Posts Tagged ‘Insurance fraud’

  • Rambling

   I really do put a lot of work into trying to put a factual face on what is going on. I even have two books on economics, one from each of the two different ideologies of how an economy should work. Totally confusing, by the way. One of Jim Mahon’s degrees gives him insight into this area and he got me the books. I do have the text of HR 3590, the Affordable Care Act on my desktop; refer to it all the time. I read and study different areas, and have for some time now, so I can try and understand from an informed place. There is a lot of myth out there that has been planted by, well big business. I was just talking to a good friend who accused me of always bashing big business. She stated as long as big business was making money she does ok. So as she said, big business needs to be healthy, but the middle class also needs to be healthy, and a dime or two in the pocketbook, is what makes big business healthy. Henry Ford created the middle class. He did this by paying his factory workers three times more than anyone else. By doing so he made his workers able to afford his cars.  At first he was called a traitor by big business, but then they saw that if there was a huge population that could afford to spend on items other than the basics, they made more money, way more than the cost of the wage increase. They also saw Henry getting very rich, so that helped. We have gotten away from this, and we are now driven by the quick profit. Companies are only dedicated to their shareholders, not their customers. We do this with minimum wage jobs, shipping jobs overseas where taxes and wages are less demanding, and the middle class is slipping away. Now this only works if unions are disabled so they cannot collectively bargain for wages, and if profits are made by using third world labor and positioning a company so as not to pay a lot of U.S. taxes. So companies have big profits, but you and me, not so much, and the federal, and yes, state governments go into debt because the revenue from big business just is not there anymore. So they feed you this bullshit about socialism and entitlements and how you and I need to tighten our belts and leave them the hell alone.  Now it used to be that as long as big business thrived you and I did ok, but the jobs the companies created were here in the U.S. being done by you and me. And even if your job was not union, a company had to compete for the best workers so had to pay a man or women well above minimum wage to attract that person. But today that is not the norm. Also, thanks to Wall Street and big banks playing with our money and lying to us about it for profit, there is a huge workforce out there desperate for any job, so again, you work two jobs if you can get it, because one puts food and maybe pays some utilities, the other puts a roof over your head, if your lucky. For those of us trying to secure the higher paying jobs, big banks are charging so much for student loans that people with degrees and an education are at risk when they retire because they are still saddled with a huge debt they still have not paid off, so must work up until the day they expire. I have found a huge portion of our mid level executives who say they will be in this fix at retirement age.  In order to afford an education at a good college, they are saddled with immense debt. Student loans are charged out at exorbitant rates, with very little oversight. So yes, they have better paying jobs, but they have less freedom than you might think. And yes I think big business has bought politics, and you and I are not represented. It is not a government by the people anymore, and it does not matter what party you are in.

I have also been allowed to read several so called less expensive insurance policies, if it was less money it was a whole lot of “less” coverage. Actually they all cut you off with severe limits if you had anything other than a small accident, and that accident had better not be too severe. Your friends, if you actually read their policies, will have severe limitations. They will have caps on hospital stays, money, testing, and what operations you are allowed to have. So basically if you stay healthy, they will be glad to help pay for a few Doc visits and take your money, since they are making a profit off of you.  But if you get sick, you get dumped faster than a rattlesnake in a baby carriage. So minimums were set for care, and maximum profits based on how much we pay the company as a collective whole under the Affordable Care Act.  So the health care industry started pouring billions into the rumor mill and the political machines to defeat the very idea.

So my dilemma is that Obamacare is too unwieldy and has some severe drawbacks, but the premise of Obamacare is not such a bad idea. And the socialism thing, big business starts banging that drum whenever anyone tries to exercise any control over their actions, no matter how outrageous they get. Wall street and the current banking systems are prime examples. They have finagled their way into being able to use our money, which means your savings, retirement accounts, even your checking, and gamble with it on Wall Street. That is why banks can fail, and this used to be illegal and for good reason. I could go on and on.In closing, Capitalism is great, but for you and me, a healthy middle class is needed. And I am sorry, the way to do that is exactly how we did it in the past, and yes it was called socialism then also. Look, big business is making more profit now than anytime in history, so if they cry, it is just more of that same bullshit I mentioned before. If you want to see how it works today, go to Detroit and drive around for a couple of hours. If you survive, you will see what todays agenda gets you. Look, I am not oblivious to the fact that we need to pay down the deficit and the debt. It has to be done. But you get our businesses paying taxes here in the U.S., wages being paid here, which also increases the tax base, and enough so we can spend on “stuff”, and that in combination with closing loopholes and austerity is the way to go. Austerity alone simply punishes those of us who are already strapped. Don’t get me started on Social Security. That is the only system, when left alone that pays for itself and adds nothing to the debt. It would have also stayed equal to the task if politicians had not stripped trillions out of it, and then when it came time to pay the piper they want the very people they stole it from to pay it back. So how is that fair or an entitlement, and how is it socialism to tell them to go suck on a rock! Most of you will know this, but your employer also matched your contribution to the Social Security fund. When they figure out how much you contributed that amount is ignored.

Oh, and bye the way, if China loves it, it stinks for you and me, guaranteed! Not sure if that statement fits the conversation, but true nonetheless, and made me feel good. 

Now usually I know whom I am going to get a response from. I also have several followers, even from foreign countries, but my friends here and in Idaho are my primary targets. So I will post on Facebook, and will email this. If you bother to read it, and disagree, as I know almost everyone in Idaho will, give me hell. I will respond and I will not be disrespectful. If you can educate me, have at it. Jim Mahon and I are great friends, best friends as a matter of fact, but we have to agree to disagree all the time. But I have learned much from the experience, and I hope, so has he.

Bye the way, one of my followers is in grade school in Eastern Europe and knows more about American politics than most of us!

How do you Know if a Politician is Lying

You can Hear them Talking

Obamacare’s critics are going to town on the cancellation letters millions of Americans are receiving from their health insurers, informing them that their health plans won’t conform to the new federal standards for health coverage as of Jan. 1.

We’re supposed to be scandalized by this, since President Obama himself assured everyone that if they liked their insurance they’d be able to keep it. And people just love plans that in some cases cost just $50 a month. At that price, what’s not to love?

Back in March, Consumer Reports published a study of many of these plans and placed them in a special category: “junk health insurance.” Some plans, the magazine declared, may be worse than none at all.

Consumer Reports is right. Plans with monthly premiums in the two figures marketed to customers in their 30s, 40s, or even 50s invariably impose ridiculously low coverage limits. They’ve typically been pitched to people who couldn’t find affordable insurance because of their age or preexisting conditions, or who were so financially strapped that they were lured by the cheap upfront cost.

“People buy a plan that’s terrible,” says Nancy Metcalf, Consumer Reports senior project editor for health, “and if they get sick, they don’t even know they don’t have insurance.”

An example from CR: A plan costing $65 a month held by Judith Goss, 48, a Michigan department store employee. When Goss was diagnosed with breast cancer, she discovered the drawbacks of the policy’s coverage limits of $1,000 a year for outpatient treatment and $2,000 for hospitalization — barely enough to cover a day and half and a Tylenol in the hospital. She delayed treatment, so her cancer got much worse before she finally opted for surgery. Those sorts of coverage limits are illegal come Jan. 1.

Many of the supposedly bereft insurance customers being paraded before viewers of network and cable news — and dredged up by House Republicans during the theatrical grilling of Health and Human Services Secretary Kathleen Sebelius — fall into this junk category. The news reporters never seem to lay out the benefits actually provided by these low-premium policies their subjects supposedly love, or their steep back-end costs if they actually get sick.

Consider the case of Diane Barrette, the 56-year-old Florida woman whose cancellation horror story was reported by a credulous CBS News and picked up by Fox News, which has been a one-stop shop for your Obamacare misinformation needs. Consumer Reports examined Barrette’s Blue Cross Blue Shield policy and made two discoveries: how junky it really is, and how badly her insurer may have misled her about her options. Barrette’s $54 monthly premium bought her almost nothing. The policy pays $50 per office visit (which can run two or three times that) and $15 per prescription (which can run to thousands of dollars a month); above that she’s on her own. Nothing for a colonoscopy. Nothing for mental health treatment. Up to $50 for hospital and ER services — and that only if her treatment is for “complications of pregnancy.” Nothing for outpatient services. Plus Barrette is not of an age where pregnancy is going to be an issue, so basically there was no coverage. This is one of the cases Fox news paraded before us as a “horror” story of lost insurance the customer loved and wanted to keep. Might have just as well cuddled up in bed with a timber rattler.

“She’s paying $650 a year to be uninsured,” said an insurance expert Consumer Reports Nancy Metcalf consulted. If she ever had a serious medical problem, “she would have lost the house she’s sitting in.”

As for the replacement plan her insurer offered, at a shocking $591 a month? Barrette has much better options via the government insurance exchange. Metcalf estimated that she’ll be eligible for “real insurance that covers all essential health benefits” for as little as $165 a month — a higher premium than she’s paying now, sure, but one that won’t cost her her home.

That raises the question of whether the insurers sending out these cancellation notices are trying to cheat their customers, expecting insurance companies to play fair with their customers is as pointless as expecting dogs not to drink from the toilet, but what’s the excuse of the reporters who retail these yarns without fully checking them out? You know how I feel  about that!

It’s time to tamp down the breathless indignation about these health plan cancellations. Many of the departing plans are being outlawed for good reason, and many of the customers losing them have no idea how much financial exposure they were saddled with in the old days. That’s the real scandal in American health insurance, and Obamacare is designed, rightly, to fix it. Look, I personally know people who have, and have had these junk insurance policies. This article and what I wrote here is the truth, they are not only junk, but they put your property and home in danger. Hospitals do go after everything you owe of value if you cannot pay. I know a nice lady, had a stroke, luckily she rehabbed nicely, no thanks to her insurance. Turned out it paid for nothing. The hospital attached her home. Luckily for her, she has three sons who were able to sell the paid for home and with the proceeds pay off the hospital and get her the rehab she needed. They then pooled their money and bought back their mothers house. So now they are all three sharing a mortgage on a house that had been paid off years ago thanks to junk insurance. The fact that our politicians are still playing politics and not doing what is right for you and me should piss you off.

Michael Hiltzik posted the original article in the Los Angeles Times; I edited and added my own thoughts and points along the way.

Here in California you can use the national website, but we set up our own called Covered California. It also had some original glitches, which have been worked out. Mostly caused by the huge mass of people who attempted to access it on opening day. However California, instead of griping and complaining, has made an effort to make it work. You can compare what you have and what is covered with what is available and compare the cost. There are numbers to call with questions. I have heard no one complaining so far, even Fox is keeping its mouth shut, I guess they couldn’t find anyone willing to prevaricate for money in this case.  At least so far as I know!

Dear state Senator,
I believe there are war crimes being committed against citizens of the United States, and some of them by entities right here in the USA! I will give you an example of one such crime.
Civilians who work for companies in war zones in support of U.S. troops are guaranteed under the Defense Base Act of 1941 to be supplied medical and disability insurance. This supposes that the insurance company selected and paid premiums to will actually perform said services. This is not the case, and it is not the case for almost all Civilian casualties who work or worked for private contractors in combat areas in support of our troops. Case in point, a Spokane area woman who worked for what was then called Blackwater as a helicopter mechanic was wounded with other soldiers and civilian workers when a mortar exploded just yards from where she was standing. She suffers from traumatic brain injury; the therapy which was recommended by eight different physicians and psychiatrists was denied her. The denial was based on one man’s opinion, a Doctor who was selected by the insurance company, Chartis WorldSource, he decided she was experiencing all of this pain, tremors, migraines, seizures, memory loss, and problems with her balance all in her head and that there was no physical trauma! He made this decision without ever examining this poor women. You and I both know he came to the conclusion he was paid to come to. A nurse was also hired by Chartis to go and evaluate the patient. She met with the patient six times; her report was the same as the other eight professionals before her, which was that this condition was from physical damage, not a mental or psychiatric one. She was terminated and her report was not used! From what I have been able to determine, this kind of rampant disregard is the status quo, not the isolated incident.
The War Hazards Compensation Act reimburses the employer or insurer for injuries or death to a worker caused by an act of war. The federal government has paid more to insurers for expenses than they have paid out in compensation under this act. So not do they only get paid back for their expenses, insurance companies have collected 1.5 billion in premiums while only paying out 900 million in compensation and expenses combined. This is according to a congressional investigation that took place in 2009. So the government is aware of what is happening to these people, aware of the federal laws and Acts which pertain to this dilemma. So my question is, do you not think that this represents a war crime perpetrated on a citizen of the these United States, and furthermore, does your inaction to force these companies to adhere to the letter as well as the intent of what they were paid to do makes you complicit. The profits are staggering, and all paid by you and me, so an even greater crime in my book, a crime you are partially responsible for as the person who is supposed to be looking out for me and those of us who cannot fight big companies or big government, which is a description of your job.
I would appreciate a response detailing just what you have done or are going to do to help this woman and those like her. I would appreciate a real response, not the canned variety I have gotten in the past. This is something you need to put your hands on, it is shameful. It is exactly the same tactic the Veterans Administration and the military tried when this type of injury first started to be prevalent among our fighting men and women. The only reason they finally changed directions and started to give some help was because families hocked their futures to get private care which in almost all cases vastly improved the lives of the individuals involved and shamed the Veterans Administration to stop telling the lie and start actually helping the people they were supposedly sworn to help.

Information from: The Spokesman-Review, http://www.spokesman.com
Also opinions formulated in my own mind, and in any mind that has an honest respect for the truth!

Respectfully,

John Love