Urgent Letter to Members of Congress to Implore Them To Reject RINOCARE/Obamacare 2.0.

I will be sending this to Members of Congress tomorrow. Please call or write members of Congress ASAP.

March 21, 2017

 

Dear Congressman/Congresswoman,

 

You were elected on a promise to repeal and replace Obamacare. If you vote “yes” on the GOP healthcare bill Thursday, you will fail to uphold your promise. I have read the bill word for word. Have you read it? I have also read the ACA, MACRA, the MACRA rules, and much more healthcare law ad nauseum word for word. Have you? The AHCA makes horrible things worse. I pray you will stand up for what is right and for what you promised, instead of acquiescing to pressure from those who represent selfish interests against the will of the American people. The bill is clearly written to appease, if not reward, big healthcare insurance executives, big hospital interests, and the Left. Why?

The healthcare debacle is extraordinarily complex; I doubt most politicians even understand a fraction of it. I implore you to pause and seek counsel from physicians and patients like me who live and work in the trenches under the shackles of bad healthcare law. I am sick and tired of hearing about sausage making and half a loaf. I long for strong leaders, statesmen who will do what it takes to achieve the exceptional, the ultimate goal, and honor their word- not settle for 2 steps back, enabling the perpetual tantrum of adolescents who throw stones from safe spaces seeking to destroy what our Founders created, as they wallow in relative truth, suckling on the government teat of dependency.

 

In addition to all the talking points fed to you, here are 3 things I gleaned from reading this bill and prior law for myself that make terrible law worse, that no one is discussing- that you will be responsible for if you vote “yes” instead of innovating, thinking outside the box, and crafting transformative, healing legislation that achieves repeal, as you promised.

 

  1. SEC. 113 Eliminates DSH cuts: The hospital and insurance interests must love this. It will bankrupt us and make healthcare costs explode, as history proved when unlimited DSH payments and financing flexibility increased DSH spending from $1.3 Billion in 1990 to $17.7 Billion in 1992. Thus, DSH cuts were implemented. Eliminating DSH cuts now will accordingly result in a 10-fold increase in government spending if we look at recent history. DSH stands for Disproportionate Share Hospital. Hospitals receive money from the federal government for providing “uncompensated care“ to Medicaid and other underprivileged patients. Such allocation of federal money applies to the cost of inpatient and outpatient care. It financially behooves hospitals and healthcare entities to artificially inflate their bills and then accept a lesser sum of money from an insurance issuer or patient to make the claim that they are providing uncompensated care and justify receiving ever-increasing sums of federal (taxpayer money). This results in the institutionalization of such bogus practices as the Chargemaster bill and lack of transparency. What we need is transparent pricing across the board and a law that fosters price transparency not massive price inflation.

 

  1. SEC. 2203 and 2204 will similarly result in artificially manufactured overbilling, lack of transparency, and increased transfer of taxpayer money to hospitals and insurance companies. Between 2018 and 2026 the federal government will appropriate $100 Billion dollars to the States and require them to pay issuers all claims that exceed $50,000 but do not exceed $350,000. It doesn’t take a genius to foresee the explosion of “bills” that will be miraculously amount to $50,000.01 and require payment from the State using federal (taxpayer) money under the pretense of “market stabilization.” In reality, no one ever pays the “bill.” “Allowables” are negotiated by insurance companies and accepted. This elimination of DSH cuts mentioned above will result in massive skyrocketing of bills, which is incentivized by the repeal of DSH cuts and forced payment of high claims to issuers by States using federal money. The hospitals and insurance companies will gluttonously consume increasing federal funds until they are all gone- and then what. Patients will be left high and dry- broke without care. Again, we need policy that fosters cost transparency and lowest cost to patient, not what this law does. This law rewards what could be construed as collusion and money laundering.

 

  1. Subtitle ___ Remuneration From Certain Insurers- This seems to me to be a bone thrown to insurance executives. (AKA a massive, flagrant personal multimillion-dollar payoff). It terminates the limitation on deduction of remuneration for taxable year exceeding $1 Million for the top 5 earners of publicly held health care insurance corporations, like the CEO, etc. Translation, under this bill, they CAN deduct huge remuneration packages. What do you think? Read it-it takes awhile pulling all the references –section 162(m) of the Internal revenue Code of 1986.

 

 

There is so much more that is bad, but while I have devoted the time to read this, most will not take the time to even read what I’ve written here. This is your job. You ran for it and were elected to do it faithfully. I just want to take care of my patients and have my doctors take care of me without such sinister, wasteful government and special interest intrusion.

 

Please, stop the insanity. Take a deep breath. Do the right thing, and do what you promised. Save the American patient and the United States of America. We can and must do better.

 

Sincerely,

Kristin S. Held, M.D.

San Antonio, Texas

 

Letter to HHS Secretary Price and “Healthcare Insurance” Company CEO Regarding Inept,Dubious Business Practices that Can Be Construed as Violation of False Claims Act, Breach of Contract, and Flagrant Theft of Patients’ and Government Payments to Their Company.

I have yet to receive a response to this letter, and the patient still has not been reimbursed by his insurance issuer (7 months after the surgery); therefore, I am presently redacting the company name. It is one of the big remaining few companies, to whom I have written before. Patients and physicians are acting in good faith. Insurance companies cuddling in bed with big government are preying on our calling and goodwill, as they laugh all the way to the bank operating per a business model that combines the ineptness of the Three Stooges and moral code of a sponge.

March 1, 2017

Dear Secretary Price and Mr. _________,

With continued dismay, I seek your attention to resolve a serious matter where government healthcare law and commercial insurance company practice collide once again to harm my patient. Ironically, we have come to the point where the patient, for whom healthcare laws and insurance companies were created, is now the last one helped and first one hurt, as if an annoying afterthought in a convoluted web of third party misplaced priority and moral inversion.

My patient is a 71 year old gentleman who suffered from decreased vision due to cataracts in both eyes. He has had 5 cardiac stents placed and is on blood thinners. I successfully performed laser cataract surgery with placement of a toric intraocular lens in each of his eyes (08/18/2016 and 08/25/2016), and thankfully he now sees 20/20 in each eye without glasses. His suffering has been alleviated, his quality of life improved, and his ability to perform his activities of daily living with continued independence markedly enhanced. Sadly, your health insurance company refuses to cover the cost of my surgical fee in what could potentially be construed as a pattern of misrepresentation and errant billing.

The patient pays for coverage under the _____ Teacher Retirement System of Texas. I am an out of network provider for TRS, and my status with Medicare is classified as “private contracted” or “opted out.” In other words, my agreement is directly with my patient, and I have no agreement with _____. In fact, neither the patient nor I can submit a claim directly to Medicare or a supplement plan. ____, on the other hand, as a commercial replacement plan, has an agreement with my patient who pays monthly premiums for promised coverage. _____ TRS serves as a Medicare replacement plan and has an agreement with CMS for which it accepts federal funds to pay for services for Medicare patients. While I have honored my agreement with my patient, _____ has not upheld its agreement with its client or the federal government; in other words, _____ is breaching its contract with its client and the federal government. _____’s stated negotiated amount of coverage for the surgeon fee for cataract surgery is $618.81. _____ refuses to reimburse their client (my patient) for this amount for each eye. Initially, _____, made a mistake and processed the claim as if I was an “in network” surgeon. Subsequently, (after the patient has already had the operation and come out of pocket) _____ is refusing to reimburse the patient. _____’s own Benefit Detail states 100% coverage for “in network” and “out of network” specialists. The patient opted for _____ as a replacement plan in lieu of traditional Medicare but is now denied reimbursement for services received from an “out of network” provider. One must ask: What has the patient been paying his monthly premiums for, and what has _____ been doing with the money it receives from the federal government?

Neither commercial insurers nor Medicare covers laser use during cataract surgery or toric intraocular lenses. Intraoperative use of such advanced technology is an instance where balance billing is the correct, legal standard of practice and billing. Had my patient gone to a “participating” Medicare surgeon, the overall fees would have been dramatically higher. As a third party free surgeon, my fees are transparent and significantly lower, saving the patient and the healthcare system at large a substantial amount of money. The patient should be commended for using such a practice- not denied coverage. _____ must reimburse the patient the negotiated $618.81 per its negotiated rate for each eye for a total of $1237.62 plus the cost of the initial examination and preoperative consultation and measurements ($135.00, $103.42, $79.54 totaling $317.96) for an overall reimbursement due of $1555.58.

The time and resources required by the physician and her staff to help the patient fight for his due from _____ is enormous and usurious. _____ willingly takes money from the patient and federal government but then fails to fulfill its agreements to pay negotiated rates to those whose services they advertise to sell. Such patterns of errant billing and denial of payment suggest either an overall ineptness (further encumbering a flailing healthcare system with 3rd party waste of resources) or a dubious underlying business plan that seeks to profit from an intentionally convoluted, prolonged, and cumbersome process of prior authorization and denial of claims. This could be perceived as a violation of the false claims act, breach of contract, as well as flagrant theft.

I look forward to resolving this issue expediently. The patient must come first. I look forward to positive solutions and clarification under Secretary Price. I await your timely response and reimbursement of your client.

Sincerely,

Kristin S. Held, M.D.