How Insurance Companies Medical Providers and Drug Companies Game the System

How Insurance Companies Medical Providers and Drug Companies Game the System

March 5, 2019 – For those feeling beat up, picked on, and maybe even a bit bullied by their doctor, hospital and health insurance company there is probably good reason to believe that way. Doctors and hospitals are charging more for services and insurance companies are denying more claims.  Patients need both their health care providers and insurers, but as respected neurologist and Houston Healthcare Initiative Co-Op (www.houstonhealthcareinitiative.org) founder Dr. Steven Goldstein tells his podcast audience, this is not a normal ‘business-customer’ relationship.  The Houston Healthcare Initiative Co-Op podcast can be heard on Soundcloud, iTunesand the web site at www.houstonhealthcareinitiative.org.

Human Shields

The Houston Chroniclereported that ‘doctors and insurance companies have proven they are willing to use patients as ‘human shields’ but what were they really saying? According to Dr. Goldstein, “the conflict is about money.” Dr. Goldstein told his audience that the insurance companies wanted premiums to be as high as possible. But the blame does not stop with the insurance company. “Doctors and hospitals want to charge whatever the traffic will bear,” he said. “A system has evolved that benefits insurance companies, doctors and hospitals but is to the detriment to the patient.”

How Doctors and Insurance Companies Do It

Here is how patients get screwed: Very high list prices for various services have been set up by hospitals and doctors. Insurance companies negotiate contracted prices for these services that are significantly less than the list price and they claim these negotiated rates have benefited the patients, “Anyone selling something can claim a high price, but then list the item as ‘on sale’ for a price that is much less and make it seem like a big savings but it is a big fake out,” he said. “That is what the insurance companies are doing to you.”

Human Piñatas

When hospitals are forced to compete in the marketplace, the market determined cash price for just about anything they offer is usually much less than the insurance company negotiated price. “Less than a shield, patients are used more like piñatas who take a beating from both the hospital and the insurance company,” Dr. Goldstein said. But according to Dr. Goldstein, there are more sensible things people can do to protect themselves and save money.

The Insurance Alternative

Alternatives to traditional health insurance are available from medical co-operatives, or co-ops. The Houston Healthcare Initiativeis a member owned, non-profit medical co-op. It will replace traditional health insurance for qualified individuals, families and provides incentives for members to adopt healthier lifestyle habits. The medical co-op promises to provide more value for the healthcare dollar. “At the same time, we will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health,” Dr. Goldstein said.  “It removes the insurance company from the relationship between doctor and patient, thus getting rid of all that expense from administering insurance,” he said.

In the medical co-op model, people pay directly for their care at the cash rate. Large hospital expenses are reimbursed by the co-op trust. “Thus, in one fell swoop, a big piece of what is wrong with the healthcare industry is removed from the equation,” Dr. Goldstein concluded.

About Houston Healthcare Initiative Co-Op

The Houston Healthcare Initiative Co-Op is a member owned, non-profit cooperative owned by the members. To learn more visit them on line at www.houstonhealthcareinitiative.org.

How Strokes Happen When You Are the Same Age As Luke Perry

March 13, 2019 (Houston, TX) — Actor Luke Perry passed away last week following what his publicist described as a ‘massive’ stroke. Perry was 52 years old. His death leaves people at or close to his age wondering if this could happen to them. That is the topic this week on the Houston Healthcare Initiative Podcast with respected Houston based neurologist Dr. Steven Goldstein. The podcast can be heard on iTunes,Soundcloudand www.houstonhealthcareinitiative.org.

Facts About Strokes

Stroke is the second leading cause of death worldwide and high blood pressure is the leading cause of strokes. Smoking, diabetes, high blood pressure, high blood cholesterol, obesity and other cardiovascular diseases put people at greater risk for stroke. “It’s true that most strokes happen in people who are much older than Mr. Perry was,” Dr. Goldstein told his audience. “Strokes in younger people like this are pretty rare. To answer how rare, only about 15 out of 100,000 under the age of 50 have a stroke and of these about 5% will die from it.”

Leading Cause of Strokes In Younger People

The most common cause of strokes in younger people today is drug abuse, particularly cocaine and amphetamines. Other drugs such as marijuana, heroin and “kush” are also associated with an increased incidence. Blood clots from the heart are also common. Holes in the heart and Mitral Prolapse are relatively common causes of strokes as well. Young women are also at increased risk from birth control pills. Arterial dissection happens when the layers of the artery wall separate.  “A blood clot will often form between the layers of the artery wall and blocks blood flow,” Dr. Goldstein reported. “If this occurs in a major blood vessel to the brain, it blocks blood flow and leads to a stroke.”

Holes in the Heart

A hole in the heart or ‘patent foramen ovale’ as they are known, is just what it says it is. “When a newborn baby takes his/her first breath a passageway between the left side and right side of the heart is supposed to close,” Dr. Goldstein said. “In about 25 percent of people, it remains open. In some of these people, the hole can raise the odds of stroke because small blood clots in the right heart that normally get cleared by the lungs, cross into the left heart and are swept to the brain.”

Blood Disorders

There are genetic conditions that make blood likely to form clots. Sickle Cell Anemia is one such disorder. Infections and other inflammatory diseases of arteries can also cause blood clots.

Aneurysms

A brain aneurysm is an entirely different type of stroke. Rather than a blood clot blocking a blood vessel, this type of stroke is caused by a hemorrhage into the brain tissue and affects brain function by compressing the surrounding tissue. “The biggest risk factor for this type of stroke is high blood pressure,” Dr. Goldstein said. “This can cause a small artery to burst even without anything wrong with the blood vessels. If there is a balloon-like bulge in a blood vessel (called an aneurysm) bleeding is even more likely. An arteriovenous malformation is a congenital tangle of blood vessels containing arteries and veins that can also bleed.

Ways to Avoid Strokes

Dr. Goldstein had four suggestions anyone could follow to reduce the risk of stroke.

  1. Stop smoking.
  2. Check blood pressure and treat appropriately.
  3. Do Not use Street Drugs.
  4. A routine physical can pick up blood diseases, infections or inflammation. Genetic diseases can be uncovered by family history.

Symptoms of Stroke

Dr. Goldstein listed these as the symptoms of stroke.

  1. Numbness in the extremities or the face, especially if it is only on one side of the body. Trouble speaking, understanding speech or sudden confusion.
  2. Blurred vision or trouble seeing.
  3. Issues with balance and coordination.
  4. Severe headaches with no known cause.

“Any of these should get our attention whether in ourselves or someone else, Dr. Goldstein said.

“But unfortunately, many people never know they have an underlying problem until they suffer a brain hemorrhage.”

F.A.S.T.

The American Heart Association recommends using the acronym F.A.S.T. to remember how to catch the warning signs of a stroke:

Face is drooping.

Arms are weak.

Speech difficulty.

Time to call 911.

And to get a better grasp on your own health, please contact the Houston Healthcare Initiative at 346-400-2789 or visit the website at www.houstonhealthcareinitiative.org.