Hi there. I'm appealing their latest decision to turn me down, and one of my arguments will be that it's probably going to be cheaper to pay for a lung transplant, one time, than vainly trying to extend my life with tons of hospital stays, antibiotics, miscellaneous CF treatments I wouldn't need post-transplant, and the like.
However, Medicaid--like any insurance company--negotiates a lower rate with hospitals and service providers than the stated rate for self-paying patients. (That's right, in case you didn't know, patients who have to, say, mortgage a house to pay their bills, or go into bankruptcy, have to subsidize those with insurance, who often receive services at a loss to the hospital through clever negotiation and dirty tricks unavailable to the layman. All praise the invisible, blood-stained claw of the free market! Allahu Ayn Rand! </sarcasm>)
Due to the above, I can't just go quoting the published rate for a lung transplant, and the published rates for those services. For all I know, a transplant might need to be paid almost in full, while hospital services are heavily discounted--defeating my argument, and making it indeed cheaper, for Medicaid, to keep me barely-alive as-is instead of paying for a recovery. If that's the case, I should hardly empathize the fact in an appeal <i>for my side</i>. But, how do I go about finding the true rates?
I called Medicaid, and they stonewalled, saying they don't release that info to patients. I called UNC, and they seemed equally freaked out, telling me to call Medicaid. The lady wouldn't even refer me to any other department that had that info, or might be of help in finding it. She seemed hostile to the very idea I might want access to the information of just how much Medicaid pays them. (Geez, it's not like national security is at stake)
Perhaps, however, that was due to my question about receiving a discount larger than the one they're willing to give. I asked her, point-blank, if she'd prefer the hospital to break even with Medicaid (or even take a loss), or receive what Medicaid would pay them, <b>plus</b> a hefty bonus on top (still not as much as they'd quote for a private patient) if I personally raised the funds. She couldn't reply to that, sounded extremely stressed (are they under legal obligation never to reveal that info?) and said she'd get back to me.
I called Medicaid again, and spoke to several levels of grunts before I realized it would likely be fruitless. I'll try again today, but I'm beginning to suspect that info is not easily available. But why? Surely it must be out there, somewhere. The legislature, for one, <i>must</i> have some kind of access on where the Medicaid money is going, at least. Could the Freedom of Information Act be used to obtain those numbers? (How quickly?) Does anyone know any tips for getting hard-to-find government data that they don't necessarily want you to have? Are there any legal issues to finding out how much Medicaid reimburses providers for a service? What's the deal, basically?
My main argument, of course, would be that (to all appearances) they shamelessly lie, hypocritically ignoring their own guidelines, when inventing "contraindications" that aren't even listed there. I just hope to convince them that such lying isn't even well-suited to the goals they might think it serves. <img src="i/expressions/face-icon-small-smile.gif" border="0">
By the way, someone (possibly from this very board) reported my comment, somewhere (I haven't been able to find it, but recall making it) to the effect of <i>"They're arguing a lung transplant--the only thing that can save my life--is an unacceptable risk to my life. Can I advocate 'National Strangle a Bureaucrat Day' yet?"</i> A UNC psychiatrist interviewed me, saying someone mentioned it to them because it was a "terrorist comment." The doc looked for that comment on my blog--where I didn't make it--and didn't find it, instead observing a statement from me (replying to someone who wished deadly lung illness on the Medicaid folks) that I didn't wish them any harm. After finding it, he concluded that I couldn't reasonably be plotting their demise via pipe bomb.
So, to whoever the person is who took my joke as a serious threat, I say: You, sir or madam, are the reason microwaveable TV dinners have "Remove plastic before eating" warning labels.
Sincerely yours,
--Abu Musab <i>Allan</i>-Zarqawi, "Internet terrorist" of the <a href=http://www.save-allan.org/wpblog>Save-Allan blog</a>
However, Medicaid--like any insurance company--negotiates a lower rate with hospitals and service providers than the stated rate for self-paying patients. (That's right, in case you didn't know, patients who have to, say, mortgage a house to pay their bills, or go into bankruptcy, have to subsidize those with insurance, who often receive services at a loss to the hospital through clever negotiation and dirty tricks unavailable to the layman. All praise the invisible, blood-stained claw of the free market! Allahu Ayn Rand! </sarcasm>)
Due to the above, I can't just go quoting the published rate for a lung transplant, and the published rates for those services. For all I know, a transplant might need to be paid almost in full, while hospital services are heavily discounted--defeating my argument, and making it indeed cheaper, for Medicaid, to keep me barely-alive as-is instead of paying for a recovery. If that's the case, I should hardly empathize the fact in an appeal <i>for my side</i>. But, how do I go about finding the true rates?
I called Medicaid, and they stonewalled, saying they don't release that info to patients. I called UNC, and they seemed equally freaked out, telling me to call Medicaid. The lady wouldn't even refer me to any other department that had that info, or might be of help in finding it. She seemed hostile to the very idea I might want access to the information of just how much Medicaid pays them. (Geez, it's not like national security is at stake)
Perhaps, however, that was due to my question about receiving a discount larger than the one they're willing to give. I asked her, point-blank, if she'd prefer the hospital to break even with Medicaid (or even take a loss), or receive what Medicaid would pay them, <b>plus</b> a hefty bonus on top (still not as much as they'd quote for a private patient) if I personally raised the funds. She couldn't reply to that, sounded extremely stressed (are they under legal obligation never to reveal that info?) and said she'd get back to me.
I called Medicaid again, and spoke to several levels of grunts before I realized it would likely be fruitless. I'll try again today, but I'm beginning to suspect that info is not easily available. But why? Surely it must be out there, somewhere. The legislature, for one, <i>must</i> have some kind of access on where the Medicaid money is going, at least. Could the Freedom of Information Act be used to obtain those numbers? (How quickly?) Does anyone know any tips for getting hard-to-find government data that they don't necessarily want you to have? Are there any legal issues to finding out how much Medicaid reimburses providers for a service? What's the deal, basically?
My main argument, of course, would be that (to all appearances) they shamelessly lie, hypocritically ignoring their own guidelines, when inventing "contraindications" that aren't even listed there. I just hope to convince them that such lying isn't even well-suited to the goals they might think it serves. <img src="i/expressions/face-icon-small-smile.gif" border="0">
By the way, someone (possibly from this very board) reported my comment, somewhere (I haven't been able to find it, but recall making it) to the effect of <i>"They're arguing a lung transplant--the only thing that can save my life--is an unacceptable risk to my life. Can I advocate 'National Strangle a Bureaucrat Day' yet?"</i> A UNC psychiatrist interviewed me, saying someone mentioned it to them because it was a "terrorist comment." The doc looked for that comment on my blog--where I didn't make it--and didn't find it, instead observing a statement from me (replying to someone who wished deadly lung illness on the Medicaid folks) that I didn't wish them any harm. After finding it, he concluded that I couldn't reasonably be plotting their demise via pipe bomb.
So, to whoever the person is who took my joke as a serious threat, I say: You, sir or madam, are the reason microwaveable TV dinners have "Remove plastic before eating" warning labels.
Sincerely yours,
--Abu Musab <i>Allan</i>-Zarqawi, "Internet terrorist" of the <a href=http://www.save-allan.org/wpblog>Save-Allan blog</a>