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Subject: Insurance hits a new low!!! Long story.

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steveVa    Posted 05-10-2018 at 21:17:17 [URL] [DELETE]        [Reply] [No Email]  
  • Insurance hits a new low!!! Long story.
  • Ever since the government got involved in health insurance it has gone from bad to worse. Not only have costs quadrupled...
    Picture this. A 94 year old WW2 VETERAN works as an engineer for the federal government for 30 years and pays into Blue Cross and Blue Shield for the past 65 years. Yes he has paid them every month for over 65 years. Now in his declining years he gets an infection and lands in the hospital and almost dies, but just almost, he survives.
    Now that he recoveres, the doctor at the hospital recommends that he go to a rehab center and get some pt and ot before he goes home. A week or two would be great for him...
    Now comes the problem. The Doctor at the hospital sets up discharge to the rehab center for 2pm. 3pm comes. 4pm. Problem?? Yes, the insurance company has denied the rehab cost. Ok why? THE BLUE CROSS DOCTOR read a note from the occupational theripist that he had trouble feeding himself and that the insurance will not cover some one who is debilitated.
    Isn't that what rehab is for?? Yes. Sooo this gets worse.
    The family agrees to pay for the rehab COST IN CASH! Then the hospital says now we still can't transfer him to rehab because THE BLUE CROSS DOCTOR HAS DENIED THE CLAIM AND IF THE FAMLY TRANSFERS HIM WITHOUT BLUE CROSS APPROVAL THEN BLUE CROSS WILL NOT PAY FOR ANYTHING!!! So the family has to pay CASH to get THE WW2 VETERAN RELEASED INTO REHAB... THIS IS 100% A TRUE STORY...
    SO NOT ONLY DOES THE BLUE CROSS DOCTOR HAVE THE ABILITY TO DENY A CLAIM, HE HAS THE ABILITY TO DELAY AND ALTER YOUR CARE.
    So a doctor who has seen you and laid hands on you for 5 days recomends a course for your care for you to recover, yet THE BLUE CROSS DOCTOR WHO HAS NEVER SEEN YOU AND IS NOT EVEN IN THE SAME STATE WITH YOU, CAN SPEND 5 MINUTES REVIEWING YOUR CLAIM AND THEN ALTER AND DELAY YOUR CARE.
    I WONDER IF THEY ARE TRYING TO KILL THEM OFF BY WITHHOLDING CARE...
    SO IF YOU GET SICK AND CANNOT FEED YOURSELF FOR A FEW DAYS, YOU BETTER DROP YOUR BLUE CROSS TODAY IF YOU DON'T WANT THEM DICTATING YOUR CARE TOMORROW...
    SPREAD THIS AROUND IT IS TRUE...

    Island Mike    Posted 05-13-2018 at 10:20:00 [URL] [DELETE]        [Reply] [Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Regarding medical expenses. 75% of a persons life time medical expense are incurred in the last 3 months of life. These are averages and obviously not the same for everyone. Some die peacefully in their sleep like my uncle, but not like the three passengers in the car, screaming in the back seat.

    Island Mike

    Dean    Posted 05-11-2018 at 11:21:42 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Such things happen when someone, anyone, attempts to create a system wherein everything is governed by an SOP, e.g., statute, regulation, etc.

    This, of course, folks, is ONE of the major reasons why socialism has never worked anywhere and will never work anywhere.

    Sadly, you've gotta love it.

    Dean

    steveVa    Posted 05-11-2018 at 18:02:15 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Unfortunately I believe this one boils down to corporate greed and the old adage that "absolute power corrupts absolutely". I was led to believe that Blue Cross would be better then Medicare, but I am learning that Medicare covers more the Blue Cross for the elderly.
    I am currently trying to compute the dollar value of someone paying into Blue Cross for 65 ++ years. At a current rate of $1400 per month. That is $16,800 per year. If that figure is the inflation adjusted number then I can just multiply $16,800 X 65 years. So I cannot compound interest. But 16,800 X 65 = $1,092,000.00
    So the corporate entity has received over a million in payment value over 65 years and now wants to deny $2500 worth of benefits. Something is wrong here.

    TheOldHokie    Posted 05-11-2018 at 08:29:09 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Nothing new or unique about this story other than perhaps a 95 year old patient being recommended for occupational therapy. Private health insurance companies of all stripes have been denying benefits for decades - it's how they keep their YOY profits growing at double digit rates and investors happy. The federal employee BCBS plan is actually one of the better ones you will find on the market and has a pretty good appeals process so I am not rushing to cancel my coverage. I also find it interesting that there is no mention of Medicare or Medicaid in this story.

    TOH

    steveVa    Posted 05-11-2018 at 17:47:04 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Why would anyone who has paid into BCBS for 65 years be involved with Medicaid??
    From what I have seen and read lately, you would be better off to be on Medicare then to continue to pay into BCBS. What do you think??

    TheOldHokie    Posted 05-12-2018 at 05:49:28 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • In his case he is a retired US Civil Service annuitant eligible for continuation of his FEHB benefits (BCBS) as well as Medicare Part B and IMO would be best off with both. Personally, when my wife and I turned 65 we opted to sign up for Medicare Part B along with continuation of my BCBS coverage (Federal Employee Health Benefit group plan). Our Medicare Part B premium is $134/month each and is our primary medical insurance. My Self+1 BCBS premium costs us another $600/month and is secondary insurance paying what Medicare does not. We have not paid a penny out of pocket since we turned 65. Medicare makes the initial determinationa nd sets the allowable rate the provider can charge. It typically pays the first 80% and BCBS picks up the rest along with co-pays and deductibles.

    The US health care system is a corrupt conspiracy between service providers and the health insurance industry and and has been for decades. I am looking at a Medicare Benefits Payment Summary right now for treatment services I received in just the last two months - a simple ankle fracture that required a small surgical plate and 4 screws on the right fibula. Some notable highlights from a much longer list:

    ER visit to stabilize broken ankle - provider billed $946, insurance allowed and paid $103
    Operating Room facility charges - provider billed $23,917, insurance allowed and payed $2,742
    Surgeon services - provider billed $2,607, insurance allowed and paid $819
    Anesthesia services - provider billed $900, insurance allowed and paid $187
    Application of cast - provider billed $309, insurance allowed and payed $92

    The actual surgery took less than an hour - I left my house for the trip to the surgical center at 5:30 AM and was back home on the couch with my leg up by 8:30. This is a perfect example of the risk young people take when they decide they don't need good insurance. Without insurance I would be looking at close to $40K in out of pocket health expenses for nothing more the kind of minor fall that could happen to anybody at any time. I can't even imagine what the potential costs would be for something serious.

    TOH

    steveVa    Posted 05-12-2018 at 09:19:37 [URL] [DELETE]        [Reply] [No Email]  
  • Re: Insurance hits a new low!!! Long story.
  • Thanks TOH. You hit this one out of the park.
    When I broke my right anckle 34 years ago, I had a simple State Farm Health Policy that I bought right out of college. It cost less then $100 per month and paid everything. So when did the wheels come off???
    They put in a small stainless plate with 4 screws. My only complaint is that they did not countersink the screws and it hurt in my ski boots until I cusum fit some foam with 4 holes for the screws... Thanks for the input, I totally agree.

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