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Thursday, October 27, 2016

U.S. Health Care Woes

There's a whole lot wrong with the health system in the U.S. for instance: 

You get a bill for a preventive service because the facility decides to bill diagnostic; while the doctor & lab bill preventive. You appeal -the insurance company (not all but Cigna/BlueCross) say we can only pay as billed.  You appeal they deny.  Seriously?  The doctor says preventive, it should all be preventive.  When picking health care ask how they determine it. If they say the doctors rules the rest of the billing, the chances are you will get better results. 


You appeal to the dept. of insurance.  They say there is a difference between insurance & provider billing issues.  What? That is the issue the provider billed your insurance incorrectly. 


Next step, if you don't have a Union to back you up on your job and have a self-funded plan it falls under the jurisdiction of the US Dept. of Labor @ 866-444-3272.  


Unfortunately, it appears your issue is with the billing from say St. Joseph Hospital (example: huge amount of billing complaints/errors they bill all insurance companies for mammograms; but are giving 3-D mammograms something that insurance companies won't cover because there is no evidence that it gives better results or consistent results. Yet, they get to write off the new equipment and most patients don't know the difference.) or some other hospital provider, and the US DOL does not regulate hospitals.  At this point you could try contacting the NH Hospital Assoc. @603-225-0900, for advice and or the Governor’s office, specifically the Consumer protection area @ 603-271-3641. 


Because this is not an insurance issue but rather a hospital billing issue.  What?  Seriously concerning since they are not regulating hospitals who is are responsible for  Medical errors that are now the 3rd leading cause of death in the U.S.  Couple that with the fact that in 2012, the American Medical Association reported that an average of 9.5% of health claims processed by private health insurers contained errors.  When in fact Medical bills are usually incorrect -8 out of 10 hospital bills contain costly errors and can bankrupt patients.  


Is Obama's s Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) for short; viable? Sadly while it is needed it is not.  


Simply, because the big players like hospitals, doctors offices and other's do not have any accountability, there are no regulatory systems in place to keep them accountable and the average person can hardly follow the trail to get some satisfaction.  Moreover, the courts are simply granting them leans against people's home. (Something else St. Joseph Hospital is capitalizing on. ) People who have no knowledge that bills they dispute that went unanswered by St. Joseph Hospital until they go to sell or refinance.  


This is the most un-American thing still going on. The Confrontation Clause. The Confrontation evidence of the Sixth Amendment to the United States Constitution provides that "in all criminal prosecutions, the accused shall enjoy the right…to be confronted with the witnesses against him." Why, do you get no notice that someone is going to put a lien against home? Because the courts deem it to be a civil prosecution. 


People can get the liens removed but at what cost? They have to take their rights back under the Fifth and Fourteenth Amendments to the United States Constitution each contain a due process clause. Due process deals with the administration of justice and thus the due process clause acts as a safeguard from arbitrary denial of life, liberty, or property by the Government outside the sanction of law.   As such, it would appear most courts are denying people of their 5th and 14th amendment rights when they put a lien of their property without giving them the right to be heard before doing so.  


If medical care is to be successful - our government players are going to have start making not only the insurance companies accountable; they have to make the hospitals, doctors, labs and other's especially the non-profits who are getting enormous tax breaks accountable.  That means people should always have the right always to be heard and vindicated. 


Americans are being forced to pay excessive Deductibles and Maximum Out of Pocket expenses before they get coverage under their insurance policies hardly equal access.  Preventive Visits really? Most parents just want to be able to take their children to the doctor when their sick. They can't afford that and if the Departments of Health and Human Services showed real numbers, you'd see how many more patients are going into health care centers for care.  


Tell your state reps, senators and out next President you want all of the above fixed no if's and's or but's, FIX IT.