Co-pays and Coinsurances are Dumb

  • by Bill Hennessey M.D.

All these do is make purchasing health care more confusing. If a health plan wants to sell more product, get rid of co-pay and coinsurance. Go ahead - adjust the deductible. Now you made it easy to understand. People buy more of what they understand. How about a health plan with a $1,500 deductible and from $1,501 onward the care is covered by insurance? Pretty easy to understand. Do not let others limit how you think. Logic is permitted.

Happy Pratterday.

Los copagos y coseguros son tontos

  • by Bill Hennessey M.D.

A “Copy and Paste” Letter for your Medical Records courtesy of Pratter

  • by Bill Hennessey M.D.


To Whom It May Concern:

I request a full copy of my medical records, including those of the hospital and the doctor, including all of the doctor’s orders, especially blood work orders.

Once you provide these to me and I get to compare them to my itemized medical bill, I will consider payment. If I do not receive the doctor’s orders, I will request all of my medical records again. You are encouraged to be thorough and timely if you want paid in a timely manner.

I will wait to hear from you. Thank you in advance for your cooperation.


The Bull

Remember, don’t be bullied. Be the bull.

FYI: send to ATTN: medical records department

Una carta de "Copiar y pegar" para sus registros médicos cortesía de Pratter

  • by Bill Hennessey M.D.

You Can't Discount a Revenue Code...

  • by Bill Hennessey M.D.

and it is causing self-insured companies to pay half of their medical bills blindly.


Revenue code:
0420 physical therapy

CPT code:
97124 massage
97110 therapeutic exercises
97116 gait training

So a revenue-coded bill comes in for 0420 for $10,200. This is happening. Which CPT code above is this a good deal for? Answer: none of them. Revenue codes skirt billing scrutiny with intentional ambiguity. 0480 means "cardiology." Was the $30K bill for a stress test or an open heart surgery? You don’t know. You just pay.

0300 means "something happened in the lab", yet we all know there are $5 and $500 lab tests. It gets this brazen when employers don't look at their medical bills before or after they pay them.

For an employer spending $100M on healthcare, chances are $50M is going out the door blindly. Who wants to be better?

Contact Mark Robinson to get your Pratter Report for your health plan spend. We diagnose and treat.

Puedes'no descontar un código de ingresos...

  • by Bill Hennessey M.D.

The Pratter Solution to Hospital Surprise Medical Bills

  • by Bill Hennessey M.D.

Hospitals have just sued the federal government to preserve their right to providing us all with surprise medical bills. By following the recommendations below, we get to keep more money and force their behavior change for the better. 

  1. Provide a surprise no payment. Keep your money.
  2. Keep your money for an extra year by asking the hospital for an itemized bill Yes, all 5,700 of them make you ask for one - sad, but leverage it. 
  3. Itemized bill must include each CPT billing code and full name of each test they want paid for. If not, ask again. 
  4. Next, ask for all hospital and physician medical records, including all doctor orders. You need to make certain what was ordered and performed is what was billed. Since they didn't tell you this pricing in advance, you have no choice but to not trust them. This will buy you another 3 to 6 months with your money. 
  5. With itemized medical bills and medical records, it is often easy for most lay people to see billing "mistakes." Call them out. 
  6. Never call them. Let the hospital call you. You bargain from a position of power. They want your money. Play hard to get. 

La solución Pratter para las facturas médicas sorpresa del hospital

  • by Bill Hennessey M.D.

Medicare versus Commercial Health Insurance Payment Disparity

  • by Bill Hennessey M.D.

Working age people pay more for health care than those on Medicare. Commercial health insurance is more expensive than Medicare insurance due to the fact that health insurance companies pay medical providers more for the same care than Medicare. Just how much pricing variation exists by both payer and provider type has been lacking transparency.

This pricing disparity does not exist in any other sector of our economy. We can purchase the same item at the same price, whether it is online via Amazon or in a retail store like Walmart, except for healthcare. With medical cost transparency, it is believed that the same result with same and better pricing will occur. This is referred to as capitalism.

The purpose of this study was to determine the pricing disparity between Medicare and commercial insurance payments for the same care by medical provider type, such as hospitals, freestanding ambulatory surgery centers, imaging centers and blood work centers.

By understanding price points and ratios for payment of care by health insurance companies to Medicare, employers and employees can better negotiate what they pay for care and best determine where they can go to receive more affordable access to care.

Download the full white paper.


Disparidad de pagos de Medicare versus seguro de salud comercial

  • by Bill Hennessey M.D.