# Bills for ambulance transporation



## cmdmfr (May 26, 2015)

is there anyone out there that can help me with a debit that may turn into a collection.  I have an auto accident in April on Hilton Head Island. I had medcial insurance for auto. My medcial paid part of it and there was a remining Balance of $220.00. I told the girl that I can pay only $5.00 a month and that is it. She said that they will take no less than $25.00. I have sent a check for $5.00 to show that I am willing to pay. I was told that as per the fair debt collections act that I can send in only what I can afford, and that they can not turn me down. If they do turn me down then thay are not allow to put me ina collection agencey because I am trying to pay. 

I am not familar with the Fair Debt Collections act but Like I said that I can pay only what I can afford and they cannot do nothing to me becasu I am trying.  

Any help on this matter would be appericated.


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## am1 (May 26, 2015)

For that amount I would find a away to pay it.  They can create a lot more hassle and expense for you if they choose.  

I wish you the best.


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## tschwa2 (May 26, 2015)

https://www.ftc.gov/system/files/documents/plain-language/fair-debt-collection-practices-act.pdf

I am not a lawyer and this is my opinion based on a 2 minute read and internet search:

I just took a look and the Fair Debt Collection Act seems to only apply to debt collectors.  If it is someone from the Ambulance company it does not apply.  Only when they sell the debt or hire a 3rd party bill collector does the act kick in.  You can negotiate but the ambulance company does not have to accept your $5.00 payment if they state $25 is their minimum.  

http://fairhealthconsumer.org/reimbursementseries.php?id=64&terms=understanding-your-medical-bill
This site also has some advice about contacting consumer assistance agencies to apply for assistance.


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## am1 (May 26, 2015)

How much is it to mail in a $5 check?  I would sell my timeshares, sell my car, and cut my internet.  Or at least one of these so I could pay off the debt.


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## ronparise (May 26, 2015)

I think I would either pay or not, but $5 is silly.  Its hard to believe that $5 is all you can afford when you can afford to vacation on Hilton Head.  You are just messing with them, or at least thats what I would be doing with such an offer.


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## Beaglemom3 (May 26, 2015)

Will they accept a credit card payment in full ?  

Simple advice.........pay them what they're due and then pay the credit card charge off.

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## billymach4 (May 26, 2015)

am1 said:


> How much is it to mail in a $5 check?  I would sell my timeshares, sell my car, and cut my internet.  Or at least one of these so I could pay off the debt.



Online Bill pay $5 is free to send.

$5 is $5 .


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## am1 (May 26, 2015)

billymach4 said:


> Online Bill pay $5 is free to send.
> 
> $5 is $5 .



She sent a check.  What is the cost to the company to process a check for $5?


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## winnipiseogee (May 27, 2015)

I own an ambulance service and I can tell you that there is no fair debt collections act that allows you to pay only $5 a month (although many many people seem to think there is).   The rule is you pay the bill or you are put into collections.  We regularly allow people to go on payment plans but only if its a sincere effort to pay.   I doubt the ambulance service believes that 4 years to pay a $200 bill is sincere.  Sorry


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## vacationhopeful (May 27, 2015)

Around my neck of the USA, a non medical treatment transport in an ambulance is over $1000 for a 10 minute run. Each way.

Cut your cableTV options to pay the bill in full ASAP ... I find it very hard to believe you ONLY have $5 in your entire monthly budget to pay for a service that appears reasonable.

Of course, next time you might consider hitchhiking to the hospital or just riding in the tow truck to the impound lot or getting a cab to a medical office.


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## WinniWoman (May 27, 2015)

Seriously, $220! These people saved your life! Many ambulance/EMT workers are volunteers as well. At the very least, they are low paid. Just put it on a credit card- pay them- and then you can pay the minimum to the credit card as you rack up interest rate debt. Or- how about just pay them in full and be done with it? It's not like it's thousands of dollars! Be grateful! You came out of a car accident alive!


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## WinniWoman (May 27, 2015)

Just reminded of the time last year when we thought my husband was having a heart attack. The ambulance came and did a full check and determined he did not have a heart attack, but to be sure he should be checked at the hospital. Me, being in the medical field, knew the trip would be almost $1000, so I decided to drive my husband by myself, releasing the ambulance of any liability. But be sure- if he was having an heart attack I would have gladly paid the $1000 to get him to the hospital alive, even if I had to eat ramen noodles every day for a few months.


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## am1 (May 27, 2015)

mpumilia said:


> Just reminded of the time last year when we thought my husband was having a heart attack. The ambulance came and did a full check and determined he did not have a heart attack, but to be sure he should be checked at the hospital. Me, being in the medical field, knew the trip would be almost $1000, so I decided to drive my husband by myself, releasing the ambulance of any liability. But be sure- if he was having an heart attack I would have gladly paid the $1000 to get him to the hospital alive, even if I had to eat ramen noodles every day for a few months.



Glad your husband was okay but what would have happened if on route he needed help?  People should not have to choose between taking an ambulance and a $1000 bill or risk going in a car or without.


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## vacationhopeful (May 27, 2015)

am1 said:


> Glad your husband was okay but what would have happened if on route he needed help?  People should not have to choose between taking an ambulance and a $1000 bill or risk going in a car or without.



Which is WHY the ambulance services do NOT REQUIRE PAYMENT before transport.

I transported my elderly mother with dementia multiple times in my vehicle for dentist appointments, hair cutting at the salon, routine medical treatments, etc from her assisted living home - my Dad could not handle her nor would she comply with getting into a car (not necessary just a low car) but could be gotten into my pickup truck ... in her wheelchair tied down in the back bed, hair flying and arms windmilling, with her screaming at cars coming up on us.... (only joking, she rode in the cab with me ... but many people totally believed that line ).


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## theo (May 27, 2015)

Beaglemom3 said:


> Will they accept a credit card payment in full ?
> 
> Simple advice.........pay them what they're due and then pay the credit card charge off.



Yes, this. Pay the ambulance company the $220 owed to them, in full and promptly. If you need to make tiny monthly payments, do so on your own credit card account.


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## Clemson Fan (May 27, 2015)

ronparise said:


> I think I would either pay or not, but $5 is silly.  Its hard to believe that $5 is all you can afford when you can afford to vacation on Hilton Head.  You are just messing with them, or at least thats what I would be doing with such an offer.



Yup, the OP is just being an a$$ to the ambulance company.

Do you really think it's fair or reasonable to ask the ambulance company to keep track of YOUR debt on their books for 44 months!?

He owns a golf cart and has enough equity in a home to worry about asset protecting it.


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## VacationForever (May 27, 2015)

OP. I don't know you.  But all I can say is pay up the $220 in full.  I cannot believe that I am even reading this post.


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## Mr. Vker (May 27, 2015)

sptung said:


> OP. I don't know you.  But all I can say is pay up the $220 in full.  I cannot believe that I am even reading this post.



This.

TUG consists of people that have been able to invest in vacation ownership. Not everyone can say that. If you can't pay $220 for an ambulance bill, how can you  afford MF's?

It's true-situations can change. So, I looked at your other posts. You are planning a trip to Aruba and a long weekend in the Blue Ridge Mountains. Get your priorities in line. 

This sounds like a choice. A poor choice.


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## Jason245 (May 27, 2015)

I could possibly understand you asking this question for $22,000 or $2,200, but $220....

Pay your bills [deleted], and if you don't want to have to pay this amount of copay in the future, get better and more comprehensive insurance.


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## DeniseM (May 27, 2015)

Folks - the OP did ask for advice, but let's keep it civil, please.


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## x3 skier (May 27, 2015)

DeniseM said:


> Folks - the OP did ask for advice, but let's keep it civil, please.



Agree but $5 a month is a bit strange to be ".....only what I can afford..." when one takes vacations and owns a car. I'm sure there's someplace in the budget for $25 a month, even if it means giving up something else like eating out on vacation.

Cheers


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## Jason245 (May 27, 2015)

x3 skier said:


> Agree but $5 a month is a bit strange to be ".....only what I can afford..." when one takes vacations and owns a car. I'm sure there's someplace in the budget for $25 a month, even if it means giving up something else like eating out on vacation.
> 
> Cheers



It just sounds to me like the OP is being "a person who deliberately avoids paying debts."


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## geekette (May 27, 2015)

Jason245 said:


> It just sounds to me like the OP is being "a person who deliberately avoids paying debts."



That is, sadly, how it sounds to me, too, since they are actively, deliberately stringing this out, looking for legislative loopholes, carefully sidestepping collections, asking us to help sidestep collections and continue non-payment!   Even these little non-pays end up coming out of the pockets of those that can afford and do pay their bills,   You and Me.  Makes me mad.  I cannot muster sympathy in this case but am sorry if op has lingering injuries.

I also find it contradictory that they cannot afford $25 a month based on other details, including vacations w/ rental cars, and that all but this 220 was paid by insurance.  

What puzzles me most is how can one put so much energy into not paying such a trivial amount?  Even posting online to see if another way to snake around it.   Seems like it would cost more in time and effort to not pay than just be done with it with one check.  Why??


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## tschwa2 (May 27, 2015)

I come from a split home and the agreement was that my father had to pay medical bills for me and my brother.  He did pay child support but was a single man working for 20+ years at the Social Security Administration.  He regularly called the doctors/dentists, etc. and told them that $10 was all he could afford to pay each month.  It was annoying and on the embarrassing side as a teenager.  And that was 20 years ago.  

I sympathize with the OP if he/she is currently in dire straights but skip the vacations, default on your MF's if you have to but pay the $25 minimum, $5 is not a reasonable amount to pay.


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## silentg (May 27, 2015)

vacationhopeful said:


> Which is WHY the ambulance services do NOT REQUIRE PAYMENT before transport.
> 
> I transported my elderly mother with dementia multiple times in my vehicle for dentist appointments, hair cutting at the salon, routine medical treatments, etc from her assisted living home - my Dad could not handle her nor would she comply with getting into a car (not necessary just a low car) but could be gotten into my pickup truck ... in her wheelchair tied down in the back bed, hair flying and arms windmilling, with her screaming at cars coming up on us.... (only joking, she rode in the cab with me ... but many people totally believed that line ).



All I can picture is Granny Clampett on the back of Jethro's truck:rofl:


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## cmdmfr (May 27, 2015)

*Ambulance bills*

I am glad that every one up here has the answer to my question but the only problem is its all the wrong answer. one said I was on the cell well I do not own one and wont because it cost too much and as to going to aruba and the blue ridge you are right I worked all my life and an am on disability because of some dummy that was not paying attention to the road. The incident has cost me 7 operations and the insurance company has went bankrupt and left me quite q few bills. I do not get a check every week. And if you would like to help me pay my bills with a small check from disability I will glad to take the help. Also if you think I am going to sit in a chair and die WRONG  so let me know when you want to help me with my bills and let me know. Oh also if you think that I can sue and get rich Think Again because you have the wrong answer. If you want my account number so you can help pay the bill let me know, and as to sell my computer I do not own one but do have use of one. If you have one and would like to donate it let me know


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## Jason245 (May 27, 2015)

Then pay nothing, . You have no assets and no income that can be garnished.  You are judgement proof.  This is also how you can get out of your timeshare liability.


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## Wonka (May 27, 2015)

In the past we've given up vacations because of unexpected changes in our financial situation.  It was the 1st thing we did to adjust our income until we recovered.  It was more important to us to pay our bills than take a vacation.  It's hard to understand your priorities.  

When I first read your thread, I was sympathetic and felt the other poster's were being too harsh.  Vacations are a luxury, not a necessity.  I do, however, wish you the best of luck and hope your situation improves.  But, I doubt you'll get many donations here to help your situation.


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## dioxide45 (May 27, 2015)

This really doesn't apply, but it is about the issue with medical costs.

I was really taken to the cleaners on Voice Therapy. Imagine that, you get strain and fatigue in your voice, $120+ for the ENT. Then they send you for a videostroboscopy, $450+. Nothing major, just not talking right perhaps some acid reflux. Then you go back to the ENT for them to tell you the results, $65. Then you go for voice therapy, first session $300, each on therafter $150. They wanted to do another videostroboscopy, I said no. I have a followup with the first ENT coming up, I will be cancelling that. They will charge me a bunch of money to tell me something I already know.

I will admit, the voice therapy has helped, or it could have been the Prilosec the also told me to take as it could all be reflux related.    I do think $1400 is a little ridiculous for the services offered.


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## Talent312 (May 27, 2015)

cmdmfr said:


> I am glad that every one up here has the answer to my question but the only problem is its all the wrong answer.



You asked if you could insist that they accept $5/month and you were told, correctly, that no law requires a creditor to accept partial payments for services rendered, absent an agreement by both parties. Their willingness to accept $25/month is a voluntary accommodation on their part.

OTOH, it does sound like you are judgment-proof, meaning they could take you to small claims court and get a judgment, but come to find that you have no assets which they could attach and no income which they could garnish. You could also file Bankruptcy, but that would cost more than the debt itself.  

It's likely that they'll hound you for a while and eventually write it off.
In short, $5/month won't cut it, but ultimately, its your call to pay or not.
.


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## Talent312 (May 27, 2015)

dioxide45 said:


> I was really taken to the cleaners on Voice Therapy... I will admit, the voice therapy has helped, or it could have been the Prilosec the also told me to take as it could all be reflux related.    I do think $1400 is a little ridiculous for the services offered.



I'm convinced that the medical profession is by and large a racket. They run you thru a mill designed not so much to provide a service as to fleece you and your insurance company of as much $$ as they can get away with. A periodontist wants me to hand over $4340 (after dental insurance) for an implant. These things are less that 1/2 that price in Mexico. Hmmm.
... And I thought my mechanic was a rip-off artist.
.


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## SMHarman (May 27, 2015)

http://mobile.nytimes.com/2015/05/0...nned-at-the-sky-high-bill.html?referrer=&_r=0


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## tante (May 27, 2015)

Talent312 said:


> I'm convinced that the medical profession is by and large a racket. They run you thru a mill designed not so much to provide a service as to fleece you and your insurance company of as much $$ as they can get away with. A periodontist wants me to hand over $4340 (after dental insurance) for an implant. These things are less that 1/2 that price in Mexico. Hmmm.
> ... And I thought my mechanic was a rip-off artist.
> .



I wish i could defend it but I can't. I had knee surgery in November and my bills for physical therapy were between $800 and $1200 for 45 minutes. My portion was $80 or so dollars, which i still found outrageous. There is no way it costs the hospital even half that amount ($800 part) to provide the service. We really need to get to the point where we should know what treatment will cost us before we get it. I guess that is one good argument for single payer.


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## Clemson Fan (May 28, 2015)

cmdmfr said:


> I am glad that every one up here has the answer to my question but the only problem is its all the wrong answer. one said I was on the cell well I do not own one and wont because it cost too much and as to going to aruba and the blue ridge you are right I worked all my life and an am on disability because of some dummy that was not paying attention to the road. The incident has cost me 7 operations and the insurance company has went bankrupt and left me quite q few bills. I do not get a check every week. And if you would like to help me pay my bills with a small check from disability I will glad to take the help. Also if you think I am going to sit in a chair and die WRONG  so let me know when you want to help me with my bills and let me know. Oh also if you think that I can sue and get rich Think Again because you have the wrong answer. If you want my account number so you can help pay the bill let me know, and as to sell my computer I do not own one but do have use of one. If you have one and would like to donate it let me know



Oh cry me a river. 

You own a car that you were wondering about registering in one name vs. both you and your wife because you also own a home that has some assets within it because you're worried about a lawsuit generated from a car accident possibly getting access to your home's assets.

You own a golf cart that you had some insurance questions on.

You own not one, but multiple, timeshares.

Frankly sir, I don't believe your new claims of poverty.


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## Jason245 (May 28, 2015)

Talent312 said:


> I'm convinced that the medical profession is by and large a racket. They run you thru a mill designed not so much to provide a service as to fleece you and your insurance company of as much $$ as they can get away with. A periodontist wants me to hand over $4340 (after dental insurance) for an implant. These things are less that 1/2 that price in Mexico. Hmmm.
> ... And I thought my mechanic was a rip-off artist.
> .


I ask how much for everything before any medical procedures are done on me or family.  You don't? 


tante said:


> I wish i could defend it but I can't. I had knee surgery in November and my bills for physical therapy were between $800 and $1200 for 45 minutes. My portion was $80 or so dollars, which i still found outrageous. There is no way it costs the hospital even half that amount ($800 part) to provide the service. We really need to get to the point where we should know what treatment will cost us before we get it. I guess that is one good argument for single payer.


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## vacationhopeful (May 28, 2015)

Jason245 said:


> I ask how much for everything before any medical procedures are done on me or family.  You don't?



The problem here is all there services are billed separately ... it is like unraveling a bowl of noodles. And billing is NOT part of the office you see for appointments .. it is somewhere else and they don't get YOUR file til after the service is provided -- the REAL service given might not be WHAT the original estimated service. And again .. it all depends on the repayment YOUR insurance gives back and YOUR deductibles at that moment in time.

Estimates are NOT provided and if provided, are NOT cast in concrete ... and all subject to YOUR insurance and deductibles.

I had surgery 2 years ago. My follow ups at 3 month, 6 month, 9 month and so forth were at the doctor's office ... 45 seconds face time, no tests, just visional look-see ... except the doctor's office was considered by THEM to be a surgery center (not) and the bill was over $600 from my insurance company for each visit.... what a crock of crap! Did NOT meet the NEW deductible for surgery ... and doctor's office expected ME to just WRITE a check for $600+ ... Office specialist visits were $50 co-pay ... but not office surgerical procedures (had no procedure in office).

It is ALL in the medical "coding" for billing ... another specialized field to get MORE money out of the insurance companies and the "paying" customers .... estimates --- favorite line is CALL YOUR INSURANCE COMAPNY who says "can't give a price as we don't know what the procedure is".


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## Jason245 (May 28, 2015)

vacationhopeful said:


> The problem here is all there services are billed separately ... it is like unraveling a bowl of noodles. And billing is NOT part of the office you see for appointments .. it is somewhere else and they don't get YOUR file til after the service is provided -- the REAL service given might not be WHAT the original estimated service. And again .. it all depends on the repayment YOUR insurance gives back and YOUR deductibles at that moment in time.
> 
> Estimates are NOT provided and if provided, are NOT cast in concrete ... and all subject to YOUR insurance and deductibles.
> 
> ...


That is why I modify the contracts they give me to sign.


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## WinniWoman (May 28, 2015)

am1 said:


> Glad your husband was okay but what would have happened if on route he needed help?  People should not have to choose between taking an ambulance and a $1000 bill or risk going in a car or without.



I made a rational decision based on everything that happened. The EMT's called the MD at the hospital to give him the numbers. Confirmed did not have a heart attack, and not currently having a heart attack. Could not confirm if he might have one in very near future. All his vitals were perfect. Yes, there was a slight chance something could have happened on the way, you are right about that. But, considering that my husband kept saying he felt fine and he didn't even want me to call 911 in the first place (I insisted), this is the decision I made. They ran some tests at the hospital; they had him stay overnight for observation and found absolutely nothing, thank goodness. We have no idea what was wrong and ended up with a few thousand dollars worth of hospital bills! At least it would have been nice to know exactly what it was!


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## WinniWoman (May 28, 2015)

I work in the medical profession (although in marketing radiology services) and I will tell you it is entirely a racket. You are treated based on what insurance you have. It is a nightmare and that is why I am very suspicious of anything having to do with treatment and billing. I try to stay away from doctors as much as possible. I hurt my knee last month and decided to just brace it rather than going to the surgery hungry orthopedics. At some point, I might have to but I really do try to stay away as I have no trust.


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## vacationhopeful (May 28, 2015)

mpumilia said:


> I work in the medical profession (although in marketing radiology services) and I will tell you it is entirely a racket. ..... I hurt my knee last month and decided to just brace it rather than going to the surgery hungry orthopedics. At some point, I might have to but I really do try to stay away as I have no trust.



I too have been told YEARS ago I needed knee surgery. I had a good friend who had knee replacement surgery after several earlier (before I knew him) knee (scoping & cleaning) surgeries. Skiing and fat-ass was his initial problem. Still fat-ass but does not ski on his "fake" knees -- took up scuba diving.

I lost 40 pounds. Still not had any type of knee surgery or scoping or injections. And I watch the wear usage on my shoes - as I tend to walk on the outside edges of my shoes. Good running sneakers last way longer than cheaper sneakers. Still way cheaper (and less painful) than surgery.


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## ace2000 (May 28, 2015)

Clemson Fan said:


> Frankly sir, I don't believe your new claims of poverty.



I probably believe his claims - only he knows for sure.  But, I'd say skip paying the golf cart insurance (mentioned on another thread), and just pay this thing off.  Or switch from Allstate insurance (notoriously high rates) and go with a cheaper insurance on your car, and put the savings towards the $25/mo required here.

OP, it appears you want to be in control of this situation but the medical company holds the cards.  They can harm you far worse than you can harm them.


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## tante (May 28, 2015)

Jason245 said:


> That is why I modify the contracts they give me to sign.



I don't understand
 You can't unilaterally modify a contact and expect it to be valid. For example you can't just write that you will get a Ferrari every time you go to the doctor.


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## vacationhopeful (May 28, 2015)

tante said:


> I don't understand
> You can't unilaterally modify a contact and expect it to be valid. For example you can't just write that you will get a Ferrari every time you go to the doctor.



I agree .. but the office staff today is also told "to NOT ALLOW the patient back to see the doctor as the patient HAS NOT SIGN THE PROPER CONSENT/RELEASE FORM"

And then you are put down as a "NO SHOW" for the appointment and YOU never get another appointment until you have REPENTED  --- ie paid for your no show appointment in full as your insurance surely will not cover that payment in any way, shape or form.

And you wonder WHY people use the emergency rooms as the doctor's office? My local hospital still has some form of "charity care". Those 245/7 centers DO NOT ... and will cause a even bigger deficient with local & regional hospitals.


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## Jason245 (May 28, 2015)

tante said:


> I don't understand
> You can't unilaterally modify a contact and expect it to be valid. For example you can't just write that you will get a Ferrari every time you go to the doctor.




No, But I can add provisions that require that the entire procedure be done at in network rates (assuming that it is an in network facility) and any doctors they call in to consult or participate as part of the procedure as well as the facilities and equipment used for the procedure either need prior consent from me or accept the in network rate. 

I can also eliminate provisions about timeliness of insurance payments and modify to say that they are required to meet insurance claim procedures as per there agreement with insurance company, ensure that they get pre-approval for the procedure from my insurance, cross out arbitration provisions and clauses (if they want to take away my rights, we better talk about it first), and add provisions that indicate that my only liability for the procedure relates to my co-pay as listed by the terms of my insurance agreement which they are responsible for coordinating with as an in network facility (my insurance requires in network PPO).  I also modify their collections process language indicating that they can not send my account to a collections agency/charge fees and/or document anything on my credit report until after they have called me directly at my phone number and my wife at her phone number and give me at least 10 business days to provide them with the funds after that phone notification

At then end I also add a provision that by them providing the services they agree to those modified provisions.  I then scan copies of everything to my cell phone using CAMSCAN. 

I do this for a number of reasons including the fact that I have heard horror stories about in network facilities and Doctors calling in out of network doctors to consult or help with procedure (or out of network anastesiologists or nurses) and then people getting hit up with big bills.  I have really good health insurance, so as long as things are in network, I am fine with the potential expense. 

My philosophy is that if you are going to provide me with a multi page  onse sided contract for services, I have every right reasonably modify it as a counter proposal.  If they have a problem, we can talk it over BEFORE services are provided, but most of my provisions are not unreasonable and usually document the things we have already agreed to prior to the procedure.  

While I have never been questioned on my modifications, my go to answer is that at the end of the day, I want to be protected the same way they do, and I am always willing to work WITH them to get them whatever they are owed, but am not willing to be caught in some type of limbo simply because they went outside their contract with the insurance company or got into some pissing match with the insurance company or made decisions that adversly impact me financially without me knowing about it.


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## Jason245 (May 28, 2015)

vacationhopeful said:


> I agree .. but the office staff today is also told "to NOT ALLOW the patient back to see the doctor as the patient HAS NOT SIGN THE PROPER CONSENT/RELEASE FORM"
> 
> And then you are put down as a "NO SHOW" for the appointment and YOU never get another appointment until you have REPENTED  --- ie paid for your no show appointment in full as your insurance surely will not cover that payment in any way, shape or form.
> 
> And you wonder WHY people use the emergency rooms as the doctor's office? My local hospital still has some form of "charity care". Those 245/7 centers DO NOT ... and will cause a even bigger deficient with local & regional hospitals.



I sign the form as modified and discussed above. If there is an issue, I would ask to speak to the Doctor. I am never trying to screw them out of the money they earned and I tell them that point blank, I just want to make it clear that if they decide to go bill happy against my insurance company, I am not paying for the consequences of anything that is declined.  They know who/what is covered, they get pre-approval for expensive procedures, and they have to stay within the lines or fight it out directly with the insurance without me having to stress out about it. 

When my son was born, I received bills for things already paid for by insurance because the hospital billing department was not competent (this was 11 months after the fact). It took me a month of letters, faxes and phone calls to get it sorted out and the hospital to agree that we owed nothing (I was only able to get this sorted thanks to my insurance company getting them on the phone since they wouldn't return my calls).  I go by what my EOB says, if they want to tack on charges I ain't paying. My insurance company is great


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## Jason245 (May 28, 2015)

By the way, you can do what I do with ANY contract you are given as a consumer.  People have won court cases as a result of  this (there was a guy who did this with his ATT cell service a few years ago). 

Just because you are handed a piece of paper to sign doesn't mean you have to accept it as is. There is no legal requirement, and in the case of goods and services being provided, if they don't agree to the modifications, they shouldn't provide the services or goods. Think of it as an offer/counter offer situation.

This is why TS contracts have provisions about only what is in writting being valid. That is your one chance as a consumer to get documented all the "Promises" the sales man provides. 

Personally, If I were to buy retail, I would get as many promises as possible, and then add them to the contract. One couple did this and there was a court case recently and they won. 

imagine.


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## vacationhopeful (May 28, 2015)

Jason245 said:


> .... and in the case of goods and services being provided, if they don't agree to the modifications, they shouldn't provide the services or goods. Think of it as an offer/counter offer situation.



Nice analysis and easy to understand ... will print your "service counter" and take with me --- attached/copy onto the "releases"/ doctors' terms of service.


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## Jason245 (May 28, 2015)

vacationhopeful said:


> Nice analysis and easy to understand ... will print your "service counter" and take with me --- attached/copy onto the "releases"/ doctors' terms of service.



My modifications are usually dependent on what is written on their stuff. One place I went to had a 12 page contract, I had to go line by line, crossing things out and making reasonable modifications. 

I always add provisions requiring they get pre-approval for insurance and all providers accept the rates as agreed to by insurance and there are no additional charges and I am only responsible for Copays as required by EOB for in network services and covered charges unless pre-approved in writting by me. 

Everything else is kind of subjective depending on what is written. 

Ultimatly, no judge in the world would ever enforce a contract saying I get a expensive car, that being said, I can see it as being reasonable for them to enforce me not having to pay extra and superfluous charges, especially when it is reasonable to expect them to have told the customer there wouldn't be anything outside of copays as discussed during per-approval.


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## tante (May 28, 2015)

Jason245. I would be surprised if your changes are valid. Insurance is for regulated and they can't give one insured or group of insured a benefit over another. They can't just charge people diagnosed with cancer more for the benefit of other customers.


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## geekette (May 28, 2015)

tante said:


> Jason245. I would be surprised if your changes are valid. Insurance is for regulated and they can't give one insured or group of insured a benefit over another. They can't just charge people diagnosed with cancer more for the benefit of other customers.



tante, this is covered by contract law, not medical anything.

Further, these are provider contracts where provider attempts to cover themselves financially.  I agree with Jason that it is not ok with me to run up the bill and am thrilled he shared this with us.  

Take care of me, for sure, but do it within the confines of my insurance (which is, hello, why I have insurance).  As things stand these days, taking care of your health also involves a firm grip on your wallet.  It's up to the consumer to contain their own costs, shop around, know the pre-cert rules, etc.  The doctor will treat you as they see fit, which could be great medicine with disastrous financial impact to the patient, not the doctor.

My insurance will punish me greatly if I go to ER when primary care doc should have been seen.  By "greatly", I mean entire cost of visit.  Bleeding from the head, I still might go to MedCheck first....


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## Jason245 (May 28, 2015)

geekette said:


> tante, this is covered by contract law, not medical anything.
> 
> Further, these are provider contracts where provider attempts to cover themselves financially.  I agree with Jason that it is not ok with me to run up the bill and am thrilled he shared this with us.
> 
> ...




People far to often see a form and fill out and sign everything ( I never give my social to a doctor, if they say it is for insurance, I get insurance company on phone with them right then and there). That is what they want. It is up to you to cover yourself the same way the docotor covers themselves, the insurance covers themselves. Once signed, a contract is final. Again, crazy provisions will never be enforced, but if there are promises made, document them, you have every right to cover yourself financially and have just as much say in any contract as the other party.  If they tell you something and arn't willing to put it in writting, then don't expect it to be enforced. 

All that being said, there are true EMERGENCY situations where you throw all this out the window, but generally those true emergency situations are covered by insurance (e.g. if you are having a heart attack, you don't start looking for an in network ambulance service and hospital and start reading over contracts, but that is why my insurance coverage has a provision for that indicating that it is fully covered for those issues).


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## tante (May 28, 2015)

I don't want misinformation to become an axiom through group think. It would be nice if someone who worked in the insurance biz or at least in him at a hospital or billing in a doctors office or clinic.

I just don't see how jason's changes actually work. When you go to a hospital, you get a diagnosis which then gets sent to your insurance company. The rate for that diagnosis has been negotiated beforehand between those two parties, it is not like they are going to pull individual contracts to see what the specific terms were for that one customer before reimbursing the hospital.  It is just too inefficient for an insurance company.


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## ace2000 (May 28, 2015)

Any contract could be negotiated and potentially modified.  Whether the other party agrees is the question.  That's the part I'm skeptical about here.


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## Beaglemom3 (May 28, 2015)

Before you all go over the cliff together, go back to Google Law School and read, then re-read, about unilateral modifications/changes to contracts. Binding ?


Ay, yi, yi, yi, yi.




-


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## Beaglemom3 (May 28, 2015)

Start here:


Per the US Court of Appeals for the Ninth Circuit in _Douglas V. TalkAmerica _:

"Indeed, a party can't unilaterally change the terms of a contract; it must obtain the other party's consent before doing so... This is because a revised contract is merely an offer and does not bind the parties until accepted." 

  In a nutshell, this is why we all receive those continuous notifications of changes to our credit card agreements, our cable/phone/internet services, FF miles, etc. 




-


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## Beaglemom3 (May 28, 2015)

ace2000 said:


> Any contract could be negotiated and potentially modified.  Whether the other party agrees is the question.  That's the part I'm skeptical about here.



  Exactly. This !


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## Beaglemom3 (May 28, 2015)

tante said:


> I don't want misinformation to become an axiom through group think. It would be nice if someone who worked in the insurance biz or at least in him at a hospital or billing in a doctors office or clinic.
> 
> I just don't see how jason's changes actually work. When you go to a hospital, you get a diagnosis which then gets sent to your insurance company. The rate for that diagnosis has been negotiated beforehand between those two parties, it is not like they are going to pull individual contracts to see what the specific terms were for that one customer before reimbursing the hospital.  It is just too inefficient for an insurance company.



  Correct. The rates have been set.


-


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## Jason245 (May 28, 2015)

tante said:


> I don't want misinformation to become an axiom through group think. It would be nice if someone who worked in the insurance biz or at least in him at a hospital or billing in a doctors office or clinic.
> 
> I just don't see how jason's changes actually work. When you go to a hospital, you get a diagnosis which then gets sent to your insurance company. The rate for that diagnosis has been negotiated beforehand between those two parties, it is not like they are going to pull individual contracts to see what the specific terms were for that one customer before reimbursing the hospital.  It is just too inefficient for an insurance company.



I don't understand how you are looking at this. 

Here is the situation I am attempting to cover myself from:

I go to in network provider for non emergency surgery XYZ. That surgery involves the provider, an anestesiologist, Nurses and support staff, a Facility and Equipment. 

There have been cases where someone goes to an in network doctor at an in network facility but uses an out of network anestesiologist for the procedure or has an out of network doctor come in and "consult" mid procedure. Because of the way my insurance is written, these doctors will not be paid unless they are in network and I will be responsible for the full costs (in one case, I think someone got a bill for like $50k for heart surgery because a "consulting heart specialist" was called in and he was not in network).  I simply tell them in advance, that everything needs to be in network and pre-approved, they generally state that yes everything will be as such, and then I add provisions to the contract indicating what was stated and if they go outside those lines they are responsible for the costs and seeking reimbursment for insurance (whatever that may be) and I have zero liability. 

If they try to bill me after all that, that is their choice, I dispute the charges and for $50k in billings, you BETTER BELIEVE I will defend and dispute that debt in court if necessary since they won't be able to validate the debt.


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## tante (May 28, 2015)

Jason245 said:


> I don't understand how you are looking at this.
> 
> Here is the situation I am attempting to cover myself from:
> 
> ...



I understand what you are saying but who in that story is accountable to understand you particular insurance contract? Hospital can have hundreds of insurance contracts and the doctors themselves are not always employed by the hospital. Who on that care team do you expect to know every doctor that is part of the network. So let's say you can clear it all beforehand and something goes wrong during surgery, would you rather die on the table than her an out of network consult? A hospital doesn't want that kind of liability. 

Health care is messy and complex, especially with so many insurance companies out there. Which is why i added my single payer comment. I can see some benefits.


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## rapmarks (May 28, 2015)

this just happened with my insurance.

I had to have a cat scan with contrast.   The provider called and told me my copay was xxx.   I asked if they got preapproval.   yes they did.  went in on Feb 2 for the cat scan, paid the copay.  they found something else on the cat scan, so needed MRI which I had on Feb 11.   They called and wanted another copay, I checked on line, and claim for first cat scan had been processed and i owed about half of what they had said.  So i tried to get them to apply the excess payment to MRI. 
 A month later, I look online, and cat scan was denied.  After many calls, the insurance company is saying they didn't get pre approval.   I said i got a letter saying it was approved, they say  yes you are correct, tell them to resubmit.  By now it is the beginning of May, and I get another bill from provider of cat scan and MRI.   the pre approval was for the date Feb 5 thru 10, they hadn't been careful, they were removing the charge which was about $3200.  the rotten thing is that when i had Medicare, no preapproval was necessary, but with Medicare Advantage it is.


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## Jason245 (May 28, 2015)

Beaglemom3 said:


> Exactly. This !



Ultimatly, they would be trying to enforce a contract against me, not the other way around.  So I sign modified provsions, they sue me to enforce contract for payment, I pull out contract that I signed (and they pull out the contract). They violate the reasonable terms, and they provided the consideration (services I asked for).  If they really want to push it, I am pretty confident that I would win in court and would fight it given the large dollars involved and at a minimum these modifications put me in a very strong negotiating position. 

http://contracts.uslegal.com/frequently-asked-questions/

"Does a written contract have to be signed by both parties in order to be enforceable?

Not necessarily — The statute of frauds requires a writing to evidence the contract which must be in writing.  This does not neces*sarily have to be a formal contract signed by both parties.  It can be a letter signed by only one party setting forth the terms of the oral agreement.  However, the writing, whether it be a letter or memorandum, must be signed by the person “to be charged.”  This means it must be signed by the person against whom you are seeking to enforce the contract.  The writing must contain all of the material terms of the contract so that a Court can determine what has been agreed to. 
 - See more at: http://contracts.uslegal.com/frequently-asked-questions/#sthash.V6rExJyN.dpuf"


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## Jason245 (May 28, 2015)

tante said:


> I understand what you are saying but who in that story is accountable to understand you particular insurance contract? Hospital can have hundreds of insurance contracts and the doctors themselves are not always employed by the hospital. Who on that care team do you expect to know every doctor that is part of the network. So let's say you can clear it all beforehand and something goes wrong during surgery, would you rather die on the table than her an out of network consult? A hospital doesn't want that kind of liability.
> 
> Health care is messy and complex, especially with so many insurance companies out there. Which is why i added my single payer comment. I can see some benefits.



I don't really care who is accountable. I am not demanding set dollars, I am simply ensuring that they can not go after me for tens of thousands of dollars in "excess" costs because they didn't follow their own contract requirements with my insurance company. (BTW: My insurance company actually states in their coverage (which I read in depth all 400 pages of it when I need a procedure) that they will reimburse doctors at in network facilities (whether in network or out of network doctors) at the in network rate.  If they want to bring in a consultant, fine, but it isn't my fault if they sue me for the difference and I tell them to pound sand because I am not liable for it.

I have successfully disputed and won thousands of dollars in denied claims simply by reading the insurance agreement and understanding my policy in full. In the end, the provider got the agreed upon rate payment, and I owed nothing.


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## tante (May 28, 2015)

Jason245 said:


> I don't really care who is accountable. I am not demanding set dollars, I am simply ensuring that they can not go after me for tens of thousands of dollars in "excess" costs because they didn't follow their own contract requirements with my insurance company.



So how is health care supposed to work if everyone in the country had their own contract with their own terms. What about cell phone contacts, websites, and credit card contacts. 

You may want to talk to a lawyer now before you assume your contact is valid in a court of law.


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## ace2000 (May 28, 2015)

tante said:


> So how is health care supposed to work if everyone in the country had their own contract with their own terms. What about cell phone contacts, websites, and credit card contacts.



It doesn't work that way.  Sure you can modify the agreement before you sign, but the other party doesn't have to accept the new terms.  It's possible they might, but they sure don't have to.


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## Jason245 (May 28, 2015)

tante said:


> So how is health care supposed to work if everyone in the country had their own contract with their own terms. What about cell phone contacts, websites, and credit card contacts.
> 
> You may want to talk to a lawyer now before you assume your contact is valid in a court of law.



I am not making a new contract. Ultimatly, everyone should do what they feel is right. I have a working knowledge of contract law, and provided you with the relevant plain language support for what I do. 

I am taking their contract and modifying on the same paper with my pen. The consideration is the procedure they perform and the liability I agree to assume (which is not unreasonable and generally what they tell me on the front end, and I am not trying to get free services ) Ultimatly, the purpose of the contract is to list the rights they have to pursue collections on me and remove as many of my rights as possible.  I fully understand if they don't want to agree to the modifications and tell me that they can not perform my procedure, and I am always open to modifying language. 

I am not trying the CHEAT them, I simply refuse to let them ABUSE me, or end up with excessive bills because they didn't disclose "extra charges" or hid them in fine print.  You do what you wish.


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## Jason245 (May 28, 2015)

ace2000 said:


> It doesn't work that way.  Sure you can modify the agreement before you sign, but the other party doesn't have to accept the new terms.  It's possible they might, but they sure don't have to.



I agree with this statement 100%. The provider has the contract to enforce their collections on me hense why only one party signs it. If they don't agree to my very reasonable modifications (and I mean it, I am not trying to cheat them, but there are so many stories of people being sent to collections and charged excess fees without even being billed because it was in the contract... or other crazy stuff) to ensure I know on the front end what the costs will be and they can't surprise me with things. 

I am honest with every doctor, am always willing to put down a  reasonable deposit (Generally the amount that I believe is going to be my copay or responsibility anyway after reviewing the insurance contract) if they are concerned about the insurance payment which they can then reimburse me for ( I did this with a dental procedure issue, and the office later sent me a check back). I always pay my bills and am responsible and upfront that they will get exactly what they are due in a lump sum right away (no payment plans, not games from me, just fair business practice).

A lot of the smaller doctors are like the rest of the country, and they need the cash flow to survive, I am not going to steal from them or make them wait months for a large dollar procedure just for us to find out exactly how much I owe because it has to go through 2 seperate insurance companies when I can back of the napkin know around what I will owe.


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## bogey21 (May 28, 2015)

Beaglemom3 said:


> "Indeed, a party can't unilaterally change the terms of a contract; it must obtain the other party's consent before doing so... This is because a revised contract is merely an offer and does not bind the parties until accepted."



I'm with Jason here.  When dealing with potentially large amounts it is imperative to try and protect your self before the event.  As to the above I would argue that by providing the service subsequent to my modifying the contract (the offer) the other party consented to (accepted) the change.

George


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## geekette (May 28, 2015)

tante said:


> So how is health care supposed to work if everyone in the country had their own contract with their own terms.



It's already that way.  I'll bet my employer coverage is different than yours and if we went to the same doctor for the same procedure, our charges would be different.  We aren't talking about health care, that's not the problem, we can both go to any doctor and have any procedure.  We're talking about Payment, and charges outside of insured's coverage without approval.  Insurers contract with providers, that is what sets my rates vs your rates.

What Jason is doing is altering the responsibility for unapproved charges, saying, No, I am not ok with that, you can't bring in a Mayo CLinic specialist for my hangnail and expect me to pay it (unless they are in-network for me).  He is not making new insurance for himself, he is not creating a chargemaster that the provider has to go from, or any of that.  It's about getting the provider to honor the insurance else they bear the financial risk, not the patient.

Sure, bring me a specialist, but get one from the list approved by my insurer!


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## Tia (May 28, 2015)

I find this very interesting. 

Health insurance , coding, and payments has gotten out of hand imho. And it's not from what they pay me the little old worker person. Our CEO at a relatively small hospital was making  $510K in 2011 , while cutting employees and working hours. 


http://www.gjsentinel.com/news/articles/millionaire-health-care/

http://www.gjsentinel.com/lifestyle/articles/how-does-hospital-ceo-pay-affect-care



Jason245 said:


> I am not making a new contract. Ultimatly, everyone should do what they feel is right. I have a working knowledge of contract law, and provided you with the relevant plain language support for what I do.
> 
> I am taking their contract and modifying on the same paper with my pen. The consideration is the procedure they perform and the liability I agree to assume (which is not unreasonable and generally what they tell me on the front end, and I am not trying to get free services ) Ultimatly, the purpose of the contract is to list the rights they have to pursue collections on me and remove as many of my rights as possible.  I fully understand if they don't want to agree to the modifications and tell me that they can not perform my procedure, and I am always open to modifying language.
> 
> I am not trying the CHEAT them, I simply refuse to let them ABUSE me, or end up with excessive bills because they didn't disclose "extra charges" or hid them in fine print.  You do what you wish.


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## hypnotiq (May 28, 2015)

Agreed on the racket part.

My wife is finishing up her program to be a Registered Dental Hygienist and last month they had a "guest speaker" come in and chat with them. The speaker was a RDH at a large dental firm. 

Part of her presentation covered insurance billing codes and she mentioned how there were obscure billing codes that practices could use (and insurance would pay) to bill insurance for way more money than if they used the standard codes.

She insisted the firm she worked at didn't do this and that as RDHs they should be aware of it because its illegal.

Makes you wonder about the medical profession where there are 10s of thousands more codes.


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## vacationhopeful (May 28, 2015)

hypnotiq said:


> Agreed on the racket part.
> 
> My wife is finishing up her program to be a Registered Dental Hygienist and *last month they had a "guest speaker" come in and chat with them. The speaker was a RDH at a large dental firm*.
> 
> ...



Let's see ... "we pay all the employees based on performance - there is no pay difference between the sexes, race, creed, sexual orientation or national origin."

RDHs and different billing codes - any relationship to home zip codes? Credit scores? Self-employed? College level completed? Age? Health insurance company? Marital status? Home ownership & years there? 

And you wonder why people are so angry about medical bills? I just finished paying off one co-pay for a hospital stay of 1 night - $4500 (no surgery, just some pain meds and IVs). And have to start paying on the 3 night surgical stay ... about $9500 of "co-insurance" - their term for "because I can bill you above all other deductibles". And did I mention, I pay over $1100 monthly now for my ACA Health Insurance Premium?

23 more months ...


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## am1 (May 28, 2015)

I thought all this was suppose to be fixed.  Prices are so high because insurance companies want to beat down the price they pay and a lot of others including the OP want to skip out on paying what they owe.  The system fails everyone.


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## Jason245 (May 28, 2015)

vacationhopeful said:


> Let's see ... "we pay all the employees based on performance - there is no pay difference between the sexes, race, creed, sexual orientation or national origin."
> 
> RDHs and different billing codes - any relationship to home zip codes? Credit scores? Self-employed? College level completed? Age? Health insurance company? Marital status? Home ownership & years there?
> 
> ...




I assume the $9500 was your out of pocket max for the year, and that any other vistis covered by insurance are free (or am I missing something)... On bright side, go to Doc every week for all kinds of expensive stuff for rest of the year and know you pay nothing. 



Is the 1100 just for you or does it cover you and your family? Take a look at your EOB, the insurance probably spent clost to 100K.... so it looks like you got value out of this.

All that being said, it might be worth it to consult with one of those navigators and try to find a better plan on the exchange if you get a subsidy, or look off the exchange if you don't.


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## Chrispee (May 28, 2015)

This has turned out to be an interesting thread to read (even as a Canadian with universal health care).  

Jason245, I'm curious to hear if you've been denied service because of contract altering?  Although I agree with your stance that altering a contract is legal (and the right thing to do), I can't imagine that most medical facilities would be willing to accept your changes given that they would generally require review by someone high up in the company, or the company's legal team.


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## Jason245 (May 28, 2015)

Chrispee said:


> This has turned out to be an interesting thread to read (even as a Canadian with universal health care).
> 
> Jason245, I'm curious to hear if you've been denied service because of contract altering?  Although I agree with your stance that altering a contract is legal (and the right thing to do), I can't imagine that most medical facilities would be willing to accept your changes given that they would generally require review by someone high up in the company, or the company's legal team.



Noone has called me out on it yet. 

Things were much easier in Canada when all I needed was a Medicare card and never had to worry about nonsense like this.


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## Beaglemom3 (May 28, 2015)

bogey21 said:


> I'm with Jason here.  When dealing with potentially large amounts it is imperative to try and protect your self before the event.  As to the above I would argue that by providing the service subsequent to my modifying the contract (the offer) the other party consented to (accepted) the change.
> 
> George



  Then your beef is not with me, but with the Ninth Circuit Court judges.


-


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## geekette (May 28, 2015)

vacationhopeful said:


> And did I mention, I pay over $1100 monthly now for my ACA Health Insurance Premium?



You pay an insurance company, not a law.  Who is your insurer?  What level did you select?  

Part of the problem is that 20% of a very large bill is still a lot of money.  I was able to get 100% paid after deductible/annual limit at last job but can only get 80/20 split this employer.

To all, be sure to reach out to insurer and/or provider in unable to pay situations.  Probably you cannot get $5/month payment plan but they will work with you, and sometimes, amounts are simply written off.  Won't happen if you don't ask.  

um, generally, that is:  a few years ago I was injured in an emergency drill (where you are a fake patient to help emergency responders).  Drill was fine, but our fake ambulance got real t-boned and several of us were injured. There was confusion because we were already sporting fake injuries and triage tags.  blah blah blah, the treating hospital wrote off all of our expenses without our knowledge.  The bill came once and I never saw it again, called to make arrangements, there was no balance.  I think it's because they knew we had helped them in staging/readiness for mass trauma and felt bad that we came right back as real trauma.


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## Jason245 (May 28, 2015)

[Deleted as I am tired of repeating myself]


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## geekette (May 28, 2015)

am1 said:


> I thought all this was suppose to be fixed.



It's not instant, this is just a start.  Fixing goes in steps.  We didn't build this mess quickly, it can't be fixed quickly.

There are maximum percentages of income people pay, there are costs insurers and/or providers eat.  Insurers must spend x% of premiums collected on procedure payouts vs admin costs.  Not sure we have slowed the rate of cost escalation enough, but that is first step (beyond getting everyone access, even with pre-existing conditions).

I know of no estimation as to when "all will be fixed" as I think that date is currently unknowable.  

There is still the matter of pharma R&D resulting in very high drug costs and I don't think there has been enough brainstorming on that but recent Hep C treatments are bringing the discussion to the forefront.  Few people I know can pay 10k/month for a pill the rest of their life (my mother now has a 6k/month cancer drug).  We need innovation and sometimes it fails yet it can take years and many millions before failure occurs.  Big Pharma can't just eat it else the innovation would cease.


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## presley (May 28, 2015)

cmdmfr said:


> is there anyone out there that can help me with a debit that may turn into a collection.  I have an auto accident in April on Hilton Head Island. I had medcial insurance for auto. My medcial paid part of it and there was a remining Balance of $220.00. I told the girl that I can pay only $5.00 a month and that is it. She said that they will take no less than $25.00. I have sent a check for $5.00 to show that I am willing to pay. I was told that as per the fair debt collections act that I can send in only what I can afford, and that they can not turn me down. If they do turn me down then thay are not allow to put me ina collection agencey because I am trying to pay.
> 
> I am not familar with the Fair Debt Collections act but Like I said that I can pay only what I can afford and they cannot do nothing to me becasu I am trying.
> 
> Any help on this matter would be appericated.



I don't know, but based on your personal situation, who cares if it is sent to collection? It won't make any difference at all if you can't pay. Credit hits don't matter to people who don't plan on incurring debts.


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## dioxide45 (May 28, 2015)

Jason245 said:


> I agree with this statement 100%. The provider has the contract to enforce their collections on me hense why only one party signs it. If they don't agree to my very reasonable modifications (and I mean it, I am not trying to cheat them, but there are so many stories of people being sent to collections and charged excess fees without even being billed because it was in the contract... or other crazy stuff) to ensure I know on the front end what the costs will be and they can't surprise me with things.
> 
> I am honest with every doctor, am always willing to put down a  reasonable deposit (Generally the amount that I believe is going to be my copay or responsibility anyway after reviewing the insurance contract) if they are concerned about the insurance payment which they can then reimburse me for ( I did this with a dental procedure issue, and the office later sent me a check back). I always pay my bills and am responsible and upfront that they will get exactly what they are due in a lump sum right away (no payment plans, not games from me, just fair business practice).
> 
> A lot of the smaller doctors are like the rest of the country, and they need the cash flow to survive, I am not going to steal from them or make them wait months for a large dollar procedure just for us to find out exactly how much I owe because it has to go through 2 seperate insurance companies when I can back of the napkin know around what I will owe.



Not sure this would have helped me. I went to in network providers and they were paid the in network discounted rate. My issue is more that I hadn't hit my high delectable yet for the year, so I was responsible for all costs.

I was provided with the codes before my procedure and could have called my insurance company, but didn't My bad. Though I still would have had the very first videostroboscopy at $450+ to rule out anything serious. I still think that even the negotiated rates for the videostroboscopy and therapy sessions were far over priced. Perhaps I could have rewritten the contract to only have to pay 50% of those charges? Though, I never had a contract. I went in for services and services were rendered. Don't think I have ever signed a contract when going for a doctor or specialist office visit.


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## Jason245 (May 28, 2015)

dioxide45 said:


> Not sure this would have helped me. I went to in network providers and they were paid the in network discounted rate. My issue is more that I hadn't hit my high delectable yet for the year, so I was responsible for all costs.
> 
> I was provided with the codes before my procedure and could have called my insurance company, but didn't My bad. Though I still would have had the very first videostroboscopy at $450+ to rule out anything serious. I still think that even the negotiated rates for the videostroboscopy and therapy sessions were far over priced. Perhaps I could have rewritten the contract to only have to pay 50% of those charges? Though, I never had a contract. I went in for services and services were rendered. Don't think I have ever signed a contract when going for a doctor or specialist office visit.


You can't make the contract dictate terms like your liability for less than your copay.  .that being said,  insurance usually negotiates discounted rates for procedure and you should have paid that discounted rate.  Check your eob and see if that is the case.


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## tante (May 28, 2015)

Jason a few questions

1. When you alter a contract and  send it back is it signed by a representative?

2. If you asked them to produce a copy of your contact, would you altered copy be produced.

3. Have you ever had to contest a health care insurance contract that you modified in a court of law.


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## Jason245 (May 28, 2015)

tante said:


> Jason a few questions
> 
> 1. When you alter a contract and  send it back is it signed by a representative?
> 
> ...



Why would I contest a health care insurance contract?

I am giving up on explaining that you are not required to sign things that remove your rights, and you have the right to alter those things in advance. I keep copies of modified contracts scanned and dated on my cell phone. In order for them to produce an unmodified contract they would have to forge my signature. 

Do what you will and I will do what I will. 

I encourage anyone who wants to discuss this to consult with their own attorney to get their own legal advise. I am done participating in this circle of a discussion.


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## dioxide45 (May 28, 2015)

Jason245 said:


> Why would I contest a health care insurance contract?
> 
> I am giving up on explaining that you are not required to sign things that remove your rights, and you have the right to alter those things in advance. I keep copies of modified contracts scanned and dated on my cell phone. In order for them to produce an unmodified contract they would have to forge my signature.
> 
> ...



You are the one that brought it up


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## Jason245 (May 28, 2015)

dioxide45 said:


> You are the one that brought it up


I explained it several times.  I don't know what else to do.


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## WinniWoman (May 28, 2015)

vacationhopeful said:


> I too have been told YEARS ago I needed knee surgery. I had a good friend who had knee replacement surgery after several earlier (before I knew him) knee (scoping & cleaning) surgeries. Skiing and fat-ass was his initial problem. Still fat-ass but does not ski on his "fake" knees -- took up scuba diving.
> 
> I lost 40 pounds. Still not had any type of knee surgery or scoping or injections. And I watch the wear usage on my shoes - as I tend to walk on the outside edges of my shoes. Good running sneakers last way longer than cheaper sneakers. Still way cheaper (and less painful) than surgery.



I have been overweight a good many years now, but the reason I hurt my knee is I went down an embankment when I was on my morning walk to retrieve a garbage bag that some idiot threw out his car window. (I regularly pick up litter on my road as I am walking for exercise anyway and I don't want to look at it). Climbing back up it was very steep and that's when I felt the pain.

My knees never bothered me except after many years of doing squat exercises, and I gave those up long ago. Now I am afraid I have ruined this knee for life as I am 59 years old and it doesn't seem to be getting better. I can't stay off it that's for sure. I exercise daily and my job requires getting in and out of the car all day. Not to mention I have lots of other stuff to do. Sigh......


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## WinniWoman (May 28, 2015)

I am pretty conservative/libertarian/small government- but after working in healthcare all my life, I am for single payor. Ex: Everyone working (under 65) or over 65 on Medicare. Option to have supplements/drug plans just like the older folks have now. Not working- on Medicaid. If you become unemployed, you must go on Medicaid until you get another job and then you go back on Medicare. We have got to make this simpler. It's so crazy out of hand.


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## John Cummings (May 28, 2015)

rapmarks said:


> ...the rotten thing is that when i had Medicare, no preapproval was necessary, but with Medicare Advantage it is.



That is because your Medicare Advantage plan is probably an HMO. That is standard for all HMOs, not just Medicare Advantage plans.


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## rapmarks (May 29, 2015)

John Cummings said:


> That is because your Medicare Advantage plan is probably an HMO. That is standard for all HMOs, not just Medicare Advantage plans.



It is not an HMO, I can go to anyone I want, I just need preapproval for procedures.  It is an open network plan, can go in or out of network,


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## Clemson Fan (May 29, 2015)

mpumilia said:


> I am pretty conservative/libertarian/small government- but after working in healthcare all my life, I am for single payor. Ex: Everyone working (under 65) or over 65 on Medicare. Option to have supplements/drug plans just like the older folks have now. Not working- on Medicaid. If you become unemployed, you must go on Medicaid until you get another job and then you go back on Medicare. We have got to make this simpler. It's so crazy out of hand.



I'm with you there.  I've had my own solo private practice for almost 10 years now and 2.5 of my 8 FT employees are dedicated to billing and all the issues that come from it.  It's not only maddening for the patients, but the doctors as well.  There are way too many insurance companies and plans with their 100 page contracts that we're expected to be experts on.  The current ACA kept all the insurance companies in play which is why it's a failure IMO.  I say get rid of them all and I'd rather just deal with the government directly as a single payer.

BTW, it's about to get exponentially worse this fall with the transition from ICD-9 to ICD-10 codes.  There are 5 times as many ICD-10 codes as there were ICD-9 codes.


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## easyrider (May 29, 2015)

cmdmfr said:


> I am glad that every one up here has the answer to my question but the only problem is its all the wrong answer. one said I was on the cell well I do not own one and wont because it cost too much and as to going to aruba and the blue ridge you are right I worked all my life and an am on disability because of some dummy that was not paying attention to the road. The incident has cost me 7 operations and the insurance company has went bankrupt and left me quite q few bills. I do not get a check every week. And if you would like to help me pay my bills with a small check from disability I will glad to take the help. Also if you think I am going to sit in a chair and die WRONG  so let me know when you want to help me with my bills and let me know. Oh also if you think that I can sue and get rich Think Again because you have the wrong answer. If you want my account number so you can help pay the bill let me know, and as to sell my computer I do not own one but do have use of one. If you have one and would like to donate it let me know



I am willing to send you funds for the ambulance bill. Do you have a paypal account ?

Bill


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## Tia (May 29, 2015)

$4800 ER couple hours no overnight stay for Kidney stone, IV hydration 1 litre , 1 IV pain and 1 IV nausea med, CT scan.






vacationhopeful said:


> ....... I just finished paying off one co-pay for a hospital stay of 1 night - $4500 (no surgery, just some pain meds and IVs). And have to start paying on the 3 night surgical stay ... about $9500 of "co-insurance" - their term for "because I can bill you above all other deductibles". And did I mention, I pay over $1100 monthly now for my ACA Health Insurance Premium?
> 
> 23 more months ...


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## rapmarks (May 29, 2015)

I have had to go to ER because of diverticulitis.   I cannot handle the drugs they put me on, especially Flagl.  I have been told I will have to be hospitalized on an IV next time.  The hitch is that my doctor doesnt have hospital privileges.  I would have to go to ER for hours, be seen, be tested, and then admitted.  so I hope if I ever get it again, it will happen inWisconsin, where doctors have hosital privileges, and not in Florida.  the surprising thing was that when i was in the ER and not admitted, I saved a real lot of money.  I  had a $65 copay, compared to paying 20 percent of the cost of the cat scan, and the doctors visit.


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## Clemson Fan (May 30, 2015)

rapmarks said:


> I have had to go to ER because of diverticulitis.   I cannot handle the drugs they put me on, especially Flagl.  I have been told I will have to be hospitalized on an IV next time.  The hitch is that my doctor doesnt have hospital privileges.  I would have to go to ER for hours, be seen, be tested, and then admitted.  so I hope if I ever get it again, it will happen inWisconsin, where doctors have hosital privileges, and not in Florida.  the surprising thing was that when i was in the ER and not admitted, I saved a real lot of money.  I  had a $65 copay, compared to paying 20 percent of the cost of the cat scan, and the doctors visit.



Just have the hospitalist handle your admission.  The trend nowadays is for PCP's to maintain very few if any hospital privleges because when they do they're usually required to take call which is a pain and it's not cost effective to see and round on inpatients anymore.  Most hospitals nowadays employ hospitalists to handle the inpatient load.  These are usually fully accredited and board certified MD's who are usually very good at taking care of inpatients.  They prefer that lifestyle because it's shift work, they get paid a pretty good salary as employees and they don't need to maintain an outside clinic with all the associated headaches.


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## rapmarks (May 30, 2015)

Clemson Fan said:


> Just have the hospitalist handle your admission.  The trend nowadays is for PCP's to maintain very few if any hospital privleges because when they do they're usually required to take call which is a pain and it's not cost effective to see and round on inpatients anymore.  Most hospitals nowadays employ hospitalists to handle the inpatient load.  These are usually fully accredited and board certified MD's who are usually very good at taking care of inpatients.  They prefer that lifestyle because it's shift work, they get paid a pretty good salary as employees and they don't need to maintain an outside clinic with all the associated headaches.


I don't mind the hospitalist, I mind that I have to wait in line in the ER, go through the whole procedure, usually about 8 to 10 hours in Floirda before I can get treatment.


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## bogey21 (May 30, 2015)

mpumilia said:


> I am pretty conservative/libertarian/small government- but after working in healthcare all my life, I am for single payor. Ex: Everyone working (under 65) or over 65 on Medicare. Option to have supplements/drug plans just like the older folks have now. Not working- on Medicaid. If you become unemployed, you must go on Medicaid until you get another job and then you go back on Medicare. We have got to make this simpler. It's so crazy out of hand.



The key to the above comment is the word "Everyone".  If everyone is covered by a Medicare/Medicade look alike, who would pay for it and if not individuals directly, how much would it add to the Federal Government's deficit?  If the Employer pays, how much would it impact wages?  In addition where would all the doctors who would be necessary come from?  The way I count it takes up to 12 years post HS for someone to become a doctor.  Otherwise I like the concept.

George


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## Passepartout (May 30, 2015)

bogey21 said:


> The key to the above comment is the word "Everyone".  If everyone is covered by a Medicare/Medicade look alike, who would pay for it and if not individuals directly, how much would it add to the Federal Government's deficit?  If the Employer pays, how much would it impact wages?  In addition where would all the doctors who would be necessary come from?  The way I count it takes up to 12 years post HS for someone to become a doctor.  Otherwise I like the concept.
> 
> George



So does the above statement mean that you support medical care 'rationing' by cost? Those that can afford it get care. Those that can't- or choose not to purchase insurance, simply don't get get medical care. And who looks the poor, but sick or injured in the eye and can say, "Sorry, no care for you. I wish you a speedy death or recovery. But either way it's not my concern because what I really care about is the deficit." That's cold. Really cold.

Jim


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## Clemson Fan (May 30, 2015)

bogey21 said:


> The key to the above comment is the word "Everyone".  If everyone is covered by a Medicare/Medicade look alike, who would pay for it and if not individuals directly, how much would it add to the Federal Government's deficit?  If the Employer pays, how much would it impact wages?  In addition where would all the doctors who would be necessary come from?  The way I count it takes up to 12 years post HS for someone to become a doctor.  Otherwise I like the concept.
> 
> George



The savings would come by getting rid of all the insurance companies and their associated infrastructures.  The problem is that by doing that you would be eliminating millions and millions of jobs which would never fly politically.  The number of middle men and women that are in between the doctor and patient in our healthcare system is frankly obscene and a huge waste of money.


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## am1 (May 30, 2015)

Clemson Fan said:


> The savings would come by getting rid of all the insurance companies and their associated infrastructures.  The problem is that by doing that you would be eliminating millions and millions of jobs which would never fly politically.  The number of middle men and women that are in between the doctor and patient in our healthcare system is frankly obscene and a huge waste of money.



And that is the problem.  If jobs can be eliminated so things can me more cost effective I am all for it.  

The same for taxis having monopolies at airports.  If there is demand for public transportation I am all for it.


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## flexible (May 30, 2015)

winnipiseogee said:


> I own an ambulance service



Hello Winnipiseogee,

Even though I am nearly certain my husband and my health insurance pays (or reimburses) for air medical services, I am wondering if I should pay the "donation amounts" for the nonprofit regional medical services.

California has three different non-reciprocal medical air ambulance services in rural counties (possibly statewide)
http://CalStar.org nonprofit regional air ambulance - service for our county
http://ReachAir.com Reach Air Medical Service - service for county 20 miles from our home

My stepson had a motorcycle accident just over the county line and even though he probably was "brain dead" within minutes he was airlifted by ReachAir two counties south to a regional trauma center in that county. His children never received a bill for their service because he paid Reach annually.

I asked the staff at our local hospital's ER regarding availability of medical care in our county. I was told if we suffered a serious burn we'd be airlifted to UC Davis' Burn ICU about 100+ miles east. Otherwise we'd probably be airlifted about 100 miles South of our home to a regional trauma center. A local nurse mentioned her husband has a serious illness and commented that her husband is regularly transported by air from the local hospital to the regional trauma center and people would be crazy not to pay CalStar.

Also, is it possible that displaying the stickers for air ambulance services would make any difference to law enforcement/fire department or whomever might respond in the unlikely even of our being in a horrible auto accident. 

Thanks


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## winnipiseogee (May 30, 2015)

flexible said:


> I am wondering if I should pay the "donation amounts" for the nonprofit regional medical services.



You are correct - if you have insurance it **almost** always covers airlifts when medically necessary.  So from a strictly financial benefit standpoint its probably not worth making the donation.

That said despite what they charge almost every single emergency helicopter medical company loses money.  The costs and risks associated transporting patients by air are insanely high.  That's why they need donations.  It may be worth a nominal donation just to make sure the chopper is available when you need it!!  We've had a reduction in air medical services in our area and its always horrible when someone needs to be flown and no choppers are available.

Probably won't help with law enforcement but..... you never know lmao.  I always had a CHP 11-99 license plate holder just in case


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## WinniWoman (May 30, 2015)

Add





bogey21 said:


> The key to the above comment is the word "Everyone".  If everyone is covered by a Medicare/Medicade look alike, who would pay for it and if not individuals directly, how much would it add to the Federal Government's deficit?  If the Employer pays, how much would it impact wages?  In addition where would all the doctors who would be necessary come from?  The way I count it takes up to 12 years post HS for someone to become a doctor.  Otherwise I like the concept.
> 
> George



All the employed would pay for it with taxes- pretty much like they do now anyway- but- yes- the taxes would be very  high- but employees wouldn't have the insurance premiums! That is why they - and the over 65 who already paid their dues- would get the Medicare and the unemployed would go on Medicaid until/if they become employed again. Employers could also pay into Medicare to take the place of what they now pay towards the health insurance premiums.  Heck - it costs so much in premiums now already. And- everyone has to pay taxes now anyway to go towards welfare and medicaid and so forth for the poor.  And- more people would be willing to become doctors unlike today where they are finding it is not worth it.

This is the MPUMILIA Health Care Initiative. LOL!


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## tante (May 30, 2015)

mpumilia said:


> Add
> 
> All the employed would pay for it with taxes- pretty much like they do now anyway- but- yes- the taxes would be very  high- but employees wouldn't have the insurance premiums! That is why they - and the over 65 who already paid their dues- would get the Medicare and the unemployed would go on Medicaid until/if they become employed again. Employers could also pay into Medicare to take the place of what they now pay towards the health insurance premiums.  Heck - it costs so much in premiums now already. And- everyone has to pay taxes now anyway to go towards welfare and medicaid and so forth for the poor.  And- more people would be willing to become doctors unlike today where they are finding it is not worth it.
> 
> This is the MPUMILIA Health Care Initiative. LOL!



Can you explain your last statement about people willing to become doctors?


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## Tia (Jun 1, 2015)

Clemson Fan said:


> ... The number of middle men and women that are in between the doctor and patient in our healthcare system is frankly obscene and a huge waste of money.



Ding ding ding we have a winner here imo


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