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BJoTX
Rookie

15 Posts

Posted - Mar 01 2014 :  6:01:37 PM  Show Profile  Reply with Quote
If someone has Medicare Parts A&B, do they really need a supplemental plan?

Things are to be used, not loved. People are to be loved, not used.
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sslei
Member

68 Posts

Posted - Mar 01 2014 :  8:48:54 PM  Show Profile  Reply with Quote
I have wondered about that myself , although we do have the supplement plans....I think maybe it would be the hospitalization where it might come in handy. My husband had a stroke last Nov 2012 and I have been meaning to add up all that the supplemental paid in comparison with what the monthly payments are and his plan also has a deductible and co-pays . Mine does not have the deductible nor co-pays.

You will probably get some more replies from those who have used the supplementals more than I have and could give more information.

Sandy
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PennyPA
Contributing Member

USA
5755 Posts

Posted - Mar 02 2014 :  12:35:14 AM  Show Profile  Reply with Quote
Yes, you do need a supplemental plan. A & B do not pay the full amount for doctors' visits, medical tests, hospitalizations, etc. Medicare pays 80% of what they deem is the "usual" charge. Without a supplemental plan, you're responsible for the remaining 20%. You can get a plan without a deductible or co-pay like Sandy has. That's what I had up until this year, a Plan F, but the monthly premium for that was getting a bit out of hand so I switched to a plan that has no co-pays but I will be responsible for the Part B deductible which is $147 this year. I've already had enough tests and doctors' visits this year to make that up. All you need is one 2 or 3 day hospitalization to break the bank, so to speak, if you don't have a supplemental plan.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
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Dave-OH
Administrator

USA
3874 Posts

Posted - Mar 02 2014 :  10:05:25 AM  Show Profile  Reply with Quote
I choose an Advantage plan - it includes dental, vision, prescriptions and medical. It has a co-pay, but it means I know what my costs are going to be. I also picked a PPO, so I can see out of network providers.

Dave, Forum Administrator
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PennyPA
Contributing Member

USA
5755 Posts

Posted - Mar 02 2014 :  12:09:26 PM  Show Profile  Reply with Quote
I think the premiums for the Advantage plans are going to be going up soon (if they haven't already) to help pay for the ACA. Since we travel around the country and see doctors all over the place, although the Advantage plans cover dental, vision and meds, they just wouldn't work for us.

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Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
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Dave-OH
Administrator

USA
3874 Posts

Posted - Mar 02 2014 :  2:32:37 PM  Show Profile  Reply with Quote
They have gone up over the years. Not sure ACA has anything to do with it.

Dave, Forum Administrator
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PennyPA
Contributing Member

USA
5755 Posts

Posted - Mar 02 2014 :  2:38:43 PM  Show Profile  Reply with Quote
Last year, I believe it was, the government made the decision to decrease how much it funded the Advantage plans since not enough people were signing up for the ACA. Of course, all our premiums are going up and will continue to go up but there's not been any news about reducing funding to the insurance companies.

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Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
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And Our Travel Blog After LVRS




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Rita1
Senior Member

541 Posts

Posted - Mar 02 2014 :  9:16:37 PM  Show Profile  Reply with Quote
There is a proposal to discontinue the extra money the government has been providing to insurers who offer Medicare coverage which provides more than the Medicare law requires - Advantage plans. Not surprising, the insurers involved as well as seniors who have such plans are objecting.

Where the money the government will save goes I'm sure is not as important to seniors who have benefited as the fact that they may lose these extras. Those with an Advantage plan can check it out by googling Medicare Advantage cuts.



Rita
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Dave-OH
Administrator

USA
3874 Posts

Posted - Mar 02 2014 :  11:48:07 PM  Show Profile  Reply with Quote
I am aware of the cuts, except they will get rid of some extras next year.

Dave, Forum Administrator
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Greg-TX
Member

202 Posts

Posted - Apr 10 2014 :  9:39:25 PM  Show Profile  Reply with Quote
I don't know how I missed this topic. It's gone virile!

It's real easy for people who have insurance to criticize Obama care, but if you don't have it, it's a God send. Over the years being self employed and having a per-existing condition, I've literally paid over the last 8 yrs $100k for insurance that didn't cover anything but a major catastrophic expense. You also have to remember, the insurance companies basically wrote the bill. You think they are not going to make money. Wait till the next phase when they analyze the enrollment and go up on the premiums.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Dave-OH
Administrator

USA
3874 Posts

Posted - Apr 10 2014 :  9:47:03 PM  Show Profile  Reply with Quote
Greg, been there, done that. We paid at one point $18,000 a year for good health insurance as a small business for the two of us.

Dave, Forum Administrator
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Greg-TX
Member

202 Posts

Posted - Apr 10 2014 :  9:55:42 PM  Show Profile  Reply with Quote
God Bless you Dave. You know how I feel. You and I both know, the price is going to go up after they review the number of sign ups. I'm still happy with what I have, it's a 1,000% better than before.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Cindi-TX
Member

USA
52 Posts

Posted - Apr 11 2014 :  3:14:29 PM  Show Profile  Reply with Quote
I am still getting my hospital bills for Dec. 28-Thrus Dec 31 on my old policy , before Obama care. $38,000 and counting. This was one of those policies that I call junk, some people say "ooh, I love my cheap insurance and want to keep it " It did NOT pay ambulance, ER room, oxygen, labs, etc. In fact, in the end it payed not quite $5,000 of my entire bill . And it was not that cheap, at the end I was paying $347 per month, had the policy for 13 years. I am very happy to now have "Obamacare"
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Greg-TX
Member

202 Posts

Posted - Apr 11 2014 :  6:41:27 PM  Show Profile  Reply with Quote
Maybe I spoke to soon thinking I finally had some decent coverage under the Health Care Act. We only have one provider BCBS of Tx. I've mentioned in the past some of the exorbitant charges my medical facility has been billing; like $1100 for two visits to rehab and $2100 for a PFT test

Just saw on the local news where this medical facility will no longer accept BCBS because they weren't being paid enough for their services they charge. Now you have to pay up front and you can file for your insurance reimbursement.

This is nothing more than legalized stealing!

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Dave-OH
Administrator

USA
3874 Posts

Posted - Apr 11 2014 :  8:07:22 PM  Show Profile  Reply with Quote
Fight with BCBS to get them to stay with the facility and pay in network.

Dave, Forum Administrator
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Rita1
Senior Member

541 Posts

Posted - Apr 11 2014 :  8:23:08 PM  Show Profile  Reply with Quote
Greg, have you looked at other medical facilities? Yours sounds like it is messed up although I don't know about the "stealing". The problem seems to be with the facility rather than Blue Cross which is a huge insurer. I know you are frustrated but you seem to be blaming Blue Cross for problems created by the medical facility.

I believe the facility is required to inform you if they will no longer accept your insurance and they can't just leave it to their patients finding out by listening to a news program. I know that years ago I received a letter from my medical group telling me that they would no longer accept my HMO and providing me with a list of medical groups that would accept it and another list of which insurers they would accept. (As it turned out, although they would no longer accept Blue Cross HMO, they would accept Blue Cross ppo so I just switched to it which cost me a lot more in premiums and co-pays but I didn't want to change docs.)

Did you ever find out what the problem was with Blue Cross not paying the rehab bill? Did it pay for the pft?


Boy, you really are having some problems with insurance!

Rita
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Greg-TX
Member

202 Posts

Posted - Apr 11 2014 :  9:12:57 PM  Show Profile  Reply with Quote
I'm not blaming BCBS, I don't blame them for not paying those ridiculous bills. The medical facility is not happy with what BCBS says they will pay for the services.

The problem with the rehab bill is that the med facility didn't get prior approval for the charges which BCBS is denying all the charges now and it looks like the hospital might hold me responsible.

Not that easy finding another facility where I live, they are the biggest. The only other facility handles medicaid patients and you basically stand in line for treatment.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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fatpuppy
Member

162 Posts

Posted - Apr 11 2014 :  10:51:33 PM  Show Profile  Reply with Quote
quote:
Originally posted by Greg-TX

The problem with the rehab bill is that the med facility didn't get prior approval for the charges



A year ago I had pretty expensive surgery and the surgeons didn't get prior approval. The $40K bill was denied by Cigna and they were prohibited from seeking payment from me or the insurance company. I know that's a fairly standard condition of the contract medical facilities have with insurance companies.

ďAs democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heartís desire at last and the White House will be adorned by a downright moron.Ē H.L.Mencken 1920
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PennyPA
Contributing Member

USA
5755 Posts

Posted - Apr 11 2014 :  11:34:51 PM  Show Profile  Reply with Quote
Greg, it'll be so much easier once you're on Medicare!

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

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And Our Travel Blog After LVRS




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MDC
Member

297 Posts

Posted - Apr 16 2014 :  8:06:52 PM  Show Profile  Reply with Quote
I LOVE the ACA!!!!!!!!!!!!Like Greg if you have a pre-existing condition you might as well file bankruptcy. I got Ark BCBS and they are great. I am stuck in that 2 year period before medicare kicks in. Problem is that I am too young (59 now) to get a supplement once I get medicare. So there we go again. Hope more changes coming.

Enrollment was higher than expected but there were more young sign up than anticipated. They are projecting a lower increase in premiums than was normal before ACA. Budget Deficit supposed to go down. I am not a Republican, Democrat, none of the above, but something needed to be done. Clinton tried but never got it off the ground

There will be a lot of fine tuning done but I think it will work.Clinton tried it but never got it off the ground. Even without a subsidy my premium would have been cheaper than what I had at work.

Mike


"I don't know what the future holds, but I KNOW WHO holds my future"
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Dave-OH
Administrator

USA
3874 Posts

Posted - Apr 17 2014 :  09:09:39 AM  Show Profile  Reply with Quote
Mike I am in your situation, look at a Medicare advantage plan.

Dave, Forum Administrator
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Greg-TX
Member

202 Posts

Posted - Apr 17 2014 :  09:19:15 AM  Show Profile  Reply with Quote
Since our small hospital or I should say emergency clinic closed last year and since we now have BCBS under the health care act, we've been trying to find a primary care physician in a major city about 1.5 hrs away (my pulmo & cardiologist are there)and we're unable to find one that will take on any new patients. Business must really be good for the docs.

I guess if an emergency arises, the hospital will assign one. Heck of a deal.

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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Greg-TX
Member

202 Posts

Posted - Apr 17 2014 :  9:35:25 PM  Show Profile  Reply with Quote
I've heard you mention that you are on Medicare Advantage in a number of posts. You may have mention what it is in the post but I have been following it. I take it Medicare Advantage is the supplemental insurance you have to cover the costs not covered by Medicare? And how much does the supplemental cost you per mth?

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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MDC
Member

297 Posts

Posted - Apr 18 2014 :  08:13:12 AM  Show Profile  Reply with Quote
quote:
Originally posted by Dave-OH

Mike I am in your situation, look at a Medicare advantage plan.



I will Dave, looks like my only option at this time. Our local hospital has kicked Humana out of the network due to inability to come to a mutual agreement on reimbursement rates.

Greg rates will vary to the best of my knowledge based on your company and what it covers. As most advantage plans cover items medicare does not cover, vision, etc. they also will take your health into consideration I believe, I am not sure.

Thanks,
Mike

"I don't know what the future holds, but I KNOW WHO holds my future"

Edited by - MDC on Apr 18 2014 08:15:57 AM
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jmrommes
Contributing Member

1600 Posts

Posted - Apr 18 2014 :  10:43:30 AM  Show Profile  Reply with Quote
Greg, both the "supplemental" plans and the Medicare advantage plans are the plans that are designed to cover the costs that Medicare A and B don't cover. The difference between them is pretty much the difference between a standard insurance plan and an HMO. The Medicare Advantage plans cover basic meds and don't require a separate plan to cover meds, but they do require co-pays for most services. Some, if not all, also cover dental and vision needs.

In the past, the Medicare Advantage plans have been subsidized by Medicare, and those subsidies will be going away. You can find out about both kinds of plans by going to www.medicare.gov

Jean

Exercise not only lets me live, it enables me to have a life.
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Dave-OH
Administrator

USA
3874 Posts

Posted - Apr 18 2014 :  1:41:29 PM  Show Profile  Reply with Quote
Jean, we have seen the prices on these plans increase over the last number of years, but are often less than a good supplement and Part D drug plan. I find it convenient to have one bill to one company.

Dave, Forum Administrator
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rosytomato
Contributing Member

USA
1309 Posts

Posted - May 16 2014 :  12:58:27 PM  Show Profile  Reply with Quote
This was in our local paper today from Associated Press.

Washington - "The Obama administration has given the go-ahead for insurers and employers to use a new cost-control strategy that puts a hard dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.

Some experts worry that such a move would surprise patients who pick more expensive hospitals. The cost difference would leave them with big medical bills that they would have to pay themselves. That would undercut key financial protections in Obama's health care law that apply not just to the new insurance exchanges, but to most job-based coverage as well.

Some federal regulators appear to be concerned. A recent administration policy ruling went to unusual lengths, acknowledging that the cost control strategy may be a subterfuge for otherwise prohibited limitations on coverage.

Nonetheless, the departments of Labor and Health and Human Services said the practice, know as referencing ricing, could continue. Plans must use a reasonable method to ensure adequate access to quality providers.

The new strategy works like this:

Your health insurance plan slaps a hard limit on what it will pay for certain procedures, for example hospital charges associated with knee and hip replacement operations. That's called the reference price. Say the limit is $30,000. The plan offers you a choice of hospitals. If you pick one that charges $40,000, you would owe $10,000 to the hospital PLUS your regular cost sharing for the $30,000 that your plan covers; AND the extra $10,000 doesn't count toward your plans annual limit on out-of-pocket costs."

So if your doctor does not have privileges in the "cheaper" hospital, then you either have to find another doctor that does, or you will have a huge hospital bill to pay.
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PennyPA
Contributing Member

USA
5755 Posts

Posted - May 16 2014 :  2:14:48 PM  Show Profile  Reply with Quote
I saw this, too, Rosy, and all I can say is that I'm darn glad I got my LVRS before ACA and all the other medicare cuts started!!!

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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Rita1
Senior Member

541 Posts

Posted - May 16 2014 :  6:03:13 PM  Show Profile  Reply with Quote
Penny, I believe they are talking about private insurance purchased through the ACA (Obamacare) exchanges and not Medicare. Medicare is a government run insurance plan, not a private plan. If the whole country could have government run insurance, like we seniors have, perhaps there wouldn't be such a mess. One thing that would change is the profit that the private insurers now make off of our fellow American's sicknesses would go into health care instead of their pockets.

Rita
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PennyPA
Contributing Member

USA
5755 Posts

Posted - May 16 2014 :  6:36:37 PM  Show Profile  Reply with Quote
Yes, they are, Rita. I was saying I'm glad I got my LVRS BEFORE the medicare cuts of which there have been at least 2 so far. More to come, I'm sure.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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Rita1
Senior Member

541 Posts

Posted - May 16 2014 :  7:39:53 PM  Show Profile  Reply with Quote
And I'm saying the article is not talking about Medicare which we are lucky to have.

Rita
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PennyPA
Contributing Member

USA
5755 Posts

Posted - May 16 2014 :  8:04:12 PM  Show Profile  Reply with Quote
So we're talking about 2 different things. However, it will be coming to medicare sooner than later.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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Rita1
Senior Member

541 Posts

Posted - May 16 2014 :  8:22:16 PM  Show Profile  Reply with Quote
Maybe we should stay on the topic which was the article that Rosy brought up. It's terrible that people who finally got insurance coverage through the ACA are being told by their insurers that they will not pay if they go to a particular hospital. It follows that they may not be able to have their preferred medical provider treat them in that hospital because s/he does not have privileges at the cheaper hospital the insurer will cover. I hope something is done about this.

And, federal money for research has been drastically cut because of the sequester and other cuts demanded by certain people in Congress. This means a cure for us is even further away.

IMO, that's enough to be mad about without worrying about Medicare cuts, none of which has affected me. I'm still going to see my docs - recently saw pcp and ophthalmologist and have pulmo scheduled - and Medicare and my secondary are paying as usual.

Rita
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Greg-TX
Member

202 Posts

Posted - May 16 2014 :  9:46:24 PM  Show Profile  Reply with Quote
Hey Kids, it's a simply fact, substantial health care is just not available for people who can't afford it. And even then, the insurance companies will still try to screw you. It's immoral!

Greg-TX
"Alcohol"- because no great story ever started with someone eating a salad!
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rosytomato
Contributing Member

USA
1309 Posts

Posted - Jun 10 2014 :  6:01:30 PM  Show Profile  Reply with Quote
I read this today in my local newspaper. It was in the editorial section.

Care, government a bad mix....

"Whether in the VA or ACA, government run health care has run amok in its failure to deliver."

It was talking about the VA debacle being a prime example of a government-run agency for our veterans health care that failed them with denials, delays and 'fake' waiting lists with devastating consequences.

"The president said he was "madder than hell", yet he broke his 2009 promise to our veterans that under his "leadership and resources" their care would be a "sacred trust." Five years later, systemic problems in the VA in 42 facilities have resulted in the deaths of American heroes.

Ironically, the VA seeks to address these failures by allowing some veterans to seek care from private doctors and facilities, and that perhaps it would also help if they fired 699 of the 700 VA lawyers and hired some doctors.

Amid broken promises regarding Obamacare, there are also serious concerns regarding affordability, hidden regulations, and the possibility of rationing care due to restricted access and exclusions of some of the finest physicians and hospitals to cut costs. Exacerbating the problem, the American Association of Medical Colleges predicts a shortage of almost 92,000 doctors by 2020. Is it ideology, incompetence or design that will compromise the health care of Americans on a much broader scale than the VA?

Will the side effects of Obamacare be compounded by the deaths of the sick and elderly? Will 4 million people added to taxpayer-funded, bare-bones Medicaid have health insurance but minuscule access to care due to abysmal doctor reimbursement?

Will government intrusion jeopardize doctor patient relationship and become a recipe for disaster? After upending health insurance of 6 million people, will Obamacare mirror the VA crisis?

The trajectory of government run health care is perilous. The president needs to put politics aside, deliver on his promises, and find solutions before this country ends up on life support."

I thought this was very well said.





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Rita1
Senior Member

541 Posts

Posted - Jun 10 2014 :  10:26:25 PM  Show Profile  Reply with Quote
Rosy, I wonder why this editorial talks about the ACA as government run insurance when everyone surely knows by now that it provides a market place for private insurers. Of note is the fact that the person who wrote this, in addition to not distinguishing between the government run VA system and the private insurance system under the ACA, does not mention Medicare which, like the VA, is government run insurance, not private. Could it be that, unlike the VA system which from what my local paper says has had problems for many, many years, Medicare has not "failed to deliver" and works just fine? Government run Medicare doesn't help his opinion, instead it contradicts his position.

Many Americans are now coming to the realization that a government run (single payer) system like Medicare should be available to everyone but, alas, it would cut out the for profit insurance companies. All that profit would have to go for ....... medical care!

Rita in Chicago

Rita
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Dave-OH
Administrator

USA
3874 Posts

Posted - Jun 10 2014 :  11:50:49 PM  Show Profile  Reply with Quote
We do not allow political posts per our policies, and your post Rossy has crossed the line.

As for the VA, I just heard some numbers earlier to put it in perspective. The VA serves 6.5 million veterans a year for health care. So 100,000 waiting for care is a small percentage of the numbers served. 6 million appointments are handled every year by the VA system, so again put the numbers in perspective.

One other point - how many of you can get a first appointment with a doctor in less than 30 days? How about a repeat appointment? 14 days is very aggressive. 30 days is more reasonable.

I am a user of the VA. I see two medical groups there, and have for a number of years. I also use a private group(s) and it is much easier to get into the VA, than my private group. And I can go to the VA urgent care any time I want for free.

Dave, Forum Administrator
COPD Support, Inc. http://www.copd-support.com/
Your source for peer support and COPD Info

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MDC
Member

297 Posts

Posted - Jun 11 2014 :  09:06:53 AM  Show Profile  Reply with Quote
Well I guess I was lucky getting on the private subsidized ACA through Ar BCBS. The only thing I have seen is an improvement in my insurance over my old Cadillac Plan with BCBS. More coverage, no waiting times. Guess it is where you are located. BCBS runs Arkansas and every provider is about in network.

God Bless,
Mike

"I don't know what the future holds, but I KNOW WHO holds my future"
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rosytomato
Contributing Member

USA
1309 Posts

Posted - Jun 11 2014 :  10:38:38 AM  Show Profile  Reply with Quote
Sorry, I didn't mean to cross the line. I apologize if I offended anyone.

Rosy
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PennyPA
Contributing Member

USA
5755 Posts

Posted - Jun 11 2014 :  2:05:35 PM  Show Profile  Reply with Quote
Rita, you said "Medicare has not "failed to deliver" and works just fine". and it has...in the past...but it's starting to NOT work just fine. Bob has diabetes and a heart issue and they may no longer pay for 4x a year blood testing. Medicare is also now not paying for the test strips diabetics use. They are also not now paying for an annual internal exam for women who have cysts on their ovaries. There are more cuts to come so be prepared.

****************************************************************
Do Not Regret Growing Older. It is a Privilege Denied to Many

You canít change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.
The Good News: Youíre still the pilot.

Penny's Lung Volume Reduction Surgery

And Our Travel Blog After LVRS




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