Blue Cross Awarded La Joya ISD Contract

August 20th, 2014

Blue Cross Blue Shield was awarded the group health insurance contract last night at the La Joya Independent School District.

ObamaCare Condensed To 4 Sentences

August 20th, 2014

kiss

1. In order to insure the uninsured, we first have to uninsure the insured.

2. Next, we require the newly uninsured to be re-insured.

3. To re-insure the newly uninsured, they are required to pay extra charges to be re-insured.

4. The extra charges are required so that the original insured, who became uninsured, and

    then became re-insured, can pay enough extra so that the original uninsured can be insured, which will be free of charge to them.

BISD Insurance Meeting – Will 10 Minutes Make A Difference On A $50 Million Decision?

August 19th, 2014

tenThe Brownsville Independent School District, the largest employer south of San Antonio, is in the process of selecting a record keeper (TPA) for the district’s self-funded employee health plan. Seven proposals were received and ranked. Instead of focusing on the top three contenders, the insurance committee decided to invite all vendors to give a 10 minute presentation as part of the evaluation process. Will 10 minutes make a difference?

http://bisd-kbsd-itv.pegcentral.com/player.php?video=941dcc709b050f2c3b1babd642276df9

The Effects of ACA On Price Transparency

August 18th, 2014

With the passage of the Affordable Care Act, transparency in medical pricing has gained added traction. Narrow networks, i.e, less expensive providers, is one trend, while the other is reference based pricing which is necessarily based on transparency. Health insurance has now become more of an individual responsibility and less of an employer’s moral responsibility. Consumers are beginning to recognize this. Once consumers have skin in the game, cost transparency becomes a market demand upon which medical care givers either do well or lose business.” – William Rusteberg

Recommended Reading

The Business Of Medical Practice: Transformational Health 2.0 Skills For Doctors by David E. Marcinko & Hope Hetico.

Page 33:  “Similarly, RiskMangers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and faiirness in direct reimbursment compensation methods – William Rusteberg, 2010, Personal Communication –www.riskmanagers.us ”

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Allied National “Provider Freedom” Plan – Sales Surge In Texas

August 18th, 2014

allied

Allied National is seizing advantages in Texas with their self-funded “Provider Freedom” plans. Provider Freedom plan sales represent 85% of new business sales for this Kansas based third party administrator. According to sources at Allied National, mid-market cities (Midland – Odessa – Longview) have been stronger markets than the metro-plexes, however traction is beginning to take hold in the larger metropolitan areas as well.

The Provider Freedom Plan is not a PPO program and is very similar to Cost Plus Insurance.

For more information, contact Dan Meylan, National Sales Director of Allied National @ dmeylan@alliednational.com

Previous Postings:

Allied National’s Cost Plus Health Insurance Takes Off

A Group Medical Plan Without A PPO & No Balance Billing Issues?

Mystery Guest Touts “Participating Contract”

August 18th, 2014

secret I’ve Got A Secret

We have been looking for a stop loss carrier that offers an old fashion participating contract for many months now. Well, we found one. Mystery Re has an experience refund calculation on their stop loss policies. Much like a participating contract without the downsides. Minimum premium is $500k. This carrier also has a “laser pool” for their groups. 

A participating contract is better than using a captive – no management fees, no capitalization, etc.

Editor’s Note: Mystery Re is a pseudonym. Write RiskManager@RiskManagers.us for details.

Hospitals Dismiss Significance Of Chargemaster Prices?

August 15th, 2014

lustig Victor Lustig

“Percentage of savings fees is the greatest fraud foisted upon consumers since Vicor Lustig sold the Eiffel Tower in 1925.  To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.” – William Rusteberg

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Medical Practice Administrator Refutes Sara “Don’t Be An Asshole” Kliff’s Advice To Medical Consumers

August 15th, 2014

asshole

Recently, longtime foil Sarah Kliff (she who couldn’t understand her own Explanation of Benefits) set out to enlighten folks in flyover country on how to negotiate better prices for their health care…..

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Balance Billing – Lesson #2 By Adam Russo

August 15th, 2014

Balance Billing Adam 2

 

See Lesson One here:

Balance Billing & Provider Push Back

Online Legal Services Company To Team Up With American Bar Association

August 14th, 2014

The largest lawyer professional group in the U.S. is teaming up with a startup whose business model—targeting people who would not otherwise retain an attorney—also challenges the traditional delivery of legal services.

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