Monday, March 19, 2018

Executive Order on Taking Additional Steps to Address the Situation in Venezuela

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (IEEPA), the National Emergencies Act (50 U.S.C. 1601 et seq.), and section 301 of title 3, United States Code,
I, DONALD J. TRUMP, President of the United States of America, in order to take additional steps with respect to the national emergency declared in Executive Order 13692 of March 8, 2015, and relied upon for additional steps taken in Executive Order 13808 of August 24, 2017, and in light of recent actions taken by the Maduro regime to attempt to circumvent U.S. sanctions by issuing a digital currency in a process that Venezuela’s democratically elected National Assembly has denounced as unlawful, hereby order as follows:
Section 1.  (a)  All transactions related to, provision of financing for, and other dealings in, by a United States person or within the United States, any digital currency, digital coin, or digital token, that was issued by, for, or on behalf of the Government of Venezuela on or after January 9, 2018, are prohibited as of the effective date of this order.
(b)  The prohibitions in subsection (a) of this section apply except to the extent provided by statutes, or in regulations, orders, directives, or licenses that may be issued pursuant to this order, and notwithstanding any contract entered into or any license or permit granted before the effective date of this order.
Sec. 2.  (a)  Any transaction that evades or avoids, has the purpose of evading or avoiding, causes a violation of, or attempts to violate any of the prohibitions set forth in this order is prohibited.
(b)  Any conspiracy formed to violate any of the prohibitions set forth in this order is prohibited.
Sec. 3.  For the purposes of this order:
(a)  the term “person” means an individual or entity;
(b)  the term “entity” means a partnership, association, trust, joint venture, corporation, group, subgroup, or other organization;
(c)  the term “United States person” means any United States citizen, permanent resident alien, entity organized under the laws of the United States or any jurisdiction within the United States (including foreign branches of such entities), or any person within the United States; and
(d)  the term “Government of Venezuela” means the Government of Venezuela, any political subdivision, agency, or instrumentality thereof, including the Central Bank of Venezuela and Petroleos de Venezuela, S.A. (PdVSA), and any person owned or controlled by, or acting for or on behalf of, the Government of Venezuela.
Sec. 4.  The Secretary of the Treasury, in consultation with the Secretary of State, is hereby authorized to take such actions, including promulgating rules and regulations, and to employ all powers granted to the President by IEEPA as may be necessary to implement this order.  The Secretary of the Treasury may, consistent with applicable law, redelegate any of these functions to other officers and executive departments and agencies of the United States Government.  All agencies of the United States Government shall take all appropriate measures within their authority to carry out the provisions of this order.
Sec. 5.  For those persons whose property and interests in property are affected by this order who might have a constitutional presence in the United States, I find that because of the ability to transfer funds or other assets instantaneously, prior notice to such persons of measures taken pursuant to this order would render those measures ineffectual.  I therefore determine that for these measures to be effective in addressing the national emergency declared in Executive Order 13692, there need be no prior notice given for implementation of this order.
Sec. 6.  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
Sec. 7.  This order is effective at 12:15 p.m. eastern daylight time on March 19, 2018.

Delaware Proposes Regulation Allowing Elementary Schoolers to Choose Own Gender and Race

Immer rein: Syrer lebt jetzt mit 2 Ehefrauen und 8 Kindern in Deutschland

Antifa-Mordaufruf: „Das Beste sind körperliche Schädigung wie mit Leuchtmunition auf den Kopf schiessen und treffen“

74% Of Americans Believe The "Deep State" Is Running The Country

For the past two years, the long-running narrative, at least that promulgated by the mainstream media which continues to "explain away" Hillary Clinton's loss to Donald Trump, is that Americans had fallen for a massive, long-running fake news scam (in part aided and abetted by the likes of Facebook), which boosted Trump's popularity at the expense of Hillary's as part of some giant "Russian collusion" conspiracy theory between the Trump campaign and the Kremlin (which Mueller was supposed to uncover, but has instead shifted to investigating obstruction, seemingly unable to find anything).
But what if that entire narrative is dead wrong: what if Americans have become so skeptical in the government process and structure, they never needed a "fake news" boost to vote for an establishment outsider?
According to a new poll, that's precisely the case because a supermajority of Americans believes the faction of unelected officials, known as the deep state, is orchestrating policy in Washington, D.C. and effectively running the nation.
The Monmouth University Polling Institute found that no less than 74% of Americans believe in a "deep state" when it is described as a collection of unelected officials running policyOnly 21% do not believe this kind of group exists.
As a result of countless "conspiracy theories" being proven as facts in recent years, chief among which the Edwards Snowden revelations which exposed the NSA as nothing short of "big brother", and the Wikileaks disclosures which revealed how the Democratic Party colluded against Bernie Sanders to promote Clinton's candidacy and countless more such examples, fully 8-in-10 believe that the U.S. government currently monitors or spies on the activities of American citizens, including a majority (53%) who say this activity is widespread and another 29% who say such monitoring happens but is not widespread. Just 14% say this monitoring does not happen at all. Shockinly, there were no substantial partisan differences in these results.
What is even more surprising, is that the poll found than 7 out of 10 Americans polled in each political group, not just Republicans but Democrats and independents as well, believe in a deep state.
31% of Republicans and 33% of independents say they believe a deep state “definitely exists,” while 19% of Democrats believe this.
"We usually expect opinions on the operation of government to shift depending on which party is in charge,” Monmouth University Polling Institute Director Patrick Murray said in a statement. “But there’s an ominous feeling by Democrats and Republicans alike that a ‘Deep State’ of unelected operatives are pulling the levers of power.”
While there is general partisan agreement on concerns about government overreach, there are some notable differences in the level of concern by two very different demographic metrics: race and membership in the National Rifle Association.

Curry Chickpeas with Potato & Spinach #MeatFreeMonday


In this first episode of #MeatFreeMonday it's a delicious combination of Spinach, Chickpeas and Potato, in a traditional Caribbean Curry sauce. Allow Chris De La Rosa of to show how simple it is to make this tasty vegan dish, which also happens to be gluten free as well.

For this vegetarian curry you'll need...

2-3 tablespoon veg oil
1/2 medium onion
4 cloves garlic
1/2 teaspoon cumin seeds (geera)
1/2 scotch bonnet pepper
1/4 teaspoon black pepper
2 1/2 tablespoon curry powder (madras blend)
1 teaspoon Caribbean Green Seasoning
3 large potatoes
1 can chickpeas (rinsed)
1/2 lb baby spinach
1/2 teaspoon salt (adjust later)
2 1/2 - 3 cups water

Breaking The Script & Programming

Level 2 Storm, Pole Flip News, Electroquakes | S0 News Mar.19.2018

Lauren Southern Banned From The UK

Greg Carlwood: The OffPlanet Chat - Hr1 Public


Greg Carlwood: Higherside Goes OffPlanet with Randy Maugans & Emily Moyer

Greg's show and website:

Greg Carlwood from the Higherside Chats comes off planet to talk about his journey into conspiracy, the development of THC as a platform, and his own consciousness-raising grasp of the realm of all things deep and dark. 

In the PATRONS EXCLUSIVE hour 2 we explore the "flat earth" controvery, or shape agnosticism as it were.To hear the full OffPlanet Radio shows plus patrons-exclusive features by joining at $3/month level or higher at:

CIA Declassified Document "Magician walks into the Laboratory”


A Wizard walks into a Laboratory

China Banning People From Transit for Bad "Social Credit" Scores



The slow-motion train wreck of "social credit" systems and the "gamification" of society has moved to the next stage. Now the Chinese government is going to start barring people from flying or riding trains if their social credit score is not up to snuff. China may be the test case for these ideas, but they're already being rolled out in other countries. So what are we going to do about it?

Sunday, March 18, 2018

VEGAN GYOZA | Tofu, Ginger & Scallion Dumplings



Gyoza Filling

14 oz firm tofu crumbled
2 leaves of cabbage finely chopped
1 inch of ginger minced
1 clove of garlic minced
1 small carrot finely diced (1/3 cup total)
100 gr mushrooms* chopped into small pieces
1-2 green onions/ scallion finely sliced
2 tsp oatmeal
1 tbsp soy sauce
1/4 tsp salt
1/8 tsp pepper
1 tsp sesame oil

50 gyoza dumpling wrappers
1 tbsp oil per batch of 15-18 gyoza for steaming and pan-frying

Gyoza sauce

1 tbsp soy sauce
1 tbsp rice vinegar
1 tbsp maple syrup
2-3 ginger slices
1 tsp finely sliced green onion

*We used beech mushrooms but feel free to use any mushroom of your choice (button, enoki, portabello, shitaki, oyster, king oyster...)

Ninurta - The Double Headed Eagle





Russian flag honoring Ninurta, the "royal" prince born of the "double-seed". Anunnaki law of succession to kingship.

Ninurta symbol of Greek Orthodoxy.

33rd degree of masonry.

Scottish Freemasonry


Ninurta, lord of St. Petersburg. The rich and powerful creating the lies and cover-up. Yes, they are all in it together, no exceptions.

Electric Volcanoes, Ionosphere in Magnetic Reversal | S0 News Mar.18.2018

Battle for streets: Arab crime clans ‘infiltrating & undermining Berlin police force’


Alex PietrowskiStaff Writer
Waking Times 
The first two pharmaceutical antidepressants were clinically introduced in the 1950’s, and the conditions they were supposed to treat would have at that time been found in about 50 to 100 persons per million. Today, some 13% of Americans now take antidepressants daily, even though we don’t yet understand the long-term effects of most psychotropic drugs.
As research develops, however, it is becoming  clear that the truth about antidepressants is far different from the rosy picture painted by pharmaceutical marketers,and biased or corrupt research journals.

In a recent study conducted at Zurich University of Applied Sciences in Switzerland, researcher Michael P. Hengartner came to the conclusion that, “antidepressants are largely ineffective and potentially harmful.”
“Due to several flaws such as publication and reporting bias, unblinding of outcome assessors, concealment and recoding of serious adverse events, the efficacy of antidepressants is systematically overestimated, and harm is systematically underestimated.” ~Michael P. Hengartner, Researcher at Zurich University of Applied Sciences in Switzerland
Remarking on the methodology of the study and the meaning of the statistical results is Peter Simons of Mad in America:
“Hengartner questioned why the “massive increase in antidepressant prescription rates over the last three decades did not translate into measurable public health benefits” in the treatment of depression. Although meta-analyses tend to find a small difference between placebo and antidepressant effect, Hengartner argues that it comes nowhere near the “clinically significant” threshold of at least 7 points on the Hamilton Depression Scale. Instead, a difference of 1 or 2 points is a meaningless numerical difference that would not be considered an improvement to a clinician or the person diagnosed with depression.” [Source]
Also noteworthy, the study’s author notes that long-term us of antidepressants actually increases the likelihood that the patient will have a relapse of depressive episodes. This is one of many detrimental known side effects of antidepressants, which were also noted in this recent study, including higher risk of suicide.
“A growing body of evidence from hundreds of randomized controlled trials suggests that antidepressants cause suicidality, but this risk is underestimated because data from industry-funded trials are systematically flawed. Unselected, population-wide observational studies indicate that depressive patients who use antidepressants are at an increased risk of suicide and that they have a higher rate of all-cause mortality than matched controls.” [Source]
The real story on antidepressants is easier to understand by looking at these easy to read infographics which show eight years of collected data, and give us a more accurate picture of what these medications are doing.
If antidepressants aren’t you’re thing, but you’re looking to boost your mood, there are natural and very effective ways of boosting your mood. Meditation is another method that can help people overcome depression and anxiety.
For more on this recent study, review the following source.
Hengartner, M. P. (2017). Methodological flaws, conflicts of interest, and scientific fallacies: Implications for the evaluation of antidepressants’ efficacy and harm. Frontiers in Psychiatry, 8(275). (Link)
About the Author
Alex Pietrowski is an artist and writer concerned with preserving good health and the basic freedom to enjoy a healthy lifestyle. He is a staff writer for Alex is an avid student of Yoga and life.
This article (New Study Finds Antidepressants to be “Largely Ineffective and Potentially Dangerous”) was originally created and published by Waking Times and is published here under a Creative Commons license with attribution to Alex Pietrowski and

China will ban people with poor ‘social credit’ from planes and trains

Vatican Underground Vault & What Goes on There


Vatican Underground Vault and What Goes on There:

The Vatican had transferred half of the Library of Alexandria's holdings into its secret vaults underground before the Library of Alexandria was destroyed the other part of the library's collection was secured in an Antarctica vault.

According to current history the Vatican had not yet existed at the time of the Library of Alexandria but with time dilation (time travel) and alterations of time line incursions as well as secret societies and organizations existing long before Jesus was born, an organization that would have been the beginnings of the Vatican could have secretly existed having an underground vault to remove half of the collection from the Library of Alexandria before it had been burned down.

At the entrance of the Vatican underground vault there are moving and sliding panels of what looks like plexi glass but it is a type of other material not built from glass, these panels act as holographic data storage servers housing digitized collections from the whole of the Library of Alexandria, Sumarian Tablets, and other ancient library holdings from libraries that had been destroyed.

The Vatican Vault Inner Library has separate Main Servers which house backup copies of modern library collections and museums in digitized formats that are not accessed through holographic interfaces but are run on computer terminals in various panels throughout the multiple levels of the server rooms, these server rooms are electronically key coded with encrypted access only to Vatican staff authorized to work on those Inner library sections of the Vatican libraries. The Vatican Vault underground base has several different library sections not just one big secret library holding facility that is on the base.

As well there are levels of working offices above the sliding server panels. These offices have white rooms and corridors as well as almost the same type of sliding holographic interface server panels at the staff desks that have encrypted collection data that the Vatican Staff work on. The Vatican archival collections and data analyst staff sometimes wear VR (virtual reality) visors to access the holographic panel glass like servers in order to fully see the various digitized collections in full video/audio type archived scenes that come up in virtual displays through the VR visors.

The Vatican also has several secret underground physical libraries that house ancient texts, scrolls, metal tablets, as well as archival manuscript rooms.

The artifacts that are rare technologies that deal with time dilation, time travel machines, distortion of realities, teleportation, those types of artifacts are stored under metallic like vaults which look like encased glass, there is also electronic security embedded near the metallic vaults, that has motion tracking sensors, cameras for video and audio surveillance, in conjunction with electrical trip wires with laser tracking capability so whoever is not coded genetically to enter the metallic vault premises can get electrocuted if they cannot provide the proper DNA sequencing codes to enter the premises where the metallic vaults are housed.

In addition to storing large and rare library collections the Vatican vault also collects advanced artifacts (technologies) which house time travel components, memory engram review stations, etc. Good examples of disclosure TV shows describing what the Vatican underground vault is like are Warehouse 13 and the Librarians which either have different warehouses that guard ancient and modern artifacts which are unassuming looking items actually being advanced technological artifacts from Earth's past, alien technologies, and as well hidden library repositories that guard magical devices.

The Vatican's underground vault had been featured in the various Assassin's Creed movies and video games. The Assassin's Creed movies involve seeing memory engram reviewing stations and time traveling artifacts being collected by the Vatican.

How would I know about the Vatican Vault and office spaces, it is part of my memory recall minus the biowall trees and plants they have similar types of office spaces on the ICC Mars Bases as well as what the Vatican Offices look like but the ICC offices do have the biowalls with trees and plants.

Nokia and Vodafone will bring 4G to the Moon


Saturday, March 17, 2018

CIA Agents Running As Democrats In 2018 Elections

The Trivium & Ethos Pathos Logos | Order vs. Chaos

Hacker Adrian Lamo who turned Wikileaks' source Chelsea Manning in to the FBI dead at 37, says father


Enuma Elish - The Babylonian Epic of Creation - Full Text

Vatican removes Guam bishop for sexual abuse

Rare Aurora, Deadly Hail, Water Below | S0 News Mar.17.2018

The Consciousness Quarantine, Skeptiko, & Data From The Fringe


Today on everyone's favorite podcast for conspiracy, paranormal, & the all-around fringe:

Alright Higherside Chatters, as time goes on sometimes it seems like we spend so much time in the alternative, we nearly forget what's really holding up consensus reality.

Because the idea that the physical is all that exists, that consciousness is nothing more than a trick of the brain- has been proven false without a doubt, even in my limited experience.

Not to mention the mountain of research done on remote viewing , near death experience, pre-cognition, dymethaltriptamine, self-healing, and many other phenomenon we can clearly say exist- yet somehow remains completely ignored and dismissed by the gate-keeping “priesthood from on high” of what we call Sciencism.

And that goes for the realm of geopolitical conspiracy too because we have plenty of information to show that our regulatory agencies are more “for show” than safety, we know false flags have been used to start many major conflicts, and it's clear to see that powerful people almost without exception come from the same old network of interlocking secret clubs and think tanks such as Skull n Bones, Freemasonry, Bohemian Grove, the CFR, the Bilderberg group, and the like.....but ask any person on the street and they'll tell you it all amounts to nothing because it wasn't on the evening news.

Well these are things today's guest Alex Tsakiris knows all too well, in that he and I really are on parallel journeys. Alex is the host of the popular Skeptiko podcast and the author of Why Science is Wrong About Almost Everything and he saw the cracks, crevasses, and gaping holes ignored by academia and instead of finding a spoonful of sugar to help that “medicine of denial go down” - he embarked on a podcasting journey to dig into the weirder data and talk to the bright minds and brilliant researchers that were just outside the box, that could tell the stories carefully kept out of the mainstream.

Putin: The New Tsar

Nassim Haramein: You are the master

How to negotiate directly with physicians and hospitals.

As the post-vasectomy head of a healthy household, do I really want to be swimming in the Obamacare risk pool with millions of morbidly obese, perpetually pregnant, HIV infected drug abusers? ­­

This is the written version of the talk that I gave last June at the First ZeroHedge Symposium and Live Fight Club in Marfa, Texas.  The symposium theme was disintermediation, and this talk was titled: How to negotiate directly with physicians and hospitals.
I have more than 15 years of experience negotiating physician practice and hospital payment agreements.  I have worked on site at more than 100 hospitals, surgical centers, and medical practices, in more than 20 states.  Regarding healthcare pricing, billing, and collections practices, I have been a conference speaker, author, and an invited witness at congressional committees.  I am not a doctor, attorney, or accountant, nor am I giving you any medical, legal, or tax advice.  I am not selling anything.  I am merely sharing my experiences and personal opinions.  I am not receiving any compensation or financial benefit for doing this.
If you have Medicare, Medicaid, VA, TriCare, Obamacare, or another subsidized private insurance because you or a family member are employed by the federal, state, or local government, including police and fire, say, "Socialized medicine!"  Now, for your comrades that live outside the USA, everywhere from the socialist utopias of Venezuela and the formerly Great the People's Republic of the United Arab Emirates, repeat after me, "Socialized medicine for the poor...and poor medicine for everyone!"
It's true.  I get to see it firsthand every day.  The wealthiest people from every nation, most with socialized medicine, mostly come to the USA for healthcare, and these people all pay cash.  Why?  Because the USA has the very best healthcare in the world.  I have seen the data, traveled widely, and discussed this with enough physicians and patients to believe this to be true. 
Don't think so?  Just think about the fact that the University of Texas MD Anderson Cancer Center in Houston recently dedicated a new 12 story 626,000 s.f. Sheikh Zayed Bin Sultan Al Nahyan Building for Personalized Cancer Care on April 9th. The celebration included His Highness Sheikh Hamed Bin Zayed Al Nahyan, chairman of the Crown Prince Court of Abu Dhabi in the United Arab Emirates (UAE).  The royal family can afford to go anywhere for healthcare, but they choose to go to the USA.  
 My point is this.  With healthcare, like everything else, you get what you pay for.  If you are on socialized medicine of some form, and not paying for it, then you should not expect to get the best medicine money can buy. 
I want to ask everyone that lives here in the USA, and either you or your private a part of your wages...actually paid twelve monthly health insurance premiums last year, unsubsidized by the taxpayer, scream, "Ouch, that really hurt!"  I know it hurt.  I'm sorry.  And not just the monthly premiums of somewhere around $1,000 for an average family, but add a $5,000 in-network annual deductible, $10,000 out-of-network deductible, and 30% coinsurance, if you actually need to use the insurance, and that really, really, really, hurt. 

Pop quiz!  What fraction of Americans have just $1,000 saved for emergency expenses like the deductible on their health insurance?  We ZeroHedge readers know the answer is only 37%. 

Approximately 63% of Americans have no emergency savings for things such as a $1,000 emergency room visit or a $500 car repair, according to a survey released Wednesday of 1,000 adults by personal finance website, up slightly from 62% last year. Faced with an emergency, they say they would raise the money by reducing spending elsewhere (23%), borrowing from family and/or friends (15%) or using credit cards to bridge the gap (15%).

And, as ZeroHedge readers, I hope every single one of you is in that 37%.  If not, then for God's sake, get your impoverished ass into one of Dave Ramsey's Financial Peace University classes.   Life is too good to spend it as a debt slave.
Primarily, this talk is to educate those of you that are, now, or may be, in the future, responsible for paying for your own healthcare.  It is not directed at the nearly half of America that is now on Medicare, Medicaid, VA, Tricare, government employee insurance, etc., those whose healthcare expenses are the responsibility of the taxpayer, and who are essentially wards of The State.  However, the conversation we are going to have should still be interesting for them, too, and God only knows how long that government gravy train will last, so all of you should really pay attention.
Like all the speakers at this first ZeroHedge Symposium, I am talking about how to, in many instances, remove the middleman, in this case the health insurance company, and how to negotiate directly with healthcare providers, specifically physicians, hospitals, diagnostic facilities, and pharmacies.  This is a discussion about how to negotiate to pay less for healthcare, and not a discussion about how to not pay for healthcare. 
As I learned in Heinlein's great book, The Moon Is A Harsh Mistress, TANSTAAFL.  It stands for: There Ain't No Such Thing As A Free Laproscopy.  Which means if you aren't paying for your healthcare, then I am.  Unlike the good ol' days in America, when we had a choice to fund our local hospital via charity, and could feel good about doing so, in 2017 America, the Supreme Court has determined that we have no freedom of choice to donate to a charity.  We are now required to pay for other's healthcare, upon threat of imprisonment by the IRS.  It's sure hard to feel good about that.
My presentation, today, will mostly be limited to technique and tools, that is, how to negotiate. Why we should negotiate directly for healthcare is mostly outside of the scope of my presentation, but I imagine we will probably get more into that during the discussion to follow.
You are going to need five things, which I am going to give to you, today, free of charge!
1)  Some absolutely critical industry vocabulary
2)  A clear understanding of how healthcare is priced in the USA
3)  Insight into to actual pricing
4)  A proven negotiation strategy, including:
        a.       The point of contact
        b.       Foreknowledge of what prices medical providers will usually agree to
        c.        A sample offer and agreement
5)  The confidence to successfully negotiate
Unfortunately, I couldn't come up with a better way to impart to you an understanding of the industry lingo, other than these simple handouts.  However, this information is so important for you to be able to understand any negotiation strategy that I simply must slog through each term with you now.  Please, I ask that you hold your questions and comments until I get through the vocabulary.  Many of the terms are cross-referenced, and will become more clear after we here them all. 
Premium:  The monthly amount enrollees pay the insurance company to be covered.
Deductible:  The amount paid by the member before insurance will begin to reimburse services.  It is reset annually, and based on the level of benefits or amount of premium paid.  For example, with a $1,000 deductible the patient must pay medical providers for the first $1,000 of allowable expenses incurred by the patient each year, after which costs may be split according to a coinsurance arrangement, and/or may be limited to the patient’s out of pocket expenses.
Coinsurance:  A cost-sharing requirement of some insurance plans where the patient assumes a percentage of the costs for covered services after the amount of the deductible has been met.  Coinsurance is described as a ratio, for example 30/70, meaning the patient is responsible for paying 30% and the insurance will pay 70% of the allowable.
Copayment (co-pay):  The amount to be paid to a physician by or on behalf of the patient in connection with the services rendered by the physician.  It is due at the time of service, is a fixed dollar amount determined by the insurance company based on the level of benefit, and is usually found printed on the patient’s insurance card.
Out of Pocket Expense:  The total of covered health care expenses that are paid for by the member or patient, not including any premium.  This is typically the total of the deductible and any coinsurance paid during a year.  It may be a maximum amount where after 100% of allowable expenses are paid by the insurance company.
Explanation of Benefits (EOB or ERA: Electronic Remittance Advice):  The insurance company’s explanation of the benefits they have, or have not, paid to a medical provider, along with any remaining amounts for which the patient is responsible, if any.
CPT code:  Current Procedural Terminology codes maintained by the American Medical Association. These five digit codes describe most medical, surgical, and diagnostic services and are used for administrative, financial, and analytical purposes such as on fee schedules and bills. These CPT codes are also known as Level 1 HCPCS codes, with Level 2 HCPCS codes being for non-provider medical services like ambulances and prosthetic devices. The CPT code is equivalent to a part number, SKU Stock Keeping Unit, or UPC Universal Product Code.
Inpatient Prospective Payment System (IPPS): A system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance).  Under IPPS, each case is categorized into a diagnosis-related group (DRG).  Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
Diagnosis-Related Group (DRG): a system to classify hospital visits into similar groups.  Its intent is to identify the products that a hospital provides, such as an appendectomy.  DRGs are assigned by group based on diagnosis (ICD code).  DRGs may be further grouped into Major Diagnostic Categories (MDCs).  DRGs are used to determine how much Medicare and some insurance plans pay hospitals and other services like home health.
ICD code:  The International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.  Supposedly, every health condition can be assigned to a unique category and given a code.
Billed charges (usual and customary fees): The undiscounted fees a healthcare provider lists on the bill (list price, or retail).  These fees are usually set well above the highest allowable of all the provider's contracts, sometime as much as 800% or even 1,000%.  The purpose of this overpricing is to force the insurance companies to the negotiating table. 
Allowable:  The discounted fee for service a healthcare provider has contractually agreed to accept from an insurance company.  It is listed by CPT code on the EOB or in a fee schedule available from your insurance company, Medicare, or Medicaid.  UNDERSTANDING THIS TERM IS THE KEY TO UNDERSTANDING HEALTH INSURANCE AND TO NEGOTIATING DIRECTLY WITH MEDICAL PROVIDERS.
Global Period: The number of days after a medical procedure when the fee for office visits is included, contractually, in the allowable for the procedure.  It is typically 30, 60, or 90 days. 
Elective: For our purposes, care for any medical condition that is not an emergency.
Emergency:  A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, and/or serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part.
EMTALA: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department of a hospital with an emergency condition to be stabilized and treated, regardless of their insurance status or ability to pay.
Insurance Verification:  the process where a healthcare provider contacts the financially responsible party (usually an insurance company, Medicare, or an employer) and verifies that coverage is in effect and the information current.  This generally includes the amount of the deductible met by the patient, copayment amounts, and coinsurance terms.
Precertification: The process of obtaining approval from insurance, in advance, for a proposed treatment or diagnostic test, and is NEVER required for emergency care.
Medicaid: The United States health program for eligible individuals and families with low incomes. It is a means-tested program that is jointly funded by the states and federal government, and is managed by the states.  Generally is the lowest allowable fee for medical care.
Medicare: a social insurance program funded by taxes and administered by vendors hired by the United States government.  Medicare provides health insurance coverage to people who are aged 65 and over, or who meet other special criteria such as a disability.  Generally it reimburses close to the average allowable fee for medical care.  It is the easiest fee schedule to access at:
Tricare:  Health insurance for military personnel and their dependents.
Workers Compensation:  Insurance that provides medical care for employees who are injured in the course of employment.  It is usually has the highest allowable fees for medical care.

OK.  We made it!  That is it for the confusing industry lingo.  Sorry to do that to you, but if it wasn't so difficult, then people might actually understand how our healthcare system works, and the powers that be certainly do not want that! 
Before we start looking at how healthcare is priced in the USA, are there any questions, comments, or burning desires regarding the vocabulary?
To begin to understand how healthcare is priced, we are going to look at 1) the doctor's bill given to a patient, 2) the claim forms the doctor and hospital send to the insurance carrier, and 3) ERAs that the insurance carrier then send back to the patient and the providers.
As we have already learned, all healthcare services have been assigned a code by the AMA, a five digit CPT code.  So, if you trip and fall off your patio, you might get a doctor’s bill like the following table located in your handouts:

On the hospital’s bill you might see something like this:
It is important to understand that the amounts shown on both of these bills are un-discounted Billed Charges (Usual and Customary Fees).  They are the highest price the provider might ever hope to receive for the service, also known as full retail, or MSRP.  Don’t panic when you get these bills, because as everyone knows, “Never pay retail.”
You may receive other bills from several doctors such as anesthesiologists and radiologists, as well as laboratory services, therapists, and the ambulance company.  The bills all look similar, and the strategy and tactics I am presenting, today, should work for each of them as well.
If you have insurance, the providers will send your carrier a claim with essentially the same data as is on the bill they will provide to you if you are not insured, or if you simply request a copy. 
An important fact is that Federal Law, as a requirement for the medical provider’s participation in Medicare, requires that a medical provider charge every patient the same amount for a given CPT item.  What it does not require, however, is that a medical provider accept the same payment amount from every patient for a given CPT item.  This allows insurance companies, government payers, and you to negotiate a discounted fee, known as a contracted allowable, and not be in violation of the law. 
The purpose of this overpricing by the medical providers is to force the insurance companies to the negotiating table.  The insurance company is bringing a large volume of patients to the medical providers, the members in their network, so they are able to negotiate a lower discounted allowable fee from the medical providers.  However, if the insurance carrier is not able to negotiate a contractual allowable fee schedule, then they will end up paying the higher billed charges of the out-of-network provider for the members that still end up being treated by that medical provider in emergencies when precertification is not required. 
This creates a tiered-pricing structure for medical services that looks very much like this table in your handouts:
At this point, if you are paying close attention, then it should start to dawn on you where I am leading you with this talk, which, after all, is titled: How to negotiate directly with physicians and hospitals. 
Spoiler Alert:  You are learning how to negotiate for Medicare rates, at worst, and Medicaid rates, at best.  In our example, a bilateral elbow fracture patient in Texas received surgeon and hospital bills totaling $179,219.  Medicare allows $30,542 and Medicaid $22,600, which means the government negotiated an 83% or 87.4% discount, respectively.  You can too!
Before we move on to providing you with access to these fee schedules, and then a negotiation strategy, do you have any questions about how healthcare is priced in the USA? 
Now, on to where you can find these prices.  Well, if you have insurance, then after you receive medical care and the healthcare providers send their claims to the insurance carrier, you should receive from the payer an Explanation of Benefits (EOB), or you probably can go online and view an Electronic Remittance Advice (ERA).  For every CPT code that the providers billed , you will see both a billed charge and allowable. 
Quick show of hands: how many of you have received a medical bill, or an EOB, and threw it away because you could not understand it?  That is intentional!  They want you to be confused.  However, after today, I doubt that you will ever do that again. 
What if we do not have insurance, or we want to know the allowable, because we think this is important information to know so that we can negotiate before receiving healthcare?  Think having a baby or elective surgery.  Do not worry!  The federal government provides us with the Medicare rates online, and I believe that each state provides its Medicaid fee schedules online. 
You would soon discover, however, that it is much easier to determine the allowable for a physician service than a hospital service, for which you will likely need to look up the DRGs for the ICD codes and then try to cross-reference them with the IPPS Fee Schedule, at a minimum, or you may even need to look up and calculate conversion factors.  It is not easy, again, intentionally so! 
Regardless, we would first need the CPT codes for the services you are seeking from the physician, and probably the ICD codes, too, in order to price hospital services.  You could try to guess at the diagnosis and the services you think the doctor is going to provide to you, and then try to use a search engine to determine the ICD codes and CPT codes, or buy a coding book. 
"I know I need a hip replacement.  My trainer at the gym told me so.  I'll just Google, hip replacement ICD and CPT code."
Good luck with that!  The odds of you guessing the correct diagnosis and appropriate procedures (without going to medical school) are incredibly slim, especially with the new ICD-10 diagnosis codes.  Also, chances are good that your athletic trainer doesn't know what the hell she is talking about when it come to medicine, and in reality, you probably just need a new athletic trainer, and not a new hip. 
Is your head spinning, yet?  Good!  Now, stop it, because you will see that we don't need to do any of that!  It's all just a red herring designed to keep us confused and the health insurers in business and profitable.  Sounds a lot like our banking system, no?
Fortunately, as you will now learn, there is a much more simple and better way to be 100% certain of your diagnosis, diagnosis code, procedure, procedure code, and even the medications the physician will offer you, at least for elective conditions. 
Here it is.  If it isn't an emergency, then make a doctor's appointment! 
You may be thinking, "Isn't that putting the cart before the horse?  Don't we want to know the costs in order to negotiate the fees before the services are provided?"
The surprising answer is, no!  
Why?  Well, because we only need to negotiate the fee schedule, specifically, Medicare or Medicaid, and not the exact fee.  This is very important.  Think back to the tiered-pricing structure.  
Eventually, we may want to know the actual (or sometimes estimated) allowable amounts in order to budget for elective procedures, but this occurs after, or at the time of the physician's office visit, when they can provide us with the ICD codes, CPT codes, and usually the allowable amount, too!  Later, we may choose to audit the allowable amount they give us, to make sure it is correct, and we were not over charged, but this is seldom done, as most people still trust their doctor, and the discounts you will be receiving are so HUGE you may feel a little guilty.  Also, I will tell you, the auditing process is very tedious, not to mention the appeal process. 
Therefore, we are now going to start talking about a negotiating strategy before we even attempt to access any pricing data.  Again, we first need to know the diagnoses and proposed treatments.  So, the solution is to start with a simple negotiation with the physician's office, probably just for the cost for the initial office visit, at the very least, and maybe some expected diagnostic tests.  This is best done over the telephone, is easier and more successful than you might think, and is analogous to finding a mechanic to, "just take a look," at your car and tell you what is wrong with it, and then getting an estimate to repair it.  Just like we expect to pay a little bit for the mechanic to diagnose our car, we should expect to pay a little bit for the doctor to diagnose us.  The funny thing is that my mechanic and Medicare both charge or allow about $100 for a diagnosis.  This is not so funny if you are the surgeon that spent 13 more years in school than the auto mechanic with a high school diploma.   
Here we go, step by step:
1) I usually prefer to skip the added expense of going to a GP or family practice intermediary just to get a referral to a specialist that can actually help, especially when I can determine what medical specialty is likely to be most helpful for by medical condition by visiting the website of the American Board of Medical Specialties.  (Is your ignition system acting up, your suspension riding a little rough, need new tires, brakes squeaking, transmission grinding?)
2) Use the links on to visit the appropriate specialty board's website, and then use their "find a physician" with the sub-specialty likely to be most helpful for the condition
3) Start calling the sub-specialty physician offices listed, tell them you are a prospective new patient, and ask to speak to the Business Office Manager.  Ask him or her the following questions:
   a) "Do you accept Medicare and/or Medicaid insurance?"  If yes, then...
   b) "Super!  Do you accept cash payment at the time of service?"  If yes, then...
   c)  "Great!  Then, of course, you will accept as payment in full, the Medicaid allowable, but paid in cash by me to you, directly, at the time of service?  Correct?"  If yes, then (e).  If no then (d).
   d) "I guess I understand.  Well, then surely you will at least accept as payment the Medi­care allowable, paid in cash by me to you, directly, at the time of service?  If yes, then (e).  If no then conclude the call, because you cannot fix stupid.
   e) "Thank you!  Can you please tell me what the estimated amount is for an office visit, using this fee schedule, so I can know how much money to bring, and please make a note on my account that we have negotiated a Single Case Agreement for me to pay these rates to you, in cash, at the time of service?
   f) Tell him or her your specific reason for the visit (I am leaking red fluid on the floor of my garage) and that you want to be fully prepared for the visit.  Ask what diagnostic tests, if any, are usually required for this type of problem, lab, X-ray, CT, MRI, ultrasound, etc., and which ones would probably need to be done outside the physician's clinic? 
   g) Make sure to get the BOM's name and contact information, and the appointment time and date.

After your office visit, if it turns out that you need a procedure such as day surgery at an Ambulatory Surgery Center (ASC), an inpatient admission at a hospital, a diagnostic test like an MRI or CT, or a series of treatments such as physical therapy, then you simply repeat the above negotiation, starting with the facility your physician recommends, and in the case of a hospital or ASC, always where he or she has privileges.  ASC's allowable rates are always much lower than a hospital, so act accordingly.  When telling the BOM that you are a prospective new patient, make sure to give the name of your physician.  Instead of just making a note of any negotiated agreement in your account, the BOM and you should execute a written Single Case Agreement.  It is usually a one-page agreement that looks something like this sample found in your handouts: