A few more comments on the UnitedHealthcare® Comm
Post# of 8387
(Total Views: 323)
Posted On: 10/12/2022 10:18:29 AM
A few more comments on the UnitedHealthcare® Community Plan Medical Policy, # CS035.K, listing five (5) HCPCS codes for an "Electrical stimulation or electromagnetic wound treatment device". The following italized paragraph irks me to no end. As much as I am loathe to admit it, it could be standard boilerplate language contained in all policy statements. Although, I am not the least bit sure.
Despite my own misgivings (entirely justified) about insurance, the fact that this document has been issued, given a policy #, does, in fact, list five (5) HCPCS codes that potentially could be used for reimbursement, is a positive sign. My concern is the classic 'bait & switch' routine. The above paragraph really could be standard language included in all insurance statements and I am overstating my case; throwing a wet blanket on enthusiasm for a potential major breakthrough.
The date on this is 01 Sept 22 which fits the timeline on other issuance of reimbursement codes for devices, medicines, etc. Officially, the list for approved codes is released on 01 Jan for that year. For some reason, there is a pre-release of sorts and I have no idea why. The whole process of reimbursement approval is sketchy, ambiguous, and rife w/ opportunities for, shall we say, unofficial data inputs from unnamed sources w/ ulterior motives. It wouldn't be the first time. I know well the history of big pharma, AMA, FDA is replete w/ bottomless pits of cash, extortion, blackmail, bribery, questionable favors, 'forgiven' loans, arson, and a plethora of other nefarious, criminal activities that never see the light of day. Doubt it? Do your homework.
My sense is BIEL knew all about this document the minute it was published. They probably had the same reaction to seeing Diapulse and Sofpulse getting mentioned as I did. That sick feeling in the pit of your stomach and then rage. Diapulse is a clunky machine that looks like it came out of a 1950's sci-fi sitcom and Endonovo (maker of Sofpulse) recently bought a cement company. Actipatch and RecoveryRx has pushed both of them to the side. When you call out the frauds who have enjoyed a free reign for many years, uncontested, expect blowback. When 'they' know you know, you got a fight on your hands.
When CEO Kelly says they are working, I believe them, w/out a shred of a doubt. I think they are 'busting their asses', truth be told. Their success is not, and has not ever been, a presumption. They, BIEL management, has known from day one, Andy included, that this is a no-holds barred, bare-knuckle, anything goes, street brawl and turf war all rolled into one. If you think the Powers-that-be are going to play nice and roll over to allow the best device to win on its' merits, you are living in a delusion. They all 'clean up' real good for the cameras but under the surface and behind closed doors, put on your dancing shoes, baby, and let the games begin.
The recent 975,000 order will generate roughly $10 million in profit. That's my guesstimate. If we get insurance coverage, worldwide, that is only the beginning. There is big money in the medical device field. Ask any successful medical sales rep. My optimism is tempered w/ life experiences and when dealing w/ big money, unverified, unjustified trust is a liability. IMO, we will overcome the obstacles. For sure, it ain't no walk in the park. Hear this, we have actual adults and battle-hardened professionals on the job. For 20 yrs, we have steadfastly refused to accept 'no' for an answer, rose to all challenges. Today is no different. We got this.
"Sic parvis magma" - Greatness from small beginnings
definitely BUY_MORE_SHARES
later, WBeacham
Quote:
The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by federal, state, or contractual requirements and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply.
Despite my own misgivings (entirely justified) about insurance, the fact that this document has been issued, given a policy #, does, in fact, list five (5) HCPCS codes that potentially could be used for reimbursement, is a positive sign. My concern is the classic 'bait & switch' routine. The above paragraph really could be standard language included in all insurance statements and I am overstating my case; throwing a wet blanket on enthusiasm for a potential major breakthrough.
The date on this is 01 Sept 22 which fits the timeline on other issuance of reimbursement codes for devices, medicines, etc. Officially, the list for approved codes is released on 01 Jan for that year. For some reason, there is a pre-release of sorts and I have no idea why. The whole process of reimbursement approval is sketchy, ambiguous, and rife w/ opportunities for, shall we say, unofficial data inputs from unnamed sources w/ ulterior motives. It wouldn't be the first time. I know well the history of big pharma, AMA, FDA is replete w/ bottomless pits of cash, extortion, blackmail, bribery, questionable favors, 'forgiven' loans, arson, and a plethora of other nefarious, criminal activities that never see the light of day. Doubt it? Do your homework.
My sense is BIEL knew all about this document the minute it was published. They probably had the same reaction to seeing Diapulse and Sofpulse getting mentioned as I did. That sick feeling in the pit of your stomach and then rage. Diapulse is a clunky machine that looks like it came out of a 1950's sci-fi sitcom and Endonovo (maker of Sofpulse) recently bought a cement company. Actipatch and RecoveryRx has pushed both of them to the side. When you call out the frauds who have enjoyed a free reign for many years, uncontested, expect blowback. When 'they' know you know, you got a fight on your hands.
When CEO Kelly says they are working, I believe them, w/out a shred of a doubt. I think they are 'busting their asses', truth be told. Their success is not, and has not ever been, a presumption. They, BIEL management, has known from day one, Andy included, that this is a no-holds barred, bare-knuckle, anything goes, street brawl and turf war all rolled into one. If you think the Powers-that-be are going to play nice and roll over to allow the best device to win on its' merits, you are living in a delusion. They all 'clean up' real good for the cameras but under the surface and behind closed doors, put on your dancing shoes, baby, and let the games begin.
The recent 975,000 order will generate roughly $10 million in profit. That's my guesstimate. If we get insurance coverage, worldwide, that is only the beginning. There is big money in the medical device field. Ask any successful medical sales rep. My optimism is tempered w/ life experiences and when dealing w/ big money, unverified, unjustified trust is a liability. IMO, we will overcome the obstacles. For sure, it ain't no walk in the park. Hear this, we have actual adults and battle-hardened professionals on the job. For 20 yrs, we have steadfastly refused to accept 'no' for an answer, rose to all challenges. Today is no different. We got this.
"Sic parvis magma" - Greatness from small beginnings
definitely BUY_MORE_SHARES
later, WBeacham
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