health insurance

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

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A Houston based neurologist, Dr. Steven Goldstein, explains the reasons patients can get very expensive hospital bills even if they went to a hospital, clinic or emergency room that is part of their insurance network on his latest podcast. The Houston Healthcare Initiative podcast can be heard on Soundcloud, iTunes, Libsyn, or on www.houstonhealthcareinitiative.org

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

No Insurance Network Required for Doctors

While the insurance industry has trained patients, doctors, and hospitals that we all must have insurance and be part of an insurance network the same is not the case for doctors. While in-network doctors and hospitals have agreed with the insurance company how much procedures and tests will cost, not all doctors who work in hospitals are part of any insurance network and can charge more than what insurance will cover. To make this worse for patients and the ultimate cause of ‘surprise hospital bills’ hospitals, emergency rooms or clinics are not required to disclose this to patients or their loved ones. As Dr. Goldstein told his listeners, “behind the scenes, the in-network doctor and the hospital agreed in advance what the charges were going to be. So, the in-network doctor is paid a flat rate based on that agreement. The doctor who works at the hospital but is not part of the insurance network can charge more and get paid more. He is under no obligation to say anything about this to the patient and will not.”

How Can This Be? Private Equity Companies

Private equity companies that own staffing firms and place doctors to work in hospitals along with the American Hospital Association have stated publicly that restricting the independent pricing capability will make putting doctors in geographic or socially challenging locations much more difficult, as higher pay is the biggest incentive for going to work in rural or economically disadvantaged areas. These doctors have no incentive to join an insurer network, which would require them to cut their fees. These are the source of many surprise medical bills.

Doctor Patient Unity Unmasked

A shadowy lobbying group known as Doctors and Patients United are owned and funded by TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country. In late July, 2019 Doctor Patient Unity placed more than $28 million in ads opposing the legislation that would ban surprise medical bill, without disclosing who was behind the ads.

Current Information on Federal Legislation

There are several committees and bills on this being considered. At this writing the following bill was being considered: S 1895: Lower Health Care Costs Act. The bill was introduced by Senator Lamar Alexander (R, Tennessee) on June 19, 2019 and reported June 26, 2019. The committees assigned to this bill sent it to the House or Senate as a whole for consideration on June 26, 2019. For resources and the information to act on this bill please go to: https://www.govtrack.us/congress/bills/116/s1895.

Well-known and respected Houston based Neurologist Dr. Steven Goldstein is dedicated to reforming healthcare in the U.S. through education and information to the people who need it most. To learn more about the Houston Healthcare Initiative please go to www.houstonhealthcareinitiative.org.

Unexpected Emergency Room Bills Add To Patient Ills

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Patients may go to the hospital designated as in network by their insurance, but the doctors who treat them may not be part of that network. This is one of the main reasons for big bills even among those who have health insurance. Patients rarely have any say about who treats them, especially in the case of accidents where they are incapacitated. This is the message that Dr. Steven Goldstein has for podcast listeners this week. The Houston Healthcare Initiative CO-OP podcast can be heard on Soundcloud, Google Play, and iTunes. The podcast and much more information is available from the Houston Healthcare Initiative CO-OP website: www.houstonhealthcareinitiative.org. Or click here to listen:

Unexpected Emergency Room Bills Add To Patient Ills

Wide Awake Nightmare

Imagine leaving the hospital after recovering from an accident, illness or some other unexpected and unwelcome ailment thinking that the worst is over, but then getting a walloping big bill to pay even with really good health insurance. It’s a scenario that plays out ever day and one that respected Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP thinks the public has a right to know.

The out-of-network billing problem exists in part because insurers have sought to rein in costs by shrinking their provider networks and steering patients to less expensive doctors and hospitals. But some specialists and provider groups have deliberately stayed out-of-networks because they can make more money.“This is especially true in emergency rooms, where the patients’ inability to choose their doctors provides a strong incentive for physicians not to cut deals with insurers,” Dr. Goldstein said.  “For example, a 2017 study on surprise bills by Yale University researchers reported that one group of emergency room physicians that exited networks to bill as out-of-network providers charged twice as much for care as their ERs used to charge. It’s ridiculously unfair.”

Facts About Bad Surprises

Unwelcome E.R. and hospital bill surprises are not unusual and that is the disappointing part. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. “Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation,” Dr. Goldstein told his audience. “But the news gets worse because the same study found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill.”

Why We All Tolerate This

When asked about the reasons the public chooses to tolerate this, Dr. Goldstein replied, “the medical and insurance industries have trained us all to think that there is but one choice for us and that is to work with them, exclusively, and that there are no alternatives available for anyone not old enough to get Medicare.” There are alternatives, like the one we have at the Houston Healthcare Initiative CO-OP, but so few are aware of this and other similar organizations that we all simply take and pay for what is available.”

To learn more about the Houston Healthcare Initiative CO-OP please visit the web site atwww.houstonhealthcareinitiative.org

Special Offer From The Houston Healthcare Initiative

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The Houston Healthcare Initiative began for one reason and that was to improve health, lower healthcare costs and provide access to doctors, medicine and treatment. There is a myth promulgated by the insurance companies that you can’t get access to healthcare if you do not have insurance. This is just not true. Starting Monday June 1, 2020, The Houston Healthcare Initiative is offering a FREE Seizure Clinic.

Special Offer From The Houston Healthcare Initiative

For seizure patients out of work because of the pandemic, we will see in office for no fee as well as provide 30 days of seizure medication for free as long as supplies last. Patients may pay office visit fees after they get back on their feet. During the COVID-19 pandemic, new patients can be seen using telemedicine for $75 & followups for $35. Insured patients will have copays waived.

 

How Insurance Companies Medical Providers and Drug Companies Game the System

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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.

HHI Podcast Page

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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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