Mary Bello

I help people navigate the clinical & financial maze of healthcare. Former health system administrator➡️current board-certified Patient Advocate

[Mary Bello @mbello7523]

@DougBrunt @megynkelly loved the book! Put so many interesting pieces of history together in great format and narration. Wanted to save it for the beach but will re-read Rudolf Diesel instead. #3?

[hunter @hxxntrr]

you're about to pay that $14,000 hospital bill. Stop

call the billing department and say five words: "I need an itemized statement"

watch $14,000 turn into $4,200

hospitals don't send you itemized bills by default. they send you a summary. one line. one number. pay this

the itemized version shows every single charge. and that's where the scam falls apart

$78 for a single Tylenol you could buy at CVS for $3 $400 for "room usage" for a room you sat in for 12 minutes $1,200 for "physician consultation"

when a nurse practitioner spent 45 seconds checking your chart $250 for "surgical supplies"

when you got 3 stitches and a bandaid duplicate charges for the same procedure billed twice under different codes

hospitals get away with this because most people never ask. they just pay the summary or let it go to collections and destroy their credit for 7 years over charges that were never real

the call script:

"Hi, I'm calling about account number [X]. I'd like a fully itemized statement showing every individual charge, CPT code, and unit cost. I'm also requesting the chargemaster rate versus what my insurance was billed"

they'll push back. "we already sent your statement." no. you sent a summary. you want the itemized breakdown with procedure codes

once you get it:

step 1: google every CPT code on the bill. compare their price to the Medicare rate for the same procedure. hospitals routinely charge 300-800% above Medicare rates. you now have negotiating leverage

step 2: call back. "I've reviewed the itemized statement. There are duplicate charges on lines [X] and [X]. The charge for [procedure] is $1,200 but the Medicare reimbursement rate is $180. I'd like to discuss a fair adjustment"

step 3: ask about financial hardship discount. every nonprofit hospital has one and many for-profit hospitals do too. most require a simple application. income under $60K-$80K for a family qualifies at most nonprofit hospitals for 40-100% reduction. they won't volunteer this. you have to ask

step 4: if they won't negotiate, say "I'd like to file a formal billing dispute and request review by your patient advocate"

this triggers an internal audit. a different person reviews the charges. errors get caught. bills get reduced

step 5: offer a lump sum. "I can pay $3,800 today if we can settle this account in full." hospitals would rather take $3,800 now than send $14,000 to collections where they'll recover a fraction of the balance

and if it already went to collections? the collection agency bought that $14,000 bill for pennies on the dollar. they'll often take a fraction of the original amount to delete it and walk away happy

you were about to destroy your credit for 7 years over a bill that was mostly inflated charges
five words would have saved you

(i repair credit in 60-90 days, links in my bio)

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Follow Dutch!

[Ge Bai @GeBaiDC]

Voluntary price transparency to gain business vs. Mandatory price transparency for compliance

Appreciate @DutchRojas

[Elon Musk @elonmusk]

Yup

[Ge Bai @GeBaiDC]

"Direct Specialty Care will quickly follow the rise of DPC. This leaves critical care, trauma, and true emergency care only with the health systems and these are much easier to insure."

[Chris Boettcher @chrisboettcher9]

A friend told me recently that his wife whose an MD at a major local hospital is seriously considering leaving medicine.

Not because she stopped caring about patients or long hours but because of the pressure from above.

In her system, every diagnosis comes with the expectation of prescribing the drug that matches the code.

If she doesn’t? She gets questioned. Evaluated. Sometimes even financially penalized through performance metrics tied to “quality measures." This sounds noble but really just means “Did you give the patient the medication the system expects?”

He said she's been dealing with it for a while and it seems to get worse every year.

She didn’t go into medicine to be a cog in a pharmaceutical machine. She went in to actually help people.

But the hospital’s incentives don’t reward lifestyle coaching, nutrition conversations, movement prescriptions, or digging into root causes.

There’s no bonus for helping a patient reverse insulin resistance.

But there's plenty tied to metrics on prescribing statins, GLP-1s, antihypertensives, SSRIs, and anything else that fits neatly into a billing code.

And the saddest part? This isn’t rare.

Between pay-for-performance systems, pharma influence, and hospital revenue structures tied to drug utilization, the entire system nudges doctors away from thinking and toward prescribing.

Many MDs feel trapped: If they want to practice slow, thoughtful medicine there’s no time. Or if they want to focus on root causes there’s no billing code.

If they want to avoid unnecessary meds they risk being flagged for “not meeting standards.” So many of the good doctors are quietly slipping away.

And we wonder why chronic disease keeps rising.

A system that incentivizes prescriptions will always produce more prescriptions.

A system that rewards dependency will always create more dependent patients.

And a system that punishes critical thinkers will eventually lose all of them.

My friend’s wife isn’t leaving medicine. She’s being pushed out of it.

And until we fix the incentives, she won’t be the last.

[Dutch Rojas @DutchRojas]

Republicans could fix this tomorrow.

The question is: will they?
Share if you think it’s time.

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

The overall effect of giving 💰 $40 billion+/yr to the insurers forever via the subsidies is to:
“cover up the coverage, keep the honeypot,sticky and sweet for the big insurers, pay for a product that in many cases is not being used, and charge your children and grandchildren dearly. Oh that pesky math!”
My latest https://t.co/UrbPiau9Xv

[Ge Bai @GeBaiDC]

.@HouseBudgetGOP: "Affordable Care Act premium subsidies were originally available only to people with incomes up to 400% of the federal poverty level. In 2025 that’s approximately $62,600 for a single person and $128,600 for a family of four. The Treasury Department transfers taxpayer funds directly to insurers to cap enrollees’ premium contributions at a certain percentage of their income.

In March 2021, at the height of the pandemic, the American Rescue Plan temporarily extended premium subsidy eligibility to those with incomes above 400% of the federal poverty level, allowing people at any income level to receive subsidies originally intended for those with modest means. In August 2022, the Inflation Reduction Act extended those subsidies through December 2025.

Letting the subsidies go away merely restores the original Obamacare premium-support structure. That preserves access to subsidies for low-income populations, who already comprise 93% of the 24 million who get health insurance through the Obamacare exchanges. The expiration will affect roughly 1.6 million current enrollees. These are the people with incomes above 400% of the federal poverty level who have been receiving subsidies that cap their premium contributions at 8.5% of income. A family of four in Arizona making $600,000, a married couple in West Virginia making $580,000, and a single individual in Vermont making $180,000 all qualify for subsidies.

Simply put, since 2021, Congress has been bribing higher-income Americans to purchase expensive Obamacare plans by hiding the plans’ true price tags using taxpayer dollars. Premiums have increased by nearly 80% since 2014 and more than doubled since 2011. They are projected to rise another 15% to 20% next year. Despite record taxpayer spending on premium subsidies—exceeding $130 billion annually—enrollees still pay average deductibles of $5,000 and out-of-pocket maximums of $21,000 while 1 in 5 of their medical claims are denied. Without Covid-era premium subsidies, these plans would hold little appeal to consumers.

Why are Obamacare plans so unaffordable? The inflationary provisions of the Affordable Care Act—such as the medical loss ratio, mandated “essential” benefits, community rating and premium subsidies—have inhibited insurers from offering affordable and flexible options. The law’s regulatory burdens on providers have also fueled consolidation and driven up service prices. These structural flaws have long been recognized and are a major reason why the ACA, the American Rescue Plan and the Inflation Reduction Act have all failed to gain bipartisan support."

[Dutch Rojas @DutchRojas]

Why do health insurance premiums go up annually?

A great question to start with:

Why Health Systems Get Paid More Than Independent Doctors for the Same Exact Surgery?

Ever heard of an HOPD or an ASC?

If not, you’re not alone.

But if you’re a patient, taxpayer, or employer, you’re footing the bill for the difference.

Let’s break it down.

HOPD =
Hospital Outpatient Department
Owned by a hospital system.
Located on health system property.
Paid like it.

ASC =
Ambulatory Surgery Center
Independent or physician-owned.
Lower overhead.
Higher efficiency.

Same surgeons.
Same procedures.
Same results.
But the prices?
Completely different.

Take a colonoscopy (19 million performed per year).

In an ASC, Medicare pays: $400–$500

In an HOPD, Medicare pays: $900–$1,200+

Why?
There must be a clinical difference.
None. Not one.

Billing difference? A the grift has started. Higher assigned facility fees and political protection.

Why?
Because Medicare adds extra payments just for being a health system even if the care is identical.

Private insurers then anchor their rates to those inflated Medicare numbers.

And health systems don’t just benefit from those rates they’ve structured entire business models around them.

A monkey could build a business model around this… see the point?

Here’s who pays for it:

Patients, in the form of surprise bills and higher deductibles.

Employers, via bloated premiums.

Taxpayers, who fund Medicare and Medicaid.

Independent physicians, forced to compete against a rigged pricing system

This isn’t a free market.

It’s a protected cartel,
designed to reward consolidation.

What’s the fix?

It’s called Site-Neutral Payment:
Same price for the same service,regardless of location.

It’s not radical.
It’s rational.

Let physicians compete.
Let employers and patients save.
Let value determine payment.

Most Americans have no idea this is happening….



[Surgery Center of OK @SurgeryCenterOK]

Surgery Center of Oklahoma founder Dr. Keith Smith believes medicine should operate on true, free-market principles that value the cost of service and the finances of the patient.

Traditional medical pricing models involve behind-the-scenes calculations the patient has no control over. We pride ourselves on a simple, transparent pricing model that is always what it promises to be.

See how we can hep you by visiting https://t.co/9AMqge6CA3.

[Rav Arora @Ravarora1]

Call-to-action 🚨:

Call your Senators and tell them why @DrJBhattacharya and @MartyMakary’s confirmation is critical for public health, science research, and regulation of drugs and food products.

You can mention ending gain-of-function research, root-cause disease prevention, and gutting perverse political/financial incentives in FDA approval process (as we saw in previous admin).

I know there’s a feeling of complacency with how seemingly uncontroversial Marty and Jay are compared to previous nominees who have gotten in, but now is not the time to sit back and relax. These are two anti-establishment doctors who bravely stood up to Covid tyranny to the chagrin of their colleagues.

The NIH and FDA utterly failed us over the past few years as Covid painfully taught us and these institutions are in need of substantial but sensible reformation.

Call your Senators today and show your support for Jay and Marty!

This link will help you find your Senator:

https://t.co/W96WIoCQ6n

[Mary Bello @mbello7523]

@DutchRojas Great idea, looking forward to listening! Always appreciate your content

[Dutch Rojas @DutchRojas]

Welcome to The Rojas Report Trailer, the show that cuts through the noise and exposes the real numbers behind America’s healthcare crisis.

No fluff.
No talking points.
Just the truth.

The Rojas Report will air on X Tuesday mornings at 6:00 a.m.

In this trailer we dive into the healthcare money pit—why health systems are still fighting price transparency, how Medicaid spending cuts are being misrepresented, and why state employees are about to get hit with huge insurance hikes.

• Why health systems don’t want you to know what anything costs

• The truth about Medicaid spending and why it’s still growing despite “cuts”

• How state employees are being forced to cover skyrocketing costs

#TheRojasReport #Healthcare

[Andrew D. Huberman, Ph.D. @hubermanlab]

I asked several different MDs: “What question should people ask to get the best possible care when admitted to the hospital or getting a checkup”?

Answer: “The patient or family member who expresses some/any/lots of knowledge re health & biology activates an extra level of focus, time & attention”.

Sorry MDs, you said it, not me.
Folks: get educated.

[Dutch Rojas @DutchRojas]

Healthcare coverage in America isn’t expensive because it’s complicated.

It’s expensive because it’s rigged.

Think about it:

1. Why can’t you see prices before you get care?

2. Why are physicians told how to practice by people who’ve never set foot in an OR?

3. Why do patients go bankrupt for treatments they need to survive?

It’s not broken.

It’s functioning exactly as designed,
for lawmakers,
governments,
governors,
and corporations….

#healthcare

[Mary Bello @mbello7523]

@drmarkhyman @function 2025

[Elon Musk @elonmusk]

That is just the tip of the iceberg.

The actual fraud and waste in government spending is much higher.

[Mary Bello @mbello7523]

@Flavourenjoyerr Haha!!