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Letter from my Eye Doctor
email

Posted on 01/12/2010 6:49:24 AM PST by ml/nj

Dear Valued Patient:
 
This letter is to inform you that effective February 1, 2010, EyeCare 20/20 will now be billing separately for the refraction portion of the eye examination.
 
The refraction portion of the eye exam is performed to determine if glasses, or a change in your current spectacle correction, will provide the best vision possible. A written prescription is given if this would be helpful in improving the patient's visual acuity level. Please be aware and informed that you may be refracted as part of the eye examination, and that most insurance plans, including Medicare, do not cover this portion of the examination. Our office fee for refraction is $30.00 and unless your plan automatically covers for the refraction charge, this fee is collected at the time of service in addition to any co-payment or deductible your plan may require. Should your plan pay us for the refraction, we will reimburse you accordingly. If you are currently seeing 20/20 with your present prescription, the refraction may not be required. You also have the right to decline the refraction at the time of your visit.
 
What is a Refraction, and why do we charge for it?
You may know the test as the one that will determine your need for glasses, this is so but it can also detect vision loss. Some of the time vision loss is slow and progressive and the patient may not notice, that is why we will check the patient's vision by refracting them. The test can also uncover other problems a patient may be unaware of.
 
Why is this charge separate from the exam?
Medicare has deemed that a refraction is not a medical service and therefore not a covered service. Medicare does acknowledge that this is separate to the rest of the eye exam and therefore there is a separate fee for this service. Most insurance companies have followed Medicare's lead and do not cover the refraction, because they consider the test to be "vision care" and unrelated to the office visit. For further explanation of refraction coverage under your insurance policy, please refer to your membership benefits contract or contact the customer service number for your insurance carrier. Medicare patients can contact Medicare directly at their toll-free number: 1-800-333-7586.
 
Do we have to charge for the refraction?
The answer is yes, especially for Medicare patients. The Office of the Inspector General has deemed that not charging for a provided service is a non-compliance. The Federal Government therefore insists that if an exam, procedure or test is performed, it must be charged for.
 
We thank you in advance for your understanding. We look forward to seeing you at your next scheduled appointment.
 
Best wishes for a happy and healthy 2010!
 
Cary M. Silverman, M.D. and the Staff of EyeCare 20/20

EyeCare 20/20- 46 Eagle Rock Avenue- East Hanover, NJ
 
 973-560-1500         www.eyecare2020.com



TOPICS: Government
KEYWORDS: healthcare
So the bottom line for me would seem to be that the cost to me of my annual eye exam will likely double. It's so wonderful to know that, "Medicare has deemed that a refraction is not a medical service and therefore not a covered service," or that this has anything to do with me. I have nothing to do with Medicare except to subsidize it.

ML/NJ

1 posted on 01/12/2010 6:49:24 AM PST by ml/nj
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To: ml/nj

I can see that this is only the beginning of the eye-opening changes coming under Obamacare.


2 posted on 01/12/2010 6:52:57 AM PST by O6ret
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To: ml/nj

Rationing is starting


3 posted on 01/12/2010 6:53:23 AM PST by Manta (Obama to issue executive order repealing laws of physics)
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To: ml/nj
Some of the time vision loss is slow and progressive and the patient may not notice, that is why we will check the patient's vision by refracting them.

I've heard it call 'screwing them', 'hustling them', 'f***ing them', 'boning them', and 'scamming them'.

I've never heard it called 'refracting them' before.

Huh.

4 posted on 01/12/2010 6:53:24 AM PST by Lazamataz (America has been dead for a while; It's interesting to watch the cadaver cool.)
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To: ml/nj
Medicare has deemed that a refraction is not a medical service and therefore not a covered service. Medicare does acknowledge that this is separate to the rest of the eye exam and therefore there is a separate fee for this service. Most insurance companies have followed Medicare's lead and do not cover the refraction, because they consider the test to be "vision care" and unrelated to the office visit.

Harbinger of the ultimate result of Obamacare.

5 posted on 01/12/2010 6:53:45 AM PST by Virginia Ridgerunner (Sarah Palin has crossed the Rubicon!)
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To: ml/nj

There are a number of businesses that sell glasses, that is, frames and lenses, that offer a free examination, the refraction, if you buy their glasses. Decline the exam from your doctor, if you need glasses, and wait until Sears, or Pearl Vision, or whatever, has a sale where the exam is included.


6 posted on 01/12/2010 6:55:17 AM PST by La Lydia
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To: Lazamataz

They’ve already been fracted once.


7 posted on 01/12/2010 6:56:09 AM PST by Sloth (Civil disobedience? I'm afraid only the uncivil kind is going to cut it this time.)
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To: ml/nj

Insanity, just plain insanity. Refraction is absolutely required for the optometrist or ophthalmologist to determine the precise correction you need. How can that NOT be a medical service?


8 posted on 01/12/2010 6:57:49 AM PST by savedbygrace (You are only leading if someone follows. Otherwise, you just wandered off... [Smokin' Joe])
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To: ml/nj

We’ve got good private insurance, and this is how they have always handled vision coverage. Nothing new, except that Medicare is apparently now handling these claims like the private firms do.


9 posted on 01/12/2010 6:58:57 AM PST by Jedidah
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To: ml/nj

Well, anybody could have seen THIS coming a mile away...

That said, I’ve never understood why vision problems are not covered as medical expenses.

After all..if I had a hand that WORKED, but did not work WELL, and the doctor could fix it, it would be covered.

Same goes for just about any other organ I can think of. A myopic eye is just another organ that isn’t functioning properly, isnt’ it? What is it about vision problems that cause them not to be covered as legitimate MEDICAL problems?

Regards,


10 posted on 01/12/2010 7:00:43 AM PST by VermiciousKnid (Grab your gun and bring in the cat.)
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To: savedbygrace

“Medical” vision coverage, as defined by our current Aetna plan and former Cigna plan, includes eye infections, diseases (glaucoma, retinal detachment, macular degeneration, corneal ulcers, etc.), and general eye health.

Measuring your visual acuity (your need for corrective lenses), known as “refraction,” has always been a separate part of the exam and billed separately by our private insurance.


11 posted on 01/12/2010 7:02:25 AM PST by Jedidah
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To: La Lydia

“There are a number of businesses that sell glasses, that is, frames and lenses, that offer a free examination,..”

...our local Wal-Mart does that....they have an optomitrst on duty and are much cheaper on frames and lenses...however now that I’m getting older I still like to have an experianced MD Opthomologist give me an exam every couple of years...I want to know the medical health of my eyes too...then I go over to WalMart for the glasses...just my two cents FWIW


12 posted on 01/12/2010 7:03:45 AM PST by STONEWALLS
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To: ml/nj
And on a related subject, I notice that the AARP offering of 'Medicare Complete' through Secure Horizons/United Healthcare which in 2009 was a $0 plan, is now available only after payment of a $25 per month premium - same name, new price: no information - just a book of payment coupons through the mail. If you want a $0 plan with them, a 'no prescription coverage' plan is listed on their website with a slight variation on the name.

So soon, so much profit to be made from gullible Medicared seniors, so many scams to be run.

If you have loved ones on an AARP plan, I suggest that you check whether they are being scammed in this way. Me, I moved to a Blue Cross Anthem Medicare Complete plan with $0 premium and prescription coverage.

13 posted on 01/12/2010 7:06:37 AM PST by I am Richard Brandon
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To: ml/nj

This is not new: my eye dr has had such a notice posted in the office for a while now.


14 posted on 01/12/2010 7:07:26 AM PST by Adder (Proudly ignoring Zero since 1-20-09! WTFU!)
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To: ml/nj

Refracting has never been a medical service. It is about vision correction. Refractions are performed by optometrists (Doctors of Optometry), who are not medical doctors and are not qualified to treat for cataracts, glaucoma, detached retina, etc. Optometrists do not perform laser surgery. All they do is examone for vision correction. If a medical condition is detected, they refer to an MD.

This is chicken feed. Quit whining.


15 posted on 01/12/2010 7:09:10 AM PST by Romulus (The Traditional Latin Mass is the real Youth Mass)
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To: Jedidah

Does your plan include any coverage for the cost of frames or lenses?


16 posted on 01/12/2010 7:09:26 AM PST by savedbygrace (You are only leading if someone follows. Otherwise, you just wandered off... [Smokin' Joe])
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To: ml/nj

You have to realize Medicare is under tremendous fiscal pressure because of reduced tax revenue and profligate federal spending. CMS (Medicare financing arm) will continue to cut around the edges. Eventually, they will have to cut out the essential services if 0bamacare becomes law. Wherever possible, the government will attempt to pass the blame off to insurance companies and providers.
But consider this. Suppose Medicare covered refraction services but only paid $10. Great. Not necessarily. In this case the provider would have to accept a price lower than the cost to deliver the service. Any non controlled prices would go up to make up the difference. If there is no place to shift the cost, the service will not be rendered or the provider will be forced to stop accepting payment from the insurance company or medical program (Medicare).
The only way to get rational prices is to expose patients to the costs. We could do this with tax exempt high deductible medical savings accounts in the private sector.


17 posted on 01/12/2010 7:11:25 AM PST by grumpygresh
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To: STONEWALLS
our local Wal-Mart does that....they have an optomitrst on duty and are much cheaper on frames and lenses...however now that I’m getting older I still like to have an experianced MD Opthomologist give me an exam every couple of years

The underlined part is what goes away under obamacare ... and because they're cheaper, the Walmart doctors will be third world.

18 posted on 01/12/2010 7:11:35 AM PST by tx_eggman (Obama has "Czars" because men with more integrity than he has still use the titles "Don" and "Capo")
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To: Jedidah

Same with our group insurance. Eye exams have never been covered, yet if you go with a problem (infection, injury to your eye, etc.) it is covered.


19 posted on 01/12/2010 7:12:42 AM PST by dawn53
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To: Romulus
Refracting has never been a medical service. It is about vision correction. Refractions are performed by optometrists (Doctors of Optometry), who are not medical doctors and are not qualified to treat for cataracts, glaucoma, detached retina, etc. Optometrists do not perform laser surgery. All they do is examone for vision correction. If a medical condition is detected, they refer to an MD.

This is chicken feed. Quit whining.

I have medical insurance and refraction, or any visit to an optometrist has never been covered. I've had 7 eye-related surgeries over 8 years. All those were covered. Just not refraction, frames or lenses. So, I would not say this is the beginning of Obamacare.

20 posted on 01/12/2010 7:15:00 AM PST by Sans-Culotte ( Pray for Obama- Psalm 109:8)
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To: La Lydia

You just pay for it is the cost of glasses. Do you really think you get something for free??? Advertising is an art form. Why should someone provide something for free???


21 posted on 01/12/2010 7:15:27 AM PST by therut
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To: STONEWALLS

I must not have made myself clear. That is what I was suggesting. Go to your opthamologist, get the medical exam, but decline the “refraction” so you don’t have to pay for it. Go wherever you want to buy the glasses to get “refracted.” My experience has been that the optometrist does a better job of getting my prescription right than the opthamologist.


22 posted on 01/12/2010 7:17:19 AM PST by La Lydia
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To: therut

This has been happening to physicians for years. Medicaid (not Medicare) would bundle a flu shot into an office vist if we gave a flu shot when we were seeing a patinet for a ear infection. Meaning we lost money giving the flu shot. So we had to inconvience our patients and tell them to come back at a different day for their flu shot so we could get payed. The.gov knows how to play the game.


23 posted on 01/12/2010 7:19:58 AM PST by therut
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To: therut

You did not understand my post, and have re-stated the obvious. Of course nothing is free. The POINT IS: you are going to spend money on glasses, and the business is HIGHLY COMPETITIVE. You can get a very reasonable deal on the refraction exam and the glasses. And, packaged that way, the exam is much less expensive that one performed by an opthamologist.


24 posted on 01/12/2010 7:24:02 AM PST by La Lydia
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To: ml/nj

Cheap Sunglasses
Artist(Band): ZZ Top

When you wake up in the morning and the light is hurt your head
The first thing you do when you get up out of bed
Is hit that streets a-runnin’ and try to beat the masses
And go get yourself some cheap sunglasses
Oh yeah, oh yeah, oh yeah

Spied a little thing and I followed her all night
In a funky fine levis and her sweater’s kind of tight
She had a west coast strut that was as sweet as molases
But what really knocked me out was her cheap sunglasses
Oh yeah, oh yeah, oh yeah

(solo)

Now go out and get yourself some big black frames
With the glass so dark thay won’t even know your name
And the choice is up to you cause they come in two classes:
Rhinestone shades or cheap sunglasses
Oh yeah, oh yeah, oh yeah


25 posted on 01/12/2010 7:26:42 AM PST by Red Badger (Obama - The first ever elected lame duck..............)
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To: STONEWALLS

Refraction has been a separate billed portion of the ophthalmologist’s medical exam for several years...This is one example of the “rationing” that has slipped in gradually with little or no fanfare...however one thing to realize, before opting out of your ophthalmologist refracting your vision, realize that most ophthalmologists are not in the business to sell eyeglasses..just medical evaluation and total eye care and if you don’t need eyeglasses, you don’t need them..BUT an eyeglass retail business offering “free exam” they ultimately want to sell you expensive eye glasses...Being in ophthalmology, I have seen many patients come into the office with glasses bought at a retail establishment perhaps with the “free exam” The lenses are plano ( plain glass or very very minimal correction) and thus the patient probably really didn’t require them...also, who is doing the refraction???? Just something to keep in mind....


26 posted on 01/12/2010 7:26:43 AM PST by BeeSkip
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To: Lazamataz
I feel so 'refracted'.

Has a nice ring, huh?

27 posted on 01/12/2010 7:29:43 AM PST by Don Carlos (I stood my watch. MSgt, USAF (Ret))
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To: ml/nj

Nothing new. Trips to the optometrist for vision exams (refraction) have generally never been covered by insurance. Maybe a few of those union-negotiated Cadillac plans cover it but, in my experience w/ a handful of employer provided plans, I’ve never had a refraction covered by insurance.

I am curious about your experience w/ health plans that do/did cover refraction. Do fill us in.


28 posted on 01/12/2010 7:29:45 AM PST by elli1
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To: La Lydia
If anybody just wants to buy glasses, get your "pupillary distance" and give a shot to Zenni Optical online.

We discovered them last year, and the product is top quality and unbelievably priced.....Just Saturday I got a pair of progressive bifocals with bendable titanium frames and the 'Transitions' (darkem-lightem) feature - $72.00.

29 posted on 01/12/2010 7:29:51 AM PST by ErnBatavia (It's not the Obama Administration....it's the "Obama Regime".)
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To: STONEWALLS
...then I go over to WalMart for the glasses

Give a study to Zenni Optical - online. Top quality, unbelievable prices. Just be sure and get your 'pupillary distance' from an eyecare person.

30 posted on 01/12/2010 7:32:06 AM PST by ErnBatavia (It's not the Obama Administration....it's the "Obama Regime".)
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To: Don Carlos

Personally, I feel outright fract.


31 posted on 01/12/2010 7:34:46 AM PST by Lazamataz (America has been dead for a while; It's interesting to watch the cadaver cool.)
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Medicare is already rationing.

I know an elderly woman scheduled for knee transplant and Medicare denied a bone density test scheduled before the surgery because she was ‘too old’. The surgeon won’t do the surgery without the bone density test to determine the health of the underlying bone.

She is in shock about the government denying her coverage. I told her to get used to it and you are welcome for voting for Obama.


32 posted on 01/12/2010 7:35:46 AM PST by WaterBoard
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To: ml/nj

FWIW, I am on Medicare, saw my eye Dr. in Dec and he charged $20 for this.


33 posted on 01/12/2010 7:41:22 AM PST by upchuck (The horse is in the pasture. The barn door is wide-open. Obama wants to know who made the hinges.)
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To: ml/nj
I am a certified coder of medical claims. The truth is that your optometrist has been giving you a "free" service for years. Refractory is ALWAYS to be billed seperately, and if they haven't been doing so, they have been billing incorrectly.
34 posted on 01/12/2010 7:41:40 AM PST by codercpc
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To: Lazamataz

Fract Obamacare.


35 posted on 01/12/2010 7:46:51 AM PST by Don Carlos (I stood my watch. MSgt, USAF (Ret))
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To: ml/nj
A number of specialists in our area are not going to be accepting medicare patients any longer.

And so it begins.

See you all at carousel!

36 posted on 01/12/2010 7:49:13 AM PST by ImpBill ("America ... where are you now?" signed, a little "r" republican!)
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To: Romulus
Refracting has never been a medical service. It is about vision correction.

I suppose having ones blood pressure checked isn't a "medical service" either.

ML/NJ

37 posted on 01/12/2010 8:09:12 AM PST by ml/nj
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To: ImpBill

We will never have rational prices without patient exposure. What we have now with Medical programs and 3rd party insurances is government fiat pricing, the hallmark of a command economy.


38 posted on 01/12/2010 8:10:14 AM PST by grumpygresh
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To: elli1
I am curious about your experience w/ health plans that do/did cover refraction. Do fill us in.

I have some Aetna plan through my wife's employer and our thousands of dollars taken out of her paycheck.

But this isn't about insurance, I don't think. The doctor is using Medicare as an excuse to begin charging for something that has ALWAYS been included in EVERY eye exam I've ever had. It is as if your GP were to start charging you to check your blood pressure.

ML/NJ

39 posted on 01/12/2010 8:14:41 AM PST by ml/nj
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To: ml/nj

My mother, who is on medicare, recently had an eye exam and she had to pay $20. Now I know why.


40 posted on 01/12/2010 8:18:37 AM PST by cajuncow
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To: Lazamataz
Ahhh, Lazz, the breadth and depth of your experience in this life is a constant source of amazement (and amusement!) to me! I'm always glad you share this stuff with us!

CA....

41 posted on 01/12/2010 9:02:29 AM PST by Chances Are (Whew! Seems I've found that silly grin again!)
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To: Lazamataz

I’ve been refracted a thousand times.......


42 posted on 01/12/2010 9:07:16 AM PST by Osage Orange (Life, Liberty and the Pursuit of Anyone Who Threatens It)
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To: savedbygrace

The medical insurance only pays for medical issues related to the eyes, not for vision correction. The separate plan for vision insurance (which is optional, you can buy it or opt out) pays for an exam and a reasonable allowance for glasses (frames and lenses) or contacts once per year.

We have always bought the vision plan because the entire family is myopic and all wear glasses and contacts, so it saves us money.

The medical plan pays for eye infections, etc., and for a yearly check on the mole on my cornea. But if I want them to do a refraction and give me an Rx for glasses/contacts while I’m in the chair, it’s a separate charge, filed on a different plan.

Always has been that way.


43 posted on 01/12/2010 11:14:29 AM PST by Jedidah
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To: ml/nj

But an important medical service like Viagra is covered.


44 posted on 01/12/2010 11:19:08 AM PST by <1/1,000,000th%
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To: Jedidah

I understand.


45 posted on 01/12/2010 11:58:37 AM PST by savedbygrace (You are only leading if someone follows. Otherwise, you just wandered off... [Smokin' Joe])
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To: grumpygresh
Agree. And we must end the practice of mandatory Medicare and stop the National Heath Care from coming about.

Age 65 is approaching for me and I have checked with a number of private insurers to purchase a primary health plan of our own and none of them want to be our primary insurer.

Congress passed a law and Bill Clinton signed it making it mandatory for Medicare to be the primary insurer and private policies secondary.

I am able and quite willing to pay for a private plan as primary insurer and yet the Government won't let me.

What's a responsible person to do?

46 posted on 01/12/2010 1:51:21 PM PST by ImpBill ("America ... where are you now?" signed, a little "r" republican!)
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To: ImpBill

Assuming 0bamacare becomes a reality, the most practical solution for the individual near term will be off shore. Of course, this will not be practical for office visits and minor procedures, but it could become a real option for expensive procedures especially if waiting times increase as in the UK and Canada. Centers of excellence will arise in places like the Caymans, Costa Rica if 0bamacare really takes root. Indeed, many seniors enjoy retiring offshore because of tax advantages and lower costs of living.
The other approach is to act at the state level by contesting and destroying this legislation on a constitutional basis.


47 posted on 01/12/2010 2:43:56 PM PST by grumpygresh
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To: grumpygresh
We are certainly in agreement.

I live on the Mexican border here in Southern Texas and already know of a number of Americans using some of the medical assets across the border. These providers have started and grown their businesses primarily for the north of the border patient and dollar. The problem of course is the rampant crime and security in Mexican border towns for both US and Mexican citizens.

The good news is that at my age, what ever takes place, it will only affect me for a relatively short period of time. My biggest concerns are for my children and grand children.

48 posted on 01/12/2010 2:56:23 PM PST by ImpBill ("America ... where are you now?" signed, a little "r" republican!)
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To: ml/nj

It costs $30 to fill a tank of gas for your car...I honestly don’t know why people can’t pay for their own damn eye examinations. Why must Medicare pay for every single thing? If someone comes up with a good explanation for me, I’ll apologize and admit I was wrong.


49 posted on 01/12/2010 6:51:43 PM PST by Hildy (This Christmas, the Democrats have given America the one gift that keeps on taking.)
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