Finance

A ‘Very Cruel’ Medicare Rule is Costing Seniors Dearly

from The Plain Dealer – by Stephen Koff –

WASHINGTON, DC – It’s bad enough to be hospitalized. But thousand of seniors across the country are finding their medical problems compounded with financial frustration and large bills because of a Medicare technicality that can cost them dearly.

The problem starts when their doctors want them to go to a skilled nursing facility as an interim, rehabilitative step between the hospital and home. That’s fairly typical when a patient needs to regain strength but no longer requires hospitalization.

But if the hospital has not classified the patient properly for Medicare billing purposes, then Medicare, the government health insurer for seniors, refuses to pay the skilled-nursing bill. Even a short stay costs the patient thousands of dollars.

For Marilyn “Micki” Gilbert, 83, an assisted-living resident at Menorah Park in Beachwood, the bills came to $17,000 after more than four weeks of skilled nursing care. Following a hospital stay of several nights last August after she fell and was hospitalized “with a head broken open and sutures,” as she put it, she expected Medicare to cover her rehabilitative care.

But Medicare administrators refused. The problem was that when the hospital sent the bill to the Centers for Medicare and Medicaid Services, or CMS, for payment, it said that Gilbert was in the hospital for “observation” rather than admitted in the “inpatient” category.

That difference, which is many cases is a technicality, means the difference of thousands of dollars for every patient affected.

“And believe me, at 83, where am I going to come up with that?” Gilbert asked. “I can’t tell you how bad it was. I have spoken with other people who have had this done. When you’re 83, you don’t have that kind of money.”

The problem is a result of Medicare rules that only authorize follow-up, skilled nursing care after a patient has had inpatient hospital care for at least three consecutive days. Even splitting that classification – say, as one day for observation and two for inpatient care – will not satisfy the three-day inpatient requirement, regardless of the fact that the patient stayed and was treated in a hospital the whole time.

The inspector general for the U.S. Department of Health and Human Services said last year that in 2012, Medicare beneficiaries had more than 600,000 hospital stays that lasted three or more nights but did not qualify for skilled-nursing facility payment. In a small share of those cases, 4 percent, Medicare mistakenly paid for skilled nursing care anyway, costing $225 million.

The distinction – observation versus inpatient — has financial consequences for hospitals as well. That may be part of the problem, say several members of Congress as well as authorities from such organizations as the American Health Care Association and Center for Medicare Advocacy. Hospitals have their own financial reasons for classifying some multi-day stays as observational.

One is that hospitals with billing mistakes can be subjected to intense CMS audits with deep financial consequences. Since 2010, CMS has used outside contractors to aggressively review admission records and seek repayment for improper admissions, according the office of U.S. Sen. Sherrod Brown, an Ohio Democrat who has repeatedly expressed displeasure for the way seniors are winding up with large medical bills.

For healthcare providers, it may be safer for many to simply classify a hospitalization as observational. That usually means they’ll get less money in reimbursement than if they coded the bill with inpatient fees, and the patients may get stuck with more out-of-pocket costs for care and prescription drugs. But for hospitals, it is better than getting hit with an audit and facing claw-back demands from CMS, health professionals say.

Hospitals may also do this to avoid Medicare penalties they can face if they have an excessive number of in-patient readmissions within 30 days of discharge.

Part of the Affordable Care Act, the Readmissions Reduction Program started in October 2012 and was supposed to result in better care the first time a patient is admitted. Excessive readmissions now can cost a hospital money, and many hospitals are reporting that their readmission rates are, in fact falling.

But one way to get around the risk of readmission penalties may be to avoid as much as possible the inpatient classification.

Asked about the rules and the financial consequence for seniors, CMS said it is following the law.

In the past, CMS has said it was concerned that too many patients were being admitted to hospitals improperly, getting inpatient services and costing CMS more money when they should have been observed for longer first.

CMS has offered somewhat broader guidelines as complaints build, but a growing number of Congress members say that hasn’t solved the problem.

Among those pushing to change these Catch-22 rules are Brown, the senator from Ohio, and Reps. Marcia Fudge of Warrensville Heights and Jim Renacci of Wadsworth. Fudge is a Democrat, Renacci a Republican.

Lawmakers have tried for several years to change the rules, but Rep. Joe Courtney, Democrat of Connecticut, noted on a call with reporters Tuesday that support this term has grown significantly, with 136 cosponsors to his bill. They include Fudge as well as Reps. Dave Joyce, Republican of Russell Township, and Marcy Kaptur, Democrat of Toledo. Renacci introduced a bill with a similar goal late last year and had 21 cosponsors.

Brown’s bill, the Senate counterpart to Courtney’s, has 25 cosponsors.

The American Medical Association, AARP and more than a dozen more organizations have gotten behind the bills. Courtney said Tuesday that the legislation could wind up in a different legislative vehicle tied to the rates that Congress authorizes CMS to pay hospitals. That kind of linkage could give the complaining lawmakers more leverage.

“Surely seniors should focus on their recovery,” Brown said. “Their families should focus on making their recovery as comfortable and as rapid as possible, instead of having to pay attention to billing technicalities and sky-high medical bills, or worse, trying to recover without the medical care that their doctors want them to have.”

Gilbert, the 83-year-old woman in Beachwood, summed it up during a telephone interview in more impassioned terms. She described calling CMS, to no avail, and asking a lawyer what she could do.

“Everybody said there was nothing they could do. It’s the law,” she said.

“It’s bad enough as you start getting older. My husband passed away about two years ago, and I can’t tell you the loss I felt.” She and Leonard had been married for 64 years.

Then she fell and was hospitalized. And “no one knew how to help.”

CMS may have its reasons. Micki Gilbert can only surmise them.

“I think it’s very cruel,” she said.

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CAB
7 years ago

It’s even worse. When my husband was hospitalized, after he collapsed, the doctors thought he had blood clots in his lungs or possibly had a stroke. They ran extensive tests and he was released after several days. Medicare declined the entire bill saying he was in for “observation”. they did not pay a dime. When I called the hospital to tell them they must have made a billing error as he was admitted they told me that Medicare has a person stationed at the hospital and they decide how to bill. The hospital has no say.

betty
7 years ago

my problem with medicare is not paying for my husband ride in an ambulance from a nursing home because he was sitting in his wheelchair and the ambulance service told medicare he could have went some other way. well anyhow he had conjesive heart failure and could not be laying down. and he was admitted to the hospital to take fluid off. he couldn’t breath if he laid down.. he was in there for a week. now tell me that was not a emergency. in fact for a year he was in and out of hospital and nursing home. yes we did no he had to be in hospital for three days in order to go back to nursing home. he did pass away in oct 2013. now I get this bill which this happen in july. this government sucks.

HAM
7 years ago

No Alice B, not one Republican voted for Obamacare/ACA. It was passed ONLY by Democrats. (It wasn’t “signed” by anyone but Obama). Where did you get the idea that ANY Republican voted to pass it? DEMOCRATS OWN this law and DEMOCRATS alone. Republicans had absolutely no input into it from writing it to voting it into law.

Mark
7 years ago

BJ, you really should not comment on things you know nothing about. If you think a flat tax puts people with a lower income at a disadvantage, please show us how. Since you are obviously a liberal Democrat, doesn’t a flat tax seem FAIR to you? The less you make, the less you pay. The more you make, the more you pay. Sounds FAIR to me.

Thomas Reagan
7 years ago
Reply to  Mark

I have been reading comments made on this article. We are straying from the article some. All good & valid. The real prob is congress., both republicans & democrats. Nothing will be done to correct any of these probe until we use our power of the vote & throw the old establishment that worry more about being reelected that doing what’s right. When you have people like john mccain there who attacks & tries to discredit people in his own party like Paul Ryan & ted cruise because they have different opinions than he does it’s hopeless. We need to clean house in both parties & put people in office that will do the right thing for their voters. Do I think it will happen in my life time? I don’t think so. This country is in serious trouble. The next mid term election is critical to fix it

HAM
7 years ago

If this issue isn’t “fixed” (bills passed to correct the law) BEFORE the election, don’t expect it to happen AFTER the election because the bills will again sit in Committee, forgotten. Someone will finally throw them into “file 13” aka “the trash”.

PaulE
7 years ago
Reply to  HAM

Correct. All incentive for any Democrat participation in these bills ends once the election is over. Then it will be back to business as usual in Washington.

audrey D'Alessandro
7 years ago

The whole problem is the part of the rule that makes the hospitals keep patients in “observation” instead of inpatient. Again, unintended consequences of Obama care and “meaningful use” rules. There are just too many unintended consequences. I understand the gov’t wanting to keep hospitals’ accountable, but this is what happens when you make broad sweeping changes. Hospitals are not one size fits all. Depending on what communities they serve they may have more readmissions because they have more lower income or older adult communities around them.
This is also what happens when drug companies write the laws that congress passes and no one reads. It passes the buck to every and anyone else.

HAM
7 years ago

I was with you until you said “this is what happens when drug companies write the laws & congress passes”. Drug companies did not write the Obamacare law. This was a collaboration: Pelosi, AARP, Obama, ALL Democrats, and capitulation of the insurance companies & possibly drug companies. “Congress” did not pass the law. “Democrats” in Congress did. DEMOCRATS OWN IT !!!! Not one Republican in Congress voted for it!!!!

PaulE
7 years ago
Reply to  HAM

Agreed HAM. People need to get their facts straight and stop blaming everyone but the Democrats for writing and ramming Obamacare through on a pure party line Democrat vote. While neither insurance companies nor pharma companies are blameless in this whole mess, they saw how the Democrat party had completely vilified the financial sector to the public at the time, for a near meltdown of our economy, that was caused by Democrat policies to start with. So rather than stand up and say no to the Democrats, which they should have done, both insurance and pharma companies acquiesced to the Democrats demands on them for Obamacare.

McGillicutty
7 years ago

I don’t care if it’s Obama’s fault, or whose fault it is. Put your partisanship aside. We have to protect our senior citizens. Please let your congressional representative’s know that we need to amend:

“title XVIII (Medicare) of the Social Security Act to deem an individual receiving outpatient observation services in a hospital to be an inpatient with respect to satisfying the three-day inpatient hospital requirement in order to entitle the individual to Medicare coverage of any post-hospital extended care services in a skilled nursing facility (SNF)”.

HAM
7 years ago
Reply to  McGillicutty

We need to vote all Democrats out of office and agree we need to pressure all our Congressmen & women to do something about this unfair trickery against Seniors. Make no mistake, Obama & HHS is waging a war against Senior citizens. Until Obama is out of office and Republicans/Conservatives are in control of our government again is anything going to be done OR unless Democrats up for election in November pressure Obama to fix this BEFORE the election. I agree with you and again urge everyone to contact your representatives in the House & Senate and let them know how displeased we are about this issue and expect them to do something about correcting it.

HAM
7 years ago

It amazes me when some people blame big business for all the ills of this country. When the company I worked for was bought out by another company the new one told us up front that the “bottom line” was what was important. Whether the company you worked for told you up front that the bottom line was what was important or not, that IS the ultimate goal and that should have been a “given” to everyone. Yes there were some, especially in the financial sector who were dishonest but that doesn’t mean the business “sector” as a whole is. They are, after all, in the business to make money. If they didn’t, WE would not have had jobs.

There are always going to be dishonest individuals and the ones who condoned it need to be held accountable but it’s NOT just Republicans!!! Also, political connections should not come into play for any restitution or fines imposed. It’s all too easy to blame the business sector as a whole when in fact it is usually isolated to certain individuals. The idea that it is only the “Republicans” fault because they are pro business has been “propagated” by Democrats. In fact, there are just as many Democrats/Liberals who have benefitted and still do from the oil & financial industries as there are Republucans. I don’t remember the Congresswomans name but I read just recently that a female Democrat voted against the Keystone pipeline because she had a financial interest in their competitor (of course that was not made public until recently!!!). The Clinton’s have been involved in questionable financial dealings. Barney Frank & Christopher Dodd have yet to be held accountable in the public eye for their roles in the housing bust. They worked in collaboration with Acorn to force lending institutions to accept alternative methods if evaluating high risk home buyers and permitted Frannie Mae & Freddie Mac to accept high risk mortgages and then fraudulently rate these mortgages as investment grade securities. Because of Clinton’s changes to the original Community Reinvestment Act (CRA), the definition of subprime borrower was reclassified. They opened the door for the financial industry to “expand” on what the Federal Government was forcing them to do. Where is the outrage against the Democrats role in he financial collapse!!!

marnie
7 years ago
Reply to  HAM

Thank you, HAM!

Lesley
6 years ago
Reply to  HAM

You are WAY off point!! We are talking about MediCare rules and the unfairness of them in regards to “inpatient” and “under observation” classification when it comes to paying for a skilled nursing facility. Hospitals should have to inform the patient, or in the case of impaired patients, the person with medical POA of the patient’s status re: “in patient” or under observation”. This is just a game that Medicare plays to keep from paying.

janet hartwell
7 years ago

I agree that more sho u ‘d be published about this situation that could happen to people and start embassy emailing to the house and Senate. It is such a disgrace to the older people who become sick as we all will at some time!

Felix
7 years ago

I just found out that Obama is going to take our guns away by ruling us as Mentally unbalanced or to put it in plain words crazy! This is not normal thinking or mentally sane to enforce his wishes upon a Free Nation under Constitutional Law that is Run, By The people, For the people and Of the people. This is a Nation under GOD! It is Protected by GOD! and his Children. I would say that accusations of threatening the people of America to find them Crazy in order to bring about a serious Crime of confiscating a Nation and thereby Breaking your Oath of Office is Tantamount to committing the Most Serious of Crimes to the Government of the United States. This in deed should void your Presidency and as it is considered to be an underhanded attact on the United States Of America, you President Obama have no longer the authority to proclaim Marshall Law upon this Nation. You have continually not attempted but tried to break certain Amendents to the Constitution. Especially the Second Amendent the right to Bare Arms. You have also contacted the Chief Of Justice Erik Holder in attempt to turn a violation of the Law by rewording it so as to legally make it law. Your attemps and schemes to run this Nation is not in the realm of Normal Thinking Mentality. You have brought this Nation to the very brink of complete distruction. In all respect as President of United States at this time I would suggest Stepping Down and possibly enjoying a life of Retirement while you can? Sincerely,..Felix Guerrera

Felix
7 years ago

What does it take to bring this Nation to Action, let alone the World, that will STOP these Criminal minded thugs from trying to not only Pilfer but Highjack a whole Country or even the world? It goes on and on and hardly not a soul has the Eyes to see or the Ears to hear what is going on. The few that can, have tried to ignite a fire under you and I speak of every person on this planet that is concerned for not only your own well being but the well being of others! For GODS sake I hope and Pray that these words reach around the world for the simple reason that we are actually Relatives of each other. Because we have never Met or have never understood our difference in Languages, does not mean we would not help each other in everyway possible. By now you should understand who I am trying to make understand. That this CRY TO ALL is to the GOOD and GODLY PEOPLE of this World. YOU are the only people that will take the time to read this because you, for many reasons care! It is not only we Americans! The trouble for all of us, is the fact that ONE HONEST VOICE is not strong enough! We have to make our voice as one and it is almost impossible. However with GODS help and our prayers we can do it! This is what has to happen! If you KNOW RIGHT FROM WRONG?, Then you should know you are dealing with the Devil there is no rightiousness in him. Now you have to know that the Devil is extremely clever but keep in your mind, that you are GREATER THAN HE ,because his greatest weapon is to get into your mind! The DEVIL will take every thought that will make you sick,have an accident, even kill you and this is when you get desperate and without knowledge of him, you fight back with all your strength to get well with any means you can. Medication, Prayer, etc. If you are of Strong Faith, some will be healed. Some will die but the righeous and believers will live even though they die, and they will not suffer condenation if they believe in Christ Jesus! Now with that said, I hope it will relieve you of any fear you have of Dieing. You are going to live either way and the end will be Paradise for us and Hell for others. We are listening to the Politicians fighting back and fourth and getting letters for donations and Straw votes and letters that complain of the ACLU. Trying to do away with GOD. I want to tell you now that even those that are complaining with us and agreeing with us saying how awful this is that Military Chaplains can’t pray over or with our men in the Armed Forces or How Obama is doing wrong all the time asking for money. This is possibly the strategy that is tearing us apart. The enemy has know for a long time, in order to defeat American it has to be destroyed from within. Remember Kruschev when he said “They(RUSSIA) will take us without a firing a shot! I have written a number of messages for the people to tell them that we are living under GODS PLAN not this Political Baloney that gets nowhere and achieves nothing while the Criminals work their schemes. And this may be the cause of you not being able to read my message to you, due to the HURT and Insult those of the media refuse to make known to you due to the Fear of losing their Prestege, their Jobs and not only the Media. The Church goers that are so Hippocrital it is such a Disgrace. ALL FOR THE SAKE OF MONEY! I hope now, all who need be rehabilitated realize, We are fighting Good against Evil, GOD against the DEVIL. LIFE against DEATH. YOUR CHOICE ! When we see the Government Law Enforcement and those working inside that have taken OATH TO PROTECT OUR CONSTITUTION AND AMERICA AND DEFY GOD ALMIGHTY AND TURN AGAINST HIS CHOSEN CHILDREN OF ISRAEL WHO THROUGH THEM GAVE US OUR GOD! BE THEREFORE READY ALSO FOR IN AN HOUR WE KNOW NOT , THE LORD COMETH! GOD BLESS AMERICA AND ALL HIS CHILDREN !…….FELIX GUERRERA

DC
7 years ago
Reply to  Felix

AMEN Brother! I am reminded though that my Bible says in the last days, “men’s eyes will be blinded”. And if we don’t have blind people with their head in the sand, I don’t know what you would call it.
GOD BLESS AMERICA!

Patricia Lewis
7 years ago

Those bills will just not get paid. What do they expect from our seniors? Consequently it might jeopardize their home or anything if they cannot pay their hospital bills. Liberals be gone!!!

cheryn pate
7 years ago

I agree that lawmakers should abide by their own laws. they need to be voted OUT! The healthcare reform act specifically denies life saving measures for the elderly. are all these comments just venting or is anyone in power looking at them?

Bernie
7 years ago

The best solution is to vote out the present Congress members, Vote out incumbents in November ,send a message to Washington, WE are tired of being screwed by people we elect, So you incumbents MUST GO !

susan
7 years ago
Reply to  Bernie

Absolutely!!! I made sure I didn’t vote for anyone already in office last November and will continue to the same every year until real change is made. I will encourage all my family & friends to do the same!!!

Rose74
7 years ago
Reply to  Bernie

I totally agree that this matters should be fixed. But I do not think they will be. The ACA is modeled on socialized medicine and I know for a fact, that in Europe, people wait for months for life saving treatment. This is my personal opinion, but I believe this could be another way to reduce population, just as abortion. This satisfies those who believe that humans should be reduced drastically (zero population growth groups)

REHJR
7 years ago

Hospitals and intermediate care facilities have gouged the system for quite a while. It seems hard to get around their system, but you can. My wife recently was hospitalized and on a brand new medication the hospital didn’t hear of or stock. They had to allow me to bring in the prescription for her to take. This tells me you don’t have to be charged for medication at an enormous rate above what you pay the pharmacy for.

If you receive a letter from a health organization in your community and has the letters ACO in it be very careful. You can do a search for ACO or KEY COMMUNITY CARE. The information is legitimate and if you don’t respond you will automatically enrolled in the program. You do have the option to say no, and I recommend that option.

I went into the web page and found that it is also linked to Medicare/Medicaid in the federal site. There is wording in it that states that OBAMA-LAMA-DING-DONG (ACA) has the right to look into the information. Imagine that!!! I asked my family physician about it and he said basically it gives him permission to tell any physician he refers you to your medical history. I found that to be odd since every new care provider asks the same information form you. I have mine and my wife’s appropriate med info printed and just provide that. This is just one more way trhe Government can use it against you. Did you ever hear what euthanasia is? LOOK OUT!!

JW
7 years ago
Reply to  REHJR

Of course we have heard of euthanasia. I remember a couple speaches obama made before elections the first time he ran for office. He stated that seniors have to keep in mind that most of their illesses are do to aging. Well, its not hard to read between the lines of a tryrant that sanctions the slaughter of millions of unborn. It wasn’t to long after those speaches I started hearing about death boards. I believe it was Mrs. Palin that warned us about them and was heavely critized for it. Well, there in place now. The question I have is, how many seniors voted for this godless outfit? From what I have read, the majority did? Well, what goes around comes around I’m sorry to say. Bye Bye. Oh, by the way, I noticed in the article, Cruel Medicare etc., there were democrats reaching out to seniors. Oh, I forgot. Elections in November. What do you want to bet they supported obama’s obmacare? Got to create distance elections are comeing up.

HAM
7 years ago
Reply to  JW

I don’t believe the majority of Seniors voted for Obama. What approximately 3 million Republicans did do is not vote in 2012. If they had I believe he would not have been elected.

Encoyrage conservatives/republicans or everyone you know to vote in November and vote Conservative/Republican just DON’T vote Democrat !!!! Help Seniors get to the polls if they need a ride. Do what you can to help.

HAM
7 years ago
Reply to  JW

I don’t believe the majority of Seniors voted for Obama. What approximately 3 million Republicans did do is not vote in 2012. If they had I believe he would not have been elected.

Encourage conservatives/republicans or everyone you know to vote in November and vote Conservative/Republican just DON’T vote Democrat !!!! Help Seniors get to the polls if they need a ride. Do what you can to help.

PEZ90
7 years ago

I think the statement, ” not a single Republican voted for the ACA, it was voted in solely by Democrats” is misleading. It is true that the Republicans did not vote for it, but it is also true that they had a chance to stop it from being funded, thus essentially ending it. Twenty-five GOP senators voted in Sept. 2013 to give Reid cloture, which allowed a simple majority to restore funding for Obamacare. These 25 RINO’s voted with Harry Reid & the Democrats. Two GOP senators did not even bother to show up to vote, Flake(AZ) & Hatch(Utah) because they evidently felt it more important to attend family weddings than to do the job of representing the people who voted them into office. Nineteen GOP senators were true conservatives & voted against Reid. If our GOP had stuck together & voted unanimously against cloture, so it could not be funded, we might not have this monstrosity today. At the very least we would know that our GOP senators were truly conservative & trying to do the right thing. We are in far greater danger from the RINO’s in our party than from the Democrats. Right now conservatives have very little representation in DC. I hope everyone checks out their senators & representatives voting records & see if they are true conservatives or RINO’s. I live in AZ & both Flake & McCain are RINO’s. We need to clean house in 2014 & 2016, vote out the Democrats & the RINO’s, otherwise, it will be more of the same, only worse. I have included 2 links explaining cloture & gives names of the senators. Please read & prepare for 2014 elections, we are fighting to save our country.

http://cnsnews.com/news/article/terence-p-jeffrey/25-gop-senators-vote-give-reid-cloture-allowing-simple-majority

http://conservativepoliticalforum.com/political-discussion-and-debate/25-gop-senators-vote-to-give-reid-cloture-allowing-simple-majority-to-restore-o/

Gaby
7 years ago

Why doesn’t our wondrous President use that extraordinary Congress-avoiding pen of his to change this law unilaterally?

JW
7 years ago
Reply to  Gaby

Death boards.

Rose74
7 years ago
Reply to  Gaby

Not convenient for his agenda!!!

Marie
7 years ago

I think we should consider a constituional amendment where government gives certain amounts for certain races and that is all they get. They would not be allowed to take any money from groups or other individuals. A flat tax would get rid of the lobbyists. Those in Washington should not be making a killing of any kind as they represent the people. Make it a sacrifice to serve the people and and we might need a whole new Congress the day after it passes. As much as we believe in free speech, people should be allowed to speak about other types of governments but the amendment would also disallow anyone from doing anything to change our government. If you like a different system, then go to a country where that system exists. The only reason they don’t do that is because they have made a killing in the free market.

BJ
7 years ago
Reply to  Marie

A flat tax will disadvantage the lower middle class and those making less. It will provide a windfall to those making $100,000 and more.

JW
7 years ago
Reply to  BJ

It would be a fair tax. Why? we would be taxed according to our ability to consume. High income people spend more so they would be taxed more. Low income spend much less, so they would be taxed much less. Nothing that man comes up with is perfect but anything would be better than what it is now. Do I think it will happened? Never, the politicians in Washington well never let it happen. Why? If they want to keep revenue coming in, they would have to work harder to keep the economy going. The perks and the special interest that fund their elections would have to go. Also, do you realize how much controll over our lives they would lose. Its not going to happen. Especially with the current administration. Controll is their agenda. When you file your federal and state income taxes, you display your life. Even your religion if you write off your donations. Do you think this administration would give that up?

Ivan Berry
7 years ago

This kind of thing is the reason we should not allow central planners to be involved in anything American. If we wanted central planning we would have chosen collectivists openly. That’s why they always appear in sheeps clothing although they are in fact wolves.
We can keep trying to turn things around or just give up,but we should not rely on those who created this mess to fix it. I have no confidence in either establishment party to do anything constructive when it is apparent that they are set on destruction of this people.
And who came up with the theory (lawyers’ tricks) that judges on the Supreme Court who are part of the central government should be the arbiters of what is or is not constitutional. That’s the fox garding the hen-house.
We need the States to stand up to the central government when they step out of bounds and, if nothing else, nullify unconstitutional laws and regulations as well as stop accepting bribes in exchange for the cent. gov. getting its way. Public education is one example, which is getting worse with “common core,” an uncommon infringement on our childrens’ education.
From earlier disclosures as well as this article, my family will pay attention to our “admissions” codes and try and nip it before it bites us. Thanks for the info.

A R Detlefsen
7 years ago

I see people mention that you should question the coding done regarding
Their experience at the hospital as well as at the Drs office. No doubt
This is good. I have never seen the coding done when I was at the
Drs office or hospital. I’m sure that same is true for most people.
I have also never seen to opportunity to see the coding or understand
what the various codes are or their application. I agree with what has
been written…. Just how to ask and understand .

I also think no politian should live being exempt from their
Legislation as many are who voted for the ACA. I also believe
No President should rule by executive order…..especially when
He can’t or won’t prove he can constitutionally be President .
How did He even get on the Democratic ticket??? He may qualify
In Kenya but not in the USA.

susan
7 years ago
Reply to  A R Detlefsen

Agree!!!

audrey D'Alessandro
7 years ago
Reply to  A R Detlefsen

I agreed with you until you went off the reservation with the He cant prove he’s an American thing – his mother was an American – he’s an American!

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