Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Medical Price Transparency

Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.

Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.

The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.

Learn more by listening to the podcast.

For Those Who Lost Their Employer Funded Health Insurance; Resources Are Available

Provided at no charge by the Houston Healthcare Initiative.  

For Those Who Lost Their Employer Funded Health Insurance Resources Are Available

Because of the Coronavirus/Covid-19 pandemic, 25–43 million people could lose their jobs and their health insurance. People who had a serious illness before the outbreak and job loss could be dealt a literally fatal blow. Others who had symptoms and even serious accidents while unemployed and without insurance could suffer more than they would have if their insurance were in place. But there are resources available as described this week on the Houston Healthcare Initiative podcast. To learn more, go to www.houstonhealthcareinitiative.org. To hear about this on Dr. Goldstein’s podcast, please visit: Job Losses Equal Employer Funded Health Insurance Loss.

  • Testing for the Coronavirus/Covid-19 illness: testing for the Coronavirus/Covid-19 virus is free. But if the test is positive and you have the virus, the treatment for it can get expensive. Fortunately, most people recover at home. However, an estimated 15% of infected people may end up hospitalized, according to the Kaiser Family Foundation. Recent data suggests that patients who go to intensive care stay there for an average of 20 days. The Castlight Covid-19 test site finder will provide information on Coronavirus testing near you: https://my.castlighthealth.com/corona-virus-testing-sites/.
  • The Health Insurance Exchange: Open enrollment typically runs from November to January, depending on the state in which you live. But people are allowed a change in coverage when experiencing a life altering event. One such event is the loss of a job and employer sponsored health insurance. You can shop for health plans through your state’s insurance marketplace. But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period. Go to this link and find out if you qualify for coverage: https://www.healthcare.gov.
  • Medicaid: Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. But do not assume that you do or do not qualify. There are online resources available from the U.S. Department of Health and Human Services along with state references to guide you. Visit the official U.S. government Medicaid site to see of you are eligible: https://www.medicaid.gov.
  • CHIP: CHIP stands for Children’s Health Insurance Program. If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. Get all the details, go to: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/.
  • Faith Based Cooperatives: Faith-based plans are designed to provide essential coverage for the good health and physical well-being of their members. In return they expect members to live faith-based lives in adherence to the principles behind such plans. As such, faith-based plans will not cover hospital costs that stem from activities they deem immoral or unessential. Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. As such, the premiums are lower in comparison to those of traditional health care. These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care. There are several options. Here are a few:Medi-Share, Liberty HealthShare, Samaritan MinistriesOneShare, Christian Healthcare Ministries.

This is not an exhaustive list for those who lost their employer funded health insurance but is some go the most popular ones that are available.

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

The Healthcare Not Received During the Coronavirus/Covid-19 Pandemic

From Heart Attacks to Cancer Screenings and Chemotherapy

During the Coronavirus/Covid-19 pandemic, people who did not have symptoms of the disease put themselves at risk as those with chronic conditions missed treatments, skipped appointments and chose not to report serious symptoms; this is the healthcare not received during the coronavirus/covid-19 pandemic. Many who lost their employer funded health insurance also missed schedules and treatments. Add to this the fear of visiting a doctor’s office or clinic with reported cases of Coronavirus/Covid-19 on the uptick, another health crisis may be on the horizon.

This was one of the issues affecting the American public discussed by Houston based neurologist Dr. Steven Goldstein on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: Soundcloud, iHeart, Spotify, or iTunes. To learn more about the Houston Healthcare Initiative, go to www.houstonhealthcareinitiative.org.

Cancer Screenings Plummet

No Visitors
Patients who may need to be seen in the office are choosing not to go to the doctor for lots of reasons.

In March and April, patients were asked to postpone appointments that were not urgent. According to a white paper published by ‘Epic Health Research Network’ cancer screenings for cervix, colon, and breast cancer decreased between 86% – 94% in March, 2020. Care for heart attacks, organ transplants, high blood pressure and diabetes fell in March and remain significantly lower compared to the same time in 2019. “There is a 20% decrease in the number of interactions between patients and their oncologists during the COVID-19 pandemic,” Dr. Goldstein told his listeners. “Anytime a screening is delayed, it means that detection and early treatment are too, plus important therapy on advanced cancer are not administered.

Some Need To Be Seen

Many physicians, like Dr. Goldstein, ramped up their telemedicine capabilities in March and see patients that way. But there are still times when a patient needs to be seen. Instances where patients have symptoms that include shortness of breath is one. This symptom could signal heart failure, asthma, pneumonia or even the Covid-19 virus. A diagnosis like that cannot be done over the phone. “Patients and their families should err on the side of caution, contact their doctor and allow their physician the opportunity to make the right decision for the best treatment,” Dr. Goldstein said.

What Concerned Patients Can Ask

For those who believe or are told they must get in to see a doctor, and there is time available in a non-emergency, Dr. Goldstein has some potential questions to pose.

  • Does everyone on staff and patients wear masks?
  • Are the number of persons allowed in the office limited?
  • Has everyone on staff been tested for COVID-19?
  • Are cleaning protocols sufficient to manage waiting rooms, offices, and labs?
  • Has the patient taken responsibility for social distancing, hand washing and mask wearing themselves?

According to Dr. Goldstein, “we have a responsibility to our patients to provide the most appropriate and effective care possible while at the same time keeping potential exposure to the Coronavirus/Covid-19 virus to a minimum.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

Job Losses Equal Employer Funded Health Insurance Loss

Closed for Coronavirus

Here Are Some Resources

Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:

 

Double Loss; Job and Health Insurance

Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”

COBRA Coverage

COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.

State Insurance Exchange

While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”

Spouse Insurance

In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.

Faith Based Health Cooperatives

Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”

Medicare

Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”

CHIP

CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.

Income Qualification for Medicare

A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.

The Good News

There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

 

News About Reform and the Covid 19 Pandemic

How the Covid-19 pandemic will leave its mark on US health care

From hospital closures to the rise of telehealth, five ways the system is already transforming.

News About Reform and the Covid 19 Pandemic


The flaws in America’s health system have been evident for decades to anyone who cared to look, but the coronavirus pandemic has left no more room for doubt: People will die because the US refuses to treat health care as a public good and a universal right. They already are.

Our decentralized system, with independent providers and many different payers, was not nimble in responding to this stealthy pathogen. These problems weren’t the only reason more than half a million people in the United States have contracted Covid-19 and tens of thousands have died. But America was particularly fertile ground for a virus to run wild.

Only in America could a man and daughter placed under mandatory government quarantine then be hit with a $4,000 hospital bill. Only in America could somebody without health insurance — a situation, all on its own, foreign to other rich countries — receive a bill for Covid-19 treatment that tops $30,000. Only in America would a dying patient ask in his final breaths who will pay for the care that could not prevent his death. The US is the richest country in the world, and yet millions are uninsured or have insufficient benefits. It has fewer hospital beds, doctors, and nurses per capita than its economic peers.

To read the entire article please click here: How the Covid-19 pandemic will leave its mark on U.S. healthcare.

Covid-19 and the Need for Healthcare Reform

The New England Journal of Medicine 

Jaime S. King, J.D.,  Ph.D.

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. Although all aspects of U.S. health care will face incredible challenges in the com- ing months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.

To read the entire article please click here: Covid-19 and the Need for Health Care Reform.

Weekly FDA COVID-19 update

 By Jenni Spinner

The agency continues to remain busy overseeing and approving potential treatments and tests for the virus behind the global pandemic.

To read the entire article please click the link below:

HTTPS://WWW.OUTSOURCING-PHARMA.COM/ARTICLE/2020/05/07/FDA-WEEKLY-COVID-19-UPDATES-AND-ACTIONS

Overweight People Have Double the Risk For Stroke… Is Losing Weight More Difficult Than Recovering from A Stroke?

February 12, 2019 (Houston, TX.) Houston based neurologist and founder of the Houston Healthcare Initiative (www.houstohealthcareinitiative.org) Dr. Steven Goldstein talked about the risk of strokes and their relationship to weight and obesity on his weekly podcast. To hear his weekly podcast go to: iTunes,Soundcloud or the Houston Healthcare Initiative web site.

While the outcomes from strokes are always bad, Dr. Goldstein allowed that from a pure psychological point of view, losing weight was more difficult than recovering from a stroke. “Assuming the patient survives and has the ability to rehabilitate him or herself, there is a lot of motivation for them to do the things that will lead to recovery,” Dr. Goldstein told his audience. Losing weight means changes in lifestyle, adding exercise, eliminating things that we all like to eat and drink in a process that takes a lot of sacrifice. It is very hard to maintain this type of change over any amount of time. Motivation for losing weight is psychologically challenging, but it is better to lose weight than endure a stroke.

What Is A Stroke

There are two types of strokes but a basic way to understand them is to know that a stroke happens when blood flow to an area of the brain is cut off. Brain cells are deprived of oxygen and begin to die. There are different outcomes from a stroke, and they are always bad. A stroke can cause the victim to permanently lose speech, movement, memory or even lead to death. In fact, there are approximately 185,000 people who die from stroke here in the U.S. every year. Stroke is the fifth leading cause of death in America and a leading cause of adult disability.

Different Types of Strokes

There are two types of stroke, hemorrhagic and ischemic. Hemorrhagic strokes are less common, in fact only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. The hemorrhagic stroke is less common but deadlier where the ischemic stroke is more common and less deadly. But any type of stroke is to be avoided if possible.

Ischemic strokes occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow, known as ischemia. Specific symptoms of an ischemic stroke depend on what region of the brain is affected. Certain symptoms are common across most ischemic stroke, including: vision problems, such as blindness in one eye or double vision, weakness or paralysis in the limbs, which may be on one or both sides, depending on the affected artery. Victims can also experience dizziness and vertigo, confusion, loss of coordination or even a drooping of face on one side.

Obesity and Strokes

New research shows that being overweight more than doubles the chances of having a stroke. In addition to increasing the risk of stroke, being overweight makes it more likely that you will have a stroke at a younger age. Medical scientists have found that being overweight leads to hypertension (high blood pressure), and diabetes both of which are the leading causes of stroke. Another effect of being overweight is that the body’s metabolism changes in ways that lead to an excess of circulating lipids, high cholesterol and elevated blood glucose, all of which, over time, harm the blood vessels of the brain and the heart and lead to the formation of stroke-causing blood clots in the heart and brain. There are some other links between obesity and stroke that are independent of hypertension, diabetes, and a high cholesterol level that are commonly associated with being overweight. So, to reduce your risk of stroke, try to lose weight.

To Learn More

The Houston Healthcare Initiative is set up to help people pay less for health care and become healthier. The more the costs of health maintenance arise, the more often the issue of weight comes up. There is help available in the form of co-operative relationships and the tools to lose weight and avoid a stroke. Those who want to know more can visit the web site at www.houstonhealthcareinitiative.orgor call with question at 346 400 2789.

Opioids and Pain Killers Can Make Back Conditions Worse

February 25, 2019 – Dr. Steven Goldstein told listeners to his weekly podcast that not only were opioid pain killers not the best option for treating back pain but that they could make the situation worse. Dr. Goldstein is a well-known neurologist and the founder of the Houston Healthcare Initiative Podcast. The podcast can be heard on iTunes, Soundcloud and at www.houstonhealthcareinitiative.org.

Why is Back Pain Such a Common Condition?

According to Dr. Goldstein there are numerous reasons. “The disk material that is in between each vertebral body deteriorates as we age,” he told listeners. “It is the shock absorber that protects the spine when weight is carried. The back and spine can be displaced from a sudden heavy lift or from an injury such as an auto accident and is commonly known as a slipped disk but is more likely when disks are degenerated. Other common causes of back pain include sprain of paraspinous muscles or sprain of ligaments that hold the spine in place.

Sprains can also occur in the small joints of the spine known as facet joints or in the ‘Sacroiliac joints’ where the tail bone connects to the pelvis.  Arthritic changes in the spine can flare and cause pain, seemingly without any injury. In the majority of cases the back pain will resolve with a short period of rest followed by gentle aquatic exercise to strengthen muscle and tighten ligaments. Contrary to popular opinion the pain from a slipped disk will respond to this treatment in most cases unless there is continued pressure on a nerve root exiting the spine. Studies show 90% will resolve in 12 weeks.

Chronic Back Pain

Chronic back pain is defined as pain that persists for 12 weeks or longer. “In my practice, the most common cause is the use of opioids in the early acute phase of the illness,” Dr. Goldstein said. “What happens is that the narcotic is effective in relieving the back pain. The patient unwittingly gets up and goes about normal activity. If there is inflammation from a slipped disk or sprained muscles or ligaments the extra activity will make the condition worse.”

Instead of opioids, Dr. Goldstein recommends patients use the pain as their ‘friend’. “If a given activity is causing pain, stop doing it and lie down. If the pain is so severe that a strong narcotic is necessary, lie down and rest for 3-4 hours until the medicine wears off before trying to do any activity.”

The Houston Healthcare Initiative is a medical co-op that is a non-profit company, owned by the members to provide ‘insurance’ at greatly reduced costs. To learn more visit, www.houstonhealthcareinitiative.com.

 

 

HHI Podcast Page

The Houston Healthcare Initiative Co-Op Podcast Page!

What Is Prior Authorization & What To Do About It

Prior approval is a way that insurance companies decide on how or whether a prescribed medical service, medication, test or procedure meets their coverage criteria. What can people do? Listen to find out.

 

What If I Do Not Have Health Insurance?

What happens if someone does not have health insurance? The ramifications will affect the tax filings of people this year but be different next year. Beyond the financial implications, there are others for patients and their loved ones. Here to help us learn what to do and why is Houston based neurologist and the founder of the Houston Health Initiative Dr. Steven Goldstein. You can learn more about The Houston Healthcare Initiative Co-Op at their web site, www.houstonhealthcareinitiative.org.

 

An overview of the Houston Healthcare Initiative Co-Op. 

Complexities of Health Coverage

Healthcare and what causes rates for services and insurance to go up at a startling rate are complicated. What is not that complex is the need for an affordable way to pay for most medical and doctor related expenses. That is what the Houston Healthcare Initiative (HHI) is offering in the form of a member owned co-op. The HHI initiative can replace traditional health insurance for qualified individuals and families. HHI will provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. The medical co-op promises to save qualifying individuals and families money on health insurance. At the same time, HHI will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health.

 

 

Changing Insurance Providers & Managing Change

Medical and health coverage is often a complex proposition for people whether they are thinking of changing providers or getting one for the first time. HHI has a free brochure and lots of other free information about the coverage available from the web site at: houstonhealthcareinitiative.org. Or call them at 346-400-2789 and talk with them in real time.

 

Unintended Consequences of Not Purchasing Insurance

Remember President Obama’s promise to lower health care rates? Experts now say health insurance will be crazy expensive again in 2019. The Heritage Foundation’s Doug Badger says Obamacare was supposed to get lots of young subscribers to sign up and help subsidize the older among us, but that didn’t happen. Young people found that in many cases paying the penalty was still less expensive than insurance. Consider too that millennials tend to marry and start families later in life than those who came before them, so the perceived need for insurance is not as obvious to them as it is for people who have more responsibility. Here to help us make sense of it all is Dr. Steven Goldstein, a much-respected neurologist and founder of the Houston Healthcare Initiative.

Fines for not purchasing insurance under ‘Obamacare’ were supposed to cause more people buy insurance and lower the cost, but neither happened. Dr. Steven Goldstein, respected Houston neurologist and founder of the Houston Healthcare Initiative (www.houstonhealthcareinitiative.org) discussed the ramifications of the cancellation of financial penalties associated with ‘Obamacare’ among other things, on his weekly podcast. To hear the podcast go to https://houstonhealthcareinitiative.org/the-houston-healthcare-initiative-podcast/.

As the Trump administration has cancelled the fines assessed for not purchasing health insurance that were mandated by President Obama, the impact of the removal of these government-imposed purchases did nothing to lower the price of insurance or make the American public healthier. The positive effect of Obamacare on the price of insurance was what was promised, though little happened to make charges for insurance more affordable.

 

Time To Renew Your Health Insurance

It is the time of year for all of us to renew our existing health insurance or pick a provider. Open enrollment for the individual health insurance market starts November 1 and lasts through December 15, 2018. The sign-up time and role of the government in our health care begs the question; is access to healthcare a right or is it a privilege or something else? Should we also have the right to not purchase insurance? To help us sort through this we need someone well versed in medicine and health coverage and we find both in the founder of the Houston Healthcare Initiative (HHI) Dr. Steven Goldstein.

 

Managing Prescription Medicine Costs

Prescription medicine is expensive, and in some cases unaffordable. The reasons for the high costs of some medicine are talked about by patients, physicians and politicians. But the reasons for high costs matter less than the reality that there are people who could get their medicine for a lot less money if they knew just a few things about how drugs are sourced and priced.  Here today to help us crack this code and hack drug prices is respected Houston based neurologist and founder of the Houston Healthcare Initiative Co-Op Dr. Steven Goldstein.

Most people have read or heard about how high the price of prescription medicine is here in the U.S. and how relatively inexpensive it is in other countries, especially Canada. What do the Canadians know? According to Dr. Goldstein, prices for drugs in Canada are set by a special review board that compares prices of medicine in Europeto then decide what to charge.  “Here in the U.S. Medicaid does not negotiate prices with the pharmaceutical companies and consequently the prices are higher,” Dr. Goldstein told his listeners.

 

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