By Dr. Alan Preston
“Who is the boogie man in healthcare? I am going to look at three possible culprits as to cost drivers of healthcare…”
By Dr. Alan Preston
“Who is the boogie man in healthcare? I am going to look at three possible culprits as to cost drivers of healthcare…”
“Madrigal recommended board members choose her, but did not disclose he had done personal business with her.”
Hidalgo County approves RFP process for professional consulting services for the Hidalgo County Self-Funded Health & Welfare plan.
Asserta Health provides enabling infrastructure for “cash” health plans that deliver significant cost savings by eliminating the “value drain” associated with the typical payment process. The entire healthcare transaction is simplified, transparent, and supported by a service model that effectively frees clinical and financial resources to focus on improving the cost, quality, and efficiency of the care itself. The result is a better healthcare experience—and outcome—for the consumer, the provider and the payer.
AUSTIN, Texas, October 1, 2015 — Associated Builders and Contractors (ABC) and Fringe Benefit Group today announced the expansion of The Contractors Plan, a benefits platform designed specifically for construction contractors, to include a full suite of benefits including ACA-compliant major medical, dental, vision, life, disability, retirement and HRA plans – all managed through a single online platform.
“There needs to be some kind of investigation, that way there is transparency at Harlandale,” says Julie Gimbel, President of the Harlandale Educational Association, the union which represents teachers.
I just got the first year bill from my payroll company for the extra reporting we have to do each year vis a vis Obamacare: $7195.50 for 2015. Note that this adds absolutely no value — this is not the cost of insurance or cost of any extra taxes sent to Uncle Sam. This is merely the cost to handle all the new paperwork required in the law.
I will repeat what I have said before — the Republicans tend to focus narrowly on taxes and often tend to miss or downplay the regulatory issues, which I think actually loom larger in destroying economic growth.
SimpleSaveRx realizes that a change is needed in the healthcare industry to make prescriptions work more like everything else in business and less like healthcare. SimpleSaveRx, by focusing on prescriptions, will enable members to achieve the greatest savings possible per prescription.
By Robert E.H. Khoo, M.D., F.R.C.S.(C), F.A.C.S.
I predict that within 20-30 years the computer will replace the venerable physician……
“The hidden fees were listed in internal BCBSM documents under a variety of names: provider network fees, contingency/risk fees, retiree surcharges, and—my personal favorite—other-than-group subsidy fees. Internal company emails showed that BCBSM knew customers were unaware of the markups and that the company actually trained its employees to downplay the hidden fees should customers suspect they were being gouged.”
Editor’s Note: How many lawsuits do you want to research before you decide the truth insurance companies don’t want you to know? Anheuser Busch vs Cigna, Oakland County vs BCBS, Weslaco ISD vs Aetna, and Hi-Lex Controls vs BCBS all expose how carriers often earn undisclosed fees through PPO contract arrangements.
Employers are leaving a bigger chunk of the bill for care to workers who use their health insurance, and benefits experts see few signs of this trend slowing.
Specialists in infectious disease are protesting a gigantic overnight increase in the price of a 62-year-old drug that is the standard of care for treating a life-threatening parasitic infection.
The drug, called Daraprim, was acquired in August by Turing Pharmaceuticals, a start-up run by a former hedge fund manager. Turing immediately raised the price to $750 a tablet from $13.50, bringing the annual cost of treatment for some patients to hundreds of thousands of dollars.
‘”When a patient offers their right to obtain benefits from their insurance, that assignment of benefits is in and of itself consideration in full, exchanged for services and treatment. An assignment of benefits is thus not a form of access to consideration, and rather, is the consideration itself. One might ask why a medical service provider would ever choose to accept an assignment of benefits in lieu of the right to bill a patient for 100%.” – Adam Russo
“An assignement of benefits contract may (can, will) create a frustration of purpose” – Molly Mulebriar
The actual purpose of a pharmacy benefits manager (PBM) is somewhat questionable. Their stated purpose is to mediate prescription medications prices for insurance companies. What’s interesting is the fact that over 80% of prescription drugs sold since 2012 are generic which means that most of these medications are inexpensive to begin with. What’s more, there’s no evidence that PBMs provide any real discounts to the prices of brand name medications.
Feds give approval for Doctors Hospital at Renaissance to double in size
STAFF REPORT | Posted 3 days ago
EDINBURG — Federal officials have granted a request by Doctors Hospital at Renaissance to double its size, which would make it the largest hospital in the Rio Grande Valley, according to a news release Wednesday evening.
By Molly Mulebriar
I recently presented a renewal to a client. The audience was the owner and his secretarial staff. When I mentioned that under the ACA, one of the requirements to maintain an “approved” plan was the prohibition of charging plan participants more than 9.5% of their gross income for individual coverage.
Due to the incredible success of our Reference Based Reimbursement solution, we are looking to add two new sales professionals to the AMPS team.
By Dave Chase
The impact out-of-control healthcare costs has been devastating to school funding. Have you ever wondered why class sizes have increased, after school programs have been cut and most teachers haven’t received a raise since 2000 (adjusting for inflation)?
It is directly linked to healthcare as the graphic below demonstrates. In “Teacher Unions On Wrong Side Of Negotiating Table,” I included more disturbing datapoints from Bill Gates’s TED Talk about how healthcare is devastating education.
That article also includes links to how the math simply can’t work without tackling health benefits in a fundamentally different manner.
A. All Three are lawsuits
B. All PPO contracts are contracts of adhesion
C. PPO “discounts” are not entirely passed on to the consumer
D. All of the above
Caution: No Cheating Allowed! Do not Google Search before taking this quiz
“We just picked up a claim from a hospital in Nebraska with a charge for $500 to borrow a baby seat to transport a new born from the hospital to home. Seat has to be returned of course. “
“To go from being ranked 2, 3 or 4 to #1 based upon a 20 minute presentation is a formidable task. To do so under a gag order takes it into the realm of impossibility.”
To simply change TPA’s to continue to manage claims under secretive managed care contracts which the district can’t see nor audit will not produce different results by lowering costs. The definition of insanity can be applied here.
“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.”
“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.
Selling too good of a plan to the wrong people at the wrong time could lead to five years in prison.
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.
This imaginary case study illustrates a common practice in the insurance industry to maximize revenue through deception.
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.
“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:
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.
“Benefits RFPs are universally awful and HR should abandon them…… RFPs are suited for buying a commodity, but not selecting a consultant……”
“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.”
Texas-based independent insurance firm Higginbotham has hired Jonathan Sakulenzki as an employee benefits producer in McAllen, Texas.
“Insurance Agents are Free, Insurance Consultants are Not”
An 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.
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.”
“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.”
Nearly half of employers will be subject to the tax when implemented in 2018
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……….
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.
Blue Cross in Dallas, for example, pays some doctors 10% less than Medicaid’s fee
Read the rest of this entry »
“The process has not been clear and concise. There has been a lack of transparency.”
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.
“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.”
“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.”
Bitten by a cow? Pecked by a chicken? Burn due to water skis on fire? Yes, there is an ICD-10 code for each………………….
We are very happy to announce that the new expanded All Savers portfolio has been released beginning with 10-1 effective dates.
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.
Automatic 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.
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.
“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?”
“Size matters less” The economic and risk equations are shifting for midsized and small employers weighing whether to self-fund their benefits claims.
“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.”
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.
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.”
Attorneys are accusing the company of deliberately inflating prices for generic drugs.
“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.”
New government accounting rules enable local officials to get unfunded obligations to retirees under control.
“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.”
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.
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.
“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.”
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.