R. Scott Wiedeback’s Post

This post highlights a critical issue faced by many in the US - the escalating cost of medical care, especially impacting the middle and lower income groups. With each new administration, concerns from citizens arise, shedding light on the pressing need to address the burden of healthcare expenses. The ongoing scrutiny of these costs underscores the challenges faced by individuals and families striving to maintain their well-being amidst financial strains. #healthcarecoststoomuch #smallbusiness #healthinsurance #brokers

One of the most common misconceptions regarding self-funding is that it is uncommon with midsized groups. That is quickly changing. A recent study said that “80% of U.S. counties have a majority of enrollees in self-funded plans.” And yet, I still hear it all the time—self-funding is considered too risky for midsized employers. Well, not if you have ParetoHealth by your side. Our two-part mission aims to reduce the risk that comes with self-insurance and help lower your clients’ cost of healthcare over time. More and more groups are seeing the benefits, control, and freedom of self-funding, especially with our captive. It’s time to help your clients step into the future. #ParetoHealth #ProudlyContrarian #FutureofHealthcare Read more about the study here: https://lnkd.in/eVY_tqR8

Check out this insightful article on the challenges many Americans face with medical bills: Nearly half of insured Americans encountered unexpected medical charges. If you or your employees are dealing with similar issues, PK can help. Contact me to find out more about how we can assist you! #Healthcare #MedicalBills #InsuranceAssistance

Investigation reveals insurers exploit out-of-network claims, burdening patients with hefty bills. Calls for systemic reform gain momentum. #HealthcareReform #PatientAdvocacy #Healthcare #DistilINFO. https://lnkd.in/diGyaHFW

Don’t want to say I told you so….but. Feds help health insurers hide dirty secret: rising denials of physician recommended care. But the major reason for denials of Doctors suggestions — “other,” accounting for 76% of them — is a big black hole. Anybody’s guess. #valuebasedcare #tripleaim #healthcarecosts #medicareadvantage https://lnkd.in/ex64fmkU

Sharing insights from a compelling Commonwealth Fund article on the profound impact of claim denials on patients. This piece highlights key findings that shed light on the challenges patients face and underscores the importance of addressing these issues in healthcare policy and practice. - Fewer than half of adults challenged their unexpected bills by contacting their provider or insurer. - Over half of those who did not challenge their bills were not sure they had the right to do so. - Almost three of five adults who experienced a coverage denial said their care was delayed as a result. #HealthcarePolicy #PatientCare #HealthcareQuality#

Insurers dictating care https://lnkd.in/eHCJiPmw #InsuranceIndustry #PatientCare #HealthInsurance #InsuranceReform #PatientAdvocacy #InsuranceChallenges #HealthcareAccess #HealthEquity

Does United Health actually approve and pay for 90% of its claims? And, does United Health include prior authorization denials as a claim? And, if so, how can a PA denied service, a service that did not take place, be counted as a claim? Some UH shareholders want to know. #corporategovernance

"Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The same report found that 41% of appealed claims got overturned, though less than 1% of consumers went through the process." I didn't use AI during the many years I worked with hospitals and health systems on denial management, I just picked up the phone and successfully got 70% overturned via peer to peer conferences. Most of the time, the health plan medical directors were not provided necessary clinical documentation when they made their original decision. Simply reviewing the clinical documentation reveals important facts that lead to overturns. Having also been on the health plan side I can tell you I have overturned many of my denials when the attending physician provided additional information during peer to peer calls. Failure to provide clinical documentation causes many unnecessary denials.

On the heels of the tragic murder of a health care executive, details emerging about the accused suggest he was radicalized and perhaps anarchical in his mind. Health care delivery and health care financing is vital to Americans financial security, but given fragmentation and regulatory silos, efforts to ensure benefits are paid compliantly and contractually often collide with providers providing services or people who seek treatment. Health plans are still largely financing a system based on fees for services at increasing volumes and unit prices. For 2026 CMS is envisioning support for more ACO type and fee-for-value systems, which aim to use scarce resources (taxpayer money, consumers' premiums and out of pocket costs) less wastefully. As articles like (https://lnkd.in/dW6X6nqN) enflaming the polarizing dilemma of health care continue, let's not let that distract efforts to improve our American system. The Price We Pay (https://lnkd.in/dgs8qkfA), written by the appointee to lead the FDA is worth picking up. Dr. Makary offers pivotal insights into areas where we can lean in to make healthcare more affordable and effective for people trying to make ends meet. Busy hands make light work. Besides putting our hands together in prayer for Mr. Thompson's family, let's join together to make American healthcare less painful for the people who use and pay for care.