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They make money by defrauding doctors and their patients.Multiplan is NOT insurance. It is essentially a scam.My problems started as soon as my company switched to Aetna for our health insurance. My long-time therapist is not in-network with Aetna. She applied to become in-network, but was rejected because she is a private practitioner, not affiliated with a hospital. She is in-network with Humana, BCBS, United, and others.Once the conventional route failed, she signed an agreement with a company called Multiplan. According to the agreement, she would have to charge me less per session in exchange for being billed in-network on my insurance plan. Once a practitioner signs the Multiplan contract they are obligated to that lower rate as long as that patient remains in their care.Meanwhile, Aetna has never considered her in network and I've had to pay thousands out of pocket for out-of-network services. I did not call this to their attention sooner because I honestly didn’t completely understand what my doctor had signed or what Aetna was supposed to do. Since every transaction with this company is a mentally and emotionally exhausting fight, I try to avoid contacting them—and consequently, avoid seeking healthcare unless it is a true emergency.In spite of the fact that Aetna and Multiplan have not upheld their end of the agreement, my doctor is still required to bill at the agreed-upon rate. She attempted to ask Aetna about it, but they claim that even speaking to her would be a HIPAA violation—even though she is the practitioner who billed for the services in question. Multiplan tells her to talk to Aetna. Multiplan won’t talk to ME because I have no relationship with their company. When I called Aetna, the representative said that because she didn't sign a form (that they never actually sent her), they don’t consider the agreement fully executed (though they DO consider it executed when it comes to her billing rate). They will not even allow us to submit this supposed form late in order to ensure that subsequent billing is correct, yet my doctor is still forced to bill at the lower rate as long as I remain a patient.My company uses ADP Totalsource to manage benefits and payroll. I tried to contact ADP because supposedly, they are supposed to advocate for me in situations like this, but now, even THEY claim it’s a HIPAA violation to help me, so as far as I’m concerned, they are complicit in this fraud.I know Multiplan is associated with all of the major health insurance providers, so I am quite certain I am not the only patient, and my therapist, not the only practitioner, to be forced to comply with a contract that Aetna does not acknowledge exists, EXCEPT when it comes to the rate she is allowed to bill.The insurance company, Multiplan, and ADP are all using HIPAA as a way to shelter themselves from actually addressing the issue, not its intended purpose of protecting patient privacy.HIPAA is not supposed to be a vehicle for multibillion dollar corporations to utilize in order to give patients and providers the runaround, is it?

Common error inherent in the term; healthcare isn’t “free”. What you’re asking for is taxpayer-funded, government-administered healthcare, which, ideally, would be rendered with no expectation of direct payment by the patient at or after time of service.Can it be paid for without hindering the economy? Of course it can. All you would do is transition all existing private healthcare plans to an agency of the government; same terms, at least for now, but the government collects all premiums and pays all claims.We have this for our senior citizens, in the form of Medicare. Medicare works much like any other U.S. medical insurance program in that there are premiums and copays payable by the beneficiaries of the plans, and then the plan pays the amount beyond the copay/coinsurance that is billed by the provider.However, it has two fundamental differences. First, anyone with an employment arrangement that the government knows about is paying the bulk of the costs of this plan, in the form of a 2.9% payroll tax, theoretically split half-and-half between your employer and you. So, if you make the US medin income of about $60k a year at 35 years old, you personally are paying $870 for a healthcare plan you legally cannot participate in, and your employer is paying another $870 toward that plan to have you on the payroll, which you will never see even in your gross pay. Unless you’re an independent contractor paid by 1099, basically considered self-employed, in which case you are responsible for both employer and employee portions of the tax ($1740 total). Multiply that by about 265 million working-age adults, and that’s on the order of about $460 billion annually that the seniors actually getting this insurance aren’t paying in premiums, because employers and working-age adults are paying this money but not getting the insurance. That’s something no other insurer on the planet besides the U.S. Government could ever get away with. Imagine having Blue Cross/Blue Shield as your health insurance, and then Cigna or Humana comes and tells your employer “hey, we need 3% of your total employee gross pay to be sent to us to help defray the costs of our own plan for another employer”. You’d tell them to pound sand. But the U.S. government has the power to tax. And it does.Why does the government need so much money to run this program? Because under Federal law, the Department of Health and Human Services which oversees the Medicare program has statute limits on its power to negotiate the “allowable amount” that providers can charge for drugs, devices and equipment. Perhaps you’ve seen the ads on TV, or gotten a robocall, from a company claiming they can get you some medical device like a motor scooter, knee brace or oxygen concentrator at no cost to you if you’re over 65 and eligible for Medicare. These companies aren’t doing it out of the goodness of their hearts; they’re doing this because they can bill Medicare on your behalf at a ridiculous markup over the actual cost of goods sold. These are literally legal insurance scams, legal because the government must pay the quoted price for any covered medical device properly prescribed and procured for a Medicare patient. They can’t choose the lowest bidder, they can’t make you get competing bids, and they definitely can’t examine the provider’s cost structure and insist on cost plus a reasonable markup. They pay the firm’s asking price, because they can do no other. The same applies for prescription drugs under Part D plans; these are privately offered, but pretty much every Medicare patient has a Part D supplemental plan. Yet the government is forbidden to negotiate drug prices on behalf of all Part D subscribers; the insurance companies offering Part D plans must negotiate on behalf of their subset of Medicare patients, a much smaller pool of people that usually have other choices for plans, making the insurer the weak link in negotiations.Much the same happens in the world of private medical insurance, which 85% of U.S. working-age residents have through their employer. Each “group”, generally representing all employees of one company in one state, negotiates with their insurer on premiums and plan features, then insurers negotiate for allowable amounts chargeable by doctors, hospitals and other providers that are “in-network”. Being a network provider has advantages in referrals and compensation for services rendered, the flip side being that providers are limited in the price they can charge for various services.This leads to the basic problem; the provider networks, especially manufacturers, have better negotiating power than any one insurer, because they’re providing healthcare across a very broad geographic area with people covered by dozens of insurers. Insurers, by antitrust law, cannot collude cooperatively to fix prices. So the providers get to set the tone of the negotiations for their products and services, and they do so by demanding ridiculously inflated prices. Unlike in any other debate, the insurer cannot easily just walk away from Merck’s entire product line or from Baylor Scott and White’s hospital system, because its customers have an “inelastic demand” for Merck’s drugs or Baylor’s medical facilities.Simply put, it’s hard to set a price on not dying.As a result, about $500 billion of the U.S.’s annual total healthcare spending is to pay costs for drugs, devices and services in excess of the industrialized world’s average prices for these things, literally “because we can, because you’ll pay it anyway”. That’s about 15% of total U.S. healthcare spending; imagine getting 15% of your current insurance premiums back onto your paycheck. I dunno about you, but that’s grocery money for me and my family. This $500 billion is more than all other reasons we spend more than other countries combined, including higher medical payroll, defensive medicine, billing system inefficiency, “Americans are sicker” etc…… with one exception. End-of-life care. The United States spends nearly 4 times as much per capita keeping the very oldest among us alive, healthy and active as the next biggest spender, Germany:Again, this comes down to “it’s hard to put a price on not dying”, allowing providers of “heroic” end-of-life treatments to charge whatever they like “because we can”. There’s an emotional component to providing care for the elderly; they’re our parents and grandparents, they raised us, they provided for us, got us where we are today. Of course we are going to do whatever we can to provide for their health and comfort in their old age, and to keep them around as long as their bodies keep working (and often after they’re not).This is why the Republican fearmongering of “death panels” under an expansion of government control over healthcare in the U.S. was so effective in limiting the power the government got under ObamaCare; the idea that the choice of how to care for your elderly parents would be taken away from you in the name of cost control scared the bejeezus out of the Baby Boomer generation, whose parents are on the right side of this graph and who are facing the foothills of this uphill climb in spending themselves (and who, not coincidentally, wield considerable power among both parties in Congress). Nobody wants to spend the last years of their lives in a gussied-up hospital complex being cared for by the lowest bidder, especially if the overall goal behind your sacrifice is to get as many others as possible into that facility who otherwise wouldn’t be able to afford it.So, we’ve basically got two problems to solve: providers are the 800-pound gorillas in U.S. healthcare cost negotiations, because they’re providing all of a particular drug or device to the entire market with very few available substitutes, and no one entity in the U.S. has the power to sit on the other side and represent all U.S. healthcare consumers (which is all 325 million of us); and, we love Nana and Pop-Pop too much not to do everything we possibly can to keep them with us as long as possible, long after these treatments are doing more harm than good.Solutions? Well, for the first problem, a single-payer program would give one entity the power to deal face-to-face with providers. This has those providers scared shitless, because the U.S. is pretty much the world’s last cash cow to pad their profit margins. The U.S. is almost literally subsidizing the drug and device prices all the other countries are negotiating; “The Brits want a 20% price reduction on Valium? Sure, fine, give it to them, we’ll just push up the price in the U.S. market to make up the difference on the bottom line”. If the U.S. goes single payer, with the muzzle taken off the government’s price-negotiating ability, that chops down the money tree; the U.S. will be looking at the prices everyone else gets and will demand nothing less.That’s going to hurt drug and device companies, and boy do they ever know it. That’s why the pharmaceutical advocacy lobby, aka “Big Pharma”, spent just shy of a billion dollars on political activity in the 2016 election cycle. $1 billion to protect $500 billion? Sounds like a pretty good business investment. And it’s working; politicians even on the Democrat side are very hesitant to propose or support anything Big Pharma can use to put their picture alongside footage of elderly people with their families and tell the nation “this politician wants your parents to hurry up and die already”.That also hurts other countries; the National Health in the UK will very likely not get the prices it currently does for Valium and fake hips, because all the providers of benzos and artificial joints will be feeling the squeeze in the US and will be looking to bid up the prices everywhere else to stay in the black. So far, we haven’t seen too much concern about that (the ability of the National Health to do business at all post-Brexit is the bigger deal right now), but that may change if and when the details of a single-payer healthcare system empowered to negotiate become widely known.As for getting our country to know when to let their parents go? That’s a far more personal thing, and it’s not something a PSA campaign is going to change hearts and minds about. Quite the contrary, that’s exactly the ammunition Big Pharma needs, a government-sponsored ad campaign encouraging hospice over life-extending treatments. Hope is a really powerful motivator, and it sells a lot of pills and pokes.

Q: Why can't we have a national healthcare system based on Medicare?We absolutely could!Sadly, were it not for the boneheads in congress who think that their job is to represent mainly the wealthiest 1% of the people (who are also the biggest campaign contributors) and the health insurance industry, we would probably already have Medicare for all.Wealthy people don’t need health insurance because they have the funds to pay any costs out of pocket, so, naturally, they don’t support any national health insurance plans.Also, the big health insurance carriers (Anthem, Aetna, Kaiser, Humana, Cigna, United Health, and Highmark) would all stand to lose billions in profits—as would the pharmaceutical companies.Many of the medical problems (that are also usually more expensive to treat) are random and unpredictable. A wealthy person would have the funds to pay for treatment, but 99% of people simply wouldn’t.The forces against any national health insurance plan are formidable, and they are fully prepared to spend hundreds of millions of dollars in marketing and advertising that is intended to persuade people into voting against their own best interests.Here is the truth.98% of us need to have health insurance.Although we could diligently set aside money for medical care during all of our working lives, we still wouldn’t have anywhere near the hundreds of thousands (in some rare cases, millions) of dollars that it can require to treat any of a host of known medical problems — many of which require very expensive medications for years.Some examples:A bone marrow transplant (commonly used to treat leukemia) costs between $300,000 and $800,00.Coronary bypass surgery costs $75,000 — not including hospitalization, medications, and follow-up care.Aids medications cost about $18,000 per year.Insulin costs about $12,000 per year.If you’re lucky and you can work, you might be able to get a group health insurance policy, but the sad fact is that no private insurance carrier is going to issue an individual health insurance policy to anyone with heart disease, diabetes, aids, cancer, high blood pressure, or any other “high-risk” health issue.It’s no surprise that the single biggest cause of bankruptcy is medical costs.(From: Top 5 Reasons Why People Go Bankrupt)“A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.”As it happens, we have a solution for this problem. It’s called insurance.Insurance is simply a way of spreading out a financial risk over a large enough number of people to minimise the impact for any individual.Most people don’t understand how insurance works. Everybody wants to have their medical costs paid for when they are incurred, but they really don’t want to pay for the insurance until after they need it. This isn’t how it works, however. The way it’s supposed to work is that everybody pays a little into the insurance fund over time, so that the funds will be available when needed.Insurance companies can use historical data to accurately predict the amount of money needed to pay for medical costs for a large population. They also can, and do, relate these costs to different “risk classes” such as age, sex, location, occupation, and known medical history. Most people don’t know that every time they file a health insurance claim, there is a database record created that all of the insurance companies share and have access to.One problem with this is that the insurance companies (for-profit companies) can use this data to select which risks they want to accept and which they don’t. A lot of people who apply for health insurance are, therefore, simply rejected.Another issue is that insurance companies can make health insurance premiums really expensive for those in higher risk segments.There are several serious underlying problems with the healthcare system in the USA. Most of these are related to the for-profit delivery of health care services, equipment, facilities resources, pharmaceuticals and research.Not everyone is required to be part of the insurance risk pool. A lot of younger or healthier people don’t see the need for health insurance. They rarely go to the doctor and don’t need any prescription drugs, so it seems like a huge waste of money to buy insurance. What they don’t understand is that by paying for it when they don’t need it, insurance premiums become lower and average out overall. And, as I said, there is no way to know if you will be affected by some disease or injury that is extremely expensive to treat. (This can happen to people who are young or otherwise healthy.)Private insurance companies are not required to accept a risk. Once the insurance company finds out that an individual has any of a number of known health issues (like high blood pressure, cancer, cardio-vascular problems, or any chronic problem) they simply refuse to accept the risk. Most people have group health insurance though their employers, but those who are not members of a group policy may find that they simply can’t get health insurance.Insurance carriers limit their liability. Private carriers set maximum annual and lifetime limits on benefits. If actual medical expenses exceed the limit, then the individual is responsible for costs.Medical service providers and pharmaceutical companies can charge whatever they want to. Price-gouging and profiteering are common.Medical service providers can refuse to join insurance company networks (where costs are pre-determined) This is one outcome of the ongoing struggle between medical service providers and insurance companies.The way to fix this whole problem is with a hybrid system that combines the financial power of the government with the administrative efficiency of private insurance carriers.Although the Affordable Care Act (aka: “Obamacare) was able to solve the problems associated with pre-existing conditions, the concept of multi-carrier, state-level, insurance risk “pools” at the heart of of the ACA was poorly thought out, inefficient, and destined to fail. It was done as a compromise to keep private insurance carriers in control.As it turns out, however, private insurance carriers are reluctant to participate (because too few are participating) and too many people who have expensive medical conditions are in the risk pool.This can’t be fixed. It’s a fatal flaw.What we need is for the government to assume the major part of the financial burden associated with health insurance and then allow the private market to participate as value-added service providers.Essentially, the solution is to use Medicare as the financial “foundation” for universal health insurance and then allow private insurance carriers to provide supplemental or “wrap-around” insurance for those who desire (and can afford) better coverage. The “wrap around” coverage (also called “Medicare Advantage”) carriers would actually handle filing the the Medicare claim on behalf of the service provider.Employers could offer the supplemental insurance coverage as a benefit for employees for much less than they are paying to subsidize group policies.I have Medicare “Advantage” insurance and my premiums are $119/month (plus the $134/month for Medicare part B premiums). This insurance covers everything with very low deductibles and copays and even includes excellent drug and dental benefits as well. This is “PPO” coverage, so I can go to any doctor I want to. The network of service providers is very extensive. I can also still go to out-of-network doctors but the co-pays are higher.Medicare-for-all would have the financial power that can come only from universal participation. It would provide the government financial backing that is absolutely necessary to cover larger major medical expenses. Government participation would also provide the “clout” to push back on unreasonably escalating medical and drug costs.As a former insurance agent, I can wholeheartedly say that Medicare for all is definitely the way to go.