The Weslaco Independent School District gets a rare Mulebriar rating of A+ for proactive management of their self-funded health & welfare plan.
“….it will take a new skill set and a new mindset to survive in our new retail-driven market.……”
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
Reacting to a Supreme Court order to reconsider, a federal appeals court refused on Tuesday for a second time to stop enforcement of the federal government’s birth-control mandate against the University of Notre Dame.
Medicaid will not cover the health care costs of inmates while they’re in jail or prison, with state and local governments often footing the bill. But there is an exception that could save millions of local dollars: If an eligible inmate requires a stay in a hospital outside the corrections system that lasts more than 24 hours, his or her suspended Medicaid coverage can kick in to reimburse the costs.
240 N. Crockett Street
San Benito, TX 78586
This article proves that managed care has failed. PPO’s drive costs up, not down. Within all PPO contracts there is, among other things, an annual escalator clause that guarantees annual increases in provider reimbursement. The annual compounding effect is enough to make grandma want to go back to the good old days when a dozen eggs would buy a doctor visit in the comfort of your own home, or a bottle of tequila and a jar of honey for that nasty cold Johnny brought home from school.
The table shown in the article leaves out Cost Plus Health Insurance Plans, or Reference Based Pricing models. These plans beat medical trend.
“Medical costs are directly related to what you agree to pay” – William Rusteberg
Florida hospitals to Scott: “You have suggested that a new tax on hospital operating surpluses might be a way to sustain the existing LIP program. Such an arrangement is not a solution to the challenge we face.”
The Arizona Legislature has passed a law seeking to force anyone getting Medicaid to have a job…
May 4, 2015 – Austin, Texas – Fringe Benefit Group, an industry leader in the design, implementation and administration of benefits for hourly and part-time workers, today announced it has acquired Houston-based Employer Plan Services, Inc. (EPSI), a Third Party Administrator (TPA). Terms of the transaction were not disclosed.
Bertolini told analysts Aetna is now in contracts with 62 ACOs. “We have almost a million members in patients that are medical homes, which is 38% growth since the beginning of ’14 and over 760,000 members in what we call our high performance networks,” the Aetna CEO said.
Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.
The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.
This week the government released new diktats requiring, among other things, that preventative care benefits extends to transgender individuals………………
“Really? Our drugs are cheaper!”
Research estimates that the number of Hyphenated (pick Mexican, African, Anglo, Latino, German, Irish, etc.) Americans with six-figure drug bills jumped from 49,000 to 139,000 from 2013 to 2014.
Dogs are man’s best friends, especially lawyers………….
A strategic ‘think-tank and back-office’ for brokers and benefits advisors
Free standing emergency rooms which by law cannot accept Medicare or Medicaid, are located in wealthy suburbs. It’s better than driving into the city and waiting for hours to see a doctor…….
“A typical bill at a free-standing emergency center is about $1,400, compared with about $200 at urgent-care centers.”
Health care revolutionaries are unusual people. Information nomads never rest, never quit, until their quench is satisfied. Sharing truths enlightens all.
Jeanne Pinder is a Health Care Revolutionary. She is one of the ten most disruptive health care anarchists in this country.
“I have made a small fortune using this simple, soft shoe approach.”
An amended version of Texas House Bill 3453 passed yesterday. The original version would have allowed Texas school districts to opt out of the TRS ActiveCare health plan. Instead, the amended version creates an Interim Committee to study the issue for future consideration.
The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old………
It turns out that one of the reasons workers have been paying more for their coverage is allegedly a common practice among insurers: charging their employer customers unlawful hidden fees.
This visit was going to be another learning experience. As I drove up to the ranch house, there he was, beer in hand, waiting. “What took you so long! I have something to tell you and it’s a god damn disgrace!”
The City of McAllen is inviting your company to participate in submitting a sealed formal proposal for the above referenced project.
“Our government is so dysfunctional that no one can trust it to honor any commitment of any kind.”
When companies hold calls discussing drug costs with investors and analysts, “I’ve heard them ask, ‘Why didn’t you price it higher.’ I’ve never heard anybody say, ‘Why don’t you price it lower?’” Mr. Kolassa said.
Session ends in less than 30 days. Will HB 3453 see the light of day?
|Relating to participation in and rates for coverage provided under the uniform group coverage program for active employees.
[HB3453 2015 Detail][HB3453 2015 Text][HB3453 2015 Comments]
” Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation.”
Important information for our sales partners from Assurant Health
Homicide detectives knocked on his door and asked him why his leg was found in the garbage.
“Provider sponsored health plans are gaining traction in the market” – Molly Mulebriar
We received an email this morning regarding the upcoming vote on HB 3453 which will allow TRS ActiveCare participating school districts to opt out of the program.
“Don’t Ask and We Won’t Tell” brings clarity to the issue of undisclosed kickbacks paid by some carriers/TPA’s to “independent” insurance consultants.
In 2015, 32% of employers plan to fully replace their existing options with a choice of only high-deductible options……
May 4, 2015
Hub International Limited (Hub) subsidiary Hub International Midwest Limited (Hub Midwest) has acquired the assets of The Holmes Organisation (Holmes), a Tulsa, Okla.-based multi-line property and casualty, employee benefits and personal lines brokerage.
Terms of the acquisition were not disclosed.
The Holmes team will continue to operate from their existing offices in Tulsa and Little Rock, Ark., and will become part of Hub Midwest, establishing Hub Midwest’s fourth location in Oklahoma. Stuart F. DeSelms, president of Holmes, will join Hub Midwest as executive vice president and chief sales officer.
Source: Hub International Limited
“ACA is the fuel which fires the self-funded engine of employee health and welfare plans, providing flexibility, control and lower costs. It is the parking brakes of fully-insured plans.” – Bill Rusteberg
“By 2030, nearly one fifth of our population will be over the age of 65 and 70 percent of them will require some form of long-term care.”
This article is about tough times for rural hospitals. Many are closing their doors because they can’t make ends meet. One solution to keep doors open are hospital-run Community Health Plans providing revenue for empty hospital beds – a win win business proposition.
School Board member accused of soliciting favor and accepting gift from school district insurance consultant.
As health care costs continue to climb, the last thing Texans need is a $145 billion health care tax that translates into higher premiums for themselves and their families.
“When I asked him what he thought of this, his response was a resounding “Hell no!” and he said he would find something else to do if this ever happened.”
“While doctors may be losing the battle for autonomy, I hope that the enterprising and fiercely independent Uber drivers never do.”
“Insurance giant Assurant is looking to sell its health insurance division……. Regardless if a buyer is found, it will pull out of the health insurance marketplace by 2016…”
The issue in this case was whether a New Jersey government agency should pay an ambulatory surgical center out-of-network health care benefits at 160% of the Medicare rate, rather than, as required by statute, a rate determined by a “nationally recognized database.”
“There are very few market forces that limit what an out-of-network provider can charge. For that reason, non-participating providers are often reimbursed significantly more than their in-network counterparts.”
One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.
Operating under multiple business names, Randall Petersen, 49, conducted a fraudulent insurance scheme that involved his theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.
Wellness programs are popular these days. Who wouldn’t be against healthier lifestyles? But according to this study exercise does not help in reducing obesity. Eating less does. The myth follows the same pattern as the global warming myth – both are politically correct but scientifically flawed – Molly Mulebriar
A fugitive in Kentucky has turned himself in to authorities after decades on the run, so he can get medical care.
Suing a Ham Sandwich has never been easier, especially in Brownsville, Texas. All is needed is $150 for the filing fee………….
By Jeff Amy | April 20, 2015
An 88-year-old Mississippi physician, who has faced scrutiny because he was practicing medicine from his car, said after a meeting with regulators that he now expects to be able to continue seeing patients.
Providers across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans……….Given their growing popularity, Providers need to be proactive in understanding and managing these types of programs.
“Roosevelt’s Progressives were the first major American party to pick up the baton of health care reform”
“The only difference between Democrats and Republicans is Republicans take longer to get there. Remember Medicare in 1966? Republicans opposed it, now they support it. Standing up for one’s principles is a fleeting, temporary and convenient emotion in politics” – Don Pedro
John, der irrt! Deutsch Bier und deutschen Frauen sind die besten!
“There are plenty of reasons to brag about living in America, like the fact that we have the most innovative beers on the planet (sorry Germany)”
Patients might only be able to get to a doctor during the day on the weekends because it’s too dangerous in the neighborhood to be going out at night……The patient goes to the pharmacy but is told the new medication requires pre-approval. The patient doesn’t know what to do so the patient goes to smoke a cigarette…………...
Whole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.”
San Antonio’s Methodist Healthcare System has entered into an agreement with the Frio Hospital District Board of Directors and will take over administration and management of Frio Regional Hospital in Pearsall in the Eagle Ford Shale area.
DOL has ramped up its audit efforts on health plans. And now the audits include requests for documentation based on Health Reform (PPACA). Could you come up with this list of 30 items DOL Audit
” The exemption allows fiduciaries to receive compensation when plans and IRAs enter into certain insurance and mutual fund transactions recommended by the fiduciaries as well as certain related transactions.”
The City of San Antonio, through punitive restrictions on free trade has run off Uber from the city effective April 1. Now the State of Texas, through special interests, runs off telemedicine companies too? What has happened to traditional Texan values of hard work, innovation and freedom to conduct commerce?