Brownsville ISD To Terminate BCBS?

September 1st, 2015

john

The Brownsville Independent School District, the largest employer south of San Antonio, is meeting tonight to award their group medical insurance program to United Health Care. The district is currently with Blue Cross & Blue Shield.

https://www.youtube.com/watch?v=7u_vygkwy4k

Undercover Work Exposes Bonus Arrangement For Insurance Consultants

August 31st, 2015

mulebriar

“Yes, and it’s beautiful! The client does not have a clue about this. It will not show up on the 5500 Form either! It simply is not disclosed at all to the client.”

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Narrow Networks Become More Common

August 31st, 2015

narrownet

“As people become more aware of the wide differences in quality and price, it’s inevitable that that information will be used in contracting with better performing providers and hospitals,” said Steve Wojcik, vice president oicy at the National Business Group on Health, which represents some of the nation’s largest employers.

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Government Criminalizes No Gap Medigap Plans

August 31st, 2015

jail

Selling too good of a plan to the wrong people at the wrong time could lead to five years in prison.

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San Benito School District Awards TPA Services to Highest Bidder

August 29th, 2015

mulebriar

Financially strapped district leaves +$500,000 on the table

The San Benito Independent School District, located in deep south Texas, has  awarded third party administration services to the highest bidder in a recent Request for Proposal process. Estimated annual fixed costs for this 1,533 employee group is approximately $920,000. The lowest bid was $280,000.

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Hoodwinking – A Popular & Proven Sales Strategy

August 26th, 2015

aaaaaaaaaam

This imaginary case study illustrates a common practice in the insurance industry to maximize revenue through deception.

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Muddled Molly

August 25th, 2015
mulebriar
“If someone could explain the convoluted world of PBM’s in a manner my pea size brain can fathom,  I would be most grateful.”

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Law Could Bring Remote Doctor Visits to Texas Schools

August 24th, 2015

medicalvideo   Starting Sept. 1, a new law will allow physicians to get paid for seeing children over a sophisticated form of video chat, as long as the student is at school and enrolled in the state’s Medicaid program for the poor and disabled.

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Insurance Agent Scores Victory In La Joya Independent School District Lawsuit

August 23rd, 2015

gleason “How Sweet It Is!”

“La Joya ISD’s former insurance agent said trustees breached their contract and favored campaign supporters, according to a lawsuit filed against the district and trustees.”

“Ruth Villarreal served as the district’s insurance agent from 2006 until the board of trustees terminated her services in January. The district renewed her contract as recently as last year, months before a new board of trustees replaced her with Pharr-based insurance agent Bob Treviño.”

“Attorneys for Villarreal allege in the lawsuit filed this month in state District Court that trustees made the move because Treviño supported the Team Liberty slate in November school board elections. During the campaign, the lawsuit alleges, trustees “openly expressed their intention to exclusively award contracts to their supporters, including Defendant Trevino who was one of their main supporters.”

“You give enough money, it doesn’t matter how poor you perform, you’re going to get the contract — at least in La Joya,” said Javier Peña, an attorney for Villarreal:

http://www.themonitor.com/news/local/former-insurance-agent-files-breach-of-contract-lawsuit-against-la/article_dd34daba-7720-11e2-be67-0019bb30f31a.html

La Joya ISD filed a counter lawsuit claiming governmental immunity…………………and lost on final appeal on August 21, 2015. Now Villarreal can move forward with her original pleading…………..and possibly another victory, either in or out of the courtroom.

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Why Consultants Should Just Say “No” To RFP’s

August 22nd, 2015

no1

“Benefits RFPs are universally awful and HR should abandon them…… RFPs are suited for buying a commodity, but not selecting a consultant……”

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Federal Government To Expand Medicare Network To Private Market

August 20th, 2015

mulebriar

“The federal government will rent access to the Medicare network of providers effective January 1, 2016. Access fees, comparable to the private market,  are projected to generate enough revenue to purchase health insurance for those who don’t want it, need it, or who can’t afford it.”

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Higginbotham Expands Marketing Blitzkreig

August 19th, 2015

blitzkreig

Texas-based independent insurance firm Higginbotham has hired Jonathan Sakulenzki as an employee benefits producer in McAllen, Texas.

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Local Blogger Reports On Cameron County Insurance RFP Disaster

August 19th, 2015
disaster
“No one, including Flores, Garza or Sepulveda will comment on the decision to drop both the consultant – Nick Long of Gallagher Benefits Services – and his recommendations based on his claims that he had already negotiated savings of up to 30 percent per employee.”

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Concerns Raised At Brownsville ISD Insurance Meeting

August 19th, 2015

tellme

“Insurance Agents are Free, Insurance Consultants are Not”

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Complacent Vendor Laments Consultant’s Firing

August 16th, 2015

clientrelAn email obtained by The Brownsville Herald shows TAC Health and Benefits Services Manager Bill Norwood was also in contact with Long during the request for proposals process, which the commission aborted last week.

“I am sorry about this outcome for you and your firm,” Norwood wrote Aug. 7. “It has been a pleasure working with you on this and we will be happy to recommend you in the future. I think we worked together well in developing option ideas for this county.

“We are going to provide them all the cost saving measures I told you about in our calls so we should see several areas with good savings.” 

Brian Naiser, a TAC representative revealed the firm held more conversations with the county in the last two weeks than in the previous five years.

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Aetna Hit With Counterclaims By Hospital

August 15th, 2015

catfight

Hospital believes Aetna’s lawsuit is part of a “scheme to sue out-of-network providers throughout the nation to coerce them into financially burdensome in-network contracts with Aetna.”

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The Real Intent of The Cadillac Tax

August 14th, 2015

socialism“In America we have inequality due to income. Not being able to afford the 60 inch TV your neighbor has is annoying. Not being able to afford the platinum health plan your neighbor has, means that they will get better treatment and better access to healthcare than you.”

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High Value Alternative To Cadillac Plans

August 14th, 2015

 Nearly half of employers will be subject to the tax when implemented in 2018

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Providers Ask Judge To Stop Medicaid Cuts

August 14th, 2015

The state has slashed any Medicaid rate that was higher than 145 percent of the commercial rate. While some rates wouldn’t change, others could be cut anywhere from roughly 30 to 90 percent……….

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Changing World of Commission Based Health Agents

August 12th, 2015

In a recent meeting with brokers, Blue Cross Blue Shield of Texas predicted that 80% of small-group business would be gone within five years. Seventy-percent of group medical in under-50 life groups will disappear and 90% of that in under-10 life groups. These small groups will migrate to self-insured plans or, in most cases, defined contribution arrangements.

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Why You Can’t Find The Doctor You Need

August 12th, 2015

Blue Cross in Dallas, for example, pays some doctors 10% less than Medicaid’s fee
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Sumitomo Life To Buy Symetra

August 11th, 2015
sumetro

 

Cameron County Fires Insurance Consultant

August 11th, 2015

firedddddd Your fired!

“The process has not been clear and concise. There has been a lack of transparency.”

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How To Handle Medical Deadbeats

August 11th, 2015

debt11

Dealing With Patients Who Refuse To Pay

Handling patients with high deductibles health care plans and/or who refuse to pay in the ACA era is a growing financial risk for private medical practitioners.

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Reference Based Pricing Gains Traction Nationally

August 9th, 2015

“While reference based pricing is not new in many regions of the country, HMA is one of the first to offer this model in the Pacific Northwest.”

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Ten Thousand Commandments

August 9th, 2015

ten

“Unelected federal bureaucrats issued 16 new regulations for every law in 2014 — that’s 3,554 new regulations compared to 224 new laws. ”

“These regulations severely hamper businesses, individuals, hiring and economic growth.”

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The Higher The Cost, The More We Make

August 8th, 2015
belk David Belk, M.D.
In my video I discuss the three reasons “insurance companies want hospitals and other health care workers to over-bill by so much.” I bet these reasons will surprise you (especially the last one).

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Hilarious ICD-10 Codes

August 6th, 2015

cow

Bitten by a cow? Pecked by a chicken? Burn due to water skis on fire? Yes, there is an ICD-10 code for each………………….

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Caprock Announces Expanded All Savers Plan Portfolio

August 6th, 2015

caprock

We are very happy to announce that the new expanded All Savers portfolio has been released beginning with 10-1 effective dates.

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The Fox Group LLC

August 6th, 2015

fox

The Fox Group is among the leading healthcare consulting firms specializing in assisting physicians, acute care hospitals, long-term care providers, and a diverse group of other healthcare providers throughout the U.S. and abroad to achieve their strategic and operational goals. Read more…

Mr. Wolfgang Rusteberg has been a long-term care administrator in Germany for over 30 years, and an affiliated consultant with The Fox Group for over 10 years.

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Payroll Firm ADP to Compete with Brokers

August 6th, 2015

competition1Automatic Data Processing Inc., the payroll- processing giant, will offer companies a new way for their employees to select health benefits, challenging firms like Towers Watson & Co. and Marsh & McLennan Cos.

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PPO Touts Higher Discounts

August 5th, 2015

mulebriar

By Molly Mulebriar

My Chief of Staff was breathlessly awaiting my return from lunch today. “Guess what, I found a heretofore unheard of PPO network that has great discounts! We should contact them!”

“Show me the evidence” I demanded.

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Are We Stepping Over Dollars To Pick Up Pennies?

August 5th, 2015

pennies dollars

“Where is the outrage over the lack of transparency for disclosing fees, charges, expenses and loads built into the healthcare system and health plans offered to employers by insurance companies ……..?”

“Why is no one demanding accountability for massive claim payment errors, overcharges, hidden charges and compensation, excessive fees, hidden spread pricing or medical errors?”

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Are Smaller Companies Poised to Self-fund Health Care?

August 4th, 2015

size

“Size matters less”   The economic and risk equations are shifting for midsized and small employers weighing whether to self-fund their benefits claims.

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The Problem with Wraps

August 3rd, 2015

ppo“What we have is an industry phenomenon.  TPAs and self funded plans complain about their networks all the time.  How the discounts are bad, how you don’t have the ability to audit the claims, how the networks really work on behalf of the hospitals and not the plans. Everyone seemed to complain about them yet need them to attract clients that aren’t willing to go the reference based pricing route.  You need a network to survive as I am told by every executive that has been in the industry longer than I have been alive.”

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RiskManagers.us Client Tracks Claims To Establish Reserves

August 1st, 2015

aaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Establishing and maintaining reserves is important for self-funded clients. Reserves are estimated based upon a number of factors. As medical trend increases claim costs, one must adjust reserve factors to compensate for the additional risk exposure.

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National Mega Health Plans

August 1st, 2015

ImageProxy

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The Solution To Texas’ Dental Medicaid Problems

July 31st, 2015

Image result for tooth pulled out string

Grandma’s Self-Insured Dental Plan 

By Darrell Pruitt, DDS

As I read your political call for dentists to help expand Medicaid/Medicare dentalcare, currently administered by DentaQuest, it occurred to me that taxpayers deserve more transparency concerning DentaQuest – an increasingly popular but secretive destiny for tax dollars.”

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Lawsuit Claims CVS Health Overcharges for Generic Drugs

July 31st, 2015

life

Attorneys are accusing the company of deliberately inflating prices for generic drugs.

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Blue Cross To Drop Individual PPO Plans in 2016

July 31st, 2015

mulebriar“Is this more evidence managed care contracts don’t cure escalating costs or are actuaries on crack?” – Molly Mulebriar

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Doctor’s Hospital Outlines Growth Plans

July 31st, 2015

“We want to be daring and take on the biggest challenges that we can face,” he said. “We are no longer waiting for cures to come to use but we want to make that cure.”

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New Accounting Rules To Help Political Subdivisions Health Care Costs

July 27th, 2015

gasb

New government accounting rules enable local officials to get unfunded obligations to retirees under control.

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When A Bad Surgeon Is The One You Want

July 27th, 2015

numbers

“Homo sapiens have always sought redemption. Today it is through data. Numbers have replaced Yahweh and Indra. But, just like the old gods were, numbers can be moody, arbitrary and, occasionally, downright unfair. Numbers are a human construct, after all.”

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K&K Launches Student Accident Coverage Website

July 26th, 2015

kkk

K&K Insurance Group, Inc., a subsidiary of Aon plc, has launched a new website at www.PrivateSchoolK12-kk.com offering K-12 student accident coverage. The website is designed for private, non-boarding K-12 schools and offers the ability to quote and purchase insurance online and receive coverage documents immediately via email.

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Anthem-Cigna Deal Creates Opportunity, Risk for Brokers

July 26th, 2015

streesed

Stressed Heath Insurance Broker Contemplates Future

“Brokers that are comfortable working on a fee-basis will be fine, but the majority of small and mid-size brokers still work on a commission basis, so this could be a real risk for them if they do not have the skill set or culture in their organization to engage clients on a fee-basis,” O’Connor says.

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Michael Turpin Nails It – Post Merger Market Place & Role of Brokers

July 26th, 2015

TURPIN “The only hope is more hospitals/health systems take-risk based contracts as accountable care organizations and fill the national void with myriad local fee standing health plans who can give the remaining national carriers a run for their money and keep competition alive.”

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The Affordable Consolidation Act Moves the Insurance Market From an Oligopoly to a Duopoly

July 26th, 2015

duopoly Only massive bureaucracies with huge compliance and legal departments are equipped to deal with the approximately 40,000 pages of the Patient Protection and Affordable Care Act’s laws and regulations.  It is crushing competition.

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Nevada School District to Settle Insurance Broker Suit for $1.65M

July 26th, 2015

clarkThe Clark County School District in Nevada says it will pay a former insurance broker $1.65 million to settle a lawsuit that claimed the public agency ended the broker’s contract prematurely.

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Greece’s Costly Health Care Craze

July 26th, 2015

envelope

Every stakeholder was benefiting from the system, except one: the patient. In addition to the official costs of care and drugs, there was another price people had to pay: a fee known as “the envelope.”

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Rio Grande Valley Medical Center Gains National Accreditation

July 24th, 2015

dhr1

EDINBURG – The Commission on Cancer of the American College of Surgeons granted three-year accreditation to the Doctors Hospital at Renaissance cancer program.

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Anthem-Cigna Deal Could Come Today

July 23rd, 2015

anthem

Report: Anthem-Cigna Deal Could Come Today

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The Case of The Missing Tooth

July 23rd, 2015

missingtooth

“The VA is funded with millions of dollars and billions of dollars but you will not pay providers? How is it the veteran’s fault that you are such an incompetent part of the United States government?” – Fred Rendon

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Assurant Self-Funded Business Sold To National General

July 21st, 2015

nationalgeneralNational General (rated A- by AM Best) has purchased Assurant’s block of self-funded business and will now provide marketing, actuary, and underwriting services.

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PPACA Exchange Plans Offer Less Choice of Doctors Than Commercial Plans

July 21st, 2015

kidding

Summary: The only way insurance companies can compete for business on the PPACA exchange is through lower rates. That is accomplished by paying providers less. Benefit design is mandated and therefore not a differentiator in plan selection.

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Sierra-Berkshire Associates Inc.

July 20th, 2015

riskassesmentSierra-Berkshire Associates, Inc. is a Nevada corporation, incorporated in February, 1996. The company’s main office is located in Reno, Nevada. Principal Associates are also located in Las Vegas, NV and in the Hartford, CT area.

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DHR Hopes To Double In Size – Competitors Whine

July 19th, 2015

whine

DHR hopes to double size, but faces opposition from other local hospitals

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Xerox, Eastman Kodak And Cost Plus Insurance

July 18th, 2015

trojan

Remember Xerox? How about Eastman Kodak? Both companies were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before.

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Pros and Cons of Using Reference-based Pricing

July 17th, 2015

tellme

“Traditional models rely on a non-transparent contracting process in which insurance companies negotiate discounts off of over-inflated charges.”

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Brownsville ISD Seeks Health Insurance Proposals

July 16th, 2015

bisd

Brownsville Independent School District (BISD) is seeking proposals for administration of the district’s self-funded employee health plan. BISD is currently with Blue Cross.

http://www.bisd.us/Purchasing/html/Solicitations.htm

Blue Cross Private Exchange Announces New Enhancements

July 16th, 2015

hcsc

Chicago, IL, July 16, 2015 — Health Care Service Corporation (HCSC), the nation’s largest non-investor-owned health insurer, today announced several enhancements to its Blue Directions private exchange solution for large employers, available now for the upcoming 2016 benefit plan year.

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Children’s Hospital Of San Antonio Joins BCBS Network

July 14th, 2015

childrenhospBaylor College of Medicine, the academic partner for Children’s Hospital of San Antonio, has reached an agreement with Blue Cross and Blue Shield of Texas to participate in the insurer’s PPO plan.

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More Evidence Manage Care Doesn’t Work

July 14th, 2015

tissue1

Premiums are spiking around the country. Obama is in denial.

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Brownsville Doctor Fined $75,000

July 12th, 2015

tdiBrownsville doctor has an extensive disciplinary record with the Texas Medical Board, agency public records show.

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Are Health Care Networks Going To Jurassic Park?

July 10th, 2015

jurassic

Charging a fee for access to a group of health care providers has been a fantastic business. Low investment in capital assets, minimal labor costs and bountiful cash flows attract our country’s smartest investors. With margins above 60 percent, it is no surprise the Goldman Sachs of the world own networks.”

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An Analysis of Popular Legal Arguments Against Price Transparency

July 10th, 2015

mfnIn health care provider-insurer contracts, three types of clauses inhibit price transparency: (1) non-disclosure agreements, or “gag clauses;” (2) anti-tiering/anti-steering clauses; and (3) most favored nation clauses.

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Anthem, Cigna Progressing Toward Deal: CNBC

July 10th, 2015

ego

(Reuters) – Health insurers Anthem Inc (ANTM.N) and Cigna Corp (CI.N) were moving ahead to sign a merger deal as Cigna backed down on its differences over governance issues, CNBC tweeted, citing sources. TRANSLATION: Ego’s at play in the boardroom

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Study Shows Free Stuff Costs Less

July 8th, 2015

freestuffNew York Times reports that out-of-pocket spending on “most major birth control methods fell sharply in the months after the Affordable Care Act began requiring insurance plans to cover contraception at no cost…………….

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New Opportunity For Insurance Agents?

July 7th, 2015

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Phia Group – Claim Negotiation & Sign Off – Case Study

July 7th, 2015

PHIA

“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”

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The Employer-Led Health Care Revolution

July 7th, 2015

americanrevolution

Intel was rigorously managing its equipment suppliers but not its health care suppliers…….Intel decided it  could use its purchasing power in markets where it had operations to influence health care players—care providers, health plan administrators or insurers, and other employers—to rise above their competing self-interests and work together to redesign the local health care system….

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Assuring Hospital Emergency Care Without Crippling Competition

July 7th, 2015

emergencyroom

“Emergency departments are often more profitable than hospitals admit, as they are the source for roughly half of inpatient admissions. Patients admitted in emergency situations are rarely price-conscious, and revenue from ED admissions is often counted as part of subsequent inpatient stays. Furthermore, as non-urgent cases presenting in the ED are often relatively cheap to treat and well-covered by ED reimbursement rates, hospitals lack the incentive to redirect them to cheaper sites of service.”

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Appropriate Use Of Reference Pricing Can Increase Value

July 7th, 2015

reference“The U.S. Department of Health and Human Services has interpreted reference pricing as consistent with the principles of the Affordable Care Act when implemented by large, self-insured employers, and has adopted a salutary wait-and-see stance.”

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Insurance Companies Blame Actuarys

July 5th, 2015

odds1

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

Upon hearing the news, hordes of actuarys flock to liquor stores throughout the fruited plane seeking solace……………..“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.”    

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Anonymous Responds To BISD vs HealthSmart Settlement Terms

July 5th, 2015

gorilla1The perception that BISD was screwed by HealthSmart over so called provider “pricing discounts” demonstrates common ignorance. This is understandable since the general public has no understanding whatsoever how our health care delivery system is structured.

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Aetna To Buy Humana

July 3rd, 2015

price

Aetna buys Humana for $37B amid record number of health care deals

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