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Mary008
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Health summit a 'stunt' and 'spectacle,' analysts say
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Dan Friedman, who covers the Senate for National Journal's CongressDaily, noted that if Democrats and Republicans couldn't find compromise in months of debate, "they aren't going to find it in a few hours in front of cameras."
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Mary008
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We have got to have something... right away.
The Health Care Summit ...........................................
Posted by Joe Klein Friday,
February 26, 2010 at 10:28 am But the obvious truth here is that the Republicans do not want any sort of health care bill
to pass at all because they do not want to hand President Obama a victory. Shame on
them.
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Mary008
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4=laro
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There has to be an underlying something to this health care thing. It just wont die, perhaps there is more to it then health care, could it be possible that hidden deep inside the bill are communist undertones? We have communists and socialists in the government, is this just a way of taking over the Republic?. None of the sitting (elected to congress) members have read it. To bad we cant find people to elect to congress that are capable of reading and comprehending what is before their eyes.
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Mary008
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..."Republicans have been clear they're not willing to work with the existing bill," said Thomas Mann, a senior fellow with the Brookings Institution. "So at this point President Obama and the Democratic leaders are looking to find votes on the Democratic side of the aisle."
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Mary008
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February 25, 2010 9:57 AM
Health Care Summit Live Blog ................................................... Posted by CBSNews.com 459 comments
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February 26, 2010Categories:Top Pelosi aide: House Dems "reasonably confident" they can pass a reconciliation packageHouse Speaker Nancy Pelosi said today that Democrats would pursue a "simple majority" strategy and her chief of staff reinforced that point telling supporters during a conference call that reconciliation is a legitimate legislative process, dismissing criticism of the move as a "non-issue," according to the notes of several participants. Article Here-
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Mary008
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Obama said poised to offer more healthcare changes
........................................................................................................................ WASHINGTON (Reuters) - President Barack Obama will offer changes to his healthcare
overhaul this week, the White House said on Monday, and a leading Democrat said the
president was preparing a smaller version of his broad bid to revamp the $2.5 trillion
industry.
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Mary008
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Grayson Bachmann, Debate Health Care Reform on 'Larry King Live'
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VIDEO
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Mary008
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News results for what is in the latest health care bill?
Obama cites GOP ideas as he preps health care plan - Yahoo! NewsMar 2, 2010 ... It will be less expensive than the health care bill the House narrowly passed in November .... The last 9 months have been an uphill battle. ...
news.yahoo.com/s/ap/20100302/ap.../us_health_care_overhaul - Cached Health care odds long, but Democrats push ahead - Yahoo! NewsQ+A: What does the Senate healthcare bill do? | ReutersDec 21, 2009 ... WASHINGTON (Reuters) - A sweeping healthcare reform bill appears headed for passage in the US Senate after surviving a test vote early on ...
www.reuters.com/article/idUSTRE5BK0KA20091221 - Cached Obama lays out goals on healthcare - Los Angeles TimesFeb 23, 2010 ... Healthcare plan: An article in Tuesday's Section A about President .... by the president last year, although the bill still would reduce the ...
articles.latimes.com/2010/feb/.../la-na-obama-healthcare23-2010feb23 - Cached White House unveils compromise health care bill - CNN.comFeb 22, 2010 ... White House unveils compromise health care bill. STORY HIGHLIGHTS. NEW: House GOP leader: Health care summit has "all the makings of a ...
www.cnn.com/2010/POLITICS/02/22/...health.care/index.html - Cached Senate Health Care Bill: Frequently Asked Questions - ABC NewsDec 21, 2009 ... Our reporter answers frequently asked questions about the latest senate health care bill. World News with Diane Sawyer has the full story.
abcnews.go.com › World News Health Care News and Video - FOX News Topics - FOXNews.com |
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Mary008
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A good read... the house has to vote on what the senate passed, junk, pork and all.
excerpt from below site-
...North Dakota Democrat Kent Conrad, the chairman of the Senate Budget Committee, put it pretty bluntly:
"I don't know of any way, I don't know of any way where you can have a reconciliation bill
pass before the bill that it is meant to reconcile passes. I don't know how you would deal
with the scoring. I don't know how I could look you in the eye and say this package
reduces the deficit. It's kind of got the cart before the horse."
( cart before the horse... a reoccuring theme... )
Updated March 04, 2010 Forget Reconciliation -- Why the Real Fight Is In the HouseBy Phil Kerpen - FOXNews.com
If the House passes the Christmas Eve version of the Senate health care reform bill, the game is up and the American people lose. If, on the other hand, the House rejects the
original Senate bill, it's all over.
Article here-
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Mary008
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The Huffington Post March 4, 2010
The White House begins its campaign to get skeptical Democrats on board health care
reform on Thursday afternoon when the president plans to sit down with a group of
progressive and pro-business House Democrats in two separate meetings.
Article- ....................
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Mary008
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. HEALTH CARE ....................... So... WHAT are they Talking About Now? From Associated Press (AP) ...Democratic leaders are looking at a two-step approach to pass President Barack Obama's sweeping health care overhaul in the next several weeks. The House would approve the Senate-passed health bill from last year, despite House Democrats' opposition to several of its provisions. Both houses then would follow by approving a companion measure to make changes to the Senate bill. The companion measure could pass under rules allowing for a simple majority vote in the Senate, thereby skirting Republican opposition – the process called "reconciliation." Article here- http://www.huffingtonpost.com/2010/03/09/blanche-lincoln-health-ca_n_491568.html ............. Mary008 |
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Mary008
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. What Is Going On All Over The US In Doctor's Offices Right Now? ................................................................................................................ YOU Will Be Asked For- Your Name?..... Birth Date?... and....Phone Number?....and.....A Photo ID We were told they will now ask those questions every time you come in... So I will be showing them a card.... get some printed up, show it and have it handed back... also have a photo ID handy. It isn't very private to be calling out all that info... get it printed on a card. Also.. Many offices are taking your photo now, feels like Sam's Costco. Don't we wish they were as streamlined as those places...they don't ask you to call out your phone number and date of Birth... I assume they will get better at it? It's the law folks... The Doc's by law have to get medical records... on line. A NIGHTMARE? .......................... ...Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law. Obama's big idea: Digital health records http://money.cnn.com/2009/01/12/technology/stimulus_health_care/ .................. |
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Mahshadin
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actually the digital health records policy was initiated by Bush.
Not a bad idea overall just needs to be worked out (Software & Security)
I recently went through a healthcare situation and after having to see several different physicians in different locals with diofferent specialties (WAS A NIGHTMARE).
Just about anything would be better than our current pathetic attempt at Medical Records.
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"In a time of universal deceit, telling the truth is a revolutionary act." G Orwell
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Mahshadin
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"In a time of universal deceit, telling the truth is a revolutionary act." G Orwell
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Mary008
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. . . . . Tossing People's Private Records Out There Without A Well Thought Out Plan... Not A Good Idea... Patients' medical records go online without consent ..................................................................................................
Article here- http://www.telegraph.co.uk/health/healthnews/7408379/Patients-medical-records-go-online-without-consent.html A NIGHTMARE? Mary008 |
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Mahshadin
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"In a time of universal deceit, telling the truth is a revolutionary act." G Orwell
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Turboguy
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LOL And it's only going to be as big an unmitigated disaster as Obama's Presidency.
Nothing like a little unconstitutionality to screw up a good thing! |
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Mary008
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The point is...
Other countries are also wrestling with >>people's personal health info out there for grabs. We are not alone. I for one would check the box that states... I am not at this time agreeable to allowing my health info on line... because- doctors have accused the Government of rushing the project through,
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Your second section is written as a continuation but now you are talking about the USA not UK. .............................. Further more the authoe is an idiot and did not do his homework. This effort is not Obamas. This is the culmination of combined efforts of three administrations and over 12 years of research starting with Clinton, then Bush, and now Obama. ........................ please :) with all the vast reading many of us do on Health Care... you think we don't already know this? As far as I see... it's presently in 'Obamas' Court' so it was mainly a figure of speech. keep up the good work... Mary008 |
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Mary008
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WRAPUP 3-U.S. Democrats move closer to healthcare deal ................................................................................................. Thu Mar 11, 2010 7:49pm EST
Democrats near agreement on changes to overhaul
Article here-
http://www.reuters.com/article/idUSN1121989820100312 ..................
Mary008
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Mary008
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Plese watch...
Congressman Asks WELLPOINT-
Is there going to be a Point When We Can No Longer Afford it?
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Just in case people didn't get a chance to see- well worth watching.
Bill Moyers The Journal: Considering Health Care Reform
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PBS VIDEO
you knew right?
............................. Obama Health Care Plan Drops Public Option
..................................................................... Updated: 02-22-10 12:11 PM
Despite the recent surge of support in the Senate for a government-run health insurance option, President Obama chose not to include one of the most popular elements of reform
in the plan he is presenting to a bipartisan group of lawmakers Thursday.
The Obama plan explicitly bridges the differences between Senate and House legislation on issues both large and small, but on the public option -- which is included in the House
bill, but not in the Senate's -- Obama is entirely silent.
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4=laro
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There simply has to be more to this bill then meets the eye. Since when have representatives and senators ever wanted something so badly that they are willing to give up their job for it? The people who vote are completely against this and really opposed to it being rammed down their throats. I for one will vote against anyone who votes for this bill and Harry Reid and his son are on the top of my list.
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Turboguy
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Harry Reid is pretty much done. I'd be surprised if the Dems even have a majority after November. They had a supermajority and couldn't even pass bills on issues that are the cornerstone of their positions.
With this many dirtbag liberals in office I'm simply astounded that they've got to push the blatantly unconstitutional reconciliation to get it through. |
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Mary008
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House panel to consider healthcare bill Monday
............................................................................. WASHINGTON Fri Mar 12, 2010 4:04pm EST
WASHINGTON (Reuters) - The House of Representatives Budget Committee on Monday will consider a reconciliation bill that Democrats hope clears the way for final congressional
approval of an overhaul of U.S. healthcare, House Democratic Leader Steny Hoyer said on
Friday.
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Mary008
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Live Pulse: Breaking news on the health care fight:
Larson says Dems have the votes
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March 15, 2010
Categories:House Rep. John Larson, the chairman of the House Democratic Caucus, said Monday night he thinks Democrats already have the votes needed to pass a
health bill later this week...
Article here-
http://www.politico.com/livepulse/ ...........
Mary008
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Mary008
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Many women in this country are older and hurting...along with
older men about age 55 who get booted out/ down sizing (HA!) if Congress can't come
accross with the carrots they hold out .. hello- we have loooong memories. And we are
looking for an entirely NEW Congress. (people are so fed up. )
Congress.. Come Across With The Promises.
December 10, 2009, 7:23 pm
Medicare for 50-Somethings?By THE EDITORS http://roomfordebate.blogs.nytimes.com/2009/12/10/medicare-for-50-somethings/ ........... THE POLL ................ http://firstread.msnbc.msn.com/archive/2010/03/16/2229331.aspx ......... |
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Mary008
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House Dems on track for vote on $940B health bill...................................................................................................................... By ERICA WERNER, AP
22 minutes ago Said House Speaker Nancy Pelosi: "He wants to be here for the history."http://www.comcast.net/articles/news-politics/20100318/US.Health.Care.Overhaul/ |
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Mary008
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Trying to Figure Out the 940 Billion Dollar Health Bill?
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VIDEO
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Mary008
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Mary008
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Source: OECD
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From... BUSINESS INSIDER
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50 Depressing Facts About The Healthcare System That Will Make You Beg For Reform#2 is
America spent $2.4 trillion on health care in 2008. That's nearlyas much as food, clothing, and national defense combined.
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Mary008
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(Think about getting Older )
Most of our Elder Americans are on "Public Health Care"
Eye Glasses
Teeth/Dentures
Hearing Aids
Power chairs/Scooters
NONE of The above are covered for all who are in need..
These items run into THOUSANDS of Dollars.
If CONGRESS is INCAPABLE of assisting our Elderly with the above Basics of life
Why in Heaven's Name do we want to Hand Over our ENTIRE H. C. System to
what appears like .. a PACK OF BLITHERING Idiots??
I want to KNOW what the deal is BEFORE I accept it. Isn't That Normal?
Isn't that the way we handle our normal contractual affairs?
This is too important to Muck About with trillions of our hard earned tax dollars.
Tell the Congress... GAME UP.
Because Americans are tired of Games.
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Mary008
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Mary008
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Boehner to Speaker Pelosi: : "Every Member Should Stand Before the American People and Announce His or Her Vote"
GOP Leader Calls for Special "Call of the Roll" to Require Members to Publicly Announce Health Care Vote on the House Floor Washington, Mar 19, 2010 ..........
Mary008
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Mary008
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Walgreens: no new Medicaid patients as of April 16Walgreens will stop taking new Medicaid patients in Washington state as of April 16, saying it loses money filling their prescriptions. By Janet I. Tu Seattle Times staff reporter Effective April 16, Walgreens drugstores across the state won't take any new Medicaid
patients, saying that filling their prescriptions is a money-losing proposition - the latest
development in an ongoing dispute over Medicaid reimbursement.
Article Cont. here-
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Phone Calls Continue to Batter Congress
.................................................................... By Emily Yehle Roll Call Staff
March 19, 2010, 12:38 p.m. Senate Democrats Will Release Letter Supporting Reconciliation
House Republicans Plan Weekend Health Care Fight Democrats Add to Whip Count as Health Care Vote Nears Hoeven Differs With Conrad Account Over Carve-Out for North Dakota Bank AMA, AARP Urge Passage; Chamber Says Vote No Members continued to be inundated with phone calls from constituents and interest
groups Friday thanks to an impending vote on health care reform this weekend.
Calls to the House numbered close to 100,000 an hour, creating a bottleneck in a phone
system only meant to handle 50,000 calls an hour. The chamber has been similarly
overloaded for four consecutive days, beginning on Tuesday when radio host Rush
Limbaugh told viewers to call the Capitol switchboard phone number.
Article Cont. here-
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Mary008
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Mary008
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Very Interesting... please read-
Factbox: Details of final healthcare bill
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Democrats, who have a majority in Congress, were taking a two-step process. The House
was set to vote on approving the version of the healthcare legislation passed by the
Senate in December. If the House passes it, (THEY DID ) that would give it final
congressional approval
and President Barack Obama could sign it into law. (HE WILL )
The House also was set to vote separately on a series of proposed changes to the
Senate-passed measure. If these changes win House approval, they would then
go back to the Senate for senators to approve ( SOON? )
before the changes then also could be signed into law by Obama.
(check it out )
Here are key provisions of the Senate-passed legislation and the proposed changes.
( I said to myself...is that all? ) Here-
Then I read this which has more info-
Even More Here-
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Mary008
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Mary008
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Note how crystal clear they were on % for fines/IRS invovement
....money they want from tx payers
but...
unclear on afffordable H.C. Ins.
Health care bill .. 940 billion worth of hot air.. not seeing afffordable H.C. Ins.
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and..
U.S. House May Try to Pass Health Care Bill Without Voting on ItPosted Mar 17th 2010 2:20PM by Joseph Lazzaro the House would vote only on the Senate's changes to the House health care reform bill,
and "deem" the health care bill to be passed. ..............
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Mary008
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Short clip from below...
The rich will not pay more, and the middle class will not pay less (although the poor may
qualify for exemptions). This is even worse than the House bill, which imposed a tax equal
to 2.5 percent of modified adjusted gross income above the minimum income necessary to
file a tax return. A family of at least two adults and two children is actually worse off under
the Senate bill if they make less than $99,350 a year, and worse off under the House bill if
they make more. The only nod to affordability is a “hardship exemption” if the lowest
available premium for a bare-bones plan is more than 8 percent of your income. But that
saves you money only if your income is less than $28,125 a year.
The Foundry
The Foundry seeks to further conservative principles and policies through daily commentary on current news and events.
The Senate Health Bill: How the Mandates Kill Jobs and Punish Poor WorkersPosted November 19th, 2009 at 3:11pm in Health Care with 3 comments Print This Post Last night, Senate Majority Leader Harry Reid released his giant version of the Senate health care bill, H.R. 3590. A first look at the bill – which is 2,074 pages long – shows yet another attempt to use taxes to punish uninsured Americans and punish companies that hire workers from low-income families, especially single parents. If you wanted to punish the poor and kill the job prospects of people who need jobs the most, this would be an effective way to do it. The Individual Mandate. First, there is the “individual responsibility” provision in Section 1501 (pages 320-340). This would require anyone who fails to obtain a qualifying health plan – with a benefit package to be defined later by bureaucrats – to pay an annual tax penalty of $750 per adult family member and $375 per child, with a maximum penalty of $2,250 per family. These penalties will be phased in from 2014 to 2016 and then indexed for inflation, which means they are likely to increase nearly every year. These taxes are fixed amounts based on family size, not income. The rich will not pay more, and the middle class will not pay less (although the poor may qualify for exemptions). This is even worse than the House bill, which imposed a tax equal to 2.5 percent of modified adjusted gross income above the minimum income necessary to file a tax return. A family of at least two adults and two children is actually worse off under the Senate bill if they make less than $99,350 a year, and worse off under the House bill if they make more. The only nod to affordability is a “hardship exemption” if the lowest available premium for a bare-bones plan is more than 8 percent of your income. But that saves you money only if your income is less than $28,125 a year. There are, however, a few exemptions. You won’t have to pay the tax if you are a member of a qualified religion, as described in Section 1402(g)(1) of the Internal Revenue Code, or if you are a member of a “Health Sharing Ministry.” You also won’t have to pay the tax if you are an illegal alien (assuming you can prove your status) or if you are incarcerated, or if you reside outside the United States for most of the year. The Employer Mandate. Then there is the “employer responsibility” provision (Section 1511-1513, pages 346-357). Companies with more than 50 employees are required to offer qualified health plans – with a benefit package to be defined later by bureaucrats – to their full-time employees or pay a tax of $750 per full-time employee. That’s a lot cheaper than providing health insurance, and the $750 is just a tax – it doesn’t count towards the employee’s premium. However, an employer who does offer qualifying insurance isn’t entirely off the hook. Suppose an employer offers insurance, but has an employee from a low-income family who qualifies for a premium subsidy in the “health insurance exchange” and decides to accept it. In that case, the employer is stuck with a tax penalty of $3,000 for that employee, and every other employee who qualifies and makes that same choice – unless it’s more than a quarter of the employees, in which case the tax is capped at $750 times the total number of full-time employees. (Workers will be permitted to opt out of their employer’s plan only if they qualify for a subsidy, have insurance through another family member, or if the employer covers less than 60 percent of their premium.) Hurting the Poor. In other words, if a company has a lot of low-income workers, they can save money by dropping their health plan and just paying the $750 per-employee tax. (And they can make as many employees as possible part-time.) However, if they have mostly middle-income workers, they face a heavy penalty — $3,000 – every time they hire a worker from a low-income family. This goes by the employee’s family income, not the income the employee is paid by any particular company. So a company could save $3,000 by hiring, say, someone with a working spouse or a teenager with working parents, rather than a single mother with three children. Even worse, if at least a quarter of the employees qualify for a premium subsidy based on their income and family size, the company is going to end up paying the same $750 per-employee tax – whether they offer insurance or not! So companies with a lot of low-income employees will essentially be encouraged to drop their health plans entire, dumping the remaining higher-income employees into the federal exchange at their own expense. Seriously Bad Policy. In other words, employers will have a strong tax incentive to lay off the workers who need the jobs most – people without other sources of income. How will employers know who those workers are? The federal officials will tell them when they send the tax bill (Section 1412). Employer will be required (Section 1513) to inform the IRS of precisely who their employees are and during which months they carried insurance, to make sure the IRS knows who has to pay the “individual responsibility” penalty. Tags: double digit unemployment, employer mandates, individual mandates, Obama Health Care Plan Author: Robert Book, Ph.D.
more hee... see comments...
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On the Tab: Food, Drinks & Health Care ..................................................................
March 24, 2010 - 10:48 AM | by: Claudia Cowan
To cover the cost, owners are either having to raise their menu prices or tack on a so-called "Healthy Surcharge" onto the tab. At some places, it's around 4 percent of the check. Others charge a flat fee of a dollar or two. Either way, customers are footing the bill for the health care of their waitstaff, busboys, and cooks, regardless of whether the workers work part time, live in San Francisco, or are in the U.S. legally.
Mary08
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Regular Folks Talkin Health Care...
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Businesses React to Rising Cost of ObamaCare:
They're Cutting Benefits
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Posted Mar 26, 2010 09:32am EDT by Henry Blodget in Healthcare Information,
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US health care reform is good for economy
................................................................
Posted: March 23, 2010, 7:54 AM
by Diane Francis
...Gouging is obvious. The health insurance lobby makes more profits in the U.S. than Canada
pays out in health care benefits for 34 million people. The pharma industry lobbied for laws
that made volume discounts illegal which is why Americans pay up to twice as much for U.S.
drugs than do Canadians or Europeans or Japanese.
article here- The National Post is now on Facebook. Join our fan community today.
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Mary008
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Mary008
V.I.P. Member Joined: June 22 2009 Status: Offline Points: 5769 |
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Who Voted Yes?
Who Voted No?
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House Vote On Passage: H.R. 4872: Reconciliation Act of 2010
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Interesting map also...
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Mary008
V.I.P. Member Joined: June 22 2009 Status: Offline Points: 5769 |
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PBS
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Shields and Brooks on US Health Care Reform Attitudes
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Mary008
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Mary008
V.I.P. Member Joined: June 22 2009 Status: Offline Points: 5769 |
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If the Government's newfangled Program Ignores your head... it is worthless
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Demand that the Human Head be added to INSURANCE.
What does that mean... "Sorta Health Care?"
It means we will spend Billions of our tax dollars to participate in a Govt. mandated
program... that does NOT include...
proper care of your teeth including, Dentures/implants
or
decent vision care to see well, including contacts/glasses/ Lazer
or
Proper care of your hearing.... like the latest in Modern hearing aid technology...
When the Lyric’s battery dies,
the entire device is replaced.
Patients do not pay for a new device every time; instead, they pay an annual subscription fee of $2,900 to $3,600 for both ears (less if the hearing loss is in only one ear).
Insurance plans typically do not cover the cost of the Lyric,
or any other hearing device.
The American People Don't want "Sorta Health Care"
The cost of the premiums do not offer decent health care. ... Head is not included.
..............
(Hoping Pres. Obama comes to my Town to talk health care. )
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Mary008
V.I.P. Member Joined: June 22 2009 Status: Offline Points: 5769 |
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The INSANITY in Government run Health Care
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See What You Have To Look Forward to?
You hear fine now.... wait til you are 80 .... you may need
$5,000.00 for hearing aids :O
Remember... if one liitle slip up happens... They WILL NOT PAY
And they STATE that ................... very clearly.
So, those 12,000.00 a yr premiums are not looking so wonderful ?
Check out the INSANITY involved in...>>>> Getting a hearing test, because you
Can't hear the TV or the Grandchildren.
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Medicare Benefit Policy Manual ...........................................................
Chapter 15-Covered Medical and Other Health Services 80 Requirements for Diagnostic X-ray, Diagnostic Laboratory, and Other Diagnostic Tests
80.3 Audiological Diagnostic Testing Benefit. Audiological diagnostic testing refers to tests of the audiological and vestibular systems, e.g., hearing, balance, auditory processing, tinnitus and diagnostic programming of certain prosthetic devices, performed by qualified audiologists. Audiological testing is covered as "other diagnostic tests" under §1861(s)(3) of the Act when a physician orders such testing for the purpose of obtaining information necessary for the physician's diagnostic medical evaluation or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem. For the purposes of ordering audiological diagnostic tests, a nonphysician practitioner may perform the same service as a physician when the nonphysician practitioner orders diagnostic tests within their scope of practice, State and local laws and any policies applicable to the setting. See subsections of section 80 of this chapter for policies relative to ordering diagnostic tests. Audiological diagnostic tests are not covered under the benefit for incident to a physician (described in Pub. 100-02, chapter 15, section 60), because they have their own benefit as "other diagnostic tests." See Pub. 100-04, chapter 13 for diagnostic test policies. Orders. If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered even if the audiologist discovers a pathologic condition. See the policies on ordering diagnostic tests in section 80.6 of this chapter. When a qualified physician or qualified nonphysician practitioner orders a specific audiological test using the CPT descriptor for the test, only that test may be provided on that order. Further orders are necessary if the ordered test indicates that other tests are necessary to evaluate, for example, the type or cause of the condition. Orders for specific tests are required for technicians. When the qualified physician or qualified nonphysician practitioner orders diagnostic audiological tests by an audiologist without naming specific tests, the audiologist may select the appropriate battery of tests.
Coverage and Payment for Audiological Services. Diagnostic services performed by a qualified audiologist and meeting the requirements at §1861(ll)(3)(B) are payable as "other diagnostic tests." Audiological diagnostic tests are not covered as services incident to physician's services or as services incident to audiologist's services. The payment for audiological diagnostic tests is determined by the reason the tests were performed, rather than by the diagnosis or the patient's condition. Payment for audiological diagnostic tests is not allowed by virtue of §1862(a)(7) when:
The type and severity of the current hearing, tinnitus or balance status needed to determine the appropriate medical or surgical treatment is known to the physician before the test; or
The test was ordered for the specific purpose of fitting or modifying a hearing aid. Payment of audiological diagnostic tests is allowed for other reasons (see Documentation subsection below) and is not limited, for example, by: Any information resulting from the test including, for example: Confirmation of a prior diagnosis; Post-evaluation diagnoses; or Treatment provided after diagnosis, including hearing aids, or The type of evaluation or treatment the physician anticipates before the diagnostic test; or Timing of re-evaluation. Re-evaluation is appropriate at a schedule dictated by the ordering physician when the information provided by the diagnostic test is required, for example, to determine changes in hearing, to evaluate the appropriate medical or surgical treatment or evaluate the results of treatment.
For example, re-evaluation may be appropriate, even when the evaluation was recent, in cases where the hearing loss, balance or tinnitus may be progressive or fluctuating, the patient or caregiver complains of new symptoms, or treatment (such as medication or surgery) may have changed the patient's audiological condition with or without awareness by the patient. Payment for these services is based on the physician fee schedule amount except for audiology services furnished in a hospital outpatient department, which are paid under the Outpatient Prospective Payment System. Computer-administered hearing tests are screening tests, do not require the skilled services of an audiologist and are not covered or payable using codes for diagnostic audiological testing. Examples include, but are not limited to "otograms" and pure tone or immitance screening devices that do not require the skills of an audiologist.
Diagnostic analysis of cochlear or brainstem implant and programming are audiology diagnostic services covered under the "other diagnostic test" benefit. Audiological diagnostic tests before and periodically after implantation of auditory prosthetic devices are covered services.
For descriptions of hearing aids and auditory prosthetic devices including osseointegrated devices, see Pub. 100-02, chapter16, section 100.
If a physician refers a beneficiary to an audiologist for testing related to signs or symptoms associated with hearing loss, balance disorder, tinnitus, ear disease, or ear injury, the audiologist's diagnostic testing services should be covered even if the only outcome is the prescription of a hearing aid. Individuals Who Provide Audiological Tests. Some diagnostic audiological tests require, for both the technical and professional components, the skills of an audiologist to perform the test and interpret not only the data output, but also the manner of the patient's response to the test. These tests must be personally furnished by an audiologist or a physician. The skills of an audiologist required when furnishing the ordered diagnostic tests involve skilled judgment or assessment including but not limited to: Interpretation, comparison or consideration of the anatomical or physiological implications of test results or patient responsiveness to stimuli during the test; Modification of the stimulus based on responses obtained during the test; Choices for subsequent presentations of stimuli, or tests in a battery of tests; Tests related to implantation of auditory prosthetic devices, central auditory processing, contralateral masking; and/or Tests designed to identify central auditory processing disorders, tinnitus, or nonorganic hearing loss. The technical components of certain audiological diagnostic tests i.e., tympanometry (92567) and vestibular function tests (e.g., 92541) that do not require the skills of an audiologist may be performed by a qualified technician or by an audiologist, physician or nonphysician practitioner acting within their scope of practice.
If performed by a technician, the service must be provided under the direct supervision [42 CFR §410.32(3)] of a physician or qualified nonphysician practitioner who is responsible for all clinical judgment and for the appropriate provision of the service. The physician or qualified nonphysician practitioner bills the directly supervised service as a diagnostic test. Documenting for Audiological Tests. The "other diagnostic tests" benefit requires an order from a physician, or, where allowed by State and local law, by a non-physician practitioner. See section 80.6 of this chapter for policies concerning orders for diagnostic tests.
The reason for the test should be documented either on the order, on the audiological evaluation report, or in the patient's medical record. (See subsection of this section titled "Benefit".) Examples of appropriate reasons include but are not limited to:
Evaluation of suspected change in hearing, tinnitus, or balance;
Evaluation of the cause of disorders of hearing, tinnitus, or balance. Determination of the effect of medication, surgery or other treatment; Reevaluation to follow-up changes in hearing, tinnitus or balance that may be caused for example, but not limited to otosclerosis, atelectatic tympanic membrane, tymposclerosis, cholesteatoma, resolving middle ear infection, Meniere's disease, sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, acoustic neuroma, demyelinating diseases, ototoxicity secondary to medications, genetic, vascular and viral conditions. Screening tests are not payable, but failure of a screening test may be an appropriate reason for diagnostic audiological tests. The medical record shall identify the name and professional identity of the person who ordered and the person who actually performed the service. When the medical record is subject to medical review, it is necessary that the contractor determine that the service qualifies as an audiological diagnostic test that requires the skills of an audiologist. A technician must meet qualifications determined by the Medicare contractor to whom the claim is billed. At a minimum, the qualifications must include the requirements of any applicable State or local laws, and successful completion of a curriculum including both classroom training and supervised clinical experience in administration of the audiological service. If a technician performs the technical component of a service that does not require the skills of an audiologist, the physician supervisor shall provide and document the physician's professional component of the service including, e.g., clinical decision making, and other active participation in the delivery of the service. This participation may not also be billed as evaluation and management or as part of other billed services.
Audiological Treatment. There is no provision in the law for Medicare to pay audiologists for therapeutic services. For example, vestibular treatment, auditory rehabilitation and auditory processing treatment, while they are within the scope of practice of audiologists, are not diagnostic tests, and therefore, shall not be billed by audiologists to Medicare. Services related to hearing aid evaluation and fitting are not covered regardless of how they are billed. Services identified as "always" therapy in Pub. 100-04 chapter 5, section 20 may not be billed when provided by audiologists. (See also Pub 100-04, chapter 12, section 30.3.) Services that are not diagnostic tests and are also not "always" therapy (according to the list and the policy in Pub.100-04, chapter 5, section 20) and are provided by qualified personnel (who may be audiologists), may be billed "incident to" when all other appropriate requirements are met. (See policies in Pub. 100-02, chapter 15, sections 60, 200, and 230.)
Treatment related to hearing may be covered under the speech-language pathology benefit when the services are provided by speech-language pathologists. Treatment related to balance (e.g., using "always therapy" codes 97001-97004, 97110, 97112, 97116, and 97750) may be covered under the physical therapy or occupational therapy benefit when the services are provided by physical or occupational therapists or their assistants, where appropriate. Covered therapy services incident to a physician's service must conform to policies in chapter 15, sections 60, 220 and 230. Audiological treatment provided under the benefit for physical therapy and speech-language pathology services may be personally provided and billed by physicians and nonphysician practitioners when the services are within their scope of practice and consistent with State and local laws. For example, aural rehabilitation and signed communication training may be payable according to the benefit for speech-language pathology services or as speech-language pathology services incident to a physician's or nonphysician practitioner's service. Treatment for balance disorders may be payable according to the benefit for physical therapy services or as a physical therapy service incident to the services of a physician or nonphysician practitioner. See the policies in Pub 100-02, chapter 15, section 220 and 230 for details.
Assignment. Nonhospital entities billing for the audiologist's services may accept assignment under the usual procedure or, if not accepting assignment, may charge the patient and submit a nonassigned claim on their behalf. 80.3.1 Definition of Qualified Audiologist Audiological tests require the skills of an audiologist and shall be furnished by qualified audiologists, or, in States where it is allowed by State and local laws, by a physician or non-physician practitioner. Medicare is not authorized to pay for these services when performed by audiological aides, assistants, technicians, or others who do not meet the qualifications below. In cases where it is not clear, the Medicare contractor shall determine whether a service is an audiological service that requires the skills of an audiologist and whether the qualifications for an audiologist have been met.
Section 1861(ll)(3) of the Act, provides that a qualified audiologist is an individual with a master's or doctoral degree in audiology. Therefore, a Doctor of Audiology (AuD) 4th
year student with a provisional license from a State does not qualify unless he or she also holds a master's or doctoral degree in audiology. In addition, a qualified audiologist is an individual who: Is licensed as an audiologist by the State in which the individual furnishes such services, or
In the case of an individual who furnishes services in a State which does not license audiologists has: Successfully completed 350 clock hours of supervised clinical practicum (or is in the process of accumulating such supervised clinical experience), and
Performed not less than 9 months of supervised full-time audiology services after obtaining a master's or doctoral degree in audiology or a related field, and Successfully completed a national examination in audiology approved by the Secretary. If it is necessary to determine whether a particular audiologist is qualified under the above definition, the carrier should check references. Carriers in States that have statutory licensure or certification should secure from the appropriate State agency a current listing of audiologists holding the required credentials. Additional references for determining an audiologist's professional qualifications are the national directory published annually by the American Speech-Language-Hearing Association and records and directories, which may be available from the State Licensing Authority. Note: There is no provision for direct payment to audiologists for therapeutic services.
Clarification of Medicare Scope of Coverage: Diagnostic Testing by Qualified Audiologists
Section 80.3 of the Medicare Benefit Policy Manual CMS Directs Medicare Carriers to Cover Hearing Tests Regardless of Diagnosis In 2000, the Center for Medicare and Medicaid Services (CMS) stated that Medicare carriers should pay for audiologic diagnostic tests when ordered by a physician for a medical evaluation, even if these tests do not discover a medically treatable condition. Some Medicare Carriers had been denying Medicare Part B audiology claims based on the outcome of the diagnostic services rather than the reason for the referral.
In brief, (stop laughing ...or you may be crying at this point ) CMS stated that payment for hearing and balance assessment services is "determined by the reason the tests were performed, rather than the diagnosis or the patient's condition." Effective May 29, 2000, CMS sent a loud and clear signal that audiology services should be covered, regardless of a hearing aid recommendation, if the referring physician ordered the tests to assist in the evaluation of the need for or appropriate type of medical or surgical treatment. The CMS policy clarification was released in Program Memorandum (PM) B-01-34 (April 30, 2000), "Payment for Services Furnished by Audiologists" and was re-issued as PM B-02-004 (January 31, 2002). It is available on the CMS Web site [PDF]. The revision insured that medical coverage determinations for audiology tests were comparable to those for ophthalmology tests currently covered by Medicare. In addition, CMS reaffirmed that such diagnostic services are to be performed by a qualified audiologist that meet Medicare's qualifications under Section 1861(ll) of the Social Security Act and payable as "other diagnostic tests" under the physician fee schedule. In the Program Memorandum, CMS refers Medicare carriers to the American Speech-Language-Hearing Association as the primary source for determining an audiologist's professional qualifications. The major clarification of the Medicare scope of coverage for "Otologic Evaluations" ( Medicare Benefit Policy Manual at Chapter 15, Section 80.3 [PDF]) is:
Diagnostic services performed by a qualified audiologist "is determined by the reason the tests were performed, rather than the diagnosis or the patient's condition." An example is given of a physician referral to an audiologist for evaluation of signs or symptoms associated with hearing loss or ear injury: "the audiologist's diagnostic services should be covered, even if the only outcome is the prescription of a hearing aid." The longstanding coverage requirements in Section 80.3 remain unchanged:
Conditions for coverage are: "Diagnostic testing...performed by a qualified audiologist...when a physician orders such testing for the purpose of obtaining additional information necessary for his/her evaluation of the need for or the appropriate type of medical or surgical treatment of a hearing deficit or other medical problem;" and
Services are excluded from coverage "where the medical factors required to determine the appropriate medical or surgical treatment is already known by the physician, or are not under consideration and the diagnostic services are performed only to determine the need for or the appropriate type of a hearing aid."
If your Medicare Carrier continues to deny payment for audiologic services as described above, please direct the carrier to PM B-02-004 [PDF] or contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, at 800-498-2071 ext. 5669 or via e-mail at mkander@asha.org . .........................
Mary008
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Mary008
V.I.P. Member Joined: June 22 2009 Status: Offline Points: 5769 |
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Second in a continuing Saga on what Medicare Does Not Do For You...
We Need To Send CONGRESS a loud and clear message...
We want better Medicare Coverage for our Seniors, Why?
Because Folks... We are next in line to recieve Mediocre Care, er ... Medicare.
If your Parent/ Partner has trouble walking and you need to deal with Medicare-
First- get something for your nerves and a bottle of Rogaine for your hair :) ........................................... Medicare Part B benefits cover physician visits, laboratory tests, ambulance services and home medical equipment. While oftentimes you do not have to pay a monthly fee to have Part A benefits, the Part B program requires a monthly premium to stay enrolled. In 2008 that premium will range between $96.40 and 238.40 per month depending on your income. Typically, this amount will be taken from your Social Security check.
What Can You Expect to Pay?
Every year, in addition to your monthly premium, you will have to pay the first $135 of covered expenses out of pocket and then 20 percent
of all approved charges if the provider agrees to accept Medicare payments.
Unfortunately, your medical equipment provider cannot automatically waive this 20 percent or your deductible without suffering penalties from Medicare. Your provider must attempt to collect the coinsurance and deductible if those charges are not covered by another insurance plan; however, certain exceptions can be made if you suffer from qualifying financial hardships. If you have a supplemental insurance policy, that plan may pick up this portion of your responsibility after your supplemental plan’s deductible has been satisfied.
If your medical equipment provider does not accept assignment with Medicare you may be asked to pay the full price up front, but they will file a claim on your behalf to Medicare. In turn, Medicare will process the claim and mail you a check to cover a portion of your expenses if the charges are approved.
Medicare will pay only for items that meet your basic needs. Oftentimes you will find that your provider offers a wide selection of products that vary slightly in appearance or features. You may decide that you prefer the products that offer these additional features. Your provider should give you the option to allow you to privately pay a little extra money to get the product that you really want.
The Advance Beneficiary Notice also will be used to notify you ahead of time that Medicare will probably not pay for a certain item or service in a specific situation, even if Medicare might pay under different circumstances. The form should be detailed enough that you understand why Medicare will probably not pay for the item you are requesting.
Every item billed to Medicare requires a physician’s order or a special form called a Certificate of Medical Necessity (CMN), and sometimes additional documentation will be required.
For some items, Medicare requires your provider to have completed documentation (which is more than just a call-in order or a prescription from your doctor) before these items can be delivered to you:
Medicare will not allow you to purchase these items outright (even if you think you will need it for a long period of time). This is to allow you to spread out your coinsurance instead of paying in one lump sum. It also protects the Medicare program from paying too much should your needs change earlier than expected. from- .........................
Mary008
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