Bunny Trails

[Judas Maccabeus]

You actually prove my point here. That 20% they take IS part of the problem. No other industrialized society would put up with this. Common estimates for Medicare range between 3% (From it's advocates) to 5.5% from it's detractors, still it is better than 20%. Remember, that 20% (or 15% percent, I will gladly concede) does not go to treating a single patient, paying a single bedside nurse, or buying needed medication. It goes to maintaining an administrative machine that frequently PREVENTS good care. Care denied drops to the bottom line.

+/- 20% does not make a big impact in care. It's 20%.

I am sure you know what a "Pre-auth" is, for others it is the insurance company deciding what treatment you can have, regardless of what your doctor thinks. Denials, and hence denial of good care are far too frequent. I will not give you examples from my professional life, but I will give you one from my personal life instead.

Myself and one of my close friends have a couple pre-auths out on us. Doctor's office requested it, it got approved within a day or two, prescription filled.

Same story for a neurological MRI. Insurance preauth was the easy part. Hard part was finding a provider who could take an appointment. Ended up waiting 4 months to get an appointment (an earlier one got cancelled because the whole office was closed due to COVID.)

One of my friends from the mission field had symptoms of trigeminal neuralgia. Tests confirmed this, his neurologist wanted to refer him for surgery. Preach was declined, and the insurance mandated treatment with medication and PT instead. Neurologist tried again, after this had failed for 3 months, then again at 6. Denied. Fortunately, his wife was Austrian, and had residency in Austria. Got on a plane, got an appointment at the teaching hospital. Diagnosis, trigeminal neuralgia, he said he told them about the treatment he had in the states. Answer-"That will never work, you need surgery." Was booked in 3 weeks, and the surgery relieved his symptoms.

So if you think our system is wonderful, and that the insurance company will cover what you need, think again. Care denied drops to the bottom line, in other words becomes profit.

This is the exact opposite of how insurance works, with care management being a large focus in insurers to try to control costs to avoid very expensive hospitalisations. Of course, since your background is providers, I can see that you can see insurers as a fountain of evil and providers as pure and righteous, but this is a vast oversimplification of the situation. My work with care management revolved around making sure people who were diabetic, etc. got regular visits from an (insurance company employee) nurse for follow up care to avoid hospitalisations or death - both of which are very expensive for insurers.

I could say more about "charge masters" but I don't want to confuse the issue.

J.M.

Why do hospitals and other providers keep them a secret? California forced them to be public record, and it seems to be working fine there. From my point of view, hospitals want to charge outrageous prices and then collude with large insurance companies on pricing, and rip off everybody else. Neither providers nor insurers are innocent in this.

They should post exactly the prices they charge for various services, patients should know what they are expected to pay, and it would be clear and transparent what insurance pays or would not pay. Medicare and Medicaid patients would continue to not have to pay anything if they are covered. This is how insurance works with things like auto body shops. I don't see why medicine is so different.

In Maryland all hospital charges and rates are set by the Health Services Cost Review Commission, so all of them are public record, so I just don't know about California's regulatory environment. They are not secret here, but almost no one is ACTUALLY charged that. What really matters is the Medicare reasonable and customary charge, and most of what carriers pay is based on it. In most cases, at least here, the charge master is a completely useless tome, and the HSCRC rate or the R+C is what matters.

You have had no problem with per-auths, well good for you, you are lucky. I have fought many, many battles trying to get people necessary care. My take on it, is the system if fine, unless you are really sick. Some are better than others, and I could name names if you like. For example, Humana just tried to deny coverage for ALL PET/CT scans, calling them "experimental!' They have been a well established use for 15 years, and Medicare will gladly pay for them, as long as it is within their criteria, which is easy to determine.

If you think insurance provider are on your side, their interest is their stockholders, and it is contrary to patient interest.

J.M.

[Josh]

Some of us use insurers that are nonprofits or are mutual insurers. So, no for profit stockholders. Many people choose a for profit insurer, you’ll have to ask them why.

Some Mennonites even use a mutual aid plan. In my experience, these plans are much more careful and thorough about sharing needs than a traditional insurer - there’s no profit bottom line for them, but every need gets way more attention and often requests for more documentation.

If you criticise the insurance industry, eventually I’m going to ask you which mutual aid plan you use and which one you recommend. Mennonites have held convictions against insurance (and against socialised medicine, such as in Canada) for a century.

[Judas Maccabeus]

Some of us use insurers that are nonprofits or are mutual insurers. So, no for profit stockholders. Many people choose a for profit insurer, you’ll have to ask them why.

Some Mennonites even use a mutual aid plan. In my experience, these plans are much more careful and thorough about sharing needs than a traditional insurer - there’s no profit bottom line for them, but every need gets way more attention and often requests for more documentation.

If you criticise the insurance industry, eventually I’m going to ask you which mutual aid plan you use and which one you recommend. Mennonites have held convictions against insurance (and against socialised medicine, such as in Canada) for a century.

Not us, and not my conference. I am fully in compliance with our guidelines on the matter. We have a fellowship fund, but many of us have insurance through our employment or former employment. So I guess you will respond with so you are not Mennonite.

For someone in your position, that would be rather interesting, no?

J.M.

J.M.

[RZehr]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

[Judas Maccabeus]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

Are you all opted out of social security and Medicare? That will make a big difference in what will and will not work. We are not.

J.M.

[Josh]

Some of us use insurers that are nonprofits or are mutual insurers. So, no for profit stockholders. Many people choose a for profit insurer, you’ll have to ask them why.

Some Mennonites even use a mutual aid plan. In my experience, these plans are much more careful and thorough about sharing needs than a traditional insurer - there’s no profit bottom line for them, but every need gets way more attention and often requests for more documentation.

If you criticise the insurance industry, eventually I’m going to ask you which mutual aid plan you use and which one you recommend. Mennonites have held convictions against insurance (and against socialised medicine, such as in Canada) for a century.

Not us, and not my conference. I am fully in compliance with our guidelines on the matter. We have a fellowship fund, but many of us have insurance through our employment or former employment. So I guess you will respond with so you are not Mennonite.

For someone in your position, that would be rather interesting, no?

J.M.

J.M.

You could voluntarily join a mutual aid programme. I know plenty of people in K. who are members of such programmes.

If you think insurers are so evil, I’m questioning why you continue to use them, particularly when you’ve had a very obvious alternative.

[Josh]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

Are you all opted out of social security and Medicare? That will make a big difference in what will and will not work. We are not.

J.M.

Holdemans never opted out en masse and yet they use their own mutual aid for health and property loss. I pay social security taxes and yet still am able to cough up the $195 a month for health aid.

Keystone is on the register of groups eligible to opt out of government mandated insurance, so I suppose that would be up to individual conviction.

[RZehr]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

Are you all opted out of social security and Medicare? That will make a big difference in what will and will not work. We are not.

J.M.

No we aren’t all. Maybe half are exempt. But every family save one retired couple, is part of this plan.

[Judas Maccabeus]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

Are you all opted out of social security and Medicare? That will make a big difference in what will and will not work. We are not.

J.M.

No we aren’t all. Maybe half are exempt. But every family save one retired couple, is part of this plan.

Our conference is not exempt, we cannot opt out, and as best as I understand could not become so, even if it wanted to. I am retired, and my health insurance is far less expensive than what you are quoting. We are urban, and most of us work for employers that provide this as a result of employment.

J.M.

[Judas Maccabeus]

Our church is a member of the Anabaptist Medical Aid Program. I think for about 3 years. I think it’s been working really well from what I can tell.
It is about $2M per year program, 32 intermediate conservative Mennonite congregations.
I think the cost averages to $145 per month per adult, children nothing.

Are you all opted out of social security and Medicare? That will make a big difference in what will and will not work. We are not.

J.M.

Holdemans never opted out en masse and yet they use their own mutual aid for health and property loss. I pay social security taxes and yet still am able to cough up the $195 a month for health aid.

Keystone is on the register of groups eligible to opt out of government mandated insurance, so I suppose that would be up to individual conviction.

As best as I know we are NOT opted out, as we have no mechanism to provide those benefits that we would need to provide. I know what register you are talking about, even one of our bishops was surprised we were on that list. You likely got that list from me. BTW the Lancaster conference is also on that list, and when those rules were created, we were part of the Lancaster conference. Just being on that list does not mean you can opt out, you as a group, have to provide and have a history of providing care for people that are opted out. But no, we, as a group, are not eligible to opt out of social security. I asked. We promise to follow those rules in our covenant.

You sure get a kick out of throwing stones at conferences that have differing rules. Care to discuss some of the Holdeman rules that other groups would differ with?

J.M.