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Hospitals To Pay Insurance Premiums For Patients?

July 23rd, 2014

thinkBy: Anthony Brino

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.

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Ruben Edelstein

July 22nd, 2014


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.

We Have To Pass The Bill So You Can Find Out What Is In It

July 22nd, 2014


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

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ObamaCare Subsidies Ruled Illegal – Roller Coaster Ride Continues

July 22nd, 2014


A federal appeals court has ruled  today that the federal government may not subsidize health insurance plans for people in 36 states that decided not to set up their own marketplaces under the law. If this ruling stands, ObamaCare is history.

Dallas Area Brokerage Firm Expands To San Antonio

July 22nd, 2014

San Antonio Business Journal

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.

The company’s website can be found here.

Arbitration Clauses In Stop Loss Contracts

July 21st, 2014

stoplosslawMany, 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. 

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Antonian Health Offers New Medical Membership Program

July 21st, 2014


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.


Who’s Afraid Of The Big Bad Wolf of Balance Billing?

July 20th, 2014

farleyjim Jim Farley, Father of Cost Plus Insurance

“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

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$395 MRI in San Antonio & The Lower Rio Grande Valley – $295 CT Scans

July 20th, 2014
MRI’s is a  fairly common procedure these days. Prices can range into the thousands of dollars to as low as $395 or even less these days. In San Antonio one MRI centers offers self-funded plan sponsors a global fee of $395 for any type of MRI. This fee includes with or without contrast, and the reading. Another MRI center in the Lower Rio Grande Valley offers the same pricing.

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Walmart To Open Texas Primary Care Clinics

July 19th, 2014


“……………customers will pay $40 for access to care……….Available medical care ranges from screenings and vaccinations, to treatment of illnesses, including chronic conditions….”

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