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RE: Your baby is too fat - 10/14/2009 6:30:02 AM

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quote:

ORIGINAL: OrionTheWolf

Well I do remember from other readings that the improper billing codes attribute for almost 10% of denied claims. So reduce that percentage I gave by 10%, and it is probably more accurate. Another artificle inflation may also be that Medicare requires every item to be on a seperate line, even if those items are put together to make up a whole, which I do not believe private insurance companies require. This would mean billing a motorized wheelchair to Medicare would be 1) Wheelchair 2) Cushion 3) Batteries 4) Options - such as leg brace, O2 tank carrier, etc).

quote:

ORIGINAL: tazzygirl

Actually, i am curious to know if the problem stems from the billing errors we have heard so much about, Master. With so many companies, and so many billing codes, the wrong code can kick out a denial. Was just curious as to how many of those percentages were attributed to that. Thank you for the link, Master.

Yes the coding can be a nightmare. I did a quick search on a HCPCS site for mechanical wheelchair and got a bunch. http://www.hipaaspace.com/Medical_Billing/Coding/Healthcare_Common_Procedure_Coding_System/HCPCS_Codes_Lookup.aspx

I wonder if they will come up with another coding system to add to the ones they already have, when they move on to a national health care plan?

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RE: Your baby is too fat - 10/14/2009 7:28:23 AM

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Well they say follow the money, which I did when we had the DME Business. The large companies that make much of the Medicare approved items, also contribute to several political campaigns from both parties.

There is a lot of money being made off Medicare, and many areas that could save money without reducing anyone's benefits. There rules make it so that you have to deliver the items first, and then bill, and the billing can be rejected due to red tape BS. This is why the patients do not usually complain. If you go to take the equipment back, and the patient complains to Medicare, it can put a hold on billing. So now companies just bill the maximums that Medicare will pay, to cover things. You don't go back and get equipment that Medicare does not pay for, because it can stop your cash flow, so you just upcharge for that overhead.

If whatever medical solution is created, it needs to have the scrutiny that private insurance offers, but with the more fairness application towards patient care that Medicare does. Somewhere between those two is the solution.

Fix Medicare and then offer it as a possible public option. Fix Medical Centers so that they are run without Doctor's have a interest in the hospitals they practice in, and that will help reduce cost. Minimal tests with maximum patient care, and we will not have these idiotic denials of claims.

quote:

ORIGINAL: Sanity

I wonder if certain people are getting kickbacks. Some here claim there is no profit motive with government run bureaucracies, but that isn't necessarily the case.

quote:

Also, many items must be medicare approved in the "specs" they have. This makes it so you can charge more for them, and medicare pays more. Take two cushions, one marked as medicare approved and one that isn't, and tell me the difference in them. There isn't one, except the Medicare approved one is about 4 or 5 times the cost.

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RE: Your baby is too fat - 10/14/2009 8:46:26 AM

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quote:

ORIGINAL: Sanity

quote:

ORIGINAL: rulemylife
Now wait, you're a big believer in free-market principles and the inefficiency of government. Get where I'm going with this?

If the government-run health care proves to be as incompetent as you claim then would that not create an even bigger demand for private insurance?

I find it strange that you don't realize this on your own, rule. Unlike a real business, tax payer funded bureaucrats can be totally incompetent and still keep "functioning". We just go trillions deeper in debt, that's all.

Sanity, you're smarter than that, yet you misunderstood the question he was asking..or understood it yet totally side-stepped it with your answer.

I don't believe he was asking you to answer if taxpayer funded bureaucracies can funtion even if incompetent..we all know the answer to that.

What he asked, and I'd like to see the answer as well from you, is if according to free market theory, if government run medical care (as a medical insurance option) isn't "cutting it" or up to par then wouldn't that drive people to the private sector for the better care they want (in the form of medical insurance)?

Because in theory, the competitor who provides the best in service, product, etc. reaps the most business. Seems to me according to that theory, and if government run health care (or insurance) would be so inept, terrible and incompetent, then the private health insurance industry would have nothing to fear. People would be flocking to their product in droves.

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RE: Your baby is too fat - 10/14/2009 10:25:56 AM

CallaFirestormBW

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quote:

At least with private health care we can vote with our feet...

I apologize if someone already touched on this -- I have been avoiding this section like the plague, and I swore I wasn't going to open my mouth again -- but I just couldn't let this go.

Sanity, you can ONLY vote with your feet if you can get another company to insure you when you ditch (or are ditched by) your old one. Unless there is a GUARANTEE that someone has to insure you, "voting with your feet" is essentially the same as giving the insurance company exactly what they want -- to NOT have to insure those who are "higher risk".

Dame Calla

< Message edited by CallaFirestormBW -- 10/14/2009 10:27:16 AM >

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RE: Your baby is too fat - 10/14/2009 10:34:50 AM

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That's the main argument for putting in some sort of safety net for people who aren't insured in the first place, is it not?

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RE: Your baby is too fat - 10/14/2009 2:02:15 PM

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quote:

ORIGINAL: Newyorkcouple10

Well, given that Medicare is only provided to people 65 and older, it would seem more likely that its denial rate is higher: just a lot more experimental procedures requested to extend a cancer victim's life for 3 weeks at age 80 than at age 8.

I'm not sure this has been addressed but Medicare is not only provided to people 65 or older. I have been on medicare for close to ten years and i am 41.

(in reply to Newyorkcouple10)

RE: Your baby is too fat - 10/14/2009 3:19:47 PM

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From: Nampa, Idaho USA
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Whats wrong with your "theory" is that government isn't a competitor, it doesn't compete in the true sense of the meaning, it just throws ever larger sums of taxpayer dollars at any problems that arise. And contrary to popular belief there isn't an unlimited supply of "free" government money to be thrown around - eventually the bills will all come due.

The private sector can't possibly compete with such government insanity, especially when its their own business taxes that are funding what you are calling the government "competition". (I'm sure you're aware that a part of the current plan is a measure forcing private insurers to help pay for at least a part of the government system, which, what kind of "competition" is that. That's like running a marathon with the fattest runner on your back part way).

Something else thats worrisome about the Democrat's proposal is that a large part of the "free" government money they will be throwing at the health care problem will be borrowed from China. Before long the Chinese will stop lending, and there is a growing consensus that soon the dollar will be so weak and so worthless that the Treasury's Wiemar printing presses won't be able to keep up with the demand.

By that point the Democrats "hope" seems to be that the free government health insurance will have monopolized the health care industry, having driven the legitimate competitors out of business, and the public will then be stuck with a broken and bankrupt system.

quote:

ORIGINAL: Anarrus
Sanity, you're smarter than that, yet you misunderstood the question he was asking..or understood it yet totally side-stepped it with your answer.

I don't believe he was asking you to answer if taxpayer funded bureaucracies can funtion even if incompetent..we all know the answer to that.

What he asked, and I'd like to see the answer as well from you, is if according to free market theory, if government run medical care (as a medical insurance option) isn't "cutting it" or up to par then wouldn't that drive people to the private sector for the better care they want (in the form of medical insurance)?

Because in theory, the competitor who provides the best in service, product, etc. reaps the most business. Seems to me according to that theory, and if government run health care (or insurance) would be so inept, terrible and incompetent, then the private health insurance industry would have nothing to fear. People would be flocking to their product in droves.

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RE: Your baby is too fat - 10/14/2009 3:28:57 PM

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quote:

By that point the Democrats "hope" seems to be that the free government health insurance will have monopolized the health care industry, having driven the legitimate competitors out of business, and the public will then be stuck with a broken and bankrupt system.

Free? what free health insurance? i dont seem to recall any mention of free health insurance.

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RE: Your baby is too fat - 10/14/2009 3:30:15 PM

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and while we're at it what 'legitimate competitors'

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RE: Your baby is too fat - 10/14/2009 3:31:56 PM

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From: Nampa, Idaho USA
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If a company develops a bad reputation, if you're diligent you and / or your employer can avoid going to them for coverage in the first place. That''s what I meant by "voting with your feet". The fat baby's provider relented because of bad publicity but once we're infected with a monopoly consisting of a gray goverrnment bureaucracy, whatever your welfare case worker shoves down your throat you're stuck with.

And again, the government is fast going completely bankrupt and so the future is a bleak one in that scenario.

quote:

ORIGINAL: CallaFirestormBW
I apologize if someone already touched on this -- I have been avoiding this section like the plague, and I swore I wasn't going to open my mouth again -- but I just couldn't let this go.

Sanity, you can ONLY vote with your feet if you can get another company to insure you when you ditch (or are ditched by) your old one. Unless there is a GUARANTEE that someone has to insure you, "voting with your feet" is essentially the same as giving the insurance company exactly what they want -- to NOT have to insure those who are "higher risk".

Dame Calla

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RE: Your baby is too fat - 10/14/2009 3:48:19 PM

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From: Nampa, Idaho USA
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We can't be out of money, we still have printing presses.

quote:

ORIGINAL: tazzygirl

quote:

By that point the Democrats "hope" seems to be that the free government health insurance will have monopolized the health care industry, having driven the legitimate competitors out of business, and the public will then be stuck with a broken and bankrupt system.

Free? what free health insurance? i dont seem to recall any mention of free health insurance.

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RE: Your baby is too fat - 10/14/2009 3:53:03 PM

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Alex Lange's parents said they wanted to switch insurers because of rising rates but were surprised to find their youngest boy was too fat to get covered. Father Bernie Lange joked to The Denver Post that the breast-feeding infant wasn't about to start a diet or hop on a treadmill to shed pounds.

"There is just something absurd about denying an infant," Bernie Lange said.

Born at just over 8 pounds, the boy's current weight puts him in the 99th percentile for babies his age. The company says it's an industry standard to reject new patients, including babies, above the 95th percentile for weight. But it says it has never before rejected a fat baby.

The boy's mother, Kelli Lange, said her baby has had nothing but breast milk and that his brief insurance rejection didn't change how she fed him.

"I'm not going to withhold food to get him down below that number of 95," she told The Denver Post.

http://cbs11tv.com/health/Colorado.insurer.reverses.2.1243827.html

Please, Sanity, read up on growth charts, breast fed babies, and what the purpose of percentiles is really for... and the history of such charts... before deciding a child is "fat". And, to my knowledge, Medicaid never rejected a baby for being "fat", only because its parent made too much money.

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Your baby is too fat - 10/14/2009 3:54:21 PM

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quote:

ORIGINAL: Sanity

We can't be out of money, we still have printing presses.

quote:

ORIGINAL: tazzygirl

quote:

By that point the Democrats "hope" seems to be that the free government health insurance will have monopolized the health care industry, having driven the legitimate competitors out of business, and the public will then be stuck with a broken and bankrupt system.

Free? what free health insurance? i dont seem to recall any mention of free health insurance.

You said free insurance. Yet, you cant back that up. Again, you may want to recheck your sources.

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Sanity)

RE: Your baby is too fat - 10/14/2009 4:43:55 PM

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From: Nampa, Idaho USA
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Now you're trying to tell me when I may or may not call a baby "fat"?

You just like to argue, a tad too much in my opinion. I hope you don't expect me to continue responding to all this nit-picking.

quote:

ORIGINAL: tazzygirl
Please, Sanity, read up on growth charts, breast fed babies, and what the purpose of percentiles is really for... and the history of such charts... before deciding a child is "fat". And, to my knowledge, Medicaid never rejected a baby for being "fat", only because its parent made too much money.

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RE: Your baby is too fat - 10/14/2009 4:49:02 PM

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a 17 lb, 4 month old baby isnt fat. he was 8 lbs at birth. his percentile had not changed, still at 99%. No pediatrician would have labeled that baby fat, put him on a diet, or demanded that his parents take him off breast milk.

as i said, read up before you dig into things you may not be familiar with. this particular insurance company had a habit of denying anyone above the 95 percentile. they got caught because dad happened to work at the local tv station there and made a stink. just because its normal pratice, like it was normal pratice to consider a black persons intelligence inferior to a white persons, doesnt make it a medical fact, or legal.

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Sanity)

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