Jump to content

HRSchenker

Legacy Members
  • Posts

    2933
  • Joined

  • Last visited

Everything posted by HRSchenker

  1. Oh man yall are about to learn today. Buckle up for this. So pharmacy billing is based around a concept called usual and customary pricing. This is set as the price you would pay if you didn't have insurance. The U&C is set high because insurance companies won't pay you more than that set figure. Imagine Optum pays $40 for a drug, Express Scripts pays $50, and United pays $70. You want to set your U&C at $70 so you can capture that revenue. If you set it at $40 then Express Scripts won't pay you $50 and United won't pay you $70. State and federal plans base their pricing on U&C as well which is where things get tricky. Let's say a patient comes in and their copay is really high, like $100. The drug they want is a slow mover and it would be nice to get it off your shelf before it expires. You cut the patient a deal at $35. Per HHS and court precedent, that is Medicare fraud. Because you sold that prescription at a price below your U&C, you overcharged the feds for any previous prescription set at that higher U&C. Doesn't matter if you made none to little net margin on that prescription, it's not allowed. What GoodRx does is bill through the same processor as Optum, Express Scripts, United, etc so the price being transmitted at the point of sale is still based on the U&C but they can set whatever terms they want. If they want to pay me $10 for a drug that costs me $50 from my wholesaler, they can do it. GoodRx makes their money on fees transmitted by the billing pharmacy. Some of yall are lawyers. Imagine you charge $1,000 to create an LLC. I come into the equation and say "hey you're gonna charge the customer $450 and pay me $50 for the privilege of lowering your price". That's the business model of GoodRx but I also sell the personal information of your clients on the side. I get that some people save money at pharmacies using those cards but it's all fake. You know the roofer that repaired the leak in your bedroom? You wouldn't be praising him if he was the one who caused the leak in the first place. GoodRx is nothing but a different side to the same corrupt coin. Cost Plus is different in that their U&C can be whatever they want it to be at any moment since they don't bill insurance. They also don't have any brick and mortar pharmacies.
  2. Health care billing is mostly bullshit. Medical billing isn't as fucked up as pharmacy billing from my experience. It doesn't help that these scumbag vultures like GoodRx exist. But then again, if our system wasn't fucked up they probably wouldn't exist in the first place. I can't blame them for taking advantage of consumers while the feds look the other way for the most part.
  3. The O/U is 54.5? What the fuck?
  4. I'm not a fan of letting folks play by different rules, with the one exception being the Galveston County treasurer removal. The joint resolution is written so that it only passes if the statewide AND Galveston County vote is a yes. I'm willing to let the county voters have the say in their government. If they want to save on tax dollars/have their finances fucked up, that's their choice. Just don't expect a bailout. This is my ballot Yes No Yes Yes No No No Yes Yes No Yes Yes No Yes
  5. HRSchenker

    Tokyo

    We did our honeymoon in Tokyo. I agree that 6 days is a lot. I'd probably knock it down 1 day to see Hiroshima if you can. The further out of Tokyo you get, the more authentic Japan you come across and it's incredible. Japan is an unbelievable place.
  6. My season ticket presale had 200 level tickets at $200 each.
  7. The atmosphere here at the ballpark is nuts. Never been to a game like this before and I'm loving every minute of it
  8. Let's fucking get it
  9. I'm going to the game tonight but worried as fuck about parking. I'm sure I'll be spending at least $50 on it somewhere
  10. What's the best podcast app for android to use this RSS feed?
  11. I'm stunning at all of the comments saying "if" he comes back next year. Why wouldn't he come back? Where does he fit in the NFL as the 4th best QB prospect in the draft? I still believe that winning the conference is our destiny this year and I can't imagine him pulling that off thinking he's accomplished enough at the college level to move on to greener pastures.
  12. Winning the Big 12 is our destiny this year. It will be done.
  13. I thought Jake was mocking Kyrie with that retweet. Was that not the case?
  14. Dak just isn't the guy
  15. SIAP but Brent Venables has a bizarre obsession with oral sex innuendos at press conferences . This is coming from the guy talking about deep throating a water hose
  16. HRSchenker

    Outcoached

    Sometimes you roll the dice and you hit snake eyes. Just the way it happens. Quinn looked fucking good on paper but the 2 interceptions and 1 fumble fucked us in the ass. We will have a rematch in the Big 12 championship game and beat their sorry asses like we did last year. Bet the farm on it.
  17. Sark dropping the F bomb on the show lmao fucking love it
  18. I guess it's gonna override my current alert settings? I turned all of that shit off after getting alerts from places like El Paso. Sorry about your missing kid but I can't do anything about it 600 miles away at 2am.
  19. Fuck the AL West title. Let the Asstros have it. I want the World Series
  20. 3 games in Tampa. I think we can do it.
  21. I swear to god I've never experienced the highest of highs and the lowest of lows of a season like this before.
  22. I can see why he transferred. Yikes this is a bad game.
  23. 5th circuit court of appeals just overturned the injunction but fast tracked the case for oral argument. HB 1181 is in effect today
×
×
  • Create New...