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[Lifetime]

"It has begun." I say this as I have a close friend who male family history indicates early Heart disorders and demise. He had no problem with his Med Ins. and has had some serious surgery in the last few years ( not cardiac). Well he had to go for a checkup for some discomforts he has. HIS Doctor knows his genetics and propensities. He prescribed a Chemical Stress Test. The Ins. Co. came back and "decided" that was too expensive and could be served just as well without the physical type.
 
Well, to make this short.... He went in and took it and GUESS WHAT??? They found a problem but, he has to go through another Stress Test...but.... this time it will be chemical to better define the problem in his heart. Hmmmm so the Ins. Co. certainly SAVED money.... 2 strss tests and the one they DID need was ONE Chemical Strss Test. DOHHHHHHH!!!
 
Needless to say, my friend is furious and will be spending "Quality Time" with his Ins. Reps. asking if any of them are a Practicing Physician. He will inform them that his Doctor doesn't OWN or SELL insurance as well. I would love to be a fly in that room but with my luck I would be hit with the latest JAMA or in some cases.... Hustler.

[NightmarePatrol]

Unfortunately HMO's and insurance companies hire doctors to make global decisions about what "best practice" is. What sucks is those doctors are not in front of the patient. They can however arbitrarily decide that if a patient exhibits "symptom a" then "test 1" is what they will pay for. If the test comes back with results that require "test 2" to be performed then they will authorize it. If they don't authorize it the responsibility to pay falls on to the patient. I don't know specifically what kind of latitude that insurers have over the physicians but I do know that the physicians have been brow beaten into compliance because the insurers will keep them on the phone for hours to argue the point. So the doctors time and the time of the phone person the doctor speaks to is with what? In the long run they saves them money, but the providers have gotten to the point where they don't want to deal with them any longer and simply fall into line.  In this case to find the problem I suggest you follow the money. It may pay off so to speak.

[Jayhawk]

Oh thanks very much NP. I haven't been reading the local rag these days...

Though, curiously, you have no problem with reading the "rag" when you can get news of importance to you without having to pay for it.

As for highmark, it was pretty obvious than a company that insures 1/3 of the local population wouldn't hold that many customers for much longer if the policyholders weren't covered at the biggest hospital in town.

You ARE a vulture, aren't you?  (A TURKEY vulture... lol)

Yeah, i realized a while ago that it's a vulture, not a hawk. I have an actual hawk picture that i keep meaning to replace it with.

as for the rag comment, it's the kind of hypocritical comment you hear that's like a vocal walmart critic ("they're evil! they kill local merchants! they sell junk!"). Yet for some reason you run into him in the checkout line every time you're there.

[Jayhawk]

They found a problem but, he has to go through another Stress Test...but.... this time it will be chemical to better define the problem in his heart.

The worst part is that cardiac stress tests are notoriously inconclusive/inaccurate. As cardiologist told me the accuracy rate is in the low 80%s, whereas most medical tests are in the high 90s. He said this as he was describing the results one i had, which turned out to be a false positive.

[Amidala]

Rest assured, I shop at WalMart, admit it freely and don't think I've ever called them evil. I don't think the paper is evil, either. I just find myself reading it in 5 minutes or so whenever I pick one up. Most of the articles don't interest me, and no, I don't read the comics. Oh, and I've never liked to touch newsprint. How's that for a weird pet peeve???

[TiFeMb]

Ami: I'm with you, I don't loke the ink on my fingers.

[Jayhawk]

I don't think the paper is evil, either. I just find myself reading it in 5 minutes or so whenever I pick one up. Most of the articles don't interest me, and no...

OK, then i misread your tone.

i actually prefer the tactile file of newsprint or book paper. And my pet peeve is those who complain about something but have no problem taking advantage of it, whether it's low prices at evil walmart or griping about how there's no good movies or music these days, yet their hard drives are full of booty from piratebay.

[Janetplanet]

I think I saw my first example of some of the changes with Highmark and MMC.  Had a bone density test a few weeks ago (have it yearly) and received an invoice from MMC for $16.  In years past it was always fully covered.  Get the feeling that we will be paying more out of pocket to make up for what Highmark cut back.  I don't really have a problem with contributing $16 towards my test, but I am already spending $650 a month for my health insurance.  Can't even think about retiring that way.