Harvard Risk Management Corporation Thrives In Niche Market

June 26th, 2017

Last year our agents earned over 114 million dollars in commissions and we plan to double that in 2017!  Read the rest of this entry »

San Antonio Company Provides Stop Loss Insurance

June 26th, 2017

SA Benefit Services, LLC principals have more than 30 years of combined stop loss experience. We provide stop loss services to third party administrators, consultants, brokers and direct with self-funded groups who have no broker of record. We use only A Rated stop loss carriers.

Read the rest of this entry »

Texas Hospitals Fear Losing $6.2B Medicaid Deal

June 26th, 2017

Medicaid in Texas is a $29,000,000,000 ($29 BILLION) business………………...

Read the rest of this entry »

54 Healthcare Blogs To Read

June 25th, 2017

Staying on top of new developments occurring at breakneck speed poses a challenge for healthcare professionals……………

Read the rest of this entry »

What Is A QSEHRA ?

June 24th, 2017

Hint: A QSEHRA is something conjured up at the Puzzle Palace in Washington DC…..

Read the rest of this entry »

AMPS Ranked Among Top Fastest Growing Middle Market Company in Georgia

June 24th, 2017

The Atlanta Chapter of the Association for Corporate Growth has identified AMPS among the top 40 fastest growing middle market companies in Georgia………….

Read the rest of this entry »

Cimarron Healthcare Capital Announces Recapitalization of AMPS

June 24th, 2017

“Last year AMPS grew by over 70% and we are on a financial track to do the same this year, and we see this strategic investment extending the significant growth we have enjoyed over the past five years.” – Mike Dendy

Read the rest of this entry »

Georgia Hospital Sues Blue Cross

June 24th, 2017

The hospital claims BCBS of Georgia is refusing to pay contractually agreed-upon rates.

Read the rest of this entry »

Single Payer Healthcare Dies On Left Coast – Liberals Outraged

June 24th, 2017

“Acting in secret in the interests of the profiteering insurance companies late Friday afternoon abandons all those people already threatened by Congress and the Trump administration” – Deborah Burger

Read the rest of this entry »

Insurance Agent E&O Coverage in Minutes

June 23rd, 2017

Get Insured 24/7 has the lowest rates for Errors and Omissions Insurance, providing affordable, easy access to protection for the unexpected. Use our secure portal to enroll and bind in minutes, wherever you are, whenever you want. Pajamas welcome.

Read the rest of this entry »

Rand Paul: Insurance Should Be Available For $1 a Day

June 23rd, 2017

“What I’d like to do is legalize inexpensive insurance, and you should be able to get insurance for $1 a day” – Rand Paul

Read the rest of this entry »

Questcor Finds Profits, at $28,000 a Vial

June 23rd, 2017

The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial…………….

Read the rest of this entry »

Green Imaging

June 23rd, 2017

MRI’s can start as low as $250…………Compare that to $2,000, $3,000, $4,000 and more elsewhere………..

Read the rest of this entry »

Vxtra Partners

June 23rd, 2017

Vxtra Partners was founded in 2004 to address the financial inequities, lack of transparency, and technology challenges associated with traditional health care benefits.

Read the rest of this entry »

Hospital Stocks Rally

June 23rd, 2017

Hospital stock prices jumped on Thursday as investors reacted to the Senate’s proposal for repealing and replacing the Affordable Care Act.

Read the rest of this entry »

Senate Republicans Post ACA Change Bill Draft

June 22nd, 2017

Congressional Aide Drafts Healthcare Bill 

The bill will “ultimately transition away from Obamacare’s collapsing system entirely so more Americans won’t be hurt,” McConnell said Thursday on the Senate floor.

Read the rest of this entry »

Simplifying Payments…………….Simplifying Healthcare

June 22nd, 2017

Accresa is an innovative payment platform that connects physicians, employers and employees…………..

Read the rest of this entry »

Reference Based BULL-ING………..A Primer For Hospitals

June 22nd, 2017

“As any person being bullied knows, and as Freud has written, there are two options: 1. Fight or 2. Flight” – Shawn Gretz

Read the rest of this entry »

Job Opening – Health Insurance Consultant

June 22nd, 2017

“This could be a career opportunity of a lifetime. We are building something unique……….”

Read the rest of this entry »

McAllen ISD Seeks Competitive Proposals for Self-Funded Health Plan

June 21st, 2017
Incumbent Group Rep. Expresses Angst
Tis the season for competitive RFP’s in the Lower Rio Grande Valley, Texas. Here is the latest………..

Read the rest of this entry »

Your Insurance Committee is Stupid

June 21st, 2017

“Your insurance committee is way out in left field! Why would anyone want lower benefits at a higher price!” offered the consultant.

Read the rest of this entry »

The Alabama Physicians and Dentists Direct Pay Act.

June 20th, 2017

Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it…………..

Read the rest of this entry »

Selerix

June 20th, 2017

Selerix Systems produces software (BenSelect) to facilitate communication, enrollment, and end-to-end benefits administration for both core and voluntary insurance products. This software is licensed to and used by carriers, brokers, and employers.

Read the rest of this entry »

Health Care 50 Years Later

June 19th, 2017

In 1967, our population was 204 million and our national health expenditures were 46.5 billion, 5.7% of our GDP or $253 per person. Today, for our population of 330 million, they’re $3.2 trillion, 17.8% of our GDP and $9990 per person…….

Read the rest of this entry »

TRS Announces Rate Increase For TRS ActiveCare Program

June 19th, 2017

“It is a program without any sense of risk management, so this will continue to be the pattern until they kill it.  One of the biggest issues is the consulting firm, which has worked with them forever and is not even located in the State.” – Insurance Consultant

Read the rest of this entry »

Nevada Governor Vetoes Medicaid-For-All Bill

June 19th, 2017

Gov. Brian Sandoval vetoed a bill that would have would have made Nevada the first state to attempt a Medicaid-for-all approach to health insurance

Read the rest of this entry »

TAGCO Provides Retiree Healthcare Solutions for Employers

June 17th, 2017

The TAGCO Multiple Employer Trust offers employers the benefits and advantages of buying Retiree Medical through the pooling of statewide Retiree Medical risk(s). The program serves residents of Arkansas, California, Louisiana, Montana, Oklahoma, South Carolina, Texas, Virginia, Colorado, Illinois, Iowa, Michigan, Nebraska, North Carolina, New Mexico, Tennessee, Utah, and Wyoming.

Read the rest of this entry »

Why Employers Need To Offer Retiree Healthcare Benefits

June 17th, 2017

Take a total benefits approach. This approach could help minimize liabilities while maximizing total benefits spend. Additionally, savings in one benefits area could allow additional funding for new retiree healthcare solutions……………….Coupling retirement healthcare with Reference Based Pricing strategies may accomplish this goal…………..

Read the rest of this entry »

Nevada Forces Drugmakers to Reveal Insulin Pricing, Profits

June 16th, 2017

The law requires drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin…………….

Read the rest of this entry »

Controlling Medical Costs In Self-Funded Employer Benefit Plans

June 14th, 2017

This paper will address the cost drivers and why the traditional solutions are becoming more and more ineffective…………….

Read the rest of this entry »

PPO Networks: The Devil Employers Think They Know

June 14th, 2017

Is the fox is watching the henhouse? The abuses that can and do exist under this model are egregious…….

Read the rest of this entry »

4 Mistakes Businesses Make When Managing Health Care Expenses

June 14th, 2017

 Mike Dendy

I recently met with a Fortune 100 company and posed the question, “how much are you paying for hospital services within your PPO network”? They had absolutely no idea. I was not at all surprised, as the actual cost of services is well hidden within a labyrinth constructed by big healthcare companies, their PPO organizations, and their “partner” hospitals.

Read the rest of this entry »

The Evolution of Reference Based Pricing Plans

June 13th, 2017

The number of employers implementing RBR plans is increasing, especially in markets where providers have shown a willingness to accept “reasonable” reimbursement……………..

Read the rest of this entry »

Lucent Health Solutions Inc., Acquires Cypress Benefit Administrators

June 13th, 2017

Nashville, Tennessee, June 7, 2017- Lucent Health (@LucentHealth), the leading Healthcare Risk Management, Administration and Advisory Services company, announced today that it has acquired Appleton, Wisconsin-based  Cypress Benefit Administrators.

Read the rest of this entry »

Crack Healthcare Costs with Cash

June 13th, 2017

Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

Read the rest of this entry »

How To Evaluate A PBM Offer

June 13th, 2017

Mildred Honeycomb, Famed PBM Professor at MMU

A two sentence tutorial on how to evaluate a PBM proposal…………………..

Read the rest of this entry »

Switch Operators Scheme to Undermine Plan’s Cost Savings Efforts

June 13th, 2017

Switch operators are like the Wizard of Oz: They’re hidden behind a curtain and being paid by manufacturers to end-run your cost-savings efforts. Therefore, you need to pull back the curtain, understand their machinations, and respond.

Read the rest of this entry »

Mulebriar Vents, Threatens Tahiti Move

June 13th, 2017

A large taxpayer supported employer now knows they are overpaying for health care……

Read the rest of this entry »

How An Industry Shifted From Protecting Patients To Seeking Profit

June 11th, 2017

In 1993, before the Blues went for-profit, insurers spent 95 cents out of every dollar of premiums on medical care, which is called their “medical loss ratio.”

The average medical loss ratio is now closer to 80 percent. Some of the Blues were spending far less than that a decade into the new century.

The medical loss ratio at the Texas Blues, where the whole concept of health insurance started, was just 64.4 percent in 2010.

Read the rest of this entry »

Employers May Become Their Own PBM

June 10th, 2017

Another form of direct contracting is when a plan sponsor outsources the administrative systems and support functions required to operate as a PBM, to a third-party vendor. These vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services.

The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsor’s of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.

Read the rest of this entry »

Why GE, Boeing, Lowe’s, and Walmart Are Directly Buying Health Care for Employees

June 9th, 2017

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

Read the rest of this entry »

Rosenthal’s Ten Commandments

June 9th, 2017

“In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.”

Read the rest of this entry »

Sprinklecare & Spitballs

June 9th, 2017

“So we spit-balled some ideas around and came up with this: The one package people are highly pleased with is Medicaid………………”

Read the rest of this entry »

Listserv Group Discusses Santa Claus & Single Payer System

June 8th, 2017

Politicians act the way they do because Santa Claus is here and here to stay………..

Read the rest of this entry »

“ERISA Fiduciary Largest Undisclosed Risk I’ve Seen in My Career”

June 8th, 2017

  David Chase

Emerging Litigation Could be the Savior to Our Dysfunctional Healthcare System. Here’s how………………..

Read the rest of this entry »

Former Pharma Reps School Docs on High Drug Costs

June 8th, 2017

As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year. Then he joined the Traitors Club of former pharma reps……….

Read the rest of this entry »

Telemedicine For Marijuana Lovers

June 8th, 2017

HelloMD is a service that uses telemedicine to connect people with doctors willing and able to prescribe medical marijuana…………………

Read the rest of this entry »

Loaded Dice – PBM’s Are Winning The Cash & Rebate Game

June 7th, 2017

“Taken from a scene in the holiday classic, A Christmas Story, I double dog dare you now to ignore the new information I’m about to share with you” – Tyrone Squires

Read the rest of this entry »

Sun Life Reports +$1 Million Claimants Up 26%

June 7th, 2017

“The total of all Sun Life Stop-Loss claims reimbursements from 2013 to 2016 was $2.7 billion. If those stop-loss claims reimbursements are added to first-dollar catastrophic claims costs (the amount that employers pay before reaching the stop-loss deductible), the overall cost for catastrophic conditions was $6.1 billion…. Million-dollar+ claimants were up 26% compared to 2012-2015. In 2016, this group represented only 2.2% of claimants but accounted for 23% of all stop-loss claims reimbursements.”

Read the rest of this entry »

This Man Will Help You Get Out of Expensive Medical Bills

June 7th, 2017

I’m angry that people who don’t understand and can’t help themselves and don’t know how to fight back are getting ripped off every day.” – David Silverstein

Read the rest of this entry »

How To Reduce Health Care Costs & Improve Benefits At The Same Time

June 7th, 2017

davechasebook

We learned back in 2007 that we can reduce health care costs for our clients by 40-50% while improving benefits at the same time. Few listened then, afraid to break away from the status quo. Now we find articles like the following one by Dave Chase. This, and his upcoming book, is a Must Read for employer sponsored health plans – Bill Rusteberg

Read the rest of this entry »

Fiduciary Duties – You Mean that Stuff Applies to the Health Plan I Sponsor, Too?

June 6th, 2017

poyner

In the summer of 2016, over 100 of CIGNA’s self-insured health plan clients were sued with the complaint alleging breach of the defendants’ fiduciary duties under ERISA for engaging in widespread fraudulent behavior involving the use of plan funds. This case should serve as a wake-up call for employers sponsoring health plans nationwide – this will not be the last case of its kind to be filed.

Read the rest of this entry »

“Tax The Rich!” Liberals To Drive Aetna From State After 164 Years?

June 4th, 2017

thatcherq

The Aetna insurance company has been based in Hartford, Conn., since 1853, but this week it said it is looking to move to another state…………

Read the rest of this entry »

San Benito ISD Believes Practice Makes Perfect

June 4th, 2017

practiceNeed practice in responding to a Request for Proposal for Group Health Insurance? If so the San Benito Independent School District is here to help you……………..

Read the rest of this entry »

Express Scripts Lawsuit Reveals Dark Secrets

June 3rd, 2017

cookie

No one has been able to determine how much a  PBM is profiting from its secret “deals” with manufacturers………..Express Scripts lawsuit raises eyebrows…………..

Read the rest of this entry »

BCBS Aggressively Tackles Non-Emergency ER Visits

June 3rd, 2017

emergency

Blue Cross and Blue Shield of Georgia  has just informed its members that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their claim won’t be paid…………

Read the rest of this entry »

Texas Bill To Address Unconscionable ER Prices Fails To Pass

June 3rd, 2017

shocked

TEXAS HOUSE BILL 3867 – AN ACT relating to unconscionable prices charged by certain health care facilities for medical care.

For purposes of Section 17.46(a), the term “false, misleading, or deceptive acts or practices” includes an emergency facility taking advantage of an individual’s medical condition by:

(1)  providing emergency care at an unconscionable price; or

(2)  demanding or charging an unconscionable price for or in connection with emergency care or other care at the facility.

Read the rest of this entry »

Half Of All U.S. Retail Jobs Could Vanish

June 2nd, 2017

checkout

“For the record, C-suite executives are actively engaged in reducing health care costs in the US, not by what they consider penny ante changes in plan design, but by replacing workers with robots and automation, self checkout machines, push button ordering in restaurants and drive thru food serves, etc etc etc. That not only cuts benefit costs but wages, workers comp, payroll taxes, sick leave, life insurance, training, on and on.  This is not to mention the rush to send US jobs to India and Mexico.  That’s how the c-suite is engaged.” – Tom Emerick  (www.emerickconsulting.com)

Read the rest of this entry »

Working The Spread

June 1st, 2017

spread

Without disclosure to Plan Sponsor or the providers – the TPA simply misappropriated the difference between what Plaintiffs paid the TPA and what the TPA negotiated to pay the providers. Working the spread is a lucrative business………………..

Read the rest of this entry »

Your Fired!

June 1st, 2017

fired

How the Molina Brothers Got Bounced From the Family Health-Care Firm…..

Read the rest of this entry »

$12,000,000 Man

June 1st, 2017

yikes

“Everyone is trying to avoid the $12 million-man,. Because whoever catches him basically can’t make money.”

Read the rest of this entry »

The Leaks Keep Coming………..

June 1st, 2017

leaks

“I want you to know that your long ordeal will soon be over,” Trump promised………….

Read the rest of this entry »

County Discovers $9.5 Million Health Plan Shortfall

May 31st, 2017

confused

Poor management leads to shortfall………………….

Read the rest of this entry »

Growing Profits From America’s Largest Health Insurers

May 31st, 2017

arrow

Why would a BUCA want to change the status quo? Doing business the same old way is in their best interests?

Read the rest of this entry »

Oncology Rx Treatments – Is An Extra Two Months of Life Worth $500,000?

May 31st, 2017

thumbdown

Based on a Cigna study, less than ½ of the oncology drugs approved from 2009-2014 have a known survival benefit…………..

Read the rest of this entry »

Prime Healthcare Acquires Mission Hospital

May 31st, 2017

prime1Prime Healthcare’s strategy is to take over struggling hospitals and cut out the least lucrative or money-losing services. Prime often cancels insurance contracts at its newly acquired hospitals, enabling it to charge the insurers higher rates for treating their members…..

See: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-prime-feds-20160717-snap-story.html

Read the rest of this entry »

How Insurance Carriers Are Screwing Employer Sponsored Health Plans

May 29th, 2017

On behalf of the Free Market Medical Association (FMMA), thank you for joining me……

Read the rest of this entry »

Health Rosetta Benefits Advisor Certification

May 29th, 2017

rosetta

Show the market your commitment to putting client interests first……….

Read the rest of this entry »

Abel HR Services

May 29th, 2017

abel1Founded in 1992, Abel is a family-owned and operated Professional Employer Organization (HR Outsourcing Company) that provides small to mid-size firms with the advantages of “PEO Services”.

Read the rest of this entry »

Memorial Day 2017

May 26th, 2017

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

Read the rest of this entry »

Army Vet Hero of Manchester

May 26th, 2017

manchester

“I’m giving up my hospital bed on my ward for somebody who needs it…………….”

Read the rest of this entry »

Reference Based Webinar Invitation

May 25th, 2017

Read the rest of this entry »

Moonbeam Leads Left Coast Towards Single Payer System

May 25th, 2017

moonbeam2

Single payer system’s projected total health care costs is an estimated $50 billion to $100 billion a year. That’s a massive sum in a state where the entire general fund budget is $125 billion…………

Read the rest of this entry »

Fifth Circuit Holds That ERISA Preempts Provider’s Promissory Estoppel Claims

May 23rd, 2017

LIED

This case offers insight into how promissory estoppel may play a role where a provider seeks reimbursement from an ERISA plan.

Houston Metro alleges that before it provided medical services to any patient, it sought and “received verification by telephone from Defendants that each patient was covered by a health benefit plan,” and “that the particular procedures were covered by the health benefit plans and would be paid in accordance with the health benefit plan.”  Houston Metro alleges that it would not have provided the services if the defendants had not made these statements.

Read the rest of this entry »

“Your Day of Reckoning Is Fast Upon You”

May 22nd, 2017

mulebriar

An inner demon has been bothering me for the past 15 months….the demon screams to be released

Read the rest of this entry »