lostyankee
enthusiast
Posts: 1261
Reg: 10-27-05
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08-18-11 10:58 PM - Post#137032
everyone knows braces are critical to patient health. And some people wonder why people question the ability of the government to manage health care.
http://www.wfaa.com/news/investigates/Bra ced--1280...
Edited by lostyankee on 08-18-11 10:59 PM. Reason for edit: No reason given.
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 07:06 AM - Post#137036
In response to lostyankee
I was just talking to a anesthesiologist about similar issues within Medicaid yesterday. Let's see, taxpayer paid cosmetic work, great system we have. The sad thing is some of these kids really need braces. That is a fact, but these doctors are putting them on anyone who has a slightly skewed tooth that would never be noticed.
Our system, both Medicaid and Medicare have fraud like this running rampant. Unfortunately no politician has the spine to say it must stop and implement the types of reform it would take.
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amcor
member
Posts: 79

Reg: 08-27-06
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08-19-11 07:34 AM - Post#137038
In response to mgrayar
I was just talking to a anesthesiologist about similar issues within Medicaid yesterday. Let's see, taxpayer paid cosmetic work, great system we have. The sad thing is some of these kids really need braces. That is a fact, but these doctors are putting them on anyone who has a slightly skewed tooth that would never be noticed.
Our system, both Medicaid and Medicare have fraud like this running rampant. Unfortunately no politician has the spine to say it must stop and implement the types of reform it would take.
This is also a red flag:
Parents are not allowed to accompany their children into treatment, said Priscilla Ortiz, who was taking her daughter to the clinic under Medicaid.
Pretty sure I would not be returning to a clinic where I am not allowed to accompany my child. I did not always go in the back with my teenager during orthodontic appointments, but I knew I could if I wanted!
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Al C
enthusiast
Posts: 5538
Loc: McKinney/Allen, TX
Reg: 02-16-01
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08-19-11 08:28 AM - Post#137045
In response to mgrayar
Our system, both Medicaid and Medicare have fraud like this running rampant. Unfortunately no politician has the spine to say it must stop and implement the types of reform it would take.
Exactly!! Medicare would actually be a good model for a national health care coverage system ... but with the rampant fraud, it's not efficient as it could be. If the govt is serious about a national plan, then they need to get rid of the fraud taking place and give this an honest look.
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 09:42 AM - Post#137051
In response to Al C
I actually think that if the government could fix these problems, single payer would be widely popular in the moderate middle. However, we all know that it is a program built with more holes than Swiss cheese, so we would be foolish to want to expand gov HC.
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sco
enthusiast
Posts: 2667

Loc: allen,TX USA
Reg: 10-26-02
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08-19-11 10:21 AM - Post#137056
In response to mgrayar
Anecdotal stories like this, while frustrating, aren't necessarily indicative of the system as a whole. I would be curious to see actual scientific data on how efficient medicare and medicaid are in comparison to other plans. There is fraud everywhere no doubt including in the private insurance system. I have often seen things we think we all "know" proven wrong. I have a friend from England. I find it interesting that she is perfectly happy with their medical system, feels that her family gets good care, and is proud of the fact that people aren't forced into bankruptcy by getting sick in her country. This from the system that terrifies so many people in this country.
On a side note, there are many people including my elderly father and mother-in-law who do thank God for medicare every day because without it they would be in a world of hurt.
Edited by sco on 08-19-11 10:25 AM. Reason for edit: No reason given.
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Jimi Ray Clapton
enthusiast
Posts: 1969

Reg: 09-03-07
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08-19-11 10:23 AM - Post#137057
In response to sco
I have often seen things we think we all "know" proven wrong.
Yep.
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Al C
enthusiast
Posts: 5538
Loc: McKinney/Allen, TX
Reg: 02-16-01
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08-19-11 10:43 AM - Post#137060
In response to sco
Anecdotal stories like this, while frustrating, aren't necessarily indicative of the system as a whole. I would be curious to see actual scientific data on how efficient medicare and medicaid are in comparison to other plans. There is fraud everywhere no doubt including in the private insurance system. I have often seen things we think we all "know" proven wrong. I have a friend from England. I find it interesting that she is perfectly happy with their medical system, feels that her family gets good care, and is proud of the fact that people aren't forced into bankruptcy by getting sick in her country. This from the system that terrifies so many people in this country.
Here are a few Medicare related stats....
Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)
Every $1 the U.S. government invests in combating Medicare and Medicaid fraud saves $1.55. (U.S. Department of Health & Human Services, 2009)
Medicare paid dead physicians 478,500 claims totaling up to $92 million from 2000 to 2007. These claims included 16,548 to 18,240 deceased physicians. (U.S. Senate Permanent Committee on Investigations, 2008)
Nearly one of three claims (29 percent) Medicare paid for durable medical equipment was erroneous in FY 2006. (Inspector General report, Department of Health and Human Services, 2008)
Medicare and private health insurers pay up to $16 billion a year for needless imaging tests ordered by doctors. (American College of Radiology, 2004)
Other Medicare Stats
Medicare paid more than $1 billion in questionable claims for 18 categories of medical supplies that patients don’t appear to need. The study covered claims between January 2001 and December 2006. The claims included walkers for patients with purported sinus congestion, paraplegia or shoulder injuries. Hundreds of thousands of claims were made for diabetes-related glucose test strips for patients with purported breathing problems, bubonic plague, leprosy or sexual impotence. (U.S. Senate Permanent Subcommittee on Investigations, 2008)
On a side note, there are many people including my elderly father and mother-in-law who do thank God for medicare every day because without it they would be in a world of hurt.
Indeed! And as I said, it's a good model. But something needs to be done about the fraud and wasteful spending. There needs to be some sort of checks and balances in place that can weed out much of the erroneous and/or fraudulent claims that are submitted.
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 11:28 AM - Post#137071
In response to Al C
Sco,
I am thankful for Medicare too. My mother has been treated well. But the flaws in the system are great. I do not feel comfortable expanding Medicare to cover EVERYONE in it's current state.
I think that is reasonable, no?
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 11:33 AM - Post#137073
In response to Al C
Al, the troubling part is all of that was known in 2009, yet Obamacare did not even address it one bit! In fact you could say the doubled down on the holes by expanding Medicaid to cover more people. How much of that cost could be covered by fixing the system?
Learn more about Cystic Fibrosis and how you can help at:
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Edited by mgrayar on 08-19-11 11:37 AM. Reason for edit: No reason given.
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sco
enthusiast
Posts: 2667

Loc: allen,TX USA
Reg: 10-26-02
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08-19-11 12:55 PM - Post#137088
In response to mgrayar
Sco,
I am thankful for Medicare too. My mother has been treated well. But the flaws in the system are great. I do not feel comfortable expanding Medicare to cover EVERYONE in it's current state.
I think that is reasonable, no?
I don't disagree that there are flaws and I appreciate Al's statistics. However it still doesn't answer my question of in comparison to private health insurance are the flaws significantly greater. I too am not comfortable expanding medicare to cover everyone but I do believe that everyone should have access to health insurance. I'd take medicare in a heartbeat over no insurance or bare bones coverage. I haven't heard many people even remotely suggest expanding medicare to everybody. I do think the anecdotal horror stories are often assumed to be the norm and I simply don't believe that to be the case. (To be precise, the original story was about medicaid not medicare.)
Edited by sco on 08-19-11 12:59 PM. Reason for edit: No reason given.
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 01:01 PM - Post#137091
In response to sco
Sco, single payer would in fact be Medicare for everyone. It has been suggested more times than possible to recount.
Learn more about Cystic Fibrosis and how you can help at:
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Everyone can make a difference! |
Edited by mgrayar on 08-19-11 01:02 PM. Reason for edit: No reason given.
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Al C
enthusiast
Posts: 5538
Loc: McKinney/Allen, TX
Reg: 02-16-01
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08-19-11 01:10 PM - Post#137093
In response to sco
Sco,
I am thankful for Medicare too. My mother has been treated well. But the flaws in the system are great. I do not feel comfortable expanding Medicare to cover EVERYONE in it's current state.
I think that is reasonable, no?
I don't disagree that there are flaws and I appreciate Al's statistics. However it still doesn't answer my question of in comparison to private health insurance are the flaws significantly greater. I too am not comfortable expanding medicare to cover everyone but I do believe that everyone should have access to health insurance. I'd take medicare in a heartbeat over no insurance or bare bones coverage. I haven't heard many people even remotely suggest expanding medicare to everybody. I do think the anecdotal horror stories are often assumed to be the norm and I simply don't believe that to be the case. (To be precise, the original story was about medic aid not medi care.)
Found this ....
The Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4.
$48B is a lot to spend on fraud.
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 01:54 PM - Post#137097
In response to Al C
Well, maybe if your a cynical Obama-hater that would seem like a lot of fraud, but for an Obama-lover that's just the cost of a few votes in reelection!
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MissingChico
enthusiast
Posts: 2228

Reg: 02-13-06
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08-19-11 04:37 PM - Post#137103
In response to mgrayar
I was just talking to a anesthesiologist about similar issues within Medicaid yesterday. Let's see, taxpayer paid cosmetic work, great system we have. The sad thing is some of these kids really need braces. That is a fact, but these doctors are putting them on anyone who has a slightly skewed tooth that would never be noticed.
Our system, both Medicaid and Medicare have fraud like this running rampant. Unfortunately no politician has the spine to say it must stop and implement the types of reform it would take.
I had a 25 yo daughter who until until recently, was on my dental plan. She seen an Allen Dentist Dr Wy@#$ to get a quote to repair some issues she had. This dentist who is sporting a brand new office quoted her little over $5000 out of pocket to complete her care. I insisted she get a second opinion with Dr Kim in Allen who determined nearly all the quoted care from the first Dr was unwarranted. My daughter was treated by Dr Kim who fixed everything and at a mere $500 out of pocket cost. Abuse is everywhere, not just Medicare. Some of you don't realize Medicare and Private insurance goes through the exact billing process and clearing houses using the same ICD9 or 10 coding. If a Dr is going to defraud Medicare, they'll do it to private insurance too.
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pup
enthusiast
Posts: 3755
Reg: 03-29-06
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08-19-11 04:50 PM - Post#137107
In response to MissingChico
I had the hospital here in Allen turn in a 17000 bill for an xray of my ankle...the insurance paid without question.
I called the insurance co, gave them the info on what actual treatment took place and they got their money back.
It was blamed on a clerical error....
| Pup has left the building. |
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mgrayar
enthusiast
Posts: 3148

Reg: 09-25-09
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08-19-11 04:56 PM - Post#137109
In response to pup
Chico, you are right. However patients in your example on Medicaid do not care to seek the second opinion because you and I are paying for it.
Pup brings up the biggest watchdog in private pay, the consumer. Because we pay co pays and co-ins we tend to know if my fly shot was billed as an in patient procedure, and we tend to care enough to get it fixed.
Learn more about Cystic Fibrosis and how you can help at:
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Everyone can make a difference! |
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Jimi Ray Clapton
enthusiast
Posts: 1969

Reg: 09-03-07
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08-19-11 05:27 PM - Post#137112
In response to mgrayar
I just simply need to pay attention. I have to admit, I don't. I will now, though.
Interesting stuff.
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lostyankee
enthusiast
Posts: 1261
Reg: 10-27-05
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08-19-11 05:34 PM - Post#137113
In response to Jimi Ray Clapton
There is no doubt fraud and abuse in private AND government plans. There is absolutely zero incentive to keep costs low from a user perspective in a government run health care system. Charged $17,000 for an xray? Who cares, I'm not paying. Half the country overweight and causing needless healthcare visits? Who cares, it's all being handled by the government.
No question we have to fix the problems. Adding more to a broken system and expecting superior results is folly, pure and simple. Kind of like expecting orthodontia to be covered under Medicare. Ridiculous.
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MissingChico
enthusiast
Posts: 2228

Reg: 02-13-06
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08-20-11 02:23 PM - Post#137152
In response to lostyankee
There is no doubt fraud and abuse in private AND government plans. There is absolutely zero incentive to keep costs low from a user perspective in a government run health care system. Charged $17,000 for an xray? Who cares, I'm not paying. Half the country overweight and causing needless healthcare visits? Who cares, it's all being handled by the government.
No question we have to fix the problems. Adding more to a broken system and expecting superior results is folly, pure and simple. Kind of like expecting orthodontia to be covered under Medicare. Ridiculous.
If your statement had a glimmer of truth, health care in Europe and Canada would be through the roof, but it isn't. Yes it's expensive when your entire country is the size of a single US state, but overall, the cost per person for care is much less than the US.
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