Support Natural Therapies

Support Natural Therapies

From Ralph Fucetola

The Institute, founded in 1998, provides a facility to promote health research in natural means. This Fundly crowdfunding program is intended to provide support for holistic practices and practitioners - www.InHeRe.org

Support this campaign

Subscribe to follow campaign updates!

Recent Updates

Update #6

10 months ago

Notes from my recent conversation with an Insurance Code expert:

Right before former President Obama was elected, Big Pharma was spending $600K a day on lobbying Congress. To see the 2018 lobbying spend by company, see: https://www.opensecrets.org/lobby/indusclient.php?id=h04

Why is this money impacting every one of us? Because it's easy to get "health care" as long as you see pill pushers or go to a hospital but you have to pay out of pocket if you want actual therapies that are not invasive and don’t rely on drugs and surgery. You could have this care without seeing a physician if there were codes to file insurance claims.

Big Pharma supports prescribers – not healers. The medical device industry is supported by hospitals and ongoing health problems – not by solving health problems. Big insurance prices insurance premiums at a minimum of 25% over expected claims – so it is not focused on saving money. This system intentionally keeps consumers in the dark according to Forbes: https://www.forbes.com/sites/danmunro/2013/02/11/healthcares-pricing-cabal/#5a3f3bd26700

The government has mandated the entire industry use codes designed by and for physicians (known as CPT) which are developed by the AMA. But if you read the link the Forbes article, you will also see that the AMA developed the pricing for its coding system.

CPT codes have even more influence on government policy than just being named a mandatory standard. CPT is also known as HCPCS I. HCPCS II codes are developed by the Centers for Medicare and Medicaid Services. By contract with the AMA, HHS agreed to retire any HCPCS II codes that may duplicate CPT. The AMA got this monopoly by giving Medicare and Medicaid a free license for use of its codes. Every insurer, hospital and health provider in the country must pay licensing fees or royalties to the AMA for use of its codes. This generates anywhere from $70 - $150 million a year in revenue for the AMA – as stated in the Forbes article referenced above, the AMA effectively hides its CPT revenue by lumping it in with other products and services.)

What can we do about it? For one, make sure that Section 2706 of the Affordable Care Act is not pulled but instead, given sharper teeth. Imagine if insurers were forced to pay for drugless and non-invasive therapies from any licensed health professional. You would not have to go to a physician to get diagnosed and sent home with a pharmaceutical. Your nurse practitioner could see you without having to follow the rules of being a physician extender. You could visit a massage therapist to reduce your stress or treat a tight muscle without having to take muscle relaxers or Prosac. You could see a holistic doctor and get a vitamin or mineral IV therapy to enhance your immune system rather than be prescribed yet another round of damaging antibiotics – which were the initial cause of your immune system’s failure.

All the evidence suggests if Insurance Companies did as their Premium-Payers wanted, and covered holistic and integrative therapies, their bottom line would benefit significantly.

More Info

Our first project for this Fundly page is to support litigation pending in New Jersey involving several holistic practitioners who are being sued by a BlueCross/BlueShield plan (herein, BCBS) for "fraud" although the customers want the natural therapies that were offered. The insurer can afford the best legal representatives; the doctors and practitioners need your help. 

Please note: Ralph Fucetola JD, President of the Institute, is not the attorney for the Defendants and is retired from the formal practice of the law.

The dynamic young attorney representing the Defendants can set a precedent requiring insurers to honor the desires of their customers and allow holistic therapies that may benefit. 

The case may very well set a precedent defining the ACA's nondiscrimination prohibition as a powerful source of protection for holistic and integrative health care options.

Here are some of the points that may be raised by the defense:

1. BCBS's suit is primarily based on accusing Defendants of providing fraudulent healthcare services.

2. In fact, Defendants have never provided fraudulent services to patients

3. BCBS states that Defendants miscoding services

4. In fact, the codes used by Defendants to file claims were not used incorrectly.

5. An outside billing expert reviewed Defendant’s claims and found that their claims used the treating and supervising provider NPI numbers in the wrong slots.

6. This same expert will testify that no practice she has audited has understood how to correctly apply for and/or use NPI numbers and that training on the correct use of these number is rare, even for medical billers.

7. Horizon did not point to errors related to NPI number placement in its audit of AIM and Dr. Gardner in 2012. 

8. Instead, Horizon withheld payments to AIM shortly after submitting its audit results to Defendants.

9. Without giving AIM a chance to correct its billing errors, BCBS violated Defendants rights under New Jersey law: https://law.justia.com/codes/new-jersey/2009/title-17/section-17-29b/17-29b-4

10. Had BCBS gone back into AIM’s practice, it would have found that AIM purchased an electronic system to better tie patients notes to patient visits after the Horizon audit pointed out this weakness.

11. This action proves that Defendants took BCBS’s audit seriously and tried to comply with Horizon’s best practices.

12. However, BCBS quit paying claims after its audit and seems to have assumed that Defendants were committing fraud instead.

13. BCBS’s presumption of Defendants’ violation of the Fraud and Abuse Act under HIPPA law has financially damaged Defendants.

14. BCBS also seems to have attempted to damage Defendants reputation with patients by contacting them and intimating Defendant’s were involved in providing illegal treatments.

15. BCBS did not ask these patients if they were helped by Defendants’ treatments.

16. In fact, over the past 15 years, no patients have never complained of the care they received from Defendants and most will be willing to testify that the care they received from Defendants was superior to the care they receive from conventionally trained doctors.

17. BCBS claims that it does not cover Alternative Medicine. 

18. In fact, BCBS’s statement violates Section 2706 of the Affordable Care Act.

These important issues will not be heard by the court without sufficient funding.  The case of BCBS vs Jonuzi et al can set a powerful precedent supporting natural therapies... if you help by giving generously!

Campaign Wall

Join the Conversation

Sign in with your Facebook account or

Help Ralph raise $100,000 by making a donation.

Ralph Fucetola posted a new update:
10 months ago

Update #6

Notes from my recent conversation with an Insurance Code expert:

Right before former President Obama was elected, Big Pharma was spending $600K a day on lobbying Congress. To see the 2018 lobbying spend by company, see: https://www.opensecrets.org/lobby/indusclient.php?id=h04

Why is this money impacting every one of us? Because it's easy to get "health care" as long as you see pill pushers or go to a hospital but you have to pay out of pocket if you want actual therapies that are not invasive and don’t rely on drugs and surgery. You could have this care without seeing a physician if there were codes to file insurance claims.

Big Pharma supports prescribers – not healers. The medical device industry is supported by hospitals and ongoing health problems – not by solving health problems. Big insurance prices insurance premiums at a minimum of 25% over expected claims – so it is not focused on saving money. This system intentionally keeps consumers in the dark according to Forbes: https://www.forbes.com/sites/danmunro/2013/02/11/healthcares-pricing-cabal/#5a3f3bd26700

The government has mandated the entire industry use codes designed by and for physicians (known as CPT) which are developed by the AMA. But if you read the link the Forbes article, you will also see that the AMA developed the pricing for its coding system.

CPT codes have even more influence on government policy than just being named a mandatory standard. CPT is also known as HCPCS I. HCPCS II codes are developed by the Centers for Medicare and Medicaid Services. By contract with the AMA, HHS agreed to retire any HCPCS II codes that may duplicate CPT. The AMA got this monopoly by giving Medicare and Medicaid a free license for use of its codes. Every insurer, hospital and health provider in the country must pay licensing fees or royalties to the AMA for use of its codes. This generates anywhere from $70 - $150 million a year in revenue for the AMA – as stated in the Forbes article referenced above, the AMA effectively hides its CPT revenue by lumping it in with other products and services.)

What can we do about it? For one, make sure that Section 2706 of the Affordable Care Act is not pulled but instead, given sharper teeth. Imagine if insurers were forced to pay for drugless and non-invasive therapies from any licensed health professional. You would not have to go to a physician to get diagnosed and sent home with a pharmaceutical. Your nurse practitioner could see you without having to follow the rules of being a physician extender. You could visit a massage therapist to reduce your stress or treat a tight muscle without having to take muscle relaxers or Prosac. You could see a holistic doctor and get a vitamin or mineral IV therapy to enhance your immune system rather than be prescribed yet another round of damaging antibiotics – which were the initial cause of your immune system’s failure.

All the evidence suggests if Insurance Companies did as their Premium-Payers wanted, and covered holistic and integrative therapies, their bottom line would benefit significantly.

Join the Conversation

Sign in with your Facebook account or

Ralph Fucetola posted a new update:
10 months ago

Update #5

The case survived a Summary Judgment Motion and will continue to test the limits of the ACA's Provider Nondiscrimination provision. http://www.inhere.org/2018/12/14/great-strides-in-the-case-for-alternative-providers-in-new-jersey/

Join the Conversation

Sign in with your Facebook account or

Ralph Fucetola posted a new update:
11 months ago

Update #4

Great News! Nestor Smith, the attorney for the Defendants appeared in court yesterday on Horizon's motion for summary judgment. The court denied the motion which means that the issue of Provider Discrimination clause of the Affordable Care Act is still in court and this case could change the way insurers have to pay for integrative and holistic care!

Join the Conversation

Sign in with your Facebook account or

Ralph Fucetola posted a new update:
11 months ago

Update #3

Just posted this at the Institute web site.

Our first Crowdfunding project involves pending litigation that can construe the Affordable Care Act to forbid insurance carrier discrimination against holistic and integrative practitioners, permitting proper insurance coding for such therapies, and, from the standpoint of the Mission of the Institute, facilitating retrospective research into holistic and integrative modalities (through coding statistics.

Read more here: http://www.inhere.org/2018/11/06/making-health-insurers-follow-the-rules/

Join the Conversation

Sign in with your Facebook account or

Ralph Fucetola posted a new update:
12 months ago

Update #2

We are having a great early response to this crowdfunding effort! Our article about it has been posted at:

www.RumorMillNews.com
www.OpenSourceTruth.com'
www.BolenReport.com

You can read it here:

http://www.opensourcetruth.com/stop-insurer-attacks-on-holistic-and-integrative-therapies/

And please, please, please share this Fundly link with everyone! https://fundly.com/support-natural-therapies

Join the Conversation

Sign in with your Facebook account or

Ralph Fucetola posted a new update:
12 months ago

Update #1

Thanks for our first donation! Thanks to The Bolen Report for posting this article: http://bolenreport.com/we-need-to-get-real-health-care-paid-for/

Join the Conversation

Sign in with your Facebook account or