hmo's

Una foto que tome ayer antes de que empezara la marcha donde se exigía los derechos de los animales y justicia por el perro Minitas que fue golpeado múltiples veces con un machete. Lo rescataron pero desgraciadamente murió dos días después de la operación.
Ver este tipo de acciones me hace darme cuenta que Hermosillo está avanzando poco a poco. Aunque sea en pasos de bebe 👶🐶🐱🐯🐷🐮🐰🐺🐵🐦🐔🐙🐳🐠🐟🐝🐣🐢 #NoalMaltratoAnimal #NoCompresAdopta #hmo #AnimalistasUnidos (en Catedral Metropolitana de Hermosillo)

Spurred by whistle-blower complaints from Kaiser’s own mental health clinicians, an investigation by the state’s Department of Managed Health Care found the HMO guilty of serious and systemic violations of California law that put mental health patients at risk. The result: In June 2013, the DMHC levied a $4 million fine — the second-largest in the agency’s history — against Kaiser for forcing thousands of patients to endure illegally lengthy waits for care, falsifying patients’ appointment records, and violating the California Mental Health Parity Act, which requires HMOs to provide psychiatric services that are on par with their primary health services.
Hunger Games, HMO-style

One of my partners, an ear nose and throat surgeon resigned years ago from a particularly abusive HMO.  He said, “never again,” as did all of the reputable ear nose and throat surgeons in the area, physicians whose practices were already solid and busy without having to deal with this outfit.  Even though many of the HMO’s are long dead and gone from Oklahoma, this particular HMO has lingered on, only to crawl back to this partner of mine, telling him to make them an offer.  They had, very simply, lost every single ear nose and throat surgeon from their “panel,"even the not-so-good ones.

He made them an offer he knew they would refuse, a ridiculous amount, one that would make this pathetic organization his best source of payment.  They accepted.  

His presence on their "panel” allowed the HMO to advertise….well…to advertise his presence on their “panel.”  Having quality ear nose and throat coverage made their product easier to sell to reluctant employer groups, most of which know the HMO hunger games by now.  Things seemed to be going well for about three months when he noticed a sudden change.  The HMO had made it impossible to schedule a patient for surgery.  Phone call after phone call.  Extended phone consultations with remote nurse manager-gatekeepers to review the indications and justify the need for surgery.  Lost, needing-to-be-refiled paperwork.  Waiting on hold for 30 minutes while attempting to obtain pre-authorization for CT scans for patients needing sinus surgery.  And more.

It dawned on my partner that what the “beneficiaries” of this HMO had as a benefit, was not unlike what the beneficiaries of the Canadian system have and what people in this country under “Obamacare” will have:  a right to hope for care, or a right to a place in line.  A health care card in your wallet may mean nothing.  As Dr. Jane Orient has now famously said, “coverage doesn’t mean care.”  

The poor child with gigantic tonsils and adenoids with sleep apnea and chronic ear infections who could be spared all of this misery with a 20 minute operation is left holding the bag.  The parents, frustrated with this waiting game of insurance approval, are now very troubled to find out that my partner has resigned once again from this HMO.  What will they do now?

If they follow the example of many patients that have been down this road, they will wind up at our facility, paying a fair price for their child’s surgery, a price that is within their budget and having their child’s surgery done immediately, and done by the surgeon they have rightly come to trust and respect.  They will wonder afterwards why they have “insurance” at all.  They will wonder if some “insurances” are really a black mark, that actually prevent them from receiving care.  Finally and angrily they may conclude that this whole HMO idea must be good for someone, just not the patients covered by “the plan.”  

I think this illustrates that while the central planners of HMO’s or ACO’s or government health care may boast that the reimbursement levels they have arbitrarily concocted are sound and fair, they will always retain the powerful tool of rationing-access-by-bureaucracy, an incredibly cruel way to balance a budget or book a profit.

G. Keith Smith, M.D.

You can see our prices here.

New Post has been published on http://hospitaljobs.us.com/understands-hmos-and-preferred-providers-in-health-insurance/?utm_source=TR&utm_medium=&utm_campaign=SNAP

Understands HMO’s And Preferred Providers In Health Insurance


by Leader Nancy Pelosi

Health insurance coverage is a should-have in the event you have a critical health-related emergency. You never know when disaster will strike in the type of illness, accident or injury. If you aren’t ready with a great well being insurance coverage program, you could stand to shed every little thing. If you have a good overall health plan in place, you can rest easy that your expenses will be taken care of. You have a couple of selections when it comes to purchasing wellness insurance. You can go with an person program, or if your employer delivers group insurance, you can save cash by picking that plan.

Ahead of you modify your overall health insurance program, verify to see if your personal or family members doctor is incorporated in the coverage. Some insurance businesses will only cover you if you use their physicians, so you may possibly want to steer clear if your loved ones physician is not an approved one particular in their network.

When applying for health insurance coverage, have a talk with your doctor. Have him pull your health-related records so you can be certain that there are no inaccuracies, and that there is practically nothing that could be detrimental to your chances of obtaining insurance. Look back at least ten years, as some health insurance firms do.

If you travel often, it is important to get healthcare coverage that can be employed throughout the nation. If you do not have this, you do not want to be visiting an additional state and get sick. If this had been to come about, you would be stuck paying healthcare bills that your health-related insurance coverage would have covered, had you been in your house state.

Do not lie about anything when taking out a wellness insurance policy. It may be tempting to omit specific specifics. Resist the urge and be totally truthful. A small white lie can make your entire policy useless. You do not want to uncover oneself stuck with the bill if you happen to get hospitalized and caught in a lie.

If you plan to have a child soon, you ought to uncover a healthcare program that will cover all expenses relating to your pregnancy, labor and delivery. Some heath insurance policies do not cover some or all of pregnancy-related services.

Believe about using an insurance broker. A broker can be invaluable when looking for wellness insurance coverage. They will shop for the very best rates, locate the ideal firm, and clarify specifically what the program indicates. You can find a suitable broker through naic.org or nahu.org. Each of these internet sites have a list of trustworthy brokers in your area.

Spend extremely close interest to each and every aspect of your bill. You may possibly feel that due to the fact you have health insurance that the added expenses you have to spend will be low. In some circumstances though, this can be incorrect, especially when the cost of prescriptions are taken into consideration. Some medical doctors will create out their prescriptions with the name brand only, never ever thinking of the generic. Don’t hesitate to compare costs as effectively. The quantity that you will pay for the generic medication may be much more at one particular pharmacy, and less at an additional.

Ahead of finalizing a deal with a distinct agency, be confident to study some customer testimonials about them. There are numerous internet sites on the web that enable customers to make complaints about items or client service and this is accurate of insurance providers as nicely. If you have noticed that they have many complaints, it may be time to locate an additional alternative.

When it comes to preparing to change your well being insurance coverage policy, be certain to make a list of all the medicines that you or your dependents are taking. Add the annual total. If they’re covered by your present strategy, add your co-spend separately and view the price of what it’d be with out your policy.

When person and group wellness insurance coverage policies are compared, you will see group insurance coverage may possibly be much less expensive each month, but individual policies might supply far more choices. It is essential that you have some kind of health insurance guarding you. To not have well being insurance coverage right now really is a recipe for disaster. If you all of a sudden fall ill, the fees could devour your savings in no time. Be intelligent, and look into wellness insurance coverage possibilities as soon as achievable.

Medical Third Party Payment Distortions

I thought it would be a good time to review the distortion in the health marketplace that third parties represent.  First we’ll start with price distortions then we’ll review the effect of third parties on quality of delivered care.

Price:

Whenever third parties are inserted into the mix, the price of any service will rise.  We have discussed before that the price of a roof repair or hail damage to your car are higher if insurance is involved.  The presence of third parties distorts the price by removing some (most) of the accountability that is normally present in free exchange, as the constant evaluation of a deal of any kind to obey the “win, win” rule is largely eliminated.

This is particularly true for health care.  The government, as a third party payor, is the most distorting influence of all.  The price rises because “someone else’s money” is being spent.  Remember Bastiat’s definition of government as that great fiction whereby everyone attempts to live at the expense of everyone else.  Government as a third party also increases the likelihood that a service will be demanded or purchased as the perceived price for the purchaser approaches zero.  This is akin to a teenager with his/her parent’s credit card or an unhinged travelling executive on an expense account.

Third party organizations such as HMO’s wouldn’t even exist were it not for the government.  Employer purchase of health insurance is the only reason HMO’s exist, as no individual would subject their family to any product like this voluntarily, where their doctor actually makes more money, to the extent that he denies care to you, your spouse or child.  Many believe that this top down control is necessary to curb the excesses of the “zero out of pocket” influence, while the real issue is the existence of an arrangement like this in the first place, one most certainly not characterized as “win, win.”

Third party presence enables fraud like no other influence and contributes therefore to a higher price for everyone as a result.

Quality:

Third parties allow awful physicians to maintain busy, lucrative practices, as an HMO, for instance, can fill the waiting room of a surgeon-butcher that otherwise would be bankrupt from a well-deserved and empty waiting room.  

The physician’s payment when third parties are present, is guaranteed regardless of the patient’s satisfaction with their treatment.  Much of the accountability of the physician to their patient is absent with intervening third parties.  What other industry can provide horrible service and treatment with no worries about payment?  

Hospitals and insurance companies have created and benefit from “network” arrangements that guarantee patient “funneling” regardless of the ability to provide good outcomes at reasonable prices.  One variation of this is the hospital-employee physician model where hospitals through coercive networking arrangements attract patients then “assign” them to the doctors who work for them, because they work for them, not because they are any good.  Physicians in this arrangement are relieved of the pressure to build a practice through quality service and reputation.   

The tax deductibility of insurance purchases by employers but not by employees allows for the existence of otherwise market-unworthy insurance arrangements (like HMO’s) that invariably attract the most incompetent and despicable actors, as those physicians and caregivers with healthy practices tend not to enter in to these arrangements.  

I marvel at organizations whose aim is to evaluate or put their stamp of approval on quality parameters.  No more cruel quality taskmaster exists than the free market.  In the market, if you are awful, you disappear, go bankrupt.  No quality control is necessary as long as the market is allowed to work.  Third party involvement in payment  for medical services, that of the federal government in particular, has interfered with the normal market-cleansing effect in medical practice that plagues the incompetent and unethical in every other industry.  

The emphasis on “insurance coverage for everyone” is exactly the wrong solution to the high price and sporadic quality of health care in the U.S.  Adherence to the principles of the free market will lower the price and raise the quality of care for all.  

G. Keith Smith, M.D.

Top surgery coverage shenanigans.

Ok. So I have health insurance through Kaiser of the mid-atlantic states. Kaiser is an HMO type system where most things are done in their network.
They have been going on a transformative journey regarding their policies for transgender care. (hahah transformative) I know this because I was really lucky and I started with them 2 years ago when all of it was starting. They have been covering my hormones and they have been taking active steps to learn how to best treat me in a respectable way.

I am currently trying to get them to cover top surgery for me. They currently won’t but I think there are several reasons that show that they could easily change their mind. 

1. They legally are being forced to cover gender reassignment surgeries for residents of DC and for federal employees and Maryland state employees. I live in Virginia where they are not being forced to cover me.
2. They have been flipping back and forth for two years. Like they have literally been questioning whether or not to cover gender reassignment surgeries each year.
3. Other Kaiser branches cover the surgeries.

I really believe that if people confronted them about this that they would change. They already have the doctors and the system in place.
I do not know how to spread this around.
But I am really not trying to do this for my top surgery. I mean I am, but if they covered it for Virginia people it would be such a huge step.