by okdrsblog
4. January 2012 06:58
December 30, 2011
There exist HMO's run by private companies which are designed specifically for Medicare patients. Their premiums, copays and deductibles may be attractively much less expensive or even non-existent. As I understand it, the company is paid a certain fixed amount of money every year to take care of all the healthcare needs of the indiviual enrollee. If one becomes ill, unlike traditional Medicare plans, the company may deny some tests and treatments. It is obvious that besides efficiency scales, which have a definite endpoint and limit, denying interventions and diagnostic tests would be an avenue to generate revenue.
The crucial question then arises regarding what constitutes nonessential tests and treatments. How is this decided on by one insurance company?
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