In June, New York City-based Pfizer raised the price of Viagra by 13 percent. Just days later, Indianapolis-based Eli Lilly followed suit, increasing the price of Cialis by the same amount, reports The Wall Street Journal.
Holy Crap! BCBS announces $50,000 sales incentive bonus on each new fully insured group sold! Why sell anything else?
Will Haff, a San Antonio insurance consultant, has had his sentencing postponed a second time (Consultant Sentencing Delayed Again – Now 30 November 2016).Sentencing is now set for February 1, 2017.
If prices rise more than an agreed upon rate, excess increases may be offset by additional rebates. For some employers this means the PBM is pocketing some or all of the rebate money, driving record profits. In these cases there is absolutely no incentive on the part of the PBM to lower Rx costs. Rather, they earn more kickbacks as drug costs escalate. This revenue sharing between the PBMs and manufacturers at the expense of consumers continues to fuel spiraling Rx costs.
“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states.”
Much to their advantage, Weslaco Independent School District in deep South Texas has effectively injected competition in local health care delivery. WISD has learned that health care givers will compete for business if given the opportunity
“Some business is being diverted away from hospitals and toward retail clinics, standalone surgical centers and urgent care facilities that advertise their prices and services……….…’
Healthcare stole the American Dream. But I’m excited to tell you a story about how forward-looking citizens, nurses and doctors are taking it back by fixing healthcare. And it’s working.
By Molly Mulebriar
Minimal Essential Coverage (MEC) plans are simply a tax dodge utilized by employers seeking to minimize the Affordable Care Act’s punishing mandates. By offering a MEC plan with essentially no benefits other than coverage for preventative care an employer can avoid the $2000 per year fine for every full time employee (minus the first 30).
“Hospital occupancy across the United States is about 65 percent,” said Dr. Cosgrove.
Possible reader concluesion/s:
- Too many hospitals
- Not enough sick people
Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.
Hello again and Happy thanksgiving…………
Good news is a pretty rare thing when discussing health care costs in the US. In fact, good news has been a rare thing overall this year. This is why I was rather shocked to discover very good news in the last place I would ever expect to find it: prescription medication prices.
One in three Americans, more than 113 million medical records were compromised in 2015. 2016 statistics show the trend will be worse, with one in four Americans affected.
What Should I Do?
By Molly Mulebriar
Tired to seeing your claim costs escalating, year after year despite representations from managed care intermediaries that cost saving “discounts” are ever increasing and have never been higher? And, you should thank PPO’s for saving you 50% or more off health care costs.
But, RiskManagers.us has now proven to your satisfaction the real truth behind ever increasing health care costs. You are finally ready to jump off the cliff into what you perceive as shark infested waters with the assurance you will (1) survive, (2) the sharks are more afraid of you than you are of them and (3) the cleansing currents will take you to an island paradise where health care costs are fair, reasonable, predictable and essentially static. Umbrella drinks abound.
Claims she would revolutionize the blood-testing industry with her patented Edison machine, a device that she said could conduct diagnostic tests with a single pinprick……………….
Hello Again Everyone! You might remember that, last Summer, I wrote a blog that questioned United Health’s claim that they lost hundreds of millions of dollars on the ACA exchanges last year. In short, I used their own financial statements to show that their profits, revenues and madical loss ratios didn’t square with their claims very well.
“She exhausted all possible treatments in the U.S. and decided to go to Cuba to try a cancer vaccine available there called Cimavax. After starting the medication, her breathing improved and energy was restored.”
A friend runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”
That’s interesting, I thought, but Mexican dogs get it much cheaper, around $200. Savvy ones, who have been around the block a few times and know how to negotiate, get it slightly north of $14…………..It’s those Mexican dogs that can teach Trump a thing or too about the “Art of the Deal.”
While in the Houston Heights over Veterans Day weekend, I took my daily walk through the Heights. As I turned to go down Courtlandt Street, I noticed a “garage sale” ahead with a small crowd around a table. As I got closer, I saw this was something extraordinary. It was not a garage sale, but something very different. And, it turned out, something very special.
Curious, I joined the small crowd of on-lookers as a young man explained the history of various WWII artifacts on display. “This is A WWI helmet, still has the insides all intact, worn by British soldiers in the trenches of France. This is a WWII helmet, used by Americans although this on has a German flag symbol on the side of it. ….”
Standing next to me was a 94 year old veteran and his daughter. He was clutching a photograph. I asked him if he was a veteran. “Indeed, here is a picture of me with my crew. I was the pilot, the one standing on the far left here.” How old were you back then I asked. “I was 21.”
I could tell this was a special gathering of spectators. The atmosphere was thick as the young man gave his most interesting “tour” of his mini-museum. He overheard my conversation with the old man, and asked if he could see the picture too. After a brief discussion, he asked “Sir, my I have your signature please. “Yes” he chuckled, “As long as it’s not on a check!”
The old man continued, “I have quite a few things I have kept since the war that I want you to have. I think this will be a good home for them…………………….
Wonder what ADA leadership thinks of Trump?
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
DALLAS, TEXAS, November 11, 2016 – HealthSmart, a leading independent provider of managed care solutions for self–funded employers across the country, today announced that Phil Christianson has been named the Company’s new President and Chief Executive Officer, succeeding Tom Kelly, who has resigned from the Company to pursue other interests.
We Collectively lost 15.2 Lbs!
“Since April, 15,000 current and former state employees—90 percent of whom are at risk for diabetes, cardiovascular disease or other related conditions—have lost more than 57,000 pounds through Real Appeal.”
57,000 lbs / 15,000 employees = 3.8 lbs each
“Hospitals agreed to assess a fee on themselves for every outpatient served and put that money into a fund that is then sent to the federal government to be multiplied.” TRANSLATION: Hospitals inflate medical charges to consumers, put these additional inflated dollars into a fund that Uncle Sam will match with money taken from working men and women through forced taxation. Consumers are charged twice, once in the form of onerous taxation and second when they seek medical care.
“Many opponents believe the district would mostly benefit the shareholders at Doctors Hospital at Renaissance. The physician-owned hospital is one of the biggest supporters of Proposition 1.” TRANSLATION: Hospital can’t lose. They fund through overcharging patients which Uncle Sam matches, then these funds which are now double return back to the hospitals in the form of patient revenue.
“Very-recent pharmacy-network changes in the marketplace are expected to cause some retail prescriptions to begin migrating out of our pharmacies this quarter.”
Editor’s Note: We have found PBM pricing at CVS to be some of the highest, along with Wallgreen’s pricing. Some of our clients have excluded both pharmacy chains from their network and have achieved plan cost reductions.
A “psychic” billy goat from Scotland named Boots chose a piece of paper that had Clinton’s name on it, thus predicting her victory.
A “mystical” Chinese monkey named Geda, who often predicts the winners of European soccer games, chose Trump as the winner of the U.S. election by choosing a banana near a cardboard cutout of the GOP candidate.
“Paying protection money 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” – Molly Mulebriar
Health care consumer reacts to shocking revelation
Wikileaks has released a purloined email today in response to Mulebriar’s interview with Julian Assange earlier this week (Wikileaks Releases Mulebriar Transcripts – Part One). In an email dated 2011 to RiskManagers.us, Mulebriar expresses shock and amazement that PPO contracts may not always pass on the full “discount” to consumers. She asks, “Are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”
Samuel Mullen, (left), walking out of federal court today in San Antonio with his lawyer, David R. Gorena (right) admitted Tuesday that he bribed a consultant for area school districts for inside information to help win insurance contracts.
Wikileaks today has released Part One of Mulebriar’s exclusive interview with Julian Assange. The interview was held at the Ecuador embassy in London on Monday.
“Treatments Dr. Bestermann advocates for are based on solidly established science. They have been disregarded, not because most physicians don’t believe in science, but because healthcare’s scientific foundation has been trumped by financial incentives.”
Wikileaks will release the first installment of Assange’s interview with Molly Mulebriar sometime later this afternoon or tomorrow morning. Julian Assange, founder of Wikileaks, says the release will rock the managed care industry.
“What is an health insurance salesman daddy?”
A 2017 webinar will cover hospital’s view of Reference Based Pricing. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements.
Revenue has increased 4.2 percent year over year, to $10.3 billion in the third quarter of 2016. Could the ever present annual escalator clause found in managed care contracts be driving revenue increases?
Read the rest of this entry »
Your decision to continue your current PPO program is understandable. You are not out of money yet.
Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.
Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.
People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.
Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….
Why Didn’t I Think of This!
The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.
Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...
“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”
The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.
The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.
The drug industry argues the 340b program has surpassed its original purpose of providing care to poor patients and now acts as a profit generator for hospitals.
One recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare……………………..
Universal health care, Medicare for All, will establish cost efficiency that eliminates major medical bills and medical related bankruptcies
Former Health Insurance Broker
Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.
Lucent is ensuring that the Plan Sponsors they serve will be provided the best fiduciary protection and objective, final appeals handling in the industry.
Ed Day, President, HST and Cindy Hom, VP of Business Development, MedWatch pride themselves in being ahead of the curve in Reference Based Pricing strategies. The HST approach makes sense. This is a must see 29 minute video:
Introducing Meritain Connect:
Now it’s even easier to stay on top of your health plan management
Meritain Health is proud to announce our new, enhanced website for members, employers, organizations and producers—Meritain Connect. It’s an all-in-one online tool for managing your employee benefits account. And this newly upgraded website will be yours to access beginning Monday, October 17, 2016.
Have you ever met a bully in your business dealings? If you say “No” you are probably lying, or too stupid to spot one. A recent experience leads us to post this excellent video on how to deal with a bully
Adam Russo, Phia Group
This past quarter has been one of the most exciting in our history, and we have all of you to thank for helping make that happen…………
In order to rebalance our existing and future book of business, we are increasing our HMO new and renewal commission rates, and reducing the commission rates for all new and renewing PPO health plans………..
10 percent annual gain in employer health care costs has held wage gains to 2 percent or so in most recent years…….Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy……
UHC customers paying $50 co-pay for a drug that cost less than $15?
“When receiving a group medical insurance proposal from the Blues, they can claim to have better discounts than the rest of the competing offers (be it a self-funded or fully insured plan) and their pricing to get the business will surely reflect substantial discounts. But now what? Will you as the client ever actually receive the full value of their hospital contracts or physician discounts? Most likely not.”
Court paperwork, however, said the corruption spread further, enabling the Mullen group to land contracts for their clients at South San ISD and Bexar Met. The FBI is also investigating the trio’s activity at school districts in the Rio Grande Valley, the documents show.
This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.
Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..
The Phia Group is pleased to support Dave Chase’s “The Big Heist” project. Dave Chase is a long-time healthcare industry consultant, entrepreneur, author, and provocateur. Mr. Chase is also the executive producer of the upcoming film, “The Big Heist.”
For years Plan Sponsors have dreamed how to transfer health care risk to the federal government. If Medicare eligible plan participants could be removed from a group’s health care plan legally, these higher risk members would no longer be a risk factor to contend with. How can one game the system? Read the rest of this entry »
Tenet Healthcare Corp. and two of its hospitals will pay $513 million and enter guilty pleas to resolve investigations into payments of kickbacks for referrals of pregnant immigrants, the U.S. Department of Justice said Monday.
William O. Haff
San Antonio insurance consultant’s sentencing delayed again to 30 November, 2016. Smart money bets more indictments to come, following this week’s indictment of Samuel Mullen……
Drugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket.