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Hard To Get Surgery Approved Via Obama-Care

From an unfazed Associated Press:

Health law uncertainty meets reality in Illinois

By CARLA K. JOHNSON | Thursday, Jan. 02, 2014

CHICAGO The new year brought relief to some Illinois patients newly insured under the nation’s health care law. Others still weren’t sure whether they were covered, despite their best efforts to navigate the often-balky new system…

Paperwork problems almost delayed suburban Chicago resident Sheri Zajcew’s scheduled surgery Thursday, but Dr. John Venetos decided to operate without a routine go-ahead from the insurance company. That was after Venetos’ office manager spent two hours on hold with the insurer Thursday, trying to get an answer about whether the patient needed prior authorization for the surgery. The office manager finally gave up.

"I’m not a happy camper," said Nate Zajcew, the patient’s husband. The couple signed up for a Blue Cross Blue Shield bronze plan through the federal HealthCare.gov site on Dec. 16. "I understand it’s just a matter of paperwork and yesterday was a holiday. I can be an SOB, too, at times, but since they’re going on with the procedure, it’s OK."

Venetos, a Chicago digestive system specialist, described "tremendous uncertainty and anxiety" among patients calling his office recently. Some thought they’d signed up for coverage but hadn’t received insurance cards yet. Others had insurance policies that were canceled and weren’t sure if their coverage had been reinstated after Gov. Pat Quinn decided to allow one-year extensions of canceled plans.

Venetos said he has decided to take a risk and provide care for these patients, at least until there’s less confusion about coverage. "We feel it’s the right thing to do," Venetos said. "We may end up stuck holding the bag and not getting paid on these claims."

Obama would probably say the doctor went ahead because he is so greedy.

Blue Cross Blue Shield of Illinois, which has the most customers in the state’s individual market, has been adding staff and extending call center hours to keep up with demand. "Every week we’re adding staff to our call centers and we’re also enhancing our call routing features to better serve our customers," said spokesman Greg Thompson…

Guess who is going to get to pay for this. Anyone who has a BCBS policy.

This article was posted by Steve on Friday, January 3rd, 2014. Comments are currently closed.

6 Responses to “Hard To Get Surgery Approved Via Obama-Care”

  1. GetBackJack says:

    Surgery Nazi – “No surgery for you, one year!”

  2. canary says:

    New Obama Care reg gives insurance more time up to 48 hours before they have to approve surgery
    This went to effect right after Obama Care was passed.soon after Obama Care was passed.


    New OBAMA CARE Federal Government Contractor NOVITAS SOLUTIONS Leaving hospitals unable to pay employees for weeks.

    Large Latin Obamacare Contractor Blamed for Slow Medicare Payments to Hospitals (Employees not being paid)

    Weekly Standard ^ | 1-2-14 | By JERYL BIER

    The contractor building the financial management system for Healthcare.gov is being blamed by a Houston hospital for delayed Medicare reimbursements that have caused the hospital to miss payrolls for weeks. Novitas Solutions is the federal government’s new Medicare payment processor for the south-central region of the country hired by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS.) ABC-KTRK in Houston reports:

    According to the CEO Jason Leday, more than 150 employees haven’t been paid in nearly a month.

    The hospital is strapped for cash not because its not making money, but because Leday says a new Medicare payment facilitator named Novitas Solutions is taking too way long to pay out Medicare claims to the hospital.

    Leday says he’s owed nearly $3 million in payments from Medicare and can’t make payroll…

    The Texas Medical Association says they are familiar with

    complaints like this one regarding the medicare payment facilitator- and a representative told us smaller community hospitals like this one are in similar situations.

    Novitas also runs the south-central region’s Medicare website which was launched just two days before the October 1 launch of Healthcare.gov. As THE WEEKLY STANDARD reported on December 19, that site has experienced problems reminiscent of Healthcare.gov’s troubles, and the site will not be fully operational until well into 2014.

    Novitas’s direct connection to Healthcare.gov stems from an emergency, no-bid contract for “financial management services” awarded in August…

    (Excerpt) Read more at weeklystandard.com …

    Latin Word List “NOVITAS – Definition: Newness, novelty, strangeness.

    From the leading The Latin Word

    Novitas Solutions tells about their big Federal Government contract, to include

    Novitas Solutions, Inc., (Novitas) proudly serves as an administrative services processing company for government-sponsored health care programs on behalf of the federal government.

    We employ more than 1,000 staff in the Mechanicsburg and Harrisburg, Pa. areas. Nearly 1,000 other associates are located in field offices in Hunt Valley, Md.; Pittsburgh and Williamsport, Pa.; Dallas, Texas; Milwaukee, Wis.; and Jacksonville, Fla. Novitas currently administers:

    The Medicare Administrative Contract (MAC) Jurisdiction L (JL), which spans four states and Washington D.C.;

    The Medicare Administrative Contract (MAC) Jurisdiction H (JH), which spans seven states, Indian Health Service (IHS) and Veterans Affairs (VA); and

    The payment processing for the Federal Reimbursement of Emergency Health Services
    Furnished to
    “Undocumented Aliens contract”, as authorized under Section 1011 of the 2003 Medicare Modernization Act.

    Click one of the images below to visit our provider websites for each of our contracts:

    On FOX News, a rep from St. Anthony Hospital said that Novitas Solutions weren’t paying patients bills because the federal health care company had the
    patients listed as quote … ” Incarcerated “.

    The company did not address this

    • canary says:

      FRIDAY, MARCH 09, 2012RSS Feed
      Highmark Medicare Services Inc Becomes Novitas Solutions Inc
      Physical therapists in Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia should be aware of a name change for the Part A and Part B Medicare Administrative Contractor (MAC) for Jurisdiction 12 (J12).
      In January, Diversified Service Options Inc, a wholly owned subsidiary of Blue Cross and Blue Shield of Florida Inc, acquired MAC Highmark Medicare Services (HMS) from its parent company, Highmark Inc. As a result, HMS changed its name to Novitas Solutions Inc.
      Effective March 10, Novitas Solutions will begin to migrate the current HMS Web site to the new Novitas Solutions Web site, http://www.novitas-solutions.com. Novitas is targeting completing the name change to all active Web page content by March 30. Although main headers throughout the Web site will be changed, some historical documents, such as Medicare reports issued under HMS, will not be changed to reflect the new name.
      For users who have bookmarked pages throughout the HMS Web site, an automatic redirect process will send page requests to the correct new Web page. The company recommends that users update the bookmark after being redirected to the new Web page.


      Other complaints of not paying and the government trying to run off little clinics and hospitals are posted.

      So, is it fair to say Blue Cross and Blue Shield of Florida Inc is getting paid by the Federal Government under their Novitas Program. ??????

      The map in the former post shows that “Novitas” covers “Undocumented Aliens” in every state in the US, and possibly Novitas has a category for “incarcerated Undocumented Aliens” to get treatment in public and private. And no wonder there is a back log with the VA.

      Maybe this is why the Blue Cross and Blue Shield keep bragging they won’t follow ObamaCare rules and most likely will get away with it, because Obama Care does not work, besides they could be in the running for single payer or Universal Health Care.

    • canary says:

      So, could this be the reason immigrants are exempt from signing up for Obama Care for even the
      cheapest plan that other Americans have to sign up for. Wouldn’t forcing them to sign up for Obama Care be a good way to get all their personal information instead of just American citizens?

  3. GetBackJack says:

    Obamacare…To insure the uninsured we first make the insured uninsured and then make them pay more to be insured again so the original uninsured can be insured for free ..

    /copied off internet

  4. Mithrandir says:

    A Few Things to Expect from ObamaCare

    1. It will be used as a weapon, just like all government agencies are. As my liberal college professor said, “Everything is political.” –Yep, healthcare is part of the “everything” definition.

    2. It will be impossible to get the care you need, and many people will die because of it.

    3. It will be purposefully so convoluted and screwed up, the people will BEG the government to fix it. Like Pelosi said, “People will be begging for single payer.”

    4. MEDICAL TOURISM WILL BE NECESSARY. I knew a guy at an L.A. Korea town store, and he FLEW ALL THE WAY BACK TO SEOUL, to have surgery, even though, a very good university hospital was a short drive away. He said it was cheaper to get international round-trip airfare, get the surgery, recover, and come back, rather than pay 20x the amount in the U.S.
    You can bet that long lines, and lack of care will make flying over-seas a whole lot more attractive to Americans who don’t feel like dying just yet.

    I blame both parties. Republicans could easily see the storm on the horizon WAY BACK when Ted Kennedy ran for president in the 70s, and health care was a democrat party platform.

    And democrats, who know absolutely nothing about anything, are more concerned about winning legislation battles whether the law passed is any good or not. They just want to win the day, get a check in the “W” column, and clink champagne glasses, like good lawyers do.

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