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Talk about leaving seniors — the poorest seniors! — “at the mercy of insurance companies.” And why has HHS decided to roll out this pilot program? As Paul Ryan has argued all along, the competition will drive down costs, especially given the headaches associated with government bureaucracy for dual-qualified seniors:
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It's unclear what this proposal is about, but as I understand healthcare reform, it will help almost everybody get a basic insurance plan. Beyond that, people and companies will be able to upgrade out of pocket. A voucher system is not necessarily bad provided you have a safety net.
Thus, if you get a $5000 credit for insurance, it will cover either Medicare or you can add in your money and get something better. What your article neglects to say is that seniors will have a guaranteed health care plan. If they're looking for faster elective surgery, private rooms, services overseas, etc., they may have to pay extra. What Ryan wants is a voucher plan with vouchers that in many cases do not cover the full cost of insurance.
When I lived in Norway the government offered a basic (and very good) health insurance plan, and private companies offered supplemental insurance. Thus, the company I worked for provided a private plan, which I could use for elective surgery, second opinions, better hospital rooms, and so on.
Bear in mind that Ryan’s plan made the vouchers optional; seniors could choose the traditional government-run Medicare plan or opt for a private insurance plan from a federal exchange of approved insurers. Ryan also allows all seniors to choose, and didn’t force the poorest seniors to take the voucher option. Not only will Obama push just the poorest seniors into this plan, in some states they’d have to know to opt back in to traditional Medicare:
Obama runs the party of no choice.
Your freedoms and choices dwindle by the day.By the time this country wakes the f-ck up and start paying attention it will be too late.
This guy makes the defenders of him look duped and dumber by the day.
First off - this is a pilot program not for every senior citizen but for very specific senior/disabled citizens - it is specifically for those people who qualify for both Medicare and Medicaid and no one else.
Secondly - as the POA for my mother, who qualifies for both, I'd be the first one to sign up for such a thing if it became available in Indiana where my mother resides.
The pilot seems aimed at streamlining the two processes and having them work as one entity rather than separately as they do currently. The current system is full of loopholes, bugs and entails reams of patience and paperwork - none of which is done by the agencies but all of which is required of the patient or the patient's representatives.
Quickly, here's how it works right now: The patient is required to use all of their resources to pay for their nursing home care - minus $50.00 per month which they are allowed to keep for personal expenses and their medicare/secondary insurance premiums. Medicaid then pays the balance of their nursing home cost - but that's it. Not their medical bills such as doctor visits, medications, surgeries, hospitalizations, transportation costs, eye care, dental care, hearing aids, x rays or lab tests.
What happens is this: My mother had cataract surgery last year. The clinic where she had the surgery billed medicare - medicare paid their portion and sent the explanation of their payment and the remainer of the bill to her secondary insurance. Ditto the ambulance company which transported her. BC/BS then paid the portion of the remainer of both bills which they were responsible for and sent the explaination to me. The clinic and the ambulance company then billed my mother for the remainder....which came to $860.00 combined.
Medicaid does not pay directly to doctors or suppliers unless they are the patient's primary insurance. It becomes the patient's responsibility to make copies of the bills, write a detailed letter in quadruplicate (one to Medicaid, one to the nursing home, one to the supplier of the service and on for your own records) asking for permission to reduce the amount you pay to the nursing home by the amount you owe the doctors/clinic/transportation company so that you can pay them the money they are owed.
It must be sent by registered mail. It takes approximately 6 weeks to 6 months to hear back from medicaid - all the while you are getting billed monthly from the suppliers of the services rendered.
Generally, it has been my experience, that they turn you down the first time due to some mistake in the wording of your request or some information which was lacking from the doctor.
So you submit it a second time and wait another 6 months.
They do, eventually, allow you to reduce the nursing home payment by the amount owed the other suppliers, but it takes close to a year...meanwhile, the patient has seen several other doctors, been to several other clinics, taken several new medications, had blood drawn, x-rays taken, dental work done, etc.
Once they approve you to pay the medical expense they increase the amount they pay the nursing home by the amount you decreased your nursing home payment. (For example, I send the nursing home $860.00 less then my normal monthly payment and send the $860.00 to the eye doctor and the ambulance company. Medicaid then agrees to pay the nursing home the difference for that month.)
Each bill must be treated the same way. Each time a new bill is received, after being paid for by medicare and BC/BS, the remainder must be submitted to Medicaid in the same manner and the same process is begun all over again.
It's a no-brainer that to link the two, Medicare and Medicaid, at the first level would save time and money for everyone concerned - Medicare and Medicaid included for if they could work out a fee schedule which satisfied both them and the suppliers of the medical service there would be much less paper work and salary spent on people who fill out paperwork. The doctors would also win for they would get their money in a timely fashion instead of being forced to wait a year or longer for full payment.
Also, having worked in a doctor's office and done billing, most doctors will just kiss off the Medicaid payment - they know they can't file it themselves and the people who they would file it on behalf of are the oldest and sickest and poorest amongst us. They simply end up writing it off - which means, of course, passing it on by raising their costs to everyone else.
I keep at it because it irritates me. I'd like to see the doctors receive every penny which is owed to them. Most people just ignore the bills because they do not really understand how to get them paid....and, like I explained, the medical personnel cannot file the claim themselves it can only be petitioned for by the patient or the patient's legal representative.
So yes, a program which would combine Medicare and Medicaid to those who are already covered by both would be one of the best things that could happen for everyone concerned.
Last edited by Mrs.PatsFanInVa; 09-08-2012 at 03:10 PM..
Don’t get me wrong — this sounds like a good program to test. In fact, it sounds a lot like the Medicare Advantage program that Obama gutted to pay for his Medicaid expansion in ObamaCare. It’s similar to the approach Ryan wants to use to drive down costs, except that Ryan didn’t propose to use the poor as guinea pigs to test it out. And he certainly didn’t propose his plan quietly while hypocritically railing against private insurance and Wall Street just as the program got ready to start.