reply to post by InFriNiTee
That would be Medicare. Healthcare for the elderly.
Most people are not aware, but by the time you reach 65, the government REQUIRES you to enroll in Medicare. This is not an option. You may opt to go
with a private insurer such us United Healthcare, or Kaiser Permanente, but another thing that most people do not realize is that these insurers,
though seen as "private", follow what is known as "Medicare guidelines".
What is Medicare guidelines, you ask? This is rather simple, overall, though complicated in its detail. Simply put, Medicare has hugely detailed
outlines for what they call "allowables". What this means is, every disease, illness, injury, everything that requires a doctor's treatment, must meet
specific guidelines. There are flowsheets for everything, down to what requirements determine how and when you are released from the hospital, and if
or when you will be committed to a nursing home, deemed to no longer being able to live alone and care for yourself. The government knows best.
For instance, if you have a diabetic ulcer, and have a wound care nurse or a family memeber that treats and cares for this wound at home. The wound,
of course, requires cleaning, dressing, and bandaging, a certain number of times per day. This equals a certain number of times per week, per month.
All of this has been pre determined based on "normalized" guidelines. One size fits all. So, when the supplies for this home treatment are divied up
and sent to your home by mail, you get an exact amount, per Medicare Guidelines, no more, no less.
1 box of sterlie gloves - medium
2 packages of 50 2x2 sterile gauze
4 boxes 4x4 gauze pads
8 rolls Kerlix wrap
2 Ace bandages
1bottle Hydrogen Peroxide
This is just an example, but let's say the wound for some reason is especially draining or nasty this particular month, and the person treating your
wound uses more than the allotted amount. The Medicare patient, usually on a fixed disability or Social Security income anyway, is forced to pay for
any extra supplies out of pocket. This means no insurance coverage, no percentage off, no discounts, and must also pay the delivery cost.
Medicare Guidelines are extremely strict. They are wont to NOT give in to outside circumstances, because as I said, the flowcharts and pathways must
be followed, and one size fits all.
Many people are not aware this even exists, let alone that what one may consider "Private Insurers" follow this.
Just a little information to shed some light into a dark corner.
Medicaid is a totally different animal, and not to be confused with Medicare. Some of the most demanding, greediest, and stingiest people I have ever
run across just so happened to be Medicaid. As I said, a whole other story, and a particularly distasteful one, at that.
What this means in the end is, doctors with UHC, Kaiser, etc., will be forced to accept Medicare allowable payouts. Not market standard negotiated
rates as may be seen with other insurance companies.
P.S. If you haven't figured this out, I will simplify it. It is simply more manipulation towards a one-payor system based on the Medicare outline,
which fails our elderly seriously, as no two people are alike, no two health issues are alike, and cookie cutter guidelines are absurd, and geared
towards putting more expense onto the ill patient that may exceed what is considered allowable, yet, the least able to afford it.
edit on 16-11-2013 by Libertygal because: (no reason given)
edit on 16-11-2013 by Libertygal because: (no reason