Miscellaneous And Off Topic Subjects

[AlabamAlum]

Well, the government is not going to streamline things or reduce red tape.

As far as deductibles and approvals go, it's the employer who dictates what is covered for their employees.

[SeattleLionsFan]

Not really AA. For some self funded plans yes, but there are very real limits even on those plans.

[froot loops]

Trump may be good for the news divisions of TV but it has been bad for their bottom line because he isn't spending any money on TV ads. A lot of these stations set their budgets in anticipation of the easy money of fall political ads. It isn't happening this year.

[iam416]

Yeah, AA. You don't know shit about healthcare. Heh.

[AlabamAlum]

Not really AA. For some self funded plans yes, but there are very real limits even on those plans.

No. Often a CFO, COO, or VPHR goes into BCBS, for example, and sets up how much coverage they want to buy for employees. Now, there are "canned" plans, but the employer absolutely sets limits of what they will pay and shops coverages and deductibles.

Spoiler: I did this. It was one of my duties in a past life. It's one of the reasons that the BCBS plan a restaurant employee gets is so vastly different from the BCBS plan a utility worker, cop, or fireman (or most union workers) get.

[AlabamAlum]

Yeah, AA. You don't know shit about healthcare. Heh.

Heh. Shaddup.

[entropy]

Miscellaneous And Off Topic Subjects

AA is correct. We are self insured (mostly) from a healthcare perspective. Employers have options and a deductible is one way to manage costs.


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[entropy]

http://www.sfgate.com/olympics/article/Olympic-Rio-sex-scandal-diving-ingrid-oliveira-9143639.php

Brazil synchronized divers split after one kicks the other out to have sex all night.... Prior to their competition.


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[SeattleLionsFan]

Well, the government is not going to streamline things or reduce red tape.

As far as deductibles and approvals go, it's the employer who dictates what is covered for their employees.

Of course a company can pick a plan with a specific deductible. I was referring more to approvals. A company cannot generally say that a claim (or necessarily even a benefit) should be granted. That is governed by the law and the plan documents.

Source: was health insurance sales and customer service for 7-8 years.

[AlabamAlum]

Of course a company can pick a plan with a specific deductible. I was referring more to approvals. A company cannot generally say that a claim (or necessarily even a benefit) should be granted. That is governed by the law and the plan documents.

Source: was health insurance sales and customer service for 7-8 years.

Co-pays, deductibles, percentage covered, and (before the PPACA) you could set a plan dollar limit on a policy. These are the big money variables decided by companies. The big dollars on approvals are RX. Generally, fertility and PDE5's and to a lesser degree generics. Techinically now, even with PPACA compliant plans, a company can set a procedure limit on a plan (most usually don't).

But no, of course, companies can't exclude psych or other federally mandated things, but the plans are indeed customized. For example, if an employee needs bariatric surgery, we could approve with any medical cert, or make them diet for YEARS under the care of a physician to get the cert. The former cost more.

I met with a VP of marketing and we decided what the plan would be. When things were stable, this was only done every four years or so. Much more often now.

[AlabamAlum]

Hell, on RX some companies sign off on plans that will only approve the cheaper statins (and other drug classes). For example, if the MD wrires for Crestor, he's gonna have to justify why he didn't write for generic lipitor.

[AlabamAlum]

And even with federally mandated reqs, companies have sued and won (Hobby Lobby and birth control, for example)

But enough about this...it won't change anything.

[WingsFan]

Any Elvis fans in the building?

BLM new target this week is Graceland

Black Lives Matter aim to 'shut down Graceland' during Elvis Week

[hack]

http://www.rollingstone.com/politics/matt-taibbi-on-the-summer-of-the-media-shill-w434484

A bit repetitive but some well-formed sentences here about media polarization. Excerpts:




In the same way that Fox used to (and probably still does) save on reporting and research costs by simply regurgitating talking points from the RNC, blue-leaning cable channels are running segments and online reports that are increasingly indistinguishable from Democratic Party messaging.

But Fox's coverage has been so overwhelmingly one-sided that it has lost forever the ability to convince non-conservatives of anything. Rupert Murdoch has turned into the Slime Who Cried Wolf. Even when Murdoch gets hold of a real story, he usually can't reach more than an inch outside his own dumbed-down audience.

This is a problem because if there ever comes a time when you want to convince your own audience of hard truths, you'll suddenly find them not nearly as trusting and loyal as you’d thought. Deep down, they'll have known all along you were full of it.

...

The public hates us reporters in the best of times, when we’re doing our jobs correctly, merely being conniving, prying little busybodies forever getting up into peoples’ business.

But the summer of Trump could easily turn into an Alamo moment for the press. There are reporters who are quietly promising themselves they'll go back to being independent and above the fray in November, after we're past the threat of a Trump presidency.

But just ask the National Review: Once you jump in the politicians’ side of the pool, it's not so easy to get out again. And what will they think of us then? Is there a word for "lower than scum?"

[Ghengis Jon]

Is there a word for "lower than scum?"

Buckeyes.