Posted on 03/19/2016 5:16:45 AM PDT by Kaslin
Late last year, while playing tennis, I reached up to serve and felt a painful pop in my shoulder. The inflammation got worse over the next few months. Now anytime I try to put my arm above my head, pain shoots up my arm. I often wake up at night with an agonizing throb in my shoulder.
So I finally and reluctantly went to the orthopedic surgeon; he said that I had a rotator cuff tear and I would probably need surgery. Ugh! He scheduled me for an MRI, but the day I was set to go, the hospital called to tell me my insurance company declined to pay for the scans. The insurance company, Cigna, tersely sent me a note: "You will need to complete six weeks of conservative treatment, such as physical therapy and anti-inflammatory medication. Once that has been completed and you have been re-evaluated, we can try to have the MRI re-authorized." Gee, thanks. You guys are the best.
I've been doing therapy for many months already, with not much improvement. The doctor explained that the insurance companies want to make sure that physicians aren't padding bills with unnecessary procedures. Incidentally, I've paid for health insurance for 30 years and have almost never used the medical care system. I calculate the insurers have made well over $100,000 off of me.
But I am lost inside the bureaucratic maze. They don't want to pay for the MRI because they don't want to have to reimburse for rotator cuff surgery. So their hope is that I will just go away. Studies show these delay tactics and bureaucratic runarounds work to reduce insurance payouts.
Everyone has horror stories of insurance companies denying coverage for valid procedures. As an analysis in The Baltimore Sun recently put it: "Among insurance professionals, it is common knowledge that health insurers are denying claims for coverage with increasing frequency." This is what the health industry calls "cost control."
Look, I get it; the insurance companies are trying to root out fraud and abuse of excessive procedures, which drive up costs for everyone. But the insurance companies are becoming barriers to care even for legitimate and necessary procedures.
What's the root of the problem here?
First, the excess of health insurance actually drives up cost. The more insurance for a procedure, the more expensive it is. Health inflation and premiums has been rising by nearly double the consumer price index for at least the last decade. This is also why there are so many frivolous procedures performed. Patients have been removed from the decision-making process.
Second, Obamacare has increased demand for health care and is driving up costs, so insurers appear to be cutting their expenses by denying claims more often. By the way, the insurance lobby should take note that this sleazy practice only plays into the hands of Bernie Sanders and others who want a single-payer government system to take over health insurance.
That will make medical care worse -- and more expensive. Studies on Medicaid patients find little or no improvement in health outcomes compared to the uninsured population -- because the level of care is so lousy. Government health care will be Medicaid-type coverage for all. It will be "fair" because we will all get equally subpar medical care -- and I would never get my shoulder surgery under that system.
The health insurance scandal in America today argues not for a vast expansion of government-run health care; instead, it suggests the wisdom of the medical savings account approach, where people put money, tax-free, into an IRA account and draw it down to pay for their first few thousand dollars of coverage. That way it isn't an insurance company who makes the call as to whether I should get an MRI. I make the call with my own money. Is the pain in my shoulder so bad that I want to shell out $1,200 to have a scan? Right now, Cigna says I don't get to make that choice. So it's "free" but I can't get it. Wonderful.
The only people who know whether I need surgery are not the faceless, bean-counting claims adjusters living in Toledo, Ohio, but my doctor and me
Cruz will repeal 0bamacare. What will Trump do?
Cruz won’t repeal Obamacare. You have to be president to do that.
Ok smart guy: If Cruz is elected he has campaigned on a promise to repeal ClearCase_guy0bamacare on the first day.
What would Trump do if elected president?
Trump has been clear that he will repeal every word. He has a detailed plan on his website.
I might have missed this, but why can’t he pay for his own MRI? He says Cigna won’t let him?
True he shouldn’t HAVE to. But are ins co’s actually telling people they can’t take care of themselves?
Replace it with something terrific. Terifficare.
“it suggests the wisdom of the medical savings account approach, where people put money, tax-free, into an IRA account and draw it down to pay for their first few thousand dollars of coverage.”
The author is in denial that a growing number of Americans 1) never intend to work, to earn money to put aside, or 2) are working but don’t have the money to contribute to such plans. Our government for the last seven years has been all about finding funding and freebies for the former.
Which solves nothing and which contradicts some things he's said. So who do we believe?
If you would get the fargin peanut butter out of your ears you just might have heard Trump say the same thing. Just in the event you have a hearing problem without the peanut butter, maybe your eyes can give them some help.
Read ‘em and weep!
https://www.donaldjtrump.com/positions/healthcare-reform
I feel better about my choices after reading this. I only have Medicare Part A so the injury wasn't covered. The whole system is appalling....proving I could pay for care before getting it, endless delays and billing procedures they had to go through even though the result was I would get bills and they get paid months later. In the OS office, the majority of the staff was billing, and they didn't even generate the bills! The cost of things has spun out of control because the issue doesn't seem to be what things cost but what will the insurance company cover.
I do not sympathize with this author, not at all. This is his shoulder he's talking about. Don't whine about whether "it's covered". If he knows he needs the MRI, he should take the financial hit and get it done. And maybe go to one of those franchise gyms and pay for a highly qualified personal trainer....there are some that are much cheaper than what the insurance company pays for and they're more focused on the individual.
This article is really a testimony to current thinking. Whine about the system but go along with it.
You could find his position in 5 seconds if you cared to.
AHA repeal is point 1 of 7.
https://www.donaldjtrump.com/positions/healthcare-reform
MSAs exist now and are available to any person with a high deductible health insurance plan. If your company doesn't offer one then you can set one up on your own.
Huh, I have three rotator cuff tears. And I and my surgeon agreed I will treat these tears with therapy. The larger muscles of my upper body support these lil torn muscles. Medicare and Tricare cover all but my chiropractor, who was the one who discovered the tears. Lift weights, FRiends but be wise.
How many times did Cruz introduce a bill to repeal RobertsCare? Is that why he called McConnel a liar?
Stay healthy. Self-fund. Have a doctor in your extended family or group of friends. Extract your hard earned money from socialist health schemes - oh wait. Be responsible for your own stupidity. Teach your children.
Disclaimer: I do not work on any candidate's campaign. I am merely posting what is public information, which anyone can find simply by going to Donald Trump's campaign website.
Cruz nor Trump nor any other President will do anything about Obamacare EXCEPT sign bills sent to them by Congress.
Cruz right now has more power to repeal Obamacare than he will when he is President and he and every other Republican in congress has done exactly two things about Obamacare.
1. Jack
2. Schitt...
By his own calculation it looks like he would have saved about $100,000 over the years just by doing it this way.
1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
You lose some popular features of Obamacare such as coverage for existing conditions and the ability to carry adult children on your policy for longer periods. People won't like that.
2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
Right now if a policy complies with Missouri state requirements then any insurance company can sell insurance in my state. If they don't then they can't. I think what Trump means is if they comply with the requirements of one state then they can sell in any state. Even so, why would I buy a policy guaranteed to cost me more? And why would a company want my business when it's guaranteed to cost them more?
3. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.
I assume that the point behind this is to make healthcare insurance more affordable for lower income families. But Trump's tax plan already says that families earning less than $50,000 will not pay any taxes so what good would an additional deduction do them?
4. Allow individuals to use Health Savings Accounts (HSAs).
Already the law. Any person with a high deductible insurance policy can establish an HSA.
Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
Already available on line.
6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
One of the features of Obamacare was expanding Medicare to increase coverage for low income individuals. About half of the states refused to do so. Why would they change under Trumpcare?
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.
Right now insurance companies lose their patents after a certain number of years and lower cost generics are available. But before then medications are a monopoly for the company which developed it and there is no way to remove that barrier except to remove the patent. Is that what Trump is proposing?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.