CSN Login
Members Online: 5

You are here

Great news!

CSN is getting an upgrade. All of your posts will still be here, but the website will have a new look, new features and be mobile-friendly. To prepare for the changes, the site will be down briefly at the end November. 

Update: CSN will be taken offline tonight, 11/30 at 10pm ET. We'll be back up soon with a new and improved site. Thank for your patience!

If true,this could be a cause for alarm if you're on medicare

coloCan
Posts: 1956
Joined: Oct 2009
PatchAdams
Posts: 271
Joined: Nov 2011
John23's picture
John23
Posts: 2140
Joined: Jan 2007

Those facilities that are complaining have been profiting at higher than normal levels for the drugs they administer. Is there any reason to charge over a thousand dollars per dose of a needed drug?

 

It’s less than a 2% drop in covered charges, if it even occurs. If the CEO took a 2% drop in the $200,000+ per year salary received, perhaps it would cover the individuals that are theoretically going to be dropped, ehh?

 

American Politics…. Ya’ gotta’ love it.

 

Best of health,

 

John

 

coloCan
Posts: 1956
Joined: Oct 2009
wolfen's picture
wolfen
Posts: 1330
Joined: Apr 2009

If the government is still providing funding to discover why squirrels eat nuts. Probably just another stupid story, but then it's the government and a prime example of wasting money.

Luv,

Wolfen

mukamom's picture
mukamom
Posts: 402
Joined: Oct 2010

Like  Wolfen's comment.

tanstaafl's picture
tanstaafl
Posts: 1303
Joined: Oct 2010

1. Without knowing the details, we need to get rid of gougers and bad providers.  I am sure there are many high cost, low value examples.  My personal experience with Medicare  companies seemed to be widespread systemic problems at the trough.  But it may be an impossible task, like cutting the fat out of homogenized milk with a butter knife.

2. As individuals, more self reliance and critical thought are key to survival, with standard care, or even "premium", much less in a breakdown.    

3. I believe we are at a financial breaking point that more money didn't solve before. 

4. Our system has long obstructed genuine competition and better answers.  I have found many just by looking for my own family.  

 

Repeatedly funding and rewarding failure is no longer an option in a global competition for resources.   I think we have to fend for ourselves, sooner is safer with a head start.  I am afraid mere reform in the US may be as successful as in the USSR....

thxmiker's picture
thxmiker
Posts: 1282
Joined: Oct 2010

I believe a lot of issues is Liability costs.  There was just a case in California. The person did not get the latest drugs because Medical did not cover them.   Let's review.  This person never paid for health insurance. Never paid for medical care. Never invested their time in education, work, etc...   If there was intentional malpractice they may have a case.  

I had a friend whom told me how bad they got treated at a hospital. They told me how they worked the nurses etc...   I told them how Laurie stayed with me and helped with getting things that I needed. Blankets, towels, dressing gowns, juice, water, etc....  The nurses were so nice to us and really did well for me.   We also pay $11K a year for health insurance, my friend is on Medical.   We helped our selves to ease the load of the medical staff helping us. The free person expected GoldStar Hotel treatment. Being in a Hospital was zero treat for us. 

 

My point:  Liability needs to be limited to the actual issue(s).  When treatments are delayed because of the dollar, then companies should have liability. (The HMO Docs whom will not refer patients to tests or expensive treatments.)  When Docs try to cover up mistakes, Corps lie about Drug Testing, then there should be liability. The Liability also needs to go all the way through the corporate veil.  When one intentially decieves, then the Corporate Veil should be non exsistent. One should not be able to hurt people for a dollar.

 

People caught cheating the Medicaid, or any other Governemnt Aid/Plan, should have loss to all future Government Aid/Plans.  It does seem simple.  Be an office manager and cheat medicare, to jepordize one's future benefits for someone else's gain.  That may get people motivated not to cheat.  If it does not, a lifetime ban is a heck of an incentive.

 

Untiil we see a Legal and Ethical balance, we are not going to see fair pricing of medical care.

 

Best Always,  mike

wolfen's picture
wolfen
Posts: 1330
Joined: Apr 2009

I am like a hawk  when it comes to reviewing the Medicare and UH websites to determine how much each is going to pay on medical claims for hubby. I have found at least two claims where Medicare has made a payment to the provider in an amount twice what the provider charged. And then passed it to UH to provide even more payment, which UH will blindly pay. I did question this and found that both insurances pay according to their chart of acceptable charges, even if the charges are less than the allowed amount. Pretty slick deal.

Of course, the other side of the coin is when the provider overcharges $20,000 for something and Medicare only allows $1,500. So maybe it all works out in the end. Or maybe the committe who determines what "allowable charges" equate to needs to rethink things and redirect funds where they are needed.

None of us are infallible, but when I see a claim that's been processed for $395 and a second claim that's been processed for the exact same date, provider and procedure for $3954, it makes me wonder if the insurance employee forgot to take their wake up pill that day. And don't bother trying to bring it to the attention of the insurance provider. It doesn't fall within their realm of comprehension.  LOL

Be Well Everyone,

Luv,

Wolfen

PatchAdams
Posts: 271
Joined: Nov 2011

We still have private insurance but I'd really thought I'd be able to trust the govt. for Medicare in a few years.  Looks like an efficient way to clear the Social Security rolls and ease up over crowding and other costs.........  Kill all those over 65 who are in need of medications (saw another article that said '4 drugs per person') or expensive treatments.........   

This is very sad.

devotion10's picture
devotion10
Posts: 631
Joined: Jan 2010

“There will be a number of drugs that will cost us more than we are going to get paid,” said Maryann Roefaro, chief executive officer of Hematology-Oncology Associates of Central New York, a large private cancer practice in the Syracuse area.

Even though her practice estimates the cuts will cost it $500,000 annually, it does not plan to turn away any patients.

“We’re not going to not take care of those people. They are our patients,” Roefaro said.

Upstate University Hospital operates the area’s other cancer practice. Upstate spokesman Darryl Geddes said hospital-based cancer clinics have not been affected by the cuts.

Two items of note here for me ...

1) The individual quoted from a large private cancer practice states that even though there will be a reduction in profits, they do not plan to turn away patients.  Isn't this what they all should be saying instead of raising an alarm like this to vunerable cancer patients because their profit margins will be affected?  

2) Hospital-based cancer clinics have not been affected by the cuts. My husband and I purposefuly sought out the services of a large NCI cancer center in order to benefit from the experience and research provided.  We would never have chosen a private for profit cancer center and definately not an oncologist in private practice.  

Remember, that in addition to necessary treatments there are also possibly unnecessary and invasive treatments and procedures that possibly should be reevaluated.  I think you often find these in the private settings as opposed to the hospital ... not stats on that ... just my personal experience in seeking and comparing treatment options along the way.

The transition of additional patients into the hospital setting may be difficult to absorb but I personally do not feel we live in society that will neglect cancer patients who need vital treatment and trust that a solution will be found. 

Best to all,

Cynthia

Tomorrow hopes we have learned something from yesterday.

coloCan
Posts: 1956
Joined: Oct 2009

health plan with FEHB program and eligible for medicare at 65 or already on medicare? I was forced to pay into medicare when i worked and in 2 1/2 years i expect to get what i paid into,assuming..........

devotion10's picture
devotion10
Posts: 631
Joined: Jan 2010

civil service pension is certainly a benefit that many do not have; as some folks have very little even saved for retirement.  

It doesn't seem as if your FEHB program differs from anyone else regarding your eligibiity for Medicare benefits.  I can tell you that being "forced" into paying for Medicare may not be so bad ... in the time that my husband has received Medicare and also had cancer treatment ... the system has paid out more than he every paid in to the system over his many, many years of employment.  While we have benefited from this, it is also part of the problem; the high costs of cancer treatment and care.  You must plan ahead, if you can, to have money set aside for the deductibles and copay.  As Medicare will become your primary insurance at some point, have you considered a secondary gap insurance policy?  Or do you presently have one that will become secondary?

Best to you,

Cynthia

Tomorrow hopes we have learned something from yesterday.

coloCan
Posts: 1956
Joined: Oct 2009

paid into my health plan in forty years (more so since i've retired)and how much i've "benefited" from it over these years,especially since 2009 but i've no complaints over all. What i'd like to know is:when medicare kicks in do i drop my current health plan (and save a bit of money)or do i continue with both? Will i save any money when medicare becomes "primary'? Seems like everything is going up except my pension and my (whoops.....).....

wolfen's picture
wolfen
Posts: 1330
Joined: Apr 2009

I don't think I'd drop my current health plan as Medicare usually pays only 80%. My secondary(UH) then picks up 50% of the balance. Of course, there's always deductibles to meet at the beginning of each year. UH costs us $250 a month, which is a lower premium than if I was working. I was lucky not to pay a dime for health insurance for 40 years. The company paid it all. After retirement, the union contract changed and employees and retirees are now paying for it themselves. You also have to consider how much medical care you require during the year against the monthly premium. In our case, hubby has been in the hospital six or seven times(can't remember) since January plus all the other specialists and the cacer treatments, so for us it's better to shell out the $250.

Oh, and also, there's certain expenses that Medicare doesn't cover, but the secondary insurance does.

Get out that calculator and see what you come up with.

Luv,

Wolfen 

coloCan
Posts: 1956
Joined: Oct 2009

dread going thru "fine print" since my chemobefogged brain isn't what it used to be

devotion10's picture
devotion10
Posts: 631
Joined: Jan 2010

are some resources out there to help you decide the best route to take, or at least understand the present options.

For instance the Medicare website has a list of Medigap policies available to you once you plug in your zip code:

http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx?AspxAutoDetectCookieSupport=1

If you currently have a primary insurance plan and your employer allows you in retirement the option to make that your secondary gap plan by assuming all or part of the costs ... that is often the most reasonable thing to do because you may then take advantage of the volume discounts your employer receives for policy costs.

You have some time. As I have gotten older, it has become increasingly difficult to keep up with all the myriad of details that accompany insurance and health benefits ... some days, operating the tv remote is challenging. Best of luck to you.Wink

gdpawel's picture
gdpawel
Posts: 525
Joined: May 2001

The nation's oncologists at community-based oncology practices were delivered a stern message last year to either learn to deliver care at lower costs or watch the government and insurance companies impose limits. Congress has just fired a shot over the bow.

Aside from sequestration, oncology has become a focal point in the health care cost control debate because its claims are rising faster than other specialties, according to The Fiscal Times last October.

Most of these private practices pay their bills by selling chemotherapy treatments and charging Medicare and insurers a mark-up on the wholesale cost of cancer drugs - 6 percent in the case of Medicare and 20 to 40 percent for private insurers.

One large healthcare company is already experimenting with agreed-upon treatment strategies that would get rid of the cost-plus model because that model provides a powerful incentive for oncologists to use not only more drugs, but the most expensive drugs.

And a proposal from academia suggests that Medicare and insurers could shift to a system where oncologists are paid for episodes of care (a bundled payment) rather than fees for the various services.

Besides eliminating the incentive to order duplicative or unnecessary tests, imaging and office visits, it would encourage physicians to use the most cost-effective chemotherapy regimens that deliver comparable results.

It's not that sequestration is a surprise to community oncology.

tanstaafl's picture
tanstaafl
Posts: 1303
Joined: Oct 2010

I think the fundamental problems are with insistence on certain kinds of expensive evidence for a corrupt FDA for generic medicines, over regulation and the medical boards, while ignoring basic science and technology as close as our nose.  We already have a lot of cheaper, better answers. Oncology allows itself to be led by a golden nose ring.  Insurance dollars continually channeled into failure only jam the gas pedal down while going over the cliff for everybody.

We have not needed expensive insurance or medicines to deal with this problem.  Aggressive participation, more informed shopping has been crucial to break the typically predicted spiral down and out.

 

 

Subscribe to Comments for "If true,this could be a cause for alarm if you're on medicare"