On Jan 15, 1:32 pm, jurim...@yahoo.com wrote:

Lik eI have told you a hundred times, moron, I do want it discussed.

Discuss away.

Say what you want.

Unlike altie idiots like you, I am pro-free speech.

Laughing at you from all over the place.

MP

On Jan 15, 10:32 am, jurim...@yahoo.com wrote:

Lassie, he says he doesn't care if the discussion takes place---what
it is it that you
want to discuss???

Ok, I'll start, and I'm sure Mark will join in, because he says he
wants to discuss it.

After reading up on the case (looking at the case itself), and then
reading in the Federal court
cases against, for example, Aetna in the recent years---that caviat
case that Peter B told me to
read, as did Mark Probert -- very discouraging reads----about the sad
state of affairs about this
country' health care system, and between the AMA, several third party
PRA review companies,
and the insurance companies themselves, anyone with any illness that
does not fit into the
standard format for what insurance companeis will pay is pretty much
screwed even though they
are the consumer.

It would appear based on the information I have read to date, that
there would appear to be a little
mafia in this country, that connects some , insurance companies, third
party review companies,
some physicians,and with ties to the pharamaceutical world.  It would
appear that this movement
started in the mid 80's, and continues to this day.  What I am having
a tough time with is understanding
(and perhaps Probert can help here), is who it is that decides the
standardization for what insurance companies
will pay claims on, and what it will not.  What I don't understand is
how all of this effects the consumer, the one
who is paying for insurance in the first place, and ofcourse doesn't
ever plan on having anything out of the ordinary--
I'm sure Peter Moran will agree--no one plans on having cancer - it
just happens for whatever reason.  I've read these horror stories
about people who have used some experimental therapies and suddenly
got a doctor's bill in the mail,
thinking that their insurance company was going to pick up the tab
because the MD ordered the treatments.    Ofcourse,
those that end up not being able to pay the bill, declare bankruptcy,
and no one pays the bill.

I see a real need for health care reform in this country.  It would
appear that a lot of this transpired in the late 70's where the
movement was more towards PPO, and HMO's --when traditional medicine
was thrown out of the window--slowing going was the "family doctor"
who had his/her own little medical practice on Main Street USA, and
for which insurance companies were billed by the doctor, and people
spent a lot of time in the hospital. These were the days that the
family doctor spent a lot of time with their patients - beyond the 15
minute protocol of today, and that doctor's only got paid if they saw
a patient or not.  As I understand it, the way that the PPO, and HMO's
of today work, you don't get a full work-up, and you get 15 minutes
with a doctor--you get lab tests if you are lucky, and you are wisked
out of the door with a magic pill that is supposed to make you well in
10 days.  After the 10 days are up,  if you are still sick, you go
back, and repeat the process---and then have to get referred outside
of the system.  And heaven forbid if what you have an illness for
which your conventional doctor has no personal experience or really
knows jack shitt about, because you will end up looping.  I think many
people are so frustrated with the health care system, that trying an
alternative therapy avoids the stress of all of this.

As far as the case goes, I find it extremely difficult (trying to
weigh out all of the sides, to be fair) to understand how any Medical
Board could just go on "anonymous complaints" against a doctor.  What
I do not understand is if the patients did not turn the doctor into
the Board, this would mean that they were satisfied with the treatment
that they received there.  So, they go home to NY, and take their
treatment receipts, and I'm guessing turned the bills into their own
insurance company and the insurance company did not want to pay for
some reason---which would have thrown the claim out of the system, and
the insurance company would tell their consumers that they don't pay
on these types of service.  I've been down the road before myself.  So
you have the option of filing an appeal, which I am assuming that they
probably did, and that was rejected.  If the patients were not unhappy
with the medical treatments they received, and their claims were not
paid, it leads me to come up with the conclusion, that the insurance
company didn't have these treatments on the list of treatments it
would pay - and in order to make sure - bumped it out of their system
to a third party review of some kind,
and they reviewed the claim, and agreed with the insurance company.
That would lead the insured to go the State of NY's insurance
commissioner for relief.   So, what happened after that review from
the third party claimant, did someone suggest the filing an anonymous
complaint with the TMB in order to clear the insurance company of any
wrongdoing?  That is the only logical explanation.  But, what would be
the sole purpose of this?  To "get the doctor in trouble?" For what?
The patients were not unhappy with the services, the insurance company
it would appear simply  just did not want to pay.

If any of this speculation is true -- then realistically why would any
insurance company even do this?  There is always the possibility that
someone could have pretended to be the insurance company, and filed an
anonymous complaint, because they had a hardon against the practices
of the physician in the first place.  These means any Tom, Dick, or
Harry could pretend to be an insurance provider, and just file
anonymous complaints all day long, just to be mean and nasty against
anyone they did not like.  For something as heavy duty as attempting
to get a doctor de licensed, means they are attempting to take his/her
livelihood away from them.  I do not think anyone should have the
right to make an anonymous complaint against doctors, dentists or any
other professional for that matter.  I think the anonymous complaint
system is totally unfair, because if you feel strong enough to obtain
to take someone's livelihood away from them, then you should be man
enough (or woman enough) to sign your own name to the complaint, so
that the party you are accusing of wrongdoing can defend themselves
properly.  And if you file a false complaint against someone just to
attempt to get rid of their livelihood, I think those individuals
should be properly fined for doing so and not just chump change
either!!  How does anyone really know if the person that filed the
original complaint wasn't doing it as a favor to someone else, and got
a handsome reward for doing it?  To be fair to everyone, anonymous
complaints should not be taken.

That's my two cents...  let the discussion begin.....let's prove
Timmie's assumption that we do not want to discuss this
event....wrong......  You've got to know, Probert, he hates it when he
is proved wrong --- I'd like to hear you ideas on this
subject......and everyone else!