Posted on 12/26/2003 10:36:41 PM PST by neverdem
I could see where there could even be some fraud if a doctor didn't sign a contract and is giving certain people better prices for the same services. It's not charity if the doctor comes out ahead financially. Some "charity" amounts to some very good tax write offs too so wouldn't be charity. Also if the doctor raises the prices on the paying patients --- it becomes them who provide the charity -- not the doctor.
The "we" is depends on what kind of health insurance you have. If you have PPO or indemnity health insurance, the "We" is the insurance company itself. If you have HMO or POS plans, the "we" is the insurance company and the pharmacy benefits company that is contracted to "control costs".
HMO's are really a "den of thieves" that have been permitted to operate in this nation based upon Clinton Administration health reform initiatives. There are direct political linkages between the executives and owners of HMO contracting corporations and the political cash contributions to the democratic candidates across California.
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First of all, I didn't go to the insurance company to be diagnosed...I went to my DOCTOR; so why is the insurance company involved in deciding which drug is "appropriate"?
The insurer believes that they can dictate to the physician what to do because they control the cash flow to the doctors. Under the guise of "cost containment" the people are being denied equal access to care for completely arbitrary and, frankly, political reasons.
It is my belief that there is a social engineering process under way. It is my belief that HMOs are specifically being used to target enhanced resources to particular ethnic communities and to particular geographic areas.
In my career, the HMO atrocities have included:
1. Having a hospital case manager tell me that it is more cost effective for the hospital and more merciful to the family to let a disabled child die.
2. Watching as a neonatal specialist chooses to overdose a baby born with a fatal birth defect on pain medication in order to assist in hastening the death of the infant upon removal of mechanical ventilation.
3. Hospital executives who claim their facility is under dire financial circumstances as they pay themselves $400,000 to 500,000 per year and then tag on extra $100,000 to $250,000 for "benefits". By the way, they also had expense accounts of greater than $10,000 per year.
4. Physician medical group medical directors who have directed me to send patients to UNCERTIFIED specialists because they are cheaper.
5. Hospital network sending 15 million dollars per year to off-shore bank accounts for "insurance reasons". (I'll say! Boy, I'd love to that kind of coverage! -sarcastic LOL)
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Secondly, they think we are too stupid to realize that the reason one drug is prescribed over another has more to do with under the table kickbacks than the drug's effectiveness.
Yes! The reason these "executives" believe that they can redline or prioritize who lives and who dies is that the Clinton Administration never prosecuted these atrocities. However, the BUSH PEOPLE need to start federal review of these processes...and WE HAVEN'T SEEN HIDE NOR HAIR OF THESE DOJ PEOPLE.
Specifically, the Attorney General of the US, John Ashcroft, needs to investigate under RICO the violations of the following:
1. Violation of Federal Trade Commission guidelines by Pharmacy Benefits companies, hospitals, and physician networks, to unlawfully monopolize markets. Specifically, PBMs take kick-backs from the drug company in order to have the drug listed in the network. This adversely impacts the ability of the American people to have a competitive market. In addition, the hospitals are making payments to physicians for "physician services" in direct violation of California state Business and Professions Code.
2. Regular violations of IRS non-profit rules by management at various hospitals who claim non-profit status while engaging in acts/conduct that violate IRS Revenue Rulings.
3. Regular violation of Federal Health & Human Services regulation by management at particular hospitals who regularly engage in physician relocation agreements to modify the physician marketplace despite information that the cities are not defined as "health professional shortage areas".
4. Regular violation of Federal HHS regulations by physicians and medical groups who accept unlawful relocation agreements in areas that do not match the regulatory constraints of such agreements.
5. Regular violation of insurance contracting by insurance companies that fail to reimburse medical groups appropriately for services rendered. Despite multiple complaints by my colleagues regarding the conduct of some of these groups, the California State Department of Managed Care has utterly failed in it's duties. We question what the lawyers do to gain their compensation in the DMHC in Sacramento.
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Insurance companies are going to be the downfall of the wonderful health care that we have enjoyed in this country. What started out as a nice cost-sharing idea has devolved into a nightmare...due to greed and avarice.
It's worse than that.
It is my belief that elements in the HMO industry are specifically attempting to carry out a Nazi-like social engineering process. I've read a book on the social engineering that the Nazi doctors were being asked to carry out in the 28-36 time frame. The same moral stances were being advocated by the Nazi's and the HMOs. The same social engineering processes are at play.
The Nazi's and the HMO industry both regularly decline coverage for children who are of particular ethnic groups. Management in HMOs tend to reflect a VERY RESTRICTED range of ethnicities and if a racist ends up in a key management position, the racist can quietly resolve to disadvantage the people of particular ethnic groups or political pursuasion in that area of our nation. In healthcare, this disadvantage translates to slower care and a literal killing of those families/individuals so targetted.
FOR THIS REASON, the Bush Administration DOJ needs to become far more assertive with enforcement of regulations on the HMO industry.
Nor should there be.
I don't know, and I don't care, about "formulary status". When I prescribe, I try to choose the right drug.
After that, it's not my problem.
Stop trying to make it into my problem-I'm refusing delivery.
If you get into trouble for keeping people from getting what they need, good-it's just what you deserve.
You certainly shouldn't feel alone. I'm in California, and all of the solo practitioners I know who are in generalist fields are struggling to stay afloat. It's a real tragedy for the patient because, I strongly believe, the best medicine is practiced by one physician working with one patient with whom she or he has a long acquaintance. Until I moved recently, I was a long time patient with one of the "last of the G.P's" who would regularly make diagnostic decisions based on his knowledge of how the patient normally looked or behaved.
Sadly, the squeeze has come from multiple directions. In the eighties, my physican owned and operated his own blood testing facility. He also regularly cajoled drug reps into giving him large amounts of free samples which he then doled out to his patients, and he had long-time employees who ran the financial end in a highly professional way.... you paid the co-pay, or you went home. As a result, the patients benefited by paying less for testing, nothing for the first month or more of most prescriptions, and being able to deal with people with whom they had an ongoing relationship.
That's all changed now. He struggled with it for several years, as reimbusements decreased, he was ordered to stop doing his own blood testing, etc. Essentially, the application of the law and rules left him without any of the ancillary revenue sources that used to help underwrite the cost of the practice. The final straw came when an insurance company sent him a letter demanding that he begin printing the entries in his charts because they were having difficulty reading his handwriting.
He walked, saying he'd signed on to practice medicine, not insurance. He's probably now sitting on a tropical beach somewhere, sipping punch, and signing the chit in the same "unacceptable handwriting".
The other movement that's become common out here is for generalists to become specialists. Radiation Oncology seems to be a popular choice.
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Here's a telling quote from the article:
Dr. Herbert Dardik, chief of vascular surgery at Englewood Hospital and Medical Center in New Jersey, scorns collecting co-payments. "I look at it as a demeaning process," he said. "I tell my secretary upfront, if there's any issue, just forget it."Aye, but does the repected Doc Dardik scorn collecting payments?
The co-pays and premiums you charge are your business, not mine.
I don't care.
Stop bothering me about it.
Frankly, your corporations should cease to exist and that would save the insurance companies tons.
What savings does your corporation bring?
Please post your corporate financials!
You are a terribly misinformed person.
HMO capitation rates vary with the age of individual. Physician offices are NOT paid according to the service rendered. So, when a physician office chooses to waive off of co-pays, they are playing a temporary game to gain market share.
The New York Times story is typical of Hillary Clinton's drivel. Senator Clinton and her cigar-loving bubba have a nasty proclivity of always blaming doctors for being the problem in healthcare. The reality is that lawyers like Clinton are the cause of the problems in the healthcare system.
HMO reimbursement to the medical office is about $5.00 per month. This totally divorces the patient-physician relationship, which is the socialist cause.
They are attempting to kill the physician-patient relationship because it violates their socialist cause to have ANY private healthcare in our nation.
Donors to the Clinton people include HMO interests and the interests of tech companies (like Oracle, Sun, and WebMD) who intend on harvesting your medical information through HMO vehicles.
Merry Christmas!
Curious - do you take any feedback from your patient if they come to you with a list of alternate medications?
Stop trying to make it into my problem-I'm refusing delivery.
Not trying to make it your problem - it's not. It's the patient's problem - not yours, and not mine.
If you get into trouble for keeping people from getting what they need, good-it's just what you deserve.
Nope, no trouble at all. I just tell them what their plan allows and what alternatives they can pursue. Beyond that, it's up to them.
Yep, it sure would. They'd have to retool to be able to handle their own prescription benefits. Then they can start their own mail service pharmacies, build the facilities, train the staff and then run them. They can also pick up the research labs that we run, the specialty pharmacies that deliver the high cost bio-meds that we deliver - all that fun stuff.
Then they can explain to the patients why their copays are so high - after all, they write the plans. All we do is manage them. Then they can explain to the doctors in their plan why they want a pre-auth for PPI's. In fact, that might be even better - then the people who pay the doctor (the insurance folks) can make sure the MD calls in that pre-auth.
Sure it'll save them money. The startup costs alone should break them.
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