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Re: Birth Plans From: jay kulkin (jkulkin@mindspring.com) Sun Jun 22 21:39:53 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: jay kulkin: "Re: galactorrhe" Previous message: Robert J. Woolley: "Re: Birth Plans" Maybe in reply to: CNMPAT@aol.com: "Birth Plans" Next in thread: Robert J. Woolley: "Re: Birth Plans" I'm beginning to worry because we almost agree too often. While your statements stand true out of context, they don't hold up from a population standpoint. Members of health plans expect MCO's to cover medically necessary care (I'm concerned because even the most obvious cases can be denied). If all of our patients were independently wealthy this would not be an issue. They do, however, have a right to expect MCO's to provide the services contracted for. All of my comments pertain to what physicians would agree is appropriate care-that is what should be covered. We should not provide care based on "what is covered". What is covered should be what is necessary. I think we can agree that medical necessity is ambiguous, but we are en route to standardizing acceptable guidelines. Jay At 09:15 PM 6/22/97 -0500, you wrote: >In message <1.5.4.32.19970623000416.00a8f2d4@pop.mindspring.com> writes: >> >> Docs, we can't even decide how many days a patient needs to stay in the >> hospital anymore. > >Of course you can; you just can't decide how many the insurane will pay for. And >that authority was taken away because you (us) decided so badly, historically. >The fact that stays have been vastly reduced without harming outcomes over the >last 10 years is ample evidence that you (we) were not at all efficient in our >use of resources. We have only ourselves to blame. > > We aren't allowed to do medically necessary procedures. > >Of course you are. You just don't have the final say in whether the insurer will >agree that something was medically necessary and therefroe pay for it. See >explanation above; it applies here, too. > >--------------------------------------------------------------------------- > >--------------------------------------------------------------------------- > >--------------------------------------------------------------------------- >Bob Woolley >St. Paul, Minnesota > >"Words never fail. We hear them, we read them; they enter into our mind >and become part of us as long as we shall live. Who speaks reason to his >fellow men bestows it upon them. Who mouths inanity disorders thought for >all who listen. There must be some minimum allowable dose of inanity >beyond which the mind cannot remain reasonable. Irrationality, like buried >chemical waste, sooner or later must seep into the tissues of thought." > > -- Richard Mitchell > > in > > *Less Than Words Can Say* > -- Jay M. Kulkin, MD, MBA, FACOG Medical Resource Group 1117 Perimeter Center West Suite 510 East Atlanta, Georgia Phone:770-392-3475 e-mail: medresourcegroup@mindspring.com Next message: jay kulkin: "Re: galactorrhe" Previous message: Robert J. Woolley: "Re: Birth Plans" Maybe in reply to: CNMPAT@aol.com: "Birth Plans" Next in thread: Robert J. Woolley: "Re: Birth Plans"

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