Rep. Ryan has stated that he wants those on Medicare to have the same options that he has and that this would put seniors in charge of their health care. Well I started taking a look at the options available to the congressman and other federal employees who are paid far more than the elderly and disabled living on Social Security. Here are a few quotes from the brochure from just one of the plans and after I post the quotes ask yourself is the patiant in charge of their health care or is the insurance company?
First quote: “prior to your inpatient hospital admission – we evaluate the medical necessity of your proposed stay, the procedure(s)/service(s) to be performed, and the number of days required to treat your condition” now your doctor has told you that you need to go into the hospital for a procedure so now what you call the insurance company and they can over rule your doctor. So who is in charge of your health care? You and your doctor or the insurance company? What happens should the insurance company decide that the procedure in not necessary? Do you die as you fight to get the care that your doctor tells you that you need? No thank you Rep. Ryan.
Second the brochure states further:”If no one contacts us, we will decide whether the hospital stay was medically necessary.
• If we determine that the stay was medically necessary, we will pay the inpatient charges, less the $500 penalty. [See Section 5(c) for payment information.]
• If we determine that it was not medically necessary for you to be an inpatient, we will not pay inpatient hospital benefits. We will only pay for any covered medical supplies and services that are otherwise payable on an outpatient basis.
If we denied the precertification request, we will not pay inpatient hospital benefits or inpatient physician care benefits. We will only pay for any covered medical supplies and services that are otherwise payable on an outpatient basis.
When we precertified the admission but you remained in the hospital beyond the number of days we approved and you did not get the additional days precertified, then:
• for the part of the admission that was medically necessary, we will pay inpatient benefits, but
• for the part of the admission that was not medically necessary, we will pay only medical services and supplies otherwise payable on an outpatient basis and we will not pay inpatient benefits.” So again if you do not allow the insurance company to use it’s own criteria as to what is necessary you will be screwed. While these restrictions may seem reasonable to someone like Rep. Ryan who has a large tax payer income and has never had a real job to a senior or someone who is disabled these restrictions and there costs will lead to avoidance of necessary care and could lead to death. So who is in charge of the patientshealth care the patient and their doctor or the insurance company? this is just an initial examination of the plans that Rep. Ryan want our seniors and the disabled to be exposed to. These plans are dictated by the insurance company for the benefit of the insurance company without regard to the needs of the patient.
Rep. Ryan you need to stop letting the Heritage Foundation write your plans and talking points. Preservation of privilege is not your job. You really need to go back to the drawing board or better yet perhaps you need to be unemployed or at least not employed by the voters who you do not represent.