Consumers Screwed with Insurance Loopholes

Insurance Loopholes & Master Pricing:
How Surprise Medical Bills Knock Consumers Down

Medical Records (photo courtesy of CX2)

Most of us know which local hospitals and doctors are covered by our insurance providers, but even when we make sure that we only see an in-network physician or surgeon, nearly one-third of privately insured Americans are still hit with higher-than-expected medical bills, often because their in-network hospital brought in or contracted out to an out-of-network service provider. How did we get to the point where so many consumers have so little information about what to expect when their hospital bill arrives? (read full article)

Consumers Screwed with Insurance Loopholes

As explained in this excellent article, even though Obamacare intended to address rising prices by promoting prevention, price transparency, and competition among payers & providers – and there has been progress – the system remains hopelessly complex and in need of serious and more aggressive reform.

I’m more convinced than ever that we need to move toward a single-payer system like Medicare-for-All, modeled after other nations that pay half as much and have better outcomes. Meanwhile there may be a role for the new Consumer Protection Agency, because complexity always allows the greedy to find loopholes and screw consumers, while it makes it more difficult for consumers to protect themselves. But if we rely too much on that, the agency could grow immense.

Most consumers, I think, are willing to assume more personal responsibility and Want to seek the best value in care, but that’s difficult to impossible under America’s current and convoluted Sick Care system, which has perverse incentives to view patients as paying customers and treat their symptoms, thus keeping them coming back, paying.

Healthcare Costs are Rising Fast. Need Reforms

NEWS: 24/9/2015 – Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms, according to a new OECD report.

Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives finds that going over budget on health spending remains endemic in most OECD countries. Maintaining today’s healthcare, and funding future medical advances, will be difficult without major reforms that will require health and finance ministries to work together, it says.

Read More …

FDA Patient Engagement Advisory Committee

Health Tech Policy

FDA Announces First-ever Patient Engagement Advisory Committee

By: Nina L. Hunter, Ph.D., and Robert M. Califf, M.D., 9/18/2015

Although it may seem odd in retrospect, the development of new technologies intended to improve patients’ lives has largely relied upon expert opinions rather than asking patients and families directly what they consider most important.

But that’s changing. We are entering an era of “patient-centered” medicine in which patients and their care partners participate actively in decision-making and priority-setting about all aspects of health care. Americans are becoming increasingly active consumers of health care, making choices about their doctors, diagnostics, treatments, and healthcare experiences rather than simply allowing health care providers to make the decisions for them. Moreover, FDA believes that patients can and should bring their own experiences to bear in helping the Agency define meaningful benefits or unreasonable risks for certain new devices.

Today we are excited to announce FDA’s first-ever Patient Engagement Advisory Committee (PEAC). This body will provide advice to the FDA Commissioner on a range of complex issues relating to medical devices, the regulation of devices, and their use by patients. It will give FDA the opportunity to obtain expertise on various patient-related topics, with the goal of improving communication of benefits and risks and increasing integration of patient perspectives into the regulatory process. Some questions that the PEAC may discuss include where and how best to engage patients across the device development and assessment lifecycle as well as how FDA and sponsors should communicate patient preference information to patients. Read More …

Republican Alternatives To The Affordable Care Act?

What Would Republicans Do Instead Of The Affordable Care Act?

By John McDonough and Max Fletcher

A new spate of proposals from Republican presidential candidates to repeal and/or replace the Affordable Care Act (ACA) raises the important question: Given an unobstructed opportunity, what would Republicans really do with the Affordable Care Act? Would they repeal the law wholly or just in part? With what might they replace it?

Some suggest that Republican Congressional leaders only advance full repeal to placate their Party’s conservative base, knowing well that repeal cannot survive a certain veto while Barack Obama is President. In January 2017, that obstacle will vanish if Republicans control the White House and both branches of the U.S. Congress. What then? Read More of this excellent article at

Is FaceTime HIPAA Compliant?

Is FaceTime HIPAA Compliant? 

By Jon Taylor, President and Founder of Bayon Health (original here)FaceTime HIPAA Compliance

In the first part of this series we wanted to address one of the most common questions we get asked; “Is FaceTime a HIPAA compliant solution?” If one was to search the internet for this answer, you’d come across a lot of mixed answers and confusion. FaceTime is such an easy tool to use when it comes to video conferencing, so it’s only natural for us to want to use it, but with all the rules and regulations regarding HIPAA, healthcare professionals want to make sure they are compliant. We decided to do a deep dive into FaceTime, looking for any information that not only answers this question, but gives us resourceful information to make a conclusion ourselves. In this report, we are going to cover what it means to be HIPAA compliant, how FaceTime works under the hood, and how FaceTime is currently being used in the healthcare industry. Read More …

Hooray for Obamacare! How’s it doing?

No matter your politics, you must respect a Nobel Prize winning economist when he speaks in economic terms. The following is pulled from yesterday’s New York Times editorial by Paul Krugman.

Hooray for Obamacare!Paul Krugman

“Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.

It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?

The answer is, better than even many supporters realize. Read More …

Supreme Court upholds Affordable Care Act… Again


Supreme Court says, "ACA OK"

The U.S. Supreme Court this morning ruled on the landmark King v. Burwell case about the legality of federal insurance subsidies. In their 6-to-3 ruling they saved coverage for more than 6M Americans.

According to FierceHealthPayer, Chief Justice John Roberts said, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Here at Modern Health Talk, we applaud the Court’s decision.

Insurance Cost = Premiums + Deductibles + Copays

Obamacare Enrollment Drive

MIAMI, FL – FEBRUARY 05: Aymara Marchante (L) and Wiktor Garcia sit with Maria Elena Santa Coloma, an insurance advisor with UniVista Insurance company, as they sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida. Numbers released by the government show that the Miami-Fort Lauderdale-West Palm Beach metropolitan area has signed up 637,514 consumers so far since open enrollment began on Nov. 15, which is more than twice as many as the next large metropolitan area, Atlanta, Georgia. (Photo by Joe Raedle/Getty Images)

OPINION by Wayne Caswell, founder & senior editor, Modern Health Talk

This is an obvious opinion piece that I posted on Huffington Post in response to another opinion piece, It’s Not Just You — Those Health Insurance Deductibles Are Getting Scary.


The article was well written but misleading because it failed to acknowledge that Total Insurance Cost = Premiums + Deductibles + Copays. Instead, it focused almost exclusively on high deductibles. Read More …

Telemedicine as good as a Doctor visit?

Video ConsultationVirtual doctor visits via video conference are starting to go mainstream, with some people putting them on par with a regular trip to the doctor’s office. UnitedHealthcare, announcing that they’ll cover virtual doctor visits through American Well, Doctor on Demand, and NowClinic, is the latest to jump on the telemedicine bandwagon.

While these consultations previously would cost $40-50 per call, United members will only be charged a regular co-pay, making virtual medicine more affordable for more people. Coverage of the virtual visits will only be available only to UnitedHealth’s self-funded customers, as opposed to those with employer-funded plans, but the feature will expand next year to most members, showing just how fast telemedicine is taking off. Read More …

Telehealth Legal Obstacles Delay Home Healthcare

Doctor Robot

DOCTOR ROBOT: Technology like this RP-VITA device at Mercy San Juan Hospital in Carmichael, Calif., lets doctors beam themselves to remote patient bedsides, but government rules need to catch up. (AP / Rich Pedroncelli)

Home telehealth” technology promises to be a critical component of providing quality care to the growing number of Americans who need long-term services and supports to “age in place” at home. Home telehealth and related technology can make it cheaper, easier and more comfortable for seniors to remain at home and avoid nursing facility placement.

But government regulations lag behind telehealth technology, according to this article in the National Law Journal. This is disappointing because “24-hour monitoring would allow Americans who need long-term care to ‘age in place’ at home.”  Read More …

Precision Medicine vs Prevention & Wellness

Health iconsPresident Obama and the National Institutes of Health have announced a Precision Medicine Initiative that complements other programs for Prevention and Wellness. That’s important because too many diseases don’t have a proven means of prevention or effective treatments.

Read More …

Are You Ready for Some Sensors… in Healthcare?

Activity Trackers

Some wearables (photo from

They’re Everywhere! They’re Everywhere! Sensors that is, and it seems they sense everything too.

Here’s a tiny subset:

  • Temperature (e.g. thermostat)
  • Light (photocell)
  • Sound & Vibration (microphone)
  • Proximity (motion sensor, Doppler radar, stud finder)
  • Pressure (altimeter, barometer, tire pressure)
  • Magnetism (security contact switch)
  • Chemicals (smoke, radon & CO2 sensors)
  • Fluid Flow (water & gas meters)
  • Electric Current (electric meter)
  • Moisture (humidifier, leak detector, rain gauge)
  • Radiation & Subatomic Particles (Geiger counter)
  • Speed, Distance & Acceleration (odometer, tachometer, accelerometer)
  • Pressure (barometer)
  • Force (strain gauge)

Read More …

Telehealth is Shaping Healthcare for the Better

Game ChangerBy Karen R. Thomas, President of Advanced TeleHealth Solutions (original article here)

As incredibly innovative and efficient as telehealth is at providing greater access to care for consumers, lowering healthcare costs for both patients and healthcare systems, and improving outcomes, barriers have always existed that hinder the widespread adoption of telehealth. Yet recently, issues such as state requirement hurdles, reimbursement limitations, and a general resistance from physicians to learn and integrate new technologies into their care routines are quickly evaporating in the wake of the overwhelming proof of telemedicine’s many benefits. Read More …

Hyper Growth of Private Insurance Exchanges

Shared with permission from MEDCITY News, by Dan Verel, 7/25/2015

Accenture Figure 1

While much attention has been heaped on the public health insurance exchanges over the year, private health insurance exchanges “are experiencing hyper-growth” and enrollment could exceed that of public exchanges by 2017, “if not sooner,” according to Accenture. Read More …

Get the Health Incentives Right

MotivationThis post is based on a comment I made when Pritpal Tamber called for “Creating a parallel system to health care” in MedCity News.

At least for consumers, Modern Health Talk ( can already be called the “Institute for New Health Thinking,” with over 100 articles on Legislative, Public Policy, and Health Reform topics written for consumers, and over 600 on modern health topics in general.

I personally think it all comes down to getting the INCENTIVES right, as I wrote two years ago when proposing a hybrid, public/private model of health care. The goal then was to exploit the differing incentives of private sector organizations that measure success in business terms such as profit, ROI, and payback period, with that of the public sector, which measures success quite differently and over much longer time periods.  Read More …

Early-Stage Obamacare – How’s it Going?

Is your glass Half Empty, or Half Ful?EDITOR: Opinions of Obamacare, and whether it’s a glass half empty or half full, depend largely on one’s political viewpoint and sources of your information. Opponents of the law, including many in the medical industrial complex with lots to lose if health reform cuts costs, often cite articles hinting that it’s a failure, while proponents cite articles highlighting successes and progress. The mainstream media, in efforts to generate buzz and attention, seem to stoke the fires of controversy by avoiding the hard task of investigative journalism and simply publishing inflammatory stories fed to them by either political party without checking the facts. Then again, the official government numbers, which you can believe or not based on your politics, present a moving target. So, I’m more interested in the trends and the long-term implications and publish today’s byline article with some editorial comments added.

Early-Stage Obamacare:
A Checkup on the Health of the Affordable Care Act Thus Far

By Paisley Hansen

What will be the ultimate impact–for good or bad–of the Affordable Care Act on Americans? Although it’s still too early to tell, a January 13 article by the Associated Press posted on AOL sheds some light on the health status of Obamacare thus far [2.2M through December, 2013]. Read More …

Austin Requires New Homes to be Accessible

Austin city council passes accessibility,
ramp ordinances for new homes

Wheelchair Lady doing Laundry
AUSTIN, TX (1/30/2014) — After two years of working on an ordinance amendment, the Austin City Council passed changes Thursday that will require all new homes be more accessible and visitable to people with mobility disabilities.

The idea to require changes to make housing more accessible first came up inside City Hall back in 1998. That’s when Austin adopted the changes for homes built with city funds. The intention was that it would lead to an across the board policy, but that never came to be.

City staff and council members have spent the last two years working with stakeholders to draft an ordinance amendment.

After much debate, and several postponements, the council passed the ordinance amendment 6-1 with Mayor Lee Leffingwell voting against the measure. Read More …

We Endorse Telehealth Across State Lines

Medicine Unplugged: Your phone, your DNA, your data

By Wayne Caswell

Modern Health Talk strongly endorses telehealth and efforts to break down barriers to wider adoption nationwide. The TELE-MED Act of 2013 (HR 3077) is still not out of committee but is intended to start breaking down barriers related to licensure and payment when medical care is given online across state lines, starting with Medicare providers. Hopefully Congress will pass this bill and then start extending telehealth to all insurance carriers. Read More …

Regulations Not Keeping Up with Technology

Health ReformBy Wayne Caswell

The rapid and accelerating pace of tech innovation has profound implications for healthcare delivery & payment, aging, and disability employment, but regulations that support that are spotty or nonexistent.

The good news

“Durable medical equipment” is a class of assistive technology that can be paid for by Medicare, Medicaid and many private insurance plans. Motorized wheel chairs most often fall into this category. Read More …