On Fri, Jun 5, 2009 at 4:55 PM, ruthsimplicity <no_re...@yahoogroups.com>wrote:
> --- In FairfieldLife@yahoogroups.com, "It's just a ride" > <bill.hicks.all.a.r...@...> wrote: > > > > On Fri, Jun 5, 2009 at 3:52 PM, do.rflex <do.rf...@...> wrote: > > > > Really? I don't know any health insurance companies that cover lost wages. > What company was it? > UHC. My friend had signed up for disability insurance with UHC through his Fortune 5 company. > > I would describe the relationship between docs and insurers as almost > adversarial, hardly in cahoots. Most of the people I know have UHC. UHC is very heavily into diagnostics. Whereas most insurance companies will pay for one of a certain test a year, UHC will pay for as many as the doctor wants to order. Want a second, third, fourth opinion at say Mayo, Hopkins, Menninger? UHC will pay. I would hardly consider it adversarial where the doctor just happened to be on call (and officed in the hospital complex) and made all the arrangements with the insurance company for pre-authorized coverage before visiting my friend with the option of having my friend surrender his drivers license to the officer outside or sign the paperwork for a week worth of wasting a bed, a bunch of nurses and 3 shifts of EEG technicians shared with one other patient (who's insurance wasn't as good so she didn't get an executive suite with a DVD player or Wii in it). The doctors and their staffs in my area have learned how to play the insurance companies. They know just the words needed to get those pre-authorizations out of the major insurance companies in my area. It appears Obama's gotten to the likes of UHC. People get calls at the hospital or home while recuperating from UHC asking if there's anything more UHC could do to help. I know of one case where the patient was having a problem adjusting to her illness. UHC offered to locate a counselor for her, as her company provided counseling as a benefit administered by UHC. I'd suspect that if you've got UHC through a Fortune 50 million company YMMV. > > > We aren't going to get a single payer plan this time around. There aren't > the votes. At best, if we have enough legislators with balls, we will have > a federal option plan to go along with the private plans. Too soon to tell. > > I see nothing but disaster. We need Evidence Based Medicine. My friend's trip to the ER, let alone his one week work up violated EBM all 4 miles round trip of the way. Then in another part of town there are all these people who use the ER out of necessity as though it were a local nurse practicioner. My town only has a few nurse practioners and they provide anesthesia survices at the high dollar day surgery clinics in town. If we were to get EBM, nurse practicioners performing triage and giving care as needed, we'd save a bundle in the aggregate. It's estimated that every trip to the ER in any part of town here starts at $2,000. Cut out a bunch of unnecessary $2,000 visits, cut out my friend's $38,000 boondoggle and after a while you're talking some real money saved. Saved by the taxpayers, saved by the insurance companies, saved by employers and their employed. Instituting electronic medical records interchange isn't going to save any money. My friend told his story to EMS technicians, a triage nurse, a bunch of ER nurses, a bunch of different ER doctors, the neurologist and then to nurses, EEG techs, a pharmacist and some doctors when he got upstairs. It turns out that though the hospital has one of the finest records systems in the country and everyone is walking around with PDAs or PC tablets, the records are organized so poorly that staff would rather blow the time to ask the patient for a history, meds, etc. rather than consult the MRS. The one good thing I see that might save a little money is the doctor/hospital/lab proposal to insurance companies and the governments to be able to submit a single bill. Right now a single week stay in the hospital will generate a hundred or more different bills which have to be settled by the insurance company, the governments, those billing and the patient. Another good thing which might come out is if the insurance companies/governments start refusing to pay for 2nd and 3rd admissions to hospitals because the hospital didn't get the care right the first time. This is all a far cry from universal $300 per person per month insurance premiums. $300 a month per person would easily cover everyone's medical needs if EBM were truly put in practice. At $300 per person companies, individuals and governments could pay for everyone in the US out of petty cash.
