Here's what's "got my goat" today about our Medical system . . . .

I had a Doctor's appointment scheduled for next week, and today got a call from the office today stating that when I come in I'd have to bring $100 "earnest money".  I've never been asked for this before, since I have a $40 co-pay to see a specialist.  But - since the practice was sold to the adjacent hospital, they are now saying that my doctor is an "outpatient clinic" and the co-pay no longer applies.  Therefore, I'd have to pay out of pocket until meeting my deductible.

Basically, they've redefined what an office visit is or is not - simply to suit themselves.  No one cares that I've paid for my insurance & included features like co-pays because I was willing to pay the premium for them.

With the advent of health care reform arriving on the scene, I've been seeing more consolidation - on the insurance company side of the business & now on the provider side.  As providers begin to consolidate, it seems they are re-defining what certain visits are, as well as, how certain hospital stays can be billed.

One example of what's happening with 'in-facility' stays, is the new phenomenon of keeping someone overnight (mainly after a visit to the emergency room) for "observation", and giving the impression that the patient has been admitted, when in fact, they have not.  What happens here can make a huge difference to some of my Medicare Advantage beneficiaries, since they pay a daily hospital rate if they are an inpatient that includes everything that happens while they are there (all tests, surgeries, etc).  If they are kept in an outpatient status, that same Medicare Advantage beneficiary would be subject to paying 20% of everything that happens there - so it's very much like 'a-la-carte' billing - resulting in a much higher bill.

Today, the patient has to be ever vigilant & ask very pointed questions about how they will be billed prior to having procedures done.  We're entering an age where none of this is about the patient & patient care, but is all about the money and the various corporate entities that are deciding everything about how care will be administered.

Look alert!  Make sure that if you have any type of serious illness or ongoing need for care, you involve a family member or friend to advocate on your behalf.  When you become seriously ill, you just won't have it in you to fight the good fight.

As for my situation, I told them to cancel my appointment and that I'd find another doctor who would honor my insurance with the features that I've been paying for. . . .

Medicare Seeks To Limit Number Of Seniors Placed In Hospital Observation Care

The "observation care" designation is a thorny one - for the providers, as well as, the Medicare beneficiary.  The patient often doesn't realize that they haven't been admitted, and end up with increased financial obligations because of it.  If a person has a Medicare Advantage plan, this can be especially troubling, since in many of the plans on the market, the patient would be responsible for 20% of all outpatient services received, rather than a straight 'hospital inpatient' daily co-pay.

The difference between the two can be enormous, especially if expensive tests are done while the person is considered to be an "outpatient".  There are other implications as well, related to requirements to be admitted into a nursing home after a hospital stay.  The requirement to have coverage in that instance is that the patient has been an "inpatient" for 3 consecutive days.  Outpatient status doesn't count.  Read more in the Kaiser Foundation & Washington Post article here . . .

More Insurance Carriers seem to be backing away from Exchanges

In the state of Illinois, fewer insurance carriers than expected are agreeing to participate in the exchanges.  I believe the trend will continue, and we may also see those who have committed to the effort drop out at the last minute.  Confusion seems to be the only constant as we march toward 1/1/2014 and all of the new requirements that individuals and businesses face concerning implementation of health care reform.  Good article today in the Washington Post.  Read it here . . .

Aetna Cuts Predictions for Obamacare Enrollment

Well, I'd heard the rumblings about some of the largest health insurance carriers not participating within the exchanges, since they think the risk pool may be worse than anticipated - and now that seems to be bearing out.  Because of anticipated delays in getting exchanges set up and problems with educating the public on what they will look like, etc., it seems that Aetna is the first major player to express doubts publicly.  Read more here . . . .