I Should Post More

30 Dec

Well, as part of my list of “things to do for 2013” (I promised I would never call them “resolutions”), I should add “Post to my friggin’ blog once in a while.” Along with “exercise” and “eat fruit and veg every day even if all you want is cookies” and “go to the dentist for preventative care”.


Jingoistic Healthcare Myths, Part I

27 Jun

Of all the healthcare myths that drive me batshit mental (and there are a slew of them), the one currently at the top of the list says:

We have a great healthcare system. No one who needs emergency treatment is ever turned away from the ER!

What an idiotic statement, and what a low bar we set for “a great healthcare system”.

First, people are turned away from ERs all the time. Sometimes an ER will flat-out refuse to treat, as happened to some dialysis patients in Atlanta. And sometimes ERs triage people, then determine the patients probably aren’t that sick. Patients are then told that if they wait to be seen, they will be charged an extra sum of money. This is the norm in my own hometown. If the patient reasonably says, “But I’ve been puking my guts up for two days and have a 103F fever and am hallucinating! I need a doctor now!”, the patient will be directed to the local walk-in clinic/acute care center – a for-profit private physicians’ office where services were priced a la carte and there is no charity care.

Second, the fact that someone in extremis isn’t usually turned away from the ER is hardly indicative of a great healthcare system.Let’s clarify a few things on that score:

  • A great healthcare system is one where people who are chronically ill do not need to rely on the ER.
  • A great healthcare system allows people to obtain treatment before they need free ER care.
  • A great healthcare system doesn’t ruin the credit of people who need the emergency room.
  • A great healthcare system doesn’t force you to lose your house and/or car and/or savings before giving you health insurance to pay for the treatment of a devastating or long-term illness or injury.
  • A great healthcare system doesn’t dump poor, sick patients on the street.

My intended, a physician, once told me about a woman who came into the clinic where he was working. The woman had breast cancer. Sad, but not shocking. What was shocking is that due to insurance problems, this woman had waited so long that the cancer had broken through the skin.

That is symptomatic of a very bad healthcare system.

Third, a great healthcare system doesn’t allow health insurers to frame the “fight” as one of payment for providers vs. care for patients. If you follow the money trail, it’s insurance companies and their lackeys who are getting and keeping the majority of the money, who are behind the most vehement anti-universal-healthcare screeds and adverts, and who have the most to lose at the end of the day. Blue Cross CEOs pocket tens and hundreds of millions of dollars in annual compensation while member premiums are increased and benefits cut, and provider reimbursement is  slashed. And the CEOs are the ones with the private jets. It’s not you, me, or Doctor Smith who takes care of you and your kids. It’s the heads of so-called non-profit health insurance companies.

So what does America have, if not the best healthcare system in the world?

We have a clusterfuck. We have an embarrassment. We have what happens when entities with a shitload of money to lose manage to convince us to think in terms of “I” about a service that should be thought of in terms of “we”.

Canadians and Europeans talk about healthcare as a “we” thing; access to healthcare is something that benefits the whole of society, that they pay for as a social service, not a product, and use when they need. Several have bluntly said to me they were able to access national health when they had no money to pay because the taxes of others allowed them to do so; and now that they are working again they fully expect to pay their fair share to help others and ensure it’s there when others need it. That’s a novel thing for an American to hear. And that novelty is very sad.

Americans like to think that you can get anything if you work hard enough, that you should be able to “pull yourself up by your bootstraps” to get anything you need. But here are some facts, kids — You can’t pull yourself up by your bootstraps if your back is broken and your fingers have been chopped off. Someone should tell the “I”-thinkers that.

We don’t have the best healthcare system in the world. We’re not even in the top 10. We’re too busy being manipulated by the money spinners to realize that we’ve been had, like the bunch of rubes we are.

So What if She IS a Slut, Mister Limbaugh?

14 Mar

Seriously, that’s my answer to the brou-ha-ha over Rush Limbaugh calling Sandra Fluke a slut. Ms. Fluke, as people who haven’t been under a rock for a week know, was lambasted by the rotund cuckoo-brained right-wing-nutburger talk-show host for her remarks before the House Democratic Steering and Policy Committee, in which she stated her support for mandated coverage of contraceptives under all health-care plans, including those with “religious objections”.

Limbaugh, whose mouth acted as the distal end of a sewer pipe that day, said that Ms. Fluke wanted “us” to “pay for her to have sex”. He then went on to state that this makes her a “slut” and that she ought to post video of her having sex.

This from the man who was caught with an awful lot of Viagra without a prescription.And who is on wife number 4 and has no children. Hmmmm…..

But I digress.

I’ve been annoyed about the commentators who’ve felt the need to make remarks such as, “Some women need contraceptives for medical reasons!” While that is true, it’s a total red herring. Women need to stand up and say, I use contraceptives to control when, if, and under what circumstances I have a child. That is reason enough. Whether a woman has sex with a husband or the entire Navy is immaterial to the conversation, and is no one’s concern but those involved and perhaps their physicians. End of story. Everyone else not involved needs to shut the hell up and worry about their own lives. 

However, we still have a massive double standard when it comes to women and sex. No one ever suggests we stop covering men’s reproductive health procedures or products (Viagra and treatment for erectile dysfuctions, for example). Medicare will pay for treatment of erectile dysfunction, including surgery, on men who are 80 years old. And apparently that doesn’t offend anyone. But let women say they want birth control to be covered under insurance that they pay for, and it’s now an issue for the entire country to discuss.

Please wake me when we get to the year where women aren’t still catalogued as nice girls vs. sluts.


Florida Blue Cross Says, We Won’t Pay Psychiatrists

14 Mar

Wow, don’t know how I could’ve missed this gem…but it’s a perfect example of what happens when a platinum insurance company decides that it needs a second private jet, or something:

In early August, Blue Cross/Blue Shield of Florida sent letters to all of its Florida psychiatrists and other providers under the category of  “mental health”,  advising them that they would be terminated without cause.


BCBS has said that it is offering coverage through New Directions, which is a managed-care corporation in Kansas, in which Blue Cross/Blue Shield owns the majority of the stock.


This will adversely affect everyone in Florida whose insurance provider is Blue Cross/Blue Shield and who is a patient of a psychiatrist or any other mental-health provider or who be in the future.


The article then goes on to break down the out-of-pocket costs for a BCBSF member who would see a psychiatrist who is now “out of network”. They aren’t cheap.

Yet another shitty way for the Blues to treat their members, just so they can save some cash on the books. Nice way for an alleged non-profit to behave. 

The Florida Psychiatric Society has information about the situation on its splash screen. If you are an affected Blue Cross policyholder, do complete the survey. The only way there will be any change to BCBSF’s policy is if the medical society can  make its case. Link is here.



The Contraceptive Brou-ha-ha

11 Feb

I totally disagree with the Catholics whining and crying about being “forced” to provide contraceptive coverage for their female employees. It has nothing to do with “freedom of religion” and more to do with “controlling of women”.

So I want a list of every single company that wanted to weasel out of providing this coverage to its employees, so I know what facilities to avoid.


4 Jul

Sometimes it goes in dribs and drabs, and sometimes you realize that six bloody weeks have gone by and you haven’t done anything you planned.

THAT isn’t what I was going for.

So time to grab time by the horns (or whatever sort of handles time has, I’m not sure) and get my proverbial and physical ass in gear.

To quote The Doctor, “Allons-y!”



Busy with the craziness

15 May

I’ve been busy the last couple of weeks with a crazy project that perfectly demonstrates why health insurance is so screwed up. I shall be describing it and how the payment method we all assume is in effect, is dead as the dodo.

GAWD-UH doesn’t want you to have healthcare!

12 Apr

So says Rick Santorum. Via Pharyngulya (and a combined hat tip and “We’re not worthy!”)…The Evil that Is HealthCare.

I’m just going to re-quote what PZ Myers did, as it is appropriately mind-boggling, and I want you to go read his entry, ’cause really, he covers things far better than I would:

“Think about how they view you,” he told the crowd of Republicans. “They view you no different than the drug dealer views the little kid in the school yard. They want to get you hooked, they want to get you dependent. They want to get you relying upon them for your wellbeing. And once they’ve satisfied you, giving them that drug, that narcotic, then you’ll be reliant on them and, by the way, you’ll also be less than what God created you to be.”

So according to Santorum, the kind and compassionate God of the New Testament would prefer me dead of an asthma attack because I can’t afford asthma meds out of pocket, than to have the government mandate that I can access treatment and medication.



What’s With All the Boring-Ass History?

9 Apr

I know, I can hear people now. “OT, what the hell, are you writing an expose of insurance industry wastefulness, or are you writing The History of the Claim?”

Bear with the history lessons. I think it’s important to understand the background so you can understand how far the insurance industry has come from its intent to pay for legitimate care received by its subscribers. You need to understand how simple it once was to compare that to how bloody complicated, Byzantine, and expensive it is today, and how those expenses have little to nothing to do with actually reimbursing providers or caring for patients.

We will get to the good stuff soon. Honest.

After Superbills, Le Deluge

9 Apr

At some point, The Powers That Be decided that superbills didn’t have enough information, so they decided to mandate use of printed paper claim forms. While things differed across the industry, larger insuers, Medicare, and Medicaid tended to insist on the new standardized forms.

The HCFA 1500 (left) was used to bill “professional” services such as doctor’s office visits, injections, lab services, and so on. Basically, anything that wasn’t a facility charge went here.

The UB-92 (below) was used to bill facility charges such as hospital bills, Skilled Nursing Facilities, Inpatient Rehab, etc.

These forms could be bought from a number of suppliers, and for some insurers, HAD to be red.

See, the advent of the new forms meant that they could be optically scanned, which was an improvement over typing in claims information. You fed a handful of claims into the scanner, the information was scanned and fed into the claims processing system, and WOOSH! a whole bunch of mundane work was done.

The problem with this, of course, was that the mailroom was still deluged in paper claims, and that you had to keep up the optical scanners, and you had to have people to run and fix them.

The next step was inevitable — using the computer to send claims.