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Discussion and Debate
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What is the right balance?
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<blockquote data-quote="MorkandMindy" data-source="post: 74036034" data-attributes="member: 172332"><p>Very interesting Myst, but I don't know enough to answer your post. Insurance companies do exist to make money and now I am over 65 I get Medicare which pays 80% and the supplemental insurance to pay the rest is pretty expensive. I really am better off on Medicaid which pays 100% for low income people, but I have to find another job to get it. </p><p></p><p>I would be pretty sure private insurance companies are not the answer because they add their own costs, but hospitals are agreeable and know they wouldn't be able to charge a fraction of the amount they charge if private insurance companies weren't doing the actual paying, so they funnel people into the insurance scam by over charging anyone who pays their own way, and Obama did they same by having a penalty for anyone with too much income for Medicaid but too little for private insurance he hit a whole bunch of us for 695 a year for not being able to afford the bronze Obama care plan, the cheapest one.</p><p></p><p>But don't get the impression I'm the only one confused, a nearby hospital has more administrators working out how to charge for 'care' they give than they have beds. The point being that private insurance pays some, medicare some, and the patient has to pay the rest and in my experience nobody can be sure who will pay what until the private insurance refuses three times then it goes to medicare and then after three times to the patient who might not have any money left so then it goes to the state which pays a fraction and it ends there.</p><p></p><p>Part of the problem is government paid care, Medicare or Medicaid I understand does not pay for medical investigations but only for treatment, but treatment begins with diagnosis so that could be where a lot of uncertainty lies.</p><p></p><p>I was in for blood tests and was told there was no way to find out if Medicaid would pay for the tests until they refused three times, then it would be all my responsibility. Well actually it is part of the Medicaid system, the charges first go to the MCO Medical Care Organisation that is between the patient and the government provided funding, and if they pass them then they get passed to Medicaid.</p><p></p><p>It has got simpler since the MCO is only allowed to take 15% of whatever funding they are dealing with so it seems now they just approve everything that makes sense and live very well indeed off that 15%.</p></blockquote><p></p>
[QUOTE="MorkandMindy, post: 74036034, member: 172332"] Very interesting Myst, but I don't know enough to answer your post. Insurance companies do exist to make money and now I am over 65 I get Medicare which pays 80% and the supplemental insurance to pay the rest is pretty expensive. I really am better off on Medicaid which pays 100% for low income people, but I have to find another job to get it. I would be pretty sure private insurance companies are not the answer because they add their own costs, but hospitals are agreeable and know they wouldn't be able to charge a fraction of the amount they charge if private insurance companies weren't doing the actual paying, so they funnel people into the insurance scam by over charging anyone who pays their own way, and Obama did they same by having a penalty for anyone with too much income for Medicaid but too little for private insurance he hit a whole bunch of us for 695 a year for not being able to afford the bronze Obama care plan, the cheapest one. But don't get the impression I'm the only one confused, a nearby hospital has more administrators working out how to charge for 'care' they give than they have beds. The point being that private insurance pays some, medicare some, and the patient has to pay the rest and in my experience nobody can be sure who will pay what until the private insurance refuses three times then it goes to medicare and then after three times to the patient who might not have any money left so then it goes to the state which pays a fraction and it ends there. Part of the problem is government paid care, Medicare or Medicaid I understand does not pay for medical investigations but only for treatment, but treatment begins with diagnosis so that could be where a lot of uncertainty lies. I was in for blood tests and was told there was no way to find out if Medicaid would pay for the tests until they refused three times, then it would be all my responsibility. Well actually it is part of the Medicaid system, the charges first go to the MCO Medical Care Organisation that is between the patient and the government provided funding, and if they pass them then they get passed to Medicaid. It has got simpler since the MCO is only allowed to take 15% of whatever funding they are dealing with so it seems now they just approve everything that makes sense and live very well indeed off that 15%. [/QUOTE]
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