was actually available a lot of this crap would dry up and blow away.

In a way this is kind of like the reason used car salesman became a punchline... because they were a joke.

__________________
I used to drink to drown my sorrows, but the damned things have learned how to swim- Frida Kahlo

Vice President Starkizzer Fan Club

dippin

I am amazed by this little game of yours. In the other thread, when people mentioned comprehensive, national level data, you sidestepped it. In this thread, when people use their own personal experiences, you dismiss as it as exceptional circumstances. What would it take to convince you that there is something majorly wrong in the American healthcare system? Because it seems no matter how comprehensive the evidence you find some way of dismissing it.

As for personal experiences and such, my uncle was a psychiatrist in a suburb of Baltimore for some 30 years. You will not find a single person more staunchly in favor of single payer healthcare.

The arrangement insurance companies had with his hospital was something that would make most people really pissed off: they got X amount for population covered in their area per year. If they kept their costs under X, they turned a profit, if it came out over X, they had to cover the difference themselves.

That (and other stories like that) are the reasons why I think tort reform is a major threat to people. Insurance companies really put a lot of pressure on doctors to reduce costs and tests, and the only thing that pushes against that is the threat of legal action.

dksuddeth

really? what action do they think they'll be able to take without paying for it at the polls?

__________________
"no amount of force can control a free man, a man whose mind is free. No, not the rack, not fission bombs, not anything. You cannot conquer a free man; the most you can do is kill him."

ratbastid

The worst part is, you can't even get a god damn refund. You've been paying your premiums faithfully like a good little customer, they come along and say, "Oooh, sorry, no, there was something wrong with your application. We're taking back that we ever issued you a policy, but... yeaaah, we'll be... we'll be keeping your payments to date. Okay, so, yeah. Thanks."

I'm SO damn ready for a public option. Let the bastards die on the vine.

---------- Post added at 09:35 PM ---------- Previous post was at 09:34 PM ----------

I think they're ready to alter the rules under which an insurance company can reconsider whether they're going to cover a policyholder, for one thing.

Some of them will take a hit in their campaign contributions from the insurance industry, though, you're right about that.

rahl

And if an industry, as a whole, makes the process so confusing and difficult to follow half or more of customers' claims get denied it's the customers fault for not understanding it.

Credit card companies are doing the same thing. What used to be a two page contract any high school kid could understand has become a thirty page, fine print, bunch of legalese most people can't comprehend. Oh, they comprehend the gist of it once they're 5 days late once and get hit with a $50 late fee and an 15% interest increase.

People are pissed off at these industries for a reason. They treat many of their clients the same way con men treat a mark. And until recently they had little to worry about. Most people have few options when it comes to their HI, they take whatever their employer is offering. If a public option was actually available a lot of this crap would dry up and blow away.

In a way this is kind of like the reason used car salesman became a punchline... because they were a joke.[/QUOTE]


When you sign up for insurance the application is around 5 pages long. You fill out basic info like name, birthday, ssn, dependant info etc. Then there is a page(or more if needed) for previous medical history. Underwriters review your application and charge you a premium accordingly. If you have a pre-ex that will generally be excluded. I never said if a claim is denied it is YOUR fault. Like I said, hospitals have to process hundreds of claims each day, when dealing with so many codes and so many patients sometimes they get screwed up. It's not your fault, it's not the insurance companies fault. But if a claim comes in and it's incorrect what are they supposed to do?

Derwood

allowing the simple problem to be fixed and resubmitted would be a start

rahl

[quote=ratbastid;2686455]The worst part is, you can't even get a god damn refund. You've been paying your premiums faithfully like a good little customer, they come along and say, "Oooh, sorry, no, there was something wrong with your application. We're taking back that we ever issued you a policy, but... yeaaah, we'll be... we'll be keeping your payments to date. Okay, so, yeah. Thanks."

If you receive a cancellation notice dated today 8/11/09 stating that your policy was cancelled effective 6/1/09 and you have paid premiums for all of june july and part of August, The insurance company is REQUIRED by law to refund your premiums, or they are subject to loose their status to sell policies in that particular state enforced by the state department of insurance. Also if you have insurance through work, they can not cancell your policy...YOU can't even cancell your own policy if you are using pre-tax dollars to pay your premiums under the "IRS section 125 plan" better know as a "cafeteria"plan unless you have a qualifying family status change(marriage, divorce, kid,etc).

---------- Post added at 09:50 PM ---------- Previous post was at 09:48 PM ----------

Let the bastards die on the vine.



Thanks

---------- Post added at 09:54 PM ---------- Previous post was at 09:50 PM ----------


I'm not playing any games. I'm trying to convey how things work in the insurance industry. What national data did I side step exactly?
The other thread is a pub discussion so there was no data. I have stated countless times that I agree that things need fixed in the healthcare industry, but I'm also stating my opinion aboloshing Insurance companies(my job) is not desireable for me thats all

---------- Post added at 09:58 PM ---------- Previous post was at 09:54 PM ----------

I agree. One thing people should know is that if you are having any problems with your claims or insurance company in general go to your HR director. They will get in touch with the Broker who has the case. It is in the Brokers interest to get all legitimate claims paid, so he will get the repeat business. I promise He will do everything in his power to assist you.

Tully Mars

I refer you back to my previous comments-

Quote:

"This codes wrong, should be out patient.... denied" "Forms states patient is female, insured is male... denied." Form states procedure preformed on right shoulder, pre-approved for left... denied." And on and on. Once it's denied getting it not denied is like putting toothpaste back in the tube. Like some circle jerk from hell. "Oh, yes we'll just change the code." "Oh, that? That's an obvious mistake we'll change it. Don't worry about it." Two months later you're getting a letter and call from a collection agency.

First the codes are so difficult to understand even the people who do it for a living are getting them wrong... repeatedly. Hmm, now who would have an interest in making this confusing? I mean who would benefit if a claim was erroneously rejected for payment?

Second if, as I stated above, you contact the policy issuer and are told "Oh, that? That's an obvious mistake we'll change it. Don't worry about it" that should be the end of it. But I had this happen repeatedly and that was never the end of it. Again once it was denied getting not denied was like putting toothpaste back in the tube.

Third, the application may be a few pages with simple questions but the last policy I had filled three booklets, the shortest was about 25 pages and I think it discussed what was and wasn't covered regarding mental health care. After reading all three books I felt like filing a claim for some mental health care.

Finally I'll just quote ratbastid-

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Vice President Starkizzer Fan Club

The_Dunedan

In regards to The Plan itself, the quotations below are from HR 3200, my own commentary is in bold.

Section 102: prevents ensureres from changing rates, or enrolling new policy-holders as of the date the prospective Law went into effect. This will put private insurance companies out of business.

(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term `grandfathered health insurance coverage' means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(1) LIMITATION ON NEW ENROLLMENT-

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

Section 123: provides for an "advisory committee" to decide who gets what, composed mostly of career bureaucrats beholden to the President. Historically, such persons have been most reluctant to give The Man the Bad News, and so things like Walter Reed or Romanian orphanages persisted.

(1) IN GENERAL- There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.

(2) CHAIR- The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.

(3) MEMBERSHIP- The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:

(A) 9 members who are not Federal employees or officers and who are appointed by the President.

(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.

(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.

Section 163 amends the Social Security Act to provide for real-time Federal-level access to all personal medical and financial data, including but not limited to bank-account information and credit ratings. It also provides for a machine-readable national ID card system, at least for those who are utilizing the system

SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

(a) Standardizing Electronic Administrative Transactions-

(1) IN GENERAL- Part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.) is amended by inserting after section 1173 the following new section:

`SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.

`(a) Standards for Financial and Administrative Transactions-

`(1) IN GENERAL- The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).

`(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS- The goals for standards under paragraph (1) are that such standards shall--

`(A) be unique with no conflicting or redundant standards;

`(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;

`(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;

`(D) enable the real-time (or near real-time) determination of an individual's financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;

`(E) enable, where feasible, near real-time adjudication of claims;

`(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;

`(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and

`(H) harmonize all common data elements across administrative and clinical transaction standards.

Shall we continue? This thing is a monstrosity.

rahl

[quote=Tully Mars;2686473]I refer you back to my previous comments-




First the codes are so difficult to understand even the people who do it for a living are getting them wrong... repeatedly. Hmm, now who would have an interest in making this confusing? I mean who would benefit if a claim was erroneously rejected for payment?

Conspiracy theorist much?

---------- Post added at 10:08 PM ---------- Previous post was at 10:04 PM ----------


They can't just take your word for it just because you said so. You need to work with the hospital and get them to contact the insurance company and refile the claim correctly.

As to your third point. The 25 page booklet you receive is not an application it's called an explanation of benefits. There are alot of things involved with healthcare...ER, Urgent Care, Primary Care Physician, and yes mental Health.

ratbastid

This is a nice summary, from the "aging" blog at psychologytoday.com. it begins with all you need to know about health care in 25 words.

Health Care In Exactly 25 Words | Psychology Today

rahl

The only problem I have with that is that the vast majority of seniors need to buy medicare supplement plans to cover the things that medicare doesn't, mainly prescriptions. So IMO medicare is not the perfect template or solution to the health care crisis

Tully Mars

[quote=rahl;2686476]No, I'm not. Just had the displeasure of being treated like a tool and taken for a fool (and watched other people suffer the same) for 30 months or so by the insurance industry.

As to your other point...

Ok if they shouldn't take your word for it then they should tell you stuff like "Oh, that? That's an obvious mistake we'll change it. Don't worry about it" Yet a started a detailed file because I got so damn tried of hearing that then getting contacted by a collection agency. By the time I was due to go to court, which never happened- they settled, that file was as thick as a average dictionary.

You want to believe your industry is by and large a helpful customer friendly business by all mens do so. Personally I don't and won't buy that pig. I was and I know a lot of other people who have been screwed raw, sans lube, by your industry.

I keep hearing people talk about how the US has the best health care system in the world, like that's some fact not in question. Sure the US has some of the best hospitals, wealthy people from all over the world travel to seek care from them. But that's not the care most people have access to, how many times have we've seen the videos of people being pushed out onto skid row because the hospital wouldn't care for patients? Or the people dying in the ER after waiting 17+ hours. I currently live in Mexico and the health care system here is (yep just my opinion, no data here) hands down better then that of the US' My doctor, very capable and well trained, makes house calls if needed, spends about 45 mins with me each visit... total cost $60 USD a visit. If I just need an Rx refill no charge. I if can't find my Rx, she'll personally call around and find it for me. I'm a US citizen, I pay full price for my health care here. Mexicans are charged a yearly premium based on income. Some pay nothing others pay as much as 500 USD a year. After they pay their premium there are no co-pays or deductibles. Get hurt or sick, go the doctor and it's covered.

__________________
I used to drink to drown my sorrows, but the damned things have learned how to swim- Frida Kahlo

Vice President Starkizzer Fan Club

rahl

[QUOTE=Tully Mars;2686510][quote=rahl;2686476]


But that's not the care most people have access to, how many times have we've seen the videos of people being pushed out onto skid row because the hospital wouldn't care for patients? Or the people dying in the ER after waiting 17+ hours. QUOTE]


I've never seen one of these video's. Hospitals are required to treat every patient that walks through the doors, insurance or no insurance, that's the law. I've also never heard of anyone waiting 17+ hours in an ER unless there was some sort of disaster like a flood, earchquake or 9/11. Both of these points have nothing to do with an Insurance company

Tully Mars

[quote=rahl;2686515][QUOTE=Tully Mars;2686510]I'm not going to search youtube for you right now, I have things to do at the moment. These have both been on CNN, Fox, and all the major networks. I'm sure the videos are out there somewhere.

And they absolutely have to do with health care (that's the topic of this thread, yes?) If there were a public option and safety net these people's care would have been paid for and they would have received care. No 9-11, no natural disaster... just didn't have coverage.

__________________
I used to drink to drown my sorrows, but the damned things have learned how to swim- Frida Kahlo

Vice President Starkizzer Fan Club

dippin

Bullshit, either generated by lack of reading comprehension or willful distortion. It doesn't say private companies will not be able to enroll new people, nor that companies can't change rates. This section simply means that current health insurances can continue to exist exempt from the coming new regulations, but that it can't enroll new people under the old policies after the regulations go into effect. It in no way prevents insurance companies from enrolling people in new policies under the new guidelines. It takes a considerable amount of spin to turn something that is essentially making a whole set of policies immune to the new regulations as some sort of new draconian regulation


Bullshit. The text itself already contains language that debunks the "career bureaucrats" spin, given that the number of "federal employees and officers" cannot exceed 8, and given how 9 members are nominated by the Comptroller General, who is not in any way under the president. Add to that the missing part ("duties") and the whole notion of career bureaucrats deciding "who gets what" is ludicrous. The "advisory committee" doesnt even make decisions, but advises the secretary of health and human services what the standard benefits should be like.


bullshit. I wonder why you stopped quoting it there, and did not include the following sections:

"(b) Limitations on Use of Data- Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.

‘(c) Protection of Data- The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are--

‘(1) used and disclosed in a manner that meets the HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), including any privacy or security standard adopted under section 3004 of such Act; and

‘(2) protected from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.’."



This is what pisses me off. People want to be against it because they don't like the merits? Fine. People want to mislead others, selectively quoting and spinning the legislation to make a false claim? That is bullshit.

The first section basically says that none of the new regulations and standards affect the old policies. It doesn't prevent any insurance companies from selling new policies, it simply prevents them from selling the old policies to new clients, which is a given when any new regulations come into effect.


The second section basically means that there is an advisory committee that makes recommendations on what the basic level of coverage should be. The advice is non binding, is not individualized, and does not stop anyone from getting additional health coverage if the public system has insufficient benefits for a given condition.

The third section coded simply says that the new public system should be constructed in a way as to reduce paperwork and increase efficiency by creating an electronic database. It does not allow anyone to collect any additional data, or any of the data that the government is currently not allowed to have.