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.

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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Press Background Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op. Led by Houston based neurologist Dr. Steven Goldstein, the HHI will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits. 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.

How Did HHI Come About?

While the promise of the Affordable Care Act was to lower the cost of health insurance, most Americans experience the opposite with much higher rates. The founder of HHI, Dr. Steven Goldstein, wanted to find a way to help patients and others find affordable health insurance and landed on the idea of the medical cooperative. The ‘medical cooperative’ or co-op as it is commonly known is possible because plans like HHI are exempt from the Obamacare tax penalties assessed to those who do not have health insurance.

What Are Health Care Co-Ops?

Consumer based cooperative purchasing arrangements are not new. The basis of the success of co-ops is they use the ability to buy large amounts on good terms. Health care cooperatives are much like other co-ops. For example, consumer cooperatives are owned by the people who buy the goods or use the services of the cooperative. But instead of electricity or milk, the medical co-op employs physicians, has access to negotiated hospital rates and prices and often own health care facilities.

How HHI Members Benefit

For a co-op to work as well as it might means that the cooperative health plan can obtain the lowest price charged to the most favored customer. For HHI, members benefit from Dr. Goldstein’s expertise and knowledge of how the hospital and pharmaceutical industries assess prices. At the same time, HHI members benefit from discounted rates with local health care providers. In the greater Houston area, health care providers, hospitals and others are able to push back their rates because HHI is in effect buying ‘in bulk’. It sounds odd and most people think of ‘Sams’ or ‘Costco’ when they think of bulk purchase, but there are discounts for large purchases of just about anything including healthcare.

The Health Care Commodity

Health care is not often thought of as a commodity, but in essence it is. It is definitely a business, but the normal laws of supply and demand do not always apply as the government regulations and insurance companies intercede and disqualify many free market concepts. It is only recently that health care has been thought of as a ‘right’ to which Americans are entitled. The public discussion and policies the government has implemented have not yielded better or more affordable medicine. Doctors are leaving their practices as large medical companies buy them out or because of the regulations imposed on them.  Dr. Goldstein has found a way to take the existing laws and build an acceptable alternative to traditional health insurance in the form of a non-profit organization owned by the members.

Details about qualifying for membership in HHI along with prices for coverage are available from the HHI web site at https://houstonhealthcareinitiative.org.

Houston Healthcare Initiative Offers Affordable Health Care Via “Cooperative” Payments

Houston (September 4, 2018) – The cost of health care 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. Led by Houston based neurologist Dr. Steven Goldstein, 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.

What HHI Offers

The HHI is similar to traditional insurance but with some unique distinctions. One is the health of the person(s) applying impacts the price charged by the co-op. The amount of the monthly payment is based on personal lifestyle outcomes. For example, a non-smoker who has a body mass index of less than 25 and can walk a mile in less than 30 minutes gets the best rate because he/she is the healthiest.

People who do not match these criteria pay more but have the opportunity to get the lowest rates if their weight and fitness levels improve. “We wanted to have a system that rewarded people who are healthier with lower rates while at the same time, provide incentives for them to improve,” said Dr. Steven Goldstein, founder of HHI. “With the exception of charging more for smokers, traditional insurance generally does not distinguish between healthier people nor does it give them a financial incentive to lose weight or become more physically fit. HHI does both.”

HHI Issued Debit Card

Members of the co-op receive a personal/family healthcare account that allows payment for routine medical procedures with a member debit card, issued by the HHI bank. The other is a trust that is maintained to allow members to pay for non-routine charges like hospital stays, specialists, surgery, and extensive tests to name a few. In addition to the cost savings, members receive a free screening (check-up) and access to the 24-hour free doctors’ hotline for routine questions. “Not every question for a doctor requires an office visit, which is why the hotline is so handy,” Dr. Goldstein said. “We believe that this approach to paying for health care will be a big help to people who are unable to afford it or do not receive employer subsidized health insurance.”

Summary of Benefits Defining Types of Health Care/Health Challenges

  1. Preventative – covered by the free yearly HHI check-up and doctor hot line.
  2. Behavior modification – leads to lower priced coverage under HHI.
  3. Injury treatment – covered by HHI.
  4. Acute illnesses – covered by HHI.
  5. Degenerative and/or genetic illness – covered by HHI.
  6. End stage care – covered by HHI.

 About HHI

The Houston Healthcare Initiative (HHI) is a non-profit, member owned medical cooperative that combines affordable health pricing with personal accountability and lifestyle incentives. With a single payment, members pay monthly into two separate accounts. To learn more visit the company website https://houstonhealthcareinitiative.org.