Fee-for-Service Primary Care Only Pays $60 – $140 Per Visit. However, Primary Care Has Been Shown to Decrease Hospitalizations by 20%… Saving $50,000 Per Hospitalization.
Fee-for-Service For Primary Care is Dumb………..
February 24th, 2021Elephant Lives Matter
February 21st, 2021Texas House Bill 1941 was introduced this month because some believe Elephant Lives Matter…………
The First PPO Was Established in 1982 – And It’s Still Touting Savings?
February 21st, 2021If PPO’s are supposed to save us money on health care why hasn’t it? We all agree forty years of managed care hasn’t worked so why are we still hoping it will?
The (never ending) La Joya Shit Show Continues…………….
February 19th, 2021To Our Friends Up North, Please Come Get Your Weather!
February 17th, 2021Overcoming Misconceptions About Health Benefits
February 15th, 2021“If you went to Denver, Dallas, OKC or ABQ you would not find a better benefits consultant. Very helpful and knowledgeable. Out of the box thinking.” – Alan, Ideacom
Another Healthcare Benefit Alternative To TRS ActiveCare
February 14th, 2021There is yet another vendor offering Texas educators a TRS ActiveCare alternative strategy which is (drum roll please)…………………….
Austin ISD Gifts $12,000,000 – Uncle Sam Rejoices
February 13th, 2021Texas school district makes a one time gift of $12,000,000 to be split between employees and Uncle Sam in an effort to bribe employees from leaving for greener pastures. This is the same district that closed down schools last year and laid off workers due to rising health insurance costs.
Would it have been better to fund a Health Savings Account for all employees instead? Of course Uncle Sam would get nothing in that case while the employees would gain ownership of the entire $12,000,000 gift, tax free, forever………………
There’s A Rate For Any Risk
February 13th, 2021This photograph from 1921 shows Millicent Woodward, a lady who took out a policy at Lloyd’s of London that year.
Only Idiots Burn Bridges
February 12th, 2021Last week we witnessed an idiot burn down a bridge. Fire department investigators reported the bridge beyond repair.
New Health Plan For Texas Educators
February 11th, 2021“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
Public Consulting Group’s (PCG) Texas ISD HealthPlan is an innovative, new healthcare program designed specifically for Texas Independent School Districts (ISDs), Texas teachers, and their covered family members.
Beware! Covid19 Vaccine May Change Your Sex Life
February 10th, 2021“Don’t go near those who have had the COVID vaccine,” warned the official, “They have become …………!”
Texas Insurance Code – Chapter 541 Unfair Methods Of Competition And Unfair Or Deceptive Acts Or Practices
February 9th, 2021Molly Mulebriar, investigative reporter from Warring, Texas, is currently winding up her investigative report of a Texas TPA’s efforts to boycott a competitor in violation of the Texas Insurance Code.
Confessions of A Reformed Health Insurance Broker
February 8th, 2021A lot has changed since I entered the world of health care benefits in 1973. The journey has been fascinating………………
HB 1646
February 8th, 2021Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans……………….
Aldeen The Magnificent
February 8th, 2021Doug Aldeen – RBP Defender Warrior
Doug Aldeen (The Magnificent), an ERISA attorney, talks about Reference Based Pricing and what he does to help plan sponsors in that space. This is a guy you want in your corner……………….
HB 1649
February 7th, 2021Relating to bids or proposals required for insurance and risk pool contracts entered into by a school district, municipality, or county.
School District Sues Health Insurance Agent for $1 Million
February 7th, 2021Lawsuit accuses the health insurance agency of trying to defraud the district……..This impoverished Texas school district is a plaintiff’s lawyer’s dream come true……………lawsuits fly left and right over the past decade……………..Meanwhile back in the classroom……………..
You’re Making How Much!
February 6th, 2021A school district in deep South Texas was paying their benefits consultant $614,000 per year but didn’t know it.
Texas Senate Bill 376
February 5th, 2021Relating to registration and annual filing requirements for governmental units establishing a self-insurance fund.
North Korea Mandates Insurance For the Masses
February 3rd, 2021People React With Joy At The News
“Insurance plays an important role in realizing the politics of love for the people.”
Promising New Chinese Flu Test
February 1st, 2021“To collect test samples, the swab needs to be inserted about three to five centimeters (1.2 to 2 inches) into the rectum and rotated several times………….”
CPO
February 1st, 2021Texas HB 1490 & The Lisa Plan
January 31st, 2021House Bill 1490 would require Texas hospitals to post cash prices for their services……….
Will The Texas Legislature Prohibit TRS ActiveCare Alternatives?
January 30th, 2021In order to protect TRS ActiveCare, the Committee on Pensions, Investments, & Financial Services recommended in their interim charges that the 87th Texas Legislature take action to “explicitly prohibit independent school districts from using District of Innovation status (as) a method for opting out of TRS-ActiveCare.”
Read the rest of this entry »
TRS ActiveCare’s Hostage Taking Strategy Under Attack
January 30th, 2021“He who has data wins. He who has good date wins a lot. He who has real time data wins all the time.” – Author Unknown
Tenent’s Second Bite At The Apple
January 30th, 2021As some of you in our space may be aware we have recently noticed Tenent is aggressively going after RBP accounts across the country seeking the difference between billed charges and plan allowable despite accepting RBP patients, taking an Assignment of Benefits, and cashing benefit checks.
The Amazon Solution To Rising Health Care Costs
January 29th, 2021Amazon knows robots don’t need health insurance but people do. A robot can be programed to do what people do while people can’t ever be programed to perform flawlessly time and time again. Robots are never late for work, never complain, don’t steal, and work tirelessly 24/7.
Texas Legislature – Three Bills Worth Watching
January 27th, 2021The Texas legislature meets biannually and is now in session. Here are three bills worth watching……
The Truth About The Shot
January 26th, 2021Simone Gold, M.D.
Simone speaks the truth about the Wuhan virus (politically correct term is Covid-19 – we don’t want to offend the Chinese do we?)
Texas School District Saves $530,457 By Replacing Agent of Record
January 24th, 2021Texas school district saves $530,457 by replacing their health insurance Agent of Record after previously awarding her $1.8 million plus an 8 year contract worth +$60,000 per month.
How To Turn A $3,500 Employee Benefit Into A $25,000 Equivalent
January 23rd, 2021The Bang Bang Health Plan
An Arizona county employee benefit plan has found a way to effectively turn a $3,500 employee health benefit into a $25,000 equivalent by crossing a manmade line in the desert………………. Read the rest of this entry »
PUBLIC-PLAN OPTION
January 22nd, 2021It’s been less than 24 hours from yesterday and noise from Washington suggests changes in the way American healthcare is financed and delivered may be imminent………..
Pricked
January 19th, 2021The price of diabetes related medicines should be an American embarrassment……………
The La Joya ISD Shit Show Continues………………..
January 19th, 2021Texas insurance agent stands to gain $68,375.00 per month for the remainder of the original term of the agreement if her eight year consulting / brokerage agreement with a Texas public school district is canceled for “any reason.”
Texas Senate Bill 120 – A Gift to ICHRA’s?
January 18th, 2021If passed, this could make ICHRA’s even more attractive to employers who are tired and fed up with all the hassles of providing group health insurance for their employees along with the ever present threat of punishing government sanctions.
Texas House Bill 573 – Health Care Sharing Ministries
January 18th, 2021If Texas House Bill 573 passes this legislative session Health Care Sharing Ministries will be prohibited from certain advertising such as touting their financial strength and past performance to provide health care benefits for their members…………… even if its true!
Texas To Consider Single Payer Health Plan
January 18th, 2021
TEXAS HEALTH INSURANCE BROKER
Texas health insurance brokers who find themselves in the unemployment line by way of passage of HB 602 will be able to retrain for other careers through state provided funding.
Discounts Don’t Matter
January 16th, 2021Medical discounts are a scheme used by health insurance companies, service providers, hospitals, and others in the medical supply chain to show “value” to their customers. “Look at how much we saved you! Aren’t you happy you choose us as your partner! Just imagine what you would have paid without us!”
PPO Network Gobbles Up RBP Vendor
January 15th, 2021MultiPlan Corporation to Acquire HST
- Accelerates Growth by Adding a Next-Generation Reference-Based Pricing Program to the MultiPlan Solution Suite
- Acquisition is the First Under MultiPlan’s Enhance-Extend-Expand Strategy
- Increases Value for Customers by Adding New and Complementary Services to Better Manage Cost
- Deepens MultiPlan’s Penetration in the TPA/Broker Segment
Nonprofit Hospitals Are Biggest Rip Off In America
January 15th, 2021All across the nation, cities big and small are having their pockets picked and their communities decimated by their local nonprofit hospitals.
Teachers Union Demands Lids on All Toilets
January 14th, 2021Fear of public toilets is nothing new and surprisingly common. But is COVID by toilet really a thing?
The Power of Incumbency During A Pandemic
January 14th, 2021By Molly Mulebriar
Third party administrators (TPAs) have always enjoyed the power of incumbency and it has never been greater than now.
Mark Cuban Cost Plus Drug Company
January 14th, 2021The Mark Cuban Cost Plus Drug Company is dedicated to producing low-cost versions of high-cost generic drugs. We pledge to provide radical transparency in how we price our drugs.
The Cost of U.S. Healthcare Shocks Brits
January 13th, 2021Medical Insurance in China
January 13th, 2021Chinese Government Encourages Private Health Insurance
January 13th, 2021China’s Communist party rolls out pilot tax benefit plan in hopes to expand private health insurance because the government’s plan is not good enough…………….
The San Antonio Free Market Medical Association
January 12th, 2021Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the San Antonio community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.
Cameron County Texas Seeks Insurance Consultant
January 12th, 2021Cameron County is seeking a qualified fee based insurance consultant to assist the county in a competitive RFP process for group health insurance for county employees.
New, Competitive Dental Plan Hits The Market
January 12th, 2021Government Initiates Broker Disclosure Requirement
January 11th, 2021Wanna hear about the broker who was making $614,000 on a South Texas 2,500 life school district while the clueless Board of Trustees thought the compensation was $128,000?.
Blue Cross To Punish Republicans
January 11th, 2021Politicians Chase Dollars To Remain In Power
Blue Cross, punching down, has announced they will no longer share member’s premium dollars with lawmakers except for those who pledged allegiance to Joe Biden…………….
Healthcare Isn’t Expense – Price Gouging Is
January 11th, 2021Healthcare isn’t expensive. It’s price-gouging and profiteering that is expensive and straightforward to eliminate………………..
Question for RBP “Experts”
January 7th, 2021If hospitals are required to publish their prices and they have patients sign agreements wherein the patient agrees to pay “in accordance with the regular rates and terms of the hospital” which are public for the world to see, what defense does the patient, who assigned benefits, have in disputing full billed charges when the average reimbursement accepted through the hospital’s payer mix is substantially less?
Contracts of Adhesion
January 7th, 2021An adhesion contract (also called a “standard form contract” or a “boilerplate contract“) is a contract that heavily restricts one party while leaving the other free (as some standard form printed contracts); implies inequality in bargaining power
If A Health Plan Could Be A Person……………..
January 5th, 2021Hyped Start Fizzles
January 4th, 2021Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years
Famed Magician Reveals How To Create Rx Savings Out of Thin Air
January 4th, 2021The cost for a Fully Insured Rx Card is 8-10% of the plan cost. So, if the Stop Loss Carrier carves out 15% for the Rx and the cost for the Fully Insured Rx Card is 10%, you’ve just cut the price of the group plan by 5%.
Hapless Plan Sponsors Are Screwed By Switch Operators
January 4th, 2021Texas County Believes All Health Care Is Local
January 3rd, 2021
Excellent 7 Minute Video Explains The Past & Possibly The Future
January 2nd, 2021This is one of Dr. Bricker’s best videos. In 7 minutes he puts the current economic status of healthcare in historical perspective.
Let The Sun Shine In………………..
December 31st, 2020Effective in 2021, employee benefit plan fiduciaries will be required to get fee disclosures from service providers…………..this means hidden fees earned by many brokers (especially the large national brokerages) must be disclosed to newly horrified plan sponsors
Employers Choice Rx Adopts RBP Approach
December 31st, 2020
Traditional PBM Representative Reacts
In 2011 when the Employers’ Advanced Cooperative on Healthcare founded Employers’ ChoiceRx (ECRx) it was the first pharmacy BENEFIT solution built to be a transparent/cost-plus program that focused on “therapeutic equivalent” drugs to achieve a lowest net cost reference price.
SmartHealth PayCard
December 31st, 2020Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….
Professor Aldine Updates SAT Test
December 30th, 2020
Professor Doug Aldine updates SAT test question/s for wannabe college students hell bent on achieving little by way of a college degree…………….
Infections Disease Racial Disparities Task Force
December 30th, 2020
Pitting Hyphenated Americans against each other using health care as a political tool to do so……………………
Holy Cow!
December 30th, 2020
TRS ActiveCare Update
December 29th, 2020Districts of Innovation offering competing health plans have impacted TRS membership this year. Market intelligence tells us one of the new competing health plans has captured approximately 12,000 employee lives with a total of 17,000 members………….
Killing Chinese Flu Virus In 30 Seconds
December 28th, 2020Lone Ranger Rejoices – No More Mask!
Researchers from Tel Aviv University have proven that the Chinese Flu virus can be killed efficiently, quickly and cheaply using ultraviolet light-emitting diodes……..all in 30 seconds…………
P&C Brokerage
December 28th, 2020In-sur-ance (in-shoor’ens) n. 1.a. The act, business, or means of insuring persons or property. b. The state of being insured. 2. A contract binding a company to indemnify an insured party against specified loss. 3. The sum of which something is insured. 4. RiskManagers
Insure (in-shoor’) v. – sured, -suring. 1. To protect against loss, damage, etc. with insurance. 2. Also ensure (en-). To insure n. RiskManagers
To Comply or Not To Comply, That Is The Question
December 28th, 2020Hospitals Hate Pricing Transparency
Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..
Providers Find Silver Lining in “No Surprises Bill”
December 27th, 2020Why would any provider want to be in-network if they know they will always get more than what a plan pays?
Government Acts Against Money Interests – Sides With The Common Man
December 25th, 2020Andrew Jackson – Champion of The Common Man
After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………
Oscar Health – San Antonio Market Rates
December 24th, 2020