I took a few of the highlights from this article but the doctor is talking about the increases first of all with his own insurance being pretty big and then continues on to how he will have to adjust for his staff. As a small employer has has provided insurance for his staff 
for many years and now like everywhere else the employees will be carrying more of the cost. His cost has doubled for what he provides employees. He too has to appeal his own insurance claims. For his own coverage for a wife and one child he’s paying $2900 a month now, up from $1480. That’s a big increase.
In addition he refers to a procedure that is about 30% of his business as an optometrist and insurers are no longer paying for and thus he has to bill patients.
Highmark Blue Cross has cut what they pay him by about 40%. He brings up the age issue when hiring a new employee too as thus far it has not been a deciding point but wonders if it will be someday as the cost of insuring older employees goes up quite a bit. He’s working hard to keep the employee insurance going and to not turn them over to the insurance exchanges, but the cost keeps rising and rising. BD
As a physician, a small business owner and a health insurance policy holder, Dr. Douglas Lavenburg feels like he's drowning in no-win situations – one squeezes his medical practice, one squeezes his employees, one squeezes his own medical care.
• Highmark Blue Cross Blue Shield, the largest insurer in Delaware, has cut what they will pay him for what he calls a "bread-and-butter" eye-care category by 40 percent. The change is fair and non-negotiable, he was told.
• The premiums for his health care policy and those he offers his employees have just about doubled for 2015, the first year they must purchase plans compliant with the Affordable Care Act.
• His own physician has ordered a CT scan of his sinuses. But his insurer says it won't cover it. He could appeal and he believes he would win, but why should he have to? Why is coverage so tough to use? What are so many claims denied first and dependent on appeals?
And that doesn't count what's happening to his patients, he says, the ones who can't pay their deductibles (the amount they must pay before their insurance kicks in) and get behind on their payments to him.
Last year, those late accounts, late by more than 150 days, totaled $17,000. This year, they're up to $40,000.
Lavenburg says he doesn't count on seeing any of that money, though it is due to him. And he tries to help patients out when he can, sometimes by front-funding their deductibles or finding other ways to ease the financial burden of their care. He had to hire someone full time just to explain insurance benefits to patients before they come to the office.
So this wave of 2015 policies are coming in with new price tags and the new essential benefits mandated by the law.
Lavenburg said his policy, which covers himself, his wife, and one of his four sons, is going from $1,480 a month to $2,900 a month next year.
His practice administrator, Greg Allen, will see his premium go from $441.91 to $826.24. Allen has a $2,500 deductible, so he thinks it's unlikely that he will see any benefit from that coverage.
"I have people who have been here 15-plus years," he said. "They're valuable to me and I don't want them to leave ever."
He says he won't cut their coverage. But he pays a flat rate toward their premiums, $350 each, which means they'll be paying a lot more for their insurance next year.
As Allen explains it, Highmark used to pay for a comprehensive exam under one code, refraction under another. Last year, they stopped paying for refractions. Doctors had to bill patients.
It's a big deal, Allen said. Lavenburg's office had done 4,038 refractions from Jan. 1 through Aug. 31.
"That's a 200,000-pound gorilla and they represent 30 percent of our patients," he said.
They just want to cheat and get out of paying money and there’s more out there of course but that was the first thing that came to mind and since Blue Cross is in here too, here’s a link with a lot of information on that billing fraud and the lawsuits and the former Ingenix buddies are right in there. Ok so these folks can repair healthcare?
have on SEC filings, but again that’s not all of the interests here as there are several subsidiaries of the corporation that own like 51% controlling interest in other doctors and surgeons groups across the US, ahs been going on for years, just flat out hiding in plain site and all the actions are taking place with subsidiaries as they can move and participate in areas of business that would seem questionable by a corporation. 
in New York for Medicare Advantage is around $55.00 or so. The number of Advantage plans with zero deductible is also decreasing. We have all read about United dropping doctors from their plans and in Florida we have Humana doing some of the same thing but the company is not near as big as United but it’s happening there too. In view of this many patients are being forced back to traditional Medicare. 
Now look at what’s at the link below..the same company that’s knocking off doctors right and left will also give you a deal on a cheap Chinese made hearing aid, one of the many companies United owns and created, hiding in plain site as they take over more and more of what the governments does with Medicare. 
called in a note on their MRI and there was no money left.
hospitals are struggling to survive as they have a number of fixed costs that can’t be reduced. The article didn’t say if the 2% sequester cuts were also passed along to doctors or not. BD 
starting to shrink so CIOs are in a spot today to determine what do we “need” and what would be “nice to have” to be blunt. 
Now they collect more than just medical information, a lot more, like car insurance, and anything else that can be used for any type of insurance risk assessment for insurers. See the notation below on the file, it says if you have not applied for insurance to be underwritten in the last year, there’s no “Consumer” file. Watch the wording today on some of this as again that’s only a “consumer” file so you can bet you still have a file but you can’t get it if you don’t meet the parameters. 
Companies and banks are going to kill us with their inabilities to create non flawed data and dump it out or sell it to the world to anyone who has a buck. They will build this up just as they did credit data so there will be more consumers having to chase this data as well to correct or that old familiar word “Denied” comes back to hit, again the data selling epidemic. 
We know what this is all about of course with hospitals, it’s about cost. 
but it goes to show that nobody is exempt and makes the case that just any old lawyer or judge is not the right person to run an agency like this or half the agencies we have out there today. They have no “data logic mechanics” and thus so their perceptions will always be off target in the way they see the impact and how things in the data world “really” work. 
need this kind of thinking too with the person who runs the Department of Justice, along with being an attorney to mix it up. Works for me and I’m so far down this ladder though but I do have two heads, former developer (I know code and data mechanics) and sales and marketing, and thus I see and write about so much before it hits. Just think of what Bill Gates knows and other hybrids like him if I can do that. CMS and HHS has way too many many models failing all at once right now and it’s scary. 
and kick in with finding patterns and potential fraud? The old Ingenix, now Optum, fraud prevention services/software have been around for a long time, even to the point to where lawsuits have been brought about stating they are too stringent and create false positives, so what gives here? I would think the company would certainly use their own software to find fraud patterns as early as they can, right? Here’s a few back links on the Lap Bands below to get you up to date on the history here. 
We know the pressure is on all insurers as CMS through an audit found a “risk fiddler algorithm” that worked for 5 years and allowed insurers to bill an additional $70 billion, or around $14 billion a year as an average. That will be gone and CMS can’t really even file a fraud cause here as insurers would probably cut more services to Medicare Advantage Plans. Why isn’t everyone honest about their numbers you could ask? 
in software overall. Sure the idea was good when created but within the last couple of years, models are not working anymore. 
mobile computers and phones. 
has partnered with Microsoft and may others over the years and now Emerge.MD is using the platform for telehealth. It can be used to engage the patient, other doctors and so on. The video below is a statement from a hospital’s success with the program. 
People are absolutely hating this complexity that has been created just to go get care. Look at the link below, some hospitals can’t eve get the ER doctor groups and the hospital itself with the same insurers, so people get screwed again on balance bills. 
don’t like this as consumers as the data gets flawed and removes our dignity. 60 Minutes has a good report on Income Tax Fraud and when companies are buying data, where is the data coming from? This is turning the story around a bit but how much gets recycled? We don’t know.