Join Early Retirement Today
Closed Thread
 
Thread Tools Search this Thread Display Modes
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 10:28 AM   #41
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by teejayevans
Washington DC JUDGE is suing a
dry cleaners for losing his pants, for ....drum roll please...
$65,000,000.


I'd love to see those pants. Must be really nice!
__________________

__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

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.
Rich_by_the_Bay is offline  
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 10:40 AM   #42
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
brewer12345's Avatar
 
Join Date: Mar 2003
Posts: 16,391
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by mykidslovedogs
A simple letter written by the doctor and sent into the insurance carrier through THE PROPER CHANNELS...
Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?

[moderator edit]
__________________

__________________
"There are three kinds of men. The one that learns by reading. The few who learn by observation. The rest have to pee on the electric fence for themselves."



- Will Rogers
brewer12345 is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 10:46 AM   #43
Thinks s/he gets paid by the post
 
Join Date: Dec 2004
Posts: 1,798
Re: Is Univeral Health Care the answer?????

After beating this horse dead several times, I'm leaving my comments as an answer to the topic.

NO!!!
__________________
You don't want to work. You want to live like a king, but the big bad world don't owe you a thing. Get over it--The Eagles
lets-retire is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 10:50 AM   #44
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by brewer12345
Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?
Ahh... she's just trolling, .
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

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.
Rich_by_the_Bay is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 10:58 AM   #45
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
haha's Avatar
 
Join Date: Apr 2003
Location: Hooverville
Posts: 22,382
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by mykidslovedogs
A lot of times, insurance carriers put limits on things like blood thinners and other potentially dangerous drugs such as narcotics, to protect people from potential danger.
Yes, it's a little known fact that the heroic and highly trained clerk at a private health insurance company is often the only thing standing between a typically derelict Doctor and his helpless patient.

They deserve a much larger cut of the health care dollar, and should publicize this important additional duty that they perform.

NOT

Ha
__________________
"As a general rule, the more dangerous or inappropriate a conversation, the more interesting it is."-Scott Adams
haha is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 11:05 AM   #46
Recycles dryer sheets
tomz's Avatar
 
Join Date: Mar 2006
Posts: 251
Re: Is Univeral Health Care the answer?????

Regarding catastrophic insurance:

That's where most of the costs are in our current system. 20% of patients account for 80% of the costs. (give or take a few %) This 20% includes chronic conditions, end of life issues, premature infants, etc. ; i.e., all the things that we consider catastrophic. In the big picture, things like tort reform and high deductibles for routine stuff are a drop in the bucket.

There are a number of studies/books available that document this. Tort reform and the horror stories that accompany it get people upset. However, the real issues lie elsewhere.
__________________
tomz is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 11:22 AM   #47
Thinks s/he gets paid by the post
 
Join Date: Feb 2003
Location: Mesa
Posts: 3,588
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by brewer12345
Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?

[moderator edit]
Sorry, Brewer. I just quit reading the nonsense before I got that far. I was insulted before getting to that statement.
__________________
sgeeeee is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 12:08 PM   #48
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by HaHa
Yes, it's a little known fact that the heroic and highly trained clerk at a private health insurance company is often the only thing standing between a typically derelict Doctor and his helpless patient.

They deserve a much larger cut of the health care dollar, and should publicize this important additional duty that they perform.

NOT
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

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.
Rich_by_the_Bay is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 12:24 PM   #49
Full time employment: Posting here.
 
Join Date: Dec 2006
Posts: 886
Re: Is Univeral Health Care the answer?????

Just thought I'd share how the Health Care system works here in Estonia. It does seem that when most people think about universal or national health care, it means all the private doctors and hospitals will cease to exist. That isn't the case at all. Here in Estonia you can also buy private medical insurance and visit your doctor/medical facility of choice. There are plenty of private practices if that's your thing.

In any case, I'm not showing this as a model for the U.S., I just thought some people might enjoy seeing how other countries approach their health care needs.

Outline of the Estonian Health Care System
http://www.haigekassa.ee/eng/health/outline/
__________________

Trek is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 01:26 PM   #50
Recycles dryer sheets
tomz's Avatar
 
Join Date: Mar 2006
Posts: 251
Re: Is Univeral Health Care the answer?????

Thanks for the info, Trek. It is useful to know how the rest of the civilized world provides healthcare to all its citizens. I have a question. What is the taxable amount referred to in the following:

The employers are required by the law to pay social tax for all persons employed, whereby the rate of this tax is 33 % of the taxable amount, and of which 20 % is allocated for pension insurance and 13 % for health insurance.



__________________
tomz is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 02:04 PM   #51
Full time employment: Posting here.
 
Join Date: Dec 2006
Posts: 886
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by tomz
Thanks for the info, Trek. It is useful to know how the rest of the civilized world provides healthcare to all its citizens. I have a question. What is the taxable amount referred to in the following:

The employers are required by the law to pay social tax for all persons employed, whereby the rate of this tax is 33 % of the taxable amount, and of which 20 % is allocated for pension insurance and 13 % for health insurance.
Taxable Amount would be the employees earnings.

This should make it more clear:

Employers registered in Estonia (including permanent establishments of the foreign entities) must pay social tax on all payments made to employees, except on those specifically exempted by law. In case of an individual engaged in business and registered as such with the Tax Authorities, social tax liability lies with the individual. Fringe benefits and the income tax thereof are also included in the taxable base. Currently only employers and individuals engaged in business are liable to make social tax contributions. Employees are not required to pay social tax.
__________________

Trek is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 02:52 PM   #52
Thinks s/he gets paid by the post
 
Join Date: Apr 2006
Posts: 1,487
Re: Is Univeral Health Care the answer?????

that's a rather hefty payroll tax!
__________________
d is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 03:26 PM   #53
Full time employment: Posting here.
 
Join Date: Dec 2006
Posts: 886
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by d
that's a rather hefty payroll tax!
It is a higher tax, but for a higher purpose.

In any case, there is a nice offset for the employer. Estonia does not tax corporate income. Only distributions of corporate income, such as dividends (taxed at the flat 22% rate). Any money reinvested is not taxed. This is why so many foreign companies have set up shop here and added to the booming economy.


__________________

Trek is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 03:35 PM   #54
Thinks s/he gets paid by the post
 
Join Date: Dec 2004
Posts: 1,798
Re: Is Univeral Health Care the answer?????

Let's see, with my current situation at a 33% tax rate, I'd have to give up saving for retirement and eating out.
__________________
You don't want to work. You want to live like a king, but the big bad world don't owe you a thing. Get over it--The Eagles
lets-retire is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 05:04 PM   #55
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Brat's Avatar
 
Join Date: Feb 2004
Location: Portland, Oregon
Posts: 5,913
Re: Is Univeral Health Care the answer?????

Total your income tax, annual health insurance, social security and medicare here in the US... What % do you come up with?
__________________
Duck bjorn.
Brat is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 05:34 PM   #56
Full time employment: Posting here.
 
Join Date: Dec 2006
Posts: 860
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by Rich_in_Tampa
This is a 55 year old woman, worked and paid for health insurance (plus employer payments) for decades, and basically played by the rules. She's screwed.


Yes, it's a little known fact that the heroic and highly trained clerk at a private health insurance company is often the only thing standing between a typically derelict Doctor and his helpless patient.
Since Rich said "She's screwed...", I was just trying to point out that, in fact, she's NOT screwed. Just about 1/2 hour of time and effort could result in the insurance company making an exception agains their 15 day rule, and agreeing, in advance, to pay for her lifetime's worth of blood thinning injections.

That second comment about the "heroic and highly trained clerk" just further re-inforces to me that MOST people don't realize that it's not the "highly trained clerk" on the other end of the phone who makes the decisions regarding what is or is not covered in the contract nor do they have any power over claim appeals. That's why I pointed out that when sent through the proper channels, and not by trying to convince a front line customer service rep that the medication is needed, a specialized care coordinator (who is typically an RN or PA) can work directly with a claims manager to walk a special appeal through the process in a relatively quick period of time and resolve this poor patient's situation.

All too often, the doctor's office makes just one phone call to the patient's insurance customer service line, and after being told that the service is not going to be covered, they take that information to the patient and then leave the patient with no hope.

I'm just trying to correct Rich that instead of just telling the patient "it's not covered", and leaving her to think she's "screwed", the doctor's office could go a step further and explain to the patient that oftentimes, a simple appeal filed as per the step by step instructions I mentioned earlier could result in coverage for the injections. A call to the patient's broker or insurance company if there is no broker, to get the correct appeals address and process, is usually the first step in moving forward. Many people just try to send a letter of request in with their billing statement or they try to call customer service, only to find they end up at a dead end.

Time and again, I have helped people who have been trying to appeal a claim for months or even years, to resolve the issue in a matter of days by bringing in the proper people from the insurance company to help out. When a claim appeal gets sent to the wrong dept or through the wrong channels, it can slow the process altogether and just lead to a lot of dead ends that seem like "the runaround", when in actuality, the claim appeal would've been processed much more quickly and timely if it had been sent to the correct address, with all of the correct information included.

I'm not trying to insult anyone here, just trying to point out that the insurance company is not going to deny a claim just for the purpose of being greedy and insensitive. Oftentimes the problem is that the insured just needs a little help going through the proper channels to get it taken care of quickly, and rather easily. The assignment of a care coordinator can be a good start if someone knows that they are going to be in for a lot of upcoming treatment. Most insurance companies have "care coordinators" on staff, and it's not hard to get assigned to one by making a simple request (preferably through a broker if you have one.)
__________________
mykidslovedogs is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 05:46 PM   #57
Thinks s/he gets paid by the post
 
Join Date: Apr 2006
Posts: 1,487
Re: Is Univeral Health Care the answer?????

Quote:
What % do you come up with?
the average federal plus state&local tax collection are about 31% ...
__________________
d is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 05:47 PM   #58
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by mykidslovedogs
Just about 1/2 hour of time and effort could result in the insurance company making an exception agains their 15 day rule, and agreeing, in advance, to pay for her lifetime's worth of blood thinning injections.
Is there any way we can put this to a test?

Could Rich and MKLD PM each other and give it a go? It seems worth 1/2 hour of time for the chance to help this lady (yeah, easy for me to say - it's not *my* half-hour, but still).

I doubt that Rich would mind 'losing' in this case. Of course, if MKLD was not able to get the deal approved, that does not prove that it can't be done in some cases. But it would be interesting to see if it even got assigned to someone and reviewed past the usual "you are not covered' statement.

-ERD50
__________________
ERD50 is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 06:04 PM   #59
Full time employment: Posting here.
 
Join Date: Dec 2006
Posts: 860
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by ERD50
Is there any way we can put this to a test?

Could Rich and MKLD PM each other and give it a go? It seems worth 1/2 hour of time for the chance to help this lady (yeah, easy for me to say - it's not *my* half-hour, but still).

I doubt that Rich would mind 'losing' in this case. Of course, if MKLD was not able to get the deal approved, that does not prove that it can't be done in some cases. But it would be interesting to see if it even got assigned to someone and reviewed past the usual "you are not covered' statement.

-ERD50
I would love to jump in and help this lady out, but Federal HIPAA regulations, and the fact that I am probably not licensed in her state will prohibit me from being able to do so. If Rich was willing to dive in and give it a go, just to see what happens, here's what I would do. These things can be done by a doctor, the patient themselves or the patient's broker with written consent from the patient:

1.) I would call the insurance company claims dept and ask if a "care coordinator" could be assigned to the insured. I would call back daily to see if it was done yet until I heard back from the claims rep that I was working with the name and direct line for the care coordinator. Most of the time, you'll have a care coordinator assigned within a day or two. Care coordinator's work directly with claims on difficult situations to help with upcoming treatment and prior approval. This helps the whole claims process run more smoothly.

2.) Once a care coordinator is assigned, I would explain the situation in detail and ask if it could be possible to send in a written letter of medical necessity from the attending physician along with a letter of request including the following information, signed and dated by the insured:
a.) Group Number
b.) Member ID or subscriber number
c.) Name of medication needed
d.) Specific rebuttal to the clause in the contract limiting the treatment.
3.) Ask the care coordinator if the request can be sent directly to him/her or if it needs to be sent to a specific address in a specific format. Follow the directions to a "T". Write down names and numbers of anyone who is assisting you with the process.
4.) Follow up until an answer is given by someone in a "higher up" position such as a manager in the claims dept.
__________________
mykidslovedogs is offline  
Re: Is Univeral Health Care the answer?????
Old 05-03-2007, 07:03 PM   #60
Thinks s/he gets paid by the post
teejayevans's Avatar
 
Join Date: Sep 2006
Posts: 1,220
Re: Is Univeral Health Care the answer?????

Quote:
Originally Posted by mykidslovedogs
lot of good stuff ...
Hey MKLD, you know what would be great, if you could write a FAQ.
You have a lot of good info, and the last append is an excellant
example. Common questions about coverage, etc.
I'd stay away from the political questions
Seems to me that be most helpful and a great service to those of us
that don't understand how the insurance companies work.
TJ
p.s. This reminds me of the first scene in "The Incredibles" movie.
p.s.s Actually there are a few other topics that need FAQs as well...
be easier then trying to search for an archived thread.
__________________

__________________
teejayevans is offline  
Closed Thread


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Poll: How do you cover health care expenses in ER? chinaco Life after FIRE 48 04-24-2007 10:45 AM
Health Care provided after retirment runnerr FIRE and Money 9 09-05-2006 04:57 PM
Health Care Costs BigMike Life after FIRE 39 05-21-2006 03:37 PM
Vanguard Health Care distibution LOL! FIRE and Money 2 03-11-2006 07:01 PM
Health Care Lovecraft Young Dreamers 3 02-20-2004 09:28 PM

 

 
All times are GMT -6. The time now is 09:14 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.