Costs & Insurance

Untangling the Dysfunction in Insurance Coverage

Ann Bartlett Health Guide August 01, 2012
  • Patients feel that health care should be altruistic, but doctors and hospitals need to run a business. These are vastly different opinions, so what’s the solution?   As patients, we pay into a dysfunctional system. The health insurance business is about risk management and so how much will...

2 Comments
  • Dr. Bill Quick
    Health Pro
    Aug. 01, 2012

    Ann, all:

     

    I am on an insulin pump, and recently started Medicare Parts A, B, and D coverage. According to Medicare, my insulin & pump supplies should be covered under Part B ---see 

    http://www.medicarenhic.com/dme/medical_review/mr_lcds/mr_lcd_current/L5044_2011-02-04_PA_2009-01.pdf for the grim details of all the hoops you have to jump...

    RHMLucky777

    Read More

    Ann, all:

     

    I am on an insulin pump, and recently started Medicare Parts A, B, and D coverage. According to Medicare, my insulin & pump supplies should be covered under Part B ---see 

    http://www.medicarenhic.com/dme/medical_review/mr_lcds/mr_lcd_current/L5044_2011-02-04_PA_2009-01.pdf for the grim details of all the hoops you have to jump through. My physician, pharmacy and myself have been submitting paperwork, getting denied, filing appeals...

     

    But you'd never know that insulin for use in a pump may be covered if using a pump and meeting all their other rules, if you read only the "Medicare Summary Notice" that I just received. Coverage for my insulin (officially described on the form as "100.0 Insulin for insulin pump use (J1817-KX)" was denied, with a definitive-sounding but erroneous comment that "Medicare does not pay for this item or service." Since there's no qualifier -- it should have read "Medicare does not pay for this item or service unless you are on a pump and meet certain criteria" -- I count the statement in the Notice as a lie.

  • Gretchen Becker
    Health Guide
    Aug. 02, 2012

    An editorial blog I follow recently had a post about the problems of professional editors trying to compete with offshore editors who can charge very low rates despite poor English skills. This blog attracted zillions of comments.

     

    Some were by young writers who said, "Why should I pay for an editor when my friends and English professors will do it for...

    RHMLucky777

    Read More

    An editorial blog I follow recently had a post about the problems of professional editors trying to compete with offshore editors who can charge very low rates despite poor English skills. This blog attracted zillions of comments.

     

    Some were by young writers who said, "Why should I pay for an editor when my friends and English professors will do it for free?"

     

    Perhaps medical professionals should be reminded that if their services become so expensive that many patients can't afford them, the patients will be driven to get their medical information "for free" from friends and Internet sources.

     

    Yes, peers and Internet sources can be invaluable in providing background information that physicians don't have time to discuss or tips on dealing with living with diabetes 24/7 that no one who doesn't have diabetes can fully understand. But only a physician can prescribe drugs and give certain types of advice.

     

    If a patient goes to a doctor and comes away with $150 of unexpected add-on charges, that patient may skip the next appointment. Without support, they're going to have poor A1cs, which will lead to complications in the long run.

     

    Is this what we want?