Cost Plus Insurance: New Reality In Provider Payment Models

April 19th, 2015

cost plusProviders across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans……….Given their growing popularity, Providers need to be proactive in understanding and managing these types of programs.

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Was There Health Insurance In 1912?

April 18th, 2015

Theodore Roosevelt. Click image to expand.

“Roosevelt’s Progressives were the first major American party to pick up the baton of health care reform”

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Republicans Surrender

April 18th, 2015

surrender

The only difference between Democrats and Republicans is Republicans take longer to get there. Remember Medicare in 1966? Republicans opposed it, now they support it. Standing up for one’s principles is a fleeting, temporary and convenient emotion in politics” – Don Pedro

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Six Ways AMPS Is The Leader In Price Transparency

April 17th, 2015

aaaaa “We have been on a RBR/Cost Plus platform for five years. We changed to AMPS several years ago and highly recommend them. AMPS provides a quality product at a competitive price” – E. Juarez

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It’s Cheaper To Fly Your Employee To Europe for their Appendectomy

April 16th, 2015

germanbeer34

 

John, der irrt! Deutsch Bier und deutschen Frauen sind die besten!

“There are plenty of reasons to brag about living in America, like the fact that we have the most innovative beers on the planet (sorry Germany)”

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Will Accountable Care For Medicaid Work In The Ghetto?

April 16th, 2015

smoker121

Patients might only be able to get to a doctor during the day on the weekends because it’s too dangerous in the neighborhood to be going out at night……The patient goes to the pharmacy but is told the new medication requires pre-approval.  The patient doesn’t know what to do so the patient goes to smoke a cigarette…………...

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Free Market Healthcare Whole Foods Style

April 15th, 2015

wholeWhole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.”

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Methodist Healthcare Strikes Deal With Eagle Ford Shale hospital

April 15th, 2015

pakman

San Antonio’s Methodist Healthcare System has entered into an agreement with the Frio Hospital District Board of Directors and will take over administration and management of Frio Regional Hospital in Pearsall in the Eagle Ford Shale area.

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Are You Ready For Your Department Of Labor Audit?

April 15th, 2015

dol

DOL has ramped up its audit efforts on health plans.  And  now the audits include requests for documentation based on Health Reform (PPACA).  Could you come up with this list of 30 items DOL Audit

ERISA – Fiduciary Duty: Proposed Exemption to Engaging In “Self Dealing”

April 14th, 2015

erisa

” The exemption allows fiduciaries to receive compensation when plans and IRAs enter into certain insurance and mutual fund transactions recommended by the fiduciaries as well as certain related transactions.”

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San Antonio Runs Off Uber, Now Texas Uberizes Telemedicine?

April 14th, 2015

seriously

The City of San Antonio, through punitive restrictions on free trade has run off Uber from the city effective April 1. Now the State of Texas, through special interests, runs off telemedicine companies too? What has happened to traditional Texan values of hard work, innovation and freedom to conduct commerce?

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Interesting Trivia for Insurance Consultant Nurds

April 14th, 2015

mulebriarA study for a large group we manage is quite interesting. Over a three year period average hospital billed charges (Chargemaster Rates) have increased 27%  while our costs have increased 2%.

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Reference Based Reimbursement: What is required to do it right!

April 14th, 2015

aaaaa“RBR/Cost Plus offers employers the opportunity to lower healthcare charges by 30% or more and will soon dominate the healthcare landscape replacing the current PPO system that often grossly overpays hospitals and physicians.”

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Connecticut Fee Schedule for Hospitals, ASCs Takes Effect

April 14th, 2015

really

Connecticut’s Medicare-based fee schedule for workers’ compensation takes effect April 1.

The new fee schedule pays 174% of Medicare for in-patient care, 210% outpatient care and 195% for ambulatory surgical centers.

This is touted as a cost savings measure. Does this mean prior to April 1 Connecticut hospitals and ambulatory centers were getting more?

So much for managed care contracts these days and another reason why Cost Plus Insurance, Medicare Plus reimbursement schemes are taking the market by storm. Payers are “mad as hell and not taking it anymore……” - Homer G. Farnsworth, M.D.

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SWBC Executive Expands Consulting Group to Austin

April 14th, 2015

swbc

SWBC is expanding its Employee Benefits Consulting Group into the Austin and Central Texas market.

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Top health insurance CEO pay exceeds $10 million in 2014

April 14th, 2015

greedy

“The CEOs of the Big Five for-profit health insurance companies all took home at least $10 million in 2014, according to each insurers’ annual filings with the Securities and Exchange Commission (SEC).”

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Why the Private Health Insurance Industry Has to Go

April 14th, 2015

tissue1

“…….the time has come for us to replace private health insurers with a more efficient, not-for-profit single-payer financing system–national health insurance (NHI)–which could be enacted by passage of H. R. 676, Expanded and Improved Medicare for All.”

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Hospitals and Prescription Drugs Leading Health Spending Acceleration

April 14th, 2015

mad

“Prescription drugs grew the fastest, by 10.5%, and hospital spending also rose rapidly at 9.0%.”

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Defined Contribution Rx Plan – What A Novel Idea!

April 10th, 2015

SimpleSaveRx is the first 100% defined contribution, 100% transparent PCM and it is the exact opposite of PBMs today.

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Here Is What Happened On January 1, 2015

April 10th, 2015

broccoli1Elections have consequences. ObamaCare, with John Robert’s blessing, is a tax. Although Congress can’t mandate everyone must buy broccoli they can sure tax you if you don’t.

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Health Insurance Brokerage: Lowest Pricing Drives Sales in Fully Insured Market

April 9th, 2015

carsalesman

By Homer G. Farnsworth

Does it matter how good you service a fully-insured account, or how long you have had it? Under the PPACA the answer is “probably no.” Low price has become the determining factor between success or failure in retention of business in today’s fully-insured market.

Most brokers remaining in the fully-insured market live or die on rates alone.

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Allstate Wins $46 Million Judgement In RICO Suit Over Health Claims

April 9th, 2015

child

By Kurt Orzeck

Law360, New York (April 08, 2015, 9:35 PM ET) — A New York federal court on Wednesday entered a $45.7 million default judgment in favor of Allstate Insurance Co. and other insurance companies in their Racketeer Influenced and Corrupt Organizations Act suit alleging a vast money-laundering conspiracy to bill for fraudulent health claims.

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San Benito ISD Struggles To Fund Health Care Plan

April 9th, 2015

actuary1

The San Benito Independent School District’s self-funded health plan is in the red. Unexpected rise in health care expenditures have the school trustees searching for a solution.

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Rx Copay: Daddy’s Credit Card

April 8th, 2015

creditDrug costs are skyrocketing and account for as much as 25% of total health care spend for plan sponsors. Most plans continue to cover prescription drugs through an antiquated system established years ago when drugs were relatively inexpensive.

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San Antonio Runs Off Uber, Now Texas Runs Off Telemedicine Companies?

April 7th, 2015

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High Health Care Utilization and Rabbits

April 5th, 2015

rabbitRomeo & Juliet on Wedding Day

Health care costs increase when utilization does……..

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What’s In Your Hospital Bill – Actual Examples Found By Audit Firm

April 5th, 2015

 

Employers, Cover Your Assets: Employee Contributions Leave You at Risk

April 3rd, 2015

Employers, Cover Your Assets: Employee Contributions Leave You at Risk

Hear this: If you are a self-funded employer or third-party administrator and you don’t have anyone looking at detailed facility claims you are jeopardizing your business.

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Employer Announces New Santa Claus Qualified Health Plan For Employees

April 3rd, 2015

Image result for here comes santa claus

“Dear Employee: As you may be aware, Santa Claus has passed a law to help us get affordable health insurance……”

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Garland ISD Employee Clinic Holds Grand Opening

April 3rd, 2015

 

With healthcare costs on the rise, Garland ISD aspired to create an affordable and convenient resource for its employees. After months of planning, construction and fine-tuning, the GISD Employee Clinic opened Wednesday, April 1.

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AXIS Acquires Ternian Insurance Group LLC

April 2nd, 2015

 

 

AXIS LOGO 2

We are excited to announce that AXIS has acquired Ternian Insurance Group, LLC, a leading provider of voluntary, limited benefit, affordable health plans and other employee benefits coverage for hourly and part-time workers and their families.

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Former Benefit Consultant Offers Innovative Partnership Opportunity

April 2nd, 2015

Benefitsally

We partner with innovative benefit consultants and employers to bring intelligent healthcare solutions to the table. These solutions are cost-cutting opportunities for mid-sized companies – regardless of industry – that are easily implemented into existing benefit plans.  http://www.benefitsally.com

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San Benito ISD Rejects TRS ActiveCare – Seeks Insurance Consultant

April 2nd, 2015

freddy

San Benito – Home of Baldemar Garza Huerta (Freddy Fender)

In a special called school board meeting (http://board.sbcisd.net/wp-content/uploads/2015/03/s033015.pdf ) on March 30 the San Benito Independent School District rejected the administration’s recommendation to join the TRS ActiveCare plan.

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TPA Earns Undisclosed Fees Through Marked Up Hospital Bills?

April 2nd, 2015

hide

“these administrative fees were concealed in marked-up hospital claims and “no longer visible” to its customers because they falsely appeared to be money owed to hospitals “

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RiskManagers.us Wins Insurance Contract

April 1st, 2015

shakinghands1

San Antonio, Texas  RiskManagers.us, a specialty company in the benefits market that 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 has been awarded a $10,000,000 insurance contract by the City of San Antonio.

“We are pleased to make this announcement today and look forward to a long and rewarding relationship with the City of San Antonio,” stated company spokeswomen Molly Mulebriar.

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City of Lewisville Publishes Health Insurance Analysis – Compares Cost Plus To PPO

March 31st, 2015

llewisville

The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.

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Mastering The ACA Compliance & Regulatory Maze

March 30th, 2015

mumbojumbo

ACA and its blizzard of ever-changing regulations has created a challenging environment for even the most proficient advisors. We asked Arthur Tacchino, Chief Innovation Officer & Principal of Sync-Stream Solutions, to discuss those challenges and to examine some of the ways advisors can master and profit from providing their clients with expert and timely advice.

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What if Your Credit Card Billed Like a Hospital

March 29th, 2015

 

aaaaaaaaaa

IMAGINE FOR A MOMENT…  Your credit card bill showed up in the mail stating nothing more than: YOU OWE $5,000

That’s it?   …I bet you are on the phone within seconds.    telephone123

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Cost Plus Insurance Reference Library

March 27th, 2015

cost plus

 

An assorted collection of articles for those interested in Cost Plus / Reference Based Pricing models

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AMPS Expands Texas Footprint

March 26th, 2015

aaaaa Growing business opportunities in Texas warrants a permanent footprint in the state. Houston targeted for AMPS newest office.

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Rick Scott Opines

March 24th, 2015

Rick Scott

Brooks Healthcare Solutions Fee Negotiation Services

March 24th, 2015

negotiatorBrooks Healthcare Solutions (BHS) has deep and broad relationships with hundreds of outpatient surgery centers across the country.

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Humana to sell Concentra for $1B

March 24th, 2015

bluelight130x130

Humana Inc. has revealed that it will sell Concentra……………

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Collapse of Southport Lane’s Insurance Empire

March 24th, 2015

Screen Shot 2015 03 21 at 10.43.47 AM

Alexander Chatfield Burns

A 28-year-old ‘financial prodigy’ built a hundred million dollar insurance empire that now might be worthless (see article at end of this post)

An insurance empire that included two insurance carriers, two offshore reinsurers, several buildings and other insurers’ investments was built by a private equity firm in part on questionable assets and is now being dismantled, according to the Wall Street Journal.

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Renting Medicare’s Provider Network

March 22nd, 2015

democratrepublican

An idea with bi-partisan support?

If the federal government would rent their Medicare network and charge what the private market charges for access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.

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Hospital Price Gouging Driving Up Healthcare Costs?

March 22nd, 2015

lustig

Victor Lustig “Why didn’t I think of this!

THE FALLACY OF HOSPITAL CHARGEMASTERS 

“Hospital industry claims that the charges  don’t matter because few actually pay the “list” price “defy common sense,” Burger said. “If there is no reason for the high prices, why bother charging them?” Burger asks.  See Hospitals Dismiss Significance Of Chargemaster Prices?

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Rio Grande City Independent School District Seeks Insurance Consultant

March 20th, 2015

rgc

The Rio Grande City Independent School District is seeking Request for Qualifications for fee based insurance consultant to assist the district in the evaluation of their Cafeteria Plan and products. Deadline to submit a response to the RFQ is April 30.

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Will AFLAC Shake Up Voluntary Employee Benefit Market?

March 20th, 2015

aflacAflac says it will now pay out certain voluntary benefit claims in one business day, an announcement that industry experts say will likely force competitors to follow suit.

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Cash Health Plans Make Sense

March 17th, 2015

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.

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Will H.B. No. 3453 Destroy TRS ActiveCare?

March 16th, 2015

Image result for run on the bank

Texas state representative J. M. Lozano filed House Bill (3453) on March 12, 2015. If passed the bill will take effect on September 1, 2015 and will allow participating school districts to leave TRS ActiveCare.

School districts currently participating in the TRS ActiveCare program are prohibited from leaving.

If districts are allowed to come and go as they please, adverse selection will begin an irreversible death spiral – TRS ActiveCare could end up being an insurer of last resort.

Should HB 3453 become law many expect a strong “run on the bank.” Will El Paso Independent School District be the first to leave? See El Paso ISD Votes To Leave TRS ActiveCare

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Drug Makers Form Alliance With Idiots

March 16th, 2015

idiot

“With the price of some treatments topping $100,000, patient (idiot) groups are pushing for state laws to make sure carriers (mean & nasty insurance companies) cover most of the costs. Their campaign is backed by an important ally: the drug industry.”

What these mental giants don’t seem to understand is that they are paying these costs through higher insurance premiums. The mean and nasty insurance companies simply pass on costs while taking their cut at the same time. And, with the Minimum Loss Ratio mandate in place the more the costs the more insurance companies are allowed to make. So these idiots are actually  screwing themselves by helping pharmacy manufacturers and insurance companies earn more money at their expense.

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San Benito ISD Considers Joining TRS ActiveCare

March 13th, 2015

sanbenitoisd

San Benito CISD Board Meeting 3-10-15  See 1:39 – 1:43 – this four minute segment gives the viewer a snapshot of San Benito’s self-insured medical funding problem.

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What If Restaurants Billed Like Hospitals?

March 13th, 2015

hospitalreciept2

Source: Clear Health Costs – www.clearhealthcosts.com

Not Insured & Pregnant? No Problem, We Got You Covered!

March 13th, 2015

freestuff

The Wall Street Journal reports that the Obama Administration is under pressure to allow uninsured women who become pregnant to enroll in Federal exchange plans at any time during the year.

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El Paso ISD Votes To Leave TRS ActiveCare

March 11th, 2015

grassisgreener

Greener Pastures Drive Move?

The El Paso Independent School District will petition the Teacher Retirement System to leave its statewide health insurance program because of rising costs to the district and employees. “It’s a hellhole” said Board President Margo

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New Mexico Rescinds Stop Loss Mandate

March 10th, 2015

raspa

Faster than a melting raspa, the New Mexico Superintendent of Insurance has rescinded the state’s new stop loss insurance mandate.

http://www.osi.state.nm.us/insurance-bulletins/docs/Bulletin2015-010.pdf

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Supreme Court Reopens Notre Dame Bid to Bypass Birth Control Coverage

March 9th, 2015

contraceptions1

Notre Dame contends the opt-out provision is insufficient to protect its religious rights.

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TRS ActiveCare Considers Plan Changes for 2015-2016

March 8th, 2015

angryteacher 

Are You Kidding Me! I can’t cover my husband anymore? And I lose my doctor too? What kind of plan is this!

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Potential Threat To Telehealth In Texas

March 6th, 2015

telehealthThe Texas Medical Board is attempting to change a rule that would restrict Texas businesses and citizens from utilizing telehealth services.

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Affordable Plumbing Act

March 6th, 2015

joe1

Michelle is not happy as she has Oprah and guests arriving the next morning.  The bucket fills up quickly and has to be emptied every hour, and there’s a risk the room will flood, so Obama calls Joe and pleads with him….….

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An Electrical Physical? How Much Is That?

March 6th, 2015

 

dayandnightclinic

“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.

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A Closer Look at Berkshire Hathaway’s Insurance Operations

March 6th, 2015

Image result for warren buffett

“And all of this began with our 1967 purchase of National Indemnity for $8.6 million,” Buffett wrote…..“Last year, our premier position in reinsurance was reaffirmed by our writing a policy carrying a $3 billion single premium”

“How much is the premium did you say Warren, $3,000,000,000 for a single policy? 

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How Group Health Claims-Shifting Affects Workers’ Compensation

March 6th, 2015

unintended

Study predicts there will be more cost shifting to workers’ compensation as ACOs gain in popularity in the group health market. A good example of unintended consequences. ACA is chock full of unintended consequences………..

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Major Insurers Provide Medical Cost Information on New Platform

March 5th, 2015

Guroo logo

Prices for the same medical service vary widely across the country, and even within the same city. To help provide transparency on costs, some of the largest U.S. health insurers will now reveal the prices they pay for a number of medical services at Guroo.com.

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Montgomery Management

March 4th, 2015

Montgomery Management, a full service MGU, has been providing flexible, innovative stop-loss and life products to the marketplace since 1986. Our professional expertise, personalized service, corporate strength and stability make Montgomery Management an industry leader.

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Aetna Hits South Texas Hospital With $120 Million Kickback Lawsuit

March 4th, 2015

'No, I'm not part of an elaborate kickback scheme.'

“To hide the scheme, Aetna claimed that North Cypress consistently overcharged for routine procedures.”

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The Secrets of AmeriPlan® Corporation’s Discount Dentistry Uncovered

March 4th, 2015

darrell

By Darrell Pruitt, DDS

Until now, those who sell discount dentistry plans like Delta Dental, BCBSTX and AmeriPlan have always been less than transparent with naïve, vulnerable consumers about how their AmeriPlan-preferred dentists can discount their fees up to 80%, and still make a living.

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Stop The Arranged Marriages Between Patient & Provider

March 2nd, 2015

marriageThe outdated notion of assigning patients to doctors has repeatedly been shown to not work for patients or save money.

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N.C. Based Blue Cross Posts Loss, Blames Obamacare, Not Actuaries

March 1st, 2015

odds1

Blue Cross and Blue Shield says it has posted its first financial loss since 1999 as a result of insuring high numbers of older and sicker people under the Affordable Care Act.

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City of Fort Worth Releases Health Insurance Fund Balance Audit

March 1st, 2015

 

ftworth

The objectives of the audit were to review the consultant’s report and determine the reason for the difference in the consultant’s calculated change in the fund surplus versus the audited change in fund balance for the Group Health and Life Insurance Fund.

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Wellness Plans Don’t Work – Weight Loss Almost Always Come Back

March 1st, 2015

diet12

Yet another paper has been published on the waste of time, money and morale that results from the recent infatuation with wellness programs.

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Why Broker Health Plan Fee Agreements No Longer Work

March 1st, 2015

4 percent signWith the PPACA rules on mandatory minimum medical loss ratios (MLR) rules now in place, brokers should not be saddling clients with “fee” arrangements or underfunded commission agreements on medical policies.

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City of Santa Fe – In A Boat Without A Paddle?

February 28th, 2015

boat

By Molly Mulebriar

The City of Santa Fe has requested proposals for stop loss insurance for their self-funded employee health plan with a proposal deadline of February 23, 2015. However, New Mexico’s Insurance Superintendent issued a regulatory bulletin the week before the proposal deadline that effectively eliminates stop loss protection as a viable option for New Mexico employers that self-fund their employee health care coverage.

The task now before the city’s insurance consultant (AON Risk Solutions) and  third party administrator (United HealthCare – UHC) is to find stop loss insurance for the plan’s July 1 effective date. According to market experts this will be a near impossibility without divine intervention.  BUCA reps. are circling city hall anticipating the coming feast.

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Hospital Costs Explode Under ObamaCare – ACO’s A Cost Driver?

February 28th, 2015

Transcending Obamacare Fig 17

Thanks to federal intervention in the health care system—Medicare, Medicaid, and the employer tax exclusion—hospitals have been able to charge whatever they want for their services, knowing that the average consumer has no idea how much he’s paying, because he’s paying mostly through taxes and other indirect means…………..

Accountable Care Organizations, whose explicit goal is to encourage hospitals to consolidate the provider industry, thereby gives them more leverage to charge higher prices…………

The U.S. hospital industry is crony capitalism at its finest

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Stop Loss Carriers To Pull Out of New Mexico This Year?

February 27th, 2015

tissue1

Stop loss carriers are likely to exit the New Mexico market this year leaving self-insured medical plans without coverage.

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