Uncompensated care was supposed to be a thing of the past, but it’s persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option.
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.
I was fortunate to know him. Mr. Edelstein ran a lean operation and took care of his valued employees. He knew each one by name. And he provided health insurance although he didn’t have to in those days. I was his broker for many years and learned more from him than he did from me.
One day he called me. “Bill, when you are in the area, please come by to see me” he said. “Of course Mr. Edelstein, I will be right over” I replied. I entered his office, sat down and asked what was on his mind. “Well, I just noticed we received a bill for an MRI for $4,200. I think that is too high, can you do anything about this? I have only so much money, and this self funded plan is not a welfare plan with unlimited funds!”
I took the bill down to the MRI center and asked to speak to the business manager. “Hi, I represent Mr. Edelstein, owner of Edelsteins Better Furniture with over 300 employees, and we would like to contract with you for MRI services” I said. “Certainly, we can provide MRI’s for $750″ replied the business manager. “Good, let’s start with this one” I said and handed him the invoice.
On another occasion, Mr. Edelstein called me and said “Bill, we have a first year employee whose coverage is limited to $10,000 under our plan. She just found out she needs an emergency hysterectomy and was told the bill would be around $28,000. Can you help?” I met with a local hospital administrator that afternoon and told her “I have $10,000, will write you a check right now if you can arrange a global fee of $10,000 for this valued employee of Edelsteins Better Furniture.” The result of Mr. Edelstein’s managed care protocol: patient was treated for $10,000.
Mr. Ruben Edelstein passed away this week at age 96.
Two U.S. appeals courts issued contradictory rulings on Obamacare subsidies Tuesday. One upheld them in a victory for the White House. The other dealt a blow to the president’s health law by striking them down for millions of Americans covered through HealthCare.gov.
The Brokerage Inc. has opened a new office in San Antonio that will specialize in selling annuities, health insurance, life insurance and long-term care insurance.
The Lewisville, Texas-based company also hired Claudia Rodriguez-Diaz to lead the office, which is located in Cadillac Lofts in downtown San Antonio.
The Brokerage Inc. also help independent brokers with marketing efforts and supplies agents with Medicare leads, Medicare certifications, contracts, free E&O coverage. The company has trained numerous agents nationwide for the rollout of the Affordable Care Act.
Many, but by no means all, carriers subscribe to the conventional wisdom that having a stop loss policy form clause requiring that all disputes between the insured group and the carrier be arbitrated and therefore not litigated in the courts is a distinct and near-universal advantage for the carrier.
SAN ANTONIO — A San Antonio medical concierge service has launched a membership program that will allow patients unlimited medical consultations, urgent care services and other benefits.
The Members MD service offered by Antonian Health is being promoted as an alternative to health insurance. Patients who enroll will receive urgent care services such as X-rays, lab work and minor medical procedures; the attention of a 24-hour on-call service; translation services; transportation to all medical appointments on request and access to Antonian Health’s network of physicians and specialists. Discounts to some hotels, fitness clubs and specialty grocery stores are included.
Antonian Health has a network of partners that includes Impact Urgent Care, the University of Texas Health Science Center at San Antonio’s Medical Arts and Research Center, St. Luke’s Baptist Hospital, Methodist Healthcare System and other providers.
Antonian Health is a luxury medical concierge that personalizes and coordinates doctor’s office visits, hospitalizations, lab tests and other medical procedures.
“Providers do not balance bill to obtain additional funds. Providers balance bill to disincentivize employer plans from using fixed price, reference based fee schedules.”
Editor’s Note: This article was written by J.P. Farley, the inventor, originator, visionary who championed Reference Based Pricing in the late 1900′s