Which Health Service Rejects the Most Applicants?

[boyntonstu]

If you add up all the private Health Insurance company's rejection rate (Blue cross Blue Shield, Aetna, etc.) it is much less than what Medicare/Medicaid rejects.

If we go to Universal Health Insurance, why would you expect it to improve?

 

[quixotecoyote]

Is this a real question or a troll thread?

I ask because it seems to imply an abject ignorance of the purpose of Medicare/Medicaid and even the most basic arguments for universal health care systems.

Maybe you should compare Medicare/Medicaid to private insurers slightly more closely and try again.

 

[tyr_13]

If you add up all the private Health Insurance company's rejection rate (Blue cross Blue Shield, Aetna, etc.) it is much less than what Medicare/Medicaid rejects.

If we go to Universal Health Insurance, why would you expect it to improve?

You're joking right. This has to be some kind of parody.

You're asking how switching to Universal Health Insurance would increase coverage, where Medicare/Medicaid (which both have specific criteria) doesn't cover most people who apply?

There is so much failure here, so much...

 

[Rolfe]

I don't even understand the question. How does Medicare reject people? I thought everyone over the age limit was covered?

I presume Medicaid rejects people who aren't destitute enough. I don't see what that has to do with the price of fish though.

I require clarification.

Rolfe.

 

[quixotecoyote]

I don't even understand the question. How does Medicare reject people? I thought everyone over the age limit was covered?

Well yes, but in the matter of massaging statistics, this means you can count everyone under the age restriction as 'rejected by Medicare."

Clever, no?


(disabled and kidney diseased people may be exceptions)

 

[Ohmer]

I 'm not speaking for boyntonstu, but I think that an interesting question to ask is what treatments are rejected* by private insurance vs government programs. To be useful the comparison would really have to cross borders to places that have universal coverage. Health care has to be rationed at some point. How it is rationed in different systems would be a discussion worth haveing. I think it is really the core of the issue.

*by "rejected" I mean refuse to pay for.

 

[Delscottio]

I 'm not speaking for boyntonstu, but I think that an interesting question to ask is what treatments are rejected* by private insurance vs government programs. To be useful the comparison would really have to cross borders to places that have universal coverage. Health care has to be rationed at some point. How it is rationed in different systems would be a discussion worth haveing. I think it is really the core of the issue.

*by "rejected" I mean refuse to pay for.

Surely the more obvious question is why were the payments denied, then move onto the types of treatment?


I may be showing my ignorance here but if someone is trying to use Medicare / Medicaid have they not been unable to get private insurance in the first place (for what ever reason) e.g they have been knocked back even before the treatment payment phase begins?

 

[Ducky]

Surely the more obvious question is why were the payments denied, then move onto the types of treatment?


I may be showing my ignorance here but if someone is trying to use Medicare / Medicaid have they not been unable to get private insurance in the first place (for what ever reason) e.g they have been knocked back even before the treatment payment phase begins?

I have no large scale numbers, just my own account.

 

[Delscottio]

I have no large scale numbers, just my own account.

I've read that post a few times (when you originally typed it) and the disbelief doesn't lessen. Hope you are clear, healthy and getting back to a reasonable financial footing.


Before we get into anecdotes about the respective failings of insurance led heathcare vs UHC, the UHC horror stories generally appear to be due to negligence whilst it appears Insurance horror stories appear to be built into the system (as well as negligence of course). Its this bit that perplexes me.

I know rationing / QALY is going to mentioned somewhere as well, am I correct that insurance coverage has an upper limit on maximum payouts over a patients life?

Obviously I may be wrong as I have no great knowledge of the US system apart from what I've seen around this place.

 

[GreNME]

@ The premise of this thread.

Tell you what: go over to this thread and be the first to provide a compelling positive argument.

 

[boyntonstu]

http://forums.poz.com/index.php?topic=15113.0;wap2

"I learned today in a management meeting at my hospital about some new changes to Medicare/Medicaid that I think everyone needs to know; especially anyone with a compromised immune system.

As of October 1, Medicare/Medicaid will no longer reimburse hospitals for expenses related to the treatment of nosocomial infections (those acquired while in the hospital). Once again, the government agencies are sticking their hand into something they should leave alone. Obviously the thought process behind this is that if you refuse to pay for the expenses, then the hospitals will stop the infections from occuring.

First off, the hospital has little control over the fact that certain populations of patients will acquire infections while in the hospital. It does not matter where a patient is, hospitalized, at home, long term care facility, etc, certain patients are going to get infections. Such patients would include: immunocompromised, patients with artificial airways or artificial ventilatory devices, patients with frequent iv/port/tube/drain access needs, patients who are convalescent, patients who are unable to tend to their own personal hygiene needs, patients with open wounds/burns, patients on multiple antibiotic coverage, patients who are non-compliant, patients who are malnourished, etc, etc, etc...."......

Hard to imagine dealing with a Government run health care system?

Think of what it was like to deal with the DMV or the IRS.

BTW As of the last reporting, a major portion of advice given by the IRS was incorrect.

 

[Ducky]

http://forums.poz.com/index.php?topic=15113.0;wap2

"I learned today in a management meeting at my hospital about some new changes to Medicare/Medicaid that I think everyone needs to know; especially anyone with a compromised immune system.

As of October 1, Medicare/Medicaid will no longer reimburse hospitals for expenses related to the treatment of nosocomial infections (those acquired while in the hospital). Once again, the government agencies are sticking their hand into something they should leave alone. Obviously the thought process behind this is that if you refuse to pay for the expenses, then the hospitals will stop the infections from occuring.

First off, the hospital has little control over the fact that certain populations of patients will acquire infections while in the hospital. It does not matter where a patient is, hospitalized, at home, long term care facility, etc, certain patients are going to get infections. Such patients would include: immunocompromised, patients with artificial airways or artificial ventilatory devices, patients with frequent iv/port/tube/drain access needs, patients who are convalescent, patients who are unable to tend to their own personal hygiene needs, patients with open wounds/burns, patients on multiple antibiotic coverage, patients who are non-compliant, patients who are malnourished, etc, etc, etc...."......

Hard to imagine dealing with a Government run health care system?

Think of what it was like to deal with the DMV or the IRS.

BTW As of the last reporting, a major portion of advice given by the IRS was incorrect.

Can you definitively show this would be the problem if universal coverage were in effect? Because I have already posted my story about how a private insurance company denied me coverage of radiation treatments, MRI's, blood tests and other needed procedures as a cancer patient. I'm not alone in this problem.

If not covering needed procedures and treatments makes you so scared, why defend the current system which denied me coverage for radiation treatments as a cancer patient? Why not support a universal plan that would force coverage for needed therapies?

 

[Delscottio]

http://forums.poz.com/index.php?topic=15113.0;wap2

"I learned today in a management meeting at my hospital about some new changes to Medicare/Medicaid that I think everyone needs to know; especially anyone with a compromised immune system.

As of October 1, Medicare/Medicaid will no longer reimburse hospitals for expenses related to the treatment of nosocomial infections (those acquired while in the hospital). Once again, the government agencies are sticking their hand into something they should leave alone. Obviously the thought process behind this is that if you refuse to pay for the expenses, then the hospitals will stop the infections from occuring.

First off, the hospital has little control over the fact that certain populations of patients will acquire infections while in the hospital. It does not matter where a patient is, hospitalized, at home, long term care facility, etc, certain patients are going to get infections. Such patients would include: immunocompromised, patients with artificial airways or artificial ventilatory devices, patients with frequent iv/port/tube/drain access needs, patients who are convalescent, patients who are unable to tend to their own personal hygiene needs, patients with open wounds/burns, patients on multiple antibiotic coverage, patients who are non-compliant, patients who are malnourished, etc, etc, etc...."......

Hard to imagine dealing with a Government run health care system?

Think of what it was like to deal with the DMV or the IRS.

BTW As of the last reporting, a major portion of advice given by the IRS was incorrect.

Seems like old news, from 2008 -
http://blog.cleveland.com/health/2008/09/medicare_this_week_stops_payin.html Looks as though a few big insurance companies are going down the same route as well. Anyone know if this has happened?

 

[boyntonstu]

Seems like old news, from 2008 -
http://blog.cleveland.com/health/2008/09/medicare_this_week_stops_payin.html Looks as though a few big insurance companies are going down the same route as well. Anyone know if this has happened?

From your link:

"Also, the government health plan, which covers the elderly and disabled, will not pay anything to doctors or hospitals for what the government calls "never events," including surgery on the wrong body part or on the wrong patient."

Imagine, they cut off your left leg in error and the government health plan rules basically says, "Big deal, handle it".


This is the current system.

If Congress accepted the new proposed plan for themselves, it might be a better plan. Why won't they even consider it?

 

[Rolfe]

There's a degree of logic to this, in the assumption that the hospitals will be obliged to eat the cost of treatment themselves if they let this sort of thing happen. But is there any safeguard to ensure that they don't try to recoup the money directly from the patient? And that they don't scrimp on treatment? I could also see wrangles in individual cases as to whether a certain infection really was hospital-acquired.

However, I can't see what that has to do with the title of the thread. Forcing the hospitals to eat the cost of treating iatrogenic events hardly equates to "rejecting applicants".

Rolfe.

 

[Shalamar]

From your link:

"Also, the government health plan, which covers the elderly and disabled, will not pay anything to doctors or hospitals for what the government calls "never events," including surgery on the wrong body part or on the wrong patient."

Imagine, they cut off your left leg in error and the government health plan rules basically says, "Big deal, handle it".

Why would the government, or any plan pay for a screw up?

If you take your car in to get the oil changed, but they end up replacing the transmission fluid instead.. would you pay for it? No. You tell them to do the job they were supposed to do.

A proper question might be: Do CURRENT insurance companies pay if the doctor performs surgery on the wrong body part? I imagine the hospital would have to suck the cost of a mistake, and still perform the correct procedure.

 

[GreNME]

From your link:

"Also, the government health plan, which covers the elderly and disabled, will not pay anything to doctors or hospitals for what the government calls "never events," including surgery on the wrong body part or on the wrong patient."

Imagine, they cut off your left leg in error and the government health plan rules basically says, "Big deal, handle it".


This is the current system.

It's also a red herring. In a situation like you describe, the hospital where the mistaken procedure was performed would be liable. The government (or the insurer, whatever) would instead pay for the correct procedure to be performed.

 

[Ducky]

Once again, with feeling:


If not covering needed procedures and treatments makes you so scared, why defend the current system of private insurance which denied me coverage for radiation treatments as a cancer patient? Why not support a universal plan that would force coverage for needed therapies?

 

[boyntonstu]

The questions is: "Can you sue the gubmint if their HC fails"?

 

[ddt]

The questions is: "Can you sue the gubmint if their HC fails"?

Strange question. What do you mean with "fail"? They can't protect you from dying someday, can they? So there'll be rules what's in the HC package and what not.

When it come to (mis)applying the rules: Why not? Can't you now sue Medicaid or Medicare when they misapply the rules?

And do you care to explain your OP? It's left me confused, as well as a dozen or so posters who expressed that in the first reactions.