“Those who have data win. Those who have good data win a lot. Those who have real time data win all the time.”
“Balance billing is representative of the last throes of a failed health care delivery system.”
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
The fate of Barack Obama’s signature health-care law may depend on how long Anthem Inc. and Aetna Inc. are willing to wait before starting to make money off it.
“Exiting the exchange market would likely indicate that the entire marketplace experiment has failed….”
Willis is seeking Towers Watson to better compete with larger insurance brokers……..
If passed, the new system would be financed by a 10 percent payroll tax hike.………This comes three years after voters approved a ballot initiative that made Colorado the first state to legalize recreational marijuana………
The nation’s largest health insurer fired a shot across the bow of ObamaCare on Thursday, citing flagging enrollment and high-risk customers in suggesting it may have to pull out of the exchanges in 2017.
“This is part of an overall national trend to move away from PPO plans that come with high costs to consumers and offer little in the way of coordinated care.” – Statement from Blue Cross & Blue Shield
Increasing pressure from rising medical costs and the looming Cadillac Tax are pushing employers to consider innovative options to manage their Health Plans.
“The hidden fees were listed in internal BCBSM documents under a variety of names: provider network fees, contingency/risk fees, retiree surcharges, and—my personal favorite—other-than-group subsidy fees………………Lest you think this scheme was something BCBSM dreamed up on its own, an actuary from the consulting firm Milliman Inc. testified under oath that many other insurers engaged in the same practices.”
Dr Stewart Adams knew he had found a potential new painkiller when it cured his hangover ahead of an important speech.
“The unnamed businessman was told that if he wanted his company to keep a contract with the school district that Infante and Yanez must be paid $10,000 each, the indictment alleges. “
Good Morning Martha,
I AM RETIRING!! Today is my last day at work. My official day of retirement will be January 1, 2016.
I just wanted to say thanks for the many years you and Bill have helped me do my job. When a situation arise and I was in doubt as to how help my co-workers with questions about their claims or insurance coverage, I knew all I had to do was to contact one of you and the situation was taken care. I will miss you. Take care and hope you’ll have happy holidays coming up and a very happy New Year!
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
National Nurse Practitioner Week is held annually to celebrate these exceptional health care providers and to remind lawmakers of the importance of removing outdated barriers to practice so that NPs will be allowed to practice to the full extent of their experience and education. Read the rest of this entry »
“Raise your hand if you know of a physician you work with who should not be practicing because he or she is dangerous.”
“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have 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.”
“Blue Cross’s accountants and actuaries determined what expenses Blue Cross wanted to recoup through the Disputed (Hidden) Fees, and then determined how much the hospital claims charged to the customers had to be falsely marked up in order to reach that amount.”
“Remember John, I’ve got pictures!”
BREAKING: SUPREME COURT TO CONSIDER OBAMACARE’S ATTACK ON RELIGIOUS LIBERTY
Personal candid comments from SPBA Active Past President Fred Hunt
I have been writing these candid report/forecasts for 35 years. I appreciate SPBA President Anne Lennan inviting me to continue the tradition each year. I am happy to say that the rate of accuracy (how things have turned out) of these reports & forecasts is about 90%. These were originally designed for reading just within SPBA, but our members believe in transparency, so the total candor is open for anyone to read. So, these are read not only by SPBA members to compare their situation to what I’m hearing from their peers….but these are also read by investors in SPBA firms, brokers, clients, etc.
Seth Chandler, a law professor at University of Houston’s Health Law Policy Institute, put it even more bluntly: “It’s dramatic that the fourth-largest city in the country does not have a PPO.”
In 2015 there were 19 PPOs available in Harris County, 12 from Blue Cross Blue Shield and seven from Cigna Health Insurance, Chandler said. Now there is none.
“We found that the individual PPO plan was no longer sustainable at the cost it was being offered,” the company (BCBS) said. “Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.”
“Had the Democrats gotten their way, the public option would have covered up those issues and pushed the insurers out of business.”
I have a love-hate relationship with the Electronic Health Record (EHR). To be precise, it’s 90% hate, 6% love. The missing 4%? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.
(See video at the end of this article)
GI societies plan to appeal the cuts to the CMS and are asking members to reach out to legislators.
On Oct. 29, 2015, in southern district of Texas Federal Court, a TPA administered self-insured ERISA plan and plan sponsor were sued for alleged ERISA plan assets embezzlements, deceptively concealed with alleged “fake PPO (CO) discounts” and “fee forgiveness protocol scam”
I have retired from employee benefits. This blog domain is one of kind. If you start typing in google’s search box the word; benefit, this benefitblog is first on the list. This can translate into a revenue generator for the firm purchasing benefitblog.
“This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.”
The insurance industry is in the midst of the most consequential season in its history, so ITL is proud to be partnering with Silicon Valley Innovation Center for Insurance Disrupted, Silicon Valley, 2015, a conference in Palo Alto, CA, on November 19 and 20, 2015. This timely gathering brings together many of the smartest people and best ideas from those who are shaping the future of insurance. You do not want to miss this summit. With limited space available, we recommend that you register today
TRENTON, N.J. – Stepping into the furor over eye-popping price spikes for old generic medicines, a maker of compounded drugs will begin selling $1 doses of Daraprim, whose price recently was jacked up to $750 per pill by Turing Pharmaceuticals.
A Pennsylvania health system is making a significant change in how it charges patients for procedures. Instead of sending them or their insurers a complex bill with dozens of different charges after the fact, St. Luke’s University Health Network is posting all-inclusive prices for common procedures on its website, then having patients pay in advance.
UCLA Health offers cash pricing for selected services. Cash-pricing packages must be paid in advance of receiving services. Insurance will not be billed and claim forms will not be provided. If you would like information on cash packages, please call (310) 794-1125 or email us at firstname.lastname@example.org
The Texas Department of Insurance (“TDI”) has drafted new and potentially transformative rules relating to medical stop-loss insurance policies issued in connection with self-funded employer health benefit plans.
“In our healthcare system, the “middleman” is not who you think………… In reality, it is the physician who has become a “middleman” in the healthcare transaction or, as I argued, a subcontractor to the insurer.”
GOVERNMENT SPIN DOCTOR ON CRACK: “The Affordable Care Act has created a dynamic, competitive marketplace, with considerable choice and affordable premiums in 2016.”
“If you want the $6,221 MRI, you should have it — but you should pay for it, not me, not my employer, not my government. If you want the $300 test, it’s yours. If you want to buy your prescription for $150, go ahead. But you should also know that if you walk two blocks, you can get it for $17. (Yes, these are real numbers.)”
Editor’s Comment: The following article is a good one. It clearly shows the convoluted pricing of health care in this country. It also brings up a valid issue: health cost discrimination in health care. Health insurance is a reimbursement benefit. Members incur medical expenses, and are then reimbursed (never mind Assignment of Benefits – all that is extended credit by providers). So why should a plan sponsor reimburse employee Jones $3000 for an MRI and only reimburse employee Smith $400 for the same exact medical procedure? That is discrimination of the worst kind…………..
“Not all prices are equal in health care” – Molly Mulebriar
Trident Public Risk Solutions (Trident) strives to be the preeminent specialty commercial insurance provider for public entities. From small municipalities who need first-dollar coverage to larger public entity risks that require unique funding and reinsurance mechanisms, Trident is your single-source platform for public-sector risk management solutions.
Ex-Hedge Fund Manager Who Jacked Up Price of Drug by 5,000 Percent Gets Lesson in Free-Market Capitalism
“Puerto Rico’s potential as a transplant center is partly based on a macabre statistic – the Caribbean island had a murder and non-negligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the United States………….”
“We all know that the average American health care consumer seldom have the money to pay their own health insurance deductibles and co-insurance, especially now that health plans are gravitating to higher deductibles and out-of-pocket exposure. Paying these expenses is difficult enough, much less balance bills” – Molly Mulebriar
“Psst, we should get in the prescription drug business Godfather!”
Drug politics go Republican as Rubio criticizes industry
Oct 20, 2015 | By Drew Armstrong and Sahil Kapur
(Bloomberg) — Republican presidential candidate Marco Rubio joined the debate over U.S. drug prices, saying in a speech last week that some practices by the industry amounted to “pure profiteering.”
Lantanprost average retail pharmacy cost $6
Retail Cash Prices:
HEB – $90
Walgreens – $76
Independent Pharmacy – $18
Cash paying customers see this and act accordingly. Those with insurance see only a small co-pay and don’t give a damn
From a Doctor:
Check this out – www.healthwarehouse.com/latanoprost-0-005-opthalmic-solution-1.html
From a PBM:
You are right on it. I looked up our MAC for Latanoprost with NDC 17478-0625-12. Our current MAC effective for October is $3.58085 per unit and the bottle contains 2.5 units which mean ingredient cost would be $8.95. Pretty good reference based pricing, huh.
Now that ObamaCare is failing in the exact way its critics predicted more than 5 years ago, the White House is preparing to use threats to increase ObamaCare enrollment numbers next year. The threat, of course, is the ObamaCare tax.
When Turing Pharmaceuticals raised the price of an older generic drug by more than 5,000 percent last month, the move sparked a public outcry. How, critics wondered, could a firm charge $13.50 a pill for a treatment for a parasitic infection one day and $750 the next?
“……if Aetna and Humana are allowed to merge, the new company would gain control of 36 percent of Texas’ health insurance market……..physician groups especially could be negatively affected by a merger as they could end up with “very little negotiating leverage to allow them to secure favorable pricing terms.”
The government is not prepared for the complicated 2016 Obamacare reporting required to determine who is eligible for premium handouts. As a result the IRS is going to assess penalties against employers even if an employer does not receive the legally required warning notice.
Governmental Budgeting Prowess: When held to private standards (without the ability or print money to borrow infinitely) this Obamacare fund will only be able to pay 13% of the money it owes under the statue.
The Federal Government decided that the old system of 13,000 medical codes wasn’t enough and has commanded that all medical providers move to a new system with 68,000 so that we can have codes for repeatedly walking in lampposts and getting sucked into a jet engine.
Dumb American health care consumers need big government to protect against evil balance billing by greedy health care providers. The government of New York is doing something about it……………
“North Korea and the drug industry are the last bastions of Marxism”
“This latest health care spending growth report is more proof that astronomical prescription drug pricing continues to send health care spending higher and higher for consumers, public programs and our economy”
New study reveals that some women pay more for health care services than other women. Identical health care services range for some women as much as 76 times more than for other women.
QUESTION: How do we know we are doing much better this year than last year?
ANSWER: What was this year is last year plus or minus this year’s changes.
If change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t now how to measure what it was before.
Source: DK Pruitt
“United States: OCR Confirms HIPAA Audits To Begin in Early 2016 – Forced to respond to a stinging audit report recently released by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) that found less than effective enforcement of the HIPAA privacy standards, HHS’s Office for Civil Rights (OCR) will commence its long-awaited HIPAA audits in early 2016.” By James E. Bowers for Mondaq, October 9, 2015
“EHRs provide long-term savings, convenience.” (No byline, ADA News, December 6, 2013).
Sucked into a jet engine, survived, then sucked in again? First of all, that really, really sucks. Second of all, this patient is obviously Wolverine, and should be detained for imaging and posterity.
“….the filing was attributed, at least in part, to financing challenges and insurance company curtailment of payments to facilities that have traditionally operated as out-of-network providers….”
Take Command Health, a Texas-based startup dedicated to helping individuals choose and save on their health insurance, is partnering with Zane Benefits to provide Texas businesses with fewer than 50 employees with health benefits products and services.
By Dr. Alan Preston
“Who is the boogie man in healthcare? I am going to look at three possible culprits as to cost drivers of healthcare…”
“Madrigal recommended board members choose her, but did not disclose he had done personal business with her.”
Hidalgo County approves RFP process for professional consulting services for the Hidalgo County Self-Funded Health & Welfare plan.
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.
AUSTIN, Texas, October 1, 2015 — Associated Builders and Contractors (ABC) and Fringe Benefit Group today announced the expansion of The Contractors Plan, a benefits platform designed specifically for construction contractors, to include a full suite of benefits including ACA-compliant major medical, dental, vision, life, disability, retirement and HRA plans – all managed through a single online platform.
“There needs to be some kind of investigation, that way there is transparency at Harlandale,” says Julie Gimbel, President of the Harlandale Educational Association, the union which represents teachers.
I just got the first year bill from my payroll company for the extra reporting we have to do each year vis a vis Obamacare: $7195.50 for 2015. Note that this adds absolutely no value — this is not the cost of insurance or cost of any extra taxes sent to Uncle Sam. This is merely the cost to handle all the new paperwork required in the law.
I will repeat what I have said before — the Republicans tend to focus narrowly on taxes and often tend to miss or downplay the regulatory issues, which I think actually loom larger in destroying economic growth.
SimpleSaveRx realizes that a change is needed in the healthcare industry to make prescriptions work more like everything else in business and less like healthcare. SimpleSaveRx, by focusing on prescriptions, will enable members to achieve the greatest savings possible per prescription.
By Robert E.H. Khoo, M.D., F.R.C.S.(C), F.A.C.S.
I predict that within 20-30 years the computer will replace the venerable physician……