Healthcare question

Ive got an acquaintance who has chosen not to work for a living, and instead live off the government. She also chose to eat herself to an unhealthy state, so because of this, her Medicaid paid doctor advised her to have a bariatric procedure.

She did so about a year and a half ago and has since dropped about 150-200lbs. She's very proud of herself and the weight she's lost, and now like many folks who've gone thru this procedure, she has a pretty large fold of skin where here belly had been.

She is scheduled to have this skin surgically removed in a couple weeks - like the bariatric procedure, this will also come at zero cost for her.

Out of curiosity, I looked up how much this would cost me if I opted to have this done... IF it was deemed medically necessary for me, my insurance would cover half the bariatric procedure. The skin removal procedure is deemed cosmetic, and not covered at all.

My wife's company has much better insurance than mine offers, but the rate of coverage is similar for the bariatric, and again, the cosmetic procedure is not covered.

Question - if the 'uninsured' have better coverage ALREADY than those who work and have insurance, why does Barry Sorento and company want to spend trillions on a new plan?

No votes yet

Would you please explain how these procedures were covered in the first place? Are you saying that medicaid/medicare covered both procedures? Although I'm not elgible for Medicare yet, I thought there was some deductible and then one had to pay the balance of what Medicare doesn't pay. That's why people need Medigap insurance. Am I wrong? Is Medicaid different? Does it pay for everything?

Thanks for enlightening me.

I was told that medicaid paid the whole ticket.

The situation here is, hubby works - and is insured. Wife and 3 kids could also be insured under hubby's plan, BUT - that would mean more out of his paycheck, so they just opt not to take advantage of that and instead wife and kids are on medicaid.

I havent heard of any deductible, and HAVE heard her bragging that the procedures are 'free'.

Bear in mind, I try to spend as little time with these people as possible because I do not believe that a person should just be able to 'choose' not to work and have tax funds pick up the ticket.

1) Its correct that there is no out of pocket liability for Medicaid patients.**

2) Billy - if Medicaid is covering her excess skin removal, then a private insurance company likely would too. Medicaid does not cover purely cosmetic procedures, her physician would have needed to obtain prior approval to show medical necessity. This prior-approval process exists at private insurance companies as well. (Basically, they have to prove that the excess skin is causing rashes/skin ulcers, pain, an increased risk of infection, etc.)

3) Catlady - yes, Medicare is entirely different from Medicaid. There is a deductible and co-insurance for Medicare, which a person can choose to purchase a supplement plan to help pick up. (A smart idea, since Medicare Part B only pays 80% after the deductible is met, and there is no cap on that.) Since Medicaid is for low-income or disabled folks, they don't get a bill for anything out-of-pocket.

For the past 15 years, I've worked for medical providers or health insurance companies in one capacity or another. You wouldn't believe how many Medicaid people abuse the system. Come to the ER 2 or 3 times a week because they have a runny nose, etc. They all have a primary care physician (as required by the Managed Medicaid program - everyone has to take one of the Medicaid HMOs). But, even though an appointment with the primary doc would cost them nothing out of pocket, they run to the ER for non-emergency situations all the time anyhow. They don't care, because there's no financial incentive for them to make responsible choices about their healthcare.

A big component of my previous job involved reviewing ER charts for Medicaid patients - oh, the things I've seen. Sigh.

** Exception being the handful of people over the income limit for Medicaid who are on the asset spend-down program. But that's a limited circumstance. The majority of people on Medicaid cannot be billed out of pocket for anything. Spend-down info here for those who are curious on what that means:

If she has Medicaid, she is not "uninsured". If she were "uninsured", she would not have had the procedure and she'd probably be dead.

Pink Slip

why is the United States the only country in the world with fat poor people?

Because shitty food is cheap, and our heath care system sucks

Pink Slip

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.