Connect with us

Business

Insurance Companies Working the System

Published

on

Getty Images

Many Californians are familiar with health insurance companies like Anthem Blue Cross, Blue Shield, Healthnet, Cigna or Aetna. We pay them a premium each month and expect that when we have a claim, they would do their part and cover us by paying our physicians and medical facilities. Although these are large companies, with many subscribers, Coast Surgery Center discover that when they pay out their claims, they pay peanuts. How do they get away with that? Coast Surgery Center reveals their inside secret.

“incorrectly billed, missing signatures, missing documentation, or missing medical records,”

Since California law allows health insurers 40 days to accept or deny a claim, then allows them to notify patients every additional 30 days if they need more time, this allows for a loophole with no real deadline. So these insurers create a special department, which some call PPR (Pre-payment Plan Review), to intentionally delay payments by sending out general denial letters. These letters provide auto-generated reasons like “incorrectly billed, missing signatures, missing documentation, or missing medical records,” in order to buy them time. They would give patients, doctors, and facilities the run-around and give excuses that may not even be relevant to the claim.

These large insurance companies pay lobbyists to help create laws that allow them loopholes to be able to get away with cheating their customers. Customers then purchase insurance policies that don’t even cover them when they need it. When customers get frustrated and demand the insurance to pay or want to ring the alarm, the insurance company then pays, but pays Medicare rate, instead of paying the Usual Customary Reasonable (UCR) or (RC) rates as they really should be. So medical providers and facilities get nearly nothing. This doesn’t make any sense when insurance premiums increase annually, and coverage keep decreasing.

California tax payers including patients, doctors, and facilities fund the Department of Insurance and the Department of Managed Healthcare (DMHC) so that they can ensure consumers of their healthcare rights and to protect consumers from being cheated. Yet these departments have either turned a blind eye towards these insurance companies or are not aware of their tactics. These Departments should be protecting consumers and investigate these insurance payout processes because they are working the system and using the loophole to scam customers of millions of dollars in premiums and paying out next to nothing or not at all. So instead of protecting the health insurance companies and letting them work the system, the Dept of Insurance and DMHC should be protecting patients.

If you are a patient, doctor or facility that have received notices from your insurance company or from a Pre-payment Plan Review department and have been struggling to get your claims paid, contact the Department of Insurance at 800-937-4357 or Department of Managed Healthcare at 916-324-8176.

Business

FBI INVESTIGATORS ARE CREATING CRIMINALS

Published

on

By

Dr. Robert Joseph, a podiatrist in California, who was indicted by the United States District Court for the Central District of California for the illegal practice of colluding with pharmaceutical marketers for writing prescriptions of compounding drugs, is now working undercover for the FBI. In exchange for a lower sentence due to his indictment in 2018, Dr. Robert Joseph is now working undercover to deceive medical facilities and doctors by intentionally offering illegal deals.

This article is to help warn medical facilities and doctors of the devious practice that the FBI is taking to catch them in the act. It is one thing to investigate incidences due to patient complaints or whistleblowers but to intentionally embed a mole to create a problem when there is no problem, this is how the FBI works. If Adam is tempted by the apple because it was offered is that the same as if he had already bit the apple without the temptation created by Eve? In this case, the FBI is going fishing in hopes of finding something.

A medical facility in Huntington Beach, CA was a victim of Dr. Robert Joseph and the FBI. Dr. Joseph came into the facility wearing a concealed camera and had the intention of catching them by offering an illegal deal. Fortunately, this medical facility did not take the bait but wanted to share their experience with the public so that other medical offices and doctors will be aware of Dr. Robert Joseph.

As the public, we want doctors to care about us and to do what’s best for us and not be greedy. That is the oath they take when they become doctors. There are doctors who are tempted to sway but being tempted versus actually acting on greed is not the same. What the FBI is doing is turning the tempted into greedy criminals. 

Ref: https://www.justice.gov/file/1076086/download

Continue Reading

Business

$150 CÓ ĐÁNG VỚI RỦI RO LÀM HẠI GƯƠNG MẶT CỦA BẠN KHÔNG?

Published

on

By

 Các phương pháp điều trị da bất hợp pháp đang được cung cấp trong các nơi chăm sóc da mặt và tiệm cắt tóc như được phát hiện bởi các cuộc điều tra bí mật gần đây về các nơi chăm sóc da mặt và tiệm cắt tóc ở Nam California. Đàn ông và phụ nữ đang trả 150 đô la cho mỗi lần khám cho các phương pháp điều trị bằng tế bào gốc, vi kim và collagen của các chuyên gia thẩm mỹ không được cấp phép hành nghề y tế. Tất cả những nơi chăm sóc da mặt và tiệm cắt tóc nói rằng họ có y tá và bác sĩ trong đội ngũ nhân viên nhưng các quy trình thực sự được thực hiện bởi các chuyên gia thẩm mỹ không có bằng hành nghề y này. Họ quảng cáo cung cấp tế bào gốc, collagen, vi kim để tiêm Vitamin C, PRP (Platelet-Rich Plasma) injections và phương pháp điều trị bằng laser IPL cũng như các quy trình làm đầy, botox, dùng kim để nặn mụn và mài da siêu nhỏ. Tất cả các quy trình này đều đi dưới bề mặt da và xâm lấn, vì vậy chúng cần có giấy phép hành nghề y tế và phải được y tá hoặc bác sĩ thực hiện. Hội đồng Nghề Làm tóc & Thẩm mỹ Tiểu bang không cho phép các chuyên viên thẩm mỹ và chuyên gia thẩm mỹ tham gia vào bất kỳ thủ thuật xâm lấn nào. Chúng chỉ được phép hoạt động trên bề mặt da. 

Khách hàng thường nhầm lẫn các dịch vụ thẩm mỹ xâm lấn này với các dịch vụ hoặc sản phẩm chăm sóc da mặt và biểu bì. Ví dụ, một loại kem dưỡng da có thể quảng cáo rằng nó làm mịn và đẹp da của bạn (dùng trong mỹ phẩm), tuy nhiên, nếu nó quảng cáo rằng nó sẽ chữa khỏi hoặc điều trị mụn trứng cá, thì đó có thể được coi là hành nghề y. Một chiếc máy có thể quảng cáo rằng nó hỗ trợ thẩm thấu các chất dưỡng ẩm, dưỡng ẩm để làm đẹp làn da của bạn (dùng trong mỹ phẩm), tuy nhiên, nếu nó tuyên bố sẽ giảm cellulite hoặc kiểm soát cơn đau, thì đây được coi là một phương pháp hành nghề y. Một chất lột da có thể quảng cáo rằng việc sử dụng nó sẽ loại bỏ các tế bào da chết không mong muốn và thúc đẩy làn da sáng, đầy sức sống (dùng trong mỹ phẩm), tuy nhiên, nếu chất lột da tuyên bố loại bỏ các đốm nâu hoặc sẹo, thì đó có thể được coi là hành nghề y học. Người tiêu dùng cũng nên biết ai đang thực hiện các thủ tục này. Ngay cả khi họ có treo giấy phép của y tá hoặc bác sĩ tại doanh nghiệp, hãy yêu cầu cá nhân thực hiện dịch vụ trình ra giấy phép hành nghề y của họ và đảm bảo rằng đó là giấy phép được cấp bởi Bộ y tế chứ không chỉ là Giấy phép của Hội đồng Nghề làm tóc & Thẩm mỹ của Tiểu bang. 

Với $150, khách hàng đang tự đặt mình vào rủi ro và các quy trình hoặc sản phẩm này sẽ gây ra tổn thương vĩnh viễn nếu không được thực hiện bởi những người hành nghề y được cấp phép bởi Bộ y tế. Nếu người tiêu dùng phát hiện ra rằng một hành vi bất hợp pháp đang diễn ra, hãy báo cáo các hoạt động này cho Hội đồng Nghề Làm tóc & Thẩm mỹ Tiểu bang tại www.breeze.ca.gov


IS $150 WORTH THE RISK OF DAMAGING YOUR FACE?

 Illegal skin treatments are being offered in beauty salons as discovered by recent undercover investigations of salons in Southern California. Men and women are paying $150 per visit for stem cells,  micro-needling, and collagen treatments by estheticians and cosmetologists that are not medically licensed. These salons say they have nurses and physicians on staff but the procedures are actually done by estheticians and cosmetologists. They advertise offering stem cells, collagen,  micro-needling to inject Vitamin C, PRP (Platelet-Rich Plasma) injections, and IPL laser treatments as well as fillers, botox,  extractions, and microdermabrasion procedures. All of these procedures go below the surface of the skin and are invasive, so they require a medical license and must be administered by a nurse or physician.  The State Board of Barbering & Cosmetology does not allow cosmetologists and estheticians to engage in any invasive procedures. They are only allowed to work on the surface of the skin. 

Customers often mistake these invasive cosmetic services for facials and epidermal services or products. For example, a skin cream can advertise that it smooths and beautifies your skin (cosmetic use), however, if it advertises that it will cure or treat acne, it could be considered the practice of medicine. A machine could advertise that it assists in the penetration of hydrating moisturizers for the beautification of your skin (cosmetic use), however, if it claims to reduce cellulite or manage pain, this is considered a practice of medicine. A skin peeling agent could advertise that its use will remove unwanted dead skin cells and promote vibrant, glowing skin (cosmetic use), however, if the skin peeling agent claims to remove brown spots or scarring, it could be considered the practice of medicine. Consumers should be aware of who is performing these procedures as well. Even if they have a nurse or doctor’s license posted at the business, ask the individual performing the service for their license and make sure that it is a medical license and not just a State Board of Barbering & Cosmetology License. 

For $150, customers are putting themselves at risk and these procedures or products cause permanent damage if not done correctly by some with a medical license. If a consumer discovers that an illegal practice is taking place, report these activities to the State Board of Barbering & Cosmetology at  www.breeze.ca.gov 

Ref: https://www.barbercosmo.ca.gov/forms_pubs/publications/skin_device.pdf

Continue Reading

Business

IRVINE COMPANY EXTORTS TENANTS

Published

on

By

If you were to run a search on the Irvine Company you will find that they have had many historical issues with tenants in the City of Irvine. The Irvine Company is privately owned by one man, Donald Bren and he owns a majority of the city’s real estate which includes housing, retail centers, schools, and parks. The organization seems like a corporate conglomerate but they operate more like an organized group of extortionists. They have used tactics to control their tenants and feel that they have the right to change the rules on their tenants and bypass government regulations whenever they deem fit for their own advantage. Of course, they have high-powered attorneys and government officials working for them. They even have their paid lobbyists to work the system so that they can make their own rules on city policies. Many of the Irvine tenants feel like they were misled or controlled by their leases and can never fight for their rights because they don’t have the money, time, and energy to go through the legal battle against one of the wealthiest real estate companies in America.

In a case of a business tenant operating in Irvine with multiple salon locations, a tenant of over 10 years in Irvine, Images Luxury Nail Lounge wanted to sell one of their locations after coming out of the pandemic in order to pay their debt. The Irvine Company would not allow them to reassign their lease and rejected all new tenant applications, even when the applicants had great credit but were told by the Irvine Company, “We just don’t like the applicants.” The reason the Irvine Company wants to hold Images hostage, is because they want to force Images to payout their entire lease terms before they would transfer the lease. They are bullying Images into staying so that they can guarantee their rent, otherwise, the Irvine Company would take over the business and Images would walk away with nothing. Just like any business owner, one would want to have the freedom to come and go and move into or out of a city but the Irvine company is making it challenging.

When Images first signed their lease at the Eastbluff location with the Irvine Company, Images was not informed of parking construction delays so this caused the grand opening of their salon to be postponed for over a year.

Then during COVID, Governor Gavin Newsom had required complete closures of salons but the Irvine Company told Images that they could go ahead and reopen and that the City would allow it. Images was informed that the Sheriff and city officials will not shut the business down but Images was afraid to open due to the fear of the Governor’s order, the County reopening guidelines, and safety for their patrons and employees so they remained closed, but this shows how The Irvine Company would disregard Government orders and public safety so that they can collect rent from their tenants. Irvine did not really help the businesses or tenants in their city during the pandemic by establishing a “rent relief” which was really only a deferral of rent of 90 days that made it difficult for many businesses to pay both the current rent and deferral in such a short period of time.

There are plenty of blogs, websites, and social media stories written by first-hand incidences of tenants similar to Images Luxury Nail Lounge complaining about the Irvine Company. Irvine tenants, whether they are business tenants or housing tenants feel extorted or misled into thinking that Irvine is one of the most “desirable” places to live and work but if you see the endless complaints on BBB’s website, and blogs by tenants being kicked out of their properties even when they have leases in place or an entire website dedicated to Irvine Company violating building codes and trying to cover it up, you’ll see that Irvine is not a desirable place to live or work and the Irvine Company is to blame.

Continue Reading

Trending

Copyright © 2021 www.truthmedia.news