Quote:
Originally Posted by blueash
Interesting how all of you are jumping on blaming the Federal government and the President. This has nothing to do with Federal efforts to fight fraud nor the ACA. This is not new and is due to the contract which the patient signed with the carrier when he was insured and the lab signed when they agreed to be in network and accepted the carrier's patients. This is a private insurance matter. The lab is required to accept the rules of the insurance company when they see one of that company's insured patients.
I am a bit surprised that there would be a prohibition of a patient declining to use their insurance and pay out of pocket as you should, I would think, be able to decline to use your insurance just as you could with a car repair or home fire which might have otherwise been covered by your insurance. Keep in mind that if you go outside your insurance you will be responsible for the full charges, not the reduced charge which the carrier has negotiated with the provider. I wonder if the refusal of the lab to do the test without a denial was an error or just their internal policy.
It is possible that it is taking time to get approval as the patient's condition does not fit the criteria established by the carrier for the test to be covered even though the doctor ordered it.
By the way, threatening everyone with lawsuits is not generally a way to get them to see the wisdom of your position.
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I think this is probably the crux of the matter as Blueash stated:
Keep in mind that if you go outside your insurance you will be responsible for the full charges, not the reduced charge which the carrier has negotiated with the provider.
Also, I think people often forget or don't know that every not every insurance plan contracted by an employer or group is the same just because it's the same insurance company. Some plans are hefty (and more costly) and some are more meager and cheaper.
Personally, I have no idea why people think denials like this (and worse) would not occur under a national government single-payer system. This is a prime example:
(CNN) -- At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.
The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.
For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care....
Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:
There's an "official" list that's shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there's the real list that's hidden from outsiders, where wait times can last more than a year...."
A fatal wait: Veterans languish and die on a VA hospital's secret list - CNN.com