Affordable Care Act

Tapate50 said:
What drug ?

There are tons of stories but for the most part there’s 100 for everyone bitching that worked out great. You only hear about the ones that complain the loudest like all things

And most of those are because people don’t understand what they are talking about

Like I’m sure you are brilliant, but it wouldn’t shock me if you didn’t know what actually happened in your cases of Medical care and insurance approval
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Call me crazy but if my doctor says I need something. Let's say a colonoscopy. Why would my insurance consider denying it because I don't meet the metrics but my doctor recommended one? Same with why would my insurance deny initially Physical Therapy recommended by the doctor and physical therapist?

I mean me, I know why, because an insurance company's job is to make profit and they will cut every legal corner and corner they feel like they can cut without public uproar to make that profit.

But that's the rub, that's where a federal system comes into play because it's not about cutting every single corner so you can make a healthy profit, it's instead about not running negative.
 
zitothebrave said:
Call me crazy but if my doctor says I need something. Let's say a colonoscopy. Why would my insurance consider denying it because I don't meet the metrics but my doctor recommended one? Same with why would my insurance deny initially Physical Therapy recommended by the doctor and physical therapist?

I mean me, I know why, because an insurance company's job is to make profit and they will cut every legal corner and corner they feel like they can cut without public uproar to make that profit.

But that's the rub, that's where a federal system comes into play because it's not about cutting every single corner so you can make a healthy profit, it's instead about not running negative.
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In Canada the insurance company is the government and if you are too expensive they will simply tell you to kill yourself
 
zitothebrave said:
Plenty of people aren't getting life saving procedures as it is.

You're confusing the privilege of good health insurance with having a good health care system.

There's no such thing as a perfect system, but would I rather be in Canada where a routine procedure doesn't cost thousands and thousands of my personal dollars because insurance is bloating the costs all through the process.
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Our health insurance sucks (thanks Medicaid and obamacare!) But it is so much better tha Canada that only a retard couldn't see that
 
Tapate50 said:
People only hear the horror stories from our health system but people are treated here quickly and effectively that other places may take months or years.
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I have spent the past 4-5 years in the bowels of " health care " and have come away understanding it has less to do with health or care and more interested in the system aspect.

first is abolish the concept of for profit care where not only governmental regulations regarding the care but insurance regulations regarding financial policies drive the matter. For instance after waiting 2 to 3 months , at least, to see a specialist a 10 AM appointment will not in fact begin until hopefully 11.
Why ? One reason, The MD is over loaded with clerical work then working as if in a piece work factory dictated by insurance companies to which, we the patient have no voice.
Back to back appointments require paperwork that could be easily duplicated on line , but not.
The care is excellent. The medicals are unbelievably efficient, inventive and responsive, The insurance and governmental requirement, which are often the same really drag the whoe process down, Frustrating not only the patients but the caregivers .
Pay them,
MDs are well paid, day to day nurses and technicians not so much. Which to their credit does not effect their care but their moral suffers because they are worked like mules so ,to meet and system business needs. A good number are distracted by other opportunities where many leave for better paying jobs,
or in a words, profit concerns drive the machine , not the care

It is a tough nut to crack agreed but, it needs much much revising
Where to start, I like everyone else I don't know, and even if i did am not in a position to enact any change .
that is why voting in a representive system is important,
Find who is talking about the cost and efficiency of the system to see what options are on the table
I don't have an answer, but that doesn't mean i say all is fine and carry on.

Not a lot i agree with Trump on but DOGE like Al Gores VP job of reviewing government efficiency was a good start.
Gore came suggestions for streamlining the welfare state. Some, many were enacted
Musk and Trump viewed DOGE as a political tool and enacted little if any change.
Another discussion for another day.
 
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zitothebrave said:
Call me crazy but if my doctor says I need something. Let's say a colonoscopy. Why would my insurance consider denying it because I don't meet the metrics but my doctor recommended one? Same with why would my insurance deny initially Physical Therapy recommended by the doctor and physical therapist?

I mean me, I know why, because an insurance company's job is to make profit and they will cut every legal corner and corner they feel like they can cut without public uproar to make that profit.

But that's the rub, that's where a federal system comes into play because it's not about cutting every single corner so you can make a healthy profit, it's instead about not running negative.
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You are crazy.

You should not take your doctor at face value. You should do your own research to some degree. Doctors will throw the big three at you and not really dive into the issue further. They don't want to. It doesn't make them money. My wife has CRAZY food allergies causing skin and stomach issues.. She is the only doctor (of Pharmacology) in GA thats been able to find a route to relief. You need to be your own advocate in regards to health. "Because my doctor said so" should no longer fly.

You mentioned a drug not being given and instead another substituted with harsher side effects. Surely you know the name?

I don't ask for a colonoscopy to be approved- i just go. I get the bill, insurance pays it out, and i pay my copay or whatevers left months later from an HSA.

They don't deny preventative care. You just go, and the carrier gets charged. Why would you call them for preapproval?

Rehab is the aftercare from surgery and or an injury. Never heard of either being denied. I had PT for my carpal tunnel if i needed it but I never went because I didnt need it.

This all feels like you aren't familiar with how this works.
 
Take my word, I am more familiar than i ever wanted. At various stages the past few years I have been actively and successfully treated for virtually the whole shebang.

I have learned to interview/ shop for care givers. Be they doctors - therapists of many stripes.

The monthly insurance reports say the costs of this ordeal was astronomical.
Where had I decided to foot the bill myself . it would gave hir a breaking point
creating the outcome of people I have seen insist on a holistic cure

In my case Medicare and supplemental insurance have not only helped but not hyperbolically save my life. From earliest meet and greets to, well, today.
I have been iand still am, n the belly of the beast. And i bring up my experiences to express what I've seen and what I've seen is a sstem that should me driven by nedicine being driven and managed to produce profit where patient wellness is kinda beside the point.
Like I said, i dont have aa big picture answer
 
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ACA is like Civil Rights
The point was access, not perfection (profit)

In both cases it was a rousing success.
To say so not is naive or blinded.
But lets point out, both need attention ,constant review
and correction.

However what we get is half the powers want to eliminate them
under the guise of they aren't perfect
and the other half fighting to keep them alive
Never reaching any kind of consensus

Now we go years or decades with no updating or correction because of
congressional infighting
 
What access do we have now that we didn’t before ?

I’d argue there are less carriers doing business in our area than before.
 
in a nutshell this is a big country with a lot of people many do not for whatever reason
have the advantages you and I have been blessed with,
I didn't post this to argue or fight but to discuss how to improve.
Not as scrap it or keep it argument

I know where this goes.
Good health to you
 
57Brave said:
in a nutshell this is a big country with a lot of people many do not for whatever reason
have the advantages you and I have been blessed with,
I didn't post this to argue or fight but to discuss how to improve.
Not as scrap it or keep it argument

I know where this goes.
Good health to you
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This is not an answer.

What obamacare gave us was a healthcare website, which already existed for hundreds of insurance carriers. It did not create something that was not there. It didn't create anything a rich person could access that a poor person could not.

There are less carriers doing business in GA than there were before the ACA. Less competition=higher rates. Thats always been the case.

Back up your opinion again, with more information.
 
For shits and giggles I looked at my EOB for my CPAP supplies. I had to pay like 264 bucks, but they billed my insurance almost a grand.

So looking at the invoice I have and comparing it to the CPAP shop.

My line cost me with insurance 38.95 at CPAP shop I get it 46, unless I do auto delivery where I get it for 39.60
My face pillows cost me with insurance I believe a 3 pack for 101 at CPAP shop it's 54 each, unless you do auto ship where you get a 3 pack for 137
The tricky comparison is the mask itself. Which I paid 89 for with insurance but is 150 on CPAP shop. But they don't look exactly the same
Finally the water chamber which I paid 11 with insurance vs. 29 from the CPAP shop.

So my insurance saved me about 115 bucks. But at the cost of being billed 600 dollars more than if I ordered from one of the more expensive places to order online.

Keep in mind, I can order off brand stuff from Amazon for 15 bucks a pop for a mask pillow, and could probably get a new mask for cheap. The actual proprietary stuff is ironically the cheapest things.
 
zitothebrave said:
For shits and giggles I looked at my EOB for my CPAP supplies. I had to pay like 264 bucks, but they billed my insurance almost a grand.

So looking at the invoice I have and comparing it to the CPAP shop.

My line cost me with insurance 38.95 at CPAP shop I get it 46, unless I do auto delivery where I get it for 39.60
My face pillows cost me with insurance I believe a 3 pack for 101 at CPAP shop it's 54 each, unless you do auto ship where you get a 3 pack for 137
The tricky comparison is the mask itself. Which I paid 89 for with insurance but is 150 on CPAP shop. But they don't look exactly the same
Finally the water chamber which I paid 11 with insurance vs. 29 from the CPAP shop.

So my insurance saved me about 115 bucks. But at the cost of being billed 600 dollars more than if I ordered from one of the more expensive places to order online.

Keep in mind, I can order off brand stuff from Amazon for 15 bucks a pop for a mask pillow, and could probably get a new mask for cheap. The actual proprietary stuff is ironically the cheapest things.
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wow that’s crazy
 
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