To protect against potential effects of adverse selection and help stabilize premiums in the individual and small group markets, the (Robin Hood) risk adjustment program transfers funds from plans with relatively low-risk enrollees to plans with relatively high-risk enrollees.
National Ambulance Service reach all over the country within 15 minutes…………
Government bureaucrats consider upping punishment for non-compliant hospitals…….
Blame Game In Health Care
Whatever happened to individual responsibility?
Transparency has revealed just how absurd the current contracting process is, and has in many ways caused more confusion and obfuscation……………….Costs could very likely rise in many markets as systems learn about higher prices being charged by their competitors – the definition of ‘unintended consequence………….
This is a clip from my first documentary feature film called King Murray. It won the Cannes Film Festival Critics Prize in 1970. Murray King was a most amazing character and ended up selling me life insurance….. at 27 years old!
The author’s message is clear. And it’s real. But there is something else within the article that’s a condemnation of our current health care system of finance in this country – If You Can’t Pay Your Gonna die.
Insurance Agents Cheech & Chong Out Making Cold Calls
Cheech & Chong, in their best dreams of years gone by, would have never thought possible mainstream insurance brokerage would ever promote a canabis benefits captive. Their idea of “captive” was that it was really bad and something to avoid.
With the magical stroke of a bureaucratic pen a list of the procedure codes may be removed from the ASC payable list, including several heart and spine procedures…………….
“When United and a provider dispute whether a claim was overpaid, cross-plan offsetting allows United to act as judge, jury, and executioner.”
By Bill Rusteberg
Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.
AON Representative Reacts To The News
Aon will pay the $1 billion termination fee to Willis Towers Watson…………..
“Somewhere in the world, there is the world’s worst doctor, and someone has an appointment with them tomorrow” – George Carlin
Will TRS ActiveCare survive massive assaults by hordes of commercial invaders who believe victory is a given? Battle plans incorporate common sense, reason and logic geared to winning in time for the TRS ActiveCare Armistice Day deadline set for December 2021…..
Unfortunately health plans traditionally do not discriminate by choice of in-network provider because members pay the same no matter who they visit for health care.
We are thrilled to invite you to our Group & Medical Client Summit on September 13 – 14, 2021.
USBenefits Insurance Services, LLC is a full service Managing General Underwriter, providing Medical Stop-Loss Reinsurance for employer groups through qualified Third Party Administrators and select brokers.
Phone Call Recordings may be Requested by Claimants if They’re Deemed Relevant to a Benefits Claim
The rise of PE in medicine has resulted in a proxy war against insurance companies exclusively for the benefit of clandestine shareholders and investment fund managers rather than patients or clinicians………………..
Powers is an expert on reference-based pricing (RBP), having worked on RBP plans for over a decade……………..
Those that don’t play by the rules get the same benefits they have always had but wish they didn’t because they want something better and cheaper………….
HOLY COW!
Interesting Milliman study on health care costs. A lot has changed since 1973………..
If this patient didn’t have “Skin In The Game” he would not have shopped for care.
As insurance costs continue to soar you will see a rapid growth in strategies like this among the ever shrinking community of independent PCP’s who remain adverse to the shackles of managed care contracts and hospital ownership of their practice………
Increasingly fed up with red tape, paperwork and meddlesome third-party rules—especially since passage of Obamacare—a growing number of physicians are opting to bypass both government and insurance companies.
Survey results for the January 2020 business indicate a continuation in the favorable loss ratio trend with more than half of all participants achieving or exceeding their respective target loss ratios.
Fee based insurance consultants in Texas have been required to hold a Life & Health Counselors License issued by the Texas Department of Insurance. Now anyone who claims to be a fee based consultant and holds a General Lines insurance license may provide insurance consulting services.
The Edinburg Independent School District held public job interviews for insurance consultant and five showed up to make their pitch.
ATTENTION INSURANCE CONSULTANTS: If you have two hours of free time and want to watch one of the best insurance consultants in our industry deal with a passive aggressive school board this is it.
“Who, me? I don’t have it!”
Edinburg ISD’s self-funded health plan lost $19,000,000 in 18 months and they want to know where it went.
It’s on us as practitioners who take insurance to be assertive and request fair reimbursement rates……………….
By Bill Rusteberg
In March 22, 1982 I quit my job with a major insurance company to strike out on my own as an independent commissioned insurance agent. By late July I was nearly broke and worried.
The day after college graduation, Ada Betty took the exam to obtain her Recording Agent’s Insurance License. She passed the exam and became the youngest licensed recording agent in the state of Texas, at the age of 20. Her father, J.C. Dunn, founded the American International Life Insurance Company in Harlingen in 1952 and Ada Betty served as Vice President upon obtaining her license.
California city requires all gun owners to maintain gun insurance……..Meanwhile back at the ranch, Texas enacts Constitutional Carry effective September 2020……….
Kim was furious when he received reports that officials tried to import Chinese, not European, medical equipment. Those involved in the import of this equipment were reportedly executed……….
Vori Health Raises Additional Capital from Strategic Partners Intermountain Healthcare, Ascension Ventures, and Echo Health Ventures
Godfather, The Cat’s Out of The Bag!
An aggressive insurance agent with relationships with school districts can make a lot of money by taking advantage of the Small Group definition by forming a cooperative for school districts as an alternative to TRS ActiveCare.
By Molly Mulebriar
Health insurance in the United States is no longer insurance in the traditional sense. It’s become an entitlement welfare scheme that’s fast becoming a heavily regulated government utility.
If we don’t buy FAN BELT insurance then why do we buy insurance for routine doctor office visits? A routine office visit costs around $75 – $150 depending on who you see and the type of visit. Insuring a $75 benefit doesn’t make sense and ends up costing more.
The erosion of the American middle class continues due directly to the medical-industrial complex. It’s time to stop that by giving working Americans better health care that costs less…….
“He who has data wins. He who has good data wins a lot. He who has real time data wins all the time” – Bill Rusteberg
TO: Reference Based Pricing plan members
FROM: Human Resources Department
SUBJECT: How to Avoid Egregious Hospital Balance Billing Practices
Some plan members have experienced threatening creditors clamoring for more money than our plan allowed and paid medical caregivers. As a reminder, our plan pays more than what Medicare pays. Almost all medical providers in the United States accept Medicare payment without balance billing their patients for any more money.
Why get paid less when all you have to do is change a few numbers on a claim form and you’d be driving a cadillac by Xmas……………
Imagine having a surprise bill reduced 95.3%, from $14,269.30 to $674. And that’s without going to court, without conceding a nickel from your initial offer, without trying to qualify for an oxymoronic “financial assistance program,” without hiring an attorney, and even without agreeing to an NDA. (We’ll name the hospital on request. To name it here seems like piling on, and we’re gloating enough as it is.)
Sandra Fluke Reacts To Outrageous Viagra Price Hike
“Outrageous. I fought for free birth control and now this! Our men are entitled to free viagra!
For years, patients, consumer advocates and U.S. lawmakers have complained about the high list prices for insulin and the significant out-of-pocket costs borne by patients.
The days when a doctor could show up in a small town, rent an office and hang out a shingle, sadly, is pretty much over. The knowledge base necessary to run a small business is not part of medical education, and few new graduates want to tackle such a task.
PBM Swamp Creature Stunned By Demand
Delaware paid three times the average drug inflationary price between 2018 and 2020 for state employee prescriptions………………
Over the past four years, we have built a leading group of employer health services companies healthcare costs while providing a seamless, positive experience to employees.
If you have clients with 1.) An annual insurance spend greater than $1,000,000 2.) A good loss history, I have a program that will save them 25%-50% on premiums while not cutting your commission.
In one of his first acts as president, Joe Biden directed his agencies to review …………. a system called ICRHA – that would sever the traditional bonds of trust between an employer and its employees.
“Hey Luigi, how’s that wall coming”
Dominant drug manufacturers use rebates to keep lower-priced drugs off the market……..
A case of Wanting His Cake and Eat It too……..A half pregnant attempt towards solving health care……………….
“Evidence included correspondence showing Aetna literally told Optum to “bury” its fees by using a dummy code…..”
The insurer’s use of a pooled bank account also suggested an ERISA prohibited transaction because it made Plan A’s interests adverse to those of Plan B……………
Teachers demanded more money in order to spend more money on….. (drum roll please)….. HEALTH INSURANCE.
Buffalo, NY, June 23, 2021 – Centivo, a health plan for self-funded employers anchored around leading providers of value-based care, announced today that it has acquired certain assets, including select client and healthcare provider relationships and intellectual property, from Apostrophe Inc., a Denver-based health benefits platform and third-party administrator, effective immediately.
Second PBM Reform Bill Becomes Law in Texas
“Texas HB 1919 became law last week. The bill prevents PBM self-dealing by prohibiting them from steering patients to affiliated pharmacies. It is the second PBM reform bill to become enacted recently in Texas.” MORE >>
I have grown more cynical as this Pandemic became politicized. Therefore this sentence is even more alarming…
Our compliance team has been auditing our records and it was identified that we do not have an NDA for you. (So?)
Texas school districts have until December 2021 to make a decision they haven’t had to make in the past 20 years. Do they stay with the TRS ActiveCare government health plan or do they choose coverage in the commercial market?
Barack Reacts To Article
“I Was a Physician at a Federally Qualified Health Center. Here’s Why I No Longer Believe Government Health Care Can Work.” – Rebekah Bernard M.D.
Dozens of school districts left scrambling to pay $11.6 million in debts, a financial shipwreck that raises concerns about such ventures, which are virtually unregulated……
More than one million individuals chose a health plan that has a monthly premium of $10 or less….
A new analysis reveals that many of the top hospitals in America pursue patients with lawsuits and other predatory billing practices
How America’s top hospitals send patient costs soaring (axios.com)
Adios Group Insurance
“Instead of employers purchasing insurance plans on their employees’ behalf, they should give their employees pre-tax cash in an HRA, with which employees can purchase ACA-compliant plans”
Why would a school district stay with a failing government health plan, be held hostage for five years, have no control over plan benefits or rates when they can access the open market with some very good options that guarantees market rates, better benefits, guarantee issue with pre-existing conditions covered immediately?
