Anthem and Anesthesia by the Minute?

CooCooforCoCoPuffs

CooCooforCoCoPuffs

Senior Member
So, since the shooting of the UH Executive, Anthem HC Insurance has reversed their proposal to limit the number of minutes of anesthesia for operations (Except for those persons under 22 and childbirth related anesthesia). So: IF your brain surgery operation - by statistics "should" take 3 hrs and 45mins Anthem would only pay for anesthesia for that number of minutes. If your surgery goes longer than that: you get stuck for anything charged as "over the limit" for a particular surgery. What do you think?
 

CooCooforCoCoPuffs said:
So, since the shooting of the UH Executive, Anthem HC Insurance has reversed their proposal to limit the number of minutes of anesthesia for operations (Except for those persons under 22 and childbirth related anesthesia). So: IF your brain surgery operation - by statistics "should" take 3 hrs and 45mins Anthem would only pay for anesthesia for that number of minutes. If your surgery goes longer than that: you get stuck for anything charged as "over the limit" for a particular surgery. What do you think?
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I think they're playing with their own lives. ;)
 
The cynical side of me wonders if this is a way to pull in some of UHC's policy holders? Sure happened fast after the murder when normally it probably would have taken months to change policy like that. I'm thinking there must be a big ulterior motive there and it most likely is driven by... yeah, the almighty dollar.
 
CallMeKate said:
The cynical side of me wonders if this is a way to pull in some of UHC's policy holders? Sure happened fast after the murder when normally it probably would have taken months to change policy like that. I'm thinking there must be a big ulterior motive there and it most likely is driven by... yeah, the almighty dollar.
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I worked for Blue Shield years ago. I was a medical reviewer...the person who reviews your claim for medical necessity, proper billing codes, prior treatments, etc.

Medical insurance companies intentionally make requests and claims confusing and nuanced for their customers and for their customer's physicians. They are intentionally vague when explaining the reasons for denials, rarely inform customers about the appeals process, and take their sweet time to communicate with your doctor, if they communicate with them at all. Even worse, medical insurance companies will change billing codes and prior treatment requirements without informing your doctor, which is pure evil because it adds several months or even over a year to the approval process...no matter what your diagnosis is or how critical or urgent the treatment is.
 
Looking at this as a Canadian, my reaction is....MAN am I ever glad I don't live in the USA. Seriously, you folks have my sympathy regarding the crazy puzzle factory that is US medical care and insurance coverage. JIM.
 
That change caught the attention of New York State’s governor and many other powerful people.

Anthem backed down but I’m confident that they will find another more subtle way to boost revenue and control costs.

We still haven’t done anything to address our expectations and our priorities about the things that are important to us.

We all need to take a hard look at how we earn our money and more importantly how we choose to spend our money.
 
Murrmurr said:
I worked for Blue Shield years ago. I was a medical reviewer...the person who reviews your claim for medical necessity, proper billing codes, prior treatments, etc.

Medical insurance companies intentionally make requests and claims confusing and nuanced for their customers and for their customer's physicians. They are intentionally vague when explaining the reasons for denials, rarely inform customers about the appeals process, and take their sweet time to communicate with your doctor, if they communicate with them at all. Even worse, medical insurance companies will change billing codes and prior treatment requirements without informing your doctor, which is pure evil because it adds several months or even over a year to the approval process...no matter what your diagnosis is or how critical or urgent the treatment is.
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I have to ask you........What training did you have to have, to be a "medical reviewer " ? I am not doubting what you wrote above, just trying to understand what kind of knowledge did that position require of you ? JIM.
 
Murrmurr said:
It would be even worse if we had nat'l healthcare (imo), because it would be as corrupt a system as medical insurance is.
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You are joking, right ? Try this...ASK the Canadians here on SF, if they would willingly switch their health care from the Canadian system, to the American one ? I'll get the popcorn ready...... JIM.
 
jimintoronto said:
I have to ask you........What training did you have to have, to be a "medical reviewer " ? I am not doubting what you wrote above, just trying to understand what kind of knowledge did that position require of you ? JIM.
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I was a licensed nurse and certified to administer Rx oral, IM, and IV medications. As a nurse, I worked in family medical clinics and psychiatric hospitals and residential facilities.
 
Murrmurr said:
Medical insurance companies intentionally make requests and claims confusing and nuanced for their customers and for their customer's physicians. They are intentionally vague when explaining the reasons for denials, rarely inform customers about the appeals process, and take their sweet time to communicate with your doctor, if they communicate with them at all.
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Sweeping reform is definitely needed in all areas of healthcare. My sister works in the medical field with billing codes and other areas, and has said the same. What we don't need is even more government control when it comes to our healthcare.
 
Murrmurr said:
I'm saying the US gov't would be nefarious if it managed a nat'l healthcare system.
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Each of the Canadian Provincial Governments operate their own health care programs. The Federal Government of Canada sets the standards that the Provinces have to live up to, and the Feds distribute funds to some of the less wealthy Provinces to balance their health care budgets. I guess we Canadians trust our Governments more than Americans trust their Government ? JIM.
 
Murrmurr said:
I'm saying the US gov't would be nefarious if it managed a nat'l healthcare system.
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@jimintoronto - I'll explain this a little further...

Elected officials at the federal level (congress/lawmakers) can become billionaires during their term of office by accepting bribes (there's no other word for it) from large corporations, such as tech giants and nationwide insurance companies. to make laws that benefit them even if it's harmful to regular people.

When you hear Americans say "take the money out of politics", this is what they're talking about.

Prohibiting elected officials from accepting huge "contributions" from major corporations, both during election campaigns and while in office, and imposing term limits, so there are no more career politicians, are 2 ways to end this problem.
 
Murrmurr said:
@jimintoronto - I'll explain this a little further...

Elected officials at the federal level (congress/lawmakers) can become billionaires during their term of office by accepting bribes (there's no other word for it) from large corporations, such as tech giants and nationwide insurance companies. to make laws that benefit them even if it's harmful to regular people.

When you hear Americans say "take the money out of politics", this is what they're talking about.

Prohibiting elected officials from accepting huge "contributions" from major corporations, both during election campaigns and while in office, and imposing term limits, so there are no more career politicians, are 2 ways to end this problem.
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Thanks for your explanation. Now read this........In Canada Corporations AND trade Unions are specifically prohibited from making ANY donations to a political party or individual Member of either the Federal OR Provincial Parliaments. Individual Canadians are RESTRICTED to donate ONLY $1750.00 per year to a party, or a candidate for office at any level of government . Most Canadian voters do not belong to a political party at any level of Government, and at the municipal level, there are no party indicators at all when you go to cast your ballot. JIM.
 
jimintoronto said:
Each of the Canadian Provincial Governments operate their own health care programs. The Federal Government of Canada sets the standards that the Provinces have to live up to, and the Feds distribute funds to some of the less wealthy Provinces to balance their health care budgets. I guess we Canadians trust our Governments more than Americans trust their Government ? JIM.
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US counties manage their own healthcare programs that are funded by state and county taxes and a federal subsidy. People who rely on county assistance for medical care get a bare-bones level of care. County medical clinics are often crowded, understaffed, and poorly equipped, and the equipment is often outdated.

Normally, each clinic has only one doctor, and the doctor works at the clinic one day a week. The doctor is more an advisor than a treating physician. Patients are most often seen by a nurse, physician's assistant, or medical assistant. Wait times for an appointment is much longer than it would be with a private physician.

There are many more problems, but I don't want to list them.

Muskrat said:
People seem to forget that medicare is government health insurance. Both the VA hospital and IHS are government ran systems.
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And they are substandard.
 
jimintoronto said:
Thanks for your explanation. Now read this........In Canada Corporations AND trade Unions are specifically prohibited from making ANY donations to a political party or individual Member of either the Federal OR Provincial Parliaments. Individual Canadians are RESTRICTED to donate ONLY $1750.00 per year to a party, or a candidate for office at any level of government . Most Canadian voters do not belong to a political party at any level of Government, and at the municipal level, there are no party indicators at all when you go to cast your ballot. JIM.
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Yes, I know. Americans have been begging for limits for decades....but we're begging for this from the very people who make the laws.

These concerns have to be taken up with either the Supreme Court or the president. Problem with taking it up with a president is that the pres has usually been a former member of congress, and is still a friend to many of its members.
 
Murrmurr said:
Yes, I know. Americans have been begging for limits for decades....but we're begging for this from the very people who make the laws.

These concerns have to be taken up with either the Supreme Court or the president. Problem with taking it up with a president is that the pres has usually been a former member of congress, and is still a friend to many of its members.
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On another forum, I am talking to a US man who takes a monthly injection of a med called Xolair, that treats his asthma condition. It costs his medical insurance about $3000 USD per injection, times 12 injections a year, equals about $36,000 USD a year. I looked up that med Xolair at a Toronto pharmacy store. The same drug ( made in the USA ) costs $1468 Canadian per injection, which is about $1042 USD per injection. In other words the American patient's medical insurance company is paying three times what the same drug costs IN Canada to treat the same condition. JIM.
 
CallMeKate said:
Sweeping reform is definitely needed in all areas of healthcare. My sister works in the medical field with billing codes and other areas, and has said the same. What we don't need is even more government control when it comes to our healthcare.
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If we don't have more government control of our healthcare, who's going to do the reforming? It's surely not going to happen from within the industry; the only thing they care about is profits and they're beholden to no one but their shareholders. The only way it's going to happen is through legislation.
 

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