So move to Canada already, you whiny bitch!
wrote in message news:3urs3iF127uchU1@individual.net...
> In article <11nvh2ucedouj34@corp.supernews.com>,
> Vic Vega wrote:
> > wrote in message
news:3s2bsjFlsjqiU1@individual.net...
> >> Only 1% of those "slaves" in Canada say they would rather have the
> >> plainly stupid American system.
> >>
> >I assume those are the one percent who can afford to come to the U.S. for
> >surgeries instead of waiting months or years on a waiting list in Canada.
> >
>
> When you assume you just make an ass of yourself. Every Canadian usenet
post
> I've read says that they do not have to wait a long time for important
things.
> I personally had to wait 2 months in Texas for the same medical procedure
> somebody in Ontario only had to wait 3 days for. The American health care
> system is a piece of shit even for people lucky enough to have insurance.
(In
> my state of Texas 1/4 of the population does not). Americans have a
limited
> choice of doctors approved by our crummy little PPO or HMO, if you have
> insurance at all, while Canadians can see just about any doctor they want.
On
> the other hand at least Americans have a bunch of paperwork to deal with
> also...
>
>
> The New York Times
> ------------------------------------------------------------------------
> October 13, 2005
> Being a Patient
>
>
> Treated for Illness, Then Lost in Labyrinth of Bills
>
> By KATIE HAFNER
>
> When Bracha Klausner returned home after an extended hospital stay for a
> ruptured intestine three years ago, she found stacks of mail from
> doctors and hospitals waiting for her.
>
> There were so many envelopes - some of them very thick - that at first,
> Mrs. Klausner, 77, could not bring herself to open them, and she stored
> them in large shopping bags in her Manhattan apartment.
>
> When she finally did open some of the envelopes, there were pages filled
> with dozens of carefully detailed items, each accompanied by a service
> code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00."
>
> On the 15th page or so of each bill, a "balance forward" line listed
> amounts in the tens of thousands of dollars. One totaled $77,858.04.
>
> Another mailing, from her insurance company, clearly said, in large
> type, "This is not a bill." But she could make no sense of the remark
> codes: "G7 - Your benefit is based on the difference between Medicare's
> allowable expense and the amount Medicare paid" or "QN - Your claim may
> have been separated for processing purposes."
>
> Mrs. Klausner's experience is shared by millions of Americans who,
> frustrated and confused, find themselves devoting enormous amounts of
> time and energy to sorting out their medical bills.
>
> Walk into any drugstore, and the next few minutes of your life are
> fairly predictable. After considering the choices, you make your
> purchases and head for the cashier. Seconds after the transaction, you
> are handed a receipt that reports to the penny what you paid for each
> product, along with its brand, its size, and the date, time and location
> of the purchase. But become a patient, and you enter a world of
> paperwork so surreal that it belongs in one of Kafka's tales of the
> triumph of faceless bureaucracies. And although some insurers and
> hospitals are trying to streamline and simplify bills, the efforts have
> been piecemeal.
>
> Medical paperwork is a world of co-payments and co-insurers,
> deductibles, exclusions and contracted fees. Nothing is as it seems:
> patients receive statements that often do not reflect what is actually
> owed; telephone calls to customer service agents are at best
> time-consuming and at worst fruitless. The explanations of benefits that
> insurers send out - known as E.O.B.'s - are filled with unintelligible
> codes.
>
> The system is so impenetrable that it mystifies even the most
knowledgeable.
>
> "I'm the president's senior adviser on health information technology,
> and when I get an E.O.B. for my 4-year-old's care, I can't figure out
> what happened, or what I'm supposed to do," said Dr. David Brailer,
> National Coordinator for Health Information Technology, whose office is
> in the Department of Health and Human Services. "I can't figure out what
> care it was related to or who did what."
>
> Dr. Blackford Middleton, a professor at Harvard Medical School with
> special training in health services research, said he did not fare much
> better than Dr. Brailer.
>
> "I understand the words of diagnoses and procedures," he said. "But
> codes? No. Or how things are paid or not paid? I don't understand that."
>
> Dr. Brailer said he often used an analogy to describe the current state
> of medical billing.
>
> "Suppose you walk into a restaurant," he said, "and you don't get a
> menu, you don't get any choice of what food you'll eat, they don't tell
> you what it is when they're serving it to you, they don't tell you what
> it's going to cost."
>
> "Then, weeks or months later, you get a bill that tells you all the food
> you ate and the drinks you had, some of which you remember and some you
> don't, and although you get the bill, you still can't figure out what
> you really owe," Dr. Brailer said.
>
> Some people make valiant efforts to sort through bills and claims, but
> end up throwing up their hands; others ignore them, until they are
> pursued by collection agencies; still others, basically healthy but
> weary at the prospect of a paperwork fusillade, stop going to the doctor
> altogether.
>
> Piles Upon Piles
>
> In the days before managed care, most insurance plans operated on a
> fee-for-service basis. Patients paid 20 percent of medical fees;
> insurers paid 80 percent. But as health care costs have continued to
> rise, many patients are being required to pay an ever-larger part of
> their medical bills, and deductibles continue to increase. And to keep
> the system churning, close to 30 cents of every dollar spent on health
> care goes for administration, much of it spent generating bills and
> explanations of benefits.
>
> "The number of bureaucrats between the point of service and the final
> cash reckoning is just incredible," said Dr. Thomas Delbanco, a
> professor of primary care medicine at Harvard Medical School who is a
> leader in the field of patient-centered care.
>
> For many people, the piles of paperwork they must contend with reinforce
> a simmering discontent with a system that aggravates tensions among
> patients, hospitals, doctors and insurers.
>
> Insurance companies are, by and large, unapologetic.
>
> "Even though the amount of paperwork a patient has to deal with might
> seem to be a lot, it would be much worse if there wasn't a unifying
> organization like a health plan easing that burden," said Dr. Alan
> Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New
York.
>
> This might come as a surprise to Ellen Mayer, an artist who lives in
> Chester, N.Y. Ms. Mayer, 54, has a rare type of gastrointestinal cancer
> that requires constant monitoring through blood work, CT scans and PET
> scans.
>
> The paperwork nightmare started for Ms. Mayer when her oncologist
> switched hospitals. Everything suddenly seemed to need a justification,
> or a new piece of paper with an authorization.
>
> The stacks of papers, folders and Post-It notes related to Ms. Mayer's
> treatment have started to take over her house. They fill manila
> envelopes, boxes and files, which fill closets. They spill from the
> dining room table onto chairs.
>
> "You can't just be sick," she said. "You have to be sick and be drowning
> in paperwork."
>
> So overwhelming has the paperwork grown that Ms. Mayer has considered
> giving up and ceasing all treatment because of the bureaucratic hassle
> that accompanies it.
>
> "It's comical, it's unbelievable," she said. "And I think to myself,
> 'What if I was an elderly person, or a single person? What if I wasn't
> healthy enough to handle it?' "
>
> Dr. Michael Mustille, associate executive director of the Permanente
> Federation in Oakland, Calif., said medical paperwork often delivered "a
> double psychological whammy."
>
> "People get these things that look expensive that they can't
> understand," Dr. Mustille said, "and then there's the worry that the
> people they've paid for insurance may decline to assume responsibility
> for it."
>
> In Mrs. Klausner's case, her son bought her an elaborate paper
> organizer, hoping it might help her face the chaos. She never used it.
>
> Creditors began to call. Whenever a collection notice showed up, Mrs.
> Klausner panicked and wrote a check or reached for the telephone to call
> her son for help.
>
> In the end, Medicare and United Healthcare paid most of Mrs. Klausner's
> bills, which added up to more than $150,000. And although the unwelcome
> mail has ceased, she cannot bring herself to throw out the bags filled
> mostly with unopened envelopes dating back to 2002, as if doing so might
> violate a law.
>
> Dr. Middleton went through something similar with his elderly mother,
> Dugan Middleton, a former nurse who died of thyroid cancer last February
> at age 79.
>
> Mrs. Middleton, who had lived alone in Palm Beach Gardens, Fla.,
> preferred to handle the paperwork herself.
>
> "It went on and on, with her reconciling her accounts with a lot of
> different doctors," Dr. Middleton said.
>
> He said that his mother wrote check after check and that "I'm sure she
> was paying many of the same bills twice."
>
> His medical credentials notwithstanding, Dr. Middleton was at a loss.
> "It was ridiculously complex," he recalled.
>
> Finally, in the last months of his mother's life, Dr. Middleton hired a
> social worker who knew how to navigate the system to help with the bills.
>
> How did things get this bad?
>
> Most health care in the United States
> is fragmented and profit-driven, a system in which everyone but the
> patient is meant to benefit financially.
>
> "Fragmentation is a fact of life in health care, and people consider
> that to be one of the most fundamental problems," Dr. Brailer said. "We
> pay by the piece. Everybody gets paid individually to do something: to
> see a patient, to admit someone, to do a lab test, to do a prescription,
> so health care is swamped by detailed, line-item bills."
>
> After an office visit, a physician sends a diagnostic code to the
> insurer, which then decides the level of payment. These codes differ
> from the codes the insurer uses in the E.O.B.'s it sends to patients to
> explain its decisions.
>
> The billing codes used by hospitals are something else entirely.
>
> "Each of them has their own system of paperwork, with their own billing
> codes," said Ron Pollack, executive director of Families USA, a health
> care advocacy group.
>
> "Everyone is bogged down by this: the physicians, the hospitals, and
> ultimately it reverberates to the consumer," Mr. Pollack said. "And to
> the extent the consumer sees the bill, it's like reading hieroglyphics."
>
> Mr. Pollack and other health care experts said they believed that only a
> small percentage of people end up calling their insurance company to
> inquire about a claim or to dispute a decision. Still fewer call a
> hospital to go over a bill they believe might contain errors.
>
> The Navigator
>
> In late 2003, Bonnie MacKellar's son Elias, then nearly 2, stopped
> eating. Then he stopped talking and walking. Elias had stage IV
> neuroblastoma, a highly malignant tumor
>
/tumors/index.html?inline=nyt-classifier>
> of the nervous system.
>
> Though pushed to their emotional limits, Ms. MacKellar and her husband,
> Thomas Dube, refused to buckle until the bills started to appear in the
> mail each day: hospital bills amounting to tens of thousands of dollars;
> invoices from doctors she did not remember meeting; E.O.B.'s from her
> insurance company that explained nothing.
>
> "It is hard to describe what it is like to be confronted with mounds of
> scary claims and bills when you have a 2-year-old who is extremely ill,
> who needs constant nursing and doesn't have a great chance of
> surviving," Ms. MacKellar said. "And to sit in a hospital room, on hold
> with the insurance company for 30 minutes or more only to have your
> child start puking just as you get a rep on the line."
>
> The E.O.B.'s seemed to serve little purpose beyond engendering fear.
> They were detailed enough ("radiology services 2/19/04"), but when it
> came to understanding the boxes listing the amounts charged, the amounts
> not covered, the fees allowed, the available benefit and the remark code
> (IT, 29, and the ever-mysterious QN ), Ms. MacKellar and her husband
> were at a loss.
>
> One statement that said, "Plan pays $00.00, patient pays $56,750.00,"
> caused panic.
>
> The remark code "07" stated, "These charges are for services provided
> after this patient's coverage was canceled."
>
> There had been no cancellation of coverage, but convincing the insurance
> company of that fact was an ordeal.
>
> The breaking point came when the group number on the health plan
> changed, and Ms. MacKellar was unable to convince the insurance company
> that it was billing under the wrong number.
>
> In despair, she consulted a social services agency, which put her in
> touch with Lin Osborn, a private consultant fluent in the arcane
> language of health care billing. For a fee, Ms. MacKellar was told, Ms.
> Osborn could take all the paperwork off her hands.
>
> An expert in deciphering insurance and hospital billing codes, Ms.
> Osborn spent several days straight working on the case and took care of
> the entire mess, Ms. MacKellar said.
>
> Still Searching
>
> Although there is no single solution to the medical billing morass, Dr.
> Brailer, of the Health and Human Services Department, said that the
> increasing use of electronic records to enable insurers, physicians,
> hospitals and pharmacies to share data would help.
>
> And in some segments of the health care system, efforts are being made
> to simplify and cut down on paperwork. Some insurance carriers, for
> example, are reducing the number of E.O.B.'s they send out, posting them
> online instead.
>
> For the past 18 months, Blue Cross Blue Shield of North Carolina
> has been working to reduce the total amount of paper it sends out.
>
> "When there's no remaining financial liability, then we don't send the
> E.O.B.'s," said Bob Greczyn, president of Blue Cross Blue Shield of
> North Carolina.
>
> Blue Cross Blue Shield of South Carolina
> is offering physicians an electronic card reader that lets patients find
> out how much they owe while they are still in the doctor's office.
>
> In another effort to improve the system, the Patient Friendly Billing
> Project, led by the Healthcare Financial Management Association, is
> working with insurance companies on a long-term project to make bills
> more comprehensible.
>
> Still, Dr. Brailer said that, on the whole, "there isn't a lot under
> way" in terms of efforts to fix the system.
>
> Dr. Brailer pointed out that there had been frequent calls for a
> standardized insurance billing form, which would sharply reduce
> duplication and paperwork costs and "make patient management of these as
> simple as online checking."
>
> But, he said, "this has not gone beyond the wishful-thinking level
> because the changeover would cost a lot."
>
> Mitch Mayne, 38, is a marketing executive in San Francisco who considers
> himself basically healthy.
>
> Mr. Mayne went to his doctor three times between March and June for the
> same thing: recurring bronchitis
>
> Yet the explanation of benefits statements he received from his insurer
> after each office visit differed drastically in the amount he owed,
> varying from $10.66 to $90, with no explanation of the services provided.
>
> "What did I do on June 27 that was different than what I did on April 6
> that was different than what I did on March 4?" Mr. Mayne asked.
>
> When he calls for an explanation of the E.O.B.'s, he said, the most
> tangible result he sees is a new card in the mail with no indication of
> the amount he owes as a co-payment printed on the card.
>
> "I'm paying through the nose for this premium, and when I go to the
> doctor it's a roll of the dice as to whether or not they'll pay it,"
> said Mr. Mayne. "It seems like it depends on the mood of whoever happens
> to be doing the claim that day, or on the phases of the moon."
>
> Mr. Mayne recently grew so fed up that he decided to try to beat the
> bronchitis on his own. "I can't deal with all this paperwork," he
> recalled saying. "It's just too much of a hassle." That turned out to be
> a mistake. Mr. Mayne became so sick that he finally relented and saw his
> doctor.
>
> What if something truly catastrophic should happen to the state of his
> health?
>
> "Oh wow, I hadn't even thought of that," Mr. Mayne said. "That's
> actually a pretty scary proposition. If I can't manage my health care as
> a healthy individual, the prospect of trying to manage it and be really
> sick at the same time - I don't know that I could do it."
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