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This room is for the discussion of current events,cultural issues and politics especially in relation to Catholic values.

Saint Thomas More was martyred during the Protestant Reformation for standing firm in the Faith and not recognizing the King of England as the Supreme Head of the Church.
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10/07/2012 new

(Quote) Jerry-74383 said: Why is that?
(Quote) Jerry-74383 said:

Why is that?

--hide--

As I stated in my original note. I belong to an HMO. Medicare rules require that a Dr., who is a sleep specialist and has "examined" me face to face, to do the prescribing. Once he writes the prescription, all other steps are automatically internal within the HMO's system. I never see the prescription.

An example: Three years ago I was on retreat at a monastery in Oregon. I had a severe asthma attack (compounded with a dose of bronchitis) and had to go to an emergency room, where I was treated and released. I was given a prescription for an anti-biotic.

I now had a problem. I could not take the prescription to my HMO in Washington, as the Dr.'s signature was invalid in WA.. So I went to the closest drugstore. Because I was under Medicare the druggist needed my medicare number to fill the prescription. But medicare would not pay because all medicines have to come to me through my HMO.

So the druggest told me to leave for a few minutes and that when I returned he would have another druggest wait on me and that I was to tell that person I had no insurance and was not covered by medicare.

The prescription was filled. Now if somehow that prescription was examined by an auditor, the drug store was in the clear. But need I describe where I stood?

10/07/2012 new

(Quote) Paul-866591 said: As I stated in my original note. I belong to an HMO. Medicare rules require that a Dr., w...
(Quote) Paul-866591 said:

As I stated in my original note. I belong to an HMO. Medicare rules require that a Dr., who is a sleep specialist and has "examined" me face to face, to do the prescribing. Once he writes the prescription, all other steps are automatically internal within the HMO's system. I never see the prescription.

An example: Three years ago I was on retreat at a monastery in Oregon. I had a severe asthma attack (compounded with a dose of bronchitis) and had to go to an emergency room, where I was treated and released. I was given a prescription for an anti-biotic.

I now had a problem. I could not take the prescription to my HMO in Washington, as the Dr.'s signature was invalid in WA.. So I went to the closest drugstore. Because I was under Medicare the druggist needed my medicare number to fill the prescription. But medicare would not pay because all medicines have to come to me through my HMO.

So the druggest told me to leave for a few minutes and that when I returned he would have another druggest wait on me and that I was to tell that person I had no insurance and was not covered by medicare.

The prescription was filled. Now if somehow that prescription was examined by an auditor, the drug store was in the clear. But need I describe where I stood?

--hide--


Paul, I would strongly suggest that you get out of the HMO and change your medicare coverage to a different plan. HMO's are the most controlling of any of the government medicare plans. Another thought which I don't know if it is possible or not, but I'm wondering if this machine would be available for sale to you from Canada or via Canada (you might want to try googling). I myself just ordered prescription medication for myself from Canada because it is so much cheaper than in the US and the drug I needed (a type of blood pressure medication that actually is excellent and has cardioprotective effects) is now no longer on most US insurance formularies (or extremely expensive if it is) because it hasn't gone generic yet even though the patent on it expired the end of 2011. The drug the formularies are using as a substitute is very inferior and in fact does not control blood pressure in many people. My own physican is the one who suggested I order the drug from Canada. It is outrageous that our drug companies here are preventing the accessibility to this drug which is available as a generic virtually everywhere in the civilized world and even in third-world countries. Shows that all they are after are the profits! Oh, and not available via Medicare drug plans either!

10/07/2012 new

(Quote) Patricia-29176 said:Paul, I would strongly suggest that you get out of the HMO and change your medicare coverage to a d...
(Quote) Patricia-29176 said:
Paul, I would strongly suggest that you get out of the HMO and change your medicare coverage to a different plan. HMO's are the most controlling of any of the government medicare plans

--hide--

Which is a clear illustration of the point I am trying to make with this subject.

The effects of Government intrusion into health care is most easily and clearly illustrated by looking at HMOs.

My HMO started out as a Cooperative. To join, you (and any members of your family) had to pass a health screening process. Comprehensive health care was provided to all members through its own staff Doctors and specialist. Any speciality not on their payroll was referred out to an Coop approved specialist by a member's primary care Doctor. All required medications were provided to members free.

A little cumberson, but overall excellent health care was provided to its members.

They had a small hospital. Because of growth, the coop wanted to expand its hospital to handle the increased load and later another hospital. A ready source of funds to accomplish the expansion was Uncle Sugar. At the time there was a lot of opposition within the membership against going to Uncle for the funds."The "easy money" advocates won out.

What followed had been predicted by the opponents. Without going into a lot of details; First Uncle specified a certain minimum number of non-members (needy) had to be treated. Then came the pressure to provide this or that elective procedures. The burden of more and more Federal Regulations caused dues to rise long before the general cost of health care soared.

Still, overall the coop managed to provide excellent overall care to members and "the needy" they were forced to treat at a reasonable cost compared to most comprehensive insurance plans.

When Hillary tried to create the Clinton Health program, our coop was one of the "ideals" used to create her program.

The end result is that we are still nominally a Coop. But in reality the Coop is just another insurance Company overburdened with Government regulations. And, as you pointed out, more so than other forms of health care delivery.

But it is a "laboratory" of exactly what everyone is facing under Obamacare.

10/07/2012 new

(Quote) Paul-866591 said: Which is a clear illustration of the point I am trying to make with this subject. ...
(Quote) Paul-866591 said:

Which is a clear illustration of the point I am trying to make with this subject.

The effects of Government intrusion into health care is most easily and clearly illustrated by looking at HMOs.

My HMO started out as a Cooperative. To join, you (and any members of your family) had to pass a health screening process. Comprehensive health care was provided to all members through its own staff Doctors and specialist. Any speciality not on their payroll was referred out to an Coop approved specialist by a member's primary care Doctor. All required medications were provided to members free.

A little cumberson, but overall excellent health care was provided to its members.

They had a small hospital. Because of growth, the coop wanted to expand its hospital to handle the increased load and later another hospital. A ready source of funds to accomplish the expansion was Uncle Sugar. At the time there was a lot of opposition within the membership against going to Uncle for the funds."The "easy money" advocates won out.

What followed had been predicted by the opponents. Without going into a lot of details; First Uncle specified a certain minimum number of non-members (needy) had to be treated. Then came the pressure to provide this or that elective procedures. The burden of more and more Federal Regulations caused dues to rise long before the general cost of health care soared.

Still, overall the coop managed to provide excellent overall care to members and "the needy" they were forced to treat at a reasonable cost compared to most comprehensive insurance plans.

When Hillary tried to create the Clinton Health program, our coop was one of the "ideals" used to create her program.

The end result is that we are still nominally a Coop. But in reality the Coop is just another insurance Company overburdened with Government regulations. And, as you pointed out, more so than other forms of health care delivery.

But it is a "laboratory" of exactly what everyone is facing under Obamacare.

--hide--

It's shocking that your HMO is required to help the "needy".If these "needy"individuals can't afford to pay for healthcare they should be left to rot and die.

10/07/2012 new
(Quote) Paul-866591 said: ...why we must get Government Beuraucrats out of health care.
(Quote) Paul-866591 said:

...why we must get Government Beuraucrats out of health care.

--hide--
Docs4PatientCare: "Politicians that passed Obamacare are guilty of malpractice"

www.youtube.com
10/07/2012 new
Obamacare Rationing Begins, States Cut Prescription Drug Benefits

www.lifenews.com
10/07/2012 new

(Quote) Paul-866591 said: As I stated in my original note. I belong to an HMO. Medicare rules require that a Dr., w...
(Quote) Paul-866591 said:

As I stated in my original note. I belong to an HMO. Medicare rules require that a Dr., who is a sleep specialist and has "examined" me face to face, to do the prescribing. Once he writes the prescription, all other steps are automatically internal within the HMO's system. I never see the prescription.

An example: Three years ago I was on retreat at a monastery in Oregon. I had a severe asthma attack (compounded with a dose of bronchitis) and had to go to an emergency room, where I was treated and released. I was given a prescription for an anti-biotic.

I now had a problem. I could not take the prescription to my HMO in Washington, as the Dr.'s signature was invalid in WA.. So I went to the closest drugstore. Because I was under Medicare the druggist needed my medicare number to fill the prescription. But medicare would not pay because all medicines have to come to me through my HMO.

So the druggest told me to leave for a few minutes and that when I returned he would have another druggest wait on me and that I was to tell that person I had no insurance and was not covered by medicare.

The prescription was filled. Now if somehow that prescription was examined by an auditor, the drug store was in the clear. But need I describe where I stood?

--hide--


That is exactly what I am telling you to do. Get a prescription from a doctor and bring it to a pharmacy or a place that has the
breathing machines and pay for it yourself. You originally said you would be willing to pay for it. Did you misunderstand what I
wrote?

10/07/2012 new

If you said you do not see the prescription and it goes automatically to the HMO when you use one of their doctors,
tell your doctor the problem. Ask him to give you a prescription. Or ask him what you should do.

10/07/2012 new

(Quote) Marianne-100218 said: That is exactly what I am telling you to do. Get a prescription from a doctor and bring it to ...
(Quote) Marianne-100218 said:

That is exactly what I am telling you to do. Get a prescription from a doctor and bring it to a pharmacy or a place that has the
breathing machines and pay for it yourself. You originally said you would be willing to pay for it. Did you misunderstand what I
wrote?

--hide--

Within the HM, I am never handed a prescription. It is put into the system within the organization and then the pharmacy, or in this case, the outside vendor contracted with the HMO responds.

The only way out of the circle would be, for examople, if I were in NY and my CPAP broke. If my HMO considered that enough of an emercgency, they would authorize me to see a sleep Dr. there who might write a prescription which would then allow me to purchase a machine.

The more likely scenario would be the HMO would require me to get home as soon as possible and be treated within the system.

All of which is further complicated because at 76 I am under Medicare and their rules need to be observed. And under their rules I cannot, again except in an emergency, seek any medical care from anyone except my HMO unless my HMO specifically authorizes it.

The point of all this thread has not been to seek a solution to my particular problem. Rather it is to use my experience as an example of exactly why Gov't needs to be kept out of the healkth care equation.

MY problem arises from the fact that I am with an HMO and Medicare. But if Obama care is allowed to stand, EVERYONE will be in the same boat and probably much worse because Washington Bureaucrats will be making ALL the rules, not just some of them.

10/07/2012 new

(Quote) Marianne-100218 said: That is exactly what I am telling you to do. Get a prescription from a doctor and bring it to ...
(Quote) Marianne-100218 said:

That is exactly what I am telling you to do. Get a prescription from a doctor and bring it to a pharmacy or a place that has the
breathing machines and pay for it yourself. You originally said you would be willing to pay for it. Did you misunderstand what I
wrote?

--hide--

Within the HM, I am never handed a prescription. It is put into the system within the organization and then the pharmacy, or in this case, the outside vendor contracted with the HMO responds.

The only way out of the circle would be, for examople, if I were in NY and my CPAP broke. If my HMO considered that enough of an emercgency, they would authorize me to see a sleep Dr. there who might write a prescription which would then allow me to purchase a machine.

The more likely scenario would be the HMO would require me to get home as soon as possible and be treated within the system.

All of which is further complicated because at 76 I am under Medicare and their rules need to be observed. And under their rules I cannot, again except in an emergency, seek any medical care from anyone except my HMO unless my HMO specifically authorizes it.

The point of all this thread has not been to seek a solution to my particular problem. Rather it is to use my experience as an example of exactly why Gov't needs to be kept out of the healkth care equation.

MY problem arises from the fact that I am with an HMO and Medicare. But if Obama care is allowed to stand, EVERYONE will be in the same boat and probably much worse because Washington Bureaucrats will be making ALL the rules, not just some of them.

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