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Shylock

Healthcare

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Shylock

Ok, let's do this here.

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HolyGrenadeFrenzy

Cool.

 

Shall we start with Dental?

 

Any house rules other than keeping personally trackable data offline?

 

I agree we should also keep things civil so keeping it civil is broad yet should remain obvious to those who understand it. If we are emotional about something we can state so yet not attacking others is very important for such discussion.

Edited by HolyGrenadeFrenzy

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Shylock

We can discuss dental as much as possible, but I do not directly deal with the workings of it...so I can only go by personal experience and that of people I know.

 

I do HEALTH insurance, and LIFE...any other is just experience rather then work related knowledge.

 

And yes, dont' disclose anything that might fall under HIPAA or any other laws that could land you in trouble.

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HolyGrenadeFrenzy

Anyone can join if they have experience, as far as I care. How about you?

 

 

To start off I should say a few things about my feelings on the whole topic which might turn a few heads if they have never had to deal with these issues.

 

Everyones favorite act could do a better job of protecting its people that is for sure. Yet the enforcement is still in a certain stage of newness so we shall see how it pans out.

 

OK Dental to start then? Afterwards we can move on the the rest. Believe it or not I have some compliments as well yet that is going to be the mixed nuts of the bowl of a topic.

 

If the pros and cons were cut and dry this topic would be short.

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Shylock

In my personal experience dental is descent AT BEST. My personal dental plan covers any dentist for 1 visit a year (yearly exam) at 100% of the cost. Anything more then that is only covered 80/20 I think. This is where it gets extremely complicated (and I read insurance certificates DAILY).

 

Emergency work is not covered as it should be covered under your health insurance plan (luckily mine is).

 

Cosmetic is not covered at all...so teeth whitening is excluded.

 

Braces are covered (once) up to 3500 dollars. Anything over 3500 is on the insured completely.

 

Those are just a few things from my personal dental plan. Which I needed to state before typing all this.

 

Dental is by far one of the biggest gray areas of insurance. What constitutes "emergency" work? Why is a basic checkup only covered once a year? I mean, i'm not complaining as I think basic hygiene (brushing twice a day) will more then cover keeping your mouth happy. But there are those EXTREME cases of people who do all that (maybe even more) and still get stuck with multiple dentist visits a year. I go every June and have never had any cavities, only mouth work ever done was wisdom teeth which is another one of those things covered but only to a certain extent.

 

Exceptions need to be made in the case of dental insurance. Which isn't even completely necessary as I think JUST a yearly check up is like 100 bucks most places...which more then covers a lot of people in america. (My yearly dental contribution is $72) But it's those few people who have serious dental problems that NEED the insurance.

Edited by Shylock

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HolyGrenadeFrenzy

You seem to have a rather liberal program although, still not the best or worse available.

 

Yet I will ask about the particulars with you in a little while because allot of the finer details is where the damage is.......because it shouldn't be a finer detail usually and the "cop to-ing" can have terrible consequences to the patient.

 

 

--------------------------------------------------------

 

Dental issues with the current system of socialized medicine have some serious problems for both the patient and the doctor or dentist.

 

The problems for the patient are more than just getting the proper care or not being able to find a dentist, surgeon or doctor who will address their condition however it is a major issue as well.

 

Another problem is that most patients are intentionally kept in the dark about why they have so much trouble finding someone who will take them on as patients and address their needs in the first place. This problem is confounded by the fact that nondisclosure agreements with health care professionals who refuse all socialized dental issues because of issues they reject the status quo of the current health car dental plan for ethical reasons of not violating their oath to their profession and patient and then are put in a situation in which they must sign a nondisclosure agreement as to why they do not take patients so the professional is legally bound to not communicate the violations they have seen, be they ethical or not, and in exchange the provider cannot insist they take anyone to even the load. The breaches in ethics are vast and dangerous to the patients both their mouthes and usually the rest of their physical condition as well. Yet the patient has no way of knowing this and the health care professionals often have little in the way of what they can say without getting their license revoked and worse.

 

The trail within the rest of the industry on the Health Care Professional gets only bloodier from there and the trail stops without answered questions within documents between the Provider and the Professional. These should be evidence veiwable and available to the patient and the court even if the nondisclosure situation has occured there should not be a way out for a government agency or a corporation working for a government agency to avoid answering for their conduct.

 

I can continue in a moment after you reply to what I have said here.

Edited by HolyGrenadeFrenzy

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Shylock

I know of what you are talking about, and although I don't seem to agree with how you put it, it is a fact of life. Companies force non-disclosure agreements on everyone/everything. You can't just single out healthcare to take the load of it. Patients can be lied to by people, who make mistakes, but the law of the land lies not with the provider/insurance company, but with the insured themself. They recieve a certificate of insurance that states every conceivable detail of what they are or aren't covered for. My health insurance certificate is 97 pages. Provider networks are ALWAYS changing but the fact of the matter is it lies with the insured to find a provider who will accept their insurance.

 

I have never once come across a case of a provider refusing to answer questions in regards to a patients health or why they chose to reject care for a patient. And I am talking about health insurance cases which are far more abundent then dental claims. I will be honest, I became somewhat confused at what you were exactly saying in the middle of it, whether it be word usage or something I just had a hard time following what you were saying.

 

 

This problem is confounded by the fact that nondisclosure agreements with health care professionals who refuse all socialized dental issues because of issues they reject the status quo of the current health car dental plan for ethical reasons of not violating their oath to their profession and patient and then are put in a situation in which they must sign a nondisclosure agreement as to why they do not take patients so the professional is legally bound to not communicate the violations they have seen be they ethical or not and in exchange the provider cannot insist they take anyone to even the load.

 

That sentence is what I had trouble following. If you could explain more into that please. Also, that is the longest sentence ever. ph34r.gif

 

LATE EDIT: And in regards to being held accountable for conduct...there is no way out. Insurance companies are audited regularly by higher powers. Business ethics are one of the most regulated areas of any sort of business type. Nothing that is being done is illegal, underhanded (probably), twisted (maybe) but all legal. I'm not making excuses, but everything is spelled out 100% in documentation given to anyone who seeks insurance. I've found it's the people who don't read everything that end up getting the shaft....sometimes I feel bad for them. Other times all I can think is "you should of read your certificate".

Edited by Shylock

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HolyGrenadeFrenzy

 

This problem is confounded by the fact that nondisclosure agreements with health care professionals,  who refuse all socialized dental issues because of issues they reject the status quo of the current health car dental plan for ethical reasons of not violating their oath to their profession and patient , then are put in a situation in which they must sign a nondisclosure agreement as to why they do not take patients so the professional is  legally bound to not communicate the violations they have seen,  be they ethical or not(IN the patients best interest), and in exchange the provider cannot insist they take anyone to even the load.

 

That sentence is what I had trouble following. If you could explain more into that please. Also, that is the longest sentence ever. ph34r.gif

This is a cache .22 for the ethics end of a doctor, dentist or surgeons possition.

 

Most of the dentists end up having to make a choice witht he doctors and surgeons yet in regards to the mouth in specific the dentists knowledge has a better veiw of the problem with doing what MANY are refusing to do.

 

Finding a dentist if you are on a Medicare or Medicaid program is very difficult and the result has gotten more difficult recently as well.

 

Your breakdown explanation. Patient looks and finds it difficult to find a dentist if they are part of said programs. If they forego the programs and find someone they know or find a way to pay themselves then they can only go to a dentist, doctor or surgeon that refuses to take any socialized patients what-so-ever unless a third party pays or something which is a way out that such professionals can still assist someone in need without stepping on any toes.......the Mouth Specialist* can still not speak of such things to anyone if they have gotten out of the program acceptance, though.

 

This sort of thing may be a fact of life yet the Freedom of Information Act should still provide a way around this and a standardized copy of such agreements and any other things that may or may not be added should be readily available for the people who would like to address these issues. The Cloak and Dagger on the patients health is abit dark for those who practice any kind of medicine and it leaves a bad taste in everyone's mouth.

 

Are you caught up with me so far?

 

If not let me know what I can do to clear my position up.

 

If you want a specific broad issue I can attempt to relay that in as few as words as possible.....without going into any particular case, just the facts.

 

EDIT: Part of the problem is whose interests are being looked out for and how the legal system has kept changing its veiws on whose interests are what.

 

The Health Care Provider (Insurance Companies) have decided that they are entittled to certain rights previously considered the patients rights as recipient of the care given and the right to be informed. Yet this has become "informed at the exclusion of the patient being informed" or an agreed upon hush-hush on the particulars other than what WILL be done and CAN be done with the current program instead of WHAT ELSE could or should be done and WHYs of the options are concidered beyond the scope or business of the patient direct.

 

This is not a little known issue.

Edited by HolyGrenadeFrenzy

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Shylock

The Freedom of Information Act has still to date, never applied to anything in the health industry. It has no bearing what so ever and rarely has the abilltiy to trump the Hipaa laws. (Health Insurance Portability and Accountability Act). Providers (Doctors, Dentists, Surgeons, Specialists etc.) have the ability to see patients who don't have insurance whether the insurance companies like it or not. It would be bad business and a breach of the aforementioned (highly) regulated business ethics practice for any insurance company to form under the table deals that restricts who providers can/can't treat. THAT is illegal. And there are several cases of companies being fined millions of dollars for violating that.

 

HMOs (Medicare(aide)) ARE extremely difficult to find providers and gain approval for coverage, since most HMOs do require approval for anything NOT of emergency nature. But this isn't and shouldn't be a surprise to those who are on that sort of health plan. Anyone who is that naive to become insured by a HMO and expect treatment coverage on par with a PPO/EPO shouldn't be enrolled in such a program. Granted most people on Medicaide take it because they have no other choice, but coverage for low income and uninsurable people is a completely different topic right now. I do think there should be more options for those who can't afford proper coverage, but I also don't see how anyone feels they are being cheated when they KNOW what they are signing up for when they initially receive coverage.

 

If I were to become uninsured...I could go to ANY doctor I wanted and receive treatment, I would pay dearly for it, but no doctor would turn me away based on me being uninsured. Doctors have a duty to treat emergency health related illnesses and the real breach of ethics would be if they DIDN'T. If you were to go to the hospital bleeding from a gunshot they HAVE to treat you, insurance or not, it's the law. They don't have to completely cure you, but they can't release you until you are no longer in a life threatening stage of illness. That, again, is the LAW. A law many doctors won't violate because malpractice and wrongful deaths suits far outweigh the cost of treating someone.

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HolyGrenadeFrenzy

 

The Freedom of Information Act has still to date, never applied to anything in the health industry.  It has no bearing what so ever and rarely has the abilltiy to trump the Hipaa laws.  (Health Insurance Portability and Accountability Act).  Providers (Doctors, Dentists, Surgeons, Specialists etc.) have the ability to see patients who don't have insurance whether the insurance companies like it or not.  It would be bad business and a breach of the aforementioned (highly) regulated business ethics practice for any insurance company to form under the table deals that restricts who providers can/can't treat.  THAT is illegal.  And there are several cases of companies being fined millions of dollars for violating that.

 

HMOs (Medicare(aide)) ARE extremely difficult to find providers and gain approval for coverage, since most HMOs do require approval for anything NOT of emergency nature.  But this isn't and shouldn't be a surprise to those who are on that sort of health plan.  Anyone who is that naive to become insured by a HMO and expect treatment coverage on par with a PPO/EPO shouldn't be enrolled in such a program.  Granted most people on Medicaide take it because they have no other choice, but coverage for low income and uninsurable people is a completely different topic right now.  I do think there should be more options for those who can't afford proper coverage, but I also don't see how anyone feels they are being cheated when they KNOW what they are signing up for when they initially receive coverage.

 

If I were to become uninsured...I could go to ANY doctor I wanted and receive treatment, I would pay dearly for it, but no doctor would turn me away based on me being uninsured.  Doctors have a duty to treat emergency health related illnesses and the real breach of ethics would be if they DIDN'T.  If you were to go to the hospital bleeding from a gunshot they HAVE to treat you, insurance or not, it's the law.  They don't have to completely cure you, but they can't release you until you are no longer in a life threatening stage of illness.  That, again, is the LAW.  A law many doctors won't violate because malpractice and wrongful deaths suits far outweigh the cost of treating someone.

Do you believe that a person should ever be required to sign an agreement with a health care provider that says,"I will never take any other insurrance lest this agreement be null and void" Then to include,"Life and Health insurrance" lest you be put in a position to cover all previous expenses?

 

The standard is strange only because of how it when things change then people behave as if things were always like the way they are now.

 

For the record: I HAVE BEEN refused entrance and an ER because of my inablity to pay just not in a long time. Year 1991, I believe and I have seen it happen to others until the law decided they had better attempt to go national with these issues instead of leaving each state solely to themselves.

 

That issue is one I am familiar with.

 

Yet back to the point I am attempting to clarify. Just because someone is poor or disabled does not mean that they shouldn't be made aware of the consequences of certain treatment nor does it mean that they should be LIED to through the alteration of what somethng is called because of their insurance program....that is dancing dangerously close to classism at its core.

 

I should give my example so I am not just playing a game of "what cards are being held though"

 

EDIT: I would never try and cross HIPAA! Nor is that my intention to suggest such infringement yet I believe that it should be made available the type of agreement made with any doctor and any patient yet not the specific patients. So everyone can take a look ... yet that is my idealist percpective shining through.

 

I do not believe your confidential items should be everyones business and even though the HIPAA act does protect the people a lttle the dog was already out of the pen when that started up...I have felt the damage myself through my information being sold and other information about me being strung across the world as well. Not all the puppies are in the pen but some of the big dogs are.

 

But as you say....I have seen some LAWS broken and not just the aforementioned refusals either but several others including some recent ones.

 

-----------------------------------------------------------------------------------------

 

Hell, I have found myself on both sides of the insurance coverage and I have encountered some other problems indirectly related towards such things... I should start another thread with Credittors for Medical Care Proffesionals and go into how they attempt to get paid for something more than once even when an insurrance company prooves they have paid something in full then the Creditors still get away with selling the account to another Creditor so you can get harrassed for the same bill over and over and over again regardless of how many times you pay the whole damn thing off and have receipts and the one the account with backing you up that something is paid.....Doesn't matter and it doesn't go away ever....even with a lawyer who attempts to make it go away it still comes up to haunt you indefinitely.

Edited by HolyGrenadeFrenzy

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SBizz6

oh damnittt.

 

Health care should be provided to citizens who cannot pay for it themselves due to lack of funds. I mean, what are we supposed to do with them? Let them die in a pile of sh*t? Come on now, the government should give them at least SOME relief. Obviously I don't want the money I earn to be paying for other people's sh*t, but as being a part of a country requires me to pay something to keep the country stable and running. And that is something I am willing to do. end of discusssssion

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HolyGrenadeFrenzy
oh damnittt.

 

Health care should be provided to citizens who cannot pay for it themselves due to lack of funds. I mean, what are we supposed to do with them? Let them die in a pile of sh*t? Come on now, the government should give them at least SOME relief. Obviously I don't want the money I earn to be paying for other people's sh*t, but as being a part of a country requires me to pay something to keep the country stable and running. And that is something I am willing to do. end of discusssssion

Yet you do want the money to be spent on the actual healthcare and not mostly on government salaries and overseers who get paid a nice chunk regardless, correct?

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Shylock

I don't really know what you are trying to argue here. But here goes.

 

In regards to an agreement to not go get other health insurance:

 

That only makes sense, you CAN'T have multiple health insurance policies. Having multiple companies pay for the same treatment is called fraud. So yes, by signing up for insurance you are in fact saying you will not go get other health insurance as long as the coverage you are signing up for is active. That doesn't say you can't have multiple coverages as there are supplemental companies that pay the cost share (copays, left over fees, personal liability aka. the 20% you owe for shared costs.)

 

It should also be stated that no health insurance company dictates WHAT treatment is best for you or how you will be treated, the doctors do. Health insurance companies can attach riders at the time you gain coverage that dictates what's covered, but once you HAVE coverage, they can't say they won't cover something that they originally said they would. Under the table deals with doctors to only provide certain treatments probably do happen, but are illegal and are severely punished. Patients have every right to question what they are being treated for and why, they can ask or research themselves. Or even, gasp, go see another doctor (2nd opinion). Medicine is an art, and not every doctor treats the same illness the same way, ethically they are responsible to treat someone the best way they know how; so that completely depends on what the doctors thinks is best.

 

Hospitals CAN and WILL reject patients, if it isn't life threatening (an emergency) they don't have to treat someone. They are capitalist businesses too. They wouldn't be functional if they weren't making money. Not to mention they wouldn't have state of the art treatment facilities if they "broke even" everyday.

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SBizz6
oh damnittt.

 

Health care should be provided to citizens who cannot pay for it themselves due to lack of funds. I mean, what are we supposed to do with them? Let them die in a pile of sh*t? Come on now, the government should give them at least SOME relief. Obviously I don't want the money I earn to be paying for other people's sh*t, but as being a part of a country requires me to pay something to keep the country stable and running. And that is something I am willing to do. end of discusssssion

Yet you do want the money to be spent on the actual healthcare and not mostly on government salaries and overseers who get paid a nice chunk regardless, correct?

Well absolutely sir. I agree with that completely. Lets be thinking honestly here. Who wants there money going to overseers and officials? No one. Why? Because those dick wads didn't earn that money, I did.

 

It should be going to the people that actually NEED the money. The people that are having trouble meeting ends meet every day. Thats why I pay taxes. Not for some fat ass sitting on his desk playing with himself.

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Tom Toole
Not for some fat ass sitting on his desk playing with himself.

hey! - what's with the pro-ethiopian-skinnyness?

 

- and whose side are you on anyway? the poor people that don't work hard enough?

 

dubabudaba

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SBizz6
Not for some fat ass sitting on his desk playing with himself.

hey! - what's with the pro-ethiopian-skinnyness?

 

- and whose side are you on anyway? the poor people that don't work hard enough?

 

dubabudaba

I'm on the side for the country as a whole. I would not consider myself poor at all, but I know that if I was poor, I would be desperate for relief. There are plenty of poor people that work hard that just cant get adequate jobs due to educational limitations. And why can't they be educated? Well because they don't have the money to pay for education! It's a cycle kind of thing, and I think SOME relief needs to be given to these people of the lower class.

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Shylock
Not for some fat ass sitting on his desk playing with himself.

hey! - what's with the pro-ethiopian-skinnyness?

 

- and whose side are you on anyway? the poor people that don't work hard enough?

 

dubabudaba

I'm on the side for the country as a whole. I would not consider myself poor at all, but I know that if I was poor, I would be desperate for relief. There are plenty of poor people that work hard that just cant get adequate jobs due to educational limitations. And why can't they be educated? Well because they don't have the money to pay for education! It's a cycle kind of thing, and I think SOME relief needs to be given to these people of the lower class.

Just so you know, the argument that people can't "afford" to be educated is garbage. I'd say 7 out of 10 of my friends (some of which are still in college) couldn't afford to be educated, so they approached various people and took out student loans to get said education. Granted they have massive debt now, but that argument is weak considering if you ARE going to school you can't really be denied student loans unless you have multiple bankruptcies and it's obvious you are going to fail at life yet again.

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