One Of My Few Rants: Medicare Advantage Plan

 

For the most part, I’ve been very satisfied – actually, happy – with my plan.  It doesn’t cost a monthly premium and I still get most of my Social Security check without having the full Medicare cost deducted.  And, I have been fortunate with the doctors I have found from the list of providers.  A good situation…  Until I found out about the following:

Last week, I received a bill from a company that provides cardiologists and hospitals with a recording device that is attached to a patient’s chest and measures whatever.  It was for a visit that occurred A YEAR AGO, when I spent most of the day at my cardiologist’s office while several different tests were accomplished.

Imagine my surprise.  I don’t recall any mention of a separate bill for this device usage.  Of course, it was a year ago.  Who would remember anything?  Well, maybe somebody would, but I think that is asking too much.

I won’t advertise the $ amount this company charged.  That is their prerogative to charge whatever they believe the service is worth while covering some of their expenses.  That amount is not the reason for my rant.

The reason is:  My insurance company paid only $2.00!!  And I am asked to pay many times that amount.  The device company allowed the insurance company to deduct almost $1,000 from their invoice, after failing to convince the insurance company to pay a larger portion.  Except for the $2.00 and my co-pay, the device company had to write off the bulk of the price.

More and more, as we are experiencing, the cost of health care is being borne by the people who can least afford it, while the insurance companies are laughing all the way to the bank.

There’s no doubt about who is ruling the roost.

 

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[Medicare Advantage Plan image from bingdotcom]

 

Discrimination By Insurance Companies Against The Chronically Ill

 

Despite the Affordable Care Act (ACA), commonly called “Obamacare,” and its requirement that medical insurance companies accept those with pre-existing conditions, insurance companies have found ways to deny services while keeping their eyes on the bottom line at the expense of those patients who are the most vulnerable.

An article by Angela Ostrom, published in Newsweek, points to the denial of quality coverage to patients with epilepsy, cancer and a host of other chronic conditions.  New and creative ways are found in which medical insurance companies could “skirt around” the lawful charge and focus of the ACA.

“One common strategy is to design plans so that medications for conditions like epilepsy, cancer [ME, fibromyalgia, lyme disease and others] and HIV/AIDS are all but unaffordable.”

“Federal rule makers are set to change that. They’re attempting to prevent insurance companies from denying quality coverage to patients with epilepsy, cancer and a host of other chronic conditions.  If they succeed, they’ll have, at long last, achieved one of the ACA’s most important goals:  ending discrimination against sicker patients.”

It is widely known that Big Pharma is getting rich upon the backs of unfortunate sufferers of chronic and/or serious and life-threatening illnesses.  These patients have huge medical and prescription costs – a greater percentage than those of us who are blessed with good health.  The more ill the patient is, the higher their cost of medical care, of course; however, the more ill the patient, the less income.  A paradoxical situation, but that’s the truth of it.

“The ACA bans insurers from outright refusing to cover people with pre-existing conditions. Unfortunately, that provision didn’t actually stop insurance companies from turning away chronically ill patients—it just forced them to find new and creative ways to do so.

Cutting back on prescription medication. It’s too expensive.

“Insurers place many or all medications for a particular condition on the highest “tier” of their drug formularies—the lists of medicines patients are allowed to take, or off the formulary altogether. For medications in the highest tier, individuals are often required to cover 40 percent—or more—of the total cost.”

“Sadly, this technique for raising the cost of essential and often lifesaving therapies is now standard.”

There are other tactics that medical insurance companies use in order to make it more difficult for very ill patients to get the medication and care they need.  Too many patients don’t buy the medication they need.  It’s too costly.  Many patients cut back on their dosage of medication, trying to make it last longer, but while doing this, they render the medication useless as it then has no beneficial effect.

On another note:

Assistance from governments – state and/or federal – is like trying to trudge through a mud slide several feet deep, while going against the slide’s direction of movement.  Not a good picture.

Social Security Disability applications go through an automatic first denial.  One applicant’s application was denied along with the explanation for denial that had totally nothing to do with the applicant’s reason for applying for financial relief.  It was evident that the federal employee didn’t take the time to actually read the application and accompanying documentation.  Or, he/she was under orders to automatically deny.  This tactic sounds more reasonable, since Social Security Administration keeps complaining about its bottom line.

As with too many federal agencies, the weakest keep getting pushed “under the rug.”

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