Maurice Landers III

Making sure no one is ever bald again / Founder of Doctours / Ex-PLTR

[Maurice Landers III @maurice3]

Medicare's first deal with doctors was simple: charge what you want.

That was July 30, 1965. Washington needed doctors to treat seniors, but the American Medical Association had spent years calling Medicare socialized medicine, and some doctors talked about a boycott.

So Congress didn't set doctor fees. It promised to pay their "customary, prevailing, and reasonable" charges, basically whatever doctors in the area usually billed.

But that formula had a loop. If doctors raised their prices this year, the "prevailing" rate went up next year.

And a doctor who didn't accept Medicare's payment could bill the senior for the rest.

Therefore fees climbed. Congress spent the next 24 years patching it: limits in 1972, a fee freeze in 1984, then a fixed fee schedule and a cap on balance billing in 1989.

Medicare had borrowed the idea from private insurers, who called it "usual, customary and reasonable." Many out-of-network bills are still priced that way.

So the price was never set by what the care cost. It was set by what doctors charged last year.

[Maurice Landers III @maurice3]

@kanavtwt The "remembers every patient" part matters more than any diagnosis demo. So much of the delay in care is patients retelling their history and getting tests redone because records don't follow them. Fix that and you save time and money before the AI makes a single call.

[Maurice Landers III @maurice3]

@nnnanceee Most did, actually. By the late 1950s most Americans had hospital coverage through work, since WWII wage freezes pushed employers to offer benefits instead of raises. What changed was price. Health spending was 5% of the economy in 1960. Now it's about 18%. Cash can't keep up.

[Maurice Landers III @maurice3]

@Liamjsm The $330 gap is the discount Anthem negotiated, and an in-network office has to write it off. So if a bill for the $330 ever shows up later, don't pay it. Call the office, read them that EOB line saying you owe $0, and ask them to fix it.

[Maurice Landers III @maurice3]

@notizzy93 Pick your plan by Dec 15 so it starts Jan 1, and before you book, confirm the surgeon, the hospital and the anesthesia group are all in network on that exact plan. Also ask the hospital for its financial assistance application. Nonprofit hospitals are required to have one.

[Maurice Landers III @maurice3]

You can buy car insurance in June. You can't buy health insurance in June.

That rule traces back to 2010.

Before the Affordable Care Act, insurers in most states could turn you down for a preexisting condition. So they didn't care when you signed up. They cared whether you were sick.

The ACA banned that starting in 2014. But if insurers had to take everyone, people could wait until they got sick to buy a plan.

Therefore Congress paired the ban with two guardrails: a penalty for going uninsured, and a once-a-year window to sign up.

In 2017, Congress cut the penalty to $0, starting in 2019. The window stayed.

So the question changed from "are you sick?" to "what's the date?"

Miss the window, and unless you move, lose coverage, get married, or have a baby, you wait a year. This year it opens November 1.

[Maurice Landers III @maurice3]

This is why it's worth opening every explanation of benefits, even when you owe $0. Fraud like this shows up there first, as visits or tests you never had. If you spot one, call the number on the back of your insurance card and report it. Fake claims can also end up in your medical record.

[Maurice Landers III @maurice3]

AI is great at spotting the duplicate charge. What actually gets the money back is boring: ask for the itemized bill with billing codes, check each code against what Medicare pays, and dispute it in writing. A bill with a code you can point to gets fixed. "This seems high" gets ignored.

[Maurice Landers III @maurice3]

@TURBOPOSSUM Have the surgeon's office send the insurer the exact procedure codes for the growth removal and get a prior auth number before the surgery date. If they deny it, ask for a peer-to-peer review, your surgeon talking to their doctor. Don't go under without that number in writing.

[Maurice Landers III @maurice3]

Ambulances were left out on purpose. When Congress banned surprise bills in 2020, it covered air ambulances but not ground ones, since so many are run by towns that set their own rates. A 2024 federal committee said ban those bills too. Congress hasn't acted, so the bill still lands on you.

[Maurice Landers III @maurice3]

@EkpoIruoghene8 Two things that could have helped Ruth. Losing her husband's plan in March gave her 60 days to buy a Marketplace plan without waiting for open enrollment. And for the MRI, call a freestanding imaging center and ask for the cash price. It's often under $1,000, not $4,800.

[Maurice Landers III @maurice3]

@CBSNews The trap is auto-renewal. Do nothing and many people get rolled into the same plan at next year's price. Log in after Nov 1, compare each plan's premium plus deductible, not just the monthly number, and pick by Dec 15 if you want coverage on Jan 1.

[Maurice Landers III @maurice3]

In a study of 9.5 million prescriptions, nearly 1 in 4 copays was more than the pharmacy got paid for the drug.

The middleman kept the difference. And until 2018, many pharmacists weren't allowed to tell you.

That middleman is the pharmacy benefit manager. It started in the late 1960s as a back-office claims processor with a plastic drug card.

Then in November 1993, Merck bought the PBM Medco for $6.6 billion. The next year Eli Lilly bought PCS for $4 billion. Drugmakers wanted a say in the formulary, the list that decides which drugs your plan covers.

But formulary spots could be bought. Drugmakers paid PBMs rebates to get their brands on the list, and rebates were often a percentage of the list price.

Therefore a higher list price meant a bigger rebate. In 2024 the FTC sued the three biggest PBMs, alleging that system pushed insulin list prices up. Your copay or coinsurance is often based on that list price.

Today those three handle nearly 80% of U.S. prescriptions, and each sits under the same roof as a major insurer.

So the card that was built to speed up paperwork now helps set your price at the counter. Before your next fill, ask for the cash price. Since 2018, the pharmacist is allowed to tell you.

[Maurice Landers III @maurice3]

@YahooFinance If you both have job coverage, price it out before you renew: family on one plan vs each of you on your own employer's single plan, kids on whichever is cheaper. Employer contributions and spousal surcharges vary a lot, so the split sometimes comes out way cheaper.

[Maurice Landers III @maurice3]

@RepBryanSteil Worth doing every single year, because of 2003. The law that created Part D ran drug coverage through private plans and barred Medicare from negotiating prices for decades. So each plan sets its own drug list and can change it every January. Same pills, different bill.

[Maurice Landers III @maurice3]

@BrianRoemmele Finding the error is the easy part now. Getting the billing office to act is the hard part. The output that matters is a written dispute citing the exact line, plus a request to hold the account from collections while it's reviewed. That letter is what actually moves a balance.

[Maurice Landers III @maurice3]

@skumWgmi Pull the EOB for that visit and look at the allowed amount, not the $385. If you haven't hit your deductible, you owe the insurer's negotiated rate, which is often well under the sticker price. If the office billed you more than the EOB says you owe, call and ask them to rebill.

[Maurice Landers III @maurice3]

@avstorm @arcinternet @diabrowser This & little arc is literally whats stopping me from switching

[Andreas Storm @avstorm]

@arcinternet @diabrowser, please add Peek (*optional) 🙏

[Maurice Landers III @maurice3]

@claudeai reverse engineer arc, make it work

[Arc @arcinternet]

We've decided to sunset Arc on December 22, 2026.

That's not an easy sentence to write. We spent years building Arc and celebrating each and every release along the way: we have so much pride and love for what we made alongside the Arc community.

Our priority is to deliver best-in-class security for our members. Keeping a browser secure takes constant, dedicated work that is only increasing in the age of AI. Dia was built from the ground up to meet today’s security standards, so that's where our engineering and security teams will focus moving forward.

We've worked to make switching to @diabrowser as easy as possible for Arc members. Here's how:

· Your passwords, bookmarks, extensions and history come over to Dia seamlessly.
· Spaces, Folders, and Tab Groups are in Dia and import over with your data intact.
· Dia now surpasses Arc benchmarks in stability, speed, and security.
· The browser features you use in Arc are free in Dia, and the AI is optional.

Thank you for using Arc, for pushing us to make it better, and for building alongside us. The team that made Arc is the same team behind Dia, and some of our most ambitious work is just ahead. We'd love for you to be there with us when it lands.