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Medical insurance co-payments

NickD on Thu April 15, 2004 7:15 AM User is offline

Gosh the paper work is astounding with Medicare, I was kicked off my 30 year old health plan this month as they claim I should be on Medicare. I have a stack of mail about a foot high for Medicare supplemental health insurance and an 3/4" thick book explaining Medicare coverage that is worse than reading an MS Dos manual.

I am told that I need Medical supplemental heath insurance because Medicare doesn't cover everything or anything, I haven't figured that out yet. But Medicare does say something about a co-payment and I believe these supplemental heath insurers are suppose to cover that co-payment. But just plowing through some of their literature, they off two different plans, one with a co-payment that is a bit cheaper and the other without a co-payment. Looking at the cheapest supplemental insurance, I have a choice of either paying $240.00 extra a year without the co-payment, or just pay a $20.00 co-payment each time I see my doctor.

Well, since I only see a doctor once or twice per year, it make sense just to pay that extra twenty for each visit as I would have to have at least 13 visits per year to come out ahead. But then it occurred to me this morning that back as late as the 70's, without any health insurance period, a typical doctor visit had a flat charge of five bucks for an office visit. And even back then, doctors were very well to do.

Now with two insurance plans, I have to pay 20 bucks for that two minute visit? That is four times as much as it was 25 years ago, plus I have to pay an extra bundle in monthly premiums. Back then it was only 40 bucks a night to stay in a hospital, so who cared about health insurance?

Recently I had some lab work done before I hit that magic age, but had a doctors appointment to let him tell me the results were negative, that was hardly a five minute visit, well, I did have to wait about an hour in the waiting room to see him. He billed Medicare $364.00 dollars for that five minute visit and Medicare said my share was half of that. But someone told me I only pay half of that until I hit something like a 800 buck deductible or something, I am so dang confused right now no one can square me away. But should I pay $1,300.00 a year in supplement health insurance premiums to cover a 800 buck deductible while sill paying that 20 buck co-payment price?

I am so screwed up on this insurance that I doubt if anyone could square me away. Shouldn't just my 20 bucks cover that five minute visit without all this health insurance?

Why can't I just give my entire paycheck to the government and let them take care of me according to thier minimum standards, the school needed $13,000 per year just to baby sit my kids for five hours a day for half the year, they sure in the hell didn't feed them on that nor teach them anything. So for my share, the government should pay me $104,000.00 per year per kid at that rate.

As it is now, I don't have to pay taxes on $3,050.00 per kid, but that is after I already paid 15% FICA taxes and 5 1/2$ sales tax on every purchase not to mention real estate taxes. Somehow I think we are getting screwed, but what do I know.

TRB on Thu April 15, 2004 3:59 PM User is offlineView users profile

Quote
Originally posted by: NickD
Why can't I just give my entire paycheck to the government and let them take care of me according to their minimum standards. Quote


With the current political climate we are all ready headed in that direction. We will soon need a name change to the USSR!!!!



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NickD on Thu April 15, 2004 4:17 PM User is offline

It's a chain reaction, the medical, insurance, oil, auto, and drug companies charge a little more so they can a couple of the politicians they want, then charge a little more to buy even more politicians, pretty soon they will own all of them.

Where to they get the money for this? From us.

JJM on Thu April 15, 2004 5:57 PM User is offline

Nick,

The problem is most seem to have forgotten what the definition of insurance really is, and that is to protect against unforeseen loss. That clearly is not the present state of medical insurance today.

Imagine using your automobile insurance policy for oil changes, tune-ups, replacing wiper blades, and most other normal maintenance items? How much more expensive it would be? Of course, this seems absurd because auto insurance is purchased to insure against loss in event of the unexpected collision, fire, or theft - something not expected to normally occur. However, this is not the case with health insurance today.

Health insurance should be primarily to insurance against hospitalization and major illness. I see no reason why someone can't pay $50 or $100 for a routine doctor visit, as well as for minor prescriptions and tests. Instead, we go into a doctors office and pay $10 for the visit - and think we're getting a bargain. But someone needs to process the insurance claim paperwork at the doctors office. Then someone at the insurance company needs to enter the claim in the computer, someone else reviews it, another approves it, another runs the check for it, and another mails it out. While this goes on for several weeks or months, a bookkeeper at the doctors office must keep track of this claim, and post the amount of reimbursement when it's finally received. The insurance company shorts the doctor, so the bookkeeper must then direct bill the patient for the balance. You receive the bill, and wish to question it, so you call the doctors office. The doctor now needs a receptionist to handle the flow of calls for billing, insurance, test results, hospital calls... etc. The bookkeeper tells you to call the insurance company, and since the insurance company receives so many insurance claims related questions, they needed to set-up a claims response call center. THIS IS WHY INSURANCE IS SO DAMN EXPENSIVE!!! Wouldn't it be so much easier AND CHEAPER to just give the doctor $50 in cash?

This whole third party pay system of medical insurance must end if costs are going to come down. If you pulled your car out of the garage and scratched the fender, and only had to pay a $10 co-pay, wouldn't you bring your car into the best body shop and have that scratch repaired like new? On the other hand, with a $250 deductible, you might consider a $5 bottle of touch-up paint. Having to lay out $400 to the body shop for the repair, then having to go through all the paperwork of submitting a claim and the worry that the company might drop you, would certainly give anyone pause. When medical insurance WAS like this some 20 years ago, it was VERY CHEAP and it's no coincidence as to why.

Legal reform (loser pays) is also needed; suing doctors and HMO's will NOT improve the quality of health care - quite the contrary. All suing doctors does is fatten lawyers already overstuffed pockets.

Joe

NickD on Thu April 15, 2004 6:59 PM User is offline

LOL, I go around with my auto insurance, and get the best price at $250.00 deductible, if I want $100.00 deductible it will cost me $145.00 more per year and $50.00 deductible would cost me about $195.00 more per year. So if I have at least two claims per year, it would pay to get the lower deductible. But I don't have that many claims, maybe a broken windshield once every three years.

In a heart to heart talk with my glass man, a close friend, while he may show on the invoice to the insurance company that a windshield costs say $450.00 in reality, he only gets $150.00, so the last couple of windshields, I paid him the $150.00 for a new windshield. He likes it, because he gets his money right now. I like it, because with my $250.00 deductible, I have to pay $250.00 and get the strange impression that somehow the insurance company is paying the other $200.00. What a racket.

Same in the medical field, it's typical for a doctor to bill the insurance company twice as much as the insurance company will only pay him half of that. Some doctors demand the full payment they billed the insurance company, others will bill you exactly what they would get from the insurance company.

One thing for sure, the insurance companies are not a charitable organization.

Anonymous on Fri April 16, 2004 12:29 AM User is offline

Quote
Originally posted by: NickD
One thing for sure, the insurance companies are not a charitable organization.

Nor were they intended to be. They are trying to make money just as any business enterprise would.

Unless things change, and soon, persons who rely on Medicare for their health insurance are going to find themselves out in the cold. Here's what's happening:

With Social Security and the Medicare funds running short, our congressmen realize that they have to do something about it. To raise taxes or premium levels might result in a political backlash that would cost them their plush positions in Washington, as would spending the money on the plan instead of pork. So they tell us that they are taking steps to "save Medicare", but not to worry, because they are just reducing the amounts paid to the service providers (doctors, laboratories, hospitals, etc.) There have been several rounds of these reductions.

Each procedure has a prescribed amount Medicare will pay. So Nick, that $364 he billed Medicare for your office visit has nothing to do with what he might collect. If Medicare says that visit is worth only $35, that is all they will recognize and will usually pay only some percentage of that. You or your Medicare Supplement Insurance pays the remaining amount, so $35 (or whatever Medicare recognizes) is what the doctor actually collects.

Now for the down side to this arrangement:

The prescribed Medicare level of payment for some procedures is, in some cases, less than what it costs the doctor to do them. Yet, they cannot refuse to do the procedure for fear of a subsequent lawsuit. It actually costs the doctor out of pocket money to care for that patient. So what is happening is that more and more doctors are refusing to take Medicare patients. A friend of mine had a family doctor for decades, but when he became Medicare eligible, that doctor would no longer see him. The result is that, as Medicare patients, we are going to find ourselves unable to choose the doctor or specialist we might want to use....our quality of care will undoubtedly decline.

Locally, doctors are now beginning to decline to visit their patients who are in the hospital. Once the patient goes to the hospital, he is turned over to interns for continuing care. How would you like to have open heart surgery and then be tended by an intern? The doctor says he can't take the time and make a trip to the hospital for what Medicare will pay him to do it.

Like nearly everything the government gets involved with, they have the medical system so fouled up that a lot of us will probably die prematurely. Primarily because we have a bunch of hack politicians who don't understand the ramifications of the actions they take....and perhaps really don't care as long as they can get enough pork in their home state to be re-elected.

We should bury our congressmen in requests to restore reasonable compensation to health service providers or we will suffer the consequences. Yes, I know doctors make lots of money. Nevertheless, why should they see a Medicare patient that costs them money when they could spend the same time with a patient who either pays or has insurance that pays for their services? Would you?

NickD on Fri April 16, 2004 6:46 AM User is offline

I guess attorneys don't have it easy either, did you watch that medical liability on the O'Reilly Factor last night regarding that 15 year old girl that died from a sloppy abortion? He says he has the largest law firm in Michigan for medical liability malpractice, the limit on liability with some law is $300,000.00, he says he has to dig deep into his pockets to pay for experts to start litigation.

In my own accident, I went to my clinic not seeking notes from my doctors as to how banged up I was, I went there to get fixed, I was broken. I had nuclear scans, MRI's, surgery, therapy that result in a medical file 3" thick. I had to find a law office that would take on my case. To this old time law office, there are only four such experts in the state, the insurance company hired two, and my attorney said we had to counter by hiring the other two. It told me it was phoney, because the two the insurance company would say everything against me, and the two we had to hire would write a report for me. But it could have been the other way around. I never ran into anything so ridiculous in my life. I had to visit all four, the two the insurance company hired they paid for my mileage with no hotel or meal expenses, in the racked up condition I was in, I was expected to make 600 mile trips in one day. In all four cases, I went to small offices and the only equipment these guys had was a little rubber hammer and a stethoscope, and each visit was about 45 minutes to an hour.

I was treated like trash by these experts hired by the insurance company, and was treated with sympathy by the ones we hired, they both had access to my medical records that cost me a fortune as four sets of copies had to be made. The insurance company experts said nothing was wrong with me, my experts embellished my medical records, what a waste, but the bottom line is that the insurance company had limits of liability, and these experts got $50,000.00 of that money that I felt I should have received. If this wasn't enough, both my auto insurance and medical insurance sent a gang of attorneys to my hearing with a claim so they could recover all of their medical expenses, and as this claim dragged on for almost four years, those were very high bills. There wasn't enough money left over for me to buy a cup of coffee.

Oh, and even though I had a very good police report, 23 witnesses to my accident, the kid that hit me had a very poor driving record with only two years on the road, both we and the insurance companies had to hire accident investigators, it's crazy. I also had a hell of a time trying to find an attorney as even these attorneys that came on TV for personal injury cases and will take good care of you, I called them first to learn they were retained by the insurance companies. I had to find an attorney two hundred miles away that also added to his expenses that came out of my pocket. I would have been better off not even to file a claim.

If this wasn't enough, by beloved wife of 25 years seeing me all banged up decides to divorce me, I didn't want to hire an attorney, but she hired one, and before I knew it, I had 9 attorneys involved in our case, social workers, assessors, counselors, more money coming out of my pocket. I was shocked as to the number of people that make a good living in this country at the expense of a victim of both an accident and a divorce.

So I could appreciate what that Michigan attorney was saying when he said very few attorneys in Michigan could even afford to take on a case like that 15 year old girl. But crack smoking Bill says, they should take on cases like this on moral grounds, LOL. Ha, when you visit any attorney, regardless of the case, the first question they ask you, is how much money do they have, it they ain't got any, no sense in even going to court, the only things are courts deal with, is money.

Before I turned 65 and even two months after, I have received a stack of mail from both Medicare and these supplemental insurance companies, must be over a foot high now. It is possible to see a good doctor if you get the right supplemental insurance, but it also costs a small fortune. I would have been much better off on my previous medical plan, but they dumped me since I am over 65 now. I guess they don't want to fool around with all that medicare paperwork.

Think of all the money we could save SS if we die early, not much different that when I was in the military, getting killed would only cost the government $10,000.00 and when you are in the military, no private insurance company would cover you, so you were only worth $10,000.00. This was much cheaper than the GI benefits, but they got around that with that St. Louis fire and still told me to go to hell, even though I have a five inch thick folder with all of my military records in it, and the original copies to boot. But I did get a letter six months ago saying my VA benefits have been restored, ha, why should I even bother. I already paid for my education and not about to drive 10 miles away to the nearest VA hospital. My brother, an MD was working there for awhile, they don't have enough money to buy a Band-Aide. My bother was a career army guy, and felt an obligation to help these poor souls, but could only take so many years of it, this country still doesn't give a good damn about our troops and the ones that do get killed are lucky. Much better to be a government contractor. This is our country.

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