Jason Saltzman’s Post

Where do I even start...I have been saying it for 30+ years that the solution to the healthcare and health insurance issues in this country involve LESS government intervention, not MORE! I pulled one paragraph out of the article that was telling..."...reduce the state’s projected $517 billion in costs over the next decade by controlling prices for hospitals, physicians and drugs, and capturing savings from reducing excess administrative costs common to the current healthcare system." That means underpaying all providers and hospitals and job losses in administrative positions. Not to mention job losses at the insurance companies and their independent sales force. Also, because these are individual states (and not the entire country), providers can and probably will LEAVE these states. Hospitals will close without additional funding. Kaiser is headquartered in CA and a major provider and insurer. What would happen if they were to say "we are out." Not to mention that these states have not learned anything from the federal government Medicaid and Medicare programs. Medicare is a "black hole" sucking money out of the government and is still on track for insolvency in just a few years from now. The residents of these states are in for a rude awakening if/when these plans are implemented. Although, it is those same state residents that voted for the people that are doing this. So, they have nobody to blame but themselves...

THE HEALTH 202 Will CMS Crack Down on Prior Authorization? By Lauren Sausser There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.” They all have something in common, aside from a nightmare diagnosis. Their insurance companies, at some point, denied doctor-recommended care through a process called prior authorization — a set of rules, unique to every health insurance plan, requiring preapproval for some tests, procedures and prescriptions. Sometimes it’s called preauthorization; sometimes precertification. Regardless, prior authorization is almost universally despised by doctors and patients. In 2021, Medicare Advantage insurers processed an average of 1.5 prior authorization requests for every enrolled patient. https://lnkd.in/eFnvKiry

If you ever get a chance to visit Europe, have a chat with a local about their National Healthcare System. The list of lies pumped out, mainly by Big Insurance, are endless. As a Physician that often presents worldwide on various medical issues, this is what I see. 1. All are covered under a National Healthcare System 2. Treatment Delays exist if you choose to utilize the National Healthcare Option. 3. Private Health Insurance exists at a significantly lower cost because they have to be competitive with the National Healthcare Option. Why pay if you don't have to? 4. With Private Insurance, you can be seen or have surgery within 1 to 2 weeks. If you are not in a hurry, people will use the National Healthcare. 5. In a National Healthcare System, Profit is not the driving factor as it is for many US Medical Practices. When I first moved to Georgia, from MAYO Clinic where I trained, I found that procedures were being performed, not because they were the right procedure, but because the Medical Practice knew that insurance would pay for them. In the United States, we DO NOT have a Healthcare System. We have an Insurance Payment System that is making record profit by continually Increaing Premiums, Raising Deductibles and Denying Coverage.

Quality improvement isn't easy, especially when it comes to critically important programs like Medicaid and Children's Health Insurance. Here are three steps to spur action and impact.

In her new Forefront article, Sabrina Corlette of the Georgetown University Center on Health Insurance Reforms argues that recent Congressional Budget Office (CBO) projections are not our destiny; several policy actions and investments in the Affordable Care Act (ACA) can help sustain 2023’s low uninsurance rate, and even bring it lower. "In the last few years, the US has made tremendous progress providing more people with access to affordable, comprehensive health insurance coverage. Coverage not only improves families’ financial security, it is proven to improve access to primary and preventive care, health outcomes, and the management of chronic disease. The CBO’s projections demonstrate the harm that will arise without policy action: 32 million people uninsured and without access to affordable health care. Policymakers have a clear roadmap to prevent the projected coverage losses and build on coverage gains—they just need to take it." Read the full article here: https://bit.ly/3RCneNh

For United States citizens, having access to quality healthcare coverage is absolutely crucial. Without it, you may be liable for massive medical bills when an unforeseen health concern arises. Many people experience difficulties finding an affordable and comprehensive plan that suits all their needs. Open enrollment scheduling and confusing health insurance jargon can make the process seem more challenging than it needs to be. This article will focus on offering the reader tips and insights about open enrollment for health insurance in 2024. https://hpnc.link/d26 #NCHealthcare #NCHealth

(AXIOS) - "Hospitals Are In The Hotseat For Their Billing Practices." Some measures under discussion could cost hospitals hundreds of billions of dollars, by paring payments that critics say are excessive and costing taxpayers and patients. #HospitalBillingErrors #HospitalBillingAudits #CPTCodes #HospitalERBills #NoSurprisesAct #OutOfNetworkProviders #DishonestHospitalBilling #SurpriseMedicalBilling #TrumpHospitalPriceTransparencyRules #TrumpHealthPlans #TrumpDrugPriceControls #TrumpHealthcareReforms #ObamacareLimitedDoctors #TrumpSurpriseMedicalBillsRule #HospitalBillings #HI4E.Org #SurpriseMedicalBills #MedicalBilling #AirAmbulanceBillings #TrumpMedicalTransparencyPricingRules #TrumpCanadianDrugImportRules #HealthcareCosts #Axios #HealthInsuranceForEveryone #ObamacareLimitedProviderNetworks #ObamacareHighOutOfPocketExpenses #HealthAndLifeSolutionsLLC #ObamacareHigherDeductibles #ObamacarePlansLimitedDoctors Finally Access To AFFORDABLE Health Insurance Plans At: HI4E.org

📢 States Step Up to Reform Prior Authorization Practices Amid Healthcare Delays 🏥💼 A wave of state legislation is sweeping across the US, aimed at reigning in the contentious practice of prior authorization by health insurance companies. This movement seeks to address the growing concerns voiced by both #HealthcareProviders and #Patients over the delays and denials of care due to these #preapproval processes. 🚨 With New Jersey leading the charge through recent legislation that mandates insurance decisions within 24 to 72 hours depending on the urgency, and Washington state implementing similar laws, the message is clear: the current system needs an overhaul. Over 20 states have passed prior authorization bills in 2023 alone, reflecting a nationwide push towards more efficient healthcare delivery. 📜🕒 These state-level initiatives, often more stringent than the proposed federal regulations by the Centers for Medicare & Medicaid Services, signify a critical step towards streamlining patient care and reducing unnecessary administrative burdens on providers. The move has been widely supported by healthcare advocates and professional associations who have long criticized prior authorization for its role in escalating healthcare costs and frustrations among consumers. 🩺💡 While some insurers have begun to roll back these policies, the widespread call for transparency, adherence to clinical guidelines, and swift decision-making underscores a pressing need for systemic change. #HealthcareReform #PriorAuthorization #Legislation #PatientCare #HealthInsurance

I'd like to preface this share with portions of an email I received last week from a Mom: “I wanted to update you and also tell you how much I appreciate allll of your assistance.  I’m happily overwhelmed with the MANY BLESSINGS that have come way today. I have been so stressed, as you know. Everything is turning out to be just fine!  I absolutely can’t thank you enough. I hope we will have the opportunity to meet you in person some day." More #disastrous information regarding HHSC's RFP process... #REPOST #texas #dfw #dallasforworth #metroplex #fortworth #fortworthtx #Medicaid #CHIP #children #pediatrics #medicallycomplex #managedcare #MCO #huge #news #HHSC #HHS #TexasHHSC #TexasHHS #decision #APPEAL #procurement #vulnerable #citizens #nonprofit #PROTEST #forprofit #national #local #share #knowledgeispower EXCERPTS FROM THE ARTICLE: “We are aware of this situation and are deeply concerned about the questions this raises about the process," officials from Cook Children's Health Plan said in a written statement. "Aetna, which is set to win a multibillion Texas Medicaid contract, got a peek at sensitive information submitted by 17 rival health plans during the bidding process after the state Health and Human Services agency erred and sent competitors’ proposals to the health insurance giant too early. The early release of documents throws into doubt the legitimacy of a procurement worth about $116 billion over the next 12 years because it gave a single competitor a look at the other bidders’ playbooks while the procurement game was still on, several bidders argue. During this STAR/CHIP contracting round, those documents were released before the bid winners were announced – and indeed before the competitors had even been interviewed by the state’s evaluation teams – and that has resulted in the losing companies crying foul. Curiously, the error was made despite two Texas attorney general rulings that stated the agency had grounds to hold records private until after the procurement process because releasing them could unfairly affect the outcome. “The agency’s misconduct created an unlevel playing field that advantaged one competitor to the detriment of all others in this procurement for the largest state contracts in Texas,” Superior attorneys wrote in the April letter. !!!! “The only appropriate remedy is to cancel … and start over. Any other response would simply be a waste of taxpayer dollars and government resources in a misguided attempt to defend HHSC’s indefensible actions.” !!!! The list of winning bids shocked many in the health care community because it dropped three Texas children’s hospital-affiliated plans — in Fort Worth, Houston and the Rio Grande Valley — in favor of competitors new to either the region or the state Medicaid programs.  Among those who would be affected are a collective 700,000 families, pregnant women and children."

Who profits the most from health insurance? Big payers ranked by 2022 profit UnitedHealth Group: $20.6 billion. Total net earnings in 2022 were $20.6 billion, up 16.4 percent year over year. ... Cigna: $6.7 billion. ... Elevance Health: $6 billion. ... CVS Health: $4.2 billion. ... Humana: $2.8 billion. ... Centene: $1.2 billion. Maybe avoid dealing with these Insurance Companies and watch their premiums drop. Our lawmakers should be more involved in the oversight of these denials for necessary and sometimes life threatening treatments and hold them accountable. Where are our Politicians and the DHHS on this issue? Profits big while denials are up. 80% denials in 2020 & 41.7 million denied in-network claims/ 2021.