Posts Tagged ‘CEO’

Healthcare Costs, Reform Misconceptions, and This Presidential Election

Friday, October 26th, 2012

I do not listen to much political rhetoric due to so many misconceptions and many misleading comments to try to sway people one way or the other. I wanted to share information about the US healthcare reform laws that many do not understand.

1. This law addresses the continuing massive efforts to stop over billing, incorrect billing, abuse and fraud in healthcare that is costing everyone so much extra money. I am a fraud and abuse healthcare auditor. Many of the statistics are true per audits that 90% of hospitals over bill. I am not just talking about the costs per item/service. Every time an item is ordered it usually placed automatically into the billing system. You may or may not receive this item (open or use it per records), yet it may not be removed from your bill. I have seen as much as 75 -85% of physician billing that is also incorrect and over billed based on documentation in the records. Not all physicians or hospitals are bad. There just are a lot of careless errors that costs us so much more money in the U.S.

2. Pre-existing condition is set to go away if the healthcare reform law stays as is. What does this mean for everyone in the US? The health insurance industry would not be able to deny claims if you change insurance. For example: if you or a spouse is downsized due to the economy or some major accident that you cannot work the health insurance companies are not allowed deny your claims because you lost coverage. Romney wants to do away with this. He is trying to mislead the public staying if you do not lose your insurance pre-existing condition will not be allowed. This is already in effect without the healthcare reform laws. This is how so many people are hurt by greed because of so many people who have been hurt financially by this economy. Medical bankruptcy is at an all time high. If you lose your job (or medical benefits) insurance companies can refuse to cover you for that condition for at least 1 year or permanently without this reform law.

3. Total dollar amount coverage will change with this law also if it stays in effect. Right now, for example, most insurance policies have a total dollar amount that they will spend to cover you for your lifetime. An example would be like $500,000 – $1 million. We should be asking what happens then. We are out of luck because if you or someone in your family has high medical bills and runs through their entire insurance policy dollar allowed amounts the only choice is Medicaid, which can have up to a two year waiting period before coverage occurs. Medicare possibly, if an adult, with enough working credits may be able to go on Social Security early payments after a length process. The healthcare reform laws change this to not allow any dollar amounts in total coverage. What does this mean for our U.S. citizens? The health insurance industry just cannot drop our coverage because of high bills. I have personally seen people who have developed catastrophic conditions like cancer, heart attack, stroke, etc. spend through their entire policy coverage amount and with such a diagnosis are refused coverage after dropped by that insurance company.

4. Profits from health Insurance and major medical (hospital) CEO’s with the healthcare reform laws have major changes. The majority of all money received is required to be used to pay for services and not for CEO’s to continue to get richer and richer at the expense of the U.S. citizens with these laws. Do we really want this law to change so that few people get the real medical care they need and can afford, while the CEO’s are getting richer and richer at our expense?

5. Medicaid Expansion – do we really want this to go away as more and more lose coverage and jobs? Many may say Medicaid that this is not important to me. What we need to keep in mind is if you run through the entire coverage amount for your health insurance and develop a catastrophic medical condition (for example: from a accident (if it is your own fault), heart attack, stroke, cancer, diabetes complications, etc) and money is not available in our Medicaid system we are just “out of luck”. The unfortunate side to this is we may physically and mentally suffer from complications, and die a possible painful early death.  If we need nursing home care/home health Medicaid money may not be available to help cover many additional individuals due to rising costs.

6. Healthcare Exchanges – What these are in a nutshell is a way for individuals to purchase health insurance at a lower cost if they do not have coverage. It is basically placing all of the individuals under a “group umbrella” to cut the costs of individual policies.

The healthcare reform laws are very detailed and complicated. We, as U.S. citizens, need to make sure we understand the basics that are at stake for us with this upcoming election. Who do you know who has lost health insurance benefits from this economy and cannot afford basic care? It will only hurt our citizens more if we keep making the healthcare CEO’s richer and continue to hurt us as a nation that deserves basic medical benefits. This is not just about the presidential election. This is also about who is elected or re-elected in the senate and congress. Even on a state level areas like health care exchanges and Medicaid block grants will be decided by who we elect.