Health Care BS

Comments 5

1. drmatt wrote:

   Actually this is not true, what you are missing here is a basic insurance fraud law, medicare patients can get as much care as they want from whomever they wish, but they may have to pay out of pocket. The bottom line is if you are a medicare provider you must first bill medicare and then be denied before you can pass the bill on to the patient. I have read much of your blog, you are obviously quite opposed to single payer systems and/or socialized medicine. I think you have to answer this question in scenario before you can criticize (with any legitamacy) any socialized or single payor system. Health care, right or privelege? There is no inbetween. If you show up in my office with your sick daughter and I determine that you don’t have the means to pay so I send you home and your daughter dies is that ok? Then you are truly for privelege, if you dont agree with this it must then be a right, otherwise you are trying to straddle the line which will require a lot of regulation. If I must operate as a business I must be able to insure that I get paid, you wont get your car fixed if you can’t pay. Otherwise it is a right, in which case we need to remove profit driven capitalistic sources from the formula.

   Posted 26 Oct 2007 at 6:14 am ¶
2. Rich wrote:

   drmatt - you are incorrect.

   If I provide a service which medicare will not pay for, and I have warned the patient, in advance and in writing, that medicare may not pay, then I can bill the patient. If I have not warned the patient in writing, in advance, I may not bill the patient.

   If, on the other hand, I provide a service which medicare DOES pay for, and I charge more than medicare allows, I MAY NOT bill the patient for the balance. Medicare must deny the WHOLE CHARGE for the service before I can charge the patient, providing I have a signed ABN from the patient before providing the service.

   So medicare recipients can get all the healthcare they want to pay out of pocket for, as long as it does not include services for which medicare pays anything.

   “The bottom line is if you are a medicare provider you must first bill medicare and then be denied before you can pass the bill on to the patient.”

   Wrong. I can only “pass the bill on to the patient” if I have a signed ABN, and medicare pays Nothing, nada, zilch. If I charge more for a service than medicare allows, and they pay, I cannot bill the patient the balance, regardless of my costs. So I may choose not to provide services for which my costs exceed what medicare allows. You have no right to force me to do so. You certainly have a right to find someone willing to provide the service, though.

   Posted 26 Oct 2007 at 8:12 am ¶
3. drmatt wrote:

   I stand corrected, I do remember getting those pesky ABNs signed. There is also the point, that if I am not a medicare provider, I may bill the patient whatever I wish. Being a medicaide provider is similar to being a provider for any of the other insurance companies in that you are bound by a “contract”. So this really is about contractual law.

   The most important point being, however, is that the assertion that the governement is making laws to limit how patient’s spend thier money really is not true. The laws are about contracts, and contracted providers, no patient’s, the patients are free to see non medicare providers and pay thier life savings out for plastic surgery if they wish.

   Posted 26 Oct 2007 at 8:35 am ¶
4. Rich wrote:

   Again - this needs a little clarification.

   For medicare, Non-particpating providers must still follow the same rules as above. In order to be a “non-medicare provider”, in your terms, means opting out. If you do not contract with medicare (non-par) you are subject to the same rules. Failing to follow them is not a contract violation (tort), it is fraud, punishable in a criminal proceeding.

   Currently, in order to opt out, you must sign an agreement with the local medicare contractor, that you will not accept payment from medicare, for any patients, for 2 years. Then, to propoerly bill patients, yo must contarct with the patient, in writing, your fees for all servcies, in advance.

   If the patient does not contract, you cannot charge them. If you widh to opt-in - you must wait until the 2 years have expired.

   Since the discussion is about health care, and not cosmetics, the plastic surgery comment is not relevant. If I opt out, and you ( a mediare recipient) would like me to attend to you in the hospital, or in my office, You must agree to my fee schecule, in advance and in writing, before I can charge you anything.

   Posted 26 Oct 2007 at 9:48 am ¶
5. drmatt wrote:

   Duly educated.

   Posted 26 Oct 2007 at 10:33 am ¶

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