Today lets talk about the other 2 groups that have the finger in your health insurance dollar pie. When you go to the doctor he has a sheet that has a long list of number codes on it this is the CPT4 codes. Let me explain what these are.
With a complex network of providers, there has to be a way to ensure standardization. This is done with the CPT4 codes. CPT4 codes organize all of the services available for proper pricing and documentation. When a doctor files a claim, he or she must provide a CPT4 code for payment. For each procedure there is a code naming that procedure. The price that is attached to that code is known as the PPO Allowable. Why is it called PPO Allowable? Since the amount charged is all the PPO will allow a provider to collect, it is called a PPO Allowable.
Guess who owns the copyright to the CPT4 codes? The AMA so every time the code is used for a claim the AMA makes money for the use of this code. Just think how many millions of times a day these codes are used in a claim to the insurance company? To the AMA it is the goose that laid the golden egg.
Who controls the medical schools? You guessed it the AMA, so this is where future doctors are taught the way to set up a practice is to sign up with as many insurance programs as they can, and file as many claims as they can a day. Are you now understanding why it is a health care delivery system and not health care.
Your doctor is at a huge disadvantage in this system because he/she cannot give their patients the time that they would like to.
They have to see as many patients as possible just to be able to keep their doors open. That is why so many doctors are going to a cash practice. This is where Direct Concepts Healthcare comes in, we allow the doctor and patient control over the patients health care. Because they get the full PPO Allowable at the time of the visit, and don’t have to pay people in their office to deal with all the insurance companies paperwork and delays. This lets the doctor spend more time with his/her patient the way it should be.
Now lets talk about everybody’s favor topic, the Government and the Politicians. Yes thy have their hand in the pie too. First we had Medicare and Medicaid form Lyndon Johnson, this was the first big step to government control of our health care. Now we have Obamacare, the complete take over of our health care. If you noticed the insurance companies, Drug companies, AMA did not say much during the hearings in congress on Obamacare. That is because they helped write part of it. The insurance companies love it because it will put everybody into the health care delivery system. Plus it will let them get rid of the agent’s because of the states health care exchange’s that have to be set up. On top of that we are going to have 15 bureaucrats making medical care decisions for you instead of you and your doctor. I know you are thinking but won’t this bring down the cost of health care insurance. It may a little but don’t count on it. So far all it has done is increased the cost. The biggest problem is the control part of Obamacare. There is a way out and I will tell you about it soon.
How many of millions dollars the insurance companies give to the re-election of the politicians every election? Where do you think the money comes from? Yep it is part of the 75 cents that you never see of your insurance dollar. Yet they don’t have to have the same health care or lack thereof, they have their on. Well you can have your own too, by opting out of the health care delivery system.
Here at JE Health Care Solutions we are ready to show you how. The Direct ConceptsHealthcare program does just that. Click on the contact button on the right hand side of the blog and enter you information and we will get back to you as soon as possible. Or go to our web site at
JE Health CareSolutions. Each person is different and has different needs so we work with each client to meet their needs. Or you can call: 865-357-3379 and Jo Anne or I will be glad to answer your questions.
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