Health Insurance and Death Panels

[jpatter666]

Re: Health Insurance and Death Panels

A family member of mine just had magnetic resonance spectroscopy performed, the doctor wanted to measure the presence of a certain chemical in his body, the scanner does this. Insurance denied the claim. because MRS is "experitmental". I don't understand, the machine measures the chemical, the doctor wants to know if the chemical is present, what's experimental about it?

I have published papers showing that the prescence of this chemical is an indicator of an underlying condition. I am appealing. we will see how that goes. In the mean time I have thousands of dollars of uncovered medical bills. Neither the ordering physician or the provider informed me that this exam might be termed exprimental.

There are some things that could easily fix a lot of these problems.
1) Doctor's and Providers know the cpt codes. Have instant verification of coverage, could be done over the web.
2) When an insurance company says it's covered. this is a legally binding agreement. They can't weasel out. (this has happened to me before too).
3) If a customer pre-pays for a procedure, they get a special rate. LIke the ppo rate. Therefore they do not have to go through insurance to get good prices. If you have no group rate, and you need medical treatment,
you're in real trouble.

I'm not in love with the insurance companines, but a gvt replacement is no panacea either. I just got an AUR from the IRS. complete incompetance.
I actually owed no additional taxes. There is no way to argue your case on the phone. A five minute phone call would have fixed it. It took three mail exchanges, and 4 months to fix it. What a waste of time. Fortunately I was not waiting for an organ transplant.

Part of the problem with insurance companies is that because the policies are offered through your employer, you don't really have a choice of carrier. My company changed carriers a few years ago, but before that
the previous company was very incompetant. I had to call on approximately half o my claims because the were not filed correctly.
Had I had a choice of carriers I would have switch a long time ago.

I don't know how portability, open enrollment, pre-existing conditions issues get solved once insurance is no longer supplied by an employer.

I work in the IT industry. Several of my friends work for (or in some cases are trying to build!) applications that would greatly automate medical care. Access to records, instant validation of procedures, automated billing.

Two things keep this from happening they tell me:
1 ) The current insurance-powers-that-be like the current system just fine thank you. The complexity serves their purposes. Transparency would reduce their profits -- other companies or (horrors!) customers might be able to see what rates they are really charging. Information might get out on the web as to which companies are really best. Information is power and these companies DO NOT WANT it to get to you.
2 ) Privacy issues. Especially for medical records. Many companies fear to implement such a system because they are afraid they will be hacked (and your local IT team is no match for a crack hacker group if they decide to come for you) and then sued to oblivion by their patients. Some protection has to be established here. Perhaps data could be in the cloud, handled by the government -- don't know.

[sunskyfan]

Re: Health Insurance and Death Panels

There is a very effective cure for the health insurance problem but it would take balls. Clearly we, as a country, lost them in our divorce with reality. The solution is that everybody quits buying health insurance. Prices for procedures and health care would drop precipitously.

[Starving Steve]

Re: Health Insurance and Death Panels

My aunt died a few weeks ago in Minneapolis-St. Paul, her age was 92 and 5/12.

She entered hospital without a sick day in her life; strong as an ox. And she was mentally sharp as a tack. She had U.S. Medicare and also a private for-profit health insurance plan to take care of any gaps in Medicare coverage.

She had the classic symptoms of a heart attack, but when she entered hospital, the doctors refused to treat her for such, and they opted to wait to see how her symptoms would develop. They thought that she might have other illnesses which mimic a heart attack.

Sure enough, on the second day in hospital, her symptoms got worse, and it was obvious that she was having a heart attack. Her intubulation was begun, and she died shortly afterward, in the very early morning of her third day in hospital--- the classic pattern of death from heart attack in a hospital.

I spoke to my brother, himself a doctor, about why my aunt was a victim of the hospital's so-called, "death panel". He told me that at age 92 and 5/12, by-pass surgery could not be done; that surgery would have very likely killed her. So, the hospital opted to hope for the best and hope that she would survive the heart attack in the intensive care unit... But she did not.

This is how we die, in the best case. My brother told me that he has seen much human suffering in other cases, so my aunt was lucky. She lived a very good life, and a very long life. She had only one bad day in life; that was as good as life can get for anyone.