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1/ The “No Surprises Act” is deeply flawed. It should not advance in its current form. Work must continue to reach a meaningful remedy to “surprise medical bills” #SMB that keeps patients out of the middle and provides balance.

Here are several concerns w/ the current proposal:

 2/ The proposal should require that the initial “interim payment” made by the insurer for out-of-network services be considered the plan’s offer for IDR, to incentivize the insurer to pay a fair initial reimbursement.

But, the proposal does not.
3/ The proposal should allow the IDR process to consider UCR and an independent charge-based database. Lest it be a form of price-fixing by insurers since the qualifying payment is indexed to the insurer-set in-network median rate (w/CPIU adjustment).

But, the proposal does not.
4/ The proposal should avoid a complex administrative burden that threatens practice viability and leads to consolidation and higher healthcare costs for patients. Cost effective independent physician practice provides patients choice.

But, the proposal does not.
5/ The proposal should explicitly prohibit the IDR process from considering Medicare, Medicaid, and other public payer rates. These are well known to be below the cost of providing care and these programs are not implicated by the #SMB provisions.

But, the proposal does not.
6/ The proposal should require that ERISA plans must submit claim information to the APCD. The growth of ERISA plans makes this an imperative. Federal statute is necessary to stipulate.

But, the proposal does not.
7/ The proposal should clearly hold all health plans accountable, with enforcement and audit programs, as robust for ERISA plans as for other health plans.

But, the proposal does not.
8/ The proposal should clearly impose penalties on plans that fail to reimburse providers for out-of-network care or that provide false or inaccurate information on their median contracted rate.

But, the proposal does not.
9/ The proposal should omit revenue cycle timelines unreachable for physician practices - small businesses; omit penalties to physicians due to delayed responses from insurers; and limit insurers’ unwarranted opportunities to operate on the float.

But, the proposal does not.
10/ The proposal should explicitly hold out-of-network physicians harmless for erroneous information an insurer includes in its in-network physician directory, especially unbeknownst to the physician and without physician input.

But, the proposal does not.
11/ A flawed #SMB proposal will:

•Further narrow networks
•Limit access to care for patients
•Jeopardize health equity, and
•Put at risk healthcare jobs for employees

This has direct and indirect economic impacts.
12/ A flawed proposal fails to hold insurers accountable for their fundamental role driving #SMB thru:

•narrow networks
•high deductibles with disproportionate cost sharing
•take-it-or-leave-it contracts spurred by market dominance

It rewards insurers reaping record profits.
13/ A flawed #SMB proposal whose CBO score indicates 80% of “savings” comes from cuts to in-network providers while physicians risk our lives fighting a pandemic, sends the message that physician service is not valued.

Esp. now is not the time to rush a flawed SMB proposal.
14/ @PAMEDSociety urges Congress to go back to the drawing board on this: https://t.co/31WYbkbiWp
15/ @AmerMedicalAssn writes “...we oppose enactment of the bill in its current form...”

https://t.co/6vAd9I5VRs
16/ Please see👆 @CongBoyle @RepBrianFitz @CongressmanGT @RepMeuser @RepJohnJoyce @RepDwightEvans @RepDean @RepHoulahan @RepSusanWild @GReschenthaler @MikeKellyPA @RepConorLamb @mgs @USRepMikeDoyle @RepCartwright @RepFredKeller @RepScottPerry 
@RepSmucker @SenToomey @SenBobCasey
17/ Please see 👆 @SenateGOP @senatemajldr @SenateDems @SenSchumer @SpeakerPelosi @GOPLeader @HouseDemocrats @HouseGOP @HELPCmteDems @GOPHELP @HouseCommerce @EnergyCommerce @WaysMeansCmte @WaysandMeansGOP @EdLaborCmte @EdLaborGOP @WhiteHouse @Transition46 #medtwitter

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@jeffreyatucker In the end, it is all a natural consequence of a very human foible, namely that we all do everything we can to blame anybody or anything else for our problems, if we can get away with it. It's the reason why rulers start wars to squelch domestic dissent - macro and micro the same

The very notion of the germ theory of disease revolves around this and while it is good for selling medical interventions, treatments and pharmaceuticals, it is no good for either personal health, or public health in any way. We need to start looking at health on a holistic level

More of a systems approach to health would get us to see that the whole instinct to stamp out viruses, like the very counter-factual notion of "zero Covid," and other nonsense, are driven by this need to blame somebody or something else for our problems, so we can have our cake

and eat it too, i.e. we can pass the blame to others and go and kill them, be they bugs or other people (lockdowns???). The results are disastrous for health on both a personal and a public level, and we continue on a path of assured self-destruction. But times are changing, now.

Lifestyle Medicine @aclifemed provides the new paradigm, more of a systems approach to health, in which personal responsibility for our habits comes first, starting with nutrition. Immune systems become depressed by fatigue, stress, inner conflict, malnutrition and so on. Change
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I'll not leave Riddlersworld. But I'll redefine the notion of riddler. A riddler is a person who doesn't know about specific dates and even about dates in general such as the year things will happen. He only knows, in general, some of the events that will take place,... 1/*

a kind of general history, a plot. In this sense continuing in Riddlersworld goes through an approach of minimums, taking riddlers as what gives an outline of some of the events that could happen at an always unknown date. 2/*

Sure, riddlers intend to convey the idea that they do know the dates, or at least the year, but they don’t know them. 3/*


Take 2020 as an example. At this point of the year you can make so many ad hoc statements as you like, but guys, 2020 clearly meant year 2020. 2020 was the year of the visible "outcomes". 4/*


On November 4, 2019 Mr Pool suggested that outcome of action Plan B is what you have been waiting = price increase. It should have happened in November and December 2020, as Plan B ended on November 7, so the outcome should be those months. 5/*
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@MargeNAlia
Part of what is going on here is that large sectors of evangelicalism are poorly equipped to help people deal with basic struggles, let alone the ubiquitous pornography addictions that most of their men have been enslaved to for years.


On the one hand, there's a high standard of holiness. On the other hand, there's a model of growth that is basically "Try Harder to Mean it More." Identify the relevant scriptural truth & believe it with all of your sincerity so that you may access the Holy Spirit's help to obey.

Helping sincere believers believe and obey the Bible facts is pretty much all the Holy Spirit does these days, other than convict us of our sins in light of the Bible facts.

If you know you are sincere and hate your sin and believe the right Bible facts as hard as you can but continue to be enslaved to your pornography addiction, what else left for you to do? Just Really, Just Really, Just Really Trust God and Give it to Him?

To suggest that there are other strategies available sounds to those formed in this model of growth like one is also suggesting that the Bible is insufficient, but it also suggests something just as threatening- that there are aspects of reality that are not immediately apparent.
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I should mention, this is why I keep talking about this. Because I know so many people who legally CAN'T.

How do I know they have NDAs, if they can't talk legally about them? Because they trusted me with their secrets... after I said something. That's how they knew I was safe.


Some of the people who have reached out to me privately have been sitting with the pain of what happened to them and the regret that they signed for YEARS. But at the time, it didn't seem like they had any other option BUT to sign.

I do not blame *anyone* for signing an NDA, especially when it's attached to a financial lifeline. When you feel like your family's wellbeing is at stake, you'll do anything -- even sign away your own voice -- to provide for them. That's not a "choice"; that's survival.

And yes, many of the people whose stories I now know were pressured into signing an NDA by my husband's ex-employer. Some of whom I *never* would have guessed. People I thought "left well." Turns out, they've just been *very* good at abiding by the terms of their NDA.

(And others who have reached out had similar experiences with other Christian orgs. Turns out abuse, and the use of NDAs to cover up that abuse, is rampant in a LOT of places.)
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Make them irrelevant > Hold a grudge

Holding a grudge is the easy thing to do.

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A grudge puts poison in your body & rewires your subconscious mind.

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Shy people are either overthinking or highly observant of the social setting.

And in many cases it can be both.

'So what do I do?'

You learn the 75/25 law.

'What is that?'

The law of charisma...👇

Let's address the over thinkers first.

Do you have any idea why you overthink?

'Yea. Because others are judging how shy I am.'

Incorrect.

Others are thinking about themselves, not you.

But the fact that you think they are thinking about you, you fuck up the interaction.

Now you stay in your head too much & avoid the present moment.

A major no no in the social world.

Your tendency to think that others are judging you for being shy, coincidentally makes you more shy.

And that's when you start giving off a strange vibration to the social setting.

This is when you begin attracting comments like 'why are you so quiet?'
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Vibhu Vashisth
@VIBHU_Tweet
🌺कैसे बने गरुड़ भगवान विष्णु के वाहन और क्यों दो भागों में फटी होती है नागों की जिह्वा🌺

महर्षि कश्यप की तेरह पत्नियां थीं।लेकिन विनता व कद्रु नामक अपनी दो पत्नियों से उन्हे विशेष लगाव था।एक दिन महर्षि आनन्दभाव में बैठे थे कि तभी वे दोनों उनके समीप आकर उनके पैर दबाने लगी।


प्रसन्न होकर महर्षि कश्यप बोले,"मुझे तुम दोनों से विशेष लगाव है, इसलिए यदि तुम्हारी कोई विशेष इच्छा हो तो मुझे बताओ। मैं उसे अवश्य पूरा करूंगा ।"

कद्रू बोली,"स्वामी! मेरी इच्छा है कि मैं हज़ार पुत्रों की मां बनूंगी।"
विनता बोली,"स्वामी! मुझे केवल एक पुत्र की मां बनना है जो इतना बलवान हो की कद्रू के हज़ार पुत्रों पर भारी पड़े।"
महर्षि बोले,"शीघ्र ही मैं यज्ञ करूंगा और यज्ञ के उपरांत तुम दोनो की इच्छाएं अवश्य पूर्ण होंगी"।


महर्षि ने यज्ञ किया,विनता व कद्रू को आशीर्वाद देकर तपस्या करने चले गए। कुछ काल पश्चात कद्रू ने हज़ार अंडों से काले सर्पों को जन्म दिया व विनता ने एक अंडे से तेजस्वी बालक को जन्म दिया जिसका नाम गरूड़ रखा।जैसे जैसे समय बीता गरुड़ बलवान होता गया और कद्रू के पुत्रों पर भारी पड़ने लगा


परिणामस्वरूप दिन प्रतिदिन कद्रू व विनता के सम्बंधों में कटुता बढ़ती गयी।एकदिन जब दोनो भ्रमण कर रहीं थी तब कद्रू ने दूर खड़े सफेद घोड़े को देख कर कहा,"बता सकती हो विनता!दूर खड़ा वो घोड़ा किस रंग का है?"
विनता बोली,"सफेद रंग का"।
तो कद्रू बोली,"शर्त लगाती हो? इसकी पूँछ तो काली है"।
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12 Most Powerful Hanuman Mantras

Hanuman ji is the Hindu God of strength, valor, agility, and wisdom. He is considered as the incarnation (avatar) of bhagwan Shiva. Hanuman ji is the symbol of devotion and dedication. He is the greatest devotee of Prabhu Shri Ram. 1/n


Hanuman ji is known by several names such as Bajrangabali, Mahabali, Maruti Nandan, Pawanputra, Mahaveer, and Anjaneya. Hanuman ji is the son of Bhagwan Vayu, the wind god.

God Hanuman played a prominent part in rescuing Mata Sitafrom the bondage of demon King of Lanka, Ravana.


One can worship Hanuman ji by chanting Hanuman Mantras. There are many different types of Hanuman Mantras, each fulfilling a specific purpose. Hanuman Mantras help to beget the blessings of Mahabali Hanuman for success. 3/n


Let’s explore these powerful Hanuman Mantras one by one. Here’s the list for you:

1. Hanuman Moola Mantra
!! Om Hanumate Namah !!
ऊँ हनुमते नम:

You can chant the “Hanuman Moola Mantra if you usually face problems and obstacles in your life.4/n
#hanumanjanmotsav


However, the Human Moola Mantra is also a very powerful success mantra.

It’s a Kaarya Siddhi Mantra.

It is highly advised that all those who usually face obstacles and problems in their life should chant the Hanuman Moola Mantra. 5/n
#hanumanjanmotsav
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AAdhira \U0001f319\U0001f1ee\U0001f1f3
AAdhira 🌙🇮🇳...
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Shri Hanuman had boon to be immortal. And be present where ever there is Ram stuti.
I came across this beautiful story that I would like to share
#threadstories
#Hanuman ji is believed to live in the foothills of Himalayas. But once he spent a lot of time in Sri Lanka
1/9


Where Ravan's brother ruled for many years..
On his way back he came across tribal people from community called #Mathanga
He gave Darshan to them. The chief of the tribe asked him to keep coming back to guide their generations
Hanuman ji said that whoever recites this mantra
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I will give them Darshan. But there are two conditions
1st he/she must know his relationship with me
2nd there must not be anyone around him in 950 mts radius. If present, that person must also know about my relationship with him /her.

He promised to come after every 41 yrs
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The Mathangs also maintain a ‘logbook’ where they record all the words spoken and ‘leelas’ performed by Lord Hanuman.
They call him their Guru
Who teaches them how to live their lives.
A Sri Lankan organization called Setuu is studying this ‘logbook’ and also conduct
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programmes for Hanuman devotees who can do ‘Sadhna‘ under the guidance of Setuu masters. Devotees who qualify all the criteria will be eligible for Hanuman’s ‘sakshaat darshan‘
The Setuu has certain conditions that need to be kept in mind which includes devoting one complete
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