[kendi]

Originally Posted by Cliff Fr

Sounds to me like they are over billing so that the medicare advantage company will payout more in the end.

That is what have heard.

[Arlington2]

Originally Posted by Laraine

I lived in Canada for five years, and found it just the opposite. As a personal example, I was having what appeared to be heart problems, and failed a stress test. It took me about 4 months to get a heart scan and see the cardiologist. I also had back problems, and the doctor signed me up for pain management. About six months later, I returned to FL, and a couple months after that, I got a call from Alberta Healthcare saying they were ready for me to start my pain management (don't know how they got my FL telephone number). A co-worker's mother had a steel rod in her spine that snapped, leaving her humped over in terrible pain. It took her 1.5 years to get into pain management, which immediately (finally) solved her pain. The main hospital in Edmonton was overcrowded, had roof leaks that impacted their operating rooms, and long waiting lists (which were jumped by people with the right connections). Wealthy Canadians went to the U.S. to get treated. And free healthcare isn't free--income taxes were about double, to pay for it.

You were fortunate they didn't recommend MAID. From what I have read they are doing that for a variety of reasons including being indigent, depression or no family caretaker. That could be the plan to reduce the demand for medical services.

[JMintzer]

Originally Posted by jimjamuser

All this stated confusion naturally brings up the question of National Health Insurance. Is the system used by Canada, Australia, and all other 1st world countries (except the US) superior to the US's confused and inefficient system? Answer, yes they get better care at lower cost.

Wrong and wrong...

You're ignoring the exorbitant waiting times (as seen in the UK) anf the significantly higher taxes (that EVERYONE pays) that are needed to fund their health care coverage...

Ask the Canadians why they are afraid to get sick while in the US.

While you're at it, ask them why they (and citizens from the other countries you mentioned, along with many others) come to the US to get much of the advance health care they cannot get at home...

[JMintzer]

Originally Posted by Laraine

I lived in Canada for five years, and found it just the opposite. As a personal example, I was having what appeared to be heart problems, and failed a stress test. It took me about 4 months to get a heart scan and see the cardiologist. I also had back problems, and the doctor signed me up for pain management. About six months later, I returned to FL, and a couple months after that, I got a call from Alberta Healthcare saying they were ready for me to start my pain management (don't know how they got my FL telephone number). A co-worker's mother had a steel rod in her spine that snapped, leaving her humped over in terrible pain. It took her 1.5 years to get into pain management, which immediately (finally) solved her pain. The main hospital in Edmonton was overcrowded, had roof leaks that impacted their operating rooms, and long waiting lists (which were jumped by people with the right connections). Wealthy Canadians went to the U.S. to get treated. And free healthcare isn't free--income taxes were about double, to pay for it.

Yup. Similar things happen in the UK... Many patients simply give up and come to the US for care...

[ndf888]

Originally Posted by snbrafford

I worked for a BCBS company. Hospitals, doctors, pharmacies routinely would threaten to drop their acceptance around contract renewal time as a negotiation method to improve the items mentioned - payment amounts, service, payment time, etc. Few providers can afford to drop the large carriers like Humana, BCBS, or United.
Next time you get an explanation of benefits from your insurance - look at the great difference between what the provider billed and what the insurance company paid (based on contract with the provider). If you did not have insurance, you most likely would be paying what the provider billed.
Medicare drives a lot the entire process but the insurance companies stand between us and Medicare (assuming you are in a MA plan). The insurance companies are held hostage to Medicare paying their claims too in a timely manner.

Actually health systems starting to drop some large carriers. Recently, the UF Health informed us that they are no longer part of the United Healthcare network starting this September. And we have a supplemental insurance through my employer. Not an advantage plan.

[ndf888]

Originally Posted by gatorbill1

You cannot be dropped from Advantage plan - same as Original Medicare

Correct. But your health provider can “drop” your insurance carrier. It happened to us this year with Shands and United Healthcare (which we had through my employer). Shands sent us a letter explaining that they would still be considered as an “in-network” provider for the duration of the treatment. Whatever that means. We are switching to a different plan next year.

[golfing eagles]

Originally Posted by jimjamuser

All this stated confusion naturally brings up the question of National Health Insurance. Is the system used by Canada, Australia, and all other 1st world countries (except the US) superior to the US's confused and inefficient system? Answer, yes they get better care at lower cost. Ask the Canadians why they are afraid to get sick while in the US.

Couldn't be more wrong. Their cost is slightly lower, but their tax rate is higher. The main cost savings is essentially "rationing" of healthcare both by denying certain services such as dialysis or ICU care in terminal cases and long waits for surgeries where the patient may die before any $$$ is spent. That may work in a society that is basically ethnically homogenous such as Sweden, but with the diverse population in the US someone will scream "discrimination", not to mention we have 10 times as many lawyers per capita to force that issue. And "better" care????? That's the biggest misperception going. Why is it that Canadians who are financially able flock to the US for health care when they have a significant illness? Also, where do those who can afford it around the world come for quality health care---Boston, NY, or Luxembourg???? And don't even bother countering with those bogus WHO statistics on life expectancy---those numbers are all skewed by the different criteria we have for reporting infant mortality vs. the rest of the world. But if anyone wants to travel to Zimbabwe for their medical care, it's a free country, go for it.

[Janie123]

Originally Posted by gatorbill1

None in florida - who cares - Advantage is growing in number of enrollees

Mayo Clinic in Jacksonville does not accept any Advantage… Moffit dropped Florida Blue Advantage, two of the best cancer hospitals in the state.

[Janie123]

Originally Posted by gatorbill1

You cannot be dropped from Advantage plan - same as Original Medicare

No but the hospital can stop accepting Advantage… I.e. Mayo Clinic and Moffit.

[Janie123]

Originally Posted by jimjamuser

All this stated confusion naturally brings up the question of National Health Insurance. Is the system used by Canada, Australia, and all other 1st world countries (except the US) superior to the US's confused and inefficient system? Answer, yes they get better care at lower cost. Ask the Canadians why they are afraid to get sick while in the US.

wrong… talked to a customer of mine once in Canada that was shocked I had my knee replaced at age 55. His mom at age 75 is on the waiting list at the time for 2 years. Hospitals in CA only do X amount of knees annually. He said it seemed like they are waiting for her to die. Another doctor I met while traveling who does knees said his brother was on the list. He would do his brother tomorrow but it was not allowed. UK is the same way. Many Canadians come to the US and pay out of pocket instead of waiting years.

[Arlington2]

It looks like the Canadian medical system will only get worse. The leaders are turning to hard core DEI to solve medical personnel shortages.

Doctors protest proposed DEI emphasis in Canadian medical school training - Do No Harm

Canada’s DEI doctors | The Spectator

[Justputt]

Originally Posted by jimjamuser

All this stated confusion naturally brings up the question of National Health Insurance. Is the system used by Canada, Australia, and all other 1st world countries (except the US) superior to the US's confused and inefficient system? Answer, yes they get better care at lower cost. Ask the Canadians why they are afraid to get sick while in the US.

Better care, no! Had a friend of a friend I met in Canada that worked as a Superintendent for CP rail. He developed a brain tumor, needed an MRI. All of BC had fewer MRIs than we had in Wichita Falls, TX and they couldn't get him in for 6 months, which he probably wouldn't have lived to make. The friend is a radiologist, few him to Texoma, did the MRI, read the MRI and sent him back with everything. Another doctor I knew in MS was trained in England. What both have said is their national health systems do well with acute care, but other than that they're pretty bad. They do have boards that basically ratio care by limiting availability, who gets it, and it is also why wealthier people in Great Britian can still carry private insurance to get care. Health/Death Boards are real.

[CoachKandSportsguy]

Coach K's hospital does frequently turn down medical insurance companies price negotiations. If that is the case, one is notified and told if they want to remain in their system, they need to find an acceptable insurance provider. They have turned down United Health, a well run mafioso organization, and one other local insurer more recently.

It will happen more and more as the insurance profit growth model collides with the hospital population / medicare reimbursements, and current cash flow needs. Hospitals aren't in business to operate with negative cash flow. However, if you want to make the case that hospital management pay relative to customer facing (physician) pay is out of line, then one has a different gripe about legal reporting requirements, legal suit prevention and the costs associated with continuously improving patient experiences and outcomes, mandated by CMS, and reimbursed by CMS, along with the cost of procuring and maintaining EMR, electronic medical records systems. EMRs require constant maintenance for ever changing regulatory filing requirements.

[Justputt]

Originally Posted by ndf888

Actually health systems starting to drop some large carriers. Recently, the UF Health informed us that they are no longer part of the United Healthcare network starting this September. And we have a supplemental insurance through my employer. Not an advantage plan.

Not entirely accurate. According to the Medicare/Advantage adviser I use, Crystal (Sphere Coverage Solutions Inc.), that was only for the Saint John's County area.

[Justputt]

Originally Posted by CoachKandSportsguy

Coach K's hospital does frequently turn down medical insurance companies price negotiations. If that is the case, one is notified and told if they want to remain in their system, they need to find an acceptable insurance provider. They have turned down United Health, a well run mafioso organization, and one other local insurer more recently.

It will happen more and more as the insurance profit growth model collides with the hospital population / medicare reimbursements, and current cash flow needs. Hospitals aren't in business to operate with negative cash flow. However, if you want to make the case that hospital management pay relative to customer facing (physician) pay is out of line, then one has a different gripe about legal reporting requirements, legal suit prevention and the costs associated with continuously improving patient experiences and outcomes, mandated by CMS, and reimbursed by CMS, along with the cost of procuring and maintaining EMR, electronic medical records systems. EMRs require constant maintenance for ever changing regulatory filing requirements.

The hospital I retired from late Spring was grossing more money than ever but was still losing money each month in large part to nationwide workforce shortages and having to pay travelers 3x normal pay. Salaries at every hospital I've work have lagged behind real inflation for decades, and I was one of those higher paid people! For the past 13 years, a good raise was 2%. It's been so bad; the hospital has had to make bulk salary adjustments to keep from bleeding people because they can make more going elsewhere. The last person I hired to help me started out of graduate school at what it took me 30 years to earn. Healthcare staff shortages are very real and VERY COSTLY!