patrick.net

Wow! Did this occur on the way to/from duty? If not, and you weren't under a transition benefit period after release from active duty, it should be pretty cut and dry: I wonder why it is not.

Because the insurance companies do whatever the hell they want to. I was in an accident and the other guy's insurance is saying that it's partly my fault, even though he admitted fault, was ticketed, and I wasn't.

Go figure.

Paralithodes says

Wow! Did this occur on the way to/from duty? If not, and you weren’t under a transition benefit period after release from active duty, it should be pretty cut and dry: I wonder why it is not.

Yes, it was line of duty. I'm now a retired soldier and disabled veteran. By law however, State Farm should have paid. My doc estimates that I saved State Farm over $2 million by being forced into the VA Hospital vs. a private facility.

I'll Be There

http://www.statefarm.com/beingthere/

Sure you will........

If it was LOD, then under what law should State Farm have paid? If this was during your reserve time, then Title 10 is pretty clear on the matter:

TITLE 10 > Subtitle A > PART II > CHAPTER 55 > § 1074a a(2). Reservists injured while traveling to/from IDT are covered. And shouldn't a lot of costs come from his auto insurance (or was he uninsured)?

I'm not a lawyer (and therefore not a JAG), and my questions are sincere. Have you spoken to a JAG officer? Or, is your lawyer experienced with military law? If not, you might want to get a second opinion from one who is.

As far as how things might be under "Obama Care..." My wife has only cried a few times, and so far we have only had to go through our Congressman once to get Tricare to partially acknowledge a large mistake on their part (they got away without full acknowledgment/correction only because we did not do our due dilligence at the beginning as far as proof: we should have logged every call, every rep ID, etc.). These were for generally routine medical care, not for anything like your situation. But why anyone thinks that the government would be better than the private sector, when current programs are no better now, is beyond me.... Especially when it is generally private sector insurance companies managing the programs as government contractors - a construct that is NOT likely to change under "Obama Care." That's why, regardless of all of the negative focus of insurance companies, they and the Democrats are actually in bed with each other. Once a bill passes, their business will greatly increase: it may decrease on the private side, but the government contracts will probably even raise their measly 2-4% profit margins. Cha-ching!

Paralithodes says

Why anyone thinks that the government would be better than the private sector, when current programs are no better now, is beyond me.

Because South Korea ($1688/yr), Portugal ($2150), NZ ($2510), Japan ($2581), Spain ($2671), Finland ($2840), the UK ($2992), Australia ($3137), Sweden ($3323), Denmark ($3512), France ($3601), Austria ($3763), and Canada ($3895) have figured out that just covering everyone in mandated national insurance is twice or more efficient than our half-assed mish-mash of non-coverage, full subsidized coverage for some people, private coverage through employment.

NOBODY starting a country from scratch would choose the system we have allowed to evolve. And only conservative inertia from kulturekampf retreads yourself is keeping us from fixing it.

LOL, If the senate were comprised of 98-2 D-R, and the bill failed by 49-51, you'd still be blaming the conservatives!

LOL, no I wouldn't. The Massachusetts vote was demonstrative of the threat Democrats are facing from the right this cycle.

You would agree, no?

jvolstad says

Paralithodes says

Wow! Did this occur on the way to/from duty? If not, and you weren’t under a transition benefit period after release from active duty, it should be pretty cut and dry: I wonder why it is not.

Yes, it was line of duty. I’m now a retired soldier and disabled veteran. By law however, State Farm should have paid. My doc estimates that I saved State Farm over $2 million by being forced into the VA Hospital vs. a private facility.
I’ll Be There
http://www.statefarm.com/beingthere/
Sure you will……..

..and just to think what would have happened to your family if we didnt have all this socialist VA hospitals around. I bet your arch-conservative ideals went right out the windows when you walked throught the doors of the VA hospital. I am happy to have paid taxes so that you can live another day to support your family. Paralithodes and others may disagree....but I think this was money well spent.

Now for the insurance companies, this is the kind of situation that needs to be shut down. Does anyone know if the healthcare reform bill includes provisions that prevent this from ocurring?

Troy says

Paralithodes says

Why anyone thinks that the government would be better than the private sector, when current programs are no better now, is beyond me.

Because South Korea ($1688/yr), Portugal ($2150), NZ ($2510), Japan ($2581), Spain ($2671), Finland ($2840), the UK ($2992), Australia ($3137), Sweden ($3323), Denmark ($3512), France ($3601), Austria ($3763), and Canada ($3895) have figured out that just covering everyone in mandated national insurance is twice or more efficient than our half-assed mish-mash of non-coverage, full subsidized coverage for some people, private coverage through employment.
NOBODY starting a country from scratch would choose the system we have allowed to evolve. And only conservative inertia from kulturekampf retreads yourself is keeping us from fixing it.

No Troy, call them out acurately......they are "arch-conservatives"

Troy says

LOL, no I wouldn’t. The Massachusetts vote was demonstrative of the threat Democrats are facing from the right this cycle.
You would agree, no?

The "threat" is not from the right. It is from J6P who is tired of working more for less (or losing his job while the elites rake in record profits). People are tired of a devalued currency. People are tired of working hard only to have their labor go to support welfare recipients and fat cats.

In order to win in Mass, you HAVE to win the majority of moderates and people with little or no party loyalty.

Blame the right, but you are fooling yourself. It was a vote AGAINST THE STATUS QUO. (so was Obama's win as well, so it was a futile gesture but most votes cast today are not FOR anything or anyone but rather AGAINST someone else or perceived status quo.)

Troy says

NOBODY starting a country from scratch would choose the system we have allowed to evolve.

got that right. It was years of government/corporate profiteering that gave us this system. It is rigged in favor of the corporate elites, in medicine, pharma and insurance. What we have today is a result of government regulation rather than lack thereof.

4X, Do you read/comprehend? It MAY be the insurance companies, but given the basic description here, it may be the government. If he was injured in the line of duty - including traveling to/from reserve drills, the law is clear on the matter. There are obviously details we don't know, but your jumping to conclusions due to your hate of the private sector, and faith in government is preventing you from taking a step back.

Troy says

LOL, no I wouldn’t. The Massachusetts vote was demonstrative of the threat Democrats are facing from the right this cycle.
You would agree, no?

No. AH has it exactly right. Look at the statistics of who gave Obama the Presidency and who gave Brown the MA Senate seat. It was certainly not people like you or me.

That you attribute the MA results as a threat from the "right" supports my point.

Just to clarify my original post, I do get full medical treatment from the VA. When I turn 60 and my military retirement kicks in. I'll get Tricare (military healthcare). The issue here is that by law my private insurance becomes the primary provider, the government secondary.

My insurance policy allows for unlimited treatment for injuries related to the car accident. It goes without saying that State Farm wants me gone and to have Uncle Sam take over with his "deep pockets". 99% of my fellow veterans do not understand why I just don't have the VA take over completely. It costs me nothing.

As a retired senior NCO, I can not put myself ahead of combat injured veterans. It's hard to civilians to understand this concept. Google "NCO Creed" for more info.

Ouch: http://www.jvolstad.com/hosp2.htm

jvolstad says

Just to clarify my original post, I do get full medical treatment from the VA. When I turn 60 and my military retirement kicks in. I’ll get Tricare (military healthcare). The issue here is that by law my private insurance becomes the primary provider, the government secondary. My insurance policy allows for unlimited treatment for injuries related to the car accident. It goes without saying that State Farm wants me gone and to have Uncle Sam take over with his “deep pockets”. 99% of my fellow veterans do not understand why I just don’t have the VA take over completely. It costs me nothing. As a retired senior NCO, I can not put myself ahead of combat injured veterans. It’s hard to civilians to understand this concept. Google “NCO Creed” for more info. Ouch: http://www.jvolstad.com/hosp2.htm

Where in the law is that? I'm not familiar with the med parts of T10 more than what I posted above.

Paralithodes says

jvolstad says

Just to clarify my original post, I do get full medical treatment from the VA. When I turn 60 and my military retirement kicks in. I’ll get Tricare (military healthcare). The issue here is that by law my private insurance becomes the primary provider, the government secondary. My insurance policy allows for unlimited treatment for injuries related to the car accident. It goes without saying that State Farm wants me gone and to have Uncle Sam take over with his “deep pockets”. 99% of my fellow veterans do not understand why I just don’t have the VA take over completely. It costs me nothing. As a retired senior NCO, I can not put myself ahead of combat injured veterans. It’s hard to civilians to understand this concept. Google “NCO Creed” for more info. Ouch: http://www.jvolstad.com/hosp2.htm

Where in the law is that? I’m not familiar with the med parts of T10 more than what I posted above.

I have spoken to the JAG about this situation, both back at home and here in the Bay Area where I work. Private insurance is the primary coverage. Anything not covered by my policy is paid in full by either the VA or later by Tricare.

State Farm wants to reverse the order. That said however, the VA takes care of me, no questions asked. The claims agent for my policy knows this. Little wonder they want me gone.

Recent conversation with agent: "We have paid enough and you should go away".

What a scumbag.

As an active reservist or gray-area retiree, you wouldn't normally be qualified for care other than service-related injuries/conditions. Title 10 is pretty clear that it covers you from portal-to-portal on drill weekends and the VA wouldn't be taking care of you if the service wasn't responsible for your injury. What law states that your private insurance is primary? How does State Farm have anything to do with this? Are they refusing you coverage under some type of "pre-existing condition" type of thing, or something else? If you need a hip replacement and the VA is not providing, and legal services are telling you they can't help you, then maybe you should contact your Congressman? Have you checked out Military.com (www.military.com) discussion boards? Maybe there will be some JAGs, Medical Corps (or "Corpse" in Obama-speak), or others who can give you some good input. Good luck! BZ on your recovery and ability to finish up 26 years!

Paralithodes says

4X, Do you read/comprehend? It MAY be the insurance companies, but given the basic description here, it may be the government. If he was injured in the line of duty - including traveling to/from reserve drills, the law is clear on the matter. There are obviously details we don’t know, but your jumping to conclusions due to your hate of the private sector, and faith in government is preventing you from taking a step back.

I get it, but my point is that people who often talk about not wanting a socialist government often find themselves relying on the same services. Yes, the insurance companies are a fraud for not covering him..they will do anything to avoid a payout.

Trust me, my wife works for one and has to reject people frequently....often times these same people die a few months later. Sadly.

4X, Your "point" is based on a completely false premise.

Paralithodes says

As an active reservist or gray-area retiree, you wouldn’t normally be qualified for care other than service-related injuries/conditions. Title 10 is pretty clear that it covers you from portal-to-portal on drill weekends and the VA wouldn’t be taking care of you if the service wasn’t responsible for your injury. What law states that your private insurance is primary? How does State Farm have anything to do with this? Are they refusing you coverage under some type of “pre-existing condition” type of thing, or something else? If you need a hip replacement and the VA is not providing, and legal services are telling you they can’t help you, then maybe you should contact your Congressman? Have you checked out Military.com (www.military.com) discussion boards? Maybe there will be some JAGs, Medical Corps (or “Corpse” in Obama-speak), or others who can give you some good input. Good luck! BZ on your recovery and ability to finish up 26 years!

I am going to look into this some more based on my read of Title 10. I was not familiar with that info but I assume the JAG back at Fort Sam Houston was/is. Thanks for the info.

I may stop by Moffett Field here in the Bay Area this afternoon on the off chance that the JAG is drilling this weekend.

http://en.wikipedia.org/wiki/Moffett_Federal_Airfield

Paralithodes says

4X, Your “point” is based on a completely false premise.

Are you saying that arch-conservatives have not been calling Obama a SOCIALIST in attempt to discredit his efforts?

The reason most of the insurance industry is a train wreck is because the government forces people to purchase insurance. They do it for motor vehichles and they force most companies to purchase it for their employees. When the customer doesn't have the option of walking away, where's the incentive to provide a decent service? There is none.

Nomograph says

theoakman says

When the customer doesn’t have the option of walking away,

When you say “walking away” from health insurance, what you mean is “becoming a ward of the state”. Think for a moment about what happens to sick people with no health insurance. They become wards of the state. Don’t you understand this?

Actually, the Medicaid system (MediCal in California-speak) is hard to qualify for. If you can't meet the narrow financial qualifying criteria, you don't have payment for services. So you go thru the ER and hope that you'll be admitted with your emergent condition. If you're not determined to be emergent, you'll go home with a prescription for which you'll be unable to pay.

There are no "wards of the state" any longer. States don't offer healthcare, they offer federal match programs or state-funded programs that help to pay for their healthcare. If they don't qualify (and many don't), their care won't be paid for. The hospital or nursing home is stuck with a non-paying patient.

There are thousands of elderly in nursing homes across the country who have no money to pay for room & board, don't qualify for Medicaid, and can't be discharged because of anti-dumping laws. Nursing homes have to continue providing service for these patients regardless of their ability to pay. The cost of their care is absorbed by the nursing home, which translates into higher costs for all. There have been cases of patients remaining in the hospital for over a year because they had nowhere to go, yet didn't qualify for Medicaid or any other financial programs.

Qualifying for Medicaid isn't easy, especially in this recession. For instance, if mom 2nd mortgaged her home for $100k to help her kids with a down payment in 2007, she won't qualify for Medicaid now for about 2 years from the date she applies. And if the kids try to pay it back, they're probably upside down in their house and can't afford to do so.

It didn't use to be this way, but unfortunately that's the way it is now. And it's just getting worse.

Nomograph says

They become wards of the state. Don’t you understand this?

No, they're FREE MEN. With a 50% of going BK when the next medical crisis hits.

Just saw this on the web tonight:

"Anthem Blue Cross's parent company, Wellpoint Inc., earned a record $2.7 billion in profits for the last quarter of 2009. Its quarterly sales grew to $19 billion, up 26 percent from $15.1 billion in the comparable 2008 period, Sebelius pointed out."

14% pure profit. Plus jacking up the cost of billing 30% or more, AND all the make-work jobs, ~50,000 in WellPoint. WLP takes in $60B in premiums and spends $45B on care, a 25% skim. All hail the efficiency of the private sector.

Troy says

Nomograph says

They become wards of the state. Don’t you understand this?

No, they’re FREE MEN. With a 50% of going BK when the next medical crisis hits.
Just saw this on the web tonight:
“Anthem Blue Cross’s parent company, Wellpoint Inc., earned a record $2.7 billion in profits for the last quarter of 2009. Its quarterly sales grew to $19 billion, up 26 percent from $15.1 billion in the comparable 2008 period, Sebelius pointed out.”
14% pure profit. Plus jacking up the cost of billing 30% or more, AND all the make-work jobs, ~50,000 in WellPoint. WLP takes in $60B in premiums and spends $45B on care, a 25% skim. All hail the efficiency of the private sector.

I work in Healthcare IT. One of the reasons that healthcare is so expensive is that the hospitals typically only get half or so of what they bill the insurance companies for. If a patient pays cash however, they will give you at least a 20% discount. You have to pay in full when you are discharged.

4X says

Paralithodes says

4X, Your “point” is based on a completely false premise.

Are you saying that arch-conservatives have not been calling Obama a SOCIALIST in attempt to discredit his efforts?

No, I'm saying that your "point," for which what you write above has nothing to do with, is based on a false premise. Get it together, son.

jvolstad says

Paralithodes says

As an active reservist or gray-area retiree, you wouldn’t normally be qualified for care other than service-related injuries/conditions. Title 10 is pretty clear that it covers you from portal-to-portal on drill weekends and the VA wouldn’t be taking care of you if the service wasn’t responsible for your injury. What law states that your private insurance is primary? How does State Farm have anything to do with this? Are they refusing you coverage under some type of “pre-existing condition” type of thing, or something else? If you need a hip replacement and the VA is not providing, and legal services are telling you they can’t help you, then maybe you should contact your Congressman? Have you checked out Military.com (www.military.com) discussion boards? Maybe there will be some JAGs, Medical Corps (or “Corpse” in Obama-speak), or others who can give you some good input. Good luck! BZ on your recovery and ability to finish up 26 years!

I am going to look into this some more based on my read of Title 10. I was not familiar with that info but I assume the JAG back at Fort Sam Houston was/is. Thanks for the info.
I may stop by Moffett Field here in the Bay Area this afternoon on the off chance that the JAG is drilling this weekend.
http://en.wikipedia.org/wiki/Moffett_Federal_Airfield

It's possible that the JAG you spoke to is simply not that familiar with reserve-related issues because this might not happen often enough to where most JAGs would have experience, if they were involved in the first place. I'd also suggest you contact ROA (www.roa.org) and see if they can recommend some type of ombudsman who can help you with this. I know little more than what I've researched for this thread (which generally just confirmed what I've been taught over the years), but if you want, I can e-mail you if I find more.

Troy says

Nomograph says

They become wards of the state. Don’t you understand this?

No, they’re FREE MEN. With a 50% of going BK when the next medical crisis hits.
Just saw this on the web tonight:
“Anthem Blue Cross’s parent company, Wellpoint Inc., earned a record $2.7 billion in profits for the last quarter of 2009. Its quarterly sales grew to $19 billion, up 26 percent from $15.1 billion in the comparable 2008 period, Sebelius pointed out.”
14% pure profit. Plus jacking up the cost of billing 30% or more, AND all the make-work jobs, ~50,000 in WellPoint. WLP takes in $60B in premiums and spends $45B on care, a 25% skim. All hail the efficiency of the private sector.

All hail the ignorance (in some cases willful) of leftists, including those who believe every black and white talking point the Administration feeds them.

WellPoint, Inc. (NYSE: WLP) today announced that fourth quarter 2009 net income was $2.7 billion, or $5.95 per share. The results included net after-tax income of approximately $2.2 billion, or $4.79 per share, resulting from a gain on the sale of the NextRx pharmacy benefit management subsidiaries ("NextRx"), partially offset by costs for restructuring activities and intangible asset impairments. Excluding these items, adjusted net income for the quarter totaled
$536.0 million , or $1.16 per share (see page 14).

Your comments regarding their quarterly sales, etc. are irrelevant. As far as "make-work jobs," ROFL LOL ROFL, you really think the goverment will be different? Oh, maybe this time, with this program, despite that they are no different than their current programs, they can change: yes they can!

Excluding the sale of NextRx, what was their profit margin, Troy? Let's see if you are even willing to give an honest answer to that!

Excluding the sale of NextRx, what was their profit margin, Troy?

Point taken on the subsidiary sale, but I already listed their overhead. 75% of premiums go to care. 25% overhead. It's right on the 10-K.

Troy says

Excluding the sale of NextRx, what was their profit margin, Troy?
Point taken on the subsidiary sale, but I already listed their overhead. 75% of premiums go to care. 25% overhead. It’s right on the 10-K.

That is irrelevant. Despite any strawman argument that those opposing the Democrats' plans must think all is OK with the system and health insurance companies, no one does.

The real point here is that you just parrotted (in this case please try not to take my use of that term personally) administration talking points that are little more than propaganda, because they attempt to portray the insurance industry - Wellpoint in this particular case - as much more profitable than they are, to politically incite people against them. You accepted the point about the sale, presumably because you understand how that works. The majority of people do not have any idea. Therefore they are easy pray to this type of propaganda. How is it ANY different from what you may think comes from Fox, Rush, or Beck, other than it is from the actual government that you want us to trust? Ask yourself, why does the administration have to lie by omission? Or are they incompetent?

Wow, responses to this thread seemed to dry up quick.... It must be just too much for some to acknowledge that the issue here just may not be private industry and may be government management, or that some of the liberals here are victims of government administration propaganda....

The same people post the same threads every time. It's boring, libs vs. conservatives. I'm waiting for Mikey to return, he's fun.

"Those opposing the health care bill but lacking any alternative ideas (you’re the poster boy for this) are a complete waste of time and shouldn’t be involved in the dialog. "

Of course, if I did offer any alternatives that happened to coincide with what Republicans are already proposing for some fixes, those would also be simply dismissed as "talking points," so clearly, ANYTHING anyone proposes that is not specifically an increased-government-control solution appears to be a waste of time in your opinion.

Meanwhile, In order to make the point that the ship is actually sinking, and sinking fast, the White House itself is engaging in PROPAGANDA. The Wellpoint profit is the perfect example. If everything was exactly as they say regarding both the problem and the solution, why not just present things honestly?

Perhaps dishonesty from the White House itself in order to incite people doesn't bother you.

Paralithodes--

Let me ask this then--

1. Do you agree that the US outspends every other country in the world in health care costs/person?
2. Do you agree that the US is somewhere in the middle of health care rankings? Based on outcomes?
3. Do you think that there is some reason why the US couldn't adopt the best of other countries' plans?

Tatupu, all good, valid questions. I will have to go back to my original question.... If things are as they say, why did the Administration engage in propaganda regarding Wellpoint, by misrepresenting its profits to the people in order to incite anger against insurance companies? If the issue is so clear, why engage in this? Why should someone who recognizes this type of dishonesty have any trust that - referring to your questions (1) this is relevant since the focus is on the middle man, (2) this is true without carefully examining the validity individual component comparisons and the weightings of each in the "ranking" (weightings are usually subjective), and (3) you already agree that the current plan does nothing of the sort?

Paralithodes says

Tatupu, all good, valid questions. I will have to go back to my original question…. If things are as they say, why did the Administration engage in propaganda regarding Wellpoint, by misrepresenting its profits to the people in order to incite anger against insurance companies? If the issue is so clear, why engage in this? Why should someone who recognizes this type of dishonesty have any trust that - referring to your questions (1) this is relevant since the focus is on the middle man, (2) this is true without carefully examining the validity individual component comparisons and the weightings of each in the “ranking” (weightings are usually subjective), and (3) you already agree that the current plan does nothing of the sort?

So, do I understand this to be a very long way to say no? To all three questions? If you'll answer those, then I'll tackle your questions.

Paralithodes says

Tatupu: You can consider it to be a very long way of saying that I’m not willing to play diversionary games. Your questions are all good, but they are not directly related to my question/point to which you were responding. I should have just been as direct as you: “If you’ll answer [my questions], then I’ll tackle your questions.”

I wasn't responding to any of your points. I was asking you 3 questions. I was trying elevate the discussion away from partisan BS into something useful. But if you'd like to get back into the same old liberal/conservative rehashing, then by all means continue with your usual postings.

Nomograph says

Your arguments rapidly fall apart when facts become introduced.

Yet someone else who doesn't want to address why the Administration was putting forth propaganda regarding Wellpoint's profits....

And wow, you made a clever take-off of my screen name to throw out a personal attack! I take it that is one of the "facts" that you have introduced that make my arguments fall apart...

tatupu70 says

Paralithodes says

Tatupu: You can consider it to be a very long way of saying that I’m not willing to play diversionary games. Your questions are all good, but they are not directly related to my question/point to which you were responding. I should have just been as direct as you: “If you’ll answer [my questions], then I’ll tackle your questions.”

I wasn’t responding to any of your points. I was asking you 3 questions. I was trying elevate the discussion away from partisan BS into something useful. But if you’d like to get back into the same old liberal/conservative rehashing, then by all means continue with your usual postings.

So it is partisan BS to point out that the Administration engaged in partisan BS by twisting and misrepresenting Wellpoints profits for the purpose of getting people even more angry at insurance companies, and to ask what valid reason they would have to do so?

My lord--you're that surprised that politicos try to spin a story to support their agenda? Are you kidding me? This is the lead story on th 10 O'Clock news in your world?

Now--can we try to get somewhere?