When they can't collect payment, they raise prices to make up that loss.
Plus they need to have all the administration of a mortgage loan servicer to try to collect those amounts. Which of course also puts people who can't afford the cost, in medical debt, which often leads to bankruptcy
Plus they need to have all the administration of a mortgage loan servicer to try to collect those amounts. Which of course also puts people who can't afford the cost, in medical debt, which often leads to bankruptcy
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Staying till 10:00 at night charting for insurance. The suicide rate in Drs is rising due to the demand of meeting req of insurance and staying in business
They act as Care Authorizers and payment processors. Can the care occur and how much will be paid.
https://www.youtube.com/watch?v=kmI76KqC94s
The first step is for self insured entities to use 3rd party TPAs and move away from insurance companies for this service
https://bsky.app/profile/rini1983.bsky.social/post/3lcyployans2w
Be true!
For my employees, we are direct contracting with providers. We are stipulating that there will be no pre authorizations. We will trust the provider
I can walk behind you and take down everything you say. At the end of the day, you could be like ”I had some good stuff to say today. Give me a transcript of my musings…" or “I wasn’t on my a-game today. Let’s not preserve that one for posterity." Just a thought. 😉
How are you splitting OON costs (i.e. 90%/10%? 80%/20%?)
Do you have an out-of-pocket maximum for OON care?
We start this program in the near future. We expect to save a lot of time and money with happier employees.
More importantly, we plan on publishing our direct contracts.
Please advise on the meaning of
OON re: medication/ insurance,
Thank you
This approach seems similar to Medicaid (albeit with premiums).
Medicaid encounters an issue where emergency department usage is disproportionately high relative to preventative care, which increases total costs.
You don’t even need a network. Just a price contract across providers….you could even publish it and accept anyone that accepts your price levels.
All you would then need is a company to hold / process the money.
Are you by chance looking for a medical director to hire for managing this work? 😃
you changed one shitty system for another shitty system
Direct contract, payments to providers. No pre auth. Just pay the Doctor and use AI to check for fraud scenarios. Eliminate the needless bureaucracy and waste and cutout the profiteering from the useless Ins.
Just need to check for fraud.
This is a world I want to live in!
You say you will trust providers. Surely you need to have a formulary; otherwise cost could be come uncontrollable. Yet there has to be a process to get formulary exceptions. Docs are not going to be aware of price outliers unless you have some sort of pre-auth process.
One of the best ways to improve the pre-authorization process would be to require insurers or TPAs to pay the treating physician speaking to the reviewing physician the same as the reviewing physician is paid.
Currently this is uncompensated; thus patients suffer.
What a novel idea!
Who is handling the contracting? Are they in-house employees or are you using outside consultants/contractors to handle the negotiations?
(Refresher for people who forgot the late 2000s https://en.wikipedia.org/wiki/Credit_rating_agencies_and_the_subprime_crisis )
To make that possible, you have to eliminate the profit incentive for performing tests or procedures.
If Moody's didn't give companies good ratings, the company would move to their competitor. So, Moody's would give better rating than they should have.
—Why do we need insurance companies between patient and provider anyway?
—Why not eliminate insurance companies then the patient pays the provider who is *paid for keeping the patient healthy*?
Or better yet: Why not take it one step further and additionally require all health insurance organizations to be Non Profit? No investors to please. No stock prices to worry about raising. The absence of the latter two things removes two incentives for denying healthcare access.
But better still if we implement more VBHC throughout the healthcare system, them healthcare teams would be asking for treatment and protocols that reflect what is necessary for improving patient outcomes
As for Docs, I have definitely seen them order tests and treatment that wasn’t needed.
202 a month. His cost.
There that would actually help America! There is no reason for them to be a corporation that sales stock.
Non profit rates go down and more paid out !
https://www.propublica.org/article/thomas-weiner-montana-st-peters-hospital-oncology
Do I call them out on what I think are unnecessary procedures? Damn right I do. Amazingly, I am still vertical. Five year Stage 4 Prostate Cancer survivor.
We don’t have a healthcare system. We have a Sickness Management System, optimized for generating wealth (not value)
Take supplements
Eat organic
Protein, fiber, no sugar, no processed food
Hydrate
Work out like a motherfucker
Sleep well (good luck with that)
Hoard sleeping pills, benzos
Don’t take them. Lock them in a safe.
When you get really sick
Open the safe.
Peace out.
Why not just save a lot of meaningless verbiage and simply say: Hey, everything is completely fucked up now, so move along, nothing to see here....?
Insurance is ruining the profession.
People without ins don't make Dr's apps. They go to the hospital, receive costly care, and leave. Costs go up. Then, everyone who pays premiums pays those unpaid bills.
and repeat this with some simple graphs? It might actually reach the people of America, I recommend during a football game for max viewer-ship.
(I’ll even donate a few bucks to help)
My Dr will go to the insurance company or give me coupons or w/e to help lower the price.
Do we believe this is actually Mark?
Doctors & Hospitals don't/can't raise or change the price of meds.
I know from personal experience of having health problems & taking a lot of meds!
My Drs will contact the insurance & give me coupons etc to lower the price for me...
This doesn't even sound like Mark..
I once paid in cash and he charged me the amount before insurance.
If medical insurance companies didn't negotiate fees based on the returns they need for their shareholders, facilities and Providers wouldn't have to make the non insured pay "100% of billed charges".
They control big pharma, hospitals, insurance, and processing of claims.
Essentially we have universal healthcare owned by a corporation.
Single payer healthcare has neither profits or paperwork.