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
Nope!
We barter.. They also use me for demos.. i have a TON of missing teeth from a work accident so every once in a while I get a free implant..
As to a regular cash customer Yes, they pay a little less than insurance does.
That's a kickass conservative attitude.
/sarc
So I guess your version of kickass conservatism is ready to fold on the 2A, also.
Don’t confuse Facts with Attitude my FRiend.
Wish in one hand and spit in the other and see which one fills up first.
Once an Entitlement is given, it can never be taken away. That is why Obamacare should have been nipped in the Bud.
You can trim around the edges like Reagan did in raising the SS Full Benefit Age from 65 to 67, but you cannot just cancel a program that Millions of People take for granted.
Regarding Reagan’s SS Overhaul, you will notice that the Full Benefit Age was extended from 65 to 67, but the early reduced Benefit Age remained at 62. Gee, I wonder why?
Please name just ONE Entitlement that was just Cancelled without any alternate Plan? Guess what, you can’t.
>>>So I guess your version of kickass conservatism is ready to fold on the 2A, also<<<
You guess wrong, but nice Straw Man. Apples and Oranges.
The Second Amendment is not an Entitlement, it is a Right.
Unfortunately, People think Obamacare is a Right. That is why we are in such deep doo doo.
Fact: the reason for perpetual and practically unlimited 'entitlements' are because of attitudes like yours.
No straw man; same concept. If you'll fold on reigning in unconstitutional cradle to grave government you'll fold on the amendments to the constitution.
I don’t have an attitude at all. Facts are facts.
Now answer my question. What Entitlements have ever been eliminated without an alternative?
Man, you are stretching.
My response to you was crystal clear.
By the way, how am I “folding”?
I’m not in Congress, I am simply an observer, same as you.
You should change your screen name. The only thing kickass about your conservatism is getting your ass kicked by the commies in DC.
Well, I gave you a couple of chances to answer my question, but you failed again.
My screen name is just fine. No need to get nasty.
If you want to change reality, write a Novel or run for Elected Office.
Apparently this discussion is going nowhere, so you stay off my Lawn and I’ll stay off yours.
First, the excess of health insurance actually drives up cost. The more insurance for a procedure, the more expensive it is... 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.#1, the premiums shouldn't be on the employer; #2, the obvious way to pay for it is to have the consumer pay for it, and using before-tax dollars; #3, using amended Medical Spending Acc'ts -- making them open-ended instead of expiring at the end of the calendar year -- would be the way to do that; #4, doctor visits could be out of pocket, but billable back to the MSA; #5 but we need coverage for hospitalization, for certain, due to the expense, and thanks to the long period to accumulate, the MSA would be worth more later in life, exactly when we start to spend about 90 percent of our lifetime healthcare dollars.
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