# Conversation and Fun > Just Conversation >  Health Care - Who should pay

## rbaker

Who is responsible for paying health care premiums for working, able bodied citizens in the US?

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## For-Life

I voted for Government, with the understanding that it would come through general taxation.  I would not want to see it come from debt.  I also am a fan of sin taxes.  Let's have those who cause the problem pay for it.  If you smoke causes me second hand smoke, then you should pay part of the my medical bill.  Therefore, taxing cigarettes will compensate for damage caused by smoking cigarettes.  

I do not think it should be 100% on the shoulders of individuals or companies.

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## bob_f_aboc

> I voted for Government, with the understanding that it would come through general taxation. I would not want to see it come from debt. I also am a fan of sin taxes. Let's have those who cause the problem pay for it. If you smoke causes me second hand smoke, then you should pay part of the my medical bill. Therefore, taxing cigarettes will compensate for damage caused by smoking cigarettes. 
> 
> I do not think it should be 100% on the shoulders of individuals or companies.


 
I've got a stomach ache and fever. I think I will go out and ask 100 people for $1. Then I will be able to afford to go to the doctor. 

Sounds good up front. Nice, fair system. Except I have gone to the doctor maybe 4 times in the last 10 years. We have patients in our office with recurrent eye infections that are non-compliant with meds that come back twice a week for 2-3 months before it finally clears up.

Under the above example, that person will pay $1 every 18 months for me to see a doctor. I, on the other hand, will pay $20 in 3 months for this person who doesn't care enough about their own health to follow the instructions. (I know this is a grossly over-simplified example)

If we are going to make it fair, the taxes should be levied based on how many times you went to a covered doctor during the previous year. And an additional tax will be levied for Emergency Room visits. This will help to minimize the wasted trips to the ER because they didn't want to wait for an appointment.

The down side to this is that, at least where I am at, the majority of the people in the ER at any given time are Medicaid patients who don't pay taxes anyway.

They tend to flock to the ER because they will be seen and they will be treated and they will not be asked to pay. No one can be refused treatment in an Emergency Room.

Social programs are great for helping people get back on their feet. They are not meant for people who won't get off their @$$ to better themselves.

Any attempt at socialized medicine or national healthcare or universal healthcare or whatever name it has this month is just going to widen the gap that already exists between the people that are trying to provide for themselves and those that hold their hands our and wait.

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## For-Life

> I've got a stomach ache and fever. I think I will go out and ask 100 people for $1. Then I will be able to afford to go to the doctor. 
> 
> Sounds good up front. Nice, fair system. Except I have gone to the doctor maybe 4 times in the last 10 years. We have patients in our office with recurrent eye infections that are non-compliant with meds that come back twice a week for 2-3 months before it finally clears up.
> 
> Under the above example, that person will pay $1 every 18 months for me to see a doctor. I, on the other hand, will pay $20 in 3 months for this person who doesn't care enough about their own health to follow the instructions. (I know this is a grossly over-simplified example)
> 
> If we are going to make it fair, the taxes should be levied based on how many times you went to a covered doctor during the previous year. And an additional tax will be levied for Emergency Room visits. This will help to minimize the wasted trips to the ER because they didn't want to wait for an appointment.
> 
> The down side to this is that, at least where I am at, the majority of the people in the ER at any given time are Medicaid patients who don't pay taxes anyway.
> ...


Why would someone on medicare and someone who has no money be in emerge more than a rich person?

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## bob_f_aboc

Because trying to get into a doctor that accepts Medicaid can result in a wait of 2-3 months.  Its much faster to go to the ER for every little thing. 

There is one situation that I remember hearing that happened in Oregon.  A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection.  They told her it would be about 2 months for an appointment.  She then got the idea to go to the Emergency Room.  When she got there, there was about a 12 hour wait. She left the ER and went home.  When she got home, she called 911 and had an ambulance sent.  I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0.  Time saved, 2 months.

The system is definately broken.  But bringing everyone down the the lowest level is not going to fix it.  When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.

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## For-Life

> Because trying to get into a doctor that accepts Medicaid can result in a wait of 2-3 months.  Its much faster to go to the ER for every little thing. 
> 
> There is one situation that I remember hearing that happened in Oregon.  A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection.  They told her it would be about 2 months for an appointment.  She then got the idea to go to the Emergency Room.  When she got there, there was about a 12 hour wait. She left the ER and went home.  When she got home, she called 911 and had an ambulance sent.  I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0.  Time saved, 2 months.
> 
> The system is definately broken.  But bringing everyone down the the lowest level is not going to fix it.  When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.


So ignoring the problem or removing medicare, that is a better solution?  It seems that these individuals have a problem and are looking for a solution.

I hope you are not one of those people who decide to throw out a whole car when you only have a punctured tire.  Fix the problem, don't throw everything else.

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## gemstone

Why don't the US gov take a couple billion from the money they are printing up for GM, and pay for the few that have preexisting conditions?  Why take over the intire medical industry?  I guess it's the democratic way.  Take over the banks, auto manufactures and now the medical industry. Who cares about taxes we want to own it ALL?

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## For-Life

> Why don't the US gov take a couple billion from the money they are printing up for GM, and pay for the few that have preexisting conditions?  Why take over the intire medical industry?  I guess it's the democratic way.  Take over the banks, auto manufactures and now the medical industry. Who cares about taxes we want to own it ALL?


Why don't the insurance companies do what they are paid to do, instead of hiring people to investigate all medical claims?  Why is it that someone who pays over $10k a year for medical insurance is being told that they cannot get medical treatment.  They were responsible, they followed all of the rules, they are no agent of welfare who was not prepared.  

Maybe they were not prepare enough and on top of the $10k a year they paid for insurance, they should have saved $10k a year for contingency.  Is that the system you want?  Where all of your salary is spent on taxes to Insurance Companies?  Yes, it is a tax.  It is just one you pay to a private business versus the government.

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## Spexvet

I didn't vote, since the choices are all the same.

If I pay as an individual, I end up paying for my healthcare or for my insurance.

If all employers pay for healthcare or insurance, the price I pay for goods and services will be higher, so I end up paying for my healthcare or for my insurance.

If the government pays for healthcare or insurance, my taxes will be higher, so I end up paying for my healthcare or for my insurance.

What's the difference?

My feeling is that if you take all the money currently being spent on direct-to-provider payments, insurance premiums (by employer or individual), taxes, throw in the tax deductions exploited by using helthcare benefits as compensation, and remove the obscene profit and overhead of healthcare insurance and pharmaceutical companies, and add some inflation control, we consumers will come out ahead.

:cheers:

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## Spexvet

> Because trying to get into a doctor that accepts Medicaid can result in a wait of 2-3 months. Its much faster to go to the ER for every little thing. 
> 
> There is one situation that I remember hearing that happened in Oregon. A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection. They told her it would be about 2 months for an appointment. She then got the idea to go to the Emergency Room. When she got there, there was about a 12 hour wait. She left the ER and went home. When she got home, she called 911 and had an ambulance sent. I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0. Time saved, 2 months.
> 
> The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.


Wow. Sounds like the best, right, and most cost effective solution would be to see ALL patients in a timely manner.

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## bob_f_aboc

> So ignoring the problem or removing medicare, that is a better solution? It seems that these individuals have a problem and are looking for a solution.


I haven't mentioned Medicare in any of my posts. Medicare is a totally different situation than Medicaid. 
Medicare is intended to help those who have worked for most of their lives and retired to still have medical benefits.  Medicaid has become a substitute for getting a job.




> Why don't the insurance companies do what they are paid to do, instead of hiring people to investigate all medical claims? Why is it that someone who pays over $10k a year for medical insurance is being told that they cannot get medical treatment. They were responsible, they followed all of the rules, they are no agent of welfare who was not prepared. 
> 
> Maybe they were not prepare enough and on top of the $10k a year they paid for insurance, they should have saved $10k a year for contingency. Is that the system you want? Where all of your salary is spent on taxes to Insurance Companies? Yes, it is a tax. It is just one you pay to a private business versus the government.


Why not go back to the days of *Major Medical Insurance*? If you have a cold, you go to the doctor and pay for the office call out of pocket. If you are in a car accident or have a heart attack or come down with Ebola then the insurance company kicks in, for *major* injuries or illnesses.

If the insurance companies were removed from the equation, the cost of most routine medical care would drop like a rock. A doctor would much rather see 50 patients per day each paying $50 cash than seeing 50 patients per day and paying someone to file the insurance claims, half of which will be denied the first time for some reason, that will ultimately pay $40 for the office visit. Again, oversimplified, but you are looking at $2500/day without insurance vs. $2000 (eventually) *minus* $80 for the insurance filer ($10/hr x 8 hours) *minus* $100 for the billing coordinator to make collection calls *minus* $20 for letterhead, envelopes, postage, etc... to send out notices for delinquent accounts. Leaves $1800 income per day with insurance company involvement.

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## gemstone

> Why don't the insurance companies do what they are paid to do, instead of hiring people to investigate all medical claims?  Why is it that someone who pays over $10k a year for medical insurance is being told that they cannot get medical treatment.  They were responsible, they followed all of the rules, they are no agent of welfare who was not prepared.


I don't believe this.  Sounds like one side of the story.

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## HarryChiling

> Why don't the US gov take a couple billion from the money they are printing up for GM, and pay for the few that have preexisting conditions?


That's not gonna work, in bobs example it's the ones that don't go often that subsidize the ones that do go often, if we put all the high risk patients on one plan the thing will go bust fast, the idea of a government system is so that instead of corporate beuracrats we will replace them with government beuracrats.  I don't know if it will work, but I'm game to try it and see.  Of course if it doesn't work lets try something else, I'm kinda like For-Life on this one it'sa broke lets do something, but I also see the flaws in this plan.  

It doesn't help that the corporate health plans are throwing gobs of money at our government to try and keep the status quo when they could just be using thta moneyt o run the system more efficiently and actually pay for their patients care. 

Although the medicare system is broke they do have the lowest administration fee's and this is what is scaring the big insurance companies if they had to operate ont he same administration fees they'd starve and so would their investors.

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## Spexvet

> ... Medicaid has become a substitute for getting a job.


If Medicaid is a substitute for getting a job, then it's not Medicaid that's broken, it's how we compensate workers. Maybe if they could make a living with a job, including healthcrare, they'd get a job. Until then, it'll be a problem. Remember this great post?:



> Lets think about this...
> 
> $10/hr is a "great" wage. Its almost 2x the amount of minimum wage. But how far does it really go?
> 
> $10/hr x 40hrs x 52weeks a year = $20,800 
> 
> for a family of 2 this is more than what you can make to qualify for any assistance! (except maybe WIC for a child under 5)
> 
> 15% of that is the bare minimun to be taken out for taxes, unless you get jeapordize having to pay state and local taxes.
> ...





> ... Leaves $1800 income per day with insurance company involvement.


Yeah - who can live on $1800 a day? ;)

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## Spexvet

> ... the idea of a government system is so that instead of corporate beuracrats we will replace them with government beuracrats...


At least they'll be not-for-profit beaurocrats. :idea:

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## bob_f_aboc

> Yeah - who can live on $1800 a day? ;)


$1800/day x 5 days per week x 52 weeks per year - 9 holidays = $451,800

$451,800 - $60,000 ($5000/month) rent

$391,800 - $48,000 ($4000/month) equipment financing

$343,800 - $48,000 utilities, office supplies, etc...

$295,800 - $26,000 ($12.50/hr) billing coordinator

$269,800 - $20,800 ($10.00/hr) insurance filer

$249,000 - $120,000 ($40,000/year x 3) nurses

$129,000 - $83,200 ($10.00/hr x 4) front desk, lab tech, janitor, etc...

$45,800 Doctor Salary with *ZERO DOLLARS* re-invested in the business.

Makes med school seem worth it, huh?

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## Spexvet

> $1800/day x 5 days per week x 52 weeks per year - 9 holidays = $451,800
> 
> $451,800 - $60,000 ($5000/month) rent
> 
> $391,800 - $48,000 ($4000/month) equipment financing
> 
> $343,800 - $48,000 utilities, office supplies, etc...
> 
> $295,800 - $26,000 ($12.50/hr) billing coordinator
> ...





> ....$2000 
> ...*minus* $80 for the insurance filer ($10/hr x 8 hours) 
> *minus* $100 for the billing coordinator to make collection calls 
> *minus* $20 for letterhead, envelopes, postage, etc... to send out notices for delinquent accounts. Leaves $1800 income per day with insurance company involvement.


You're counting things twice! You're also overstaffed. This practice does at least 60 exams a day, with an office manager, a receptionist, a tech, and an insurance/letters/etc. person. And me. And I deliver more than twice your net to the doctor, by myself, from the dispensory.

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## Steve Machol

FWIW Medical Insurance is NOT the same as Healthcare. In fact Insurance companies have a fiduciary incentive to deny healthcare as much as they can. Furthermore these companies are actually rewarded by the financial markets when they pay a lower percentage of their customers' premiums out for claims. It's called the Medical Loss Ratio (aka, 'Your loss is our gain'.)

Second there is no 'free market' in medical insurance. No one can freely shop around for insurance and companies do not have to compete for our business. I cna choose which store I buy my groceries from. I cannot choose a medical insurance company.

Given these factors (not to mention the cost and results of healthcare in the U.S. vs. other industrial nations)  I have trouble understanding how anyone can defend the current fiasco that is the U.S. 'healthcare' system.

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## bob_f_aboc

> You're counting things twice! You're also overstaffed. This practice does at least 60 exams a day, with an office manager, a receptionist, a tech, and an insurance/letters/etc. person. And me. And I deliver more than twice your net to the doctor, by myself, from the dispensory.


_$1800/day x 5 days per week x 52 weeks per year - 9 holidays = $451,800

$451,800 - $60,000 ($5000/month) rent

$391,800 - $48,000 ($4000/month) equipment financing

$343,800 - $47,000 utilities, etc...

$297,800 - $120,000 ($40,000/year x 3) nurses 

$177,800 - $83,200 ($10.00/hr x 4) front desk, lab tech, janitor, etc...

$94,600 - $35,000 Office Manager (I forgot about this position)_

_$59,600 Doctor Salary with ZERO DOLLARS re-invested in the business.

Makes med school seem worth it, huh?_

_Corrected to account for double figures._

_How is this over-staffed for medical office?_

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## Spexvet

> _....__How is this over-staffed for medical office?_





> ... This practice does at least 60 exams a day, with an office manager, a receptionist, a tech, and an insurance/letters/etc. person. And me. And I deliver more than twice your net to the doctor, by myself, from the dispensory.


I can only tell you our staffing for this _medical office_. No need for 3 nurses, a janitor, etc.

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## For-Life

> I haven't mentioned Medicare in any of my posts. Medicare is a totally different situation than Medicaid. 
> Medicare is intended to help those who have worked for most of their lives and retired to still have medical benefits.  Medicaid has become a substitute for getting a job.
> 
> 
> Why not go back to the days of *Major Medical Insurance*? If you have a cold, you go to the doctor and pay for the office call out of pocket. If you are in a car accident or have a heart attack or come down with Ebola then the insurance company kicks in, for *major* injuries or illnesses.
> 
> If the insurance companies were removed from the equation, the cost of most routine medical care would drop like a rock. A doctor would much rather see 50 patients per day each paying $50 cash than seeing 50 patients per day and paying someone to file the insurance claims, half of which will be denied the first time for some reason, that will ultimately pay $40 for the office visit. Again, oversimplified, but you are looking at $2500/day without insurance vs. $2000 (eventually) *minus* $80 for the insurance filer ($10/hr x 8 hours) *minus* $100 for the billing coordinator to make collection calls *minus* $20 for letterhead, envelopes, postage, etc... to send out notices for delinquent accounts. Leaves $1800 income per day with insurance company involvement.



Because that situation is not competitive and will leave Americans with larger health bills.

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## For-Life

> I don't believe this.  Sounds like one side of the story.


It is a constant story posted from many different people.  When you have insurance agents and not doctors determining what tests you need, there is a problem.

I mean we always talk about bureaucratic governments, but what about bureaucratic insurance companies.  I work for the Ministry of Health and we have less staff than I hear the insurance companies in the US have.

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## bob_f_aboc

One more insurance issue to add. 

I just received a letter in the mail from my health insurance company today.  In it they explain that due to the high cost of prescription drugs they are changing the Rx policy.  Our plan was set up with $10 generics, $40 'formulary' brand name drugs, and $50 'non-formulary' drugs.

The new policy is $10 generics and the only brand name drugs covered were listed on just over half a page.  If your brand name medication is on the list, you will pay $40 or 40% of the retail cost, whichever is higher.  If your brand name drug is not on the list, you will pay the full retail price with no insurance coverage.

Luckily, the 6 different medications that my daughter has to take every day are all available as generics.  However, there are no ophthalmic brand name drugs anywhere on the list.

The letter goes on to say, (paraphrasing) if the medication that you take is not listed, speak to your doctor and request to have your medication switched to one of the covered brands.

I couldn't help but notice that about 75% of the covered brand names were from a single manufacturer...coincidence??

With health insurance like this, we don't even need doctors.  Next time I'm sick, I will just call the insurance company and ask what they want me to take.

Just something else that points to the fact that insurance companies are what is ruining healthcare.

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## Steve Machol

> It is a constant story posted from many different people.  When you have insurance agents and not doctors determining what tests you need, there is a problem.
> 
> I mean we always talk about bureaucratic governments, but what about bureaucratic insurance companies.  I work for the Ministry of Health and we have less staff than I hear the insurance companies in the US have.


Exactly. It amazes me when someone runs in horror at the thought of a 'government bureaucrat' determining what treatments you can have (which is a red herring that is not even something being considered) but they are perfectly happy having a insurance company bureaucrat make the same decision (which is EXACTLY what we have now.)

Let's compare the - Government bureaucrat who's ultimate resonsibility is to the taxpayer.

Or the Insurance company bureaucrat who's responsibility is to the shareholders of the company who reward them for not paying on claims (see previous link about Medical Loss Ratio.)

Anyone who prefers that latter is hopeless.

As for the bogus 'free market' claim there is no free market in healthcare in this country. Anyone making that claim either is lying or does not understand what a free market is. If there were then Medical Insurance would actually be equivalent to Health care (it isn't) and I could shop among many different companies who would compete for my business based on price and services (I can't and they don't.)

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## For-Life

I get daily health clippings, here is one of them.  In this one, it is interesting because it criticizes the Canadian system, but also offers ideas on what route the US should take.  Also, I know that me being a Canadian and commenting on the American system can be annoying.  But I think it is because I do not see people as Canadians or Americans, but people, and I just want people to have the best system.





> Much to learn from our health care; If Obama looked at our
> 
> successes and failures, he could avoid making the same
> 
> mistakes
> 
> (The Toronto Star)
> 
> IDNUMBER 200907190009
> ...

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## For-Life

> One more insurance issue to add. 
> 
> I just received a letter in the mail from my health insurance company today.  In it they explain that due to the high cost of prescription drugs they are changing the Rx policy.  Our plan was set up with $10 generics, $40 'formulary' brand name drugs, and $50 'non-formulary' drugs.
> 
> The new policy is $10 generics and the only brand name drugs covered were listed on just over half a page.  If your brand name medication is on the list, you will pay $40 or 40% of the retail cost, whichever is higher.  If your brand name drug is not on the list, you will pay the full retail price with no insurance coverage.
> 
> Luckily, the 6 different medications that my daughter has to take every day are all available as generics.  However, there are no ophthalmic brand name drugs anywhere on the list.
> 
> The letter goes on to say, (paraphrasing) if the medication that you take is not listed, speak to your doctor and request to have your medication switched to one of the covered brands.
> ...


You should watch the movie The Corporation.  It discusses part of the drug costs in the US.  I forget the main issue, but it had something to do with US drug companies being able to patent diseases.  Therefore, would have the ability to be the only producer for drugs for those problems.

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## bob_f_aboc

Why watch a movie about it?  I'm living it.

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## For-Life

> Why watch a movie about it?  I'm living it.


well it gives background information and talks about more than just drugs

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## Spexvet

> ...There is one situation that I remember hearing that happened in Oregon. A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection. They told her it would be about 2 months for an appointment. She then got the idea to go to the Emergency Room. When she got there, there was about a 12 hour wait. She left the ER and went home. When she got home, she called 911 and had an ambulance sent. I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0. Time saved, 2 months.
> 
> The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.


Currently, we have a for-profit system, and we have to deal with this type of situation:





> Doctors at UCLA determined she needed a transplant and sent a letter to Cigna Corp.s Cigna HealthCare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant, saying the procedure was experimental and outside the scope of coverage.
> The insurer reversed the decision Thursday as about 150 teenagers and nurses rallied outside of its office. But Nataline died hours later.

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## Spexvet

> ...The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.


 Do you accept Medicare at your practice?

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## bob_f_aboc

> Do you accept Medicare at your practice?


 
Yes!

We still have claims from May of 2008 that haven't been paid yet.  They have been submitted electronically and denied, submitted on paper and denied, submitted through a clearing-house and denied.

I can only imagine what this will be like when the government has its hands in ALL the insurance plans.

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## Spexvet

> Yes!
> 
> We still have claims from May of 2008 that haven't been paid yet. They have been submitted electronically and denied, submitted on paper and denied, submitted through a clearing-house and denied.
> 
> I can only imagine what this will be like when the government has its hands in ALL the insurance plans.


Then you need training on how to correctly file the claim. Why are you blaming everybody/everything else but you? We participate with Medicare. They reimburse VERY well,(better than any for-profit plan that I know of) and we have very few problems getting paid. Try calling them directly - they'll help you get your claims right.

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