Christian|Married Up|Father of Beauties|Over Achiever|Regional Anesthesia Specialist|My comments are my own & retweets/follows don't =endorsement/medical advice
Dallas, TX
Joined September 2013
- Tweets8.7K
- Following1.2K
- Followers1.3K
- Likes10.4K
Pinned Tweet
Health Affairs: Hidden Incentives Drive IDR Volume & Cost, It’s not physicians driving Independent Dispute Resolution surge under the #NoSurprisesAct, it’s insurer “shared-savings” schemes that reward underpayment of physicians & providers costing employers big. Read Below:
Christopher Cook, D.O., FASA retweeted
Congratulations to Dr. Robert E. Johnstone for receiving ASA’s Distinguished Service Award in recognition of his enduring contributions to the specialty as an accomplished educator, researcher and advocate with a career spanning 60 years: asahq.org/about-asa/newsroom…
#ANES26
Christopher Cook, D.O., FASA retweeted
🌴 #ANES26 is taking over San Diego! Over 11K attendees will soon be arriving in "America's Finest City" to explore 350+ educational sessions, 200+ booths in our giant Exhibit Hall. Five full days of learning, new ideas, discovery, and connection—it all starts here 👇
Christopher Cook, D.O., FASA retweeted
ASA President @pgiam005 updates members on ASA's recent meeting with senior DEA officials to discuss #ketamine safety and outdated controlled-substance rules affecting mobile #anesthesiology practices. Learn more in this week's Monday Morning Outreach: ow.ly/mBk850ZVC8n
Christopher Cook, D.O., FASA retweeted
Just seems like no matter what doctors do under this law it’s seen as gaming the system.
The point of the NSA was to
(1) prevent patients from receiving surprise bills
(2) drive doctors and insurers/employers into contracts
Now we get reporting that an employer and physician group negotiated a contract out of the results of the NSA and it is seen as a problem.
So…
(1) take claims to arbitration and win - gaming the system
(2) negotiate contracts with employers based on fair market value, not what the insurer unilaterally says is fair - gaming the system
It’s pretty clear what many wanted out of the NSA… for the government to once again put their thumb on the scale in favor of large conglomerates who have driven costs up exponentially. When the government instead chose to let an independent third party to decide, predictably doctors won on the small (5%) of claims that went into arbitration. The system is fine. It’s just not what the insurers wanted.
High arbitration awards under the No Surprises Act should give providers leverage to demand higher contract prices.
This looks like TeamHealth beginning to use that leverage in direct deals with employers.
Good reporting from @Marketplace:
marketplace.org/story/2026/1…
Christopher Cook, D.O., FASA retweeted
John, to your first point, CA’s AB 72 was signed into law in Sept. ‘16 and is a state commercial insurance rate setting law at 125% of Medicare for OON non-ED services (ED services were already covered by a CA Supreme Ct case known as Prospect Medical Group case). The cumulative growth of ERISA health insurance for both employers and employees exceeded +44% from ‘17-‘25.
MI’s law was enacted in ‘20 (HB 4459) and set a state benchmark for ED and other hospital services at 150% of Medicare. The cumulative increase in MI was 19% for ERISA based health care. Facts are stubborn things—and there is simply no proof that anyone has produced showing that benchmarking physician rates causes lower premiums—full stop.
Christopher Cook, D.O., FASA retweeted
Rep. Pallone (D-NJ) has issued his new bill to reform the #NoSurprisesAct and let me count my top 3-4 reasons why it is a trainwreck for physicians and hospitals (and wait until you see #4):
1. IDR would be eliminated in favor federal rate setting at the "qualifying payment amount" (QPA or initial payment determined by the health plan).
There is no recognition here that the federal district and appellate courts (TMA I, II, III and IV plus 2 appellate court decisions, so 6-0 for the TMA) have found issues with the administration of the QPA and recently that the QPA rules should be void and have no legal effect due to health plans' inclusion of ghost rates and other QPA manipulations (TMA III US Court of Appeals for the Fifth Circuit, Aug. '26).
The Rep. includes the CPI-U adjustment in his bill which is laughable as the current law requires it and few if any plans actually comply with the requirement. One reason--no real audits of the QPA (see #4 below).
Why? The current CPI-U is +28% from a 2019 baseline.
2. No other factors would be considered in final payment--just blatant federal rate setting.
NSA requires acuity of the Pt, prior contract rates, qualifications of the clinicians and one can use the Transparency in Coverage (TiC) data which shows market rates among other factors for the IDRE to consider--none of that for Mr. Pallone.
Ask your colleagues in CA and MI how they like state based rate setting for applicable OON claims?
3. Another laughable provision--payment w/in 30 days but no interest or penalties--and yes that is in the current NSA.
As I have cited so many times here, the data is overwhelming that the plans are in systemic non-compliance with payment. Why would they comply in the future without enforcement, penalties or interest?
4. My favorite--no judicial review of the QPA. The plans have the ultimate and unquestionable power to set the QPA and never be questioned by any physician or hospital in court.
Oh, CMS can audit and that's true today. 4+ years ago CMS announced they were conducting over 20 audits, one has been announced in that time and the plan was out of compliance with setting the QPA.
To the physician and supporting community--time to get ready to become active again to preserve and enhance the NSA.
If that bill above becomes law, independent practice as we know will largely cease for groups actually accepting insurance and patient access to care will greatly suffer.
democrats-energycommerce.hou…
Christopher Cook, D.O., FASA retweeted
This is probably the most misguided and erroneous tweet I’ve seen in 2026.
Ending the 25-modifier will be a great INEFFICIENCY for patients and physicians (and patient families who have to takeoff to bring grandma into the doctor) and will not save money, there’s absolutely no data or even a suggestion that it will.
If @DrOz lets this change go through, I believe it will be one of the most demoralizing policy change
we’ve seen hit healthcare in the last 15 years.
We need to keep the 25-modifier and CMS needs to reject that proposed 2027 change.
This quoted post is unavailable.
Christopher Cook, D.O., FASA retweeted
Attorney General Ken Paxton Investigates UnitedHealth Group for Denying Patients the Coverage They Need and Engaging in Deceptive Practices: texasattorneygeneral.gov/new…
Christopher Cook, D.O., FASA retweeted
🚨INVESTIGATION LAUNCHED🚨
TX AG Ken Paxton is investigating UnitedHealth Group for alleged deceptive and unlawful practices that deny Texans medically necessary care.
Reports claim United has improperly administered benefits and patient-care decisions, including allegations that it bribed nursing homes to delay hospitalizing patients who needed care.
In one Texas case, United approved a prior authorization for a procedure at Austin’s RedBud Surgery Center, then withdrew that approval afterward and left the patient with a large bill.
Paxton also says United’s coverage decisions may amount to the corporate practice of medicine by overriding physicians’ medical judgment, delaying treatment, and increasing the risk that care comes too late.
He has issued Civil Investigative Demands to gather evidence of possible violations of the Texas Deceptive Trade Practices Act and other state laws.
Christopher Cook, D.O., FASA retweeted
Once again our @KenPaxtonTX taking on healthcare giants on behalf of Texans. Love to see this. Could also see the ban on corporate practice of medicine laws finally enforced?
@EPotterMD
🚨INVESTIGATION LAUNCHED🚨
TX AG Ken Paxton is investigating UnitedHealth Group for alleged deceptive and unlawful practices that deny Texans medically necessary care.
Reports claim United has improperly administered benefits and patient-care decisions, including allegations that it bribed nursing homes to delay hospitalizing patients who needed care.
In one Texas case, United approved a prior authorization for a procedure at Austin’s RedBud Surgery Center, then withdrew that approval afterward and left the patient with a large bill.
Paxton also says United’s coverage decisions may amount to the corporate practice of medicine by overriding physicians’ medical judgment, delaying treatment, and increasing the risk that care comes too late.
He has issued Civil Investigative Demands to gather evidence of possible violations of the Texas Deceptive Trade Practices Act and other state laws.
Christopher Cook, D.O., FASA retweeted
NEW: I am investigating UnitedHealth Group for denying patients the coverage they need and for engaging in deceptive practices.
Christopher Cook, D.O., FASA retweeted
@galjs2 gave a great couple of talks to @BSWanesthesia this week as part of our endowed Gillespie Lecture. Biggest takeaway for me: collecting data for @CMSGov MIPS incentives cost more than the actual incentive! @EMARIANOMD @ASALifeline @MBonilla1 pubmed.ncbi.nlm.nih.gov/4092…
Christopher Cook, D.O., FASA retweeted
I was honored to join the Fresh Flow Podcast. We cover workforce, growing demand, NORA, staffing ratios, AI, physician leadership & professional engagement. And stay through the credits for the “Marvel Film Bonus.” 😄 @TSAPhysicians @UTMBProvost @ASALifeline
No Surprises Act: Another federal court rejects an insurer’s attempt to relitigate IDR eligibility. @AnthemBCBS v. AGS Health was dismissed WITH PREJUDICE. The court held NSA judicial review limits cover eligibility not just the payment amount.
@DOGE @RobertKennedyJr @DrOz @realDonaldTrump
@RepRaulRuizMD @DrKimSchrier @RepHerbConaway @herbconaway @MaxineDexterMD @Morrison4MN @RepBera @RepMMM @RepMarkGreen @RepGregMurphy @RepRonnyJackson @RepJohnJoyce @RepNealDunn @RepAndyHarrisMD @RichforGA @RepDesJarlais @SenJohnBarrasso @SenBillCassidy @RogerMarshallMD @DrRandPaul @MikeKennedyUT @BobOnderMO
@RepRaulRuizMD @DrKimSchrier
@RepHerbConaway
@MaxineDexterMD @Morrison4MN
@RepBera
@GOPDoctors
litigationtracker.law.george…
Christopher Cook, D.O., FASA retweeted
Independence Blue Cross to Pay $22.5M to Resolve False Claims Act Allegations
“The government pays private insurers over $530 billion each year to care for Americans enrolled in Medicare Advantage,” said @AAGShumate. “When insurers knowingly and improperly retain inflated payments based on inaccurate and untruthful diagnoses, we will hold them accountable whether they are a small regional plan or a large nationwide organization.”
🔗: justice.gov/opa/pr/independe…
ALT “The government pays private insurers over $530 billion each year to care for Americans enrolled in Medicare Advantage,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “When insurers knowingly and improperly retain inflated payments based on inaccurate and untruthful diagnoses, we will hold them accountable whether they are a small regional plan or a large nationwide organization.”
Christopher Cook, D.O., FASA retweeted
It is hypocritical and cowardly for BCBSA to fault hospitals for using AI to enhance claims while they simultaneously use it every day to automatically down code claims submitted by doctors. They must think we are stupid. Shame on them.
The Blue Cross/Blue Shield Association says that AI is already driving *up* healthcare costs, as hospitals use the technology to find instances where they can bill more for the same level of care. bcbs.com/about-us/associatio…
Christopher Cook, D.O., FASA retweeted
A new HHS‑OIG audit found that most high-risk diagnosis codes submitted by UnitedHealthcare Benefits of Texas for Medicare Advantage risk adjustment were not supported by medical records, resulting in an estimated $24.4 million in overpayments. Learn more: direc.to/fXKf
ALT Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), Submitted to CMS (A-07-24-01215)
Christopher Cook, D.O., FASA retweeted
BREAKING: I am investigating Blue Cross Blue Shield insurance company over denials and delays of urgent and medically necessary care.
Christopher Cook, D.O., FASA retweeted
Personal post script and this is not attributed to any organization that I work for or with as an employee or volunteer.
@BCBSTX specifically cited statements made by me on this platform and from a presentation I made to a national physician organization on the NSA in their lawsuit.
That crossed the line IMHO.
Memo to the senior management of @BCBSTX and their counsel: if you meant to try to discourage or intimidate me from speaking out about your abysmal business practices and conduct, you’ve actually done the exact opposite.
I will oppose you and your minions with every fiber in my being—lace ‘em tight boys as we like to say on the tennis courts—it’s going to get real!
I simply respond with my new motto from John Paul Jones (the founding legend of the US Navy) who uttered this statement on this day in 1779 in an epic naval battle against the British navy: “I have not yet begun to fight!”
And I really did not need additional fuel to oppose the health plans but there you go—LOL!