Today I saw an article about a Trump post on Truth Social where still my President said he is “seriously looking at alternatives” to the Obamacare – if he is elected next year. This reminded me of suggestions I sent to our President at the time Obama… who denied the people offered alternatives. Here is what I wrote as found on the Internet archive at https://web.archive.org/web/20110212052456/http://auto-accident-lawyer-directory.com/did-obama-really-not-get-healthcare-reform-suggestions/:
Did Obama Really Not Get Healthcare Reform Suggestions?
Posted on December 5, 2010 by admin
Dr. Michael Haley Wrote:
My understanding is that “healthreform.gov” was set up so Americans could submit real solutions for consideration for health care reform. Good suggestions would supposedly MAKE IT TO PRESIDENT OBAMA. But when President Obama addressed the nation, he said something like “I asked you to submit solutions that addressed rising insurance premiums and fraud… where is it? He was justifying the necessity for moving forward with the socialized obamacare program under the code name “health care reform”. I doubt I am the only one that submitted solutions. If you read what follows and consider how the proposed money flow changes would affect the consumers role in health care costs, I think you’ll agree these are some pretty fine suggestions.
What follows is the healtreform.gov email acknowledgement of receipt and includes the suggestions that I personally submitted on 9/29/09 to healthreform.gov. The words are the same. Only formatting changes were made for the sake of readability:
Thank you for sharing your story and sending in ideas about why we need health reform this year.
The following is the content of your comment:
(Contact Information has been Excluded for Privacy)
Share your questions and ideas for changing Health Care for all Americans:
HEALTH INSURANCE FRAUD PREVENTION PLAN
Many health care facilities “waive” co-payments and deductibles and then excessively bill the patient’s insurance company. Many times, the patients know… but don’t care because they don’t have to pay. Other times, patients are just lied to by the physician’s office being told something like: “you have no out-of-pocket expenses” or “you only have a $20.00 co-payment” or “you’ll never have to pay anything here”. After excessively billing the insurance company, they write off the balance. Oftentimes, diagnosis terms and the related codes are stretched to a higher diagnosis for the benefit of justifying unnecessary services. Sometimes services are billed that aren’t actually performed. The higher diagnosis codes electronically trick the insurance companies software so they miss the illegal billing. The terms they document in the charts help justify their decisions in case their records are ever checked.
Example:
In August 2008, my 28 year old wife went to a physician with mastitis. She has been nursing our infant and told the physician she had mastitis. She has had it before. She and I are both health care professionals and agreed on the diagnosis. However, instead of documenting that she had tenderness in her breast, the physician wrote “chest pain” and ordered an EKG. The risky differential diagnosis justified a comprehensive exam with a medical decision making of moderate complexity. Eventually, he prescribed the not so complex antibiotics for mastitis. However with chest pain on the documents they can do a bigger exam and also perform tests for a differential diagnosis such as heart problems. Our insurance company was billed $668.68 for the visit. My wife only had to pay an in-network $25.00 co-payment. Just a few hours earlier, we chose to not go to the out of network walk-in clinic because we would have had to pay the entire bill… $100.00. It seemed more reasonable to pay only $25.00 and go to an in-network “Preferred” Provider and let the insurance pay the difference. The insurance company will no doubt “adjust” the bills. But it will certainly cost them more than $100.00. They have to pay the physician. They’ll also probably have lab charges. Maybe another physician will interpret lab findings and have more fees. Finally, the insurance company will have the administrative costs. But it only cost me 25 bucks! …right? Oh, and those high insurance premiums because everyone else is doing it too!
Another Example:
Recently, a potential patient was interviewing me to see if he should switch physicians. He gets regular spinal manipulations, electrical muscle stimulation, and massage therapy. My office is much more convenient for him so he wanted to see how much it would cost him to come to me. After an insurance verification and going over his co-payments, he asked if he would have to pay his co-payment. He went so far to tell me that all the county employees go to the other guy because they don’t have to pay anything to the other guy. He admits that the other doctor over-bills the insurance company, but hey, its free! He did not switch chiropractors, but instead chose the “free” care from the guy that would not make him pay his share. He admits he goes often not because of pain, but just because it feels good.
It Gets Worse!
A patient once asked if I needed patients. The guy he goes to gives him money every time he comes in. He thought I might pay him more to have permission from him to charge his insurance whatever I wanted. This mechanic didn’t tell me his name and wouldn’t tell me who he was going to. He only told me: “times are hard, anything to make a buck”.
A POTENTIAL SOLUTION???
The solution to fraud of this nature is quite simple: have the insurance company pay the physicians 100% and then turn around and charge the patient their co-payments and deductibles. This will require a few additional regulations like advanced fee disclosures to the patients. But this will save the insurance companies money because:
THEY’LL GET MOST CO-PAYMENTS AND DEDUCTIBLES BACK
PATIENTS WILL FEAR HAVING TO PAY THEIR CO-PAYMENTS AND DEDUCTIBLES AND WILL GET LESS UN-NECESSARY CARE
PATIENTS THAT DON’T PAY RISK HAVING THEIR POLICIES TERMINATED
TERMINATING SUCH CONTRACTS ELIMINATES THE HIGH RISK CUSTOMERS
WOULD THIS REALLY BE FAIR TO THE INSURANCE COMPANY?
Because laws and insurance plans vary from state to state, let me present a scenario for Florida residents. Everyone knows that in Florida, Personal Injury Protection for auto accident victims pays quite well. The insurance companies usually get to talk to their insured prior to them seeking injury care – unless they are transported to a hospital in which case treatment is probably necessary. Imagine you were in a motor vehicle collision and your insurance company called and told you something like this: “Don’t worry Mr. Johnson, you can go to whatever doctor you choose. But don’t pay the physician anything ever. We’ll pay the physician 100% of your bills and only charge back to you your deductible, the first $1000.00 dollars, and then 20% of any charges after that; also, make sure you sign a fee disclosure document that tells you how much they are billing for your visit”.
Now the insured knows that a $200.00 visit will cost $200.00 or $40.00 if the deductible is met! They realize it will add up if getting therapy 3 times a week for several weeks. Chances are, people will only go if really injured. And the doctor won’t be able to say: “you won’t have any out of pocket costs”. Or “you’ll never have to pay the deductible and co-payments”. How will this affect the honest physicians? It will level the playing field. Suddenly, patients that go to the “free” guys will choose the guy they really want to go to. Also, with fraud decreased, the insurance premiums can probably also decrease. Patients will afford better insurance. “Usual and customary” reimbursements can also better reflect true usual and customary fees because physicians will no longer be billing so many services per visit. Doing so would create too much confusion when the patient asks: “how much will my insurance be charged?”. They ask, of course, because now they’ll actually be paying the required percentage that the other guy just waived.
Patients will certainly report much more illegal activity now that it directly impacts them. This will weed out, expose, squash, and shut down many of fraudulent “health care” facilities.
Do we really need a whole new health care system when a simple change in the flow of money would save billions and billions?
Please reply and let me know that this is seriously being looked at and considered. At least do a pilot study in the medicare program.
Now that you see what I wrote, please add your comments and opinions.
Sincerely,
Dr. Michael Haley
Pomano Beach, FL
