Doctors Beware! Don’t Piss Off The Medical Industrial Complex

Doctor Remains Silent – Resorts To Sign Language – He’s Eternally Hopeful The Medical Industrial Complex Understands Sign Language

Don’t rock the boat! Stay silent. Big Brother and the Medical Industrial Complex is watching you. Otherwise lose your reputation, family, friends, fortune, license and freedom. (Cheer up though, you can keep your children).

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A New Horizon in Health Care: How ICHRAs Could Transform American Health Insurance

Individual Coverage Health Reimbursement Arrangements present a compelling blueprint for a more inclusive, flexible, and sustainable health coverage model. By embracing this innovative approach, we can move closer to the ideal of universal health care coverage, tailored to the needs and preferences of every American.

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TSHBP Risk Pool Goes Bye Bye

The TSHBP risk pool has been unsuccessful in turning around significant underwriting loses despite back-to-back annual rate increases and a cash call to the tune of millions of dollars.

TSHBP officials are “Throwing in the towel” while attempting to replace commissions at the same time by offering commercial health coverage on a stand-alone basis to each TSHBP member district.

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American Healthcare Finance Is Bullshit

Billed Charges = $2,341,142.50. PPO allowed amount = $1.872,530.66. Plan negotiated down to $531,818.53……………Proof that billed charges are bullshit and PPO discounts are bullshit too. The American healthcare finance system is bullshit controlled by bullies……………....

Does this possibly prove there is no such thing as a $1 Million claim?

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Marshall Allen: A Relentless Voice for the Little Guy

By Dave Chase – May 19, 2024

On Sunday, May 19, we lost an extraordinary man, Marshall Allen, a dedicated journalist and former member of the clergy, whose unwavering commitment to investigative journalism has left an indelible mark on the healthcare industry. His tireless work exposed the deep-seated issues within the healthcare system, shedding light on price gouging, sloppy billing, fraud, insurance denials, and unnecessary treatments that preyed on vulnerable Americans.

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Aldeen’s Sunday Morning Bathroom Read – The OMG Edition

By Doug Aldeen

Rand recently published its report ( Rand 5.0) that suggests hospitals, on average, markup their prices for commercial carriers at 254% of Medicare. The American Hospital Association in its press release, in typical fashion, takes organizations like Multiplan to task and asserts that Multiplan and its commercial carrier clients are somehow to blame.

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Miami ISD Considers Bolting From TSHBP In Favor of Curative Health

“We have received information from TSHBP that the yearly claims for the program were over budget and therefore a surcharge of $150 per employee for 10 months will be assessed.  Due to this, we are pursuing other health care options through a fully funded insurance program for our employees.  Currently, the best option is the Curative plan.” 

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Leveraging Risk Transfer Through The Federal Risk Adjustment / High Risk Pool Program

Hot Potato Risk Transfer Method

Self-funded health plans have traditionally ceded large and unexpected losses through insurance policies naming the plan sponsor as the insured. Under these policies plan sponsors are reimbursed for losses. Many have now discovered they can duplicate this risk transfer strategy through a more efficient and economical method by naming the plan member as the insured.

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Government Mandates Reference Based Pricing For Indians

“Tonto That Hospital Charged Me 4 Times More Than They Charged You!”

Dear Tonto,

“I am pleased to announce that on June 4 the Indian Health Service (IHS) and the Centers for Medicare & Medicaid Services (CMS) published the much anticipated final rule implementing “Medicare-like” payment rates. The “Medicare-like” payinent rate will constitute payment in fill1 to Medicare-participating hospitals that deliver services to American Indians and Alaska Natives…..” SOURCE: Tribal Leader Letter

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School District Alert: Beware of Health Insurance Cooperatives

Although the following article is 3 years old we may be seeing a similar debacle unfolding before our very own eyes in Texas in 2024……………

Dozens of school districts left scrambling to pay $11.6 million in debts, a financial shipwreck that raises concerns about such ventures, which are virtually unregulated……

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Why Do Insurers & Hospitals Fight Over Prices?

Baylor Scott & White Health to Terminate Blue Cross Blue Shield Agreements in July

Why should health insurance companies negotiate lower prices with hospitals when, thanks to the federal government mandate known as the Minimum Loss Ratio, both get paid more through higher prices? A sign of a good business deal is when both sides walk away from the table happy.

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Free Medical Care Coming To All Houston ISD Campuses Next School Year

Article Referred By Lori Ramos

Houston ISD to offer free telehealth services to all campuses after expanding partnership with national provider

The program is funded through a combination of insurance and fees. Hazel Health will bill for services on behalf of students with health insurance through their parents. A portion of Hazel Health’s platform fees are used to offset any out-of-pocket expenses not covered by insurance. Students with no insurance receive free care too. Hazel Health verifies uninsured status after sign-up.

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Mexican Dogs Get Better Deals

A friend runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

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An Open Letter To The Amarillo Independent School District

This Open Letter to the Amarillo Independent School District has far more implications than just a story about a West Texas public school district’s failed efforts to reign in rising health insurance costs. It’s a story about a malaise affecting elected officials under status quo influence where nothing changes.

Josh Butler, a local Amarillo taxpayer and nationally recognized health insurance expert writes an excellent piece that, quite frankly, is one of the best we’ve seen. His open letter is representative of the continuing failure of elected officials everywhere to control health care costs when it’s been proven by others they can.

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Confuse & Delay Is Always To The Advantage of The Incumbent

A risk pool of more than 20,000 member lives composed of an aggregation of Texas public school districts is looking for a home. The pool has suffered significant underwriting losses necessitating a mid-year cash call to the tune of millions of dollars to pay claims and cover expenses. A run on the bank appears imminent.

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Virtual Care Becoming A Highly Competitive Business Model

Modern Age Doctor Visit

We are seeing more companies entering the virtual care market supported by deep pocketed investors sensing lucrative opportunities in an emerging market.

This virtual care program connects users to a doctor in less than 60 seconds, 24/7/365. Enhances efficiency supporting early diagnosis and treatment while improving health outcomes and reducing healthcare costs.

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