Health Insurance in US
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
I was hoping someone would convince me that the US system actually works, but your experiences and the others posted in the last day or so make me more and more convinced we're on the right track in the UK (even if the system does wobble a lot). When Karen was pregnant with our firstborn (Ciaran) back in 1998, she had all sorts of complications and was constantly in and out of hospital throughout the pregnancy. He was born 4 weeks early by C-section and spent the first week and a half in the Special Care Unit at North Hampshire Hospital. All in all it was a very worrying time, and I'm extremely glad we didn't have to worry about health insurance. :) Andy Metcalfe - Sonardyne International Ltd
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I was hoping someone would convince me that the US system actually works, but your experiences and the others posted in the last day or so make me more and more convinced we're on the right track in the UK (even if the system does wobble a lot). When Karen was pregnant with our firstborn (Ciaran) back in 1998, she had all sorts of complications and was constantly in and out of hospital throughout the pregnancy. He was born 4 weeks early by C-section and spent the first week and a half in the Special Care Unit at North Hampshire Hospital. All in all it was a very worrying time, and I'm extremely glad we didn't have to worry about health insurance. :) Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul WatsonI had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? Have fun, Paul Westcott.
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
Black Cat wrote: We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me. You should read more about these Socialist approaches to healthcare before you pass judgment. Canadians have to wait months and sometimes YEARS for surgery. Several years ago, the president of Simon Fraser University in Vancouver, B.C., died while waiting for a CAT scan. Chances are he would still be alive if he were in the U.S. You can try the url below but I would suggest doing a search on google because there are a lot of sites out there that have to do with the downfalls in Canadian healthcare. Canadian Health Care -Jack To an optimist the glass is half full. To a pessimist the glass is half empty. To a programmer the glass is twice as big as it needs to be.
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
When I was over in Canada a year ago I saw a program about a US medical insurance company that altered the reports made by THEIR doctors so they didn't have to pay anything. :mad: The NHS (UK state health service) has a long way to go but if you aren't rich you're worse off in the US
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
Black Cat wrote: The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. of course they do, when they see cases like #4. they can't afford to be generous with the money they give out because handing out money is *not* their business. they're in the business of collecting money and investing it for themselves. if you want money from them, you've gotta prove that you're entitled under the contract you signed. i'm not defending the system, but that's the way it is. -c
According to convention there is a sweet and a bitter, a hot and a cold, and according to convention, there is an order. In truth, there are atoms and a void. Â Â Â Democritus, 400 B.C.
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Black Cat wrote: We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me. You should read more about these Socialist approaches to healthcare before you pass judgment. Canadians have to wait months and sometimes YEARS for surgery. Several years ago, the president of Simon Fraser University in Vancouver, B.C., died while waiting for a CAT scan. Chances are he would still be alive if he were in the U.S. You can try the url below but I would suggest doing a search on google because there are a lot of sites out there that have to do with the downfalls in Canadian healthcare. Canadian Health Care -Jack To an optimist the glass is half full. To a pessimist the glass is half empty. To a programmer the glass is twice as big as it needs to be.
Jack Handy wrote: Several years ago, the president of Simon Fraser University in Vancouver, B.C., died while waiting for a CAT scan. Chances are he would still be alive if he were in the U.S. I do not know about the Canadian health care system, but the fact that you have a developed health care system supported by the state does not exclude the existance of pay-hospitals (couldn't fina a better word for this). My girlfriend has a health insurance which will pay for treatments at a pay-hospital if needed, such an insurance is out of my reach due to my childhood astma and my diabetes, so i am quite relieved that i live in a country where i get a fair treatment anyway. It may be that a person like Simon Fraser could afford the CAT scan in US, but the large crowd of poor people that are also a part of US are not that privileged. Jack Handy wrote: You should read more about these Socialist approaches to healthcare before you pass judgment Why do you think a developed health care system is a Socialist approach?, i can tell you that when we last year voted for a Liberal government to take over from the democrats, then it was largely because they promised to enhance the health care system and definately not so that they could tear it apart. The problems we are having with the health care system in Denmark are not that of quality, but it seems that we don't get enough out of the money we throw at it. The easy solution would be handing the responsibility over to 'the free market forces', but that does not imply that it is the best and sole solution. Jan "It could have been worse, it could have been ME!"
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
Black Cat wrote: 1. The insurance company almost never pays the full amount it should. The insurance company will typically pay what is called, "reasonable and customary". This is the cost, determined statistically, to be appropriate in a given locale for the incident. --> Otherwise you will have doctors charging whatever they want, not what is reasonable. You also have to consider the deductible, a portion you are required to pay. To fashion the process any other way has costs running amuck. Black Cat wrote: 2. The insurance company seems to assume everyone is guilty (of insurance fraud) 10% of all insurance claims filed involve fraud. A statistical fact. Black Cat wrote: 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. A common practice called cost shifting. Happens a lot. Hospitals shift costs to those with insurance to cover costs of indigents (and others) who have no insurance. Problem is actually worse than you describe. Governmental programs force low charges for those with medicare, for example, then folks with group or individual insurance must pay much more (medical costs, and higher insurance premiums) than they otherwise would --> the wonders of creeping socialism. Black Cat wrote: 4. A friend of mine has a small restraunt. His father had a stroke This is absolute fraud - not a neat way of beating the system. By the way, the insurance company really didn't pay every dime, but all other insureds did. The frequency of such fraudulent activity causes increases in insurance premiums for everyone else. An insurance company operates on the basis of something called a cost ratio - the ratio of premium dollars to claim dollars. Most pay out in excess of 55% to 60% of the preium dollar collected. The difference between the amount the 55% to 60% paid out and the collected premium dollars collected goes for employee salaries, cost of physical plant, with a small profit margin for shareholders. By the way - when the ratio exceeds the 55% to 60% quoted above, the insurance company will begin increasing the preiums of all insureds to cover the increased claims costs. So again, your friend didn't beat the insurance ccompany - he beat all the rest of the insureds covered by the same plan of insurance.
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Black Cat wrote: The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. of course they do, when they see cases like #4. they can't afford to be generous with the money they give out because handing out money is *not* their business. they're in the business of collecting money and investing it for themselves. if you want money from them, you've gotta prove that you're entitled under the contract you signed. i'm not defending the system, but that's the way it is. -c
According to convention there is a sweet and a bitter, a hot and a cold, and according to convention, there is an order. In truth, there are atoms and a void. Â Â Â Democritus, 400 B.C.
Well, it seems like this system offer relatively poor people in medical need two solutions: 1. Commit a crime. 2. Beg for mercy and charity. Nice... Jan "It could have been worse, it could have been ME!"
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. Nah, people would never defraud the insurance companies. Nah. :wtf: Tim Smith I know what you're thinking punk, you're thinking did he spell check this document? Well, to tell you the truth I kinda forgot myself in all this excitement. But being this here's CodeProject, the most powerful forums in the world and would blow your head clean off, you've got to ask yourself one question, Do I feel lucky? Well do ya punk?
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I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? Have fun, Paul Westcott.
Paul Westcott wrote: I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? I shudder to even think about it. :mad: Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul Watson -
Black Cat wrote: 1. The insurance company almost never pays the full amount it should. The insurance company will typically pay what is called, "reasonable and customary". This is the cost, determined statistically, to be appropriate in a given locale for the incident. --> Otherwise you will have doctors charging whatever they want, not what is reasonable. You also have to consider the deductible, a portion you are required to pay. To fashion the process any other way has costs running amuck. Black Cat wrote: 2. The insurance company seems to assume everyone is guilty (of insurance fraud) 10% of all insurance claims filed involve fraud. A statistical fact. Black Cat wrote: 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. A common practice called cost shifting. Happens a lot. Hospitals shift costs to those with insurance to cover costs of indigents (and others) who have no insurance. Problem is actually worse than you describe. Governmental programs force low charges for those with medicare, for example, then folks with group or individual insurance must pay much more (medical costs, and higher insurance premiums) than they otherwise would --> the wonders of creeping socialism. Black Cat wrote: 4. A friend of mine has a small restraunt. His father had a stroke This is absolute fraud - not a neat way of beating the system. By the way, the insurance company really didn't pay every dime, but all other insureds did. The frequency of such fraudulent activity causes increases in insurance premiums for everyone else. An insurance company operates on the basis of something called a cost ratio - the ratio of premium dollars to claim dollars. Most pay out in excess of 55% to 60% of the preium dollar collected. The difference between the amount the 55% to 60% paid out and the collected premium dollars collected goes for employee salaries, cost of physical plant, with a small profit margin for shareholders. By the way - when the ratio exceeds the 55% to 60% quoted above, the insurance company will begin increasing the preiums of all insureds to cover the increased claims costs. So again, your friend didn't beat the insurance ccompany - he beat all the rest of the insureds covered by the same plan of insurance.
Mike Gaskey wrote: This is absolute fraud - not a neat way of beating the system. By the way, the insurance company really didn't pay every dime, but all other insureds did. The frequency of such fraudulent activity causes increases in insurance premiums for everyone else. An insurance company operates on the basis of something called a cost ratio - the ratio of premium dollars to claim dollars. Most pay out in excess of 55% to 60% of the preium dollar collected. The difference between the amount the 55% to 60% paid out and the collected premium dollars collected goes for employee salaries, cost of physical plant, with a small profit margin for shareholders. True - it is fraud, and as such is illegal and wrong. However, I would argue that any patient who can't get insurance in such a system (especially if they're refused it for whatever reason) should be guaranteed the same standard of care as anyone else - regardless of whether they can pay. To do otherwise is to effectively tell them they're not worth saving, which surely should not be something a civilised culture should do. Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul Watson -
2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. Nah, people would never defraud the insurance companies. Nah. :wtf: Tim Smith I know what you're thinking punk, you're thinking did he spell check this document? Well, to tell you the truth I kinda forgot myself in all this excitement. But being this here's CodeProject, the most powerful forums in the world and would blow your head clean off, you've got to ask yourself one question, Do I feel lucky? Well do ya punk?
Tim Smith wrote: Nah, people would never defraud the insurance companies. Nah. Or vice-versa. Never. Honest guv, our premiums are the lowest around. Know wot I mean (knudge, knudge)? ;P Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul Watson -
I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? Have fun, Paul Westcott.
Paul Westcott wrote: I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? I guess I'm confused. In the UK with the NHS does the government just pay any and all bills that a healthcare provider isssues without looking at the cost? If so, what keeps the doctors and hospitals from just charging astronomically high prices and making themselves super rich? Is capitalism at work here or are the prices also set by the NHS? If prices are artificially set, isn't this bound to cause a stagnation in the healthcare field like it would anywhere else in your economy? A few years ago when my mother was fighting cancer the bills started rolling in. Each was turned over to her insurance company. In EVERY case where the bill was deemed higher than what is "usual and customary" in our area the insurance company paid the "usual and customary" cost and the doctor/lab/hospital ate the rest. Most did so automatically, the remaining half dozen did so after I made a telephone call. Basically, I used the insurance company as our "consumer advocate".
Mike Mullikin :beer:Our lager, Who art in barrels, Hallowed be thy drink, Thy will be drunk, (I will be drunk) At home as I am in the tavern, Give us this day our foamy head, And forgive us our spillages, As we forgive those who spill against us, And lead us not to incarceration, But deliver us from hangovers, For thine is beer, The bitter and the lager, Forever and ever, Barmen.:beer:
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I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? Have fun, Paul Westcott.
My inlaws showed my the bill for my wife's birth back in 1955. The complete charge, covering everything, including a seven day stay in the hospital was $125.00. They didn't have insurance because they did not need it. A middle class income was sufficinet to cover their health needs. Health care was affordable because it was driven by market forces (competitive forces:rose: ). Health care costs have far exceeded inflation because they have become independent of simple capitalistic parameters. The reason for this is the reliance upon health insurance scams (it should be outlawed) and because of government bureacratic bungling. Capitalism is the solution to the problem, not socialism. "There's a slew of slip 'twixt cup and lip"
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Someone seems to have said that healthcare in the US is as good as any other country, which I strongly disagree. Both my wife's employer and mine provide "good" health insurance (we have to pay our share of course). However, there are things that are just annoying. 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent. I used to have too much confidence in my health so that I haven't visited a doctor until I was over 40 years old. This must be good for the insurance company since I am paying for my coverage all the time, right? Wrong! When I first visited the doctor to have a check-up, the insurance company refused to pay the bill because they think I have another insurance coverage. But they didn't even bother to give me a call. It was my responsiblity to make multiple phone calls (again) to straighten everything out. 3. When my wife was a poor student, the hospital charged a lot more than the insurance was willing to pay. However they charged less for someone without insurance, so we ended up paying almost the same amount. 4. A friend of mine has a small restraunt. His father had a stroke and stayed in the hospital for two months and the insurance bill was over a million. You thought he would have to go bankrupt because nobody would insure a 80 year old man. But he knew how to play the game, he had listed his father as an employee in his restraunt and ensured him as a new employee a year ago (although he could never work), he and his lawyer made the insurance company pay every dime. We have friends from France, Switzerland, and my brother lives in Canada. According to them, their healthcare are not just better, it almost sounds like heaven to me.
Black Cat wrote: 1. The insurance company almost never pays the full amount it should. We have to make multiple phone calls to get them to pay to the bill, otherwise we will be responsible for it. Sometimes when the amount is small, we just pay ourselves to avoid the trouble. They don't pay the full amount of the bill or they don't pay the full amount they "should"? If the former is true then I suggest you use them as your advocates and refuse to pay the doctor more than what is "usual and customary". If the latter is true, than your insurance probably isn't as "good" as you think. Black Cat wrote: 2. The insurance company seems to assume everyone is guilty (of insurance fraud) until proven innocent.... ...It was my responsiblity to make multiple phone calls (again) to straighten everything out. First, read your comment #4. It's not "playing the game" it's "insurance fraud" and it is a felony. Secondly, whose responsibility should it be to straighten out your insurance issues? Do you really think paying bureaucrats would 1.) be more cost efficiant and 2.) cause any less confusion?
Mike Mullikin :beer:Our lager, Who art in barrels, Hallowed be thy drink, Thy will be drunk, (I will be drunk) At home as I am in the tavern, Give us this day our foamy head, And forgive us our spillages, As we forgive those who spill against us, And lead us not to incarceration, But deliver us from hangovers, For thine is beer, The bitter and the lager, Forever and ever, Barmen.:beer:
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Paul Westcott wrote: I had a friend in the US who's wife had complications with her pregnancy. They ended up with a 20K (30K? something like that) bill that I believe their health insurance finally paid for. But it was a long long fight to get them to cough up. That would have been a fun stress at the same time as looking after your first-born wouldn't it? I guess I'm confused. In the UK with the NHS does the government just pay any and all bills that a healthcare provider isssues without looking at the cost? If so, what keeps the doctors and hospitals from just charging astronomically high prices and making themselves super rich? Is capitalism at work here or are the prices also set by the NHS? If prices are artificially set, isn't this bound to cause a stagnation in the healthcare field like it would anywhere else in your economy? A few years ago when my mother was fighting cancer the bills started rolling in. Each was turned over to her insurance company. In EVERY case where the bill was deemed higher than what is "usual and customary" in our area the insurance company paid the "usual and customary" cost and the doctor/lab/hospital ate the rest. Most did so automatically, the remaining half dozen did so after I made a telephone call. Basically, I used the insurance company as our "consumer advocate".
Mike Mullikin :beer:Our lager, Who art in barrels, Hallowed be thy drink, Thy will be drunk, (I will be drunk) At home as I am in the tavern, Give us this day our foamy head, And forgive us our spillages, As we forgive those who spill against us, And lead us not to incarceration, But deliver us from hangovers, For thine is beer, The bitter and the lager, Forever and ever, Barmen.:beer:
Mike Mullikin wrote: I guess I'm confused. In the UK with the NHS does the government just pay any and all bills that a healthcare provider isssues without looking at the cost? If so, what keeps the doctors and hospitals from just charging astronomically high prices and making themselves super rich? Is capitalism at work here or are the prices also set by the NHS? If prices are artificially set, isn't this bound to cause a stagnation in the healthcare field like it would anywhere else in your economy? Not exactly. The NHS is broken into "Trusts" (introduced by a previous Conservative government) which run the hospitals and employ the bulk of the medical staff directly. Since the Trusts are government funded and publicly owned, they don't need to fix prices as such (and no profit is involved) - instead they just have to cover running and investment costs. Each Trust sets their own budget and is funded by Government from National Insurance. I'm pretty sure they have to justify those budgets in excruciating detail, based on fixed costs, salaries, overheads, expected patient numbers etc. In some circumstances a patient from one Trust will receive care either in a hospital run by another Trust, or a private facility. In these cases I guess the parties involved will negotiate the fees in the same way as any other commercial organisations. Confused yet? ;) Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul Watson -
Mike Mullikin wrote: I guess I'm confused. In the UK with the NHS does the government just pay any and all bills that a healthcare provider isssues without looking at the cost? If so, what keeps the doctors and hospitals from just charging astronomically high prices and making themselves super rich? Is capitalism at work here or are the prices also set by the NHS? If prices are artificially set, isn't this bound to cause a stagnation in the healthcare field like it would anywhere else in your economy? Not exactly. The NHS is broken into "Trusts" (introduced by a previous Conservative government) which run the hospitals and employ the bulk of the medical staff directly. Since the Trusts are government funded and publicly owned, they don't need to fix prices as such (and no profit is involved) - instead they just have to cover running and investment costs. Each Trust sets their own budget and is funded by Government from National Insurance. I'm pretty sure they have to justify those budgets in excruciating detail, based on fixed costs, salaries, overheads, expected patient numbers etc. In some circumstances a patient from one Trust will receive care either in a hospital run by another Trust, or a private facility. In these cases I guess the parties involved will negotiate the fees in the same way as any other commercial organisations. Confused yet? ;) Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul WatsonAndy Metcalfe wrote: The NHS is broken into "Trusts" (introduced by a previous Conservative government) which run the hospitals and employ the bulk of the medical staff directly. This could NEVER work in the US. This would make our doctors, nurses, lab technicians, etc. government employees. We haven't had a government employee do ANYTHING in decades!!! ;P Honestly, I shudder to think about the quality of healthcare anywhere in the world when it is provided by civil servants. X| X|
Mike Mullikin :beer:Our lager, Who art in barrels, Hallowed be thy drink, Thy will be drunk, (I will be drunk) At home as I am in the tavern, Give us this day our foamy head, And forgive us our spillages, As we forgive those who spill against us, And lead us not to incarceration, But deliver us from hangovers, For thine is beer, The bitter and the lager, Forever and ever, Barmen.:beer:
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Mike Gaskey wrote: This is absolute fraud - not a neat way of beating the system. By the way, the insurance company really didn't pay every dime, but all other insureds did. The frequency of such fraudulent activity causes increases in insurance premiums for everyone else. An insurance company operates on the basis of something called a cost ratio - the ratio of premium dollars to claim dollars. Most pay out in excess of 55% to 60% of the preium dollar collected. The difference between the amount the 55% to 60% paid out and the collected premium dollars collected goes for employee salaries, cost of physical plant, with a small profit margin for shareholders. True - it is fraud, and as such is illegal and wrong. However, I would argue that any patient who can't get insurance in such a system (especially if they're refused it for whatever reason) should be guaranteed the same standard of care as anyone else - regardless of whether they can pay. To do otherwise is to effectively tell them they're not worth saving, which surely should not be something a civilised culture should do. Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul WatsonAndy Metcalfe wrote: True - it is fraud, and as such is illegal and wrong. However, I would argue that any patient who can't get insurance in such a system (especially if they're refused it for whatever reason) should be guaranteed the same standard of care as anyone else - regardless of whether they can pay. And just why should anyone be "guaranteed" a standard of health care? And who should guarantee it? I worked until yesterday just to pay my 2002 taxes (local, state, federal). Shoud I work another month to pay additional taxes so everyone can be so guaranteed? I don't think so. This is an individual, personal, and/or family problem - not a societal one. Insurance is available for anyone who is willing to pay the cost as long as they never have a break in coverage (and simply re-enter the system when ill). Not having insurance is generally a personal choice made on the basis of cost. Yes it is more (much more) expensive as you age but the fact is it, health care, is more esxpensive the older you get. Just my opinion - Mike
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Mike Mullikin wrote: I guess I'm confused. In the UK with the NHS does the government just pay any and all bills that a healthcare provider isssues without looking at the cost? If so, what keeps the doctors and hospitals from just charging astronomically high prices and making themselves super rich? Is capitalism at work here or are the prices also set by the NHS? If prices are artificially set, isn't this bound to cause a stagnation in the healthcare field like it would anywhere else in your economy? Not exactly. The NHS is broken into "Trusts" (introduced by a previous Conservative government) which run the hospitals and employ the bulk of the medical staff directly. Since the Trusts are government funded and publicly owned, they don't need to fix prices as such (and no profit is involved) - instead they just have to cover running and investment costs. Each Trust sets their own budget and is funded by Government from National Insurance. I'm pretty sure they have to justify those budgets in excruciating detail, based on fixed costs, salaries, overheads, expected patient numbers etc. In some circumstances a patient from one Trust will receive care either in a hospital run by another Trust, or a private facility. In these cases I guess the parties involved will negotiate the fees in the same way as any other commercial organisations. Confused yet? ;) Andy Metcalfe - Sonardyne International Ltd
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"I would be careful in separating your wierdness, a good quirky weirdness, from the disturbed wierdness of people who take pleasure from PVC sheep with fruit repositories." - Paul WatsonDoes that mean that your doctors, nurses, etc are government employees? If so, I *REALLY* hope that they aren't even the tiniest bit like government employed construction workers in the U.S. BTW, if I'm understanding you right, what incentive (other than the desire to help people) does any hospital have for putting serious effort into new medical research? John