Republicans Rejoice – New Medical Cure For Democrats?

April 28th, 2017

elephant

Republicans are ecstatic over news Italian surgeon Sergio Canavero has a potential solution for Republican efforts to influence minds and souls through a new medical break through….. 

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Health Rosetta Outlines Difference Between Status Quo Broker & New Age Broker

April 28th, 2017

rosetta

Does this describe your broker? If so, you probably need to look for another one:

  • “Shops” the insurance every year
  • Facilitates insurance 1 year at a time
  • Believes costs are dependent on the best offer of the carrier
  • Gives limited data on where your money is going
  • Provides limited ways to control underlying costs
  • Doesn’t talk about their compensation or worse, is solely paid on commission, meaning more income the more rates go up
  • Advocates cost shifting in the form of increased deductibles and copays to lower the employer impact of premium increases
  • Blames costs exclusively on employee behavior and poor health

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Stricter Chargemaster Regulations Needed To Rein In Healthcare Costs

April 27th, 2017

trumpeeeee

“It’s Not My Fault They Read My Book!”

Hospitals use fairy tale chargemaster pricing — which are shrouded in secrecy — to negotiate with third-party payers and generate revenue, yet Hospitals Dismiss Significance Of Chargemaster Prices?. A good negotiator, seeking maximum profits, always starts out high……Hospitals know the Art of The Deal…………..
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Will California Health Insurance Brokers Become Extinct?

April 27th, 2017

beggar

Former Health Insurance Broker 

California single-payer healthcare bill passes first committee test…………………

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Plan Sponsors May Face A Perry Mason Moment?

April 26th, 2017

perrymason

Perry Mason Has Never Lost A Case

If an ERISA Plan Sponsor has irrefutable evidence the plan is overpaying for health care, can a plan participant sue the Plan Sponsor and it’s trustees, jointly and individually, for wantonly squandering plan assets and win?

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Asking the Right Questions about Health Care

April 25th, 2017

“Health insurance is a classic example of the Law of Subsidy in action”

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How Late Will Late Adopters Be Late?

April 25th, 2017

sand

It’s been eight years since I wrote Health Care Strategies for Texas Political Subdivisions: costplusinsurance.com/articles/Health%20Care%20Strategies%20for%20Texas%20Political%20Subdivisions.pdf

Since then there have been early adopters who have blazed the trail for others to follow. But most Texas political subdivisions still have their heads in the sand.

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Health Insurance is NOT Health Care

April 25th, 2017

evans

I’ve said for years that one of the main reasons ObamaCare passed was because they did a great job of confusing Health Insurance with Healthcare financing, or Healthcare.  I recently ran across the attached article that does a great job of addressing this point and wanted to share it.  I hope you enjoy it as much as I did.

Have a great day!   Jeff Evans, Director, Benefit Services jevans@healthplan.org

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Craig Lack – “The Most Effective Consultant You Never Heard Of”

April 24th, 2017

coolaid

Craig Lack is “the most effective consultant you’ve never heard of,” according to Inc. magazine. He consults nationwide with C-suites and independent healthcare broker consultants to eliminate employee out-of-pocket expenses, predictably lower healthcare claims and drive substantial revenue.

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5 Biggest Mistakes CFOs Make When Buying Healthcare

April 23rd, 2017

ifix

Most CFOs don’t know whether their company’s medical plan pays retail, wholesale or institutional charges.

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AMPS Announces Investment to Continue Rapid Growth

April 22nd, 2017

AMPS_Blue111

“Last year AMPS grew by over 70% and we are on a financial track to do the same this year,” said Dendy.  “However, beyond financing, we also see the new investors as an opportunity to build and expand our leadership footprint in healthcare cost management services for employers, health care plans, and government entities.”

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Price Transparency App For Diminishing Middle Class

April 22nd, 2017

transparencyiiii“Household salaries have remained flat over the past 20-plus years as every potential salary raise is applied to feed the healthcare beast…………”

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Beating Medical Trend

April 22nd, 2017

arrow

Medical inflation continues to rise at a rate above the growth rate in the economy. Facing rate increases year after year, plan sponsors, with their financial backs to the wall, have historically resorted to cost shifting. These continued failed attempts to control costs have […]

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Robbing Peter To Pay Paul

April 21st, 2017

peter

The risk-adjustment program program is supposed to protect plans from covering more than their fair share of sick enrollees. Program managers at CCIIO take cash from plans with low-risk enrollees and send the cash to plans with high-risk enrollees.

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TPA Lesson 101 – How To Be Sneaky & Always Be”Lowest Bidder”

April 20th, 2017

mulebriar

Our website (www.mollymulebriar.orggets emails from time to time through our Tip Line exposing industry secrets……

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How Drug-Company ‘Benevolence’ Silences the Sick

April 20th, 2017

outrageous12

For decades, the price of Syprine was $1 per 250-milligram tablet, or about $1,460 a year………. Today, Valeant charges around $300,000 for a year’s worth of Syprine…………

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Is Direct Contracting the Right Strategy for Your Organization?

April 20th, 2017

mulebriarConnect with employer and provider peers who are actually developing and strengthening direct contracting relationships to discuss the pros and cons of direct contracting at the 3rd Annual Employer-Health System Direct Contracting & Partnership Strategies Summit on July 25 in Boston.  Gain insights into such questions as:

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Amazing: Nostradamus Predicts TRS ActiveCare Future

April 19th, 2017

nostr

An amazing discovery, an ancient manuscript found yesterday by Waring, Texas Girl Scout Troop 34, buried near an oak tree on the grounds of the Texas state capitol is purported to be one of the missing chapters in famed Nostradamus book “The Future of Government Health Care in Tejas.”

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How Does Your Stop Loss Premiums Compare To The Market?

April 17th, 2017

stoplossinsuranceHow does your current stop loss policy premiums compare to the market? Aegis Risk’s premium survey provides average industry benchmarks…………………..

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Do Fee Based Consultants Earn Kickbacks From Carriers They Recommend?

April 15th, 2017

dontt

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.

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RiskManagers.us Offers Post Graduate Course For Plan Sponsors

April 14th, 2017

classroom

If you wish to continue operating your self-funded plan the old fashion way this advanced course will not be of interest to you – Homer G. Farnsworth, PHD

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Protection Money In Health Care

April 13th, 2017

godfather

Paying protection money (PPO access fees) 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.

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Games Brokers Play – A True Story

April 12th, 2017

mulebriar

“Those who have data win. Those who have good data win a lot. Those who have real time data win all the time” 

 

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Texas Feeding Frenzy Begins…………

April 10th, 2017

sharkfeeding

Texas Senate Bill 789, which will gut the TRS ActiveCare health plan for Texas school districts, will pass according to our sources in Austin. (The Coming Implosion of TRS ActiveCare?The next 14 days will tell the story.

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AMPS

April 10th, 2017

AMPS_Blue111“Over the last 3 years, AMPS average reimbursement level on hospital claims has averaged 156% of Medicare or approximately 37% less than PPO reimbursement levels. For every 1,000 employees on an employers’ health plan, this 37% decrease in cost equates to approximately $2,550,000 in savings.” 

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Klepper’s Blog – A Resource Center For Employer & Union Purchasers

April 9th, 2017

klepper

Brian Klepper

I’ve decided to reconstitute my blog, Care & Cost, to be more inclusive again of other writers, and to focus on purchaser issues.

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Question for Hospital Administrators

April 9th, 2017

question1

It is no secret in our industry what plan sponsors pay towards patient advocacy, balance billing defense and legal defense. I am positive you know too.

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Second Opinion From Doctor Nets Different Diagnosis 88% Of Time, Study Finds

April 9th, 2017

ohno

A new study finds that 88% of people who go for a second opinion after seeing a doctor wind up receiving a refined or new diagnosis.

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Stop Overpaying For Healthcare

April 9th, 2017

pricetoohigh

“We are building an army of volunteer attorneys prepared to represent people when the time comes. In fact, when communicating with providers and bill collectors, we’ve been asking them to sue the patient. Thus far, none have.” – David Silverstein

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Hospital Knows How To Play The System – Turning Cost Sharing Plans Into 100% Plans

April 8th, 2017

winkHospital system knows how to turn cost sharing health plans into 100% plans, much to the delight of plan members…………….

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House Passes Stop-Loss Definition Bill by Huge Margin

April 5th, 2017

wowThe bill, H.R. 1304, would block federal efforts to regulate small stop-loss plans as health insurance by excluding the plans from the federal definition of “health insurance coverage.”

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How To Fight Unfair Hospital Billing – Deny Payment & Dispute Bill

April 5th, 2017

silverstein

David Silverstein –  www.BrokenHealthCare.org

Broken Health.org’s system of fighting unfair hospital billing is centered on “Denial of Payment.”

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Texas Legislature To Tackle Balance Billing Issues – Jeff Evans Opines……….

April 4th, 2017

evans

As a citizen of the great state of Texas, I am curious about the introduction of several bills designed to “ensure health plans are discouraged from underpaying providers.” – Jeff Evans

To Jeff’s point, David Silverstien addresses a basic problem with government interference in our health care system:

“We recommend extensive legislative education. We genuinely believe that legislators do not understand the true nature of healthcare pricing and that, as the paramount issue of our time, they must. Our form of government is grounded in the expectation that the citizenry elect wise and noble people who then study the issues before them to an extent not possible by the general public. The nature of healthcare pricing is such that the limited knowledge of legislators is approaching the danger level.” – David Silverstien

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Government Continues To Interfere With Free Market Despite Republican Pledge To Repeal ObamaCare

April 3rd, 2017

obamal

“My legacy continues!”…………..

As the Trump administration continues to debate the future of the Affordable Care Act, a new Obama-era health insurance rule is taking effect…………….

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The Cost of Convenience

April 3rd, 2017

ppoo

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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Where Art Thou RBR Program Transparency?

April 3rd, 2017

binocolorsIf an RBR provider’s marketing efforts signal pricing based on a starting point versus an actual post-negotiation result, then the Plan Sponsor will likely be very disappointed

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Tenet, BCBSTX Sign Multi-Year Agreement

April 3rd, 2017

dogs

For those of you insured by BCBSTX, would you like to know what kind of prices have been negotiated for you at Tenet Healthcare? Maybe your prices went down?

As a BCBSTX policy holder, whether you know it or not, you have a dog in this pricing arrangement. Why don’t you ask to see a copy of the negotiated contract? After all you will be subsidizing the agreement as a premium paying card carrying member of the Caring Company, right?  

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Hospital PPO Pricing Exposed in South Texas

April 2nd, 2017

topsecretLarge employers of the Lower Rio Grande Valley have relied on third party intermediaries to negotiate pricing with local hospitals for over 35 years. Now, for the first time, some Valley school districts are learning the truth about the value of PPO discounts and they don’t like what they see…….

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Meet The 105 Year Old Doctor Who Is Still Hard At Work

April 1st, 2017

doctor

He worked with Alexander Fleming and was a Prisoner of War 

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Lloyds Reacts To Brexit

March 30th, 2017

dodd

Ken Dodd’s Teeth Insured By Lloyds

Lloyd’s, one of Britain’s oldest institutions, is the world’s leading insurance and reinsurance market. It focuses on specialist markets, such as marine, energy and political risk, but also branches out into more unusual areas, such as insuring comedian Ken Dodd’s teeth.

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A Health Care Plan so Simple, Even a Republican Can Understand!

March 30th, 2017

coulterIt’s always impossible to repeal laws that require Ann to pay for greedy people, because the greedy run out on the streets wailing that the Republicans are murdering them.

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WEB Sponsors Reference Based Reimbursement Session In March Meeting

March 28th, 2017

webqJoin the Worldwide Employee Benefits (WEB) network for our March luncheon for an in depth look behind the driving costs of Healthcare as we discuss Reference Based Reimbursement.  This session will address why costs continue to rise each year and provide case studies of groups who have successfully beaten this trend. 

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Thoughts on “Repeal and Replace”…

March 26th, 2017

mess

I am not the first to say this, but I am disappointed that given the opportunity to replace the “access” program represented by ACA/Obamacare with real reform, our friends in Washington have “punted” again! I guess the financial and other benefits provided by the American Hospital Association, American Medical Association and Blue Cross and Blue Shield Association ultimately outweigh doing the right thing.  

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“It’s Been A Great Week!”

March 26th, 2017

obamal

“In power or not, we Rule!……..Have a nice day!”

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Allied National Has Answers For Consumers on Reference Based Pricing

March 24th, 2017

allied

“Our experience is that virtually all providers will accept these Medicare “plus” reimbursement levels.”

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Patient Concerned About Black Testicles

March 24th, 2017
balls
“There’s nothing wrong with them, Sir. They look magnificent.” 

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Ransom Insurance vs Dental Insurance

March 24th, 2017

petersen1A Rio Grande Valley woman said she’s not going back to a dentist in Mexico. She claimed she wasn’t allowed to leave the office.

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What Can US Policymakers Learn About Essential Health Benefits From Israel?

March 23rd, 2017

israel

It may surprise readers to know that Israel has a system very much in line with many US policymakers’ goals of fostering a competitive private insurance market. The Israeli system rests on the concept of competing private health plans selling care in a market of empowered consumers. But one crucial difference is how Israel approaches the question of what it means to be covered.

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What Does Bernie & The Donald Have In Common?

March 22nd, 2017

bernietrump

Trump has promised that “ (Rx) pricing for the American people will come way down.”

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Reduce Total Health Benefits Spend By 20-40%

March 22nd, 2017

riskmanagers.logoLearn how moving to self-insurance managed by a fully independent Third Party Administrator (TPA) linked to high value providers and services can reduce your total benefits spend by 20 to 40%.

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ObamaCare Is 60% Welfare

March 22nd, 2017

handout

ObamaCare Is 60% Welfare – Lunch Alert!

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12 Years Later…… Do Undisclosed, Secret, Back Door Agreements Still Exist?

March 21st, 2017

mulebriar

Do insurance agents, brokers and consultants still receive undisclosed compensation from the vendors they recommend? 

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The Tale of Two Waiting Rooms

March 19th, 2017

whores

Like the old whore houses of the Wild West, patients at the Mayo Clinic may be directed to one of two waiting rooms. In the good ole days, upon entering the local cat house one was directed to one of two waiting rooms. The room on the left was for “second rate citizens” and the room to the right was saved for “1st class citizens” such as lawyers, doctors, and the wealthy.

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Average Reimbursement Rates For Hospitals Exposed

March 18th, 2017

screwedaaIf you are not getting 70-80% off billed charges you are getting screwed……………..This article proves the fallacy of hospital charge master rates which no one ever, ever pays……………

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Weslaco ISD – THE FIRST Texas School District To Seek Competitive RBP Proposals

March 16th, 2017

weslacoUnder the leadership of the district’s risk manager, Mike De La Rosa, the Weslaco Independent School District has historically demonstrated an almost unequaled track record of  “thinking outside the box” amongst Texas school districts.

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Thoughts From The TPA Front Lines

March 15th, 2017

mcs

Things are moving at light speed for TPAs, with new technology, approaches to disrupting traditional use of PPOs, carriers seeing TPAs as sources of business, increasing interest in participant engagement and widespread investor interest.

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Broker Asks RiskManagers.us Opinion on Direct Contract Offer

March 15th, 2017

mad

The game is over. Plan sponsors are becoming more educated. The secret ingredients of managed care contracts are now known to many. And they are mad as hell and not going to take it anymore.

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AssuredPartners Acquires Keenan

March 15th, 2017

keenanAcquisitive insurance brokerage AssuredPartners Inc. is making a significant move into California with the purchase of Keenan & Associates in a deal that will push AssuredPartners’ annual revenue over $800 million.

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Invitation to Join Broker and Benefit Executives

March 13th, 2017

whealthcongressWith the acknowledgment that many benefits consultants drive decisions that are at odds with optimal health plan performance, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.

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Where’s The Beef?

March 12th, 2017

beef

“No one is entitled to health insurance. No one is entitled to health care. And just as certainly no one is entitled to a $1 million bank account or one with unlimited funds. So where’s the beef?” – Molly Mulebriar

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MediBid Enhances its Free Market Medical Pricing for Self-Funded Employers

March 12th, 2017

medibid

“This groundbreaking innovation in medical price transparency will further disrupt the insurance company dominated status quo and give patients increased leverage in obtaining the best value for their health care dollar,” says MediBid CEO Ralph Weber.

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A New Reference Based Pricing Self-Funded Plan Design Available Soon!

March 10th, 2017

Starmark Healthy Choicesâ„  – Available Soon

Starmark

AtlasMD Touts Allied National

March 9th, 2017

allied

He founded the Wichita direct-care medical practice more than six years ago ……. He cited Allied National Inc. in Overland Park as an example of an insurance company whose profit margins have increased by incorporating the Atlas model………….

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Republicans Lay Waste To Their Base On Health Reform

March 8th, 2017

sherman

William Tecumseh Sherman, who laid waste to the South at the end of the Civil War, famously said, “War is Hell”.  So, too, is health reform.

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The Difference Between A BUCA and an Independent TPA Can Be Stark

March 8th, 2017

stark

A recent request from one of our clients to their record keeper was simple; What have we been paying, on average, for certain procedures? The response/s in a string of emails lays out a simple request into one of enormous complexity, seasoned with a good dose of Bull S–T.

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2007 Leap Into Uncharted Waters Saves Clients Millions

March 7th, 2017

riskmanagers.logo“It has been seven years since our first client exited the managed care world. Subsequently more clients have embarked on the same journey, most with equally good results. None have returned to the world of managed care” – 

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Escalator Clauses, Rising Prices, And Why We Should Care

March 7th, 2017

escalatorYou may have asked yourself why health prices rise inexorably. Are escalator clauses, the automatic price increases common to many managed care contracts, the driving force behind trend factors?

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Responding to Non-Network Plans Using Reference-Based Pricing

March 7th, 2017

rope

Father of The Rope-A-Dope Method of Winning – Mohammed Ali

Attorney advises hospitals how to respond to Reference Based Pricing Plans…………..a revival of the Rope-A-Dope?

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The Coming Implosion of TRS ActiveCare?

March 6th, 2017

angryteacher

TRS-Care 1, 2 and 3 will go away………….There will be only one plan: a high deductible health care plan…….Premiums would be an estimated $430 per month, or $5,160 per year!…..The deductible of $4,000 would need to be met before plan coinsurance starts……There would be 80/20 coverage after meeting the $4,000 deductible…….The maximum annual out-of-pocket (MOOP) limit will be $7,150……There would be no prescription copays. All prescription coverage is part of deductible requirements…

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Why Benefits Advisors With A Future Are Developing More Transparent Arrangements

March 6th, 2017

klepper

Currently, many benefits consultants drive decisions that are at odds with optimal health plan performance. Organizational purchasers, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.

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TRS Healthcare Bill Offers Fewer Options, No Savings

March 6th, 2017

Man shouting, pulling hair

If passed, SB 789 would limit districts that may participate in TRS-ActiveCare to those with 1,000 or fewer employees. The bill would eliminate the traditional co-payment insurance plan option, leaving only one plan (high-deductible, no copays) Districts with fewer than 1,000 employees will be given a one-time opportunity to opt out of TRS-ActiveCare.

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Free Market Solution To Rising Health Care Costs

March 5th, 2017

mulebriar

“The only difference between Republicans and  Democrats is Republicans take a little longer to get there” – Molly Mulebriar

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Tx. School District Feeding Frenzy Begins…………………

March 2nd, 2017

feedingfrenzy

Insurance agents, sensing an opportunity of a lifetime, are lining up to feed on the TRS ActiveCare scraps.

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Small Groups Can Combat Rising Healthcare Premiums with Level Funding

February 26th, 2017

costcontrol

The rising cost of employee healthcare has more small employer groups choosing level funding over their traditional fully-insured health plans. What are the advantages of this option for your small business?

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Texas School Insurance Newletter

February 26th, 2017

txnews

Be prepared for double digit increases in all of your insurance rates – not just Property & Casualty

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