A rare bipartisan bill in Congress aims to end the health insurance industry’s billion-dollar scam that charges taxpayers twice for care only the VA provides.
You can't “government” your way out of this. You don't need more regulation, you need systems in place, like everyone else, to determine who has paid and who has not. We call those billing systems. This is just another example of people fumbling around in the dark, doing ‘things’ and hoping it gets better.
The only real solution is to put the big payers out of business. That way there is no multiple billing in the first place.
We, SentiaHealth, right here on Substack, can and have automated the entire insurance industry. That eliminates medical coding, insurance networks, adjudication, delays, denials, rate negotiation, sales/brokers/agents, the cost of a third party EMR, skyscrapers in every major city in the US, and the hundreds of thousands of employees that work at the insurance company that you, as the insured, pay for.
That's the long way of saying “it eliminates HALF the cost of health insurance”
Sorry for the hijack, but this is the only thing that matters, as it is the only viable solution that solves any of those problems.
I hear the current pro corporate appointees for CMS will use a private for profit pre authorization company to prior authorize doctors orders for those of us on traditional/original Medicare. We must stop this.
I’ve written and deployed a TON of PA and RTA code and solutions and there’s no logic in there that changes a medical code.
There’s a comparison done between diag, proc, patient history, internal data points etc., to ensure a given auth follows EBMG, continuity of care, etc. and isn’t upcoded, unbundled etc.
If any of these tests fail against the logic, the auth is pended and pushed to a queue for a medical review.
I suggest private for profit health insurance corporations are doing this exact deal with Medicaid also.
Completely corrupt corporate welfare.
I wonder why none of these solutions are in the Bad Ugly Bill that Republicans are pushing today.
You can't “government” your way out of this. You don't need more regulation, you need systems in place, like everyone else, to determine who has paid and who has not. We call those billing systems. This is just another example of people fumbling around in the dark, doing ‘things’ and hoping it gets better.
The only real solution is to put the big payers out of business. That way there is no multiple billing in the first place.
We, SentiaHealth, right here on Substack, can and have automated the entire insurance industry. That eliminates medical coding, insurance networks, adjudication, delays, denials, rate negotiation, sales/brokers/agents, the cost of a third party EMR, skyscrapers in every major city in the US, and the hundreds of thousands of employees that work at the insurance company that you, as the insured, pay for.
That's the long way of saying “it eliminates HALF the cost of health insurance”
Sorry for the hijack, but this is the only thing that matters, as it is the only viable solution that solves any of those problems.
Another heist is in the making.
I hear the current pro corporate appointees for CMS will use a private for profit pre authorization company to prior authorize doctors orders for those of us on traditional/original Medicare. We must stop this.
Nice one guys 👍
I still struggle with the upcoding references.
I’ve written and deployed a TON of PA and RTA code and solutions and there’s no logic in there that changes a medical code.
There’s a comparison done between diag, proc, patient history, internal data points etc., to ensure a given auth follows EBMG, continuity of care, etc. and isn’t upcoded, unbundled etc.
If any of these tests fail against the logic, the auth is pended and pushed to a queue for a medical review.
Say what?
This terrible scheme and many more have been evolving for decades with the private for profit health insurance lobbyists buying our government.