Judiciary says it’s unconstitutional, so legislators have developed a cure of their own………….
Austin, Texas Sick Pay Leave Unconstitutional
November 21st, 2018More Employers Are Leaving Fully Insured Plans………………
November 21st, 2018
“To gain control over the ever-increasing cost of employee health insurance, more and more employers are discontinuing their fully insured coverage and switching to self-funded models.”
Health Care Ate America
November 21st, 2018
In the five decades after the passage of America’s two largest health care entitlements, that sector has become a maw, eating everything in its path. Health spending has reshaped the nation’s job market, its household finances, and its public budgeting…………………..
Ending American Greed?
November 21st, 2018
“The greed of the prescription drug industry is literally killing Americans and it has got to stop…..”
Texas School District Seeks To Exit TRS ActiveCare
November 20th, 2018
Once enrolled on the TRS ActiveCare health plan, school districts are forever prohibited from leaving. There are no exceptions permitted. Or are there?
BenefitMall
November 18th, 2018Merloch Coins New Term For Reference Based Pricing
November 18th, 2018
Michael Meloch, President of TPAC Underwriters, comes up with a new term for Reference Based Pricing in a Phia Group podcast…………………………..
Blues Plans Enjoy Record Profits
November 17th, 2018
Blue Cross Blue Shield plans have collected billions of dollars in profit in the first six months of this year………………………….Premiums have vastly outpaced the claims that the health insurers had to pay out to hospitals and doctors……………..
Pfizer to Raise Prices on 41 Drugs in January
November 17th, 2018
“Drug Costs Are Too Damn High”
As long as consumers purchase drugs with other people’s money big pharma knows consumer (market) blow back from pricing increases will be minimal……..
Allied National Returns Unused Claim Dollars To Clients
November 16th, 2018
Allied National’s Funding Advantage contract returns unused claim fund dollars to employers who have favorable claims experience!
I’m A Reformed Broker – Having Second Thoughts Is Not Possible…………
November 14th, 2018
Making $2 million on an 8,000 life Texas school district is really easy. I know because it’s been done, even as we speak…………………..
AWP – Ain’t What You Pay
November 14th, 2018
INSIDE AWP: THE ARBITRARY PRICING BENCHMARK USED TO PAY FOR PRESCRIPTION DRUGS
One Man’s Experience with Free Market Medical Care in the U.S.A.
November 14th, 2018
What’s ironic about this story, is this is exactly how we’d do it if our dog needed knee surgery…….
Battle For Patient’s Wallet Moves To EHR
November 14th, 2018
“The only party not taken into consideration is the employer who is on the hook for the vast majority of the cost of drugs that will be sold through this channel……………….”
Providers Push Back – N. Carolina Treasurer Pushes Back Harder
November 13th, 2018
“It doesn’t matter who the governor is, or who controls the legislature. It’s not political. It’s mathematical.”
Jury Hits Aetna With $25 Million Judgement
November 12th, 2018
“Aetna pays its ‘medical directors’ bonuses for increasing the company’s profits by denying claims…….”
Final Regs – Exemptions from Contraceptive Coverage Mandates
November 12th, 2018
Memorial Day 2018
November 11th, 2018
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
How to Defend an ERISA Lawsuit
November 11th, 2018
Firestone deference – Many ERISA plans use plan document language stipulating the plan administrator has the authority to interpret plan terms and resolve any ambiguities. The United States Supreme Court has held that when a plan contains this language, courts must show deference to the administrators and review their decisions under an arbitrary and capricious standard…………….
Healthcare Waste is Costing Billions…………
November 10th, 2018
Sun Life Tops Market Expectations
November 9th, 2018
Business strategy is to focus on four pillars of growth: the Canadian home insurance and wealth market, US group benefits, global asset management, and distribution excellence in higher growth markets in Asia…………………………
90+ Medications To Be Dropped by Insurance in 2019
November 9th, 2018
Drugs excluded includes brand-name drugs for which less expensive brand or generic alternatives are available in the market…………………………………..
GR Data Insights: MSK – Quality matters………………
November 8th, 2018
Grand Rounds is focused on reducing high cost claimants and improving patient outcomes and we have tangible evidence to prove it……………………
Here Comes The Judge
November 8th, 2018
He’ll give you time if you’re big or small
All in line for this court is neat
Peace brother, here comes the Judge
Here comes the Judge…………………………………….
Gridlock Sets In……………….
November 8th, 2018
With a Democratic House, a Republican Senate, and President Trump in the White House, get ready for two years of maneuvering but little progress on health care…………..
State of Utah Fights High Drug Prices With Results
November 8th, 2018
The savings are anywhere between 38% to 75% well may save the state millions each year……..
CMS Delays Dramatic Office-Visit Coding Changes Until 2021
November 6th, 2018
Proposed changes would have increased CPT 99213 by 30%……………..Primary Care Physicians lose out on pay raise.
November 4th, 2018
How do you know if your surgeon is the best of the best or the worst of the worst? Unfortunately most patients play Russian Roulette when it comes to picking one………………….the results can be hazardous to your health…………..
More Texas Doctors Switch To Concierge Medicine Model
November 4th, 2018
More doctors in Texas plan to make the switch to primary care out of frustration with the current healthcare system…………………………….
Employers Are Becoming More Active in Healthcare Claims Management
November 2nd, 2018
“Employers are cutting out insurers completely and contracting directly with providers and/or creating near-site or on-site health clinics for primary care……………….More traditional cost management techniques are simply running out of gas. Employees, who have borne half of recent-year cost increases, simply can’t afford anymore,”
San Patricio County Seeks Stop Loss Insurance
November 2nd, 2018
San Patricio County is seeking competitive specific stop loss proposals for a January 1, 2019 effective date. This 400 life case has been on Reference Based Pricing for the past ten years and does not access any managed care networks.
Today’s Medical Students Lack Skills For Surgery
October 31st, 2018
New medical students have spent so much time on screens that they lack vital practical skills necessary to conduct life-saving operations, a leading surgeon has warned………………
MedSave Management LLC
October 31st, 2018
MEDICAL BILL SOLUTIONS – A Medical Debt Resolution & Advocacy Services Company……
Ballot Measure Limits Hospital Reimbursement To Cost +15%
October 30th, 2018
Voters in two California cities will decide two ballot measures that aim to curb healthcare costs, according to a Kaiser Health News report……………………
Health Care Stole The American Dream – Here’s How We Take It Back
October 30th, 2018RBP Quiz – What Level Of Benefits Will 100% of Medicare Buy?
October 30th, 2018
What level of benefits could one expect based on claim reimbursement of 100% of Medicare allowable charges?
Interview With Greg Everett, President of Payer Compass
October 30th, 2018
In this episode, The Phia Group chats once again with one of their Partners in Empowerment, Gregory S. Everett, President and CEO of Payer Compass.
PBM Practices Exposed
October 28th, 2018
PBMs use arbitrary and opaque DIR fees to derive record profits at the expense of independent pharmacies, plan sponsors and most importantly consumers……………………..
How We Are Getting Screwed…………………
October 28th, 2018
The healthcare industry is rife with secrets the healthcare industry doesn’t want you to know. If you have the courage to read this article, you may be wise to order The Schuessler Stick™, overnight delivery.
70% of Americans Back Medicare For All?
October 28th, 2018
Medicare for all is only one election away. Opponents may win 1,000 wars but proponents only need to win one. But this author writes “Medicare for All’ will never work, so let’s stop pushing it.”
Hospital Gouging Practices Exposed
October 28th, 2018
Victor Lustig
Adam Conover explains hospital gouging practices 20 in this eye-opening 5-minute clip……..
High Cost vs. High Quality: How Do You Navigate Health Insurance?
October 28th, 2018
By Dave Chase
The most persistent myth in healthcare is that high cost equals high quality. It’s a proposition that holds across a great many products that are bought and sold in actual, functioning markets — but that’s not a description that applies to the U.S. healthcare industry.
Texas Man Scams TriCare For More Than $50 Million
October 28th, 2018
A Dallas man has admitted to defrauding a military health insurance program for $50 million.
If You Can’t Beat Them, Join Them
October 28th, 2018
Blue Cross of N. Carolina has announced a new, no network health plan (Reference Based Pricing). Coupled with a high deductible, BCBSNC touts a 33% premium savings.
County Sues Insurance Broker Over Secret $250,000 Commission
October 28th, 2018
The county’s complaint alleged broker accepted a $254,000 kickback for referring the county to a major insurer…………………in addition to fees paid directly by the county to the broker…………
Trump Plans To Revamp Employer Based Health Care
October 28th, 2018
The Beginning Of The End of Group Health Insurance?
The proposal would allow companies to use HRAs to reimburse employees’ premiums on the individual health-insurance market……………………….In lieu of adopting a group medical plan for employees, an employer can give employees money to purchase individual health insurance in the open market....
Pharmacy Owner Charged In $10 Million Health Insurance Scam
October 28th, 2018
An Alabama pharmacy owner has been charged as part of an alleged conspiracy to scam more than $10 million from a federal health insurance program………………
If You Can’t Beat Them, Join Them
October 26th, 2018
Earlier this month we learned the state of North Carolina will be terminating their state health plan’s contract with Blue Cross and will instead adopt a Reference Based Pricing plan (Another State Adopts Reference Based Pricing Strategies). Now we learn Blue Cross of N. Carolina will be introducing a new, no network health plan, which is of course, Reference Based Pricing. Is this a case of “If you can’t beat them, join them?”
“It is normal comprehensive insurance, with a high deductible, and the main difference being that reimbursement is based on a ‘reference pricing’ approach similar to what state Treasurer (Dale) Folwell has recently proposed for the state employee plan…………….”
HealthSmart
October 26th, 2018
Reference Based Pricing – Misconception #1
October 25th, 2018
“Every day you remain in an RBP plan, your risk of massive liability increases”
I Don’t Care
October 22nd, 2018
“Why aren’t you gonna pay for my prescription! My doctor ordered it!!!!”
Balance Billing Is A Plan Sponsor’s Best Friend
October 21st, 2018
“Balance billing only occurs when purchasing goods or services without asking the price.”
Uproar at Purdue
October 18th, 2018
Employees upset with cost containment move by University officials………….“How long can we continue to offer health care coverage when we’re experiencing 20 percent to 30 percent increases on a regular basis?”
KISS – Keep It Simple Surgery
October 18th, 2018
The KISx Card was created as a solution for self-funded employers to tackle egregious surgical pricing while bringing simplicity to the employee experience……………….
Blue Cross Blue Shield IL Sued for Fraud, Robbing Chicago Taxpayers
October 17th, 2018
Working The Spread is nothing new. Seems quite common. The article below is about a lawsuit in which spread pricing is alleged.
Email Solicitation – To Good To Be True? You Decide
October 17th, 2018
We get unsolicited emails every day like the one below. This one touts a plan we have never heard of before, offering what appears to be “to good to be true” pricing. We thought we would share this for our three readers…………………….
Paying for Coverage Without Any
October 17th, 2018
“What are you talking about! That’s insane” cried the HR lady. …….”I thought you needed to know” I replied.
Chinese Government Demanding Big Discounts from Drugmakers
October 15th, 2018
The power of large numbers, 1.379 billion Chinese, brings big benefits when negotiating with drug manufacturers…………………………….
Many Agents and Brokers Are Still Uncertain About “REFERENCE BASED PRICING”
October 12th, 2018
Breaking The Status Quo
Allied National employer groups are proving beyond the shadow of a doubt that the Freedom Plan (our reference based pricing reimbursement) is a better, lower cost, solution than traditional PPO networks.
South Texas Health Cooperative
October 12th, 2018Rest Easy In Our Pool
Taming Health Care Alligators Since 1998
The South Texas Health Cooperative (STHC) provides affordable health insurance to member school districts since 1998. Through careful risk management strategies, the STHC risk pool has achieved lower and stable costs while improving benefits at the same time.
Wow! What a Difference!
October 12th, 2018
Earlier this year I moved a client from a BUCA PBM to an independent PBM. No benefit or formulary changes were made. Now that I have mature credible claim data on the move from the BUCA PBM to an independent PBM, I find Rx claims have reduced 30.1%.Big News! FTC to Probe Hospital Contracts
October 11th, 2018
This may become the tipping point in health care reform. “The Senate Judiciary Committee chairman questions contract terms between insurers and hospital systems…………..contracts between insurers and hospital systems are limiting competition and pushing up health-care costs……………..”
Gag Clauses Now Illegal
October 11th, 2018
In an effort to increase drug price transparency, President Donald Trump signed two bills into law that ban insurers from writing gag clauses into their contracts with pharmacists………………
Texas Spanks Humana – Who’s Gonna Pay For It?
October 11th, 2018
Now let me get this straight. Humana tries and fails to negotiate a reasonable rate with enough in-network providers and is punished for it. Well, the solution is to get rid of the network and treat all providers as out-of-network. That’s what Reference Based Pricing plans do.……………..BTW guess where Humana is going to get the $700,000………………………..
– Bill Rusteberg
Hospital Profits High In Indianapolis
October 11th, 2018
Hospitals in central Indiana enjoy a higher profit margin than those elsewhere because they overcharge insurers…………………..
UMMC / BCBS Squabble
October 11th, 2018
The following article (Posted on Linkedin by Carl Schuessler) brings to mind deeper issues than the “surface” issues most consumers reading this will take away. The article hints of a gold mine of information leading to more questions than answers.
We All Have Health Care Stockholm Syndrome
October 8th, 2018
“The Stockholm syndrome we have been suffering under is starting to break……………
Another State Adopts Reference Based Pricing Strategies
October 5th, 2018
First it was Montana, a smallish state somewhere up north of us, who adopted Reference Based Pricing for their state health plan (Montana Adopts Reference Based Pricing Strategies). The little lady up north has big brass cojones! (Tough Negotiator Saves State Millions In Health Care).
Next there is California which is currently considering similar efforts. (California Assembly Bill 3087 Would Control Prices in the Commercial Market).
Now there is yet another state adopting Reference Based Pricing for their state employee plan. They must have heard about the little lady in Montana.
I thought Texas would lead the country on this. After all, several of us have been making noises in Austin over the past two years. Has Texas Lost It’s Cojones?.
– Bill Rusteberg
Deductibles Hit $2,000 As Employers Intensify Cost Shift
October 5th, 2018
“Annual deductibles for Americans with employer-based health coverage are hurtling toward $2,000 on average, according to new studies analyzing employee medical benefits.”
New England Journal of Medicine Slams Wellness Programs
October 4th, 2018
“Outcomes-based wellness programs don’t work, so why do them? There is no upside and therefore no argument in favor of poisoning the doctor-patient relationship. “
Employer-Provided Health Insurance Approaches $20,000 a Year
October 4th, 2018
Rising prices “chiefly tied to rising prices paid for health services.” Yet health care costs have remained essentially static for the past ten years. It’s the prices that have increased, not the cost of health care. – Bill Rusteberg
San Antonio Emergency Room Raises Concerns
October 4th, 2018
San Antonio’s newest Emergency Room service sparks interest among residents and government officials. The Emergency Room “is not even open for business but is already causing controversy.”
Tough Negotiator Saves State Millions In Health Care
October 2nd, 2018
Marilyn Bartlett
Marilyn Bartlett took a deep breath, drew herself up to her full 5 feet and a smidge, and told the assembled handful of Montana officials that she had a radical strategy to bail out the state’s foundering benefit plan for its 30,000 employees and their families………………..
Will Texas be next?
An Electrical Physical? How Much Is That?
October 1st, 2018
“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.
