[Winona Online Democracy]
As it stands now, the government, through its Medicare and Medicaid programs
and insurance companies are indeed making medical decisions for patients by
deciding which tests and procedures will be paid and which will not. The
reality is that too many people forgoe medical treatment and medications
because of the cost--including people with medical insurance.
Insurance companies and the government are determining the amount that
physicians will earn, to a large extent, by determing which tests and
procedures will be paid and at what rate. Unfortunately, this is serving to
limit the pool of candidates for medical school as our best and brightest
are forced to weigh the financial realities of pursuing a career in medicine
while struggling to pay the enormous debt incurred while preparing for that
career, in addition to setting up their own business, with all of the
responsibilities and expenses that implies.
In my opinion, neither the government nor the insurance agencies are
qualified to make medical decisions for patients. In fact, I consider this
to be practicing medicine without a license. It gets worse when insurance
companies (including govt. ones), in an attempt to control fraud, institute
rules which actually work against patients best medical interests, leaving
families to scramble to try to find alternative providers/funds to obtain
much needed medical care for loved ones. Having been in that position
myself, I can tell you that it can and does create some difficult and even
dangerous situations for patients and their families.
What I do think the government can and should do is to institute the same
sort of oversight into the billing practices of insurance companies. As Dr.
Davis pointed out, many insurance companies stall payment as long as
possible. Each time a bill must be sent out again, a cost is
incurred--which cost is passed on to us as consumers. And of course,
insurance companies also bank on patients not wanting to bother with the
hassel of multiple claims, documentation, phone calls, etc (which are all
costs to the consumer/patient) and simply paying themselves. Or doing
without.
In my opinion, the state of Minnesota could help by allowing local branches
of government: cities, counties, school districts, other governmental
bodies, to lower their insurance costs by allowing them to opt into the
State insurance plan offered to state employees.
State and federal governmental bodies can and should act to standardize
claim procedures and to put into place safeguards that make it difficult for
insurance companies to avoid paying legitmate claims.
Terri Hyle
From: "Paul Double" <[EMAIL PROTECTED]>
To: "Online Democracy" <[email protected]>
Subject: FW: [Winona] Medical-loss ratios of largest for-profit insurers
Date: Thu, 23 Mar 2006 21:46:35 -0600
[Winona Online Democracy]
Addressing some of the questions
#1 Medicare does not process payments to providers- They contract with
private companies to do that and those companies may be insurance companies
but the important thing to note is that the reason the claims are processed
for 3% is that the work is contracted to private "for profit companies".
#8 Medicare or any system must audit for fraud and there may cases of bogus
providers billing Medicare for services not used but coded in such a manner
as to facilitate payments. Providing electronic audits of the data stream
can identify those providers who attempt to milk the system by
understanding
it and then attempting to beat it. It may be the number of claims filed
using a particular code that based on the population matrix is to high
which
then triggers further investigation. Any system without safeguards is to
invite corruption. We have designed a data base which records by drug or
service code processed payments to check for price variance on identical
things and to different patients by provider. The logic is to catch
processing errors and to ensure compliance with the law that requires the
same price be charged for identical items to all of our subscribers.
The items covered are what are already is in current law as deductible
medical expenses listed in many IRS publications applicable to personal
income taxes deductibles and the rules which govern HSA, HRA and FSA
medical
reimbursement accounts. Cosmetic items are not allowed under current rules.
Paul Double
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of Davis, William MD
Sent: Thursday, March 23, 2006 5:40 PM
To: [email protected]
Subject: RE: [Winona] Medical-loss ratios of largest for-profit insurers
I started a reply but I must have hit the wrong key so I will try again. I
find Paul's idea very intriguing. It provides a single payer system with
universal coverage. The poor pay little or nothing and the rest pay up to
7.5% of their income on medical care. I like the smart cards but I would
suggest eliminating the insurance companies as middle-men for the
processing
and just have the federal government pay directly. They would issue the
card and it would kick in when the person reached the 7.5% deductible for
the year. There are a few issues that would need to be decided. What
types
of care would not be covered (cosmetic, etc.). How the fee schedule would
be established. Very interesting! Paul, please explain in more detail
#8.
I don't understand that step. Bill
William Davis MD
[EMAIL PROTECTED]
507.454.5050 ext 623
825 Mankato Ave
Winona MN 55987
"Two seconds is too long!" Neal Patterson CEO Cerner Corp
_____
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of Paul Double
Sent: Wednesday, March 22, 2006 9:10 AM
To: Online Democracy
Subject: [Winona] Medical-loss ratios of largest for-profit insurers
A single payer can be simple
1) Every tax payer would be required to spend 7.5% (Current IRS
Disallowance) of the reported taxable income in the prior year which
becomes
their deductible for the current year. Medical expenses include
Chiropractic, Dental, Medical, Medical Supplies, Non Traditional,
Prescriptions, Psychological and Vision
2) Everything over the 7.5% is paid by the government as catastrophic
coverage.
3) All purchases are tracked with a smart card to insure the deductible is
paid which is charged at the time of first use in the then current year
based on the prior tax year filing. The current cycle year is July 1- June
30 based on calendar years for establishing the tax year base for the
deductible. This allows the period January to June for taxes to be
processed for the prior year and the data to roll into the data base
establishing the base line for the deductible.
4) The Federal government contracts the payment processing to providers,
the same as they currently do for Medicare, for 3% or less.
5) Coverage is afforded at birth to age 65. Medicare remains the same
except Part D is added using the Medicare 3% payment system eliminating
insurance.
6) The cost less than $1.50 per month times each person's age, adult or
child paid for by either an employee or employer tax.
7) All federal employees and Congress would become a part of the plan with
no exceptions.
8) Cost control of providers is achieved with electronic hard data based on
actual payment processed.
The solution is logical, affordable and easy to put in place. The
political
will to do it is not yet there!
Paul Double
<< ATT00113.txt >>
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