I said I was taking a break from the political and media pundits giving voice to the minority who want to control the USA and destroy the Presidency. Those who know me, know that is difficult for me to step back. So, motivated by a true story that is recent, I had to post this:
A young woman, mother, wife, in her late 30's, suffered a cardiac event: ventricular fibrillation (this is not conducive with life). Rushed to the Emergency Room, the doctors there initiated immediate cardiac surgery to correct the problem. They were successful. She did very well after the surgery and has returned to living a fairly normal productive life.
2 Weeks after her surgery, she received the hospital and physician bill totaling almost 100,000 dollars because HER MANAGED CARE HEALTH INSURER DENIED THE CLAIM as UNECESSARY MEDICAL EXPENDITURE. She is fighting it. I hope she wins. And if I knew the name of the insurer, I would name them here. But I don't want to affect her case.
In the NEW health reform public option plan, there would be no such incident or denial. And I believe, once a public option is in, managed care insurers will have to compete and denials as ridiculous as this one, will go away.
So it's a matter of life or death. Which do you choose? If you are currently insured with one of the managed care health insurers, this story could be about you.
Make a difference. Make your voice heard. CALL your congressional representatives, senators, and tell them you support the public option health plan. Here is the phone number, just ask for your representative: Congressional Switchboard: (202) 224-3121
Showing posts with label managed care. Show all posts
Showing posts with label managed care. Show all posts
Tuesday, September 8, 2009
Wednesday, August 19, 2009
Health Care Reform or Revolt? An insider's view
First and foremost, I wanted to say how proud I am to be part of a blogging community that is taking action to provide accurate, truthful, factual information on health care reform as proposed under the Obama administration. Much has been written, printed, pontificated about already. Much of it wrong. This blog will attempt to offer opinions and views, facts that will dispel the horrendous propaganda being dispelled by people who have a mission to destroy health coverage for all. Others will report more facts and this blog has listed resource for you also. Today, I want to talk about polls, myths and my own experience working in the insurance industry...managed care (and it is managed).
First, let's talk about public opinion. How can you have an opinion if you don't know the facts?
Polls: the reports are polls are showing people are against healthcare reform. Well it doesn't take a rocket scientist to realize that when people are reporting that the new reform will kill elders and ration healthcare, people would fight back. BUT THIS IS NOT TRUE.
How polls are reported is up to selection of material by politician and media alike. They usually choose those aspects of polls that support their views. On the Health care Blog yesterday, the Chairman of Harris Interactive posted one of the most thoughtful, factual truths about the health care reform polls. I urge you to go and read it NOW: http://www.thehealthcareblog.com/the_health_care_blog/2009/08/health-care-reform-what-do-people-really-want.html
Humphrey Taylor, Chairman of The Harris Poll, Harris Interactive. reports on what do People Really Want? He lists the top 13 items people really want or feel about health care reform. He says its not about cherry picking polls as politicians do and choosing those aspects of polls that confirm and individuals opinion.
More on polls:http://polls.newsmax.com/results/obama_health.html is from a sight Newsmax that offers an immediate online poll on health care reform. Anyone can take it. I went to the site and the results listed are above. You have to sign up with your email so this is really a site, in my opinion, that really is soliciting information based on your email that they can perhaps sell or reveal. That is my opinion because when I went to the site for results: see url above, the poll was over 70% against health care reform and the same percent were people who voted for McCain. Factual and reliable poll? No. Be careful what polls you use or believe.
HMOs, Managed Care from the inside: I am a nurse. I worked in managed care for 7 years. I even worked in appeals and medical management where claims and issues with members were attempted to be resolved. People please understand that this affects YOU, your family, your health. Here are some examples of issues I found that made me sick:
A woman went to the hospital for surgical removal of a suspicious breast lump. When the surgeon went to remove it, it was obviously malignant and spread to lymph nodes. He removed the breast lump, the breast and some of the lymph nodes. The HMO denied coverage because the surgeon did not call the managed care organization for pre-authorization for a mastectomy instead of lump removal.
Mandates for hospital stays that were unreasonable and have changed but these included 1 day post op for mastectomy; 1 day hospitalization for postpartum care following vaginal delivery.
What happened? Cases such as the above caused more repeat hospitalizations for complications thus various states, and politicians, started a movement that finally resulted in certain conditions having to follow mandates for good health care. This was the first public mandate of health care. Whether you choose to believe this or not, this is true. So public, or government mandated care, actually saved lives, and money. And had it not been for the government and human outcry, this deplorable restriction on health care would be alive and well today.
Did you know: that most health insurance, including yours, has a cap on care? Did you know that your insurer has the right to deny coverage for care based on fine print including such terms as medical necessity?
Did you know that UNLESS you have group health coverage with an employer, the health insurance company can elect not to cover certain pre-exisitng conditions? These include asthma, diabetes, and more. So if you lost your job....which is entirely possible in this economy, and could not afford COBRA or ran out of COBRA and had to buy an individual health coverage plan, you would pay top dollar and still NOT be covered for pre-existing conditions.
And let's talk about individual purchase of health coverage. My son works. The company where he works is small and cannot afford to provide health coverage. Understandable. So my son purchased a HMO plan of one of the nation's largest HMOs. It started out at $150 per month. It went up every single year and hit $400 per month in 36 months. My son never was hospitalized, is in good health, went to a doctor once a year for a physical that was the extent of his claims. Health coverage for individuals and families who do not have access to employer covered health insurance is UNAFFORDABLE.
MYTH: the most widely spread myth out there is that the proposed government insurance will ration health coverage and kill off elders. Spare me. The stupidity of this is unbelievable. Public insurance will provide "end of life coverage". That is Hospice care. Hospice is offered for people of ALL ages who have a terminal illness. What it says is even though you have a terminal illness and may die within 6 months, you CAN STILL GET HEALTH COVERAGE to keep you pain free, and avoid complications that would hasten death. THIS HAS BEEN AROUND FOR YEARS. It is needed. Ask anyone who has experienced a catastrophic illness affecting a family member. Hospice has gotten the family and the patient through this difficult time. NO ONE KILLS ANYONE.
Where to go for more information:http://www.healthreform.gov/
I urge you to contact your congressional representatives TODAY to support health care coverage for all human beings. This blog has been touching on issues for the last week. YOU need to do your own sole searching based on solid facts and what you want and deserve for yourselves, your children, your families.
I urge you to visit Time Goes By, the site that started the movement among "elder"bloggers that spread to all ages blogging on health reform today. Here is the link to see the list of bloggers on health care reform: http://www.timegoesby.net/weblog/
Also, a great blog with questions and answers to help people understand the health care reform movement:
http://darleneshodgepodge.blogspot.com/2009/08/questiona-and-answers-on-health-care.html
To your health, and for your health, please, please be vocal, make your voice heard. "One voice can change a room, and if one voice can change a room, then it can change a city, and if it can change a city, it can change a state, and if it change a state, it can change a nation, and if it can change a nation, it can change the world. Your voice can change the world." — Barack Obama
Show YOUR support: http://www.healthreform.gov/support.html
First, let's talk about public opinion. How can you have an opinion if you don't know the facts?
Polls: the reports are polls are showing people are against healthcare reform. Well it doesn't take a rocket scientist to realize that when people are reporting that the new reform will kill elders and ration healthcare, people would fight back. BUT THIS IS NOT TRUE.
How polls are reported is up to selection of material by politician and media alike. They usually choose those aspects of polls that support their views. On the Health care Blog yesterday, the Chairman of Harris Interactive posted one of the most thoughtful, factual truths about the health care reform polls. I urge you to go and read it NOW: http://www.thehealthcareblog.com/the_health_care_blog/2009/08/health-care-reform-what-do-people-really-want.html
Humphrey Taylor, Chairman of The Harris Poll, Harris Interactive. reports on what do People Really Want? He lists the top 13 items people really want or feel about health care reform. He says its not about cherry picking polls as politicians do and choosing those aspects of polls that confirm and individuals opinion.
More on polls:http://polls.newsmax.com/results/obama_health.html is from a sight Newsmax that offers an immediate online poll on health care reform. Anyone can take it. I went to the site and the results listed are above. You have to sign up with your email so this is really a site, in my opinion, that really is soliciting information based on your email that they can perhaps sell or reveal. That is my opinion because when I went to the site for results: see url above, the poll was over 70% against health care reform and the same percent were people who voted for McCain. Factual and reliable poll? No. Be careful what polls you use or believe.
HMOs, Managed Care from the inside: I am a nurse. I worked in managed care for 7 years. I even worked in appeals and medical management where claims and issues with members were attempted to be resolved. People please understand that this affects YOU, your family, your health. Here are some examples of issues I found that made me sick:
A woman went to the hospital for surgical removal of a suspicious breast lump. When the surgeon went to remove it, it was obviously malignant and spread to lymph nodes. He removed the breast lump, the breast and some of the lymph nodes. The HMO denied coverage because the surgeon did not call the managed care organization for pre-authorization for a mastectomy instead of lump removal.
Mandates for hospital stays that were unreasonable and have changed but these included 1 day post op for mastectomy; 1 day hospitalization for postpartum care following vaginal delivery.
What happened? Cases such as the above caused more repeat hospitalizations for complications thus various states, and politicians, started a movement that finally resulted in certain conditions having to follow mandates for good health care. This was the first public mandate of health care. Whether you choose to believe this or not, this is true. So public, or government mandated care, actually saved lives, and money. And had it not been for the government and human outcry, this deplorable restriction on health care would be alive and well today.
Did you know: that most health insurance, including yours, has a cap on care? Did you know that your insurer has the right to deny coverage for care based on fine print including such terms as medical necessity?
Did you know that UNLESS you have group health coverage with an employer, the health insurance company can elect not to cover certain pre-exisitng conditions? These include asthma, diabetes, and more. So if you lost your job....which is entirely possible in this economy, and could not afford COBRA or ran out of COBRA and had to buy an individual health coverage plan, you would pay top dollar and still NOT be covered for pre-existing conditions.
And let's talk about individual purchase of health coverage. My son works. The company where he works is small and cannot afford to provide health coverage. Understandable. So my son purchased a HMO plan of one of the nation's largest HMOs. It started out at $150 per month. It went up every single year and hit $400 per month in 36 months. My son never was hospitalized, is in good health, went to a doctor once a year for a physical that was the extent of his claims. Health coverage for individuals and families who do not have access to employer covered health insurance is UNAFFORDABLE.
MYTH: the most widely spread myth out there is that the proposed government insurance will ration health coverage and kill off elders. Spare me. The stupidity of this is unbelievable. Public insurance will provide "end of life coverage". That is Hospice care. Hospice is offered for people of ALL ages who have a terminal illness. What it says is even though you have a terminal illness and may die within 6 months, you CAN STILL GET HEALTH COVERAGE to keep you pain free, and avoid complications that would hasten death. THIS HAS BEEN AROUND FOR YEARS. It is needed. Ask anyone who has experienced a catastrophic illness affecting a family member. Hospice has gotten the family and the patient through this difficult time. NO ONE KILLS ANYONE.
Where to go for more information:http://www.healthreform.gov/
I urge you to contact your congressional representatives TODAY to support health care coverage for all human beings. This blog has been touching on issues for the last week. YOU need to do your own sole searching based on solid facts and what you want and deserve for yourselves, your children, your families.
I urge you to visit Time Goes By, the site that started the movement among "elder"bloggers that spread to all ages blogging on health reform today. Here is the link to see the list of bloggers on health care reform: http://www.timegoesby.net/weblog/
Also, a great blog with questions and answers to help people understand the health care reform movement:
http://darleneshodgepodge.blogspot.com/2009/08/questiona-and-answers-on-health-care.html
To your health, and for your health, please, please be vocal, make your voice heard. "One voice can change a room, and if one voice can change a room, then it can change a city, and if it can change a city, it can change a state, and if it change a state, it can change a nation, and if it can change a nation, it can change the world. Your voice can change the world." — Barack Obama
Show YOUR support: http://www.healthreform.gov/support.html
Monday, August 17, 2009
Want health coverage? Get Informed
Unfortunately, the majority of the population would qualify to be on Jay Leno's stupid answers section of the show when it comes to healthcare reform. Why is this? You work, you get health coverage, right? Do you know what your health insurance covers and does not cover? How much do you pay for this? If you lost your job tomorrow, what would health insurance cost you? If you could even get it.
Don't be stupid please. Be informed. More people, more uninsured. More unemployed, more uninsured. Make no mistake: YOU PAY FOR EVERY UNINSURED PERSON, in one way or another.
Make no mistake also: the Republican conservative right wingnuts are out to kill health care reform. In fact, under their fearless leader, Russ Dimbat, they are out to destroy the Obama Presidency. And they just might succeed if you, yes YOU, allow this to happen.
They are the ones that started the health rationing rumors and rumors the new health reform bill will kill elders. NOT TRUE PEOPLE. Read it yourself.
On August 20th, many bloggers will be speaking out with facts on the health care reform bill. Join us. But know of what you speak. You can also speak to the President and tell him your thoughts on this and more at usa.gov and whitehouse.gov. And you can look up your Congressional team online and tell them your thoughts. Rest assured, that "other" side is doing that now. Step up for you and your family!
Some Facts for You: On June 13, 2009 "President Barack Obama announced new Medicare and Medicaid savings proposals that will contribute more than $300 billion over 10 years to paying for health care reform, beyond the historic $635 billion down payment included in his FY 2010 Budget. The President stressed in the address that the health reform effort must be deficit neutral and that reform is a fundamental part of the solution to our long-term fiscal problems".
There is a website that lists reports, facts and the truth about healthcare reform under President Obama. You can also let your support be heard. I urge you to go to this website: http://www.healthreform.gov/reports/index.html
Here is a sample of info you will see at the site:
Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. A new report Hidden Costs of Health Care: Why Americans are Paying More but Getting Less details the rise in health care costs.
View Report
Don't be part of a diagnosis of disaster. Get the prescription for good health for all of us! Don't fear health insurance companies but be strong because the managed care groups DON'T want a public health insurance. the reasons are obvious; think about it: the CEO of BC/BS and Wellpoint got HUGE payoffs when they retired, in the tens of millions of dollars. You and I paid for that. What did it do for us?
Get involved now!
Don't be stupid please. Be informed. More people, more uninsured. More unemployed, more uninsured. Make no mistake: YOU PAY FOR EVERY UNINSURED PERSON, in one way or another.
Make no mistake also: the Republican conservative right wingnuts are out to kill health care reform. In fact, under their fearless leader, Russ Dimbat, they are out to destroy the Obama Presidency. And they just might succeed if you, yes YOU, allow this to happen.
They are the ones that started the health rationing rumors and rumors the new health reform bill will kill elders. NOT TRUE PEOPLE. Read it yourself.
On August 20th, many bloggers will be speaking out with facts on the health care reform bill. Join us. But know of what you speak. You can also speak to the President and tell him your thoughts on this and more at usa.gov and whitehouse.gov. And you can look up your Congressional team online and tell them your thoughts. Rest assured, that "other" side is doing that now. Step up for you and your family!
Some Facts for You: On June 13, 2009 "President Barack Obama announced new Medicare and Medicaid savings proposals that will contribute more than $300 billion over 10 years to paying for health care reform, beyond the historic $635 billion down payment included in his FY 2010 Budget. The President stressed in the address that the health reform effort must be deficit neutral and that reform is a fundamental part of the solution to our long-term fiscal problems".
There is a website that lists reports, facts and the truth about healthcare reform under President Obama. You can also let your support be heard. I urge you to go to this website: http://www.healthreform.gov/reports/index.html
Here is a sample of info you will see at the site:
Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. A new report Hidden Costs of Health Care: Why Americans are Paying More but Getting Less details the rise in health care costs.
View Report
Don't be part of a diagnosis of disaster. Get the prescription for good health for all of us! Don't fear health insurance companies but be strong because the managed care groups DON'T want a public health insurance. the reasons are obvious; think about it: the CEO of BC/BS and Wellpoint got HUGE payoffs when they retired, in the tens of millions of dollars. You and I paid for that. What did it do for us?
Get involved now!
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