A doctor at Cigna comes clean about insurance company denials. If you ever wondered why clean claims get denied, a doctor shows us what is wrong with insurers who will do almost anything to increase their profits. The mantra of deny deny deny is alive and well in our insurance system. I tell our patients, fight for what you believe you are owed. I recently had the situation with my own insurer, Horizon for a colonoscopy that was supposed to Read More
Medical billing practices and high deductibles are why our medical costs are rising yearly; here’s why. Medical billing practices and high deductibles are why our medical costs are rising yearly; here’s why. It’s amazing that even during the pandemic when the federal government was paying for covid related hospital bills and testing and few people were visiting their doctors or the hospitals, yet insurance carriers continued to charge us more in insurance premiums while increasing our copayments and deductibles. As a front-line healthcare practitioner, the increase Read More
Insurance companies lose their antitrust exemption with the Passage of The Competitive Health Insurance Reform Act of 2020 Insurance companies lose their antitrust exemption with the Passage of The Competitive Health Insurance Reform Act of 2020 Insurance companies have long had an exemption from anti-trust violations as a result of a 1944 Supreme Court Case, United States v. South-Eastern Underwriters Association, the Court established that the business of insurance constitutes “interstate commerce,” and therefore is subject to Congressional oversight under the Commerce Clause of the Constitution. This decision specifically Read More
Obamacare or Nobamacare, why this is just a symptom of what is wrong with healthcare in the USA Obamacare or Nobamacare, why this is just a symptom of what is wrong with healthcare in the USA The election is over and a large portion of the population has either renewed or newly purchased a new health care plan from one of the exchanges beginning this month. The insurance companies are slowly removing themselves from the exchanges and talk of a public option of some sort to fill in Read More
The real math behind why your health insurance keeps rising (it has not been published in your newspaper yet) The real math behind why your health insurance premiums keep rising, and what the media hasn’t told us about Obamacare yet. From the wealthy to the not so wealthy, one thing seems to be a common theme of anyone buying health insurance; the cost continues to increase yearly without any relief. Today, I was speaking to someone who is a major employer and he is looking at other options than Read More
Health insurance companies fly in the ointment tactics, and how to win the game. How to win against a health insurer’s delay tactics
My health insurance just increased 25% in NJ; something is very wrong here. My health insurance just increased 25% in NJ; something is very wrong here. Obamacare or nobomacare, it makes no difference to me or the patients we care for as long as it serves our needs at a reasonable cost. Something has gone off the rails in Washington, as the partisans politicians fight to defeat Obamacare. These sets of rules and regulations, already present in New Jersey before Obamacare were designed to make it Read More
The Emergency Room was in my network; why wasn’t the doctor? The Emergency Room was in my network; why wasn’t the doctor? In network, out of network, why is this so confusing and complicated. As a healthcare consumer, it is getting harder and harder to trust that our healthcare costs will be properly paid by our insurer. Why should we have to worry about this anyway? Patients who want to use an in network doctor can usually go through their insurer Read More
Doctors selling their practices have an unpleasant surprise for their patients; unreasonably high prices according to the NY Times. Doctors selling their practices have an unpleasant surprise for their patients; unreasonably high prices according to the NY Times. Anyone who has ever gone to the hospital for a test, an overnight stay, or just an emergency room visit is likely to have a story about unreasonably high prices for the work performed. Unfortunately, hospitals have been given economic clout and a free pass on pricing their services because they Read More
Physicians are fed up with high drug prices too; one physician offers some good ideas on how to lower drug costs in the USA Physicians are fed up with high drug prices too; one physician offers some good ideas on how to lower drug costs in the USA. Drug prices in the USA are the highest in the world. Why do we pay so much more? The answer is that there is a willingness to do so at any cost and insurers are part of the problem and legislation that limits a willingness to Read More
Government health care plans are being developed within the Obamacare similar to the ones government employees have says the NY Times Government health care plans are being developed within the Obamacare similar to the ones government employees have says the NY Times The NY Times is reporting that the public option was deleted from the new healthcare law, but a privately run public option (as a substitute for the government run public option) goes into effect to compete along with other plans in the insurance exchanges each state is supposed to Read More
Why did my doctor leave my managed care network? The problem with managed care… Why did my doctor leave my managed care network? The problem with managed care… Since the 1990’s, the managed care networks are something we in the United States have been forced to live with. Many doctors joined these networks because access to patients became synonymous with the networks. Employers embraced these networks because they saved costs, or at least, this was the promise made to all of us. Patients learned Read More