In total, prosecutor Mark Roomberg said, the commissions resulting from the rigged contracts were “$2.5 million for the entire group.”
Rigged Insurance Contracts Bring Indictments / Guilty Pleas
September 27th, 2016Are PPO’s Saving Money, Or Costing Employers More?
September 27th, 2016
A Medical Bill Review audit of a large, 4,500 life employer group performed in 2016 exposes the truth about PPO “discounts.”
Over 100 CIGNA Administered Plans Sued For Embezzlement
September 26th, 2016
By Mark Flores
Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”.
More Proof Reference Based Pricing Is Growing Market Share
September 25th, 2016
The following article illustrates the angst hospitals are undergoing in defending their indefensible and egregious pricing strategies through their PPO collaborators. The solution posed in this article by a hospital advocate is: Identify Reference Based Pricing (RBP) patients and don’t treat them! But that short sighted response brings on Cash Pricing strategies through companies like Asserta Health (www.assertahealth.com) which often times saves plan sponsors even more money than otherwise would have been paid hospitals under a typical RBP plan. Making lemonade out of lemons……………
Insurance Consultant To Be Sentenced Wednesday, 28 September?
September 24th, 2016
A 46-year-old San Antonio independent insurance consultant William O. Haff is facing up to five years in federal prison….
California’s Health Care is 70% Socialized
September 23rd, 2016
This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to a new analysis released Wednesday by the UCLA Center for Health Policy Research.
TransparentRx – Elimination of Hidden Costs
September 23rd, 2016
Most TPAs do not pass on the strong discounts for prescription drugs or do not have access to it. A quality TPA should be offering all prescription drugs at AAC + admin fee.
Proceeding With Caution On Worksite Clinics
September 20th, 2016
Illinois Extents Hep. C Treatment for Medicaid Recipients
September 20th, 2016
If Medicaid allowed overseas treatment for Hep. C (Harvoni) the savings by utilizing a five star hospital system 495 miles south of Florida would save taxpayers 753 X ($95,000 – $19,000) = +$57 million...
For Information on Health City, contact Sarah Rusk, Health City Cayman Islands
t 345-640-4257 m 345-525-2131 w healthcity.ky
Which Physicians Generate The Most Money for Hospitals?
September 20th, 2016
Primary care physicians presented the best return on investment for hospitals
Apex Management Group Announces 4 Year Rate Guarantee
September 16th, 2016
FOR IMMEDIATE RELEASE – September 2016
Apex Management Group (Oak Brook, Illinois) has announced a 4 Year Rate Lock on their APEX Suite of MEC Offerings.
Grand Theft Health Insurance
September 15th, 2016
It is the Obama administration, and not the insurers, who perpetrated this heist….
Would You Like Some Insurance With Your Insurance?
September 15th, 2016
“After I got off the phone with him, I realized: That’s actually just insurance for my insurance,” she said, laughing.
2016 Directory of Third-Party Administrators
September 13th, 2016
See our detailed directory listing of TPAs, which includes their 2015 revenue, claims business by type and by volume, types of client managed and other contact information.
Cost Plus Health Plan Guarantees No Balance Billing
September 13th, 2016
“We guarantee no “balance bills” to our covered members for the amount taken as a discount from your provider’s retail bill.”
Will England Eliminate 7 Day Health Care – Don’t Get Sick On Weekends?
September 12th, 2016
“16% more likely to die if they are admitted on a Sunday compared with a Wednesday” SOLUTION: Eliminate all health care services on Sunday…………..
Healora – Cash Pay Health Plans Make Sense
September 10th, 2016
Imagine being in control of your individual employee healthcare costs. Our low cost network puts you in control of your daily healthcare spend. You decide whether the employee is better off using existing insurance options or pre-paying for the specific procedure. Our pre-paid pricing is based on discounts of up to 70% and can save companies millions of dollars a year.
Super TPA Purchases Maxor Administrative Services
September 9th, 2016Study: Chargemasters still drive up revenue at US hospitals
September 8th, 2016
Victor Lustig
Just like sticker prices on new cars, no one ever pays hospital chargemaster rates. So why have them? A previous blog posting (Hospitals Dismiss Significance Of Chargemaster Prices?) offers a possible reason, while the following article does too.
Senator Addresses EpiPen Scandal
September 8th, 2016
How Employers Can Avoid Outrageous Health Care Overcharges
September 7th, 2016
Employers, adept at tracking business expenses, are surprisingly lax when it comes to double-checking healthcare costs.
Farnsley Responds To Forbes Article
September 6th, 2016
“We learn from history that we do not learn from history” – George Hegel
Have PPO Networks Perpetrated The Greatest Heist In American History?
September 5th, 2016
EpiPen alternative costs pennies in Mexico
September 4th, 2016
McALLEN — A life-saving medication that costs more than $600 in the United States is only a few cents in Mexico.
California Passes Balance Billing Protection Legislation
September 2nd, 2016
California medical consumers will enjoy strong new protection against surprise out-of-network medical bills..………..
Narrow Networks Growing More Common
September 1st, 2016
California Senate Approves Reference Based Pricing
September 1st, 2016
“The bill would relieve patients from having to pay surprise medical bills out of pocket by requiring insurers to reimburse out-of-network doctors and other health providers a “fair amount” and doctors to accept the payments, said its author, Assemblyman Rob Bonta (D-Oakland).”
“That rate would be 125 percent of the amount Medicare pays for the same service or the insurer’s average contracted rate for the service, whichever is greater.”
Editor’s Note: If California passes this bill into law (very likely), Reference Based Pricing in California will take off in the private sector. No network plans, similar to what we have implemented in Texas since 2007, will have solved the problem of balance billing risk. And if Texas passes a similar law TPA’s like Caprock Health Plans and Continental Benefits, both of which administer Reference Based Pricing plans will achieve new business sales that will make Ben Feldman look like an amateur.
Single Payer System Is Inevitable
August 29th, 2016
The following article is based on the premise that health insurance is health insurance. In truth, “health insurance” is not insurance at all but has simply become a government mandated welfare assistance program administered by insurance companies and TPA’s.
Consultants Compete To Help Insurers To Manage Costs
August 29th, 2016With ObamaCare in full swing, with little likely hood of meaningful repeal, insurers are targeting population management and statistical metrics to bolster a competitive edge and revenue…..
Anchoring Health Care Pricing (See Previous Post)
August 28th, 2016
Anchoring – What Car Dealers & Hospitals Have In Common
August 28th, 2016 
That first number thrown out there serves as an anchor — a first reference point. Every other price becomes an adjustment of that price. Take a hospital’s charge master rates for example………..
When Should Patients Pay Cash for Prescriptions?
August 28th, 2016
Some consumers who pay far more than the cash price of a medication when using health insurance.
8 Memorable Quotes About Hospital Prices
August 26th, 2016
“There’s more price transparency and quality transparency regarding a refrigerator than there is about your heart surgery.”
Health Insurance Agents Turn To Begging
August 24th, 2016
Please Mr. Plan Sponsor, pay me direct. I really am worth it! I used to get $35,000 per year on your 75 employee life group plus an undisclosed bonus. I’m sorry I only showed up on renewal, and I promise I will change that. Please, Please, Pretty Please…………………
Price Gouging Continues – Deep Pockets Targeted
August 24th, 2016
As long as health plans, with deep pockets, continue to roll over and play dead, health care costs will escalate to a point the entire health care finance system will implode.
Health Care Pricing Transparency Drives Competitive Free Market
August 24th, 2016
Consumers Flee High Cost Hospital
Texas General Hospital in Grand Prairie may be struggling to attract patients for elective services after a report named it the most costly hospital in the state, reports Dallas Observer.
Largest Physician Owned Hospital in USA Expands Foothold
August 22nd, 2016
Edinburg, TX–– Leaders at Doctors Hospital at Renaissance Health System (DHR) and Mission Regional Medical Center (MRMC) have signed a non-binding letter of intent (LOI) to explore collaborative opportunities between the organizations.
Who Is Getting Rich from the Price of Prescription Drugs?
August 21st, 2016
Today, most drug companies offer large rebates to pharmacy benefit managers on behalf of different health plans and employers to reduce patients’ out-of-pocket costs. The problem is a significant portion of the savings is not being passed onto the public.
PBM Exposes Industry Secrets on Specialty Drugs
August 21st, 2016
Pascal Metrics Provides Patient Safety Analytics
August 21st, 2016
Pascal Metrics is the field leader in measuring and improving patient safety through advanced Patient Safety Analytics (PSA).
Comrade Bernie Touts Medicare for All
August 18th, 2016
Sen. Bernie Sanders says the ability of Aetna to disrupt the public health insurance exchange system in 2017 by withdrawing from 11 states’ programs shows why letting private companies sell health insurance is a bad idea.
BMA TPA Announces New Website
August 18th, 2016
|
San Antonio, TX – Locally owned BMA (Third Party Administrator of Health Insurance plans) announced today that it has launched a new Web site along with enhancements to its End User Portal. Company officials are excited to make this upgrade to their Web site and enhance the user experience in their end-user Portal.
|
Employers Look To Direct Health Care Contracting
August 17th, 2016
Cutting out the middle man………………………..
Industry denials notwithstanding, reducing healthcare costs is fundamentally against nearly every healthcare organization’s perceived economic interests.
Specialty Drugs – What Can A Plan Sponsor Do?
August 16th, 2016
Drug Crazed Elderly – America’s Other Drug Problem
August 16th, 2016
An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects.
Texas School Districts – Insurance Fraud & Political Empowerment
August 15th, 2016
Why You Can’t Find The Doctor You Need
August 15th, 2016
Some exchange plans are paying doctors less than Medicaid pays. Blue Cross in Dallas, for example, pays some doctors 10% less than Medicaid’s fee. If insurance buyers were forewarned, that would be one thing. But no exchange plan is advertising that access will be worse than it is for Medicaid patients.
Health Care Statistics Between USA, England & Canada
August 14th, 2016
King George III ruled England, Canada and what is now the USA. All three share the same language and are similar in many ways. But health care statistics show the USA a leader in health care delivery.
Keeping Up with New Payment Models: “Cost Plus” or “Medicare Plus”
August 14th, 2016
Providers across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans.
CFOs & HR Execs Facing Millions In Personal Liability Over Health Plans
August 14th, 2016
The first shots across the bow have been fired highlighting how benefits leaders need to pay as close attention to health benefits as they have been paying to retirement plans.
“The Number One Hidden Cost for Plan Sponsors is Embezzlement of Plan Assets” – Bill Rusteberg
Video Helps TPAs To Market Reference Based Pricing Plans
August 14th, 2016
This video is the second in a series and features a bold, fresh white board format to explain how a growing number of self-funded health plans are using Reference Based (or Cost Plus) Pricing to cooperate with area hospitals to agree on a pre-determined margin, thereby eliminating PPO networks.
Hospitals Disposing of Organs, Refusing Transplants
August 12th, 2016
Tenet Healthcare Terminates Humana Contract
August 11th, 2016
‘You’re fired, eliminated, laid off, let go, downsized, terminated …’
Tenet Healthcare has notified Humana that as of September 30, 2016, Tenet Healthcare facilities and physicians will no longer be participating in any Humana provider networks.
How Common Procedures Became 20 Percent Cheaper for Many Californians
August 11th, 2016
At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.
Next President Faces Possible ObamaCare Meltdown
August 11th, 2016
The next president could be dealing with an ObamaCare insurer meltdown in his or her very first month.
BCBS Offers RBP Selling Tips
August 11th, 2016
Aug. 10, 2016
Tips for Explaining Reference-based Pricing to ASO Employer Groups
Call To Action – Help Expose The Truth – Whistle Blowers Welcome
August 9th, 2016
Insurance insiders know the truth about undisclosed compensation paid to insurance agents, brokers and consultants by the BUCA’s. It is the industry’s best kept secret ( Health Insurance Consultant’s Best Kept Secret)
Patient Held Hostage By Hospital Over $53,000 Bill
August 8th, 2016
Ms. Stinson had a 99 percent blockage of an artery, and her family was forced by the hospital to pay $25,000 before she could receive treatment, Ms. Stinson’s son-in-law told the Indy Star. A second blockage was discovered, and the hospital demanded $30,000 upfront before the second operation.
Big California Firms Take On Health Care Giant Over Cost of Care
August 8th, 2016
Scheme Switches Medicare/Medicaid Patients to Private Insurance
August 7th, 2016
McAllen ISD To Award TPA Contract – Proposed ASO Agreement Made Public
August 6th, 2016
Mr. Phelps of Mission Impossible
Your mission Jim, should you decide to accept it, is to review all documents to ensure best value for the McAllen Independent School District. As always, should you or any of your staff be caught or killed, the Secretary will disavow any knowledge of your actions. This pdf will self-destruct in five seconds. Good luck Jim.
Proposed Form 5500 Changes To Increase Plan Sponsors Obligations
August 6th, 2016
It is clear that future Form 5500 reporting obligations will require more data, more resources and be subject to increased scrutiny by Federal agencies. Employer sponsors of group health plans should begin to evaluate plan documentation and the potential new disclosures required by Schedule J to ensure that each plan sponsor will be in a position to access such information and adequately communicate the new reporting requirements.
Most Expensive Fairy Tale of The Modern Era
August 6th, 2016
“The notion that insurance companies previously charged high premiums, or withheld coverage, from “high-risk” customers because they were evil and mean and greedy, but now Daddy Obama would make them see the error of their ways, was the dumbest and most expensive political fairy tale of the modern era.”
“The illusion of lower premiums today would be financed by higher tax bills tomorrow, and of course they’d never tell you they were raising your taxes to keep the ObamaCare scam floating. They’d tell you it was for bridges, or schools, or Social Security solvency, or something.”
Deerwalk, A Powerful Tool For Plan Analytics
August 5th, 2016
Does your TPA use Deerwalk? Deerwalk is a state of the art system that will allow, among other things, a plan sponsor to compare PPO pricing against Medicare benchmarking on a real time basis. Plan sponsors, for the first time, can determine the real value of PPO “discounts”. Many will be shocked by the results.
The ACA Medical Loss Ratios – “COST-PLUS” Health Insurance in Disguise
August 4th, 2016
By Jeff Evans
“I recently read an opinion piece that effectively summarized much of what many of us, in the health insurance and employee benefits business, have already figured out.”
Managed Care – Cat Is Out of The Bag
August 4th, 2016
The best kept secrets of managed care are no longer the industry’s best kept secrets. The cat is out of the bag,
Welldyn Sold – Will Super TPA Benefit?
August 4th, 2016
“The owner of Welldyn PBM and Continental Benefits has a vision to reduce health care spend in this country by 25%. With fresh capital from the sale of Welldyn, smart money bets Continental Benefits will become a national super TPA in short order. Before the Welldyne sale Continental Benefits was on a fast track. Now it will be nuclearized on an even faster track.” – Molly Mulebriar
Narrow Networks = Balance Billing
August 4th, 2016
Narrow Networks Fueling Surprise Medical Bills and Fights Between Insurers, Providers and Patients
Tenet Increases Reserve To Settle Kickback Allegations
August 3rd, 2016
Tenet believes it has reached an agreement in principle with the government to resolve the criminal investigation and civil litigation for $514 million.
HealthCare’s “Brawl For It All”
August 2nd, 2016
“Woodrow Wilson once said “the seed of revolution is repression”. Healthcare has operated on a model outside of free market forces, where consumers have paid the price, literally for decades.
BCBS of Texas To Drop 470 Kelsey-Seybold Physicians
August 1st, 2016
Blue Cross and Blue Shield of Texas will sever ties with Houston-based Kelsey-Seybold Clinic, putting approximately 100,000 patients out of network with the providers’ physicians, the Houston Chronicle reported.
Shrinking Networks
August 1st, 2016
Reid Rasmussen
Insurance carriers know it. If you build self-funded plans, you know it. There are ways to reduce plan costs while ‘hiding’ the reduced benefits. One of the rapidly growing methods is to shrink the provider network.
Are Insurers Ditching PPO’s?
July 31st, 2016
Insurers that have been offering PPO plans in the healthcare marketplace appear to be cutting back on the number of offerings or eliminating PPOs from the marketplace altogether, leaving consumers with fewer options. Is this becoming an industry-wide trend?Offshoring American Health Care: Higher Quality At Lower Costs?
July 30th, 2016
Is the future of American health care 430 miles offshore? American health care providers are watching closely and anxiously.
Ex-UnitedHealth CEO Raising $81 Million for New Insurance Startup
July 28th, 2016
Bob Sheehy, the former CEO of CEO of United Healthcare UNH 0.76% , is back with a new startup called Bright Health.