Patrick Velliky

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Patrick Velliky

Patrick Velliky

@PatrickVelliky

Chief External Affairs Officer, HaloMD. Former House and Senate staff. Health policy sponge. Nerd. Opinions are my own.

Silver Spring, MD Katılım Mart 2024
175 Takip Edilen83 Takipçiler
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CH@chertz·
I think if yon have covered the salacious rumors and innuendo from the insurer smear campaign against doc, you should be updating your stories today
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
To be clear, your defense of payer offers is that they’re offering the QPA once they get to arbitration? The unaudited QPA, that even if calculated as intended (and there’s LOTS of evidence to suggest it’s being manipulated), would be 15-20% lower than in-network rates…?
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
In dismissing another of Anthem's frivolous NSA suits, the Northern District of Georgia said exactly what the provider community has been saying for years: "...the Plaintiff argues that it loses a lot of IDR arbitrations... It cites CMS data that Providers prevailed in 85% of IDR payment determinations. It is highly improbable to infer from these facts that there is a vast conspiracy of providers and IDREs that have conspired to defraud the Plaintiff of millions of dollars in thousands of NSA IDR proceedings over many years. It is highly plausible to infer that the Plaintiff [Anthem] engages in a consistent practice of submitting lowball offers to [OON] providers in an effort to maximize its profits..."
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
@mcuban @DrAlexUrology Insurers create high deductible plans precisely because it allows them to shift risk away from themselves and onto patients and providers. The insurer has a contract with the patient and (usually) the provider. Why don’t they pay for care and collect patient cost-sharing?
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Mark Cuban
Mark Cuban@mcuban·
To all independent doctors. What percentage of your patients are in their deductible phase ? And what percent of those are getting care for less than their deductible? Ins carriers know you take all the risk of payment. Time for that to stop
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
Like Woody Allen said, "80% of success is just showing up." My latest substack digs into a key driver of clinician success in the NSA's IDR process: participation. open.substack.com/pub/patrickvel…
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
@sgremminger @ntlalliancehlth Thanks Shawn. If you'd like to understand HaloMD and the NSA before engaging in a witch hunt, let me know. I'm extremely proud of the work HaloMD does. 77% of our clients are small practices trying to remain independent and serve their communities. Underpayment leads to IDR.
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Shawn F. Gremminger
Shawn F. Gremminger@sgremminger·
@PatrickVelliky @ntlalliancehlth You're correct, Patrick. I misspoke and corrected the record with the journalist. The article has been corrected. That being said, what HaloMD is doing is truly abhorrent and I look forward to doing everything in my power to stop your fleecing of employers and working families.
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
Concerning message from @sgremminger, CEO of @ntlalliancehlth, today in STAT. He suggests plan sponsors can increase patient responsibility following No Surprises Act arbitration - this is illegal. Sincerely hope NAHPC member companies aren't getting this advice.
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
@EdGainesIII @EDPMA Thanks, @EdGainesIII! Context is king! Education is the biggest threat to the insurance lobby’s priorities. The more you understand an issue, the less likely you are to agree with the plans.
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Ed Gaines
Ed Gaines@EdGainesIII·
Health, yours are excellent points. My fellow @EDPMA board colleague Patrick Velliky has analyzed the numbers provided by AHIP & BCBSA in Q4 2025 in their published survey. His calculation is that merely 4.4% of the NSA IDR eligible claims by physicians and hospitals are determined in the IDR process. So, how is it possible that less than 5% of OON claims are causing run-a-way premium inflation for patients? It is a false narrative by the health plans to scare Congress into revising the NSA and to remove the IDR process. The plans want the “benchmarking” bill that they advanced in the House Energy and Commerce Committee that would have set OON rates at Medicare or the plans’ determined median rates—and that bill was rejected by Congress in part because it had no IDR process as part of the bill. But they will never stop trying to make the federal law a version of CA’s AB 72 (OON rates benchmarked to 125% of CMS) or MI’s law benchmarking all physician rates to 150% of CMS. patrickvelliky.substack.com/p/insurers-pre…
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Heath Veuleman@HeathVeuleman

Every time you see someone question the No Surprises Act, I want you to consider a few things: 1. The ~4.13 million federal IDR payment determinations (completed arbitrations) under the No Surprises Act represent an extremely small fraction of total U.S. healthcare claims—roughly 0.034%, or about 1 in every 2,900 adjudicated claims—over the same period (April 2022–March 2026). 2. Multiple analyses of CMS public use files and supplemental data show that independent physicians represent a small minority of initiators and determinations. 3. In various periods (2023–early 2025), the top 4–10 initiators (e.g., Radiology Partners, TeamHealth, SCP Health, Envision, and middlemen like HaloMD) account for 45–70%+ of disputes (often 50%+ in recent quarters). Many of these are PE-affiliated hospital-based staffing or specialty groups (emergency medicine, radiology, etc.). Facilities initiate ~20% of provider-side disputes in some periods. The remaining share (after top groups) is hospital-employed physicians. Now, considering the foregoing, ask yourself why this is being framed, by certain lobbyist-adjacent “think tanks” and legacy corporate media, as a “windfall” for physicians that will drive premiums up?

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Bob Onder
Bob Onder@RepBobOnder·
Today, EBSA Assistant Secretary Aronowitz testified about the real-world consequences for patients and doctors caused by the lack of enforcement of the No Surprises Act. Insurers are sidestepping @POTUS’s legacy legislation on surprise medical bills, and shifting costs onto patients and small physician practices already struggling to stay afloat. That’s why @RepGregMurphy’s No Surprises Act Enforcement Act matters. It would impose real penalties, and hold insurers to the same accountability standards as physicians.
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
Anthem v. HaloMD et. al. dismissed without leave to amend. @ElevanceHealth's attempt to intimidate doctors and weaponize the courts lands with a thud in Central Dist of CA: "[Anthem's] theories are all end runs around the NSA's limits on judicial review." prnewswire.com/news-releases/…
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American Hospital Association
American Hospital Association@ahahospitals·
The No Surprises Act’s IDR process exists for a reason. When insurers don’t like the outcome, the answer isn’t to circumvent federal patient protections through administrative policy. Anthem’s new “Facility Administrative Policy” — that took effect this year across 12 states — does exactly that. It threatens hospital payment cuts and network removal for conditions hospitals cannot possibly control. If Anthem wants to reform IDR, there are legitimate paths: cleaner coding standards, prompt good-faith responses to provider offers, and fair payment proposals. Weaponizing hospital contracts isn’t one of them. Worth a read from AHA’s Rick Pollack: healthcaredive.com/news/keep-care…
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Scott A. Baldwin
Scott A. Baldwin@ScottABaldwin·
Governor Braun has signed SEA 189 into law. This legislation prevents health insurance companies from penalizing health care providers when care involves an out-of-network provider, reinforcing the intent of the federal No Surprises Act and helping ensure patients maintain access to the care they need. 📄: iga.in.gov/pdf-documents/…
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Patrick Velliky
Patrick Velliky@PatrickVelliky·
"Those who continue to rely on a misdiagnosis to treat the problem should be viewed with significant skepticism, as they are either uninformed or intentionally attempting to deceive." open.substack.com/pub/patrickvel…
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