Naw. The government controls it. It’s a workaround they called medical necessity. So they decide if a procedure/equipment/service is medically necessary. You have no say, they have final approve and if u do want to add a procedure or equipment to being covered it takes 2-4 years.
Link.
National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1)
It’s a hidden trick Bernie has in his Bill, some black democrats tried to get it removed.
Liz used to be against it, by saying every service would be paid for. But backed down and added it to her plan as well.
It’s a dirty tactic that was started by republicans with medicaid to essentially deny services to certain populations, historically blacks.
It’s rooted in racism.
Sidenote- Biden has it as well and I support him. Ppl need to know about what her plan actually says tho, she’s being purposely opaque.
its not a trick my friend. if you pay taxes and you vote for people that run your government YOU control your plan. sure we have to agree on what we want in our plan but if we're willing to pay extra or less thats the plan we will get. it aint rocket science like some foreign government is over our health insurance.
bernies plan:
SEC. 201. COMPREHENSIVE BENEFITS.
....
(b) Revision And Adjustment.—
The Secretary shall, on a regular basis, evaluate whether the benefits package should be improved or adjusted to promote the health of beneficiaries, account for changes in medical practice or new information from medical research, or respond to other relevant developments in health science, and shall make recommendations to Congress regarding any such improvements or adjustments.
here's the link to the full plan which has links to other pieces of medicare and social security due to the fact there is no reason to write it down twice when its already in a previous document.
Text - S.1129 - 116th Congress (2019-2020): Medicare for All Act of 2019
there's no TRICK. No medical coverage will cover every single thing. NON. the ACA covered way more than normal private insurance for most workers. that was a fact. but it didnt cover everything. it never will. Unless of course you the tax payer are willing to pay whatever it takes to cover any and every thing that may arise. even some things that may arise .000002% of the time. even some things those .00002% could go out and pay for themselves and it wouldnt cost an arm and a leg to purchase.
medicare for all is not a cover everything for everyone plan. its a cover most things for everyone plan. and do it for less.
priv insurance as currently constructed is covered some things for some people at a very high and highly increasing price tag.
and i want you to understand something. you never had any say as an individual when it came to what was medically necessary or not. unless you wanted to buy it outright. i know this because i use to work for a very large DME company. we sold products and we had to include with our products what is known as a LMN (letter of medical necessity). that letter would summarize the patient's isssues with a few key numbers and why they needed said device. or devices. it also in most cases needed to be accompanied by Office notes and charts for at minimum 3 to 9 months back from that persons PCP/Referring physician.
Now what this, for the most part that company did a solid job of providing a solid service to the patient's that needed it. but lets be clear, that company was out to make money especially once it was picked up by a larger company that was publicly traded on the stock market. They do have a bottom line. and sure they have things about patient health in their motto. but lets be clear, usually these business if at first well meaning are about that $$$. so you already know we were churning out DME products without the LMNs in hopes the insurance companies would pay without requesting the info. some would, others wouldnt, and some eventually asked for this info a year later and if we didnt provide it. they would retract their payments.
Now thats not it. we would also try to get patients on more expensive products or the newer ones(to have that sale on the new product market) it costs more and it has newer accessories that you need for it to work even though some of these patients were just fine with the old product from 5 years ago. no issues. why do i need a new thing? i dont. but that company wanted to show better sales in that quarter , that year, etc.
so now you have the insurance companies where they hire Nurses to read these letters of medical necessity. but they also have an agenda. TRY TO DENY as much as possible. depending on the insurance company. You know how i know this? because I use to also work from one of the larger health insurance companies in the US. So yes you have companies out there pushing shady stuff. and you have insurance companies trying to deny everything ...shady or legit if they can. it was never up to the employee or person thats paying for benefits to tell their insurance that they have a medical need for procedure A B C or equipment XYZ. that insurance payer would laugh in their face and say you aint no doctor. nor are you a nurse.
and because this is all based on the company you work for and how much money they are willing to pay. the only way you can get that overturned is to appeal it and pray that the same people who looked at it the first time the insurance company will approve your appeal(why would they, they denied it first. you dont have any new info.) So how would you get this approved? you have to go to the person paying the premium. your Job. and hope they will fight for you and tell the insurance that they will leave them and go elsewhere if they dont take care of this legit case. I've seen this play out numerous times.
So i'm telling you, you never had control. and at least with M4A, you are the citizen who pays the taxes who pays for insurance from your government. so yes you are closer to having control over what they call medically necessary or not. you can say lets relax what is medically necessary. but remember for everything you want there is a price tag. the more you relax that. the more money the coverage will cost you. as long as you're willing to pay. thats on us the citizen.
