I got a foretaste of upcoming ObamaCare that will come into being.
I decided to take advantage of my "Age 65 Medicare Physical Exam" that all turning 65 and enrolling in parts A and B are entitled to as per the Medicare 2010 Handbook. Sounds easy? Read on.
I have been using the same GP Doctor for 25 years. Additionally my whole family has been going to this clinic. My wife's best friend is his receptionist. So, it's not like they don't know me/us.
When I get in the office, after standard BP/Temp/Pulse/ht and wt. readings, the Doctor whisks me out of the exam room and into his own office. We sit down and he small talks a while, then tells me this: With my personal insurance, he does not "think" Medicare will indeed pay for my "Age 65 Physical". However, my personal insurance will not either if they key up on my having Medicare and turning 65. Catch 22. Bottom line is I AM getting a physical, but he has no idea "who" is going to pay for it. He wonders if we should change my diagnosis and reason for visit to something like chest pains, and bill as usual? I remind him of the Medicare Handbook. Yes, he knows that, but unless Medicare is all you have, it does apply and there is no payment to the provider. That has been the clinic's recent experience, leading them to write off a lot of recent work.
(Bear in mind that in my new life at age 65, Medicare has to be the first payer, or there are NO payers.) In my case, my personal insurance picks up anything not covered by Medicare, as long as Medicare has had their look and chance to pay it.
I tell the doctor I want a full bells and whistles medical exam.
He then tells me that as of recently, the blood panels he needs to complete physicals, the payments thereof, are being denied by "most" insurances. This is because of misunderstandings of the new laws and the HMO's are refusing to pay for these, except in the absolute case of emergency, like someone having cardiovascular problems. He asks me again if I have had any chest pains, or shortness of breath? He does not want me to get back an Explanation of Benefits (EOB) showing denied charges.
Time is going by and doctors are busy, so he sends me to the lab for my blood panel. The lab has a "form" that EVERYBODY must sign, agreeing that if the insurance does not pay for this stuff, the patient is responsible. I ask "so will Medicare and/or my private insurance pay for this? ($375.00). Answer:
"With ALL the confusion out there today, we just don't know".
After the whole physical is done (it was a "bells and whistles one"), I finish up in the Doctor's Office. We talk about a few things and I am done. I ask him what is all this coming to?
He states, and this is a direct quote: "Herb, it means that guys like me are going to have to get out of the business, or start working for some type of government managed HMO's at a salary". I kid you not, it is a direct quote.
btw I was an Age 65 Poster Child of Health!!!!!
Health Reform Bill---Circa 2011 and On.
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AlexOliver
- Posts: 461
- Joined: Tue Aug 03, 2010 7:25 pm
I don't have to pay for health insurance until I'm 26 now, so that's cool. I'm covered by my dad's policy, which is one of those that will be subject to the "cadillac tax" (assuming that part went through?), and his employer pays for it.
I think the confusing will work itself out between now and when all the new regulations are in place. New laws are always confusing, and the health care one was huge.
I just wonder how it'll affect HDHPs.
I think the confusing will work itself out between now and when all the new regulations are in place. New laws are always confusing, and the health care one was huge.
I just wonder how it'll affect HDHPs.
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Steve Austin
- Posts: 177
- Joined: Thu Jul 22, 2010 12:17 am
Calling it "ObamaCare" leads me to believe we're not in store for a reasonable discussion of the relative merits of the healthcare reform bill. Just a feeling.
So confusion over coverage means the reform is a failure? Surely you're not implying that private insurance never has confusion over procedure coverage and benefits?
So confusion over coverage means the reform is a failure? Surely you're not implying that private insurance never has confusion over procedure coverage and benefits?
Private insurance will still have to deal with hugely increased govt bureaucracy... It was a cluster before, now it's going to be a complete nightmare.
I'm going to fly to Taiwan if I ever need anything done... I have insurance now, but I still prefer to get things done in other countries that don't jerk you around as much.
@Carlos: this is no more "reform" than the joke of a financial "overhaul" was "reform"... Seems to me like a mandate for citizens to buy services from a private country.
Hopefully you are not so partisan you can't agree this is a dangerous precedent.
I'm going to fly to Taiwan if I ever need anything done... I have insurance now, but I still prefer to get things done in other countries that don't jerk you around as much.
@Carlos: this is no more "reform" than the joke of a financial "overhaul" was "reform"... Seems to me like a mandate for citizens to buy services from a private country.
Hopefully you are not so partisan you can't agree this is a dangerous precedent.
What's the dangerous precedent? That we'll have universal health care like many other first world countries? The slippery slope argument itself is a logical fallacy.
It sounds like the issue with the original scenario has nothing to do with the upcoming "ObamaCare" changes. But rather because we neither have a fully private system (no medicare) nor a single payer government system. Thus you find yourself in the situation of being doubly covered so neither wants to pay. Given the HMO's are private companies, unless there's a law requiring them to treat blood screens as part of a standard physical, they can deem that they'll only cover it as an emergency procedure, since theoretically you have a free market to choose another HMO plan from.
It sounds like the issue with the original scenario has nothing to do with the upcoming "ObamaCare" changes. But rather because we neither have a fully private system (no medicare) nor a single payer government system. Thus you find yourself in the situation of being doubly covered so neither wants to pay. Given the HMO's are private companies, unless there's a law requiring them to treat blood screens as part of a standard physical, they can deem that they'll only cover it as an emergency procedure, since theoretically you have a free market to choose another HMO plan from.
You mean medicare which you're already forced to buy, or social security which is "buying for your retirement"? Or car insurance which is mandated? School system? Fire, police, ambulances?
On a less hyperbolic note, would you have less issue with a single payer system than this current mish-mash of government/private, or I guess I could see the argument for regulated monopolies like the electric grid.
On a less hyperbolic note, would you have less issue with a single payer system than this current mish-mash of government/private, or I guess I could see the argument for regulated monopolies like the electric grid.
There is no law requiring one to work for income and pay SS or income taxes. There is no law that says I must buy a house to pay property tax for schools. There is no law that says everyone must drive, and insure, an automobile.
This is a tax you are being forced to pay simply for being born and existing. It's criminal.
This is a tax you are being forced to pay simply for being born and existing. It's criminal.
Except that you don't have to buy insurance if you don't have any income. That's where medicaid and exemptions come into play.
So I think I'm get the impression the objection you have is more how it's implemented, rather than the principle behind it? As in if it were just an income or property tax would you have less objection to it? If anything, given the penalties are just monetary, you could choose not to get health insurance and instead pay the new 'tax' on uninsured people (who make above a certain amount of money).
So I think I'm get the impression the objection you have is more how it's implemented, rather than the principle behind it? As in if it were just an income or property tax would you have less objection to it? If anything, given the penalties are just monetary, you could choose not to get health insurance and instead pay the new 'tax' on uninsured people (who make above a certain amount of money).
The whole issue is this:
Mr Doctor needs a blood panel (cost $375.00) to properly complete a medical examination for the patient. (I don't see this as an issue for anyone--the blood panel can tell the doctor about a myriad of problems the patient may or not have.)
Whether or not the Doctor wants to order the panel is HIS call. Not some insurance company, not the Surgeon General, and especially NOT the government. You don't want the doctor ending your physical by telling you he has no idea whether or not your liver is ok, whether or not you have diabetes, or whether or not your Lipids are crossed up.
I want the doctor to decide whether or not to stick his finger up my hindquarters and if he wants to draw my blood. Not some government office worker with a manual.
Mr Doctor needs a blood panel (cost $375.00) to properly complete a medical examination for the patient. (I don't see this as an issue for anyone--the blood panel can tell the doctor about a myriad of problems the patient may or not have.)
Whether or not the Doctor wants to order the panel is HIS call. Not some insurance company, not the Surgeon General, and especially NOT the government. You don't want the doctor ending your physical by telling you he has no idea whether or not your liver is ok, whether or not you have diabetes, or whether or not your Lipids are crossed up.
I want the doctor to decide whether or not to stick his finger up my hindquarters and if he wants to draw my blood. Not some government office worker with a manual.
You might not have to "pay" for it, but it is still required... I don't want to receive benefits against my will... I can take care of myself and wish that would be respected.
Also, like other welfare programs, it might get confusing when you have assets, even if you are low income. A situation many in retirement might be in.
Also, like other welfare programs, it might get confusing when you have assets, even if you are low income. A situation many in retirement might be in.
@HSpencer
Under any system of insurance (private or public) you'll always have another person telling you what services are covered for what amount. That's the nature of insurance. I think it's nuts that we have routine exams covered through insurance. In my opinion insurance should be for emergencies. Everything else should be paid for out-of-pocket.
If you or your doctor want a blood test you're free to pay for it, regardless of what the insurance company wants.
I don't know the answer to our healthcare problem. Seems to me however that spending 2 or 3 times the amount on healthcare of other developed nations for WORSE health outcomes indicated the current system sucks.
There was a really interesting article in the Atlantic last year. It compared the medical cost per capita of two similar cities in Texas. I recommend it if you can find it. Very interesting.
Under any system of insurance (private or public) you'll always have another person telling you what services are covered for what amount. That's the nature of insurance. I think it's nuts that we have routine exams covered through insurance. In my opinion insurance should be for emergencies. Everything else should be paid for out-of-pocket.
If you or your doctor want a blood test you're free to pay for it, regardless of what the insurance company wants.
I don't know the answer to our healthcare problem. Seems to me however that spending 2 or 3 times the amount on healthcare of other developed nations for WORSE health outcomes indicated the current system sucks.
There was a really interesting article in the Atlantic last year. It compared the medical cost per capita of two similar cities in Texas. I recommend it if you can find it. Very interesting.
@Carlos
It seems you are advocating "out of pocket" for anything other than major medical services. In my specific case, a $500.00 periodic medical exam is not really a burden for me. Neither is an exam and medication for a viral infection, or say $175 charge for earwax removal. For me this would work as I am blessed with the financial assets to make it happen for me, my wife, and children if mine were not already grown.
Now, I would ask you to investigate if most of the population is in this same situation? I don't think you would find it to be so. We would quickly become a population of extremely poor health. Insurance is something that is purchased to shield us from financial depletion through periodic medical costs of all kinds.
Thanks for your article, I will attempt to find and review it.
It seems you are advocating "out of pocket" for anything other than major medical services. In my specific case, a $500.00 periodic medical exam is not really a burden for me. Neither is an exam and medication for a viral infection, or say $175 charge for earwax removal. For me this would work as I am blessed with the financial assets to make it happen for me, my wife, and children if mine were not already grown.
Now, I would ask you to investigate if most of the population is in this same situation? I don't think you would find it to be so. We would quickly become a population of extremely poor health. Insurance is something that is purchased to shield us from financial depletion through periodic medical costs of all kinds.
Thanks for your article, I will attempt to find and review it.
@Johnny
I certainly understand your frustration. In reality however aren't we already paying for it? When I was hospitalized and went through the bill I found the usual crazy charges - the $50 aspirin and what-not.
When I asked why the prices has no basis in reality the response was - "when people come in and can't pay we have to charge someone". If you get stabbed or shot the emergency room is going to treat you regardless of ability to pay. All of us pay for it in the end.
Funny how non-covered services (like Lasik) drop in price every year while other healthcare costs skyrocket. Maybe the answer is price transparency and everyone pays out-of-pocket.
I certainly understand your frustration. In reality however aren't we already paying for it? When I was hospitalized and went through the bill I found the usual crazy charges - the $50 aspirin and what-not.
When I asked why the prices has no basis in reality the response was - "when people come in and can't pay we have to charge someone". If you get stabbed or shot the emergency room is going to treat you regardless of ability to pay. All of us pay for it in the end.
Funny how non-covered services (like Lasik) drop in price every year while other healthcare costs skyrocket. Maybe the answer is price transparency and everyone pays out-of-pocket.
@HSpencer
The article was in the New Yorker, sorry. Here's the link
http://www.newyorker.com/reporting/2009 ... ande?yrail
it's long but I think it's very interesting.
The article was in the New Yorker, sorry. Here's the link
http://www.newyorker.com/reporting/2009 ... ande?yrail
it's long but I think it's very interesting.