toad 📌

Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies. They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight. Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient. This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country

@pmarca, wanna bet that 95 percent or more of your portfolio uses the same companies that make price shopping impossible (despite what their PR says) ? Here is something fun for your portcos to do 1. Run their PBM and Insurance contracts through your fave LLMs and ask "Where are they screwing me over" 2. Create an agent that takes the terms of your contracts and uses them to review the invoices the company receives, probably weekly, and list the mispricing and mis charges 3. Have them ask for ALL of their claims, and have an agent analyze the claims for mispricing and non adherance to your contracts 4. Create an agent that makes an attemp to price all the medications that your members are prescribed and determine the net price. 5. Oh, and ask the LLMs to review your broker and our consultants contracts , and also their RFP.. Just ask it if they are doing the best job they can do for you Simple stuff.. Will save you tens of millions of dollars