Newly Designed Scale For Physician Practices
April 14th, 2021It’s All About The Money
April 14th, 2021
Two legislative sessions ago (Texas legislature meets once every two years) I was involved with a group whose goal was to influence certain legislative initiatives towards reforming public health care financing in Texas. We met with all the right people as well as highly connected lawyers active in the political arena. It quickly became evident we were not going to be successful without hiring them directly or their surrogates on a monthly retainer fee basis.
No Ding Credit Bill Does Not Apply To Texas RBP Plans
April 13th, 2021
Reference Based Pricing Vendor Reacts
Texas Attorney General Opinion issued April 13, 2021 negatively affects Reference Based Pricing plans in Texas.
Are You Getting Proper Underwriting Credit?
April 13th, 2021
Are you getting proper underwriting credit for your Reference Based Pricing plan?
“When it comes to stop loss options, most carriers are pooling the highly engaged employer with a large block of business made up of groups who have not adopted the best programs to contain costs and improve the lives of their members.”
TPA’s & The Maytag Repairman
April 13th, 2021Cash-pay centric health plans are turning TPA’s into Maytag repairmen lookalikes. In this case the phone has stopped ringing by 90%………………
Historic Breach – The Political Value of PHI
April 9th, 2021
The first documented PHI breach by government officials…….Government operatives steal PHI from locked filing cabinet for political purposes……
The Poorer You Are The Richer You Become
April 9th, 2021
Check out the Redistribution of Wealth Calculator to find out if you qualify…………….
Rx Patient Assistance Programs
April 9th, 2021
“What did you just say! Free Drugs? Where?
If you’re single earning less than $75,000 you will qualify for free specialty drugs through Big Pharma. Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine.
Meet The Billionaire Who Controls Your Medical Records
April 9th, 2021
Epic Systems founder Judy Faulkner built an empire pioneering—and later dominating—electronic medical records. For decades, she’s kept them walled off from competitors, but now the pandemic is fueling a digital health care race that might finally topple her from the throne.
Meet The New Chinese Flu Billionaires
April 9th, 2021
Chinese manufactured flu virus spawns instant Chinese billionaires and others across the globe. Manufacturing a problem then selling a solution is very smart business.
Schuessler & Company – The E.F. Hutton of Health Care
April 8th, 2021“We eliminate the middlemen,” says Schuessler, inventor of The Schuessler Stick™.
Bankrate Publishes Guide For Financial Rx Assistance
April 7th, 2021
I thought your readers would benefit from our guide on financial assistance for prescription medication……………..
Damian Lamendola Sells Continental Benefits
April 3rd, 2021
Founded in 2013, Continental Benefits operates in all 50 states. It is a privately owned organization headquartered in Tampa, FL.
Want Your Claims Experience? It’ll Cost $2,000
April 3rd, 2021
TRS officials say if HB 1342 passes the Texas legislature this session it will cost $2,000 per school district to provide their own claim experience……………..
It’s Money For Nothing When The Risk Is Free
April 3rd, 2021
I’ve often argued that health insurance companies in the U.S. provide almost no real insurance because they assume almost no actual risk from the people they cover. I think their financial disclosures from last year back up what I’ve been saying.
American Greed Grips Big Pharma
April 3rd, 2021
Just because you can charge $2.1 million doesn’t mean you should charge that amount.
RiskManagers.us Receives Nobel Peace Prize
April 1st, 2021
Texas based insurance group receives word via Linkedin. Waiting for confirmation call from Oslo.
You Gotta Pay Up Regardless of The Final Diagnosis
March 31st, 2021
Relating to the definition of emergency care for purposes of certain health benefit plans…..
You Can’t Squeeze Blood From A Turnip
March 30th, 2021
Pharma Witch Brews New Specialty Drug
Excluding or Carving-Out Specialty Drugs – “When specialty medication is excluded from the covered benefit, the member is completely on their own to cover the expenses for their specialty medications”.
Spurious Single-Employer Self-insured Group Health Plans Hurting Vulnerable Consumers
March 28th, 2021
A report, issued by a mysterious group of 30 unnamed patient organizations warns consumers to avoid these plans – and a call to action to lawmakers to step in and end them………….
Man With Upside Down Head Fears Chinese Virus
March 27th, 2021
A BRAZILIAN man with an upside-down head has revealed his terror of catching the Chinese Virus.
The Lisa Plan
March 27th, 2021
Happy Hour Outline of The Lisa Plan
The Lisa Plan is the future of healthcare financing. It makes sense for all the right reasons. Providers win, patients win, and employers who fund all of this win too.
The Future is Here!
March 26th, 2021
Cash pay centric health plans, coupled with PCP medical homes is the future of employer sponsored healthcare. And the future is NOW!
Texas Legislature Considers Two Bills of Interest
March 24th, 2021
Senate Bill 1684l is action packed with many items of interest particularly to Reference Based Pricing plans and includes, among other things, this:
Hospitals must list the gross charges for each health care service provided by the facility with the Medicare reimbursement amount for the health care service next to the relevant gross charges.
Government Turbocharges Individual Health Insurance
March 24th, 2021
Government subsidized individual health insurance creates an unfair advantage for private employer sponsored health plans……………
Oh Oh, No More Secret PPO & PBM Contracts
March 23rd, 2021
Managed Care Rep. Reacts
Most group plans will be required to provide members (1) In-network provider rates for all covered items and services (2) Out-of-network allowed amounts and billed charges for all items and services and (3) Negotiated rates and historical net prices for covered prescription drugs.
Chinese Virus Impacts Cheerleader Squad
March 23rd, 2021
Holy cow: 42% of Americans report undesired weight gain during Covid 19. The average weight gain is 29 lbs. And 41 lbs for Millennials! This will ramify for years to come.
Oral Vaccine For The Dreaded Chinese Virus
March 23rd, 2021SOURCE: The Jerusalem Post
An Israeli-American pharmaceutical company is preparing to launch a Phase I clinical trial for what could become the world’s first oral COVID-19 vaccine.
Reference Based Pricing Fees
March 23rd, 2021
“Guess how many TPAs or consultants are willing to implement reference-based pricing on a flat fee structure? Very few, if any.” – Mark Flores
Reference Based Pricing Under Fire
March 22nd, 2021
A recent Supreme Court case in Texas involving a hospital lien held that contract payments involving Medicare multipliers and other accepted payments could be evidence of reasonable, fair market value.
Plan Sponsors Slapped Senseless
March 21st, 2021
Plan Sponsor takes another hit from Prescription Queen
“The fact that a drug is 10% higher in cost or in price than last year, it doesn’t mean it’s 10% more effective. It just means that because payers are willing to pay for them, that [the drug makers] keep increasing the price”
Wanted: PBM To Administer An Essential Medicines Rx Plan
March 19th, 2021
The World Health Organization (WHO) has developed a list of essential medicines that “satisfy the priority health care needs of the population.”
Is Replacing Your PBM With GoodRx A Good Idea?
March 19th, 2021
GoodRx co-founder Doug Hirsh once said: “A company like ours should not have to exist.”
Who Gets The Clawback Money?
March 18th, 2021
By Molley Mulebriar
“This nightmare scenario is something that’s been happening to more and more pharmacies over the past few years. It’s part of a widely reviled practice called “clawbacks” — fees, often totally unpredictable, that PBMs charge pharmacies to “claw back” some of the money they’ve already paid them in reimbursements.”
How To Use GoodRx To Check Drug Prices
March 16th, 2021When a Doctor Prescribes You a Medication, Look It Up on the GoodRx App While Still in the Examining Room.
San Antonio Ordinance Violates the Texas Minimum Wage Act.
March 14th, 2021
San Antonio’s sick & safe leave benefits ordinance would have required private employers to provide certain paid sick and safe leave benefits to employees based on hours worked within the city limits.
Having Skin In The Game Almost Never Works In Health Care
March 14th, 2021“Skin In The Game” in health care spending really means the misguided hope of wise consumer spending using thousands of dollars they don’t have. But on the other hand having no “Skin In The Game” ends with the same results. In the later case Fat Albert would be wearing some outstanding duds courtesy of other people’s money.
Shark Advocacy Rx Program
March 14th, 2021Taking a high cost maintenance, brand or specialty medication?
Drug Fueled Rage Gripping Plan Sponsors
March 13th, 2021
Price of Drugs Is Too Damn High!
By Bill Rusteberg
High cost specialty drugs can bankrupt a self-funded plan, even if you have stop loss cover. It’s just a matter of time. So do you act now to preserve your plan or do you wait until it’s too late?
100 Percent COBRA Subsidy Starts April 1
March 12th, 2021
“Plan administrators should identify the individuals who will need to receive a notice about the new subsidy…. Generally, this means anyone who had — or could have had — COBRA as far back as November 2019, because their 18 months of coverage would extend through April 2021.”
Another Texas School District To Join The Rebellion?
March 12th, 2021
“There has been a lack of transparency in the bidding process that has caused some of us concern about how rates with such a large pool of people continue to climb at exorbitant levels………… And the sheer fact that I believe with local control we can actually reduce some of those rates and maintain, if not improve upon, the benefits, it’s something we need to look at.”
Carl’s Employer Built Health Care
March 12th, 2021
Medical Community & Cash Pay Centric Health Plans – An Eternal Love Affair
March 11th, 2021
Most Americans are insured through their employer’s health plan. The problem is most employers don’t treat healthcare like they do every other purchase. Those few that do reduce their costs by as much as 50% while improving benefits at the same time.
They know the cost of health care has remained essentially static for the past 15 years or more while the cost of health insurance hasn’t. They know because they took the time and effort to educate themselves as to the true cost drivers of health care enabling them to take corrective action.
They took the time and effort because they are the only employers that truly care about their employees (and their bottom line).
Preauthorization Bills Introduced in Texas Legislature
March 10th, 2021
HB 410 is the first TMA-supported prior authorization bill this session to get a hearing, but it’s just one piece of TMA’s broad offensive on the practice.
A Texas School District Finds Comprehensive Benefits Package
March 8th, 2021
What Does The Chinese Flu Have To Do With ObamaCare Subsidies?
March 8th, 2021
Insurance companies will benefit most by receiving even larger government subsidies on behalf of people who already have coverage,
The Payer You Never Heard Of
March 7th, 2021
You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”
Actuarial Calculations The Old Fashion Way
March 7th, 2021
Unless you’re intellectually bleached, actuary work in forecasting medical trends and rating basis is not rocket science. Manipulation of value parameters is made easier with a Dial A Matic.
TRS ActiveCare Trustees Concerned About Competing Coverage Options
March 6th, 2021
Over 140 Texas school districts now offer a TRS ActiveCare commercial health plan alternative, effectively challenging the TRS ActiveCare mandate prohibiting member districts from doing so.
Following The Flow of Drug Kickbacks (Rebates)
March 6th, 2021
Drug kickbacks / commissions (rebates) can account for about 20 – 30% of an employer’s drug spend…….
Solving Health Care Is Not Rocket Science
March 6th, 2021
As consumers, we do have the power to say that hospitals and some doctors have been riding the gravy train on the backs of American employers for far too long, and it is time to derail it.
Amazing What You Can Do In 10 Minutes in Deep South Texas
March 5th, 2021Courtesy Timer For New Yorkers (Not For Use In South Texas – It doesn’t Snow There)
The following is a true story:
By Molly Mulebriar
I dialed the number and almost immediately the mark answered with “I’ll call you back in ten minutes!”
David Rendall Is Recognized with CEO Today‘s Prestigious Global Award
March 5th, 2021
We are pleased and honored to announce David Rendall has been selected as the recipient of the prestigious 2021 CEO Today Global Award for North America. The influential CEO Today magazine recognizes and honors the most respected international business leaders and singles out those who consistently disrupt the industry’s status quo to lead their company to new levels of innovation and growth.
Small Group Health Sales – It’s Worth Your Time
March 5th, 2021
Liz Wilson
You can earn $6,000 on average when you sell a Funding Advantage level funded plan for a 15-person group – more if you add dental and vision. If you need more compensation, just tell us the amount you need and we’ll build it in.
School District Becomes The First State Approved Vaccine Provider
March 4th, 2021
Stetson Roane is an exceptional leader who doesn’t understand the concept of “It Can’t Be Done.”
Texas Declares Independence……..Again
March 2nd, 2021
What did the governor just announce Tonto?
Tonto convinces Texas governor to reaffirm Texas independence…….Will other states follow?
Health Plan Claim Analytics – Self-Insured Reporting
March 2nd, 2021Four years later and a (cough) amount of money, here we are . . . and the results are better than anyone could have imagined………………
Victor’s Feats Were Never As Good As This One
March 1st, 2021
Victor Lustig was a world class hustler in his time but he never had an opportunity like this one……….
What If Commercial Health Plans Paid 100% of Medicare……………..
March 1st, 2021
Hospital Administrator Reacts To Study
Study shows total health care spending for the privately insured population would reduce 41% if employers and other insurers reimbursed health care providers at Medicare rates.
Cash Driven Health Plans Make Sense
February 28th, 2021
Great Ideas And Business Models Are Often Memorialized on Bar Napkins…………………
Unmasked: Someone Is Lying
February 28th, 2021
“We will need to continue to wear masks into 2022!” says a Biden administration official. “We’ll be done with the scourge by April 2021!” says a medical expert. Someone is lying and I suspect we know who it is…………..
Fee-for-Service For Primary Care is Dumb………..
February 24th, 2021Fee-for-Service Primary Care Only Pays $60 – $140 Per Visit. However, Primary Care Has Been Shown to Decrease Hospitalizations by 20%… Saving $50,000 Per Hospitalization.
Elephant Lives Matter
February 21st, 2021
Texas House Bill 1941 was introduced this month because some believe Elephant Lives Matter…………
The First PPO Was Established in 1982 – And It’s Still Touting Savings?
February 21st, 2021
If PPO’s are supposed to save us money on health care why hasn’t it? We all agree forty years of managed care hasn’t worked so why are we still hoping it will?
The (never ending) La Joya Shit Show Continues…………….
February 19th, 2021
To Our Friends Up North, Please Come Get Your Weather!
February 17th, 2021
Overcoming Misconceptions About Health Benefits
February 15th, 2021
“If you went to Denver, Dallas, OKC or ABQ you would not find a better benefits consultant. Very helpful and knowledgeable. Out of the box thinking.” – Alan, Ideacom
Another Healthcare Benefit Alternative To TRS ActiveCare
February 14th, 2021
There is yet another vendor offering Texas educators a TRS ActiveCare alternative strategy which is (drum roll please)…………………….
Austin ISD Gifts $12,000,000 – Uncle Sam Rejoices
February 13th, 2021
Texas school district makes a one time gift of $12,000,000 to be split between employees and Uncle Sam in an effort to bribe employees from leaving for greener pastures. This is the same district that closed down schools last year and laid off workers due to rising health insurance costs.
Would it have been better to fund a Health Savings Account for all employees instead? Of course Uncle Sam would get nothing in that case while the employees would gain ownership of the entire $12,000,000 gift, tax free, forever………………
There’s A Rate For Any Risk
February 13th, 2021
This photograph from 1921 shows Millicent Woodward, a lady who took out a policy at Lloyd’s of London that year.
Only Idiots Burn Bridges
February 12th, 2021Last week we witnessed an idiot burn down a bridge. Fire department investigators reported the bridge beyond repair.
New Health Plan For Texas Educators
February 11th, 2021
“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
Public Consulting Group’s (PCG) Texas ISD HealthPlan is an innovative, new healthcare program designed specifically for Texas Independent School Districts (ISDs), Texas teachers, and their covered family members.
Beware! Covid19 Vaccine May Change Your Sex Life
February 10th, 2021
“Don’t go near those who have had the COVID vaccine,” warned the official, “They have become …………!”