Posted on 12/22/2024 1:48:42 PM PST by ChicagoConservative27
Luigi Mangione’s alleged killing of UnitedHealthcare CEO Brian Thompson has sent waves through the medical community. This horrific act of violence, while tragic and inexcusable, forces us to confront an uncomfortable reality: frustration with the unchecked power of publicly traded insurance companies has reached a boiling point, for patients and doctors alike.
As a pain management physician, I deeply empathize with the anguish of denied care. While my patients desperately seek relief, insurance companies reject treatments that are evidence based, cataloging them as “unnecessary” or “experimental.” They use opaque and unreliable artificial intelligence algorithms to deny care and rely on the medical record notes to contextualize the humanity of my patients. The process of scheduling appeals with insurance representatives or “peer” reviewers is frequently a time-consuming exercise in futility. Decision-making “peers” can be individuals without expertise in the relevant medical field, incentivized to deny care. The appeals process can take months, leaving patients to suffer while the clock ticks on their quality of life.
(Excerpt) Read more at thehill.com ...
The money shot, When a patient qualifies for Original Medicare, I am relieved,as it is subject to stricter regulatory oversight as compared to private insurers.
With Medicare Advantage you get all kinds of cool perks.
With Original Medicare, you are never out of network (no surprises).
I have to make that decision in a few months
An interventional pain management doctor will use an anesthetic to numb the medial nerves connected to a specific facet joint.
Dr Shravani Durbhakula is a board certified interventional pain physician and anesthesiologist with nationally recognized media projects. She joined the faculty of the Johns Hopkins School of Medicine in 2017. In the past she has served as the Director of Pain Education and the Program Director of the Multi-disciplinary Pain Fellowship. Currently, she is the Course Director of the School of Medicine’s pain and opioids course, a novel mandatory curriculum for medical students that was featured on NPR due to its innovative value
Way back in the dark ages as an Undergraduate I was trained to always consider your sources view points and agendas
The source here has a specific agenda. She is not an advocate for clients. I doubt she actually does anything so "pedestrian" as treating patients looking at her bio.
What she is is an academic pushing an agenda point no different then any "News media" figure.
The American people have got to learn that most the "experts" the media push are actually propagandists for an agenda.
I would love to see a cost benefit analysis of what an average family of 4 would be paying out of every paycheck for health care if these utopian's notions that every claim must be approved no matter what was actually enacted.
NOTHING is free someone always has to pay for it.
We went with Original Medicare with a supplement by Manhattan Life, and Wellcare Value Script (PDP). All of my wife’s ENORMOUS medical costs were covered 100%, except for a pair of medical shoes. We did incur some steep prescription costs, but I don’t know if those meds would have even been covered in a Medicare Advantage plan.
It’s a personal decision. I would advise consulting an insurance agent.
Speaking of deadly costs,
all insurance and taxes equal half income now.
WTF is with that?
Choosing insurance plans seems a lot like playing 3-card monty...
One way to pay for medical stuff is via insurance.
Insureds should bear all of the financial risk, so insurance companies don’t profit from jerking insureds and providers around.
Health (and auto) insurance should have an issue fee [~$100], a potentially refundable issue margin reserve charge [~$100], a monthly profit allocation [~$20], and an offer premium.
The second way to pay for medical stuff is by periodic future payments. Providers of medical treatments and products might be required to provide periodic future payment options. Doctors and drug companies don’t tend to be poor. They can afford to do business by consumer finance far more than millions of Americans can pay PPACA premiums.
A refinement would be to have appeal boards of five independent doctors decide.
If three out of five approve, the partially coverage patient would have to pay 40% plus the insurance contract listed co-pays/co-insurance.
I wonder if health insurers are seeing more appeals or just a bit more likely to approve procedures.
Many forget the original purpose of insurance. It was to help you in a catastrophic event after you have self-insured yourself for the basics.
Now insurance is viewed as pay for everything.
“We went with Original Medicare with a supplement by Manhattan Life, and Wellcare Value Script (PDP).”
I have original Medicare and Wellcare Value Script.
Wellcare Value Script seemed to offer the best pricing for the drugs I thought might need to take based on family history and those I take now[none]. From what I read, it’s $0 premium for 2025 as well as 2024. I would have to pay a penalty if I took a Part D plan in the future if I did not have a Part D plan after age 65 plus a few months.
“steep prescription costs”
As I recollect, the Medicare website to price out drug costs seemed to be quite useable.
Unfortunately, my knowledge of drugs is outdated.
That's how I understand it.
The Medicare Part D drug deductible for 2025 is $590 (2024 = $545), payable over time during the year in 2025. Not sure how the new incremental deductible payments will be allocated.
Most the meds were fine, but the Eliquis and Xifaxan were murder.
Blue Cross as I read originally offered up to 16 days of hospital billable coverage. When my family used it, it covered the bills as promised.
Blue Shield was added to cover the cost of surgeons and anesthesiologists, but my mother found it to be lacking. She paid them $10/week [decades ago], which they were satisfied with.
There’s also the “Donut Hole”.
Are you sure there is a donut hole in 2025? Last I heard, there is a $2000 out-of-pocket cap on Medicare drug expenses.
Original Medicare Part A covers inpatient hospital care for up to 90 days per benefit period:
Days 1–60: You pay nothing after meeting your Part A deductible. In 2025, the deductible will be $1,676.
Days 61–90: You pay a coinsurance of $408 per day in 2023, and $419 per day in 2025.
Days 91–150: You can use up to 60 lifetime reserve days, which are additional days of coverage for long hospital stays. For each lifetime reserve day, you pay a daily coinsurance, but Medicare pays all covered costs.
After day 150: You pay all costs.
*********************************
Medicare Supplement plans:
Plan G: Covers all Part A deductibles and coinsurance, but does not cover the Part B deductible ($257).
Plan C: Covers both Part A and Part B deductibles and coinsurance.
Plan F: Covers both Part A and Part B deductibles and coinsurance.
Plan N: Covers most Part A and Part B costs, but may require small copayments for certain doctor visits and emergency room visits.
Plan M: Only covers half of the Part A deductible.
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