What Does the Matrix Represent in Healthcare?

Notice the pregnancy test for this non-menstruating patient.

The Matrix, Theme of the Free Market Medical Association’s 2021 Annual Conference

The Highly Uncompetitive Healthcare Market Failure

Small Businesses and Healthcare

Bundled Pricing in the Emergency Room and Maternity Care

Laws to Improve Access to Care and Affordable Healthcare Coverage With Legislation

Seth Denson

“There is only one way to reduce health insurance premiums, you reduce the number of claims you’re consuming, or the price at which you’re consuming those claims.”~

It’s also important to keep in mind, there are only two types of insurance, self-funded and fully insured; there is no “in between”.

“Healthcare trend will be up next year.  In turn, health insurance trend will be significantly up two years from now, and so those are the things that you want to start thinking about as you start thinking long-term.” ​​

“Roughly 90% of all APIs, (these are what are called active pharmaceutical ingredients), that go into the drugs that you and I take each and every day, are manufactured in the People’s Republic of China.  That should strike fear into anyone in the United States.  If China wanted to get really serious about having an overall impact economically or socially in the United States, they could do so without ever firing a shot.  They just shut us off from our drugs.” ​

 “As a result of Coronavirus, insurance companies who, by and large, along with Medicare have set RV units, have restructured the way by which doctors can be compensated for their work.

“Insurance networks provide no intrinsic value to the healthcare system.  They create an opaque curtain by which the healthcare system and the health insurance system can be in collusion….What I loved seeing as a result of the situation that we were in is, for a brief moment, nobody was worried about insurance networks, the Javits Center in New York became a makeshift hospital. No one knows today whether or not that was in-network with Blue Cross, United, Cigna, Aetna, insert-name-of-insurance-company-here, and quite frankly, nobody cared.  And, that’s the way it needs to be.

In short, while they shouldn’t conflict with each other, healthcare needs to be healthcare, and insurance needs to be insurance, and neither one should interfere with an understanding of the care received or the price paid.

Future predictions for the short term; lower health insurance trend. Long term, however, higher health insurance trend..  Secondary long-term health insurance trend will be higher than the first.  As health insurance trends tend to follow healthcare trends, whatever healthcare does today, the health insurance industry will quickly follow.

 “70% of all drugs delivered in the United States are done so through a mechanism of one of three pharmacy benefit managers.  They were supposed to be the Sam’s Club and Costcos of the pharmacy industry.  Instead, they have become more like the loan shark on the back end where you never know what you’re getting and what you’re paying for. The pharmacy benefit manager is the cash cow for the health insurance industry."

70 percent of all prescription drugs are filled by one of three prescription benefit managers.

“You may ask, if they’re very thin and there’s no margin, why are hospital systems buying physician practices as quickly as they can and why would a recent financial report show that their average return on investment is eight to one? Because that’s the sales force. The doctor has become the sales force, which is why it has never become more important for you to engage with the doctor.”

​“The American citizen is not a good consumer when it comes to healthcare.  We must help them along and give them the tools to be that.  The second thing is everybody is self-funded.”  “You need to get engaged with your insurance company whether you’re fully insured or self-funded; start understanding the pool structure.  Ask questions! Get them answered!  You don’t like the answers?  Go find somebody else!  That’s the American way.  Start being a consumer and acting like it.  That’s the only thing that’s going to solve this problem.  Don’t be subservient to the industry.  Take control of it.”

WEBSITES

​DRUG DISCOUNTS AND INFO

References

Dr. Mark Haverkorn, DDS, MD receives a Nice List Certificate from Santa Claus during Open House and one year celebration.

​I joined FMMA to get the word out. I really believe in being transparent about prices. We have all of our prices posted on our website and Facebook. Currently, River City OMS is the only Oral & Maxillofacial Surgery center with prices as low as ours. I’m hoping that other surgeons will follow and do the same and that coming together through FMMA will help.

​There’s three groups of patients we deal with:
​

• We’ve got patients who don’t have insurance or who do not have a lot of money, we obviously help them.

We’re the cheapest oral surgeons in the state of Texas, probably in the whole country. The going rate in San Antonio for four wisdom teeth removal is about 3 grand, I do it for $1,000.

• The patients who want higher-end treatments

You see the commercials that say, “Come in take out all your teeth put in implants in a day!” What they don’t tell you is that it averages $25,000 per jaw, about $50,000 for the mouth. But we can do it for $40,000, that’s 20% off.
We can help the high-end consumers, we can help the folks who are just looking for an affordable way to get care.
​

• Then, in the middle, patients who have insurance and a job are a little more hesitant, but they come out ahead too.​

We had a patient who had two impacted wisdom teeth removed. Our prices are $675. That patient submitted a claim to their dental insurance and got $475 back. That means their out of pocket was a little over $200 to have two impacted wisdom teeth removed.
​
$100 a tooth? You will never find that kind of a deal like that. The dental school charges a lot more than that and they have students in residence who are doing it. The clients who come to us and try this do well!
​
Problem wise, I think we help out people who just cannot afford to get treated. All the time, we have patients who walk in. They've been to a couple of other places and they couldn’t afford it and they were just going to have to deal with their problem until they could take care of it.

​Some will fly down to Honduras or Central America to get surgery at a discount, but then you have patients that don’t want to do that, but don’t want to fork out 50 grand so when we come a bit lower, that helps them too.

No one’s angry, but I think a lot of people think it won’t work. In dental school, everyone wanted to be fee-for-service, which we are, but they wanted to be FFS with ridiculously high prices. Like $3,000 for a crown. No one ever talked about being fee-for-service at a price people could afford. They’re intrigued by it.

Members of the SATX FMMA pictured left is Mark Haverkorn, DDS/MD of River City OMS, center is Chrissy Navejar, DO of Dominion Primary Care and right is Co-Founder of FMMA and CEO of Shankx Web Development, Mr. Shankar Poncelet.

Giving back. I’m very fortunate that my wife is right on board. We’ve always liked to do charity. We like giving things away and trying to help people. This Wrappin’ Jack will be at Fiesta Texas and we’re collecting donations and sponsoring that. It goes to Family Services Association that started in 1903 serving underprivileged families. The average family makes less than $10,000 per year.

I learned about where the name Camp Bullis came from! There’s a colonel in the army that was fighting on the border in the 1800’s in the Indian War. I was always interested and then I found an article about it.

​I’m a Cattle Rancher! My father-in-law was a rancher so he taught me. My pickup truck is actually used for that.

We sponsor a football team! South Texas Rangers. Cops, firefighters, paramedics, everyone on the team is an active officer or relative. They’re growing. We also have a small ranch and we sponsor a local 4-H chapter. We also sponsor a couple of events the Christian Dental Association does every year.

My passion for oral surgery started from seeing my dad, who was also a surgeon and then discovering there was a lot of variety in this field. We do trauma, pathology, cancer. Some do cleft!

What's the last book you read? I really enjoy non-fiction. The last book I read, was Killers of the Flower Moon by David Grann. An Indian tribe in Oklahoma is given a reservation that everyone thought was worthless, but they found oil. They were the wealthiest people in Oklahoma. People came in and tried to take advantage and there were murders. It’s an interesting story!