Custom Design Benefits Presents TrueCost Referenced-based Pricing at Conference

October 19th, 2014


Julie Mueller, Disruptive Health Care Revolutionary

TrueCost offers employers a simple payment structure in which health provider reimbursements are based on fixed Medicare pricing plus a set percentage. “Using a reference based pricing model is consistent, rational and transparent,” said Julie Mueller, president of Custom Design Benefits. 

“TrueCost has caught on with many local healthcare providers that have embraced its simplified and efficient reimbursement system.”

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Government Preparing To End Loophole

October 17th, 2014

loop12Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don’t include hospital benefits. Now the administration is concerned too.

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Consultant Advises 2,000 Life Case To Remain Fully-Insured

October 17th, 2014

mulebriar   By Molly Mulebriar October 17, 2014

Last night a +2,000 life South Texas school district was advised by their insurance consultant to remain fully-insured.

The consultant informed the Board of Trustees that over a 6 or 7 year period there would only be a 4% savings under a self-funded arrangement. The consultant informed the board that he has clients with three to four thousand employee lives and “they are, and should be fully-insured.”

A survey  of the district’s employees was conducted to determine if plan participants wanted to remain fully-insured or participate in a  self-funded health plan.

During the presentation a  board member opined that a self funded employee health plan  could jeopardize district bond issues “because losses come out of reserves.”

The district is in the midst of a Request for Proposal for Group Medical Insurance for district employees.

Editor’s Note: Mulebriar is a free lance reporterette from Waring, Texas and former Miss Texas.  (




From A Consultant

Who is the consultant? Who is the district? Are you hiding their identity to protect them from public embarrassment?

From An Insurance Agent

Makes perfect sense to me. What better way to hid agent commissions

From A TPA

It is obvious there was a hidden agenda here. The consultant was simply “going along to get along.”

From A Former TPA Owner

There is a software app that tells what a broker makes on a case.  It is available by State, Region, and Nationwide.  It’s called miEdge.  I have used it and it appears to be pretty accurate.

Cost Plus / Reference Based Pricing Gains 10% Market Share

October 16th, 2014

Managed Care Contracts & Trend Factors

October 14th, 2014


From an actuary:  “Medical cost trends include components for many drivers.  Net unit price increases from providers drives half of the effect in general.  So a 5% increase in a schedule will drive a 10% overall cost increase.  The rest of the components include: increased utilization, coding creep, deductible leveraging, etc…”

Editor’s Note: Is this confirmation from an experienced actuary/underwriter that escalator clauses common to all Managed Care Contracts are the driving force behind trend factors?

Coverage For Lawsuit Doughnut Hole

October 14th, 2014



New Hepatitis C Drug Costs $94,500

October 13th, 2014

'The upside of this drug is you'll live longer. The downside is that you'll live in poverty.'

(Bloomberg) — Gilead Sciences Inc. won U.S. approval for the first all-oral hepatitis C treatment for the majority of people infected with the virus.

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BUCA Renewal – The Story Behind The Numbers

October 13th, 2014

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Hospital Bills Are Worse Than You Thought

October 13th, 2014

mad Today’s Plan Sponsor

Fact of the Week: The price that hospitals and pharmacies pay for a bottle of 500 tablets of doxycycline, a decades old antibiotic, rose from $1,849 in April from $20 in October 2013 -

“Plan sponsors who don’t audit their group hospital bills ought to have their heads examined” - Homer G. Farnsworth, M.D.

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The Top Ten Most Affordable Hospitals In Texas

October 13th, 2014

bluelight130x130Using public information found through hospital’s annual cost reports to CMS, this article pinpoints the lowest cost hospitals in Texas. To see cost-to-charge ratios at any hospital as reported to the government, go to

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