IMAGINE FOR A MOMENT… Your credit card bill showed up in the mail stating nothing more than: YOU OWE $5,000
IMAGINE FOR A MOMENT… Your credit card bill showed up in the mail stating nothing more than: YOU OWE $5,000
An assorted collection of articles for those interested in Cost Plus / Reference Based Pricing models
Humana Inc. has revealed that it will sell Concentra……………
Alexander Chatfield Burns
A 28-year-old ‘financial prodigy’ built a hundred million dollar insurance empire that now might be worthless (see article at end of this post)
An insurance empire that included two insurance carriers, two offshore reinsurers, several buildings and other insurers’ investments was built by a private equity firm in part on questionable assets and is now being dismantled, according to the Wall Street Journal.
An idea with bi-partisan support?
If the federal government would rent their Medicare network and charge what the private market charges for access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.
Victor Lustig “Why didn’t I think of this!”
THE FALLACY OF HOSPITAL CHARGEMASTERS
“Hospital industry claims that the charges don’t matter because few actually pay the “list” price “defy common sense,” Burger said. “If there is no reason for the high prices, why bother charging them?” Burger asks. See Hospitals Dismiss Significance Of Chargemaster Prices?
The Rio Grande City Independent School District is seeking Request for Qualifications for fee based insurance consultant to assist the district in the evaluation of their Cafeteria Plan and products. Deadline to submit a response to the RFQ is April 30.
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.
Texas state representative J. M. Lozano filed House Bill (3453) on March 12, 2015. If passed the bill will take effect on September 1, 2015 and will allow participating school districts to leave TRS ActiveCare.
School districts currently participating in the TRS ActiveCare program are prohibited from leaving.
If districts are allowed to come and go as they please, adverse selection will begin an irreversible death spiral – TRS ActiveCare could end up being an insurer of last resort.
Should HB 3453 become law many expect a strong “run on the bank.” Will El Paso Independent School District be the first to leave? See El Paso ISD Votes To Leave TRS ActiveCare
“With the price of some treatments topping $100,000, patient (idiot) groups are pushing for state laws to make sure carriers (mean & nasty insurance companies) cover most of the costs. Their campaign is backed by an important ally: the drug industry.”
What these mental giants don’t seem to understand is that they are paying these costs through higher insurance premiums. The mean and nasty insurance companies simply pass on costs while taking their cut at the same time. And, with the Minimum Loss Ratio mandate in place the more the costs the more insurance companies are allowed to make. So these idiots are actually screwing themselves by helping pharmacy manufacturers and insurance companies earn more money at their expense.
Source: Clear Health Costs – www.clearhealthcosts.com
Faster than a melting raspa, the New Mexico Superintendent of Insurance has rescinded the state’s new stop loss insurance mandate.
Notre Dame contends the opt-out provision is insufficient to protect its religious rights.
Are You Kidding Me! I can’t cover my husband anymore? And I lose my doctor too? What kind of plan is this!
Michelle is not happy as she has Oprah and guests arriving the next morning. The bucket fills up quickly and has to be emptied every hour, and there’s a risk the room will flood, so Obama calls Joe and pleads with him….….
“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.
“And all of this began with our 1967 purchase of National Indemnity for $8.6 million,” Buffett wrote…..“Last year, our premier position in reinsurance was reaffirmed by our writing a policy carrying a $3 billion single premium”
“How much is the premium did you say Warren, $3,000,000,000 for a single policy?
Study predicts there will be more cost shifting to workers’ compensation as ACOs gain in popularity in the group health market. A good example of unintended consequences. ACA is chock full of unintended consequences………..
Montgomery Management, a full service MGU, has been providing flexible, innovative stop-loss and life products to the marketplace since 1986. Our professional expertise, personalized service, corporate strength and stability make Montgomery Management an industry leader.
“To hide the scheme, Aetna claimed that North Cypress consistently overcharged for routine procedures.”
By Darrell Pruitt, DDS
Until now, those who sell discount dentistry plans like Delta Dental, BCBSTX and AmeriPlan have always been less than transparent with naïve, vulnerable consumers about how their AmeriPlan-preferred dentists can discount their fees up to 80%, and still make a living.
Blue Cross and Blue Shield says it has posted its first financial loss since 1999 as a result of insuring high numbers of older and sicker people under the Affordable Care Act.
The objectives of the audit were to review the consultant’s report and determine the reason for the difference in the consultant’s calculated change in the fund surplus versus the audited change in fund balance for the Group Health and Life Insurance Fund.
Yet another paper has been published on the waste of time, money and morale that results from the recent infatuation with wellness programs.
By Molly Mulebriar
The City of Santa Fe has requested proposals for stop loss insurance for their self-funded employee health plan with a proposal deadline of February 23, 2015. However, New Mexico’s Insurance Superintendent issued a regulatory bulletin the week before the proposal deadline that effectively eliminates stop loss protection as a viable option for New Mexico employers that self-fund their employee health care coverage.
The task now before the city’s insurance consultant (AON Risk Solutions) and third party administrator (United HealthCare – UHC) is to find stop loss insurance for the plan’s July 1 effective date. According to market experts this will be a near impossibility without divine intervention. BUCA reps. are circling city hall anticipating the coming feast.
Thanks to federal intervention in the health care system—Medicare, Medicaid, and the employer tax exclusion—hospitals have been able to charge whatever they want for their services, knowing that the average consumer has no idea how much he’s paying, because he’s paying mostly through taxes and other indirect means…………..
Accountable Care Organizations, whose explicit goal is to encourage hospitals to consolidate the provider industry, thereby gives them more leverage to charge higher prices…………
The U.S. hospital industry is crony capitalism at its finest
Stop loss carriers are likely to exit the New Mexico market this year leaving self-insured medical plans without coverage.
Independent insurance firm, Higginbotham, announced has united its three Houston offices under one roof and one operating name.
Allstate Insurance Co. has plans to approve 20 agency offices in the San Antonio and Austin markets this year as part of a broader plan to add 130 new agency owners in Texas.
Humana Inc. and Weight Watchers International are teaming up to provide San Antonio employers that carry Humana health insurance the ability to give their workers the option of signing up for free and discounted access to weight-management services.
“To put this simply, governments don’t tax other governments,” said DeWine. “This illegal taxation is another example of federal overreach the administration’s refusal to operate within the boundaries of federalism.”
“Account managers are like Army sergeants. A well seasoned sergeant makes sure the goals of the officer corp are reached and they only have to take an order once to get the job done. Failure is not an option……..”
“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”
National Underwriting Services, Inc., (NUS) is a Managing General Underwriter providing stop loss solutions for self-funded employers. Founded in 1985, NUS is located in the beautiful Texas Hill Country near San Antonio, Texas.
Why did our fund balance fall so sharply last year? And why is it still declining? Our decline in fund balance is primarily due to our self-funded health insurance program, which is simply not sustainable as presently designed.
February 20, 2015
Wisconsin Gov. Scott Walker is proposing that state employees be offered $2,000 a year to opt out of state health insurance coverage.
The 1115 Waiver is a federal program meant to provide incentives to taxpayers to become more dependent upon government. It takes political courage to recognize the 1115 Waiver for what it is. Mayor Beto Salinas of Mission, Texas is a rare man of courage………
Now groups with as few as 5 employees can take advantage of self funding…….
Entrepreneurial Spirit and the drive to do things differently
Healthcare Highways is a new, innovative health plan partnered with providers, employers, payers and other strategic business relationships to develop and offer a real choice in the delivery of healthcare.
Orein Risk Analysts, Inc., has a unique stop loss insurance product that provides plan sponsors with the ability to budget for future expenses with stop loss terms locked in over a three year period.
Health Insurance Broker Contemplates Future
ACA Allows States to Open Exchange To Big Employers in 2017.
Guthrie also said that the legislature would have to change the law to allow districts to opt out of ActiveCare, which TSTA supports.
The Harlandale ISD board of trustees will discuss Tuesday whether to have outside law enforcement agencies investigate former board president Velma Ybarra for possible violations of state procurement laws.
No one will bring down America’s highest-in-the-world health-care prices until consumers and the employers who pay for most privately financed care know what the prices actually are, says Mike Dendy, CEO of Atlanta-based Advanced Medical Pricing Solutions. Americans not only pay the world’s highest prices for care, but what they pay varies wildly from doctor to doctor, hospital to hospital.
From Dr. Pruitt, one of our three readers:
“Democrats seek relief from ACA penalties – The official sign-up season for President Barack Obama’s healthcare law may be over, but leading congressional Democrats say millions of Americans facing new tax penalties deserve a second chance.” By Associated Press, February 16, 2015.” (more).
If the wheels aren’t falling off, they are sure wobbling. To make matters worse, the ACA is intimately tied Meaningful Use of certified EHRs – which is also wobbly.
“Why are patients paying more for health care? It’s the drug prices…….increasing 13% last year alone…”
ObamaCare Solution: Bronze Plan $6000 deductible with no first dollar coverage. Rx covered after satisfaction of deductible, and is a reimbursement benefit to the insured (insured pays for Rx with cash, then files claim like in the old days…..) A patient who must pay cash up front before reimbursement will be a better consumer with skin in the game instead of an entitlement zombie who could care less about what costs are other than that egregious $10 co-pay.
“CMS: Meaningful Use penalties to reach $200M – Current CMS data indicate that eligible professionals are facing an estimated $200 million in Medicare reimbursement penalties in 2015 for failure to fulfill Medicare meaningful use obligations. The numbers were announced this week during a HIT Policy Committee meeting.” By Heather Caspi, February 13, 2015. (more).
Regardless whether the eligible professionals deserve the claw-back penalties or not, the important lesson here is: Do everything you can to avoid doing business with the U.S. government, Doc. They will own you.
Dr. Pruitt – firstname.lastname@example.org
“My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing something he loves, and his dream had always been to open his own garage.”
“The problem with socialism is that you eventually run out of other peoples’ money.” – Margaret Thatcher
Second Acquisition in Three Months for New Employer Healthcare Benefits Platform
(Sacramento, California) January 16, 2015―Lucent Health Solutions, Inc., in conjunction with NaviMed Capital, a Washington, DC‐based healthcare growth capital firm, announced today its acquisition of Capitol Administrators Inc. (Capitol).
Obamacare’s startup health insurance plans are flirting with financial distress, as all but five of the 23 nonprofit companies had negative cash flow from operations in the first three quarters of 2014, Standard & Poor’s said in a report today.
“…..when I hear large corporations that make billions of dollars in profits trying to blame our interest in providing health insurance as an excuse for cutting back workers’ wages, shame on them,” Obama”
Patrict Carrier, CEO Christus Santa Rosa
“Christus Health, which operates hospitals in several Texas cities and in Louisiana, New Mexico, Chile and Mexico, is reducing the number of its domestic operating units from eight to three. Carrier said the changes will streamline and simplify Christus’ regional operations and expedite the decision-making process across all affected markets. He will divide his time between both markets.”
From its simple beginnings in my mother’s basement to our current status as an industry leader, even I, confident as I was that we’d succeed, am shocked and grateful for the level of success we’ve achieved together.
“To say the move both surprised and shocked the state’s wholesale insurance broker community would be an understatement.”
“Few were willing to speak publicly about it. However, off the record many members of the Texas MGA community expressed frustration and confusion — in some cases disgust — that the largest state affiliate of the Big “I” would go into direct competition with them in the wholesale insurance marketplace.”
Update on previous post: ADMINISTRATION IGNORES BOARD, AWARDS $3.3 MILLION INSURANCE TO SAME VENDOR, CONSULTANT
Vendor writes complaint letter to BISD – Klement Letter
“This is the kind of stuff that the FBI is looking for,” said a BISD administrator. ”
“As I speak to folks in my district, I regularly hear stories of confusion regarding the difference between urgent care clinics and these freestanding emergency rooms, which are generally far more expensive,” the Republican from Georgetown said.