As a women's health advocate for over 26 years, I want to confirm that I have seen this play out over many years. There's no question, some people pay out of pocket rather than tangle with the appeals process, though it so often works. I applaud the makers of this film and the wonderful people at this clinic for doing what needs to be done for their patients.
Wendell, thank you for extending your platform to these fantastic advocacy efforts. It is not easy speaking truth. Julie and Claudia are simply AMAZING! Some other advocates are being targeted in an attempt to silence them. https://casetext.com/case/paydhealth-llc-v-holcombe
I worked for CIGNA and trained on the first ChoiceFund team in Chattanooga when you were in leadership, including the first Medicare D plans. I'm also now a disabled worker that first hand faced the barriers in care Medicare Advantage plans have. I couldn't afford healthcare and mine worsened ultimately losing benefits to find employment with another major carrier. Still disabled, and still face barriers. I appreciate the work you're doing, and if there's anyway I can contribute please reach out.
The system is so complex. The average American can be so confused by it. I have been working in healthcare in multiple capacities for over 30 years. The system needs to change.
I try to help families and friends the best that I can do; but even at times I get confused. It should not be so complicated!
I personally believe this is a compounded issue by the industries insistence to use automation, including AI, and their push to offshore claims and customer service so they don't have to pay US workers (salary and benefit packages). It's more complex than system predictions and taking that to countries that do not have the same system expecting them to understand issues in processing is just absurd.
For point of reference, when I was hired at CIGNA the training was in waves but overall 6 months of training to be able to answer calls regarding benefits, eligibility, and claim status. When I learned HRA, HSA, FSA which includes regulation to guidelines if was easily an additional few weeks to a month as we had to learn pharmacy since the benefits combined. When Medicare D went to market, it was such a hard thing to market they actually held seminars at colleges to educate seniors on a product. It is designed to not be well understood by layperson, but how the market has changed since I started even knowledgeable people suffer because the providers and insurers continue to put the stress on resolution on the same members that have their health to be concerned with.
Absolutely true. As a disabled veteran, I'm discovering many ways that the Reaganists ("privatize!") are closing around the VA also. I'm told, as a Diabetic Type 2 doing through a crisis, that I cannot check my glucose more than twice a week. The VA will not provide any more test strips, even while I pay a co-pay. So I'll have to go to CVS or the like to buy more.
Also, I'm now told I can only see my doctor once a year. Whatever else I need will have to be either by phone/email or not at all. Where does this end? I think 20 JAN 25 will be a day that lives in infamy... only for so long, because the system is collapsing... has to collapse.... and the sociopaths of reaganism just want to grab what they can before the end engulfs us.
I experience this a lot with my daughter who is medically fragile and medically complex. Our insurance and pharmacy have caused 2-3 hospital stays because of not covering medicine. Thankfully, there is a department at my daughter's doctor's office that helps patients with appeals. We hope we can avoid another hospital stay.
Shout out to all the patients, pharmds, physicians and taxpayers that have been delayed and denied by the insurance companies who do NONE of the actual healthcare and make profits off the backs of everyone. Claimable is a game-changer to help patients APPEAL their denied care. Thank you Wendell Potter for carrying the message to advocate for access to care. Julie Baak
I find this Substack newsletter extremely informative. My questions to Mr. Potter: what are the best practices the ideal health insurance company would employ? Is there any possibility of a non-profit health care company being created that would use these practices and compete with the existing health care companies?
Direct Contracting with the physicians and pharmacists who do the actual work. Cut out the middlemen Pharmacy Benefit Managers (PBM) looking at Express Scripts, Optum and CVS Caremark. Show these crooks the door.
A start is getting banking out of healthcare on a whole. HSA accounts bending to IRS requirements while funneling though private equity- which massively bought out property medical buildings are on, the buildings themselves, the practices in mergers, as well as the agencies that staff them. The same equity or financial institutions that continue to increase loan repayments for the education of praxtitioners the nation uses for care. It's moving money between the same hands and deeply corrupt.
As a women's health advocate for over 26 years, I want to confirm that I have seen this play out over many years. There's no question, some people pay out of pocket rather than tangle with the appeals process, though it so often works. I applaud the makers of this film and the wonderful people at this clinic for doing what needs to be done for their patients.
Wendell, thank you for extending your platform to these fantastic advocacy efforts. It is not easy speaking truth. Julie and Claudia are simply AMAZING! Some other advocates are being targeted in an attempt to silence them. https://casetext.com/case/paydhealth-llc-v-holcombe
Thank you for continuing to highlight these issues. Yes, the healthcare system must change.
Cost containment is simple. Fire everyone who works in cost containment.
When insurers say “cost containment, they mean “profit enhancing” practices, for their benefit! Profiteering off people
suffering has no place in health CARE!
I know. I agree.
I worked for CIGNA and trained on the first ChoiceFund team in Chattanooga when you were in leadership, including the first Medicare D plans. I'm also now a disabled worker that first hand faced the barriers in care Medicare Advantage plans have. I couldn't afford healthcare and mine worsened ultimately losing benefits to find employment with another major carrier. Still disabled, and still face barriers. I appreciate the work you're doing, and if there's anyway I can contribute please reach out.
The system is so complex. The average American can be so confused by it. I have been working in healthcare in multiple capacities for over 30 years. The system needs to change.
I try to help families and friends the best that I can do; but even at times I get confused. It should not be so complicated!
I personally believe this is a compounded issue by the industries insistence to use automation, including AI, and their push to offshore claims and customer service so they don't have to pay US workers (salary and benefit packages). It's more complex than system predictions and taking that to countries that do not have the same system expecting them to understand issues in processing is just absurd.
For point of reference, when I was hired at CIGNA the training was in waves but overall 6 months of training to be able to answer calls regarding benefits, eligibility, and claim status. When I learned HRA, HSA, FSA which includes regulation to guidelines if was easily an additional few weeks to a month as we had to learn pharmacy since the benefits combined. When Medicare D went to market, it was such a hard thing to market they actually held seminars at colleges to educate seniors on a product. It is designed to not be well understood by layperson, but how the market has changed since I started even knowledgeable people suffer because the providers and insurers continue to put the stress on resolution on the same members that have their health to be concerned with.
Absolutely true. As a disabled veteran, I'm discovering many ways that the Reaganists ("privatize!") are closing around the VA also. I'm told, as a Diabetic Type 2 doing through a crisis, that I cannot check my glucose more than twice a week. The VA will not provide any more test strips, even while I pay a co-pay. So I'll have to go to CVS or the like to buy more.
Also, I'm now told I can only see my doctor once a year. Whatever else I need will have to be either by phone/email or not at all. Where does this end? I think 20 JAN 25 will be a day that lives in infamy... only for so long, because the system is collapsing... has to collapse.... and the sociopaths of reaganism just want to grab what they can before the end engulfs us.
John T. Cullen JTC Sheep Heil!
johntcullen.substack.com
MARA Make America Real Again
I experience this a lot with my daughter who is medically fragile and medically complex. Our insurance and pharmacy have caused 2-3 hospital stays because of not covering medicine. Thankfully, there is a department at my daughter's doctor's office that helps patients with appeals. We hope we can avoid another hospital stay.
Shout out to all the patients, pharmds, physicians and taxpayers that have been delayed and denied by the insurance companies who do NONE of the actual healthcare and make profits off the backs of everyone. Claimable is a game-changer to help patients APPEAL their denied care. Thank you Wendell Potter for carrying the message to advocate for access to care. Julie Baak
I find this Substack newsletter extremely informative. My questions to Mr. Potter: what are the best practices the ideal health insurance company would employ? Is there any possibility of a non-profit health care company being created that would use these practices and compete with the existing health care companies?
Direct Contracting with the physicians and pharmacists who do the actual work. Cut out the middlemen Pharmacy Benefit Managers (PBM) looking at Express Scripts, Optum and CVS Caremark. Show these crooks the door.
A start is getting banking out of healthcare on a whole. HSA accounts bending to IRS requirements while funneling though private equity- which massively bought out property medical buildings are on, the buildings themselves, the practices in mergers, as well as the agencies that staff them. The same equity or financial institutions that continue to increase loan repayments for the education of praxtitioners the nation uses for care. It's moving money between the same hands and deeply corrupt.
The EMBED code provided does NOT WORK. Please fix so film can be more easily shared, or upload to YOUTUBE. Thx.