My View of H.R. 3200 continued (this could take a lot of blogging)

I've continued to read the H.R. 3200 bill and have come across another crucial piece that I'm liking quite a bit. That's the "timely payment of claims" portion. I'm not sure if it only applies to the national payor or to all private insurance in general. I've billed medical insurance for thirteen years. Medicare always paid timely, you just had to make sure you had the following: Certificate of Medical Necessity, qualifying diagnosis, every little box that needed to be checked, properly checked...you would usually see a turn around of about 4 to 8 days. Private insurance on the other hand, usually needed a preauthorization, then an authorization, then a participating physician, a prescription, and had to be filed within 30 to 90 days depending upon the carrier.

Blue Cross Blue Shield was notorious for "never" receiving the claim. And unless you had a good aging report that caught these unpaid claims quickly, a lot of times you'd be out of luck, because then you'd be out of timely filing. With medicare, you have 18 months to file the claim. Why so long? Well, sometimes a service may be provided in the emergency room, by a resident or visiting doctor. That doctor is the attending and ordering physician. If that doctor is visiting he/she may not be there anymore when you send the certificate of medical necessity for his/her signature. That's when the real fun begins...tracking down that doctor. So, if this bill requires private insurance to follow in the steps of medicare then that will be a big improvement in our healthcare system.

Here's a part of the bill that I think answers or quells all those people screaming that we won't have access to doctors:


No Restrictions on Coverage Unrelated to Clinical Appropriateness- A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.


I'm not seeing where there will be long lines of people just waiting to see the doctor. I'm also not seeing where people will be denied preventative maintenance, yearly check ups or delay in getting treatment. I know I got lots more to read, but so far...it's good.

H.R. 3200...A Middle Class View

I'm in the process of reading H.R. 3200 which is the National Health Care bill that's on the table for confirmation. I got the idea of reading the bill because of the recent 9/12 protests rallies. I was asked to attend the one over in Odessa, but I declined. My reason for declining was because I wasn't quite sure what I was protesting. I mean, what if this health care bill really is a good one and I'm out there yelling against it, that would be pretty asinine of me.

So far, I've not come across anything that scares the beegeezus out of me. But I'm only at the beginning and I fully intend to read the bill, the entire bill and nothing but the bill...no commentary or someone else's opinion on what he/she thinks it really means. I'm rather tickled with the naysayers and doomsayers.

There are a few things that I really like about the proposal; strong insurance reforms, allowing us the option of a national health payer or private insurance, reduced insurance costs set according to one's income (that's sorta like reduced and free lunches for kiddos at school), but...I'm not so sure exactly what "shared responsibility" is referring to, and that's the one I'm gonna have to read a bit more about. I'm thinking that the "shared responsibility" has to do with the basic concept of our government "promoting the general welfare."

As I kept reading, I came across something truly wonderful and that's this:
Prohibiting pre-existing condition exclusions. That's a big one and a major reason why a lot of people can't get insurance. I worked in human resources for about 3 years. When a person leaves a company, they have the option of continuing their insurance coverage under something called COBRA. Of course, the person loses what employer contribution was being made, and has to foot the entire bill. Most times this is extremely expensive...upwards to about $700 - $800 per month. Some people have no choice, but to keep the insurance due to maybe already having a disease, such as diabetes or COPD. They just can't fore go having insurance until the next job, also they risk being denied new coverage for "pre-existing" diagnosis. It's a horrible calamity.

I also keep hearing (ooops, I said I wouldn't listen to others) that the feds have screwed up medicare. I think medicare works just fine. Medicare claims are paid timely. In fact, years ago, a provider could electronically submit claims to medicare get reimbursement within a few days...an electronic deposit. It wasn't until SOMEONE decided to farm out the management of medicare to some PRIVATE insurance groups such as SECURE HORIZONS that things started getting really messed up.

That's all I've read so far, and I'm only at the beginning. The only thing I've come across that I'm not liking is the tax on people who don't have insurance.