Nooooobamacare!

[SW03ES]

Kind of funny? Here are three articles telling people how to save money by paying cash. I am sure I can find you loads more. And by the way if the Doc doesn't submit the claim to the carrier than they don't know what he charges.

If he is a member of the network, he HAS TO submit the claim to the insurance company. If he doesn't then it doesn't count against the patients deductible or out of pocket maximums for the year either.

If a provider sees a patient that is in network, and doesn't report it he can loose his membership in the network.

Nothing to stop a patient from just not using their insurance, but that may ultimately cost them money because those expenses don't go towards their deductibles or out of pocket maximums for the year, so should something more major happen, they're going to have to meet deductibles and maximums they would have already met.

I don't care how many articles you find, I'm telling you this is how it works.

Less than two weeks I have a copy of the EOB that shows what was paid to the Doc. I have had people sit at my desk while I call Carefirst to see why something wasnt paid. Many times it is the way something was billed. Then I call the Docs office or the facility and tell them how the bill should be corrected they resubmit and it is paid. What is funny is how lazy some of the receptionist are...have had this happen a couple of times that they copy the new insurance card and bill the old one.

Yeah the billing is VERY complex, with a lot of complicated codes and if one code is off, the claim gets denied. The insurance companies bury the providers in paperwork, duplicate and redundant to try and create descrepencies where they can deny claims.

Providers are cheap, and they don't want to pay trained and experienced billing services to do their billing so it gets done right, they have some receptionist do it and its a total nightmare. When I was selling my mom's services way back when that was the objection I always had to overcome

Doc or Admin: "Well, Chantelle does it here in the office"

Me: "What percentage of your claims come back denied due to billing errors?"

Doc: "35%"

Me: Ours is 0, sign here.

But you can't possibly tell me that the bulk of the claims aren't paid the way they should be. If that is the case there is a problem with the way the bills are being submitted. I still have quite a few individuals on the books and a few groups. It is rare to have a problem with claims getting paid. My own Doc has told me that there are providers he hates dealing with because he feels like he has to pay someone to call on every single bill to get it paid.

It varies a lot from provider to provider, but I would say 80% of claims that are filed properly get paid properly. The other 20% get hung up because of some beurocratic reason that involves getting on the phone, sending documents you've send a dozen times, etc to get paid. Thats PROPERLY FILED claims. You can see how if you had someone filing the claims who was messing up it would create a HUGE problem for the provider.

I can only relate when it applies to my mother and mother-in-law. They both have the billable medicals bills after medicare.

Sure' date=' if they have no supplemental. Check into an AARP supplemental plan.

But the fruadulant billing has been experienced with both mothers. There is just too many codes, subjective billing etc. If doctors were allowed to a item list with charges it would be a beneficial education to folks in what they are really paying.

Was it fraudulent or just wrong?

The issue is the sheer number of services a doctor can provide, and what codes are necessary to bill for those services.

Medicare is different. That is why they have supplemental plans to cover that. But Lenore the big problem is here is a government run plan. Here's what you have got. Medicare part A Medicare part B got to make sure to sign up for Medicare Supplment or a Medicare Advantage Plan. Oh by the way want Prescription Drugs? Got to sign up for Part D which has a couple of options (by the way most people in the insurance industry will not sell different plans cover different drugs so you sign someone up for the wrong plan big E and O) by the way did I mention you have Plan a,b,c, f and high deductible f for the supplemental plans?

Trying to figure out what Medicare plan you need to be on is a complete nightmare lol

[lenore]

I caught the Doctor billing for a visit where my mom had no visit. I would call that fraud. I turned them into the State Attorney General for the fraud, but never heard back....I wonder how many doctors or their staff pull that kind of stuff. By the way when I confronted the Doctors office, they hung up on me.

[LEXIRX330]

http://newmediajournal.us/indx.php/item/1630?sms_ss=newsvine&at_xt=4ddbd287da7f3854%2C0

Lenore use someone anyone other than AARP. There are loads of other providers for that. I refuse to sell AARP. I get a call every other week offer to appoint me to sell their products. I tell them everytime I have no interest in supporting any company or representing any company with views like theirs.

[pj8708]

IMHO, these disscussions have finaly and definatly proven that we know a great deal about nothing, but will die with our sword's in our hand's defending our right to be as proud of being as ignorant as we choose.

My ignorant opinion is that after all this election year assanation attempents, the Affordable Healthcare Bill will stay in place. The entire healthcare field has already, and is preparing for it's further roll out. Most importantly, even though the Republicans say their going to repeal it, what with? They have no bill drafted and if they plan on starting over after the first of the year, given the way Congress has worked these last several years, we would never come up with a healthcare plan.

[LEXIRX330]

IMHO, these disscussions have finaly and definatly proven that we know a great deal about nothing, but will die with our sword's in our hand's defending our right to be as proud of being as ignorant as we choose.

My ignorant opinion is that after all this election year assanation attempents, the Affordable Healthcare Bill will stay in place. The entire healthcare fieldhas already, and is preparing for it's further roll out. Most importantly, even though the Republicans say their going to repeal it, what with? They have no bill drafted and if they plan on starting over after the first of the year, given the way Congress has worked these last several years, we would never come up with a healthcare plan.

Paul I think at last count 26 states have already stated they will not implement the exchanges. So you can say what you want but this law even though passed there are still many hurdles. Some states including MD hav been moving full speed ahead on creating the exchanges. since the Supreme Court will not allow the Feds to withhold funding the states don't have to. They don't have to replace it with anything to repeal it either.

I think that we have had a civil debate back and forth. If our elected leaders would do the same maybe we wouldn't be in the situation we are in.

[pj8708]

Your interpretation it would seem is that this is all about the exchanges, exchanges, exchanges! Remember, there are scores of provisions within the bill that affect more than just the insurance business.

This is supposed to be about the patient, or future patient. Not what's in it for me..(the Insurance Co., the Congress People, the Pharmacy manf.).

[LEXIRX330]

Paul my interpretation is what I am aware of and what I have read about and have seen covered in the news. Feel free to educate me on what you know about it. I have said all along health insurance is not the problem it is the cost of health insurance that is the problem. So when the government that by the way regulates the insurance companies is going to compete with them using the exchanges and make loads of new rules about what has to be covered, says everyone met be accepted, kids can stay on the parents plans longer, etc I find it hard to imagine the prices are going to go down.

I have discussed a great deal more on here than the exchanges...maybe you just didn't read the whole 4 pages? :;

By the way this isn't about what's in it for me. This is about me as a person in the insurance business that can tell you no one is aware of what is going on with these exchanges. But it is supposed to be up and running soon. This is about a employer that may drop his healthcare plan, and after talking to several small employers they also may do the same. I make little to nothing off of health insurance and do it as a convenience for my customers and actually have started just sending leads to someone else to do it. I could give a !Removed! if I can sell it or not. It is just the fact I don't understand how any logical person can look at the what is to come of this law and not anticipate rates going up. By the way...my wife is a RN, neighbor is a DR, know quite a few DOCS. How many doctors do we have to take care of all of these new patients? That's right. It has nothing to do with me Paul. I just see things a little different. But that is ok that is what makes this country great.

[SW03ES]

I caught the Doctor billing for a visit where my mom had no visit. I would call that fraud. I turned them into the State Attorney General for the fraud, but never heard back....I wonder how many doctors or their staff pull that kind of stuff. By the way when I confronted the Doctors office, they hung up on me.

Its also entirely possible it was mistakenly billed...

Lenore use someone anyone other than AARP. There are loads of other providers for that. I refuse to sell AARP. I get a call every other week offer to appoint me to sell their products. I tell them everytime I have no interest in supporting any company or representing any company with views like theirs.

The AARP plan is a UnitedHealthcare plan. My Dad had it and we were 100% satisfied, he had no bills when he was sick...its cheap. My mother just went on the same plan. I couldn't care less what company "stands for", I care if its good insurance...

[LEXIRX330]

Lenore use someone anyone other than AARP. There are loads of other providers for that. I refuse to sell AARP. I get a call every other week offer to appoint me to sell their products. I tell them everytime I have no interest in supporting any company or representing any company with views like theirs.

The AARP plan is a UnitedHealthcare plan. My Dad had it and we were 100% satisfied' date=' he had no bills when he was sick...its cheap. My mother just went on the same plan. I couldn't care less what company "stands for", I care if its good insurance...

[/quote']

All I am saying is there are other plans that are just as good and are priced just as good. These Medicare Supplment plans just cover what Medicare doesn't cover anyway depending on your plan. I hope they don't give Docs a hard time to get paid for their services?

[SW03ES]

I don't have a lot of reason to try other plans when I know one thats great...

[LEXIRX330]

I don't have a lot of reason to try other plans when I know one thats great...

Who cares you are like a far cry from 65? And it isn't like they did anything the other plans don't do...they cover what Medicare doesn't depending on which plan you pick it can cover it all. And they all increase in price as you get older.

[SW03ES]

Obviously I'm not looking for me, but I have a lot of family members who are of the age where they're starting to look at these plans.

[LEXIRX330]

Well I just got my group renewal for 09/01. Anybody want to tell me why my rate didn't go down since the Health Care Bill, is now LAW...and it was going to make insurance affordable?

RATES went up 30.84%, just got off of the phone with a broker I use and he told me the last two he saw had over 40% increases.

[pj8708]

Well I just got my group renewal for 09/01. Anybody want to tell me why my rate didn't go down since the Health Care Bill, is now LAW...and it was going to make insurance affordable?

RATES went up 30.84%, just got off of the phone with a broker I use and he told me the last two he saw had over 40% increases.

No offense to insurance companies,for they have never been found to take advantage of policy holders, especialy when it comes to assesing preminums and those generous settlments.

The Affordable Health care Act does not come into full implmentation until the end of 2014.

If your being charged 30% more for your premiums at this point with no increase in cost ( if there is that much were is it coming from and show me in public documents that they have to turn in to state, and prove to your state where the justification.

[lenore]

The scarey part are all of the TAXES (oh excuse me FEES) that Obama care is going to start charging when IT goes into effect. 3.8% realestate tax on sale of home for starters in 2013 (of course right after the election) How wonderful for the retires moving to downsize in the future. And the list will go on as we start reading what Congress didnt read before they passed it. THe only change will be the further destruction of the middle class with no means of ever funding this boondogle....Vote in November and understand what your doing.

[1990LS400]

I think it is about time for LEXIRX330 and Lenore to take their "hate-fest" off-line. Did I grow up in the same country as these two.

I'm a fairly smart guy who retired from a very large multinational insurance company, who actually understands the provisions of the "Patient Protection and Affordable Care Act" and who has read all nearly 200 pages of Chief Justice Robert's opinion on the matter - which is actually an easy and fun read.

Would LEXIRX330 and Lenore please take the time to read the same information I have read and analyzed and stop just throwing bombs?

[LEXIRX330]

Well I just got my group renewal for 09/01. Anybody want to tell me why my rate didn't go down since the Health Care Bill, is now LAW...and it was going to make insurance affordable?

RATES went up 30.84%, just got off of the phone with a broker I use and he told me the last two he saw had over 40% increases.

No offense to insurance companies,for they have never been found to take advantage of policy holders, especialy when it comes to assesing preminums and those generous settlments.

The Affordable Health care Act does not come into full implmentation until the end of 2014.

If your being charged 30% more for your premiums at this point with no increase in cost ( if there is that much were is it coming from and show me in public documents that they have to turn in to state, and prove to your state where the justification.

Paul- don't know what to tell you. That is the rate increase. I also got another one for a landscaping company that I have insured and his went up 26%. These are with Carefirst and they both are HSA plans.

I think it is about time for LEXIRX330 and Lenore to take their "hate-fest" off-line. Did I grow up in the same country as these two.

I'm a fairly smart guy who retired from a very large multinational insurance company, who actually understands the provisions of the "Patient Protection and Affordable Care Act" and who has read all nearly 200 pages of Chief Justice Robert's opinion on the matter - which is actually an easy and fun read.

Would LEXIRX330 and Lenore please take the time to read the same information I have read and analyzed and stop just throwing bombs?

Wow that was informatitive I am glad you shared that with us. I don't understand why I am having a hate-fest? I also don't know what bombs I am throwing. You also have no business telling me to take this off line. Point blank if you don't like it don't read it and don't respond to it. If you have something to say feel free. I have read more on this healthcare bill/law, have been to a number of meetings with delegates and senators that I think I have an idea of what I am taking about. Served as the President of our local NAIFA association and you know what just because you may disagree with me...I do know what I am talking about. Now feel free to correct me or debate me but I have certainly not have been throwing bombs.

Those rate increases that I have stated are accurate. The rates are based in MD small group both HSA Plans.

[LEXIRX330]

I went back and read everyone of my post and I honestly don't know what I have posted that would make someone respond like Jim has? I don't even think he has read the post on here.

[nc211]

I think it is about time for LEXIRX330 and Lenore to take their "hate-fest" off-line. Did I grow up in the same country as these two.

I'm a fairly smart guy who retired from a very large multinational insurance company, who actually understands the provisions of the "Patient Protection and Affordable Care Act" and who has read all nearly 200 pages of Chief Justice Robert's opinion on the matter - which is actually an easy and fun read.

Would LEXIRX330 and Lenore please take the time to read the same information I have read and analyzed and stop just throwing bombs?

No sir, I think you're the one who needs to put the pin back in your grenade. Your interpretation of "facts" is little more than one man's "opinion". Nothing more, nothing less. I think I've been on here long enough (7 years I believe) to have earned the right to say that you're a bit out of line, Jim. Let the men discuss, as they see fit.

In my line of work, which too included a 5 year stint with one of the best insurance companies on the friggin' planet, so much so that during 8 months in 2009, if you needed more than $50 million for your commercial real estate project, it was me (a team of 11), or the bank of China. Snoppy was toast, Pru was burning, NYL was hiding in the closet, Hancock was learning French, and Mother Mass was praying their equity bets weren't about to blow them out. Principal, as usual, last one to leave the party, and they're lucky Sun LiCo didn't take them out when their stock hit $6/share for their 401k business. I, know what I'm talking about. Now, I lead a team of bankers for a banking firm that represents the 20th best performing stock in the entire universe of all stocks for decades here in DC. I know what I'm talking about.

This healthcare law, is "change". Change scares people, and it isn't free. What is or is not going to happen, is perception of fear. Fear equals volitity.

Volotiliy creates opportunities of profit making. It's fact in a capitalistic society such as ours. Am I for universal health care coverage? You damn right I am. I haven't forgotten those 3am cups of coffee I had in the basement cafeteria of Childrens Mercy in downtown Chicago over two years ago, while my son was going through what he was going through, my pregnant wife was going through what she was going through, and in all of that painful coius, I noticed what real fear looked like, on the faces of other dads in that cafeteria who knew they just got financially wiped out. My bill for those 5 days, nearly $50,000. My wallet felt $435 of that, of which $400 was an HMO technicality that I was happy to pay for. Is that fair? Is it fair that I can have two children delivered for the cost of a single co-pay of $20 per child, while the nurse who actually delivered the children can't? No, it's not. Is it fair that, like I had to do just yesterday for myself, walk into any urgent care for $25 and see a doctor because Iet a summer cold turn into an ear infection, while the guy who was mowing the lawn of the actual office building, on a Sunday in 103 degree heat, had a ratty arm cast on his right arm that clearly needed to be changed a long time ago, but probably couldn't afford to have it done? No, it's not. And to top it off, while on my way home from the pharmacy, for my $5 copay antibiotic medication, I decided to check out a couple of BMW's to see if I want to replace my GTI next march with one, or go for another GTI, fully loaded of course. New GTI is winning so far, even at $31k for a "Golf".

But, is it fair to put forth a law that has not been explained well enough to the public that it serves to prevent such an air of confusion and fear, that people aren't able to see what I've just described over what it might cost? No, it's not, and will serve as an example as to why Mr. Obama will ultimately be a one term President. It's a shame too, because what he just did with this healthcare bill, is something no President who has attempted it in our history has ever been able to do.

That being said - "It's the economy, Stupid!"

[LEXIRX330]

I think it is about time for LEXIRX330 and Lenore to take their "hate-fest" off-line. Did I grow up in the same country as these two.

I'm a fairly smart guy who retired from a very large multinational insurance company, who actually understands the provisions of the "Patient Protection and Affordable Care Act" and who has read all nearly 200 pages of Chief Justice Robert's opinion on the matter - which is actually an easy and fun read.

Would LEXIRX330 and Lenore please take the time to read the same information I have read and analyzed and stop just throwing bombs?

No sir, I think you're the one who needs to put the pin back in your grenade. Your interpretation of "facts" is little more than one man's "opinion". Nothing more, nothing less. I think I've been on here long enough (7 years I believe) to have earned the right to say that you're a bit out of line, Jim. Let the men discuss, as they see fit.

NC I wish there was a like button for that post! :)

[1990LS400]

One man's opinion? Have you guys read Supreme Court Chief Justice John Robert's opinion? It's quite close to mine.

This doesn't seem to be much of a discussion - mainly uninformed people flaming.

[nc211]

One man's opinion? Have you guys read Supreme Court Chief Justice John Robert's opinion? It's quite close to mine.

This doesn't seem to be much of a discussion - mainly uninformed people flaming.

Which part of Robert's opinion do you like the best? The part where he says the Comerce Dept can't pay for it w/o violating the constitution, but the governmental taxing authority can, therefore the constitutionally of the proposal to require all to get health insurance or face a fine is acceptable, kind of like a fine for not paying, say, your income taxes? (but, it's not a tax, right?)

Come on gunslinger, "discuss" with the boys. Show them why they're throwing bombs, where they're wrong. Don't just stroll on into the chat and accuse the crowd of being ignorant, if you're not willing to pony up your own points of proof. Should be easy for an intelligent man who retired from a multinational insurance company and who has read the entire legal opinion of Judge Roberts. Do us the honor of putting our errors of understanding to rest. You rang the door bell, come on in.

[LEXIRX330]

This doesn't seem to be much of a discussion - mainly uninformed people flaming.

Who's flaming who?

[1990LS400]

Why don't you tell us specifically what you don't like about the Robert's opinion? Surely you agree with some of his views - like the view he has about people who "freeload" on the healthcare system.

This whole discussion reminds me of the hype about Y2K - that there was going to be a total economic and social meltdown on January 1, 2000. Hmmm .... what actually happened in that hyped disaster?

I'm betting that the Republican leadership is reading the same poll I am reading - that their own party members like and approve the Affordable Care Act by a healthy margin when they understand its provisions.

Time is of the essence to get this overturned because a lot fewer people are going to want to once they understand the provisions.

[lenore]

tell me something are the illegals going to pay the fine (TAX) whatever....No they will continue to stream to the ER rooms. There are just so many illogical solutions which will solve little if anything. As for the parties like the affordable health care, how many have actually read and comprehend the stipulations in the BILL? This was an underhanded, poorly solved, and not supported by both parties. Like I said both parties need to throw away their party hats and come to the table and do so real problem solving.