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Re: Americans want universal health coverage
Old 06-20-2006, 07:40 AM   #161
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Re: Americans want universal health coverage

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Originally Posted by free4now
The absolute worst part is the way doctors require patients to sign a statement saying if the insurance company rejects a claim the patient has to pay. Even if the doctor is "in network" for their insurance company.

If the doctor and insurance company have established a contract for working together to decide what procedures are covered, why should the patient bear the fallout when they can't agree?
A. If a doctor and patient decide a service is needed, the doctor provides that service, and the insurance company rejects it, you feel the doctor should pay for it? Think we have a doctor shortage now?

B. Now the "the doctor and insurance company have established a contract for working together to decide what procedures are covered." That's almost as common as the misbelief that doctors get paid by the prescription, or that the AMA runs medical practice in this country.

In fact, if the doctor signs a participation agreement with an insurance company, she generally agrees in advance to accept whatever they deem the "proper" fee to be. For* noncovered services, it is between you and the patient; better to tell them in advance if a recommended service is not covered by insurance - unless you'd rather be surprised. Insurance companies often do not play nice with doctors; it is not a collusion, but rather an objectionable, reluctant and tense tug of war.

I used to make house calls to needy and elderly patients. The trip charge (about an hour round trip) was not covered by Medicare. I billed the patient a small amount for that (not nearly enough to cover the 3 additional patients I didn't see that day due to lost travel time). They were uniformly grateful, often not only paid the bill but threw in a batch of cookies. I always told them in advance that a travel fee was necessary or else I simply could not take the time to make house calls.

In fact, most doctors spend hours of time and money fighting insurance companies who on their own decide that particular services are "not medically necessary" or are "not covered." The only doctors who work with insurance companies to determine one-sided policies are the ones who work for the insurance companies (i.e. on their payroll).

So, feel free to rant at the system (I do it all the time )* -- I strongly support universal health care for reasons such as yours. Just wanted to clarify the misunderstandings.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Re: Americans want universal health coverage
Old 06-21-2006, 12:26 AM   #162
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Re: Americans want universal health coverage

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For noncovered services, it is between you and the patient; better to tell them in advance if a recommended service is not covered by insurance - unless you'd rather be surprised.
Right on. If the doctor looks up the procedure and says insurance won't cover it but it's a good idea, then the patient is empowered to decide to go ahead, decline, or shop around for a better deal (in terms of quality, price, or both).

In contrast, the bad situation is when the doctor thinks something is covered, performs the procedure without telling the patient it's not covered, and then goes after the patient for the the fee because they can't get it out of the insurance company. It sounds like you don't do this Rich, but I betcha your office makes patients sign something that puts them on the hook for such cases.

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Re: Americans want universal health coverage
Old 06-21-2006, 12:29 AM   #163
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Re: Americans want universal health coverage

I live near San Francisco and have been considering moving to the city. Maybe this will hasten my plans:

Mayor Gavin Newsom unveiled a proposal today that would make San Francisco the first city in the country to provide health care for all of its uninsured residents through a plan that covers everything from patient doctor visits and surgeries to prescription drugs.

http://sfgate.com/cgi-bin/article.cg...NG3OJHDTV5.DTL
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