Fine for refusing health care?!?!?! - The Health care thread....

[C-Kwik]

In that case I would agree with you. If I had a doctor try and schedule multiple operations to remove stuff in the same place I would find another doctor. The insurance companies should push back at those style practices and not pay. If insurance did not pay for it and the people can't afford to pay then the doctors would not do it.

While I understand you may be presenting this as more of an ideal way of dealing with it, an insurance company's primary responsibility is to provide its contractual benefits to their insureds. That means that if they refuse to pay the doctor in such a way that makes the insured responsible for a covered treatment, then the insurance company can be exposed to a bad faith lawsuit. It would have a duty to protect the insured from the financial obligation. Not sure if that is legally possible as I am not as familiar with how fraud cases are handled in health insurance claims.

[audtatious]

No, I understand. It's one of those things that should be fixed within the system. There is a lot of greed and waste going around that could be resolved easily enough without mandating a single payer plan (or anything close to it).

[heliochrome85]

its about as easy as getting the US population to eat healthier. in reality, what you are asking is for doctors (some, since id say the majority dont think this way) to leave money on the table and actually work ethically. Its really hard to live in such an income and wealth driven country and NOT try to make as much as you can. Believe it or not though, there are alot of doctors out there who dont aspire to make 7 figs a year. The scenario i gave is a small example of a bigger problem of medical ethics, and realistically, you might want to go to a different doctor, but id be willing to bet that in most cases, the patient is oblivious to this sort of shady ethical situation. There are alot of physicians who get caught doing this sort of stuff. Enforcement of medical ethics is what is required and that can be done at the Medical school level.

[srellim234]

C-Kwik - an insurance company's primary responsibility is to provide a profit and insure that the company will continue to survive in a "for-profit" system of health care.

Contractual obligations to provide healthcare to the insured is secondary to protecting profit and the company. After all, if the company doesn't survive, those patients don't matter a bit to them. The same manner in which the fine print allows the credit companies to screw their customers is currently being used by insurance companies to deny coverage to theirs.

The average consumer has virtually no choice in the matter. He/she is forced to take whatever insurance company the employer dictates. The employers are being forced to make that decision based on price, not customer service and coverage any more.

[smockers83]

thats how Mayo clinic does it.

And Cleveland Clinic. Yet these two hospitals are some of the most respected hospitals in the country, if not the world. Famous and very important people from across the world go to those facilities for care because it is of the utmost quality found virtually anywhere. There are only a few hospitals that could come close to them in terms of quality.

At the same time, you see hospitals failing using the pay-for-each-service model. If you were to talk to the doctors at either of the two aforementioned hospitals, I bet they would say they wouldn't work anywhere else.

[heliochrome85]

the various royal families of the middle east use their A-RAB moneys to spend weeks at a time each year at these facilities. Cant be that bad

[audtatious]

its about as easy as getting the US population to eat healthier. in reality, what you are asking is for doctors (some, since id say the majority dont think this way) to leave money on the table and actually work ethically. Its really hard to live in such an income and wealth driven country and NOT try to make as much as you can. Believe it or not though, there are alot of doctors out there who dont aspire to make 7 figs a year. The scenario i gave is a small example of a bigger problem of medical ethics, and realistically, you might want to go to a different doctor, but id be willing to bet that in most cases, the patient is oblivious to this sort of shady ethical situation. There are alot of physicians who get caught doing this sort of stuff. Enforcement of medical ethics is what is required and that can be done at the Medical school level.

Understood and I don't disagree. I avoid being unethical to my customers and I expect the same from the service providers I use. If I think that is not the case then they lose a customer.

[C-Kwik]

C-Kwik - an insurance company's primary responsibility is to provide a profit and insure that the company will continue to survive in a "for-profit" system of health care.

Contractual obligations to provide healthcare to the insured is secondary to protecting profit and the company. After all, if the company doesn't survive, those patients don't matter a bit to them. The same manner in which the fine print allows the credit companies to screw their customers is currently being used by insurance companies to deny coverage to theirs.

The average consumer has virtually no choice in the matter. He/she is forced to take whatever insurance company the employer dictates. The employers are being forced to make that decision based on price, not customer service and coverage any more.

As a business model, sure. But they are legally obligated to the contract. And perhaps even moreso considering the possible outcomes of a bad faith lawsuit that comes out of a failure to put the insured's interests first when interpreting the benefits of a policy:

http://lawyersusaonline.com/bl...-case/

Even in a situation where the verdict is for the insurance company, the legal costs alone can be staggering. A company I worked for denied a fraudulent claim that was valued at $30K. They spent about a million defending the ensuing bad faith simply for doing the right thing. Nothing is as simple as it might seem. Ultimately, due to the way the system works, meeting their contractual obligations is to be concerned about their profits...

[smockers83]

the various royal families of the middle east use their A-RAB moneys to spend weeks at a time each year at these facilities. Cant be that bad

Yet the country wants to move towards socialized medicine because that's what every other industrialized country has. If we did that, these two hospitals would no longer be what they are today. The country wants to move towards socialized medicine to "reduce costs" yet we have two very well proven models of high quality and low cost in our very own system that are known around the world.

Plus, if we move to a socialized system, doctors are going to be salaried anyway. So why vote for this crap in the House?

[C-Kwik]

Yet the country wants to move towards socialized medicine because that's what every other industrialized country has. If we did that, these two hospitals would no longer be what they are today. The country wants to move towards socialized medicine to "reduce costs" yet we have two very well proven models of high quality and low cost in our very own system that are known around the world.

Plus, if we move to a socialized system, doctors are going to be salaried anyway. So why vote for this crap in the House?

Can't speak for anyone else, but I'd like to see socialized medicine simply because I want everyone to have access to reasonable medical services. Please explain why we would HAVE TO place doctors on salary if we move to UH?

[srellim234]

Most, admittedly not all, of those legal fees will be forced upon the losing side in such a lawsuit. So yes, the company spends a lot defending itself but it's not necessarily out that money if the defense is successful.

Bad faith lawsuits are almost in the same category any more with class actions and malpractice. And, not everyone has the time, energy or money to pursue the litigation path.

Many of the insurance companies have clauses, be they in the fine print or up front in bold letters, that they get the final word and can't be challenged or that any claim will go to arbitration. If you refuse to agree to those terms, they won't cover or treat you at all.

Corporations don't see people. Bean counters in corporations don't see people. They only see numbers and percentages. Then they weigh the risk, be it the expense of the treatment or the odds of losing a large suit as a result, against the profit to be made by such an action.

The occasional suit is calculated into the numbers and the risk is assessed. That's why a "not-for-profit" option should be available, including inconveniences like having to wait in line for procedures, for those who either need that type of coverage or opt for that type of coverage.

It's not for everybody, but there are over 40 million people in this country who don't have the health insurance luxury the rest of us have.

[C-Kwik]

Most, admittedly not all, of those legal fees will be forced upon the losing side in such a lawsuit. So yes, the company spends a lot defending itself but it's not necessarily out that money if the defense is successful.

Technically, you are right. However, the reality is that most people who file bad faith suits don't have the money to pay back the defense costs. Insurance companies aren't going to waste further money trying to tap a dry well.

Bad faith lawsuits are almost in the same category any more with class actions and malpractice. And, not everyone has the time, energy or money to pursue the litigation path.

Not really. Generally, it takes some major screwing up by many people in an insurance company for a bad faith suit to be legit. They are relatively rare, but a single case can have a huge impact.

Many of the insurance companies have clauses, be they in the fine print or up front in bold letters, that they get the final word and can't be challenged or that any claim will go to arbitration. If you refuse to agree to those terms, they won't cover or treat you at all.

Feel free to scan your insurance policy and show me where that is stated. No insurance company has the last word. The policy can't absolutely limit a person's right to trial. At best (at least with auto policies), they may require that a person agrees to an arbitration or appraisal process before bringing a suit against the company. But it can't bar a consumer from his legal right to trial.

Corporations don't see people. Bean counters in corporations don't see people. They only see numbers and percentages. Then they weigh the risk, be it the expense of the treatment or the odds of losing a large suit as a result, against the profit to be made by such an action.

Sure. But more often than not, insurance companies do adhere to fair claims practices to limit the exposure to bad faith. And this is as a result of the bean counters.

The occasional suit is calculated into the numbers and the risk is assessed. That's why a "not-for-profit" option should be available, including inconveniences like having to wait in line for procedures, for those who either need that type of coverage or opt for that type of coverage.

Bad faith suits can be highly unpredictable and volatile. It would be extremely difficult to place a rule of large numbers type of assessment on something that is relatively low in occurrence and can have widely varied values and outcomes.

Not sure your "not-for-profit" statement fits into this aspect of the discussion (insurance company's responsibility). It feels out of context. I assume the line below is also following that train of thought as well.

It's not for everybody, but there are over 40 million people in this country who don't have the health insurance luxury the rest of us have.

[srellim234]

The "non-profit" aspect is where I'm going for the 40+ million people in this country who can't afford the healthcare.

For those who are crying that ANY government involvement in a health care plan amounts to "socialized medicine", we have all these seniors on Medicare and we have a little thing called the VA complete with non-profit hospitals that according to the naysayers in this debate should have destroyed private insurance companies and our health a long time ago.

A government plan can co-exist with the current private sector. They already are.

Why does continually making bigger and bigger profits have to be the ONLY motive for doing anything any more? Sometimes we should just do the right thing for people who truly need the help.

[audtatious]

40+ million uninsured is a misnomer. We are only talking 8 million or so "US citizens" who are in a situation in which they cannot get nor afford health care. The rest are non-US citizens, choose not to have health care, or meet the criteria to be in the medicare system but have not done so for some reason. That number also represents people who went any portion of a year without health care for some reason so there is a percentage that do have health care that are represented in that number.

How about we work with the 8-ish million to help them out instead of potentially putting worse policy in place? Wouldn't that be far cheaper and safer as an initial solution? Then we can have bipartisan committees to look into resolving some of the issues with the current setup.

[heliochrome85]

Obama wants to kill your grandma

Five right-wing myths about healthcare reform, and the facts

http://www.salon.com/news/feat...hcare/

[audtatious]

Republicans are bad. Gov run health care, with the efficiency of the Post Office and sensitivity of the IRS, will work wonders.

I can't help it sometimes

[heliochrome85]

wasnt really taking a position perse, myself. but rather i found the article a bit interesting.

[audtatious]

I know you were not taking positions. Some of those talking points could lean either way and can be up to perspective.

Heck, from a perspective perspective (lol) you could view cash for clunkers as the US taxpayer giving away a free car for every 3.5-4 sold under the plan

[heliochrome85]

quite true. although, based on what epople are buying with their C4C money, i dont know if id be all THAAT interested. Ill pass on a Honda Fit, Ford Focus, and Toyota Pius.

[audtatious]

At this point we really don't know what is being bought as for some reason the Administration has been withholding the true numbers and their list that is out does not jive with the list that Edmunds has put together.

[audtatious]

Interesting article on the success of France's UH:

http://online.wsj.com/article/....html

[telcoman]

The "non-profit" aspect is where I'm going for the 40+ million people in this country who can't afford the healthcare.

For those who are crying that ANY government involvement in a health care plan amounts to "socialized medicine", we have all these seniors on Medicare and we have a little thing called the VA complete with non-profit hospitals that according to the naysayers in this debate should have destroyed private insurance companies and our health a long time ago.

A government plan can co-exist with the current private sector. They already are.

Why does continually making bigger and bigger profits have to be the ONLY motive for doing anything any more? Sometimes we should just do the right thing for people who truly need the help.

exactly!

http://sickforprofit.com/ceos/

Telcoman

[smockers83]

^ Medicare and Medicaid are both bankrupt/failing. Just saying.

[audtatious]

VA has its own issues as well.

[srellim234]

I never insinuated that Medicare and the VA were perfect, or even well run. They are, however, government run healthcare plans currently running alongside private healthcare plans. They have not destroyed the healthcare industry for all those who are claiming that a new government plan will do just that to the private sector.

[smockers83]

I never insinuated that Medicare and the VA were perfect, or even well run. They are, however, government run healthcare plans currently running alongside private healthcare plans. They have not destroyed the healthcare industry for all those who are claiming that a new government plan will do just that to the private sector.

Wasn't necessarily directed at you, because for the most part I agree. Medicare/Medicaid haven't destroyed the system, however, it's made it more complicated, more wasteful, harder to use and doctors don't like it.

[smockers83]

Please explain why we would HAVE TO place doctors on salary if we move to UH?

We wouldn't have to, but it's my impression that most, if not all doctors under current UH systems are salaried. How many employees of the government, besides volunteers and part timers, are not salaried though?

[audtatious]

I never insinuated that Medicare and the VA were perfect, or even well run. They are, however, government run healthcare plans currently running alongside private healthcare plans. They have not destroyed the healthcare industry for all those who are claiming that a new government plan will do just that to the private sector.

You are correct, the health care industry itself (not the insurance industry) has not been ruined by Medicare nor Medicaid, they simply utilize those two entities to pay for the services they perform on covered patients. From a financial aspect, both Medicare and Medicaid are poorly run and financial nightmares. The bureaucracy within the system and low reimbursement rates for medicaid, including some rationing of services, restriction/access to services and prescription drugs, etc. show what "slippery slope" we will begin should the Gov push forth a UH system which will lead to a single payer system (Obama's direction from the start).

If the Gov could show us anything of this nature they run today as being successful I'm sure there would be less issue from myself and others. They can't because it's all a big mess. Why should anyone expect things to be different?

[smockers83]

I don't know why I didn't think of this before, but after reading the above post by Matt, this plays into one of my Politics and the Economy threads where I gave examples pitting the USSR against the US and how each time the USSR failed miserably with tons of waste. I think that was series 1.

[C-Kwik]

We wouldn't have to, but it's my impression that most, if not all doctors under current UH systems are salaried. How many employees of the government, besides volunteers and part timers, are not salaried though?

It would be closed minded to think that we have to implement UH the same way as existing programs. There are UH programs in other countries that are indeed based on procedures and the doctors are entirely autonomous. Medical expenses would be paid by the government. Not delievered by it.