(07-07-2021, 12:15 PM)Lucky2Last Wrote: [ -> ]It's got some resistance, sure. It's just easier to measure do to it's longevity. I really think we need at least 5 years with this vaccine before companies should be able make anything mandatory. It's an arbitrary number, sure, but I don't think it's unreasonable to let it get some time under it's belt before making it mandatory.
I see no problem with your thoughts, but I also think that each organization has the right to set their own standards.
Ugh... just realized I typed do to instead of due to. I hate it when that happens.
So, now for a "Pandemic" with an "Infectious" disease.
They're gonna send people, door to door?
Please FSG, tell me how that makes sense.
All the people that are saying that people that have had covid get the vaccine are using the CDC as their source. I don't trust the CDC and neither should you.
Sen. Chris Murphy (D–Conn.) sprang to Walensky's defense. "I frankly appreciate the fact that we have leaders today who recognize that we still have gaps in information [and] who occasionally may err on the side of caution in order to save lives," he said.
Murphy assumes that "gaps in information" explain the CDC's reluctance to relax its recommendations, that the agency is actually saving lives, and that erring on the side of caution means disregarding the burdens imposed on Americans yearning for "normal life." The CDC's track record provides little reason to believe any of those propositions.
https://reason.com/2021/05/19/why-americ...19-advice/
(07-07-2021, 03:11 PM)Hard_Eight Wrote: [ -> ]So, now for a "Pandemic" with an "Infectious" disease.
They're gonna send people, door to door?
Please FSG, tell me how that makes sense.
I'm not supportive of what they are doing, I think it's dumb. You seem to think I support what the Biden Admin is doing when I really don't, I support vaccination and making sure that people have good information on which to make decisions; not just quackery and conspiracy theory. I think the pandemic has been used for political gains and ends on both sides of the aisle and that's unfortunate because it puts people immediately into an attack/defend mindset instead of one of collaboration. I'm not for forced or mandatory vaccination either, though the more of us who get the shot the better it is for society. I'm not for door to door harassments though I want people to understand that HIPPA doesn't forbid it, because bad information travels fast. Same for the anti-viral meds stories, I hope Ivermectin really is the key to the therapeutic side of this. I'm for education campaigns though even that is so conscripted by political bickering so as to be worthless at this point. Ultimately I'm concerned about what happens to us if we have a truly catastrophic pandemic in the future that's orders of magnitude greater than this somewhat moderate one. Our leaders have failed us, but that doesn't mean our scientists and doctors have; they are busting their [BLEEP] to help solve this thing once and for all, it's just a shame so many people think that "they haven't earned that trust" because of the noise.
(07-07-2021, 03:50 PM)flsprtsgod Wrote: [ -> ] (07-07-2021, 03:11 PM)Hard_Eight Wrote: [ -> ]So, now for a "Pandemic" with an "Infectious" disease.
They're gonna send people, door to door?
Please FSG, tell me how that makes sense.
I'm not supportive of what they are doing, I think it's dumb. You seem to think I support what the Biden Admin is doing when I really don't, I support vaccination and making sure that people have good information on which to make decisions; not just quackery and conspiracy theory. I think the pandemic has been used for political gains and ends on both sides of the aisle and that's unfortunate because it puts people immediately into an attack/defend mindset instead of one of collaboration. I'm not for forced or mandatory vaccination either, though the more of us who get the shot the better it is for society. I'm not for door to door harassments though I want people to understand that HIPPA doesn't forbid it, because bad information travels fast. Same for the anti-viral meds stories, I hope Ivermectin really is the key to the therapeutic side of this. I'm for education campaigns though even that is so conscripted by political bickering so as to be worthless at this point. Ultimately I'm concerned about what happens to us if we have a truly catastrophic pandemic in the future that's orders of magnitude greater than this somewhat moderate one. Our leaders have failed us, but that doesn't mean our scientists and doctors have; they are busting their [BLEEP] to help solve this thing once and for all, it's just a shame so many people think that "they haven't earned that trust" because of the noise.
Just like everyone else, doctors and scientists lie for money.
I mean just look at the food pyramid... the sugar industry got scientists and doctors to lie and say fat was what caused heart disease... when in fact it's sugar. This actually happened. Same thing with lead being in everything back in the day, it took one person fighting corporations (and their doctors and scientists that were lying for.. you guessed it.. money) to get everyone to realize it was slowly killing the entire world.
(07-07-2021, 07:18 AM)flsprtsgod Wrote: [ -> ] (07-07-2021, 02:01 AM)p_rushing Wrote: [ -> ]https://www.hhs.gov/hipaa/for-individual...index.html
Look at the law. Government is a Healthcare insurer at a minimum and someone showing up is a business associate at a minimum.
Read opinions on the law but it is established that you cannot discuss or be asked about your PHI without first agreeing to share that info. It's why you have to sign the hipaa form before seeing a doctor for the first time.
Sent from my SM-G781U using Tapatalk
Ok, your source is simplified for the general public, but from your own source then:
"Know Who Has Seen It.
By law, your health information can be used and shared for specific reasons not directly related to your care, like making sure doctors give good care, making sure nursing homes are clean and safe, reporting when the flu is in your area, or reporting as required by state or federal law. In many of these cases, you can find out who has seen your health information."
I'll also point you to the CDC here: https://www.cdc.gov/phlp/publications/topic/hipaa.html
And to quote the relevant section:
"A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations:
[*]Public interest and benefit activities—The Privacy Rule permits use and disclosure of protected health information, without an individual’s authorization or permission, for:
2. Public health activities
9. Research, under certain conditions
10. To prevent or lessen a serious threat to health or safety"
So, to sum it up, no, HIPAA is not grounds for you to make felony citizen's arrests of government workers engaged in public health activities. Frankly anyone who says that "HIPAA means you can't ask me!" is always wrong because there's no circumstance where asking is forbidden even of covered entities. And even so, you are under no obligation to disclose either, so maybe just say that instead of going all Sovereign Citizen on some poor schmuck canvasing your block for minimum wage.
[*]
So in the current situation where there is no emergency orders any where, there is no public health interest. 2nd the state doesn't have access to my vaccine info unless I have granted them access. They may have been granted access when you get the covid vaccine but they have no info on someone who has not gotten the vaccine and agreed to share info for a "free" shot. The contractors where there are no public health emergency, are not federal or state health employees, and probably have no understanding of HIPAA will certainly be violating HIPAA by just asking as they are representing a covered entity who has no authorization under the privacy rule. Now if they send a real government health worker, during a real emergency, maybe they can argue a federal need to satisfy the privacy rules. State rights though would trump the federal government in whether there is an emergency or not.
HIPAA also protects spoken info. There are requirements that say you must discuss things in a private setting and must get approval from the person if anyone else is present. Standing at someone's door is not a private setting and anyone could over hear. Even if they satisfy every rule for having access to the information, asking in public makes it a violation and prosecutable.
Having contractors going door to door will not allow them to satisfy HIPAA privacy rules. How do you protect the tablet or paper? How do you limit access to just that person's info for the correct amount of time? How do you keep info from being stolen, seen, physical device stolen, etc. This would be a nightmare and would expose the government to countless threats and violations.
(07-07-2021, 01:29 PM)flsprtsgod Wrote: [ -> ] (07-07-2021, 12:15 PM)Lucky2Last Wrote: [ -> ]It's got some resistance, sure. It's just easier to measure do to it's longevity. I really think we need at least 5 years with this vaccine before companies should be able make anything mandatory. It's an arbitrary number, sure, but I don't think it's unreasonable to let it get some time under it's belt before making it mandatory.
I see no problem with your thoughts, but I also think that each organization has the right to set their own standards.
Here is an interesting thought. Since the manufacturers have been given exemption from liability what happens if a company mandates that an employee must be vaccinated to maintain employment and then there is an issue with the vaccine?
(07-07-2021, 08:12 PM)copycat Wrote: [ -> ] (07-07-2021, 01:29 PM)flsprtsgod Wrote: [ -> ]I see no problem with your thoughts, but I also think that each organization has the right to set their own standards.
Here is an interesting thought. Since the manufacturers have been given exemption from liability what happens if a company mandates that an employee must be vaccinated to maintain employment and then there is an issue with the vaccine?
Lawsuits are ongoing on this. I think it depends on the states if they will be allowed to do it without liability or not. I would ask them to confirm their or insurance liability. Plenty of people are finding out their insurance isn't covering their hospital stays and they now owe a ton of money for a "free" shot.
(07-07-2021, 03:50 PM)flsprtsgod Wrote: [ -> ] (07-07-2021, 03:11 PM)Hard_Eight Wrote: [ -> ]So, now for a "Pandemic" with an "Infectious" disease.
They're gonna send people, door to door?
Please FSG, tell me how that makes sense.
I'm not supportive of what they are doing, I think it's dumb. You seem to think I support what the Biden Admin is doing when I really don't, I support vaccination and making sure that people have good information on which to make decisions; not just quackery and conspiracy theory. I think the pandemic has been used for political gains and ends on both sides of the aisle and that's unfortunate because it puts people immediately into an attack/defend mindset instead of one of collaboration. I'm not for forced or mandatory vaccination either, though the more of us who get the shot the better it is for society. I'm not for door to door harassments though I want people to understand that HIPPA doesn't forbid it, because bad information travels fast. Same for the anti-viral meds stories, I hope Ivermectin really is the key to the therapeutic side of this. I'm for education campaigns though even that is so conscripted by political bickering so as to be worthless at this point. Ultimately I'm concerned about what happens to us if we have a truly catastrophic pandemic in the future that's orders of magnitude greater than this somewhat moderate one. Our leaders have failed us, but that doesn't mean our scientists and doctors have; they are busting their [BLEEP] to help solve this thing once and for all, it's just a shame so many people think that "they haven't earned that trust" because of the noise.
I support vaccination as well, but I don't support having a vac that was thrown together in 8 months being pushed down everybody's throats. There's a reason why they do long trials on new stuff like that. They want everybody to blindly get this vac, yet nobody has any idea how it could effect us 3 years from now, 5 years, 10 years etc etc.
I know there's a lot of incredibly smart people working on these things, but incredibly smart people can still make mistakes and get things wrong.
If you want to get the shots, great. If you don't, great. It's your body, your choice and nobody should ever force it upon you.
And further more, why do these people pushing the vac so hard, who claim to have gotten the shots, care about people that aren't vacc'd? If you got it, you should be safe right (if not, what's the point of getting the vac in the first place)? So why such a hard push to have EVERYBODY get it? These big wigs/gov don't give two craps about us (the people), but now they suddenly care about us so much and want everybody to be safe? I don't buy it one bit honestly.
They give a lot of craps about the money.
(07-07-2021, 08:10 PM)p_rushing Wrote: [ -> ] (07-07-2021, 07:18 AM)flsprtsgod Wrote: [ -> ]Ok, your source is simplified for the general public, but from your own source then:
"Know Who Has Seen It.
By law, your health information can be used and shared for specific reasons not directly related to your care, like making sure doctors give good care, making sure nursing homes are clean and safe, reporting when the flu is in your area, or reporting as required by state or federal law. In many of these cases, you can find out who has seen your health information."
I'll also point you to the CDC here: https://www.cdc.gov/phlp/publications/topic/hipaa.html
And to quote the relevant section:
"A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations:
[*]Public interest and benefit activities—The Privacy Rule permits use and disclosure of protected health information, without an individual’s authorization or permission, for:
2. Public health activities
9. Research, under certain conditions
10. To prevent or lessen a serious threat to health or safety"
So, to sum it up, no, HIPAA is not grounds for you to make felony citizen's arrests of government workers engaged in public health activities. Frankly anyone who says that "HIPAA means you can't ask me!" is always wrong because there's no circumstance where asking is forbidden even of covered entities. And even so, you are under no obligation to disclose either, so maybe just say that instead of going all Sovereign Citizen on some poor schmuck canvasing your block for minimum wage.
[*]
So in the current situation where there is no emergency orders any where, there is no public health interest. 2nd the state doesn't have access to my vaccine info unless I have granted them access. They may have been granted access when you get the covid vaccine but they have no info on someone who has not gotten the vaccine and agreed to share info for a "free" shot. The contractors where there are no public health emergency, are not federal or state health employees, and probably have no understanding of HIPAA will certainly be violating HIPAA by just asking as they are representing a covered entity who has no authorization under the privacy rule. Now if they send a real government health worker, during a real emergency, maybe they can argue a federal need to satisfy the privacy rules. State rights though would trump the federal government in whether there is an emergency or not.
HIPAA also protects spoken info. There are requirements that say you must discuss things in a private setting and must get approval from the person if anyone else is present. Standing at someone's door is not a private setting and anyone could over hear. Even if they satisfy every rule for having access to the information, asking in public makes it a violation and prosecutable.
Having contractors going door to door will not allow them to satisfy HIPAA privacy rules. How do you protect the tablet or paper? How do you limit access to just that person's info for the correct amount of time? How do you keep info from being stolen, seen, physical device stolen, etc. This would be a nightmare and would expose the government to countless threats and violations.
[*]
Again you are misinformed, there is still a Federal PHE in effect today that will most likely be renewed and continue through the end of 2021.
https://www.phe.gov/emergency/news/healt...l2021.aspx
Everything you said after that is irrelevant until that is no longer true.
The State has your vaccine record no matter where or how you received it because all vaccines are currently provided from the Federal government through the local Department of Health, therefore all records of those administrations are returned to them. I'm sure you can see how those records can be easily be cross-referenced by address to find those who are not yet on record. Though I think President Potato was talking more about blanket canvasing like the Census work than tracking down specific unvaxxed individuals, but with that moron who knows?
Further, there is NO prohibition against asking a person their vaccine status, by either a Covered or a non-Covered Entity, in the Privacy Rule and there are specific exclusions to the oral violations you mentioned that are applicable in the office, facility, or person's doorway. This makes sense, because if a Covered Entity is forbidden from asking you about it how can they ever obtain your authorization for those elements that actually ARE protected by HIPPA? If you would like some additional information here is a nice article from Health.com that lays it out pretty well:
https://www.health.com/condition/infecti...id-vaccine
Protecting the tablets that the canvassers use is not particularly different from any other piece of healthcare tech, controls are in place to ensure that the data is secured and the hardware can be disabled if lost or stolen.
Basically you are trying really hard to make a case against something that the legislation was specifically written to permit in an emergent situation like this one. Couple that with widespread misunderstanding of exactly what HIPPA is and does and we are rife with faulty positions all over the place.
(07-07-2021, 08:24 PM)p_rushing Wrote: [ -> ] (07-07-2021, 08:12 PM)copycat Wrote: [ -> ]Here is an interesting thought. Since the manufacturers have been given exemption from liability what happens if a company mandates that an employee must be vaccinated to maintain employment and then there is an issue with the vaccine?
Lawsuits are ongoing on this. I think it depends on the states if they will be allowed to do it without liability or not. I would ask them to confirm their or insurance liability. Plenty of people are finding out their insurance isn't covering their hospital stays and they now owe a ton of money for a "free" shot.
Can you provide a source for this claim? I looked at Aetna, Florida Blue, United Healthcare, Kaiser, Cigna, Avmed, Humana and all of the Florida-based Medicare Advantage plans and didn't find a single instance of this behavior. Nor did I find anything about it on the sites for the AMA, AAFP, AAPC, MGMA, AHIMMA, or ACHE. If you could point me in that direction I'd like to take a look.
(07-07-2021, 08:12 PM)copycat Wrote: [ -> ] (07-07-2021, 01:29 PM)flsprtsgod Wrote: [ -> ]I see no problem with your thoughts, but I also think that each organization has the right to set their own standards.
Here is an interesting thought. Since the manufacturers have been given exemption from liability what happens if a company mandates that an employee must be vaccinated to maintain employment and then there is an issue with the vaccine?
I'm certain that this issue will make its way through the courts until we have a precedent.
(07-07-2021, 09:10 PM)Eric1 Wrote: [ -> ] (07-07-2021, 03:50 PM)flsprtsgod Wrote: [ -> ]I'm not supportive of what they are doing, I think it's dumb. You seem to think I support what the Biden Admin is doing when I really don't, I support vaccination and making sure that people have good information on which to make decisions; not just quackery and conspiracy theory. I think the pandemic has been used for political gains and ends on both sides of the aisle and that's unfortunate because it puts people immediately into an attack/defend mindset instead of one of collaboration. I'm not for forced or mandatory vaccination either, though the more of us who get the shot the better it is for society. I'm not for door to door harassments though I want people to understand that HIPPA doesn't forbid it, because bad information travels fast. Same for the anti-viral meds stories, I hope Ivermectin really is the key to the therapeutic side of this. I'm for education campaigns though even that is so conscripted by political bickering so as to be worthless at this point. Ultimately I'm concerned about what happens to us if we have a truly catastrophic pandemic in the future that's orders of magnitude greater than this somewhat moderate one. Our leaders have failed us, but that doesn't mean our scientists and doctors have; they are busting their [BLEEP] to help solve this thing once and for all, it's just a shame so many people think that "they haven't earned that trust" because of the noise.
I support vaccination as well, but I don't support having a vac that was thrown together in 8 months being pushed down everybody's throats. There's a reason why they do long trials on new stuff like that. They want everybody to blindly get this vac, yet nobody has any idea how it could effect us 3 years from now, 5 years, 10 years etc etc.
I know there's a lot of incredibly smart people working on these things, but incredibly smart people can still make mistakes and get things wrong.
If you want to get the shots, great. If you don't, great. It's your body, your choice and nobody should ever force it upon you.
And further more, why do these people pushing the vac so hard, who claim to have gotten the shots, care about people that aren't vacc'd? If you got it, you should be safe right (if not, what's the point of getting the vac in the first place)? So why such a hard push to have EVERYBODY get it? These big wigs/gov don't give two craps about us (the people), but now they suddenly care about us so much and want everybody to be safe? I don't buy it one bit honestly.
I covered that earlier, but in short, about 20% of the world's population either cannot be vaccinated or the vaccine will fail, not mention untold numbers who will refuse. That's almost 2 Billion people affected, so the interest to protect those people is sizable.
Still think my dark web vaccine passport business is going to be the next big thing.
(07-07-2021, 10:10 PM)flsprtsgod Wrote: [ -> ] (07-07-2021, 08:24 PM)p_rushing Wrote: [ -> ]Lawsuits are ongoing on this. I think it depends on the states if they will be allowed to do it without liability or not. I would ask them to confirm their or insurance liability. Plenty of people are finding out their insurance isn't covering their hospital stays and they now owe a ton of money for a "free" shot.
Can you provide a source for this claim? I looked at Aetna, Florida Blue, United Healthcare, Kaiser, Cigna, Avmed, Humana and all of the Florida-based Medicare Advantage plans and didn't find a single instance of this behavior. Nor did I find anything about it on the sites for the AMA, AAFP, AAPC, MGMA, AHIMMA, or ACHE. If you could point me in that direction I'd like to take a look.
(07-07-2021, 08:12 PM)copycat Wrote: [ -> ]Here is an interesting thought. Since the manufacturers have been given exemption from liability what happens if a company mandates that an employee must be vaccinated to maintain employment and then there is an issue with the vaccine?
I'm certain that this issue will make its way through the courts until we have a precedent.
(07-07-2021, 09:10 PM)Eric1 Wrote: [ -> ]I support vaccination as well, but I don't support having a vac that was thrown together in 8 months being pushed down everybody's throats. There's a reason why they do long trials on new stuff like that. They want everybody to blindly get this vac, yet nobody has any idea how it could effect us 3 years from now, 5 years, 10 years etc etc.
I know there's a lot of incredibly smart people working on these things, but incredibly smart people can still make mistakes and get things wrong.
If you want to get the shots, great. If you don't, great. It's your body, your choice and nobody should ever force it upon you.
And further more, why do these people pushing the vac so hard, who claim to have gotten the shots, care about people that aren't vacc'd? If you got it, you should be safe right (if not, what's the point of getting the vac in the first place)? So why such a hard push to have EVERYBODY get it? These big wigs/gov don't give two craps about us (the people), but now they suddenly care about us so much and want everybody to be safe? I don't buy it one bit honestly.
I covered that earlier, but in short, about 20% of the world's population either cannot be vaccinated or the vaccine will fail, not mention untold numbers who will refuse. That's almost 2 Billion people affected, so the interest to protect those people is sizable.
Technically you have to get prior approval for any experimental treatments but I haven't heard of anyone denying claims, plus they aren't coding things as caused by vaccines. When I said covered, using terms that regular people are using when their hospital bill is huge and insurance has deductibles and/or large %s. The hospital bills are going to be large and they are responsible for it, not the government, employer, manufacturers, etc. People are expecting that someone should pay for their bills since the free vaccine caused it.
Then with some of these plans based on the diagnosis codes, insurance isn't going to pay. If they can't find anything wrong and there are plenty of people going to lots of doctors to try to find some cause, then that gets coded as whatever the hospital and plan agreed to. It could be anything but plans aren't paying when they can claim you are making it up or having a panic attack.
When plans don't pay for things because of coding, you or the hospital has to get it fixed. If the hospital does something more or codes it wrong, the plan could deny the provided treatment when the accepted protocol is less than what was done. That generally is the hospital's responsible to cover but it doesn't stop them from trying to get you to pay for it. If the plan says to code treatment one way and it's not covered or the coverage is less, there isn't much that can be done because the hospital has an agreement to bill it that way and you end up getting screwed.
Sent from my SM-T970 using Tapatalk
(07-08-2021, 02:23 AM)p_rushing Wrote: [ -> ] (07-07-2021, 10:10 PM)flsprtsgod Wrote: [ -> ]Can you provide a source for this claim? I looked at Aetna, Florida Blue, United Healthcare, Kaiser, Cigna, Avmed, Humana and all of the Florida-based Medicare Advantage plans and didn't find a single instance of this behavior. Nor did I find anything about it on the sites for the AMA, AAFP, AAPC, MGMA, AHIMMA, or ACHE. If you could point me in that direction I'd like to take a look.
I'm certain that this issue will make its way through the courts until we have a precedent.
I covered that earlier, but in short, about 20% of the world's population either cannot be vaccinated or the vaccine will fail, not mention untold numbers who will refuse. That's almost 2 Billion people affected, so the interest to protect those people is sizable.
Technically you have to get prior approval for any experimental treatments but I haven't heard of anyone denying claims, plus they aren't coding things as caused by vaccines. When I said covered, using terms that regular people are using when their hospital bill is huge and insurance has deductibles and/or large %s. The hospital bills are going to be large and they are responsible for it, not the government, employer, manufacturers, etc. People are expecting that someone should pay for their bills since the free vaccine caused it.
Then with some of these plans based on the diagnosis codes, insurance isn't going to pay. If they can't find anything wrong and there are plenty of people going to lots of doctors to try to find some cause, then that gets coded as whatever the hospital and plan agreed to. It could be anything but plans aren't paying when they can claim you are making it up or having a panic attack.
When plans don't pay for things because of coding, you or the hospital has to get it fixed. If the hospital does something more or codes it wrong, the plan could deny the provided treatment when the accepted protocol is less than what was done. That generally is the hospital's responsible to cover but it doesn't stop them from trying to get you to pay for it. If the plan says to code treatment one way and it's not covered or the coverage is less, there isn't much that can be done because the hospital has an agreement to bill it that way and you end up getting screwed.
Sent from my SM-T970 using Tapatalk
Your first sentence is incorrect, the ICD-10 code for what you're saying is T50.Z95A and it's used ancillary to the primary symptom or diagnosis code. For instance a cardiomyopathy patient would be coded I42.7/T50.Z95A to show cardiomyopathy caused by an adverse vaccine reaction. That information goes on the claim and routes the appropriate governing bodies including the FDA and CDC.
You second sentence is not really different than any other day at the hospital, patients frequently don't want to pay their portion, but that doesn't mean the insurance company didn't do their part. Total claim denials are fought by the facility, and denials of legitimate treatment for conditions cause by vaccine injury aren't singled out for denial. Further, the CICP provides reimbursement to patients for Covid-19 vaccine related injury to cover damages and out of pocket costs for treatment and recovery.
Second section, insurance companies pay "suspicion of" type admitting diagnoses all the time. Admission for chest pain for instance is perfectly acceptable as both the admitting and principle diagnosis for an inpatient stay, even if they can't find a cause. Denials for lack of medical necessity are countered with a letter from the admitting physician, again that happens all the time, because insurance companies will often make it hard to get your legitimate claim paid as a cost saving tactic as United Healthgroup is notorious for doing. Nothing in that is particularly Covid specific or related, but also to their credit almost all insurance companies waved patient copayments last year as part of their pandemic response to encourage their subscribers to go to the doctor if they felt ill, and a few still are. For instance, Florida Blue waived ALL copays for ALL reasons last year and just recently scaled that back to just co-pays/co-insurance related to Covid-related visits. They also kicked in reimbursement for virtual and tele-health visits where it was not previously covered.
Last section, the contract spells out specifically what the facility or provider can bill to the patient according to what will be returned on the EoB. Violating that by either balance billing or by waiving the cost to the patient will both end the facility up in court with a losing case. I've overseen dozens of CMS RAC audits where charts were examined for adherence to protocol, documentation compliance, the correct use of procedure and diagnosis coding, chart/claim agreement, and proper assignation of out of pocket responsibility. It's like going to meet with the IRS except for doctors, and believe me, it's not fun, because if you fail they have to power to extrapolate the violation over your entire claims history. "We found this error so we are going to calculate that you made it 35% of the time and we're taking back that much in future payments, plus you get a $15,000 per instance fine for these 125 instances we found." When hospitals and insurance companies play the responsible party game the patient who might call the insurance commissioner is the last person we want to feel the impact because that's what gets the auditors involved and nobody wins.
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