Every time I have any procedure done my insurance company sends me an EOB, Explanation Of Benefits, that I usually read very closely even though I know everything has been covered.
What has always made me furious is to see that a hospital, lab, doctor, etc. charges the allowable Medicare amount. BUT because of contracts the provider accepts the amount or percentage my insurance company agrees to pay for the service. This amount is very often approximately 10-15% of the amount charged. And this is the amount the doctor, lab or hospital considers acceptable for the services rendered. When I have a surgery with a one-month hospital stay and a hospital bill over $130,000 BUT the hospital was willing to accept $40,000, that tells me there's something wrong with our system! If I didn't have insurance I would be expected --no, *required*-- to pay the full amount. Medicare pays the full amount. But the hospital is simply gouging private payers and the Medicare system simply because it can. If a doctor is willing to accept 10% of what he/she charges, then THAT should be the amount he/she actually charges regardless of insurance, Medicare, or private pay. Otherwise, the only other explanation is that medical institutions are using private payers and Medicare to supplement that which they lose through contracting with insurance companies. Our health care system in the US would not be in nearly the trouble it is if the TRUE cost of services is being charged to those who need it. Also, those individuals without health insurance would be charged the TRUE amounts and would not be required to go bankrupt or pile mortgages on top of mortgages in order to cover themselves in a catastrophic incident. Just my opinion... so far very few have been able to argue convincingly to point out major problems in this point of view. Best regards All, --Tod ---- [EMAIL PROTECTED] wrote: > > > Back in the 1960s, Claude Castonguay chaired a Canadian government committee > studying health reform and recommended that his home province of Quebec — > then the largest and most affluent in the country — adopt > government-administered health care, covering all citizens through tax > levies. > The government followed his advice, leading to his modern-day moniker: "the > father of Quebec medicare." Even this title seems modest; Castonguay's work > triggered a domino effect across the country, until eventually his ideas were > > implemented from coast to coast. > Four decades later, as the chairman of a government committee reviewing > Quebec health care this year, Castonguay concluded that the system is in > "crisis." > "We thought we could resolve the system's problems by rationing services or > injecting massive amounts of new money into it," says Castonguay. But now he > prescribes a radical overhaul: "We are proposing to give a greater role to > the > private sector so that people can exercise freedom of choice." > _Canadian-Health-Care_ > (http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931) > > Einstein once said The height of insanity is doing the same thing over and > over again and expecting different results. > > Both the Canadian and the British national health care systems are literally > medical disasters--and also monetary black holes. > Plus they are losing all of their finest doctors who don't want to work for > peanuts. > Those who can afford it, seek medical care out of country. > > The US life expectancy just increased to 78 years; Canada's fell to 75 years > and Britain's to 73 years. > Does this not tell you that we are doing something right? > > > > In a message dated 6/27/2008 9:35:17 P.M. Eastern Daylight Time, > [EMAIL PROTECTED] writes: > > > Bad news for persons with disabilities and elderly. > > In July 1, doctors will get a 10 percent payment cut, a disaster for both > patients and doctors that the bill would have averted. None of the senators' > excuses for this vote hold water: > > The bill was a partisan exercise. Not so. The bill passed 355 to 59, a > veto-proof majority, in the House of Representatives. More Republicans voted > for > HR. 6331 than against it. > President Bush would have vetoed it anyway. So what? If enough Republican > senators put the interests of people with Medicare ahead of their loyalty to > President Bush, there would have been enough votes to override a veto in the > Senate. > > Senators will be back home attending fundraisers and marching in > Independence Day parades. We need to tell them to show a little more > independence from > President Bush and a little more backbone to the insurance company > lobbyists. > Medicare belongs to the American people. It is not a racket for the > insurance > industry. > > > > > > Asclepios > Your Weekly Medicare Consumer Advocacy Update > > > Medicare Racketeers > > June 27, 2008; Volume 8, Issue 26 > > The Medicare bill defeated in the Senate last night would have improved > coverage for mental health and preventive services and helped pay medical > and > drug costs for more people with Medicare living on fixed incomes. The Bush > administration objected to these improvements, which were paid for with a > modest > cut to some of the excessive subsidies Medicare pays to insurance companies. > Administration officials opposed this reduction in subsidies, they claim, > because it would result in reduced benefits for people with Medicare > enrolled in > private health plans offered by these companies. > > Translation: No one gets better Medicare benefits unless our pals in the > insurance industry get a cut off the top. > > It's as if the Medicare program had been taken over by Mafia goons. > > Numerous independent, nonpartisan studies have shown it cost taxpayers > substantially more—about $1,000 a head, according to one study—to provide > coverage through a Medicare private health plan instead of through Original > Medicare. > > Just this week, the Government Accountability Office reported that, in 2005, > insurance companies pocketed as profit $1.14 billion in subsidies that the > companies had told Medicare would go toward medical benefits. > > Last night, 39 Republican senators joined President Bush in opposing HR. > 6331, the Medicare Improvements for Patients and Providers Act. As a result, > the > benefit improvements in HR. 6331 will not take effect, and on July 1, > doctors will get a 10 percent payment cut, a disaster for both patients and > doctors > that the bill would have averted. None of the senators' excuses for this > vote hold water: > > The bill was a partisan exercise. Not so. The bill passed 355 to 59, a > veto-proof majority, in the House of Representatives. More Republicans voted > for > HR. 6331 than against it. > President Bush would have vetoed it anyway. So what? If enough Republican > senators put the interests of people with Medicare ahead of their loyalty to > President Bush, there would have been enough votes to override a veto in the > Senate. > > Next week, these senators will be back home attending fundraisers and > marching in Independence Day parades. We need to tell them to show a little > more > independence from President Bush and a little more backbone to the insurance > company lobbyists. Medicare belongs to the American people. It is not a > racket > for the insurance industry. > > > Medical Record > > Senate vote to invoke Cloture on the Motion to Proceed on HR. 6331 fell > short of the 60 votes needed. Yea votes indicate support for passage of HR. > 6331. > No votes indicate opposition. Majority Leader Harry Reid, Democrat of > Nevada, voted No to preserve the right to bring the bill up for a vote again > (Roll > Call vote on HR. 6331 > (http://www.kintera.org/TR.asp?a=hhKWI5OFLdIPKcJ&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F&af=y), > June 2008). > > "On average, [Medicare Advantage] organizations' self-reported actual profit > margin was 5.1 percent of total revenue, which is approximately $1.14 > billion more in profits in 2005 than [Medicare Advantage] organizations > projected" > ("Medicare Advantage Organizations: Actual Expenses and Profits Compared to > Projections for 2005 > (http://www.kintera.org/TR.asp?a=kkI2JePRKgLWImI&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F&af=y)," > Government Accountability Office, June > 2008). > > "I am an elder advocate with an Area Agency on Aging. Even though several > Medicare Advantage plans, including four PFFS plans, are listed as plans > accepted in our county, that is actually not the case. Once a beneficiary > enrolls > in one of these Advantage plans, they find out that providers in this county > actually do not accept the plans. If the beneficiary cannot see a provider > in > this county, they are forced to leave the county to find providers. Some > have > to drive 50, 100 and 200 miles to see a provider, or get their > prescriptions, because there are no providers in our county who will accept > their plan. > Many of these elderly people can't drive because they have poor eyesight, > dementia, etc. These elderly beneficiaries come to our Area Agency on Aging > to get > out of these Medicare Advantage plans because the local hospital and their > doctors will not accept the plans" (Story submitted to the Private Health > Plan > Monitoring Project > (http://www.kintera.org/TR.asp?a=ddJOKTNpE9KJK2L&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F&af=y) > from Spencer, Iowa, Medicare Rights Center, > April 2007). > > * * * * > > Medicare Part D Appeals Help for Advocates is here! > > MRC's new Medicare Part D Appeals: An advocate's manual to navigating the > Medicare private drug plan appeals process offers an easy-to-understand, > comprehensive overview of the entire appeals process, including real-life > case > examples, a glossary of important appeals terms, a sample protocol for > advocates, > and links to important resources. > > Download a FREE copy > (http://www.kintera.org/TR.asp?a=hrKWI1OELmIQK7J&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F&af=y) > of this great resource. > > * * * * > > Medicare Part D Monitoring Project > The Medicare Rights Center (MRC) would like to hear about your experience, > or that of someone you know, enrolled in a Medicare private drug plan. With > information about what the issues are with Medicare Part D, we will be able > to > demand that those problems be fixed. > > Submit your story at http://www.medicarerights.org/partdstories.html. > (http://www.kintera.org/TR.asp?a=kkI2JaPQKpLXIhI&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F > &af=y) > > * * * * > > The Louder Our Voice, the Stronger Our Message > > Asclepios —named for the Greek and Roman god of medicine who, acclaimed for > his healing abilities, was at one point the most worshipped god in Greece—is > a weekly e-newsletter designed to keep you up-to-date with Medicare program > and policy issues, and advance advocacy strategies to address them. Please > help build awareness of key Medicare consumer issues by forwarding this > action > alert to your friends and encouraging them to subscribe today > (http://www.kintera.org/TR.asp?a=ddJOKPNoEiKKKXL&s=qtJ3JcMJJbKWJ7MSF&m=guKSIaMVKkL2F&af=y). > > > > * * * * > > The Medicare Rights Center (MRC) is the largest independent source of > Medicare information and assistance in the United States. Founded in 1989, > MRC > helps older adults and people with disabilities get good, affordable health > care. >
