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Thread: Michael Moore is brilliant

  1. #10
    Ancient Arachnid Spider's Avatar
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    Default Re: Michael Moore is brilliant

    Quote Originally Posted by RYou View Post
    Sorry to hear about that situation Spider. Anytime it deals with a life situation we all wish they would side with patient. I'd be interested in knowing which insurer it was.

    It was Blue Cross/Blue Shield. I'm pretty sure it was before they became Anthem - it was about 13 years ago. Even though chemotherapy was covered and it is just a form of high dose chemoptherapy, they denied it because they said it was an experimental procedure, which is was not. After some legal wrangling, they agreed to pay for it, but said that this was a one time exception and that they would not cover it again for anyone under our plan.
    Atrophy: what you get when you win atournament.

  2. #11
    Olympic Champ RYou's Avatar
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    Default Re: Michael Moore is brilliant

    "Our health care system, like our immigration system is broken on many different levels, and leveling blame on one party, or focusing just one aspect of the system, is short-sighted (unless your intent is to persuade by being short-sighted)."

    I totally agree the system is broken, no argument there. The sole alternative is socialized medicine, but even it has an entirely set of new problems. In Canada the social system offer fre care for all, but the cost only born by those that are employed as cost is assessed in an employment tax. Same for Europe. The cost of care is so significant in Sweden, income tax which funds the care is almost 60% of your gross. Some situations are no different. In Europe a medical panel decides which patients receive experimental care. The outcome, some patients are excluded, is no different than an insurer making the same decision here.

    There was a period in the 90's where medical costs to the user declined and in some instances at dramatic rates. Heck I was paying less for $0 deductible family coverage in 1995 than I was paying for myself back in the 1970's. Something is totally amiss when that happens but that was the result of projected savings from HMO programs. Well, those costs blew out in the late 90's as doc and physicians starting opting out as insurer service providers. You'll still find HMO style programs today but the cost is no different than a point of care plan and you the patient has little say in who you see.

    Now if you want to dictate your care, look for an indemnity plan. An indemnity plan reimburses you for your costs and there are no referral programs. You see, who you want to see you. But you'll pay quite a bit more for that option. And it will specifically address experimental care under the terms and conditions of coverage.

  3. #12
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    Default Re: Michael Moore is brilliant

    Most people want simple check ups and prevention medical coverage. Even Cuba can afford such a coverage for every citizen. No need to make it complicated RYou.

    Why can't every citizen go to a doctor for a free of charge check up regardless of coverage? Why can't anyone get a filling for their tooth? Shameful. simply shameful.

  4. #13
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    Default Re: Michael Moore is brilliant

    My mother stayed at the hospital for what turned out to be a minor thing. She has good insurance. She had to pay $800 for 3 days of stay out of pocket as a deductible. Bunch of crap.

  5. #14
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    Default Re: Michael Moore is brilliant

    I totally agree the system is broken, no argument there.

    But many say otherwise.

    The sole alternative is socialized medicine,

    Many more will disagree and for some just calling it socialism or socialist medicine is intended to end the argument and put you in your place.

    but even it has an entirely set of new problems.

    Could be. For starters, such a system would be a radical departure from they way we're used to doing business now.

    In Canada the social system offer fre care for all, but the cost only born by those that are employed as cost is assessed in an employment tax. Same for Europe. The cost of care is so significant in Sweden, income tax which funds the care is almost 60% of your gross. Some situations are no different.

    In Europe a medical panel decides which patients receive experimental care. The outcome, some patients are excluded, is no different than an insurer making the same decision here.[/I]

    I disagree in that these panels have a different motivation (serving the public) than insurers (making profits). The result may be the same, but their motivations are not the same.

  6. #15
    Olympic Champ RYou's Avatar
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    Default Re: Michael Moore is brilliant

    Quote Originally Posted by Spider View Post
    It was Blue Cross/Blue Shield. I'm pretty sure it was before they became Anthem - it was about 13 years ago. Even though chemotherapy was covered and it is just a form of high dose chemoptherapy, they denied it because they said it was an experimental procedure, which is was not. After some legal wrangling, they agreed to pay for it, but said that this was a one time exception and that they would not cover it again for anyone under our plan.
    You have to read the coverage under the terms and conditions which most everyone never ever does. You and I just assume that if the doc says I need it, it's coivered. Sometimes though, it is not. For example high dose chemotherapy and autologous bone marrow transplant ("HDC/ABMT") is usually covered for some maladies such as a Stage III or IV Hodgkin's disease or acute lymphocytic or non-lymphocytic leukemia which has come back after an initial complete remission. However, the same treatment for multiple myeloma is considered experimental bacause past results have have very limited if no success. Usually, this differentiation is written in the coverage terms and conditions. You have remember even medical insurance is not an " all medical care conceivable coverage". There are limitations as to coverage in every policy. Exclusions can get pretty extensive too because generally if not excluded, it's covered.

    The chacks and balances of "managed care" are intended to minimize abusive docs that over bill for unnecessary treatment. Those claim administrators are working statistiical tables that indicate, number of visits, success rates, with a number of other variables. It is intended to prevent runaway medical care from docs that like to bill needlessly. Yes, they will question care that slides outside of the traditional. But if the doc can put forth an reasonable argument favoring the course of care, those administrators listen.

  7. #16
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    Default Re: Michael Moore is brilliant

    As RYou alludes to, even if we had social medicine, there would have to be limits on care (just as there currently is with private insurance). The issue then becomes how to do this fairly and effectively.

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