Oh and just one more thing...(health care)

I'll call this "why do people hate their health insurance carriers" and be done with it.  The villian here is Blue Cross Blue Shield  ....better known as "we may be stupid but it's policy".

My wife had two outpatient procedures, both required anesthesia.  She didn't pick the anesthesiologist, just the doctor who performed the procedures at his outpatient clinic. So we get this bill from the knock 'em out docs for about 3 grand as BCBS won't pay anything as the procedures weren't done in an approved place although the docs were approved and the anesthesiologists, whom we didn't pick or have any say about, were out of network although our health care plan says we can go to anyone.

So I call the nitwits at BCBS who explained to me how everything was being applied to out "out of network" deductible.  As we don't have a network I thought that was interesting.  But the real problem was that the clinic where these procedures took place was not approved although it was an extension of the Dr.'s office.
So I trudged up the the notification sent to  BCBS a week before by the doctor explaining to BCBS the where and who.  Yes BCBS had that but they didn't specifically approve the location, and wanted it done in the local Long Island hospital rather then the clinic (at about 5x's the cost mind you).

So this is why I hate BCBS.  8 months ago BCBS stopped partnering with the 3 hospitals that service the east end of Long Island.  They won't pay them until a contract for payments is reached and as I follow this through my old local online paper i find that BCBS is about 6 months late in payments submitted and they pay - now get this - at the last rate which was 2001.  So they pay 180 days late and at 55% of what the hospital submits.

I'm sure glad there is no need for health care reform.  Friggin' nitwits.

Just a pondering on health insurance and I'll get off my soapbox.

I was a guest of the Cleveland Clinic these past 3 1/2 days for some medical problems that could simply happen to anyone and does frequently.

First of all hospitals and ERs take everyone - they have to so this is a two part mini-rant.  I had a referral to a regular doctor there who saw me as my symptons went acute and he sent me to the ER and eventually into the hospital.  I would have never gotten in to see the initial doctor if I didn't have insurance End of story. My insurance card was my carte blanche into the system.  Without it I would have been sent directly to the ER.

As it was I spent 18 hours there which, again would have happened insurance or not but now my bill is over $7000 and my insurance will pay but if not the hospital is in the hole 7 grand. So two days in patient in a modified ICU for non-critical but those who require round the clock...bill is now approaching 20 grand. Insurance pays and I'm treated.  Hospital is out only the difference between what my insurance is paying and the limits to my deductable. Now it gets crazy. 

I am discharged and my non-insured ghost either stiffs the clinic for $20,000 or makes an absurd payment agreement but $20k is like a car payment. I went to the pharmacy to get a ton of Rx's. My co-pay is $200 and I'm told that the flat out cost was about $1000. So this is where non-insured people quite frankly go to die.  I'll be out $200 a month for the rest of my life.  A small price to pay to stay alive but I can't miss a day ever.

The poor among us or the uninsured among us simply die.  And judging by how I felt the last while, it would not be a kindly death.  They die leaving a pile of bills and in horrible shape and always one more step to go to get back to just even...never preventive, never proactive, just trying to stay close to the game.

I could go on and on as to who actually pays for the uninsured (we all know that the insured pays or the hospitals just dish it out for free)...but who pays for suffering and death?  Our collective society does. So many would have health care recourse if the programs in place were taken full advantage of but walking into an ER, sick as a dog and then fending through the medicine procurement issue just doesn't seem logical.

Mr. Forbes again and Swine Flu Vaccine for the needy

Treated to yet another dose of Mr. Forbes this morning on MSNBC we find that he is hawking a book ergo he piddle-twiddles with commoners and earnestly explains why free markets are the solution to everything...although caught repeatedly in "you can make it up" facts and figures....I loved the "life expectency rate", in which the US is not a world leader...in fact we are pretty much dead even with Albania.....to which (and this was a health care question)..it's because of guns and auto accidents so Mr. Forbes alleges without which we would be #1....so why change anything.  Of course you can't just push him aside and call him a teller of tales, but that is what he is.

He went on to challenge Canada which puts up better numbers across the board in health care effected expectencies and that is "because all Canadians come to the US to get well".  Yet another red herring. I don't admire anyone in "position" who tosses out bonbons of silliness because they cloud the debate.

It is a bit like our buddies Goldman.  It is perfectly legitimate for corporations or entities to put in for vaccination distribution.  It happens all the time.  That Goldman got 200 doeses as did Lenox Hill hospital seems a bit out of place but I wonder who the PR person is at Goldman....does he, like Mr. Forbes, live on another planet where common sense doesn't matter?...where doing or saying something really dumb is ok just because you can?

I really have to believe there are better decision makers around who can see a situation for what it is and react decently.

Tort reform and the health care bill and of course Steve Forbes

It was a lot of fun watching Steve Forbes and Howard Dean  on TV this morning. Fun because I (and speaking only for myself here) don't much like Mr. Forbes who thinks he has a voice by being the son of Malcom and spending $100 million to garner 1% of the vote.  I don't like him because he is a sloganeer..a shill of sorts....and he gets air time with that big goofy airhead grin and it makes me mad.

Howard Dean caught him this morning after Mr. Forbes recited a laundrey list of why health care reform was such a horrible thing and of course he trotted out Tort Reform.  Mr. Dean pounced stating correctly that  Tort Reform is a state issue and for those who hate federalism why would Mr. Forbes want to negate laws in 50 states that deal with Tort Reform and make a federal law that supercedes it?  Mr. Forbes's response was a deer in the headlights gulp.

But let's look so we are clear.  About half the states have enacted Tort Reform dealing with medical malpractice.  You know what? Tort reform does nothng to drive down malpractice suits. Nada. It does allow more doctors into these states and these doctors by  in large get lawsuits at the same rate as doctors living in state without tort reform.  California has very stringent tort reform. The number of suits filed has actually increased.

The over-riding FACT is that about half the malpractice suits filed in any state are against the same 3.5% of the doctors.  In essence, if you want to cut medical malpactice suits in half toss out 3.5% of the doctors in any given state (average numbers...and the difference state by state is fairly substantial).

So we have Mr. Forbes and others wailing about helath care reform because it doesn't have tort reform tied into it.  The worst part of the non-argument argument is that he gets airtime to voice what can only be nicely described as time ill-spent on the issue.