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  1. #361  
    Quote Originally Posted by xForsaken View Post
    Ok, they are raising their rates, hmmm, quick question, why do they automaticly assume person X is unhealthy? Is this another of the (real) death panels that the insurance companies got busted over? You know the ones, the ones that never kept any records of or minutes of, but where people were just cut off from coverage?! If they will be getting an additional 30 plus million people paying into the system, and they have raised the rates across the board, wouldnt they be making MORE money than they were before? Again, if they are not being forced to pay out more, they believe they will have to pay more, in the future, this rate increase is what ,, a) a hedge against future increase in costs, or b) fear mongering at the expense of the people of the US. Both are still bad, the latter being the worst in my mind. What better way to kill something than to raise the rates well prior to actual implementation. OHHHH look you will eventually get this, and WE think it is going to cost us, so you get to pay more now, without recieving one iota more in coverage.. hmmm
    Okay....let's go through this slowly....first of all, there is no open insurance for everyone and no one is being forced to enroll for coverage at this time. The only "open" enrollment that has occured deals with children under the age of 19 (no pre-ex) and dependents under the age of 26. So, it stands to reason that the only rush of insureds coming on board would be those that were unable to get coverage before. Do you think healthy children are rushing in to get coverage? If you think that, please explain how you came to that conclusion? The only children rushing in right now are those that have health issues....this ain't rocket science. And what makes more sense....waiting until you suddenly find the claims paid exceed the premiums or trying to deal with it in advance. Again, you can't be thinking like a government employee here, you have to think like a business that must take in more, or at least as much, as they pay out.
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  2. #362  
    Quote Originally Posted by clemgrad85 View Post
    Okay....let's go through this slowly....first of all, there is no open insurance for everyone and no one is being forced to enroll for coverage at this time. The only "open" enrollment that has occured deals with children under the age of 19 (no pre-ex) and dependents under the age of 26. So, it stands to reason that the only rush of insureds coming on board would be those that were unable to get coverage before. Do you think healthy children are rushing in to get coverage? If you think that, please explain how you came to that conclusion? The only children rushing in right now are those that have health issues....this ain't rocket science. And what makes more sense....waiting until you suddenly find the claims paid exceed the premiums or trying to deal with it in advance. Again, you can't be thinking like a government employee here, you have to think like a business that must take in more, or at least as much, as they pay out.
    i agree with the biz layout.. no need to go slowly,, i understood that perfectly,, however is there any proof that its only sick kids coming in.. that i can not believe. sorry its only been passed a few months.. sooo i can not will not believe that its only sick kids coming in,, this is a pure money grab.. ohh wait insurance companies would never do that,, ie cutting people off after they have paid for years... for no reason what so ever naww never happen..
    Life is short, Play hard, and enjoy every moment as if it was your last.
  3.    #363  
    Given that this is the second gigantic Medicare fraud bust under Obama's leadership, I would say he is meeting his stated goal of decreasing Medicare fraud....to a much greater extent than any previous president. Let's hear some congrats.

    In what has been deemed the "largest Medicare fraud scheme ever perpetrated by a single criminal enterprise," 73 people--including members of an Armenian-American organized crime syndicate--were charged Wednesday with submitting to Medicare more than $163 million in phony bills from 118 non-existent medical clinics spanning 25 states. The scam, which started in 2006, netted the participants nearly $36 million.

    Stolen identities from both doctors and patients were used in the reimbursement requests, reports the Wall Street Journal, including 2,000 from New York-based Orange Regional Medical Center alone. However, many of the bills submitted didn't even bother to take into account which types of doctors were performing which procedures. For example, the newspaper reports, one bill submitted was for an eye doctor who performed bladder tests; other bills involved patient visits to doctors who conduct autopsies.



    Read more: Mammoth Medicare fraud bust targets organized crime group - FierceHealthcare Mammoth Medicare fraud bust targets organized crime group - FierceHealthcare
    Subscribe: Healthcare Industry Newsletter, Healthcare Newsletter - FierceHealthcare
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    #364  
    Under Obama's leadership? bwah hahahahahaaaa!
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  5.    #365  
    Quote Originally Posted by Micael View Post
    Under Obama's leadership? bwah hahahahahaaaa!
    That's the nice thing about facts....they speak for themselves.

    Crackdown on Medicare fraud a priority for Obama administration

    A new sense of urgency is shaping the U.S. government's fight against Medicare fraud as the Obama administration strives to sell the public on expanding healthcare to cover uninsured Americans.

    Cabinet officials commenting on this week's trio of Medicare fraud crackdowns in Miami and other cities pushed an emerging two-pronged approach, focusing on fraud prevention as well as prosecutions.
    The latest indictments -- exposing almost $200 million in Medicare scams involving HIV treatments, physical therapy and diabetic services -- follow a recently announced partnership between the Justice and Health and Human Services departments.
    The agencies have expanded criminal "strike forces" that existed under the Bush administration, most recently to Detroit, but also have committed about half a billion dollars to fraud prevention efforts this year. They are working on sharing suspicious billing information with Medicare -- an agency notorious for paying claims fast without verifying them -- to help stop fraud and waste.
    Experts estimate the huge entitlement program loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis.
    "The Obama administration is committed to turning up the heat on Medicare fraud and employing all the weapons in the federal government's arsenal to target those who are defrauding the American taxpayer," HHS Secretary Kathleen Sebelius said during a news conference at the Justice Department with Attorney General Eric Holder.
    "But our joint efforts don't just stop at the jailhouse door," she said. "Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries."
    The government's job will be anything but easy. During the past five years, thousands of Medicare fraud offenders have shown that they can outsmart the vulnerable healthcare system for the elderly and disabled. Their weapons: cash kickbacks to Medicare patients, manipulation of medical records to justify bogus charges, and use of different billing codes to get around Medicare's technology to block false claims.
  6. Micael's Avatar
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    #366  
    Note that it was a Bush administration program, but THIS time he's not "blamed".
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  7. Micael's Avatar
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    #367  
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  8.    #368  
    Quote Originally Posted by Micael View Post
    Any bets? I sincerely hope the republicans try to repeal it. I can't wait for that discussion. It will simply highlight all the things about the bill that the republicans have promoted in the past....and they want to repeal it. Good thinking.
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    #369  
    Quote Originally Posted by davidra View Post
    Any bets? I sincerely hope the republicans try to repeal it. I can't wait for that discussion. It will simply highlight all the things about the bill that the republicans have promoted in the past....and they want to repeal it. Good thinking.
    Oh, I'm certain you'll be entertained.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  10.    #370  
    Quote Originally Posted by Micael View Post
    Oh, I'm certain you'll be entertained.
    I must be easily entertained. Look where I am.
  11. Micael's Avatar
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    #371  
    Quote Originally Posted by davidra View Post
    I must be easily entertained. Look where I am.
    Honestly, I don't think you have that much to worry about. I doubt it will succeed, and even if the repugs do get some power this cycle, they'll only be partially successful, at best, at repealing some portions of the bill.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  12. #372  
    Quote Originally Posted by Micael View Post
    Note that it was a Bush administration program, but THIS time he's not "blamed".
    true, he will not be blamed for it.. but a law that was not enforced by bush is just so much paper. cant enforce something when you dont give the cops the money to do the job.
    Life is short, Play hard, and enjoy every moment as if it was your last.
  13. #373  
    Quote Originally Posted by xForsaken View Post
    i agree with the biz layout.. no need to go slowly,, i understood that perfectly,, however is there any proof that its only sick kids coming in.. that i can not believe. sorry its only been passed a few months.. sooo i can not will not believe that its only sick kids coming in,, this is a pure money grab.. ohh wait insurance companies would never do that,, ie cutting people off after they have paid for years... for no reason what so ever naww never happen..
    Did I ever say it was JUST sick kids coming in? They were putting children on the product before the mandate. Good grief. My point was that an increase in healthy children is not occuring....why would it? They could get the coverage before.

    By the way....an update on the request by insurance companies to be able to have an "open enrollment period" for children's pre-x conditions. This would help in stopping parents from adding children when sick or injured and then removing them when they have been treated. Well, the HHS has denied this request: U.S. official calls out insurance companies | The Post and Courier, Charleston SC - News, Sports, Entertainment

    It's a shame that the obama administration refuses to work with insurance carriers on this. For those that don't understand this request, the insurance companies were simply requesting a period of time, say December of each year, when children could come on board with no pre-ex. Then, if they got treatment and dropped the plan say in May, they couldn't come back on until December. This would possibly make it less attractive for parents to add and drop coverage as needed. Seems like a reasonable request but, of course, obama is not really a reasonable person when it comes to the evil insurance companies.
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  14. #374  
    That actually answered a question from earlier about some of the options the insurance companies had to help protect themselves.

    In her letter, Sebelius outlined several ways insurers could keep costs in check. Carriers are allowed to charge a fee for people who drop coverage and later reapply, for example. Or they may adjust rates depending on health status, the letter said.
  15. Micael's Avatar
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    #375  
    Quote Originally Posted by xForsaken View Post
    true, he will not be blamed for it.. but a law that was not enforced by bush is just so much paper. cant enforce something when you dont give the cops the money to do the job.
    Source?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  16.    #376  
    Quote Originally Posted by clemgrad85 View Post
    By the way....an update on the request by insurance companies to be able to have an "open enrollment period" for children's pre-x conditions. This would help in stopping parents from adding children when sick or injured and then removing them when they have been treated. Well, the HHS has denied this request: U.S. official calls out insurance companies | The Post and Courier, Charleston SC - News, Sports, Entertainment

    It's a shame that the obama administration refuses to work with insurance carriers on this. For those that don't understand this request, the insurance companies were simply requesting a period of time, say December of each year, when children could come on board with no pre-ex. Then, if they got treatment and dropped the plan say in May, they couldn't come back on until December. This would possibly make it less attractive for parents to add and drop coverage as needed. Seems like a reasonable request but, of course, obama is not really a reasonable person when it comes to the evil insurance companies.
    The request is clear. The insurance companies still want the ability to deny insurance to children with pre-existing conditions. And as outlined there are ways for the companies to protect themselves. Admittedly this portion of the bill will likely decrease somewhat the record profits scored by insurance companies (please don't bother to post percentages; record profits are record profits).

    Again, without a doubt, the best way to avoid people signing up and dropping out and gaming the system is simply to have everyone covered through a single-payor system.
  17. #377  
    Quote Originally Posted by davidra View Post
    The request is clear. The insurance companies still want the ability to deny insurance to children with pre-existing conditions. And as outlined there are ways for the companies to protect themselves. Admittedly this portion of the bill will likely decrease somewhat the record profits scored by insurance companies (please don't bother to post percentages; record profits are record profits).

    Again, without a doubt, the best way to avoid people signing up and dropping out and gaming the system is simply to have everyone covered through a single-payor system.
    Yes....why post profit percentages that are low when you want it to appear like health insurance companies are ripping everyone off. And as usual, davidra's answer to everything is more government. Why do liberals believe that the government is the answer to everything? It really is amazing. Problem in the country? Well, just get the government to make more laws and/or run that area of concern....that's the answer, right?

    It does appear that HHS has agreed that insurance companies can charge more for unhealthy children: http://www.nytimes.com/2010/10/14/he...r=1&ref=health

    I must admit the article is a bit confusing because at one point it says the administration agreed they could have open enrollment periods to accept ALL children. Apparently the option given was if they had an open enrollment period to enroll ALL children, then they could not write policies on any children outside that period, including healthy children. Some interesting quotes in the article.
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  18. #378  
    Quote Originally Posted by Orion Antares View Post
    That actually answered a question from earlier about some of the options the insurance companies had to help protect themselves.
    Yup....per the article link I posted above, insurance companies can charge more for unhealthy children. Not sure this accomplishes getting unhealthy children covered necessarily, but.....
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  19. #379  
    I forgot about this little nugget that 60 Minutes reported on about a year ago:

    Annual Medicare Fraud: $60 Billion; Annual Profits of Top Ten Insurance Companies: $8 billion | The Weekly Standard

    So, rather than worry about the evil insurance company's profits, seem like we should worry more about the Medicare fraud. I applaud obama if he had anything to do with that recent Medicare fraud "bust", but seems like it might benefit us if we concentrated more on that. I just wonder how much fraud will occur once davidra gets his public option.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  20. #380  
    Quote Originally Posted by Micael View Post
    Source?
    i look to reports of laws being enacted and some of the biggest rip offs in the financial world as well as health care happening, one of the things that was fact bush gutted enforcement ends of the financial and health care investigators. that was reported repeatedly. ohhh wait thats right we can trust all these fine corps to police themselves. madoff anyone. how about the latest one where they busted that medicare (i think it was medicare anyway) fraud ring. hundreds of millions. no that was not a corp. but it sure as hell says there is some real problems with no enforcement if ids can be stolen and no one around to notice.. but hey thats just me.
    Life is short, Play hard, and enjoy every moment as if it was your last.

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