Posted on 01/10/2014 8:28:06 AM PST by justlittleoleme
The Question: I've had pain in my right knee for more than a year. After waiting five months, I had an MRI which showed two ligament tears. The specialist cannot see me for months. I have to work and care for my two children under age 10. The anti-inflammatory pills do not help, and my leg is so swollen I can hardly walk. What is my right to be treated?
The Answer: It's frustrating: You've paid into medicare for years and it's not available when you need it. Rationing and waits are endemic to our public health-care system, but that's cold comfort for you now. Across Canada, it can take months just to see an orthopaedic surgeon and more months before the operation. Hip and knee replacements have shorter waits because they have a higher priority with governments.
(Excerpt) Read more at theglobeandmail.com ...
Fear not, if your over 75 Obamacare wants you gone.
Yes, it is a rule just started Oct 1, and hospitals are now having to deal with this. Basically, there is guidelines established by a company called Milliman. The hospital reviews the patient’s signs and symptoms with Milliman guidelines, and the patient gets categorized as observation or inpatient. If you are in the hospital less than 2 midnights, you can also be categorized as observation. Observation status means more out of pocket expense for the patient. Medicare pays less, and you do not qualify for nursing home or rehab placement. This is one of the subtle ways funding for Medicare has decreased. If you hospital participates in Medicare- as they all do- then they have to apply the same rules to private pay health insurance. Thats right- the private BCBS policy follows Medicare rules. Any law pertaining to Medicare also applies to everyone else.
I really appreciate you taking the time to explain this. My poor mother is now planning a future heist of her body from the hospital.
If you are white.
bfl
I’m on Medicare and sent this article to all of my kids last summer when I first heard about it.
Astonishing.
Thanks. I forwarded the link to her. I hate that they have never spent a dime on themselves because they think we will be allowed to inherit it. I know she is thinking she’d rather suffer than “take” the money from the grandkids.
“I hate that they have never spent a dime on themselves —”
They will do what they want to do-—if they are anything like me.:-)
.
You people are so stubborn! Take a vacation, buy a dishwasher. What do you think I work for?
-Your daughter (I become you more every year:)
Welcome to Death Panels
Welcome to socialist rationing aka universal health care.
It was a sneaky way to insert Medicare cuts without people really understanding why.The new rules are complicated. The thing that really astounds me, is that every insurance has to follow the same rules because Medicare made a rule that if a hospital accepts Medicare, they have to apply the same rule to everyone. People who are on private BCBS, Aetna, etc. are also under this rule. My advice- if you get admitted to a hospital, ask them what your status is. if you cannot get an answer- demand ( or close friend or relative) that you talk to a utilization review nurse with either your hospital or insurance company. I think the reason why it is coming out now is it takes about 3 months for Medicare to process a claim, and people are now geting sticker shock at the higher prices they are paying. The new rule came into effect Oct 1. I work UR, so that is why I responded to your post.
I’m glad they passed ACA to prevent the tragedy of medical bankruptcies. Do you know if this was a provision of ACA? No one I know knows this about denial of coverage due to status. This is going to be a huge issue. People of all ages are admitted for “evaluation” after they walk in claiming chest pains.
We always categorized patients as inpatient or observation, but on Oct 1 they really tightened up the rules.Now, in a lot of cases- you have to be in the hospital for 2 midnights before you can be considered inpatient. it was a Medicare rule, but I suspect the ACA has something to do with it. When you have more patients under observation, they have to pay more and possibly default on their bills. The hospitals will have a harder time getting paid because the patients don’t have money. This is going to be a huge issue as more and more people find out about this. Chest pain without evidence of a MI is observation.
What a mess. From the hospital’s point of view, you don’t want to throw them on inpatient status because of readmits. But you know you could be bankrupting your facility if you keep them on observe. A hospital job used to be the safest bet there was, but I can imagine the pressure inside of them to do more with less now. Everywhere in healthcare is the same right now. Best wishes for your sanity.
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