Open Letter To Dr. Jack Kruse About Calley Mean’s Mother
Gayle Means died of stage 4 pancreatic cancer just weeks after receiving the diagnosis. Although Ms. Gayle was not jabbed with a covid jab, Uncle Jack eludes to the possibility of her turbo cancer as still being vaccine related?
The death certificate is public record, can somebody anonymously send it to me?
Jack also brings up Stanford Hospital and their EOB’s (Explanation of Benefits).
Most of us in America are familiar with EOB’s but other international people may not be? EOB’s are the patients line item “receipts” of medical providers and hospitals services sent to patient’s insurance company for services rendered.
These receipts (EOBs) will show all charges, all maximum allowable reimbursement rates, co-pay & co-insurance responsibilities, and deductibles where applicable. If anything was denied or non-covered there would be a standard explanation.
Since I’m an expert in medical billing and a once HMO Claims Auditor approving and denying reimbursement to the very same Stanford Hospital in question, I’m asking Uncle Jack to put me in touch with his people and let me analyze the EOB’s minus any HIPAA sensitive info of course.
Stanford is notorious for over charging, but so is everybody else. That’s why there are official terms like Maximum Allowable Reimbursement, Reasonable & Customary, and Contractual Adjustments.
Stanford could bill millions for a few nights stay in a hospital but can be irrelevant because of negotiated contractual adjustment agreements based on maximum allowables per in-network agreements.
It’s a vicious trap patients find themselves in paying out of pocket for services that are non-covered and at exorbitant prices. Usually Advance Beneficiary Notices (ABNs) are designed and in place to protect patients against financial obligations for non-covered services.
In simple speak the rendering hospital or physician is obligated to tell you what will NOT be covered before service is rendered and what your $$ obligation will be before it’s performed. It’s at this moment you have the right to decline service.
In the minutiae of all this detail and reimbursements aside, family members and concerned 3rd parties can get deep insight and a complete picture a “case” and a chain of events of what was done. This may be what Uncle Jack is referring to he says “over charges”.
A lot of institutions bill twice and three times for a lot of redundancy. It’s the insurances job to spot those redundancies and not reimburse and classify these charges as contractual adjustment “write-offs”.
Here is a simply example of a “redundancy” I can think of: A two view chest x-ray is ordered and reimbursed which includes the technical and professional component. Technical being the x-ray tech dealing with the patient, the x-ray film, processing, etc.
The professional component is the radiologist professional “read” from one professional to another. Now six different Stanford specialists cycle through and look at the chest x-ray and each bill for the professional read (modifier 26).
In billing, those six specialists get $0 for their interpretation or professional “read”, that is only paid once from the radiologist to another professional, like the doctor who ordered it.
All the other doctors have to read the written words of the radiologist, even though they like to look the actual film or in todays’ world the image.
Diagnostic laboratory can get pretty complicated as there are many “panels” within panels and bundling rules that can apply, but I think you get the picture now.
What do say Jack? Feeling frisky?
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