How does mandatory heath care help if...

[BeHereNow]

insurance companies are still allowed to deny treatment and claims?

Also, wondering, has any one examined how this will
affect mental health patients?

About to leave, but will return later-
Curious to hear what DUers know about these two aspects of
the HCR bill.

Thanks,

BHN

[dflprincess]

1. It helps the insurance companies a lot by giving them a captive customer base

that's how it helps.

From where most of us sit, it will just be the same old system with high premiums and high out of pockets and no guarantee the insurance company will keep it's end of the bargain.

[Individualist]

6. Exactly!

[Myrina]

18. +10

:thumbsup:

[napi21]

2. The majority of claims are denied because of a preexisting condition or

you have reached your max. lifetime allowance. Those are both gone with this bill.

Sorry, I donp't know anything about how it will affect mental health issues.

[dflprincess]

19. A lot of claims are denied because they are "coded wrong"

or just because they can deny them. Most people don't bother to question it when a claim is denied and the insurance company will play the odds that the person won't fight them on it.

[napi21]

22. Well, I hate to say it, but those people are just being stupid!

If they're really concerned about being covered, THEY should take the inititive to contact the Dr. & the provider to find out what the problem is and how it can be fixed!

I believe in fairness but not in someone "taking care of you or holding your hand"! The users of HC a;sp have responsibility!

[dflprincess]

24. Often it has nothing to do with anything the doctor's office did

insurance companies do die claims for no particular reason just to try and save a few bucks. They also make it difficult to appeal a denial - people may fight with them over big claims but the smaller ones they'll decide just aren't worth the time.

I've found that threatening to file a complaint with the state AG's office or Commerce Commissioner often takes care of the matter in a matter of minutes.

[T Wolf]

3. YEs, the parasites can still deny to pay for any claim they choose. ANd fight you to get you

to stop trying to have something paid for.

There is plenty of bullshit in the bill that some will "interpret" to prevent this, but they cannot deny the reality. The exclusion of "pre-existing" etc,. just refers to denying someone the "ability" to buy the policy in the first place. Once you have paid for it and have a piece of paper saying "you are covered," the old rules still apply.

[Xicano]

10. "That's an experimental procedure"

"We don't cover experimental procedures - sorry."

They have millions of excuses they'll pull out so as not to pay. The people who support this bill should know better. You cannot trust wall street - period.

[derby378]

23. +100

Doesn't matter if the treatment works. Doesn't matter if there's medical research to confirm it. If there isn't an article in JAMA about the procedure, Big Insurance will consider it "experiemental."

A gross oversimplification, I know, but you get the idea.

[tridim]

4. Because denying treatment and pre-existing conditions will be against the law immediately.

http://edlabor.house.gov/documents/111/pdf/publications/AHCAA-Immediately-102909.pdf

[T Wolf]

13. There is NOTHING in your citation that says anything about denying claims for any specific

treatment or procedure.

They will collect more money and deny claims at the same rate (or higher) than they currently do.

[sandnsea]

16. They have to pay out 85% or more of premiums n/t

[Lars39]

5. Also, How does mandatory heath care help if...

it still eats up a huge percentage of your income? We're still going to be paying huge premiums compared to other industrialized countries.

[sandnsea]

8. Subsidies

How many times does that have to be said. We've got to get the House subsidies, it's the most important part of the bill.

[Lars39]

11. Does it take into account the huge medical bills you already have?

[sandnsea]

12. Yes, there will be a waiver process

You know, you can keep what you have. Huge medical bills and no health care. Whatever you want.

[dflprincess]

20. It doesn't

and the subsidies cut off at relatively low levels.

It also takes money that consumers might have spent on other products that might acutally help the economy, rather than just transfering funds from your wallet to the same old bunch of parasites who produce absolutely nothing.

It also does nothing to help make other industries competitive with those in other countries as employers will still be paying for health insurance and adding that cost to their products.

[sandnsea]

7. On what basis do they deny claims?

Pre-existing condition? They can't.

They also have to pay out at least 85% of premiums in claims. And all the policies in the exchange will have coverage mandated, in tiers.

The only game that I see left for them to play is experimental treatments. But Medicaid and Medicare don't cover everything either.

[T Wolf]

15. They only cannot CANCEL YOUR POLICY because of pre-existing conditions. They can still deny

to pay for anything they want.

[sandnsea]

17. That is not true. That is just crazy

Edited to add,

That is death panel crazy. Stop making shit up.

[kestrel91316]

9. There is NO mandatory "health care" in this bill. There IS mandatory

purchase of medical insurance, which will still mean denial of care.

[sandnsea]

14. Just like Medicaid, Medicare, VA,

and every government program does. Be honest. You of all people know that not one system in this country covers everything. Neither would single payer. There would still be procedures, medicines, etc., that one doctor considers unnecessary and another considers a life-saver. I think acupuncture often works, for instance. But I wouldn't insist it always be covered in a private insurance or a govt plan. There should be riders for that sort of thing, so people can choose the kind of health care they want.

[dflprincess]

21. No it is not like the other programs

this program allows some big out of pockets (aka "costsharing") in addition to whatever part of the premium you're paying. While the bill will cut the number of uninsured the number of underinsured will continue to grow. People paying coverage will still not be able to afford the out of pockets and will still have difficulty accessing care.

[BeHereNow]

25. That's what I thought, so again what good does the bill do?

So they can't deny coverage for pre-existing conditions- so what?
Apparently they can still deny treatment and claims!
So where is the "reform?"
Do you know if there is any regulation on deductible rates?
Hell, our existing insurance plan has such high deductibles that
a catastrophic illness would wipe us out before the insurance kicked in.
Also, if you have serious dental problems, too bad.
When you go through the basic coverage, there is nothing left over for emergency treatment.

From what I've seen, this bill is bull shit.
Just another scam to bilk more money out of the taxpayer with nothing in return.

BHN