Someone help me out here. Insurance companies dont provide heath-care services. Right? We give them our money. They hold it and dictate things like copays, stop-pays, whats covered, whats not and pricing for hospital services that an individual, generally, doesnt have the clout to negotiate for himself. Weve known that about health insurance companies since the rule of the pharaohs and were apparently OK with it. Congress doesnt provide health-care services. Congress doesnt take our temps, check our blood pressure or perform surgery. The folks who run the U.S. Center for Medicare and Medicaid Services (CMS) dont provide health-care services. They manage a federal program, but they dont have anything that I know of to do with hands-on medicine. Recovery audit contractors (RAC), a 10-year-old creation of Congress, doesnt provide health-care services. All RACs do is delve into Medicare and Medicaid claims to determine which ones dont get paid or which ones should not have been paid. RACs get paid a percentage of the claims they overturn, or they dont get paid. Its big, big business. If you think cancer surveillance is urgent medical by CMS definition, think again. Recovery audit contractors, who roam the hallways of every hospital in the U.S., say cancer surveillance isnt urgent medical care. Most hospitals and doctors disagree, but even the biggest cancer centers in the U.S. that held hands with cancer patients a month ago are now telling Medicare-eligible people with cancer to pay for CT or PET scans at the hospital business office before services are rendered, or take a hike. Connolly Recovery Audit Experts is a RAC. Novistas Solutions, a private for-profit service that processes Medicare and Medicaid claims for the U.S. Center for Medicare and Medicaid Services (because CMS cant do it for itself), doesnt provide heath-care services. Novistas isnt government but it shuts down with the government when Congress folk dont play well together. So, who provides health-care services? Nurse-practitioners have bandaged me up the last dozen or so times Ive needed services. They should unionize. Ive written this far to raise what I think is a simple question: Who are we paying not to keep us well? If you live in the southern half of U.S., write this down: Novistas Solutions and Connolly Recovery Audit Experts. These people are hazardous to your health. Beyond a couple of cheap websites, they operate somewhat under the public radar. Thats got to change. Im guessing these newcomers would argue they weed out unnecessary claims so that correct claims are funded. Id argue they take money out of the pipeline and who knows what we get for it? At the same time, folks who didnt think they could afford health insurance . . . it turns out they can (or else) thanks to the Affordable Care Act (Obamacare) of 2010. Still, more money in the pipeline. How much of it winds up on your wound will be tough to quantify.
Posted on: Thu, 31 Oct 2013 07:34:07 +0000
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