The ongoing negotiation standstill between UnitedHealthcare and a few health systems underscores the complexities of healthcare contracts, and emphasizes the need for timely negotiations and fair reimbursement rates.
Balancing provider compensation with affordability for patients and addressing rising administrative costs are some challenges that arise when negotiating contracts. Skilled negotiators are essential in navigating these challenges to ensure patient access and quality of care remain a priority.
Click the link in the comments to read the full article from Healthcare Brew.
#PayerContracting#HealthcareNegotiations#InsuranceKevin Isaacs
The increasing complexity of healthcare billing, insurance verification, and regulatory compliance is putting additional pressure on hospitals' financial management systems. The rise in administrative costs and claim denials indicates that hospitals are struggling to keep up with the evolving requirements from both government programs like Medicare and private insurers. This makes it critical for hospitals to adopt more sophisticated billing, coding, and denial management solutions to mitigate financial losses.
By streamlining these processes and improving claim accuracy, hospitals can address the root causes of these trends.
It’s always great news to find out when you are denied treatment because your doctor claims that United healthcare never pays up , just a great feeling lol
Effective January 1, 2025, the Florida DWC adopts updates to the Florida Workers' Compensation Health Care Provider Reimbursement Manual to include "convenience kits" as a "specialty service," and to adjust out-of-state provider reimbursement. Read more: https://bit.ly/3DASUhL#MyMatrixx#Statehousewatch
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Reform of a rigged system is pretty much impossible. But people need to have some sort of coverage to ensure they can get medical care when necessary. Employers experience this also. Most people recieve their insurance coverage with partial or complete coverage reimbursed by their employer.
Employers are key to restructuring this doom spiral of healthcare expense. And kicking health insurance providers out of the equation.
Healthcare. Affordable and accessible healthcare for everyone, everywhere.
Why are your premiums so high?
It’s not bad luck or rising expenses—it’s because insurance carriers and large health systems have rigged the game.
Instead of competing or innovating, they lobby Congress to change the laws in their favor.
This is regulatory capture, and it’s why healthcare feels more expensive and less accessible every year.
Consider it: physician-owned hospitals are blocked, preauthorizations are endless, and pricing is opaque.
None of this happens by accident—it’s all designed to eliminate competition and protect profits for a few influential players.
The solution?
Demand transparency.
Support independent medical practices and physician-owned hospitals that compete to lower expenses and improve care.
Healthcare reform isn’t about more laws but fixing the ones rigged from the start.
It’s time to break the cycle and bring competition back to healthcare.
#healthcare
Dutch Rojas is exactly right! The high cost of healthcare and health insurance is no accident. The costs are high by design. They game has been rigged against us.
The insurance carriers continue to post record profits quarter after quarter, while premiums and out-of-pocket amounts continue to grow making record numbers of Americans functionally uninsured.
That's right, we continue to to struggle to afford the premiums and cost of healthcare while they continue to reap rewards of higher profits.
So, do you continue playing a losing game? Or do you change the game, the rules, to benefit your company and your employees instead of the Big Health Insurance companies, healthcare systems, PBMs and Big Pharma?
Yes, it is possible, and an advisor who aligns your best interests with theirs can show you how. If your current plan isn't working for you, what can it hurt to have a conversation with someone who can show you how to change the game?
Healthcare. Affordable and accessible healthcare for everyone, everywhere.
Why are your premiums so high?
It’s not bad luck or rising expenses—it’s because insurance carriers and large health systems have rigged the game.
Instead of competing or innovating, they lobby Congress to change the laws in their favor.
This is regulatory capture, and it’s why healthcare feels more expensive and less accessible every year.
Consider it: physician-owned hospitals are blocked, preauthorizations are endless, and pricing is opaque.
None of this happens by accident—it’s all designed to eliminate competition and protect profits for a few influential players.
The solution?
Demand transparency.
Support independent medical practices and physician-owned hospitals that compete to lower expenses and improve care.
Healthcare reform isn’t about more laws but fixing the ones rigged from the start.
It’s time to break the cycle and bring competition back to healthcare.
#healthcare
🏥📊 In the healthcare industry, prior authorization is a critical cost-control mechanism that requires providers to secure approval from insurance companies before administering specific services.
This process aims to prevent overutilization and ensure that treatments are medically necessary. 📝💼
However, it can also lead to service delays and claim denials if not managed properly.
As healthcare professionals, how do we balance the need for cost control with timely patient care?
Share your insights and experiences.
#Medicare#Employeebenefits#Medicarecoverage#HRInnovation#HRChallenges#HR#DoctorsChoiceusa#Healthcare
📉 Navigating the Math of Healthcare Reimbursement 🟰 An Unfair Equation? 📊
In today’s healthcare landscape, the math often doesn’t add up in favor of providers. With insurance reimbursement rates declining, denials on the rise, documentation and authorization requirements skyrocketing, the equation becomes increasingly complex.
As we grapple with these challenges, it’s crucial to recognize how these factors compound to create an uphill battle against payer technology. Healthcare providers are caught in a relentless cycle where increasing paperwork and decreasing reimbursements create a disparity that is anything but fair.
The question we need to address is: How do we balance the scales to ensure a system that supports both quality care and fair compensation?
#Healthcare#Reimbursement#Documentation#HealthcareTechnology#HealthcareChallenges#FinancialManagement#Denials
★ Hospitals or clinics, along with healthcare practitioners such as doctors or nurses, comprise the group of covered entities that offer medical services, focusing on providing direct medical care to patients. Health plans are designed to provide coverage for various entities, including insurance companies like Medicaid, or for other means of accessing healthcare. In contrast, healthcare clearinghouses act as middlemen to convert non-standard health information into a standard format.
★ An external entity offering specialized assistance to a covered entity with access to PHI is a business associate. PHI handling on behalf of covered entities is often assisted by individuals or organizations known as business associates. Included in the definition of a business associate are billing organizations together with IT service suppliers along with businesses providing cloud-based data storage or transcription solutions
#hospitals#compliance#clinics
In 1995, 74% of employers offered Health Indemnity plans. When managed care came along, it favored major medical HMO and PPO plans.
The expectation was that managed plans would lower healthcare costs. Today, we can see that managed care has done the exact opposite.
Health care costs have instead skyrocketed! 🚀
Smart and educated shoppers are switching back to the indemnity plan, because they provide better benefits at half the cost.
👉 Learn more: https://revolt.health/wqq#healthinsurance#health#healthcare#medicalinsurance#jointherevolt#revolthealthcarealliance#revolthealthcare
***Why Cost-Effective Healthcare Matters: A Call for Action***
In today’s world, access to quality healthcare is not just a necessity—it’s a right. However, with rising medical costs, many patients find themselves choosing between their health and their finances. This is where cost-effective healthcare comes in, and it’s vital for every hospital, healthcare provider, and doctor to understand why it matters.
💡 Cost-effective healthcare isn’t about cutting corners. It’s about making smart, informed decisions that provide high-quality care at the best value for patients. By optimizing treatment plans, reducing unnecessary tests, and leveraging preventive care, we can ensure that patients receive the right care at the right time—without excessive costs.
⚕️ Why is this important?
Patients deserve affordable care without compromising on quality.
Cost-effective practices help reduce health disparities, making healthcare more equitable.
Hospitals and doctors benefit from better patient outcomes, which can reduce the burden on our healthcare systems.
Every healthcare provider should prioritize value-based care that empowers patients to make informed decisions while keeping costs in check. After all, healthcare should heal—not break the bank.
#Healthcare#CostEffectiveCare#ValueBasedCare#PatientFirst#HealthcareInnovation#HealthcareEquity#insurance#healthinsurance#trending#viral#hospital#medical
Great post from Dean Jargo last week regarding the abuses of UnitedHealth Group (https://lnkd.in/dGByAC57). The same behaviors that make United, and other BUCAH carriers incredible stocks will also make them the next Blockbuster.
Just like Blockbuster, these firms are middlemen that are abusive of their customers (remember those late fees?).
Over the next five years, these firms are about to be hit with a wave of lawsuits tied to profit-seeking abuses. Why do we know that? Because their customers are about to be hit by a wave of lawsuits tied to overpayments from poor claims adjudication or PBM abuses.
While that is happening, new innovative firms will be given an opening to disrupt. While they won't be perfect, here are the paths new firms will take to disrupt:
✅ Removing High Deductibles: The math on high deductibles does not add up. Many studies have shown that HDHPs do not curb healthcare spend--they just change who pays. New health plans will find that they can offer the same costs to employers while removing HDHPs if they just cut out the waste that BUCA carriers added. Everyone wins, except for the current carriers.
✅ Simple: The next generation will find new ways to make paying and identifying what coverage you have SIMPLE. There will always be some friction in what is covered, but we all know it can get SO MUCH BETTER.
✅ Primary Care Focused: Direct primary care has proven itself dozens, if not hundreds of times over. It works. New plans will make this a cornerstone of their care, again saving employers while helping employees with powerful, connect convenience.
✅ Protective: Remember when the Apple app store was revolutionary because apps in it were 'safe'--they would not kill your phone. Future healthcare will be similar. Not every provider will be included--only ones that are proven to be safe and high quality. Consumers will trade less choice for better safety. Again, by not including poor-quality providers, these new firms will be saving employers money. In healthcare, the most expensive care is the bad care.
So why has this not happened yet? These BUCAH carriers have over 800 billion in combined revenue. They have invaded every part of the ecosystem, sharing their wealth with brokers, employer plan sponsors and providers so that they can hold onto the status quo. I have worked in healthcare for 20 years and have seen it from both the hospital and employer side.
We are already seeing these firms' largest customer, Medicare, start to play hardball with them. Aetna told us last week that they are hurting.
While we all want the better healthcare, the disruption to healthcare will be enormous. Hospitals and providers will be paid differently. Employers will buy differently. Huge companies will go out of business.
Is your company ready for these coming changes?
#healthcarewaste#employeebenefits
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The 7 Level ‘Why’ of United Health’s Stock Performance
1. Why has United Health’s stock performed so well since 2014?
Because of the Affordable Care Act (effective in 2014).
2. Why did the ACA contribute to United’s stock increase?
In large part, because the ACA mandated a Medical Loss Ratio that requires health insurers to pay out 15-20% of premiums as claims.
3. Why did the MLR contribute to United stock’s rise?
Because the MLR fixes the % profit that any health insurer can earn.
4. Why does fixing the profit % of health insurers cause United’s stock to increase in value?
Because United now has a financial incentive to grow total spending on healthcare claims (to grow their profit).
5. Why does United’s financial incentive to grow total claims spending drive their stock price up?
Because United “negotiates” with profit-motivated health care systems that want higher fees for their services.
6. Why does United’s “negotiations” with healthcare systems drive United’s stock price?
Because United can easily agree to pay higher healthcare prices.
7. Why does agreeing to pay higher healthcare prices drive United’s stock price up?
Because higher healthcare prices result in higher premiums, higher premium revenue drives higher profits, and higher profits drive a higher stock price.
Optimizing RCM Operations with Advanced Processes & Technology to Enhance Hospital & Practice Efficiency
3moThe increasing complexity of healthcare billing, insurance verification, and regulatory compliance is putting additional pressure on hospitals' financial management systems. The rise in administrative costs and claim denials indicates that hospitals are struggling to keep up with the evolving requirements from both government programs like Medicare and private insurers. This makes it critical for hospitals to adopt more sophisticated billing, coding, and denial management solutions to mitigate financial losses. By streamlining these processes and improving claim accuracy, hospitals can address the root causes of these trends.