Consulting Fee Sticker Shock

January 20th, 2018

Some insurance consultants set their fees based upon the value they will deliver to their clients. Others don’t.

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Association of Independent Doctors

January 19th, 2018

“We as independent docs save patients and employers 200-300% in cost of care compared to hospital employed/subsidized physician care. We are worth supporting and saving!” – Cristin Dickerson

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Sedera Health

January 17th, 2018

Recognizing the unmet needs in the traditional health insurance industry, Sedera Health was founded in 2015 as an alternative solution………………..

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January 16th, 2018

National Producer Number Lookup

Oscar Enters Pact With AXA

January 16th, 2018

Oscar’s claim to fame is its use of technology and clinical integration to help consumers both use their benefits and navigate the healthcare system………………...

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DOL Proposed Regulation Would Allow Association Health Plans

January 16th, 2018

 

Treating health coverage sponsored by an employer association as a single group health plan may promote economies of scale, administrative efficiencies, and transfer plan maintenance responsibilities from participating employers to the association.

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Independent Fiduciary for Self Funded Plans

January 16th, 2018

Looking to hiring an independent fiduciary?

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Self-Funded Employers: Quit Losing Money to Hospitals

January 15th, 2018

“What we’re seeing is the gross billed charges are rising anywhere from three to up to seven times the cost,” Glascott said. “It’s stunning.”……………………..The charge increases while the costs are flat.”

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Reference Based Pricing Roadmap

January 15th, 2018

If your client is weighing conversion to a Medicare Reference-Based Pricing plan, there’s a lot to consider. You need to ensure they avoid common pitfalls, and that’s why we’re here to help.

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Does “Free” Administrative Services In Exchange For Insurance Product Constitute Rebating?

January 14th, 2018

The Texas Department of Insurance (Department) has recently received questions and complaints regarding whether insurance companies, agents and/or agencies may provide administrative services to clients without additional charge.

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CFOs And HR Execs Facing Millions In Personal Liability Due To Unmanaged Health Benefits Plans

January 14th, 2018

” I don’t see how it’s possible to serve as a fiduciary while not having access to claims data, the ability to hold providers accountable by auditing detailed bills or providing transparency in cost and outcomes to guide participants.” – Chris Shoffner

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National Alliance of Healthcare Purchaser Coalitions

January 14th, 2018

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The Klement Letter

January 14th, 2018

“As an outsider looking in and not having all the political implications and considerations that board members face, I’d like to give you our perspective and advice for consideration on your choices.” – Greg Klement

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H3N2

January 13th, 2018

Flu season is shaping up as one of the worst in years, officials say…………………….

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Healthcare Debate – “I Must Be A Mean Person”

January 13th, 2018

Tucker Carlson debates Texas liberal seeking to oust Ted Cruz in November………………

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Kentucky Imposes Medicaid Work Requirement

January 13th, 2018

Kentucky on Friday became the first U.S. state to require that Medicaid recipients work or get jobs training, after gaining federal approval for the fundamental change to the 50-year-old health insurance program for the poor……

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Haas Opines On Reference Based Pricing Intermediary Fees

January 12th, 2018

“We have encountered resistance with RBP service providers that base their fee on a percentage of billed or savings…………………..”

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Healthcare Becomes Largest US Employer

January 12th, 2018

The majority of new healthcare jobs are not in clinical roles, but are in administrative and management positions, such as receptionists and office clerks……………

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What You Don’t Know About Rx Marketing

January 12th, 2018

Today I received an email asking if I wanted to be the “…only pain management/orthopedic practice that CVS recommends to all their customers for a year…”

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Trump Work Requirement Rewrites Health Care Rules

January 11th, 2018

I gotta work? I never had to before! This is messed up!

States to be allowed to require “able-bodied” Medicaid recipients to work……………

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Humana Officially Leaves AHIP

January 11th, 2018

Humana officially ended its membership in America’s Health Insurance Plans just before the start of 2018, a spokesperson for the insurer confirmed to Modern Healthcare……………….

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Trump To End ObamaCare As We Know It

January 10th, 2018

The other shoe in Donald Trump’s war on ObamaCare is about to drop. It will end ObamaCare as we know it.

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Are Political Subdivisions Stupid or Corrupt?

January 10th, 2018

QUESTION: Do political subdivisions have a fiduciary duty towards management of their self-funded employee health & welfare plans? If so, why do some make really stupid decisions?

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Don’t Overlook Fact That Association Health Plans Are MEWAs

January 9th, 2018

“The regulation of AHPs is colored by the fact that they constitute Multiple Employer Welfare Arrangements (MEWAs). Under [ERISA], states have broad authority to apply their insurance laws to self-insured MEWAs. Many states regulate self-insured MEWAs like a commercial insurance company……………….

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Fixing Healthcare & Direct Contracting

January 9th, 2018

We are a direct contracting and bundling entity that works on free market principles and is achieving exceptional results from providers. Pre-negotiated deals have the same level of disruption as retrospectively negotiated deals, but are far less confrontational and afford the ability for providers to step up and do the right thing proactively.

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January 9th, 2018

Are you ready for your 2018 health plan rate increase?

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Idaho Rebellion

January 8th, 2018

Idaho to allow sale of “illegal” health plans……………………..

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Man Who Posed as a Doctor at 18 Is Going to Prison at 20

January 8th, 2018

He wore a white lab coat and a stethoscope, but as several would-be patients in South Florida learned in 2015 and 2016, Malachi A. Love-Robinson was no doctor……………….

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The Man With 11 Hips

January 7th, 2018

Even with thirty years of experience as an actuary in the insurance industry, it took me a year to figure this out………

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To Win Accounts, Stop Competing

January 7th, 2018

This is another great article from Griswold. Some say competing against the large brokerage houses like Gallaghers, Higginbotham, Willis and others is tough. It’s not………………………….

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Supply Chain Management Is Launching A Benefits Revolution

January 7th, 2018

A few months before adviser Mick Rodgers of Boston’s Axial Benefits Group was named EBA’s 2017 Employee Benefit Adviser of the Year, he and 29 other forward-thinking benefits advisers from across the country signed their name to the “Declaration by NextGeneration Benefits Advisers that declares nothing less than a revolution in employee benefits.

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Buying Business

January 6th, 2018

       “How Sweet It Is!

Agreement gave the Blue Cross the health plan business, including administrative services and possibly reinsurance coverage, for six years. In exchange, Blue Cross and Blue Shield gave the plan sponsor more than $20 million………

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Pharma, Under Attack For Drug Prices, Started An Industry War

January 5th, 2018

It’s not easy to get Americans mad at a behind-the-scenes industry they’ve barely even heard ofbut pharmaceutical companies have spent most of this year trying………………“Who decides what you pay for your medicines? Not who you might think,” a concerned woman’s voice says in a radio spot airing in the District last month. “More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”

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Eliminating The Middle Man

January 5th, 2018

 

 

Embodiment of Corruption: Your Health Insurance Network

January 5th, 2018

Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..

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Congress Outlaws Health Insurance – Workers Rejoice Over New Found Wealth

January 4th, 2018

If 17.5% of GDP could be transferred to workers tomorrow, and health insurance outlawed, you would see……………………

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Made in China: New and Potentially Lifesaving Drugs

January 4th, 2018

One new drug promises to stop cancer from spreading to other organs. Another would treat blood cancer. A third would use the body’s immune system to kill tumors.

All three show encouraging results, and need just one more step to be approved for use in the United States. The drugs have something else in common: They were created in China.

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Pharma’s Utilizes Blame Game Strategies To Defend High Prices

January 4th, 2018

Public anger over pharma price gouging is running high…………”More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”

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340(b) Hospitals Vow Fight Over Program Cuts

January 4th, 2018

Hospital groups are vowing to push forward with a fight against the Trump administration over changes to a federal drug discount program following a setback last week…………….

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Caught

January 4th, 2018

3 weeks ago the facility quoted us billed charges of over $13,000 per dose for the patient’s chemotherapy drugs. We know the Wholesale Aquisition Cost of those drugs is under $700 per dose. (Thank you micromedex!) .

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Patient Cures Own Cancer With Kitchen Spice

January 3rd, 2018

Woman, 67, who battled blood cancer for five years ‘recovers after treating it with TURMERIC’ in the first recorded case of its kind……………….Doctors say her case is the first recorded instance in which a patient has recovered by using the spice after stopping conventional medical treatments…………..

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Why the U.S. Spends So Much More Than Other Nations on Health Care

January 3rd, 2018
“Great read: Why the U.S. Spends So Much on Health Care. Studies point to a simple reason: the prices, not the amount of care. But lowering prices would upset a lot of people in the industry. Most of the explanation for American health spending growth — and why it has pulled away from health spending in other countries — is that more is done for patients during hospital stays and doctor visits, they’re charged more per service, or both.” – John Glascock, AMPS

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Do You Believe In Magic?

January 2nd, 2018
Health care costs have remained static for years. We have the evidence. But health insurance costs have increased year after year. We know why.

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Medicare To Adopt Reference Based Pricing?

January 2nd, 2018

“A proposal from the Hamilton Project would give the Centers for Medicare and Medicaid Services (CMS) more resources to scrutinize medical technologies and allow the agency to experiment with “reference pricing”.

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Why American Doctors Keep Doing Expensive Procedures That Don’t Work

January 2nd, 2018

American doctors routinely prescribe medical treatments that are not based on sound science………………

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January 1st, 2018

Join the Austin Chapter of the Free Market Medical Association for our September Meeting on Wednesday, Jan 10th at 11:30a-1:00p at Independent Bankers Assoc of Texas 1700 Rio Grande St, Third Floor Third Floor – Doyle Conference Room Austin 78701.

 

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Definition of Fully Insured Health Plan

January 1st, 2018

“A fully-insured health plan is a bundled approach of smoke and mirrors wherein the House sets the rules and always wins.”

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Are you a Thermostat or a Thermometer? 

January 1st, 2018
 
In 2018, be memorable………………………………………….

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RiskManagers HealthCare Purchasing Coalition 2018

December 31st, 2017

RiskManagers HealthCare Purchasing Coalition ™ is a high performance health care Management Services Organization founded on a simple proposition: Health care cost can be reduced while maintaining or even improving benefits at the same time.

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A Carrier’s Economist’s Take On ObamaCare

December 30th, 2017

Blue Cross economist Michael Bertaut recently tweeted a series of posts explaining what has gone off the rails, and why.

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Removing Waste, Gimmicks, Cost Shifting & Tricks From Healthcare

December 29th, 2017

By Jeff Bernhard, President of Continental Benefits

When I see the below chart, it reminds me how much Employers need real solutions to get the wasted spend out of the system. 

When I see the info in the chart on the right it reminds me of an Employer with an eroding margin.  It also reminds me of the union member that doesn’t get a pay increase because unpredictable healthcare costs have eaten up the budget. 

Lastly, it reminds me of the school that needs to lay off 100 teachers because of the wasted, unnecessary spend in the system. 

It has been this way for the past 20 years and has gotten worse each year. 

I am so glad to bring a real solution, with reputable partners (TBA), in 2018 to the self-funded Employer market that helps self-funded Plan Sponsors get rid of this waste with no gimmicks, cost shifting or tricks.  This solution will work on a “A” carrier PPO network. 

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Protection Money In Healthcare

December 27th, 2017

“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices. I am positive we will one day see plan participants sue their plan for breach of fiduciary duties. We are seeing this trend among retirement plans, health plans will be next” – Bill Rusteberg

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The Haff Brothers

December 26th, 2017

 

 

A parents worst nightmare………………

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 80+ Drugs to Be Dropped By Insurance in 2018

December 22nd, 2017

If you’ve got health insurance, now’s a good time to be paying attention. Each year, prescription coverage changes, and yours will likely be changing in 2018…………………..

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This old drug was free. Now it’s $109,500 a Year.

December 22nd, 2017

“As long as third party intermediaries continue to pay for these high cost drugs, the manufacturers will remain at the trough…………Many of our clients remove these drugs from their formularies” – Bill Rusteberg

 

 

It takes balls to say ENOUGH IS ENOUGH I’M NOT PAYING THIS ANYMORE!

 

 

 

Self-Funded Plan Sponsor Discovers He Has Balls……….

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School Board Members Rejoice: It’s Ok To Accept Bribes Between Friends

December 20th, 2017

A Texas jury has ruled it OK for school board members to accept bribes if the transaction is between friends. Therefore, bribes exchanged between enemies must be illegal…………………………..

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The “Secret” Driver of US Health Care Costs: Politicians Wanting to Get Reelected

December 19th, 2017

“If you told me six years ago that we’d be able to find that when a hospital had a payment increase, a member of Congress representing that hospital got a funding increase, I would have laughed you out of the room……………..”

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Challenging Oncology Therapies With Moonshot Price Tags

December 19th, 2017

SOURCE: Brian Klepper

New oncology therapies carry astronomical price tags—most people know this. Receiving far less attention is the question of actual therapeutic value……………..

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Wired For Sound – FBI Builds Insurance Corruption Case

December 18th, 2017

Humana representative Andrew Grove, whom prosecutors named as an unindicted co-conspirator, recorded a May 2013 conversation between himself, Mullen and Hernandez……………..After being confronted by the FBI, Haff agreed to cooperate and began secretly recording conversations ……………….Joshua Cerna was cooperating with the FBI by then, and in a recording of their conversation………………………..

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Feds Rest In Insurance Bribery Case – Are Bribes Gifts Between Friends?

December 17th, 2017

“The Mullen Group had 20 accounts, but SAISD represented 80 percent of their commission revenue, so it was important to keep its relationship with Mrs. Hernandez,” Holmes testified…………….

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Trump Threatens Gravy Train – Insurers Pissed

December 16th, 2017

 

 

Groups representing health insurers and consumers are urging state regulators to prevent the damage that could result from one of President Donald Trump’s executive orders……………..

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Universal Health Coin

December 16th, 2017

The timing is right for the Universal Health Coin; it’s revolutionary, disruptive and anonymous utilizing blockchain for the future of healthcare……………………

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We Don’t Have To Buy Broccoli Any More?

December 14th, 2017

 

Proposed tax bill, if passed, will eliminate the government’s broccoli mandate. Americans will no longer be forced to purchase broccoli. Currently, citizens who don’t buy broccoli are subject to a  broccoli tax as much as 2.5% of income.

A spokesman for the American Broccoli Association stated “Broccoli is a right, not a food. If broccoli consumption declines, we will see people die in the streets. We are gonna do everything we can to turn this around in 2018!

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If A 1.4 Million Life Case Can’t Solve Rx Costs, How Can You?

December 14th, 2017

Rx costs are bankrupting health plans across the United States. Rx costs amount to 25-35% of total health care spend and rising. Many plan sponsors are besides themselves, failing to reign in costs. Instead, they suppress wages and hire less employees………………..

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FBI Informant Testifies – School District Insurance Contracts Attract Rogue Agents

December 14th, 2017

Conspirators forged a conspiracy that lasted from 2007 through 2015, federal authorities contend.

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San Francisco Increases Health Care Contribution Requirement

December 13th, 2017

 

Ordinance requires employers with at least one employee who works within the city limits to either pay at least a specific amount per hour worked within the city and county limits (or for paid time off) towards the cost of health coverage for any such employee, or pay a surcharge over to the city…………

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The Texas Medical Board Substantially Revises Telemedicine Regulations

December 13th, 2017

The Texas Medical Board’s (the “Board”) adoption of new telehealth licensing regulations may finally put to bed long-running challenges to the state’s historically rigid position with respect to healthcare services delivered remotely via telemedicine…………..

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All Businesses Operate a Health Care Business Unit, and It’s Losing Money

December 12th, 2017

The status quo insurance broker focuses the renewal conversation around carriers, networks and plan design changes. Focusing on these areas and not the health-care supply chain does absolutely nothing to reduce true costs.

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Half Pregnant Tulip Lovers vs Cliff Dwellers

December 12th, 2017

 

 

 

The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals  which are  lower costs, better benefits and higher wages.

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Healthcare Stole the American Dream – Here’s How We Take it Back

December 9th, 2017

Dave Chase explains how healthcare has stolen the American Dream……………..

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The Mystery World Of PBM’s & The Black Box

December 9th, 2017

The price you pay is all a black box………………………..

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The Decline of Employer-Sponsored Health Insurance

December 9th, 2017

Working families across the country are spending more of their income on insurance that doesn’t protect them as much as it used to………………….

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December 9th, 2017

“If one has a brain and a backbone, they can achieve amazing things in health benefits. “ – Dave Chase

Socialism Spawns Medical Flea Markets

December 8th, 2017

Peddlers offer everything from antibiotics to contraceptives laid out among the traditional fruits and vegetables…………

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Remember This?

December 7th, 2017