| You are so right vincent. I have the advantage of being one of the people that worked at a hospital doing billing. I understand "most" of what the insurance companies are doing. The key word is "most". They change the rules so often you need a lawyer to keep up with the contract changes.
I think the only way we will ever get reform is for the system to totally disintigrate. We can't count on the politicians because they are backed by campaign contributions from the health insurance industry and pharmeceutical companies. Even if someone uses healthcare as their platform (Clinton) they will back out after elected. They can't afford to lose these special interest groups.
HMO's were not designed to save money for us. HMO's were designed to save money for the insurance companies. Their rules are designed to confuse not only the general public, but the providers themselves. We have more and more good doctors bailing out of the medical profession because they can no longer afford to care for patients. Anyone can be a doctor if they understand insurance rules.
Medical groups get paid a certain amount of money per month by the insurance companies depending on how many members they have. When you and I go to the doctor for a headache the doctor is paid only once a month for each patient no matter how many times they see them. So lets say they get $50.00 per month per patient. If I go to my PCP (primary care physician) once that month or ten times that month he/she still only gets $50.00. Ever wonder why they are booked up two months in advance??? There is your answer. If you tell the doctor ahead of time you have diabetes you will magically find out they are not taking new patients. You will take up to much of their time for to little money. They are also given a certain amount of money per month for specialty care. Lets say that amount is $5,000.00 per month. If one person in the group sends people in for a couple of CAT scans or MRI's that money disapears and the people in that medical group frown at that doctor. This is because, if there is any of that $5,000.00 at the end of the month, it is distributed between the doctors in the medical group. So, they have incentive NOT to send patients to get tests. My numbers were totally arbitrary, but you get the picture.
I am frightened the way things are going. Most people (and rightfully so) have no idea the games that are being played with our lives. They keep us confused and when we start to get it, they change the rules again.
Nancy  | 
