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Sometimes... The Truth Hurts...
By: Tim Callender, Esq.

The following is completely fictional.  Well, not really, but it makes me feel better to pretend that it’s not true.  As always, with my posts, the guilty (and innocent) shall remain nameless.  All the names and places I have used in this blog are fictional.

In the past 10 years I have attended many fundraisers for many different causes.  As I sit here today, pondering healthcare spend and the insanity that is our system, I think back to a particular fundraiser that I attended and how my experience at the event was so drastically different from all the other attendees.

A close family friend experienced a stroke.  For storytelling purposes I’ll name her Sally.  Obviously this was a terrible occurrence.

Sally had young children and she was the primary breadwinner for the household.  Sally spent weeks in the ICU and then months admitted to in-patient physical / occupational therapy.  Although she “recovered,” Sally would never be the same.

Sally’s medical bills piled high and her family buckled under the financial and emotional strain.  The community rallied around Sally and her family.  A fundraiser was put together, advertised, and executed incredibly.  There was live music, numerous food vendors, a silent auction, corporate sponsors, etc.

Oddly enough, the local health system sent representatives to the fundraiser.  They took the stage and provided heartwarming stories about Sally, her road to recovery, and how amazing it was to see the community rally around Sally to help pay her medical bills.  “Yeah… to pad your pockets,” I remember thinking as I stared at the stage, slack-jawed.

By the end of the evening, the event’s organizers announced that the event had raised nearly $80,000.00 for Sally and her family – a staggering amount.  Now.  Here’s where my pessimism (and knowledge of provider billing practices) overrides the “rainbows and unicorns” happy feeling of a successful fundraiser.  While everyone else applauded the giant, fake check being paraded across the stage, and cried while hugging one another, I leaned over to my friend and chirped, “You know she’s judgment proof, right?  The health system could sue her all day long, get a judgment against her, and end up garnishing $10 per paycheck for the next 40 years.  She doesn’t own anything they can attach a judgment to!  She’s judgment proof!  Why are we all here enabling the hospital’s egregious billing practices by helping Sally pay these ridiculous bills!”  That’s when I realized the room had gone silent and numerous people were listening to my ranting.  Suddenly I was the bad guy.  Oops.

Why do I tell this story?  Is it to reminisce about a Friday evening gone bad?  Is it to poke fun at Sally?  Is it to demonize a local health system?  No.  My purpose is none of these things.  Instead, I provide this brief story as a reminder that all of us “normal people” on the street own a great deal of responsibility when it comes to “feeding the dog.”  As often as we want to decry health systems for egregious billing – for predatory financial practices – for “war profiteering” – we need to step back and honestly assess whether we have enabled this reality.  Were there more claims that could have been negotiated?  Were there changes that could have been made to the health plan to control these charges such as a better definition of “maximum allowable?”  Were there plan member incentives that could have encouraged the member to choose other, high-result but less-expensive treatment options?  Were there wellness or medical management steps that were missed?  Was there an opportunity to educate plan beneficiaries as to the landscape of medical billing practices?  Were there plan design opportunities missed?  The list goes on.

In short, as we sit back and observe a system that is rife with out-of-control billing, we have a duty to not only criticize but also look for causes and real solutions at every step, including those that directly involve us.  And also – be careful who might be listening when you start popping off at fundraisers.

Empowering Plans Segment 05 - The AHCA Failed: Where To Next?
Join The Phia Group's CEO, Adam V. Russo, Sr. VP, Ron E. Peck, and Attorney Brady Bizarro as they discuss the recent, stunning failure of the GOP's American Health Care Act, the most recent news and predictions on the effort to repeal and replace the ACA, and what this all means for the self-funded industry.

Click here to open the Podcast!

Trump’s Healthcare Bill Failed… Here’s Why
By: Adam Russo, Esq.

The fact that Trump’s healthcare bill failed is big news and now everyone in Washington and in the media is trying to place blame on someone, whether it’s president Trump, Speaker Ryan, the Freedom Caucus or the Democrats. The reality is that this bill would not have worked and I believe that no bill passed in the next few years will work either and the reason is simple. Neither the Democrats nor the Republicans are willing to truly lower the overall cost of healthcare.  The only way that we can have a successful health plan for all Americans is by fighting the root of the problem – the ridiculously high priced hospital and other facility bills and the huge sticker prices on specialty drugs.

There is an easy solution – force the hospitals to justify their charges and negotiate with the pharmaceutical companies on what they can charge. However, the politicians in Washington will never do it because these two entities are the reason they are in DC in the first place. They fund the campaigns, they feed the lobbyists, they are the biggest employers in most representatives’ districts.  They will never push them or fight them or even question them because they need them. If you are a politician and the largest employer in your district that employs the most people is the hospital, then are you really going to criticize their practices? Hell, no! Until this changes, we will see the same games being played as they are now. That’s why we are here at The Phia Group, because we are not afraid to criticize, to fight, to question and to ensure that our clients can offer their employees the best health care coverage at the lowest prices possible.