I think this topic could use some discussion and hopefully some insight.
The issue is what medical “codes” are covered (paid for) vs not covered.
First let us note that I think there are two classes of health insurance. The First one would be commercial Group plans, offered by many employers and handled by a few insurance companies. Into this group I declare are included Medicare so-called “Advantage” plans offered by the same health insurance companies. The common factor is that in all cases, what is covered vs NOT is decided by your insurance company.
The Second class would be Medicare. Under this gubbermint plan, the US Govt determines what is covered vs not. By the way, this is the major factor in why straight Medicare is superior to ALL “Advantage” plans: There is NO second entity to tell you what is covered and at what rate! No networks or preferred providers, only providers who accept Medicare.
Now we get to our example: Routine blood work typically ordered by physicians. They outsource the phlebotomy to companies like Quest and Labcorp. But we unwittingly run into “not” covered tests, with the excuse that it depends upon the [declared] condition of the patient/victim. If doctor provided the correct “code” then it can be covered. Otherwise, pay up, victim!
QUESTION! Does anyone know of any data base of medicare-covered tests and conditions?
It would be interesting to know the denial rates of Medicare, Medicaid, private health in general or private health company based or what the denial rates are with countries that have a national health service
We have Medicare with a supplemental plan. The codes are so complicated that, more than once, a doctor has told one of us if any claim is rejected to let him or her know and they will resubmit under a different code.
Blood test costs are frequently rejected because Medicare covers only a small number of conditions subject to tests. Routine tests, such as cholesterol or blood sugar (if one is not diabetic), are not covered. Generally, if you have been identified with a specific condition, related tests are covered. Blood tests to identify a condition are generally not covered.
During the end of my husband’s life he was treated by hospice at a skilled nursing facility. When he went on hospice all his Medicare benefits were assigned to hospice and Medicare would only pay for the doctor at the skilled nursing facility, the doctor at hospice, and medical treatments that were recommended by hospice. This did not include the cost of the skilled nursing facility which cost me $13,000 per month because Medicare does not cover the cost of a skilled nursing facility except for short term rehab.
Medicare doesn’t but Medicaid does, although it does require that you “spend down” your savings.
This brings up something I wonder about…I see a LOT of YouTube videos about “protecting your assets” should you need a nursing home. And the five year lookback used by Medicaid and ways to get around this so that your assets are protected and Medicaid pays for your care.
I often wonder how many people seeking this have voted for candidates that want to cut or eliminate Medicaid. I think a lot of “protecting assets” translates into “protecting inheritance”. There was one advisor who, surprisingly enough, addresses the moral issues of this practice. Comments to the videos include the ones about the shitty care you will get at a Medicaid facility, while others have pointed out that while their parents were paying for their own nursing home care, the person in the next bed was on Medicaid.
The moral and legal way around that is to spend your kids future inheritance on them now. People will give their kids a down payment on a home, take them on a nice vacation every year, buy them a large purchase such as furniture or vehicle. You can’t take it with you so you might as well see your kids enjoy it while you’re alive.
So does this mean that you will stop voting for candidates that want to reduce or eliminate Medicaid so that you can spend your final days on the government dime? Wouldn’t that make you a moocher? After all…it’s not the government that dictates the cost of nursing home care. And while the government under Medicaid is willing to cover you…part of the deal is that they will come in to help when you can no longer afford it.
Lol…no. it means I’d rather see my kid own a home and get a head start on his life than be the richest guy in the cemetery. If you want to hoard your money that’s your choice, I’d rather enjoy mine while I’m alive.
Which is the way it’s supposed to be, Medicaid is for people who have no money or assets.
Great. So you treated all your kids and now find yourself needing nursing home care. And you are okay with bitching all your life about the moochers who need to pull up their bootstraps, then turn an accept far MORE from the government so you can be in a nursing home. They have a name for that - hypocrite. Since you’ll vote for candidates that want to stop these moochers from getting Medicaid…I hope that they are successful in your lifetime, so that when you need it…you’re fucked. Or at the very least - hold a means test…if you are living in a million dollar house but have given all your assets to your kids - they put you in a Medicaid shithole nursing home. For the folks who spent down for their care, they will be put in a better quality nursing home.
Then I’ll have to pay for it until my money runs out and Medicaid kicks in. Like I said if you want to hoard your money to be the richest guy in the cemetery it’s your choice, I prefer to enjoy my money now.
There already is a means test. Medicaid doesn’t kick in until you don’t have enough to pay for it on your own.
[quote=“kcflyer, post:9, topic:77708”]…if you are living in a million dollar house but have given all your assets to your kids - they put you in a Medicaid shithole nursing home.
For the folks who spent down for their care, they will be put in a better quality nursing home.
[/quote]
???
You’re making no sense. Medicaid doesn’t kick in until you’ve spent all your money, it doesn’t matter if You’ve been poor your whole life or were worth millions but spent it all on care until you were broke.
As do I. And…when it comes time to where I can’t wipe my own ass and have to have someone do that…when I can’t recognize my kid or grandkid, then I will minimize my nursing home costs by stipulating that I do not want food or water and I’ll leave this world.
And here’s the thing about the YouTube videos…they are encouraging people to “spend down” so that Medicaid kicks in on day one.
Just curious though…but you are a “pull yourself up by the bootstraps like I did” kind of guy…did your parents give you the bulk of their estate now, instead of waiting? I mean…so they could see you and the family enjoy the fruits of their labor?
There’s nothing illegal or immoral about spending your own money how you want. There is a 5 year claw back for people who are trying to game the system, but that’s very different.
They were very generous with the grand kids and paid for family trips for 10 adults and 7 kids several times. They also never needed long term care so the point is moot.
Thank you KC for hijacking this non-political thread with your own BS agenda, and thank you for being done. Maybe now we can get back to the topic?
And thank you J2 for your useful response.
We have been thru the “doctor will re-code” a couple of times; says she does that automatically when she sees a reject. But the net result on at least two occasions here has been getting dunned by quest, giving up, and paying the amount demanded.
As far as rejection for want of required diagnosis, I find this to be obscene, particularly in the case of blood sugar. Diabetes is a horrible disease and the easiest way to find out you got it is to test. Millions of diabetics test twice a day, and I thought that having doctor check once or twice a year would be covered.
I am not an advocate of Canadian health care in general but like the way they handle long term care. The Canadian government evaluates what each resident can afford to pay and subsidizes the rest. So very wealthy people pay the entire bill but the average person only pays part of it. This is much better than our system where a person either pays the entire amount or gets it for free.
It could just be a partial benefit, like a few thousand a month to offset the cost. The rich and middle class will be able to keep more of their assets and poor people can still go on Medicaid.
