No matter what type of healthcare insurance coverage you have, "Jiggered" will help you understand where you fit into the overall scheme of things, how your specific type of insurance works and how it will be affected in both quality and quantity over the next few years. You'll find that the only real crisis in healthcare is the one caused by the Federal government's inability to fiscally control and monitor itself. Who is being jiggered? Who is being unethically manipulated for someone else's gain? It's probably you and everyone like you. You have a job, pay your taxes, feed, clothe, educate and insure your children, own a home or are saving for one and generally behave in a lawful, fiscally responsible and upstanding manner. You're an ordinary upper or middle class American. Some of you have made it through the daily struggle to realize your dreams and have found financial rewards and others of you are still working at it. You all have one thing in common. You're part of the solution, not part of the problem. Are you jiggered? You figure it out.

Jiggered

The Healthcare Insurance Industry; Unraveled, Explained and ExposedBy C. E. Nash

iUniverse, Inc.

Copyright © 2010 C. E. Nash
All right reserved.
ISBN: 978-1-4502-5635-3

Contents

Dedication:......................................................................................................................................................................................................................................viiPreface:.........................................................................................................................................................................................................................................ixIntroduction:....................................................................................................................................................................................................................................xiiiChapter 1: A Little Business; A little Background; A Big Reality Check...........................................................................................................................................................................1Chapter 2: Private Insurance Funding: I Have Insurance So Why Is My Healthcare So Expensive? Why Do I have To Pay The Balance That My Insurance Company Didn't Cover? I'm Frustrated, Angry and Don't Understand This Stuff!.....................14Chapter 3: Medicare Funding: At Long Last, Free Healthcare! Not So Fast! It's Not All Free and It's Not All Covered! (and It's Broken Anyway)....................................................................................................26Chapter 4: Public Aid Funding: What Funding? It looks More Like 50% Waste, Fraud and Abuse To Me!................................................................................................................................................43Chapter 5: What's An EOB? I Have No Idea How My Insurance Company Did This! Help! I Don't Know What This Says! I Can't Pay This!.................................................................................................................49Chapter 6: Our Military: Shameful Dirty Doings Then and Now......................................................................................................................................................................................63Chapter 7: Your Not So Ordinary Dry As Dust Statistics; An Eye Opener?...........................................................................................................................................................................72Chapter 8: Fraud and Abuse: The Real Down and Dirty Behind The Scenes Corruption; Who Are Some Of The Really Bad Guys?...........................................................................................................................75Chapter 9: A Word To The Wise When Dealing With Your Healthcare Provider's Bills. We've Heard It All Already!....................................................................................................................................102Chapter 10: A Few Interesting Tidbits. Definitely Worth Perusing! Questions, Answers and Dissertations...........................................................................................................................................118Bibliography.....................................................................................................................................................................................................................................129

Chapter One

A Little Business; A little Background; A Big Reality Check.

Never forget the basic premise that wherever there's big money to be made, there will be big corruption to capitalize on the financial opportunity.

You may personally think that everyone should be entitled to healthcare because it's the humane thing to do. That might be fine in Utopia, but it doesn't work in the real world. While that's a laudable ambition, it is not a reality. You have a choice. You can have the best healthcare system in the world with some limits on access or you can have mediocre care available to nearly all. Limits are naturally imposed by the number of people available to provide the service. Is there a balance somewhere in between? Probably; I believe there is but it will never be achieved with politicians making the decisions.

Let's look at Washington and their recent healthcare reform bill. Healthcare reform is a misnomer. There is nothing wrong with the healthcare provider system in this country. The bill that passed in Washington DC was not about healthcare at all. It was about reforming the payment system. Its stated objective was to provide healthcare to forty-seven million more people. The current bill didn't even come close to achieving that goal. It did; however manage to increase the cost of what we already have at the expense of the taxpaying public. Without going into specifics in the bill itself, just take a look at who actually decided the healthcare fate of our nation. Given the basic premise that healthcare is a business, we should look at the background experience of our senators and representatives. Only a very small number of our congressmen (and congresswomen) actually have some experience in the healthcare industry. Those same representatives had virtually no voice in the legislative process. If you're going to completely overturn an industry, wouldn't it make sense to have a thorough understanding of its workings? The vast majority of the decision makers who were involved in this process in Washington DC have no business experience, no medical or healthcare experience and have been in the netherworld of politics for years; some for decades. Many are wealthy and have probably never held down a hardworking, honest job in their lives. Talk about a disconnect from reality! And they're making our decisions for us! No wonder we're in such a mess. It's said that the best cure for liberalism is to start up your own business. You'll most likely turn into a conservative overnight. Perhaps Nancy and Harry should give it a try.

Most people think of healthcare providers as their doctors and their hospitals. Hospitals have a huge number of employees but they also have something else that most Americans overlook. They have a very large number of small business owners under contract to provide your care. That's right, a vast amount of your healthcare is being provided by small business owners. Your primary care physician is most likely a small business owner. Many physician groups set up private practices and provide services to hospitals under agreement or contract. They provide care from the emergency room to the surgical suite and everywhere in between. If these healthcare provider groups don't like their contract terms, they can and sometimes do, take their business elsewhere. That's why you periodically see a hospital change its service base. All of a sudden, your local hospital no longer provides OBGYN services, Pediatric Intensive Care services or Level I Trauma services. For whatever reason, the medical group was not able to negotiate a favorable contract with the hospital. Cost driven rationing? Most likely.

Those same small business healthcare providers also contract with Federal and State Government agencies to provide healthcare for Medicare and Public Aid recipients, and agree to provide healthcare at a markedly reduced fee for their services. They provide medical care and then bill the appropriate...