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Post by Deleted on Aug 26, 2014 2:52:24 GMT
Hello. I said not once but twice--offer affordable catastrophic coverage insurance for the big events. Fully on board with that.
People who aren't throwing thousands of dollars a month at insurance companies for premiums that only cover certain portions of things can afford to handle their own healthcare costs, especially when they learn to shop around for affordable care and when they are motivated to spend less because their dollars are their own.
It's a different way of life for sure but it does work. It's takes a little bit of courage, for sure. Does it work for everyone? No of course not.
There are a lot of people bowing at the alter of big insurance and living in fear of "what if". And that's what is bankrupting them.
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Oct 10, 2024 20:25:53 GMT
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Post by Deleted on Aug 26, 2014 3:01:00 GMT
I don't need or want a bunch of paperwork, government blah blah blah. Simple is way better, in my opinion. But I suppose that would lessen the need for coders...so sorry about that. What alternate universe are you finding these "simple" providers in? I'm amazed that a neurologist practicing at Vanderbilt would agree to take your child on as a patient. What if he were to have an aneurism or need a million dollar brain surgery? I agree that simple is better, but to some extent you get what you pay for. I don't really know how to respond to this...would you like her name and number? For the past 15 years, Vanderbilt University Medical was our "local" hospital...12 minutes down the street. We have been paying for care there many times over. Why is that hard to believe? My son is Autistic and has a seizure disorder. Living near a world-class hospital was a gift. I said several times--buy insurance for big catastrophic events. Pay cash for little things. It's not so hard to do when you aren't throwing thousands at an insurance company. I have to stop posting now. I tend to get a little worked up over medical care conversations...and I have to be up at 4am.
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Post by megop on Aug 26, 2014 3:02:04 GMT
This model is great on paper and will benefit many; unfortunately, there are a number of patients that will not fit into this model because of their lack of finances or their lack of willingness to help take care of themselves.
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And that is what is the beauty of the ACO space. That providing entities, can actually get reimbursed for employing persons, to be able to go the "extra mile" to help these individuals get into treatment compliance, thus reducing readmission rates...etc.etc..
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Post by megop on Aug 26, 2014 3:09:15 GMT
sdeven, I'm glad it's working for you. But please, I would urge you to stay diligent as to future changes and offerings. It really is happening that fast within the landscape of delivery. I'm not saying "go get insurance." I'm saying stay mindful that more an more, innovative options will continue to open up for individuals for coverage choices.
I totally hear your "simple" as there are providers now that offer a "yearly fee" for their patients that cover all office visits for families, with email access. There are even more others that offer pay scales for varying degrees of access for the self pay.
At the end of the day, there will be vast, vast choice and people will have to figure out what truly works for them.
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Post by megop on Aug 26, 2014 3:19:52 GMT
And sdeven, don't be so hard on coders. It's their work that supplies valuable data composite information, that the providers who are accepting cash also review for best practice and evidence-based medicine for better outcomes.
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Post by jamieson on Aug 26, 2014 4:57:01 GMT
I don't really know how to respond to this...would you like her name and number? For the past 15 years, Vanderbilt University Medical was our "local" hospital...12 minutes down the street. We have been paying for care there many times over. Why is that hard to believe? My son is Autistic and has a seizure disorder. Living near a world-class hospital was a gift. I said several times--buy insurance for big catastrophic events. Pay cash for little things. It's not so hard to do when you aren't throwing thousands at an insurance company. I have to stop posting now. I tend to get a little worked up over medical care conversations...and I have to be up at 4am. I guess it's difficult for me to believe that the average family can comfortably dole out hundreds of thousands of dollars. Your provider at Vanderbilt may not have a problem with self-pay, but it's puzzling to me that she would opt to pay out of her pocket for testing and imaging she orders for your child. Sounds like you have a good deal and I'm glad, it just doesn't seem realistic or sustainable for the majority of providers. Megop, it's true that change is the only thing you can count on in healthcare these days. We see policies enacted one week fly out the window the next. And really, bless those coders! My head swims when I look up ICD codes, which also change frequently.
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Post by megop on Aug 26, 2014 13:48:55 GMT
Ok, a bit of time this morning to try and help you from my perspective.
Well as you see around you, experienced, read, or observed others go through (expectations, expenses, what benefits, etc) about their healthcare? If you are speaking from a delivery standpoint, our data presents that those we serve expect no or very little waiting, convenience, cost control (are willing to pay for quality/convenience, but not overly so) and they want personalized care.
What costs do the lawyers contribute to the cost of healthcare and how? I don't have specific data, but from memory, on a national level, litigation typically adds around 2.5 percent to healthcare costs overall. I could be way off on that, but could probably get some data from HHS or CMS.
What is the preferred system of the physician/hospitals? Confused here, preferred system of what? Coding? I thought everyone had to be ICD-10 compliant by what, October of next year? If you are referencing health care delivery, well that's going to be a system by system decision whether they stay fee-for-service or follow the population health route.
How money should be spent and who should spend it? Again confused...sorry...whose money? The government? The system's? Consumers?
What about benefits and treatments? What should be covered? What limitations? In my opinion and mine alone, I would guess that consumers would want everything covered as no one wants to be a patient and no one who does find themselves being a patient, want to be denied any sort of treatment if their is any shadow of hope. Unfortunately, that isn't sustainable from a public funding standpoint, so yes, there must be limitations. And while it isn't popular sometimes, it is necessary. I support evidence-based and best practice measurements in this area for this reason. Isn't perfect, as sometimes there is delay in this space as new and effective treatments expand, but that is where I believe the pharmas should come in and self-fund the expanded testing period so that it opens up to more patients just prior to FDA approval for commercial use. That, I would think, speed up the system.
How do all the parties feel about these issues? Answered above and in other posts.
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Oct 10, 2024 20:25:53 GMT
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Post by Deleted on Aug 26, 2014 15:40:31 GMT
And yet families are paying thousands of dollars each month for partial medical insurance coverage...every month even when there's no medical event.
What? I'm not sure what you aren't understanding about how being a cash-pay client actually works. Our pediatric neurologist did not pay for any testing or imaging for her patient. Why do you think she would do that?
When he needed testing, scans, EKGs, medications, therapies, even two separate weeks in a psychiatric hospital...we paid his way.
This child (he's now 18) was well insured as a two year old until we received a form letter from our highly rated very large insurance company saying they were dumping all their clients in our state. This was illegal, we later found out but what could we do?
At about that same time he was diagnosed with Autism and a serious seizure disorder. So now he's uninsurable...no insurance company would cover him at any price and certainly not at a price we could afford.
At that time we realized his care was going to be our responsibility so we did what was required to care for him. Through the years We assembled a team of care givers who met his needs at an affordable price.
We were abandoned by our great big insurance company...what other choice did we have?
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Deleted
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Oct 10, 2024 20:25:53 GMT
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Post by Deleted on Aug 26, 2014 15:44:44 GMT
sdeven, I'm glad it's working for you. But please, I would urge you to stay diligent as to future changes and offerings. It really is happening that fast within the landscape of delivery. I'm not saying "go get insurance." I'm saying stay mindful that more an more, innovative options will continue to open up for individuals for coverage choices. I totally hear your "simple" as there are providers now that offer a "yearly fee" for their patients that cover all office visits for families, with email access. There are even more others that offer pay scales for varying degrees of access for the self pay. At the end of the day, there will be vast, vast choice and people will have to figure out what truly works for them. Always. I am very invested in the many alternatives as it hits very "close to home" for me and mine. In our experience, big insurance is not the answer most people think it is. There is a lot of room for improving the many options to everyone.
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Post by jamieson on Aug 27, 2014 3:08:06 GMT
Sdeven, it sounds like you have a rare and wonderful situation. I'm so happy you were able to secure such great care for your child, I only wish this was available to everyone.
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