Hey Bob

Weren't there significant cuts to Medicare advantage in obamacaid?

PkrBum wrote:Weren't there significant cuts to Medicare advantage in obamacaid?

When you owned (or I thought you said once) your medical device company were you a provider for Humana?

Oh and no there wasn't significant cuts in Medicare in fact a couple years ago or maybe 3 instead of a decrease to dr's and hospitals it was raised 4%.

All insurance company's have several different networks and provider's pick and choose which network and plans they want to be in, a provider may contract for one network and not the other. Well this is just what happened here the other company says you have to take all are networks or none. So here we have it. This happened several times in the years I managed two of our offices in other county's with them back in 1998. then back in the next year then out again in 2003 and 2 or 3 years later back in and so on. With the same company. This has everything to do with the insurance company.

ppaca wrote:

PkrBum wrote:Weren't there significant cuts to Medicare advantage in obamacaid?

When you owned (or I thought you said once) your medical device company were you a provider for Humana?

Oh and no there wasn't significant cuts in Medicare in fact a couple years ago or maybe 3 instead of a decrease to dr's and hospitals it was raised 4%.

All insurance company's have several different  networks and provider's pick and choose which network and plans they want to be in, a provider may contract for one network and not the other. Well this is just what happened here the other company says you have to take all are networks or none. So here we have it. This happened several times in the years I managed two of our offices in other county's with them back in 1998. then back in the next year then out again in 2003 and 2 or 3 years later back in and so on. With the same company. This has everything to do with the insurance company.

Ppaca's right that it's all about the insurance company.  United Healthcare, the company AARP always recommends, is notorious for pulling in and out of various health care networks/facilities.  For stability I don't think one can beat BC/BS and that's one of the main reasons why I picked Florida Blue.

I did think the significant federal subsidies of the Advantage plans were to be cut to help fund Obamacare -- this was the only thing I didn't like about Obama's platform.   Are you saying the subsidies stayed in place in full, ppaca?  News to me. I do agree that services haven't been cut -- just part of the subsidies (or so I thought) which is ostensibly why premiums, even though small, have risen along with some co-pays and co-insurances.

And Pkr why do you insist on calling it "Obamacaid," when it's not a Medicaid program?  Just curious.

RealLindaL wrote:

ppaca wrote:

PkrBum wrote:Weren't there significant cuts to Medicare advantage in obamacaid?

When you owned (or I thought you said once) your medical device company were you a provider for Humana?

Oh and no there wasn't significant cuts in Medicare in fact a couple years ago or maybe 3 instead of a decrease to dr's and hospitals it was raised 4%.

All insurance company's have several different  networks and provider's pick and choose which network and plans they want to be in, a provider may contract for one network and not the other. Well this is just what happened here the other company says you have to take all are networks or none. So here we have it. This happened several times in the years I managed two of our offices in other county's with them back in 1998. then back in the next year then out again in 2003 and 2 or 3 years later back in and so on. With the same company. This has everything to do with the insurance company.

Ppaca's right that it's all about the insurance company.  United Healthcare, the company AARP always recommends, is notorious for pulling in and out of various health care networks/facilities.  For stability I don't think one can beat BC/BS and that's one of the main reasons why I picked Florida Blue.

I did think the significant federal subsidies of the Advantage plans were to be cut to help fund Obamacare -- this was the only thing I didn't like about Obama's platform.   Are you saying the subsidies stayed in place in full, ppaca?  News to me.  I do agree that services haven't been cut -- just part of the subsidies (or so I thought) which is ostensibly why premiums, even though small, have risen along with some co-pays and co-insurances.

And Pkr why do you insist on calling it "Obamacaid," when it's not a Medicaid program?  Just curious.

Yea, I think  the government was paying around ten grand a year they pay around 9 now. There is some place you find out what they're paying the insurance company's, but a lot has to do with the star ratings. The higher the overall star rating is of an insurance company the more they receive the lower the less. The drugs are damn near what pushes the premium's up and yes the obamacare rule closing the gap by 2020 or almost closing.

Had to edit or file this response with Medicare. lol silly rules set in place by Bush.

I call it that because of the medicaid expansion. Yes it adds millions to the insured... but it's not free.

The promises were hollow... and anyone with any business sense knew that. It was designed to fail.

It's the working middle class that will really feel it. Furthermore... that individual mandate is Nazi shit.

that individual mandate is Nazi shit.

Nonsense.....you withdraw early from a qualified plan you pay a 10% penalty tax......you do not pay for medical insurance you pay a penalty tax......nothing remotely Nazi.......A democracy where priorities are set, taxes paid, and the general welfare provided......that is what happens in a constitutional democracy, but keep misusing political concepts......it is a tell.

2seaoat wrote:that individual mandate is Nazi shit.

Nonsense.....you withdraw early from a qualified plan you pay a 10% penalty tax......you do not pay for medical insurance you pay a penalty tax......nothing remotely Nazi.......A democracy where priorities are set, taxes paid, and the general welfare provided......that is what happens in a constitutional democracy, but keep misusing political concepts......it is a tell.

If not for Roberts reinventing the intent of the mandate... it would've died it's natural death.

Obama was too cowardly to call it a tax for political expediency... he counted on the useful idiots.

Just like you.

http://abcnews.go.com/blogs/politics/2012/06/obama-in-2009-its-not-a-tax/

Back to HB. Just spoke with his case manager and she wants to talk with him, hopefully I can get through to him or his girlfriend before I get busy.

A doctor has to sign off if he is to go into hospices, preferably his cancer doc. Hospice usually arranges transportation free of charge.

Nope just called Bob his mailbox is full.

Left message with his girlfriend.

If anyone wants to know for possible future if you're on a Med Advantage plan once in hospice full Medicare takes over for the facility or if someone comes to your home, but any treatment outside of hospice falls back on your Med Advantage.

Sal wrote:I wish the news was better.

Please let Bob know that I am praying that he finds some peace and comfort, and that his presence on this forum is sorely missed.

That echos my sentiments. It's really hard to know what to say. I wish there was something we could do.

PkrBum wrote:

Sal wrote:I wish the news was better.

Please let Bob know that I am praying that he finds some peace and comfort, and that his presence on this forum is sorely missed.

That echos my sentiments. It's really hard to know what to say. I wish there was something we could do.

I feel your helplessness, Pkr. I think it's likely something we all share, wishing we could fix it for dear Bob. But it's out of our hands.

I think all of us has been through this with a loved one and it does become a point to honor their wishes. I hate to see it too, but I do not know what I'd do in the same position.

RealLindaL wrote:

PkrBum wrote:

Sal wrote:I wish the news was better.

Please let Bob know that I am praying that he finds some peace and comfort, and that his presence on this forum is sorely missed.

That echos my sentiments. It's really hard to know what to say. I wish there was something we could do.

I feel your helplessness, Pkr.   I think it's likely something we all share, wishing we could fix it for dear Bob.  But it's out of our hands.  

Well said, it's a feeling of helplessness . . . .

Hi Bob just checking in. Will try to come see you in the next few days. Life has been hectic here with my kids and grandkids....running in different directions with 2 major projects going on. 

Miss you bunches.

Joani

Joanimaroni wrote:Hi Bob just checking in. Will try to come see you in the next few days. Life has been hectic here with my kids and grandkids....running in different directions with 2 major projects going on. 

Miss you bunches.

Joani

He'd love to see you, the more the merrier.

Someone correct me if I'm wrong. So norco is basically the same as loritab? If you are being given a norco, loritab and a muscle relaxer at the same time do you think this should be a crime? Is it a crime, so the person receiving it will not want to participate in pt and therefore the people giving can send in bad reports to the insurance company so they will cut coverage and the place where this person is presently can charge full price? Since I am skeptical of skilled and custodial nursing homes I believe this is going on. What say you?

Have to edit, I think I just remember that third drug and if memory serves me right it was fentanyl, which is no good anyway.

ppaca wrote:Someone correct me if I'm wrong. So norco is basically the same as loritab? If you are being given a norco, loritab and a muscle relaxer at the same time do you think this should be a crime? Is it a crime, so the person receiving it will not want to participate in pt and therefore the people giving can send in bad reports to the insurance company so they will cut coverage and the place where this person is presently can charge full price? Since I am skeptical of skilled and custodial nursing homes I believe this is going on. What say you?

There are agencies to protect the elderly. Is he complaining of pain? Those aren't necessarily strong drugs.

PkrBum wrote:

ppaca wrote:Someone correct me if I'm wrong. So norco is basically the same as loritab? If you are being given a norco, loritab and a muscle relaxer at the same time do you think this should be a crime? Is it a crime, so the person receiving it will not want to participate in pt and therefore the people giving can send in bad reports to the insurance company so they will cut coverage and the place where this person is presently can charge full price? Since I am skeptical of skilled and custodial nursing homes I believe this is going on. What say you?

There are agencies to protect the elderly. Is he complaining of pain? Those aren't necessarily strong drugs.

Yes he does complain about his leg hurting although they are not strong drugs (we don't know the dosage) the three at one time several times a day is not good on your outlook and doesn't motivate you to want to participate in PT. I know about the agency's to protect the elderly and if it comes to that and notifying ACHA I will. I'm up for a fight with something is being fucked with by someone who wants to make a buck.

What would you think if you were told you were getting kicked out of skilled nursing but we can put you in our hospice? BTW searched for that facility to be designated as an approved hospice facility, could not find it. I can only assume hospice to them is putting you back in the custodial care part of nursing home and charging you $200-$400 a day. I don't believe they're a Medicare approved hospice facility.

Doesn't sound good to me either. I'll read up on fraud cases like this tonight.

ppaca wrote:

PkrBum wrote:

ppaca wrote:Someone correct me if I'm wrong. So norco is basically the same as loritab? If you are being given a norco, loritab and a muscle relaxer at the same time do you think this should be a crime? Is it a crime, so the person receiving it will not want to participate in pt and therefore the people giving can send in bad reports to the insurance company so they will cut coverage and the place where this person is presently can charge full price? Since I am skeptical of skilled and custodial nursing homes I believe this is going on. What say you?

There are agencies to protect the elderly. Is he complaining of pain? Those aren't necessarily strong drugs.

Yes he does complain about his leg hurting although they are not strong drugs (we don't know the dosage) the three at one time several times a day is not good on your outlook and doesn't motivate you to want to participate in PT. I know about the agency's to protect the elderly and if it comes to that and notifying ACHA I will. I'm up for a fight with something is being fucked with by someone who wants to make a buck.

What would you think if you were told you were getting kicked out of skilled nursing but we can put you in our hospice? BTW searched for that facility to be designated as an approved hospice facility, could not find it. I can only assume hospice to them is putting you back in the custodial care part of nursing home and charging you $200-$400 a day. I don't believe they're a Medicare approved  hospice facility.

Norco and Lortab are the same (hydrocodone). Fentanyl is very strong pain medication....it is used in the OR to begin induction.

Joanimaroni wrote:

ppaca wrote:

PkrBum wrote:

ppaca wrote:Someone correct me if I'm wrong. So norco is basically the same as loritab? If you are being given a norco, loritab and a muscle relaxer at the same time do you think this should be a crime? Is it a crime, so the person receiving it will not want to participate in pt and therefore the people giving can send in bad reports to the insurance company so they will cut coverage and the place where this person is presently can charge full price? Since I am skeptical of skilled and custodial nursing homes I believe this is going on. What say you?

There are agencies to protect the elderly. Is he complaining of pain? Those aren't necessarily strong drugs.

Yes he does complain about his leg hurting although they are not strong drugs (we don't know the dosage) the three at one time several times a day is not good on your outlook and doesn't motivate you to want to participate in PT. I know about the agency's to protect the elderly and if it comes to that and notifying ACHA I will. I'm up for a fight with something is being fucked with by someone who wants to make a buck.

What would you think if you were told you were getting kicked out of skilled nursing but we can put you in our hospice? BTW searched for that facility to be designated as an approved hospice facility, could not find it. I can only assume hospice to them is putting you back in the custodial care part of nursing home and charging you $200-$400 a day. I don't believe they're a Medicare approved  hospice facility.

Norco and Lortab are the same (hydrocodone). Fentanyl is very strong pain medication....it is used in the OR to begin induction.

I only hope he was wrong when he told me what the drugs were, but he was very lucid when I got there, within 30 minutes after taking all three he was not.

Does Bob have a case manager? I would exert pressure on that person with the threat of the authorities that protect the elderly... both public and private. The facility will have all of those resources listed on a wall in the building... and must provide them to you if requested. Please contact me if there's anything I can do from a thousand miles away. I just hate the thght of Bob not getting the care he deserves. Thank you so much for being there for our friend.

Joannie,
I sent you a PM. Bob I am going to try to visit you after the election if I am recovered from lung surgery on Tuesday which allows me to travel.......do not expect it to be a big deal with Bronc. However, Has anybody set up a medical taxi and offered to let you spend an afternoon at your home. You have to be going light on the pain pills, or they will grab you and take all quality of life away. I get pain, but if the docs are saying you have a year or two with the cancer, and the mobility thing is not improving, then you have quality life which you can enjoy. It is none of my Fricking business, but I am pizzed that you may be suffering and may not have an advocate. I think P and Hallmark have been remarkable friends, and you are blessed, but you HAVE to set some goals and not get zapped out of your mind. Hell, by the time I meet you I might think I am talking to Mr. Markle or Pace. You can tell me when I get down there to go F myself, but it sounds like some boat needs rocking to make sure you are getting the best care.......this dying is a bitch on caretakers, but without a game plan you lose quality......none of us have much to say about the time thing, but the quality and being pain free.......and keeping a lucid mind.......stay strong, and DO NOT give up.

PkrBum wrote:Does Bob have a case manager? I would exert pressure on that person with the threat of the authorities that protect the elderly... both public and private. The facility will have all of those resources listed on a wall in the building... and must provide them to you if requested. Please contact me if there's anything I can do from a thousand miles away. I just hate the thght of Bob not getting the care he deserves. Thank you so much for being there for our friend.

Ok got a minute. Here's the deal that is not getting relayed to me properly and yes he has a case manager and also a blue nurse. This is something I did not know, when you're in a skilled nursing facility the approvals are done weekly and by improving progress. The case manager and nurse have been in touch with the social worker at the snf and right now he only has until Oct 28th because of the progress the home is reporting, if he shows progress in the next few days they can extend another week. Through no fault of his own I was told there were a couple days he was pretty sick and on antibiotics for an infection not related to what he is in there for. The case manager has been in touch with Bob several times this week and he has told her the desire to have hospice come into his home. She said it was intermittent and I hope Bob knows that.

Even though Medicare/Medicare advantage plans allow 100 days if no improvement is shown then it will be deemed no longer medically necessary and even if he was on regular Medicare he would not keep his 100 days.

Because a major hospital and all their doctor's that are affiliated are parting ways Jan 1 for Medicare Advantage and I am presenting seminar's for Medicare I have been unable to see him but have spoken with him and his case manager.

I know an excellent nurse w hospice. Please let me know if that's the route he takes... or even if the referral has been made. I've known that person for thirty years. Excellent character.