AMA: Insurers Misused CPT Codes To Hide Administrative Costs

February 27th, 2020

Aetna Inc., Aetna Life Insurance Co. and Optumhealth Care Solutions Inc. allegedly misused CPT codes to pass on administrative charges under the guise of medical care………….

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Sleepy TRS ActiveCare Trustees & Clueless Texas Legislators

February 27th, 2020

“Legislative inaction has now led to an insurance program for school district employees that is more burdensome than beneficial, and for many educators, it amounts to a pay cut year after year.”

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Coronavirus Highlights Chinese Drug Dependency

February 25th, 2020

Coronavirus has jeopardized the “domestic supply of some 150 prescription drugs, including antibiotics, generics, and branded drugs…………..”

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The Great American Healthcare Scam

February 24th, 2020

The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States.

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BCBSMN ASO Agreement

February 23rd, 2020
A self-funded plan using BCBSMN as the Plan Administrator pays out-of-network providers 200% of Medicare. What do they pay in-network providers (Hint: it’s more).

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Ruben Edelstein

February 20th, 2020

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.

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Survey Reveals “Me Too” Brokers In The Majority

February 20th, 2020

“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”

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Turning Bronze Into Gold

February 18th, 2020

Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?”

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China Can Shut Down U.S. Pharmacies & Hospitals in Months

February 15th, 2020

“China’s stated aim is to become the pharmacy to the world with its own companies. And what we’re seeing with Western generic drug companies, they’re collapsing because they can’t compete.”

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What’s An Actuary?

February 14th, 2020

How do we know we are doing much better this year than last year?

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The Payer You Never Heard Of

February 13th, 2020

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?”

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Quizzify’s Surprise Medical Bills Solution

February 10th, 2020

“If a hospital (y) later turns down “two times Medicare (2x) and it goes to court, their lawyer is going to say, ‘We could lose this thing……………………..”

200% of Medicare represents a “savings” over a typical 60% PPO discount?

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TRS ActiveCare Can Be Fixed, But We’re Tired of Waiting

February 8th, 2020

Rather than kicking the can down the road to the next legislative session, sleepy TRS ActiveCare trustees should take note and consider adoption of newer, proven risk management strategies as other risk pools have done……………………….

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

February 7th, 2020

Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club

February 7th, 2020

Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….

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TASB Issues Health Insurance Survey Results For Texas School Districts

February 6th, 2020

Hard working Matamoros street vendors may make more than Texas school teachers………………..

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Pricing Customers Out of Health Care

February 5th, 2020

               You Want How Much!

As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care

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Happy New Year! Your Drug Prices Just Went Up!

January 31st, 2020

“Drug prices are out of control, and Big Pharma continues to raise the prices for all Americans……….Not only does that mean higher prices at the pharmacy counter, it also means higher premiums and other healthcare costs for everyone.”

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Dual Coverage Dilemma

January 30th, 2020

After satisfying their initial waiting period averaging 47 years, approximately 30% of the American workforce is eligible for special health care pricing while the remaining 70% aren’t. Paying for it during their entire waiting period, they deserve better pricing………………..

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Austin Independent School District Seeks Insurance Consultant

January 29th, 2020

The RFP is essentially requesting the services of an assortment of experts…………….

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Okahoma To Eliminate PBM Middlemen

January 26th, 2020

“It’s time we cut out the middleman and get our citizens the savings they desperately need.”

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Half Pregnant Tulip Lovers vs Cliff Dwellers

January 25th, 2020

Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.

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Washington D.C. Symposium Highlights Private Initiatives in Health Care

January 24th, 2020

The purpose of this event is to inform employers, brokers, legislators and regulators about emerging initiatives to expand access, improve quality and reduce the cost of health care. – Dan Meylan

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Pandemic?

January 24th, 2020

The fatality rate may prove to be comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally……………

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Once Deported Illegal Back – Demands $5,000,000 Plus Needed Medical Care

January 22nd, 2020

Texas Detainee demands immediate release, $5,000,000 and medical care…………

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Health Policy Predictions for 2020  

January 22nd, 2020

The private market will offer new funding strategies for employer-sponsored health plans……

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Texas ER Doc’s Gravy Train in Jeopardy

January 22nd, 2020

Emergency room physicians (and their anesthesiologist cousins) are a different breed. They don’t often join managed care networks. They serve a captive audience. The only emergency room door exit is to the billing department. They  charge an arm and a leg. They are the Balance Bill Kings of Health Care because they almost always do and never, almost never, ever, negotiate. But that’s about to change in Texas………………unless your’e insured through an Arm & A Leg Plan (self-insured plan). 

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Self-Funded Employers Driving Health Care Cost Containment

January 20th, 2020

Under prevalent status quo heath plans, cost containment means higher deductibles, higher out-of-pocket expenses, less choice. All are impediments to health care.

On the other hand, under Reference Based Pricing plans, cost containment means lower deductibles, lower out-of-pocket expenses, more choice. There are less impediments to health care. 

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The WellRithms Shield

January 19th, 2020

The Shield is an ERISA-compliant product that deals with high-dollar medical claims and COMPLETELY PROTECTS the member from balance billing abuses with guaranteed savings.

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CIGNA Sued For RICO Violations

January 19th, 2020

In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed charges and requests the same amount from the self-insured health plan.

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Everything Starts With A Spark

January 19th, 2020

Psst……Have You Heard About Distilled Concepts?

These guys are marketing geniuses – well done website effectively sends the message that health plans can be made better……………..It starts with a Spark………..

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Schuessler Takes Aim At Rural Health Care

January 18th, 2020

The creator of The Schuessler Stick™, Carl Schuessler explains his success in building a rural community health care plan while freezing his ass off in a Georgia deer blind. Listen to Carl starting at 8:00 – 20:30.

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Texas School Districts Want More Choice in Health Care

January 17th, 2020

Texas school districts enrolled in TRS ActiveCare have not had competitive options available to them until now. No matter how large a risk pool is, economies of scale doesn’t matter when risk management systemically fails to adopt proven strategies in a dynamic and changing market.

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Reverse Engineering A Health Plan

January 15th, 2020

We have budgeted $2 million for our employee health insurance plan. Build me a plan  for my 350 employees that doesn’t cost a penny more than that!” was the directive from the CEO, a Type A personality who doesn’t take “no” for an answer and expects results even if impossible. So we did……………..

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CIGNA Says “Sorry, It Ain’t Yours!

January 14th, 2020

“It is a common misconception that clients are entitled to receive any data, at any time, simply by virtue of being self-insured and having elected to receive Protected Health Information (PHI). This is not the case…….”

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High Deductibles Are Silly – Rural Hospitals & Patients Suffer The Most

January 13th, 2020

High deductibles are road blocks to needed health care and do nothing to impact health care costs. Smart employers are discovering they can improve benefits and lower costs at the same time. The following article referred by Dan Meylan describes the problem we all face to these man made barriers to health care……………..

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Houston Doctor Joins DPC Revolution

January 12th, 2020

Dr. Rebecca is passionate about providing holistic primary care to families. She understands that healthcare is expensive, which is why she is starting her practice with an innovative new model called “Direct Primary Care.”

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$40,000,000,000 Fraud – Reporting Non-Existent Diagnosis

January 10th, 2020

Inspectors found that Medicare Advantage insurers had added diagnoses for diabetes, heart disease and other conditions in 99.3% of chart reviews of patient information…………….

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Best Practices In RBP Negotiation

January 9th, 2020

Click on the link below and learn how Bartlett successfully moved the State of Montana state health plan over to Reference Based Pricing……………..It’s all about Rational Analytics and ARM TWISTING…..

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Cigna Group Insurance Acquired By New York Life

January 9th, 2020

From: Bill Smith, President, Cigna Group Insurance [mailto:businesscommunications@cigna.com]
Sent: Wednesday, December 18, 2019 12:03 PM
To:
Subject: Important news from Bill Smith, President, Cigna Group Insurance

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David John Rendall

January 9th, 2020

David John Rendall
March 19, 1937 – January 1, 2020

David used his marketing skills and passion for deal making to start several healthcare related businesses that have evolved into a large enterprise, which currently has operations in 4 continents and clients in over 80 countries.

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Congress Delivers Christmas To Health Care Industry

January 7th, 2020

Congress showers health care industry with multibillion-dollar victory after wagging finger at it for much of 2019

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Large Claims Present Large Problems

January 6th, 2020

“The emergence of biologics and gene specific medications will serve to drive these increases further as we move forward, as evidenced by Zolgensma (treats Spinal Muscular Atrophy) at an estimated $2.1 million and Luxturna (gene therapy for a retinal disease) at an estimated $850,000.”

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 HUB International Names Stephen Cali Benefits Consultant

January 6th, 2020

Posted by: MBJ Newswires in InsuranceNewsmakers 01/06/2020

Stephen Cali is joining HUB International’s Employee Benefits division, accepting the role of Sr. Vice President / Sr. Benefits Consultant.

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Non-Profit Hospitals Are Making a Killing

January 6th, 2020

“The problem is moral hazard in an administrative state………..people alter behavior when they don’t have to pay for something………”

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RBP Business Plan – 5 August 2005

January 4th, 2020

Market Evolution of Reference Based Pricing Plans

Timing is everything when it comes to new and innovative ideas in health care delivery as the market must be ready and receptive. In 2005 it wasn’t……………..But two years later it slowly took hold in Texas…………And we were ready.

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Another Great Article By Mark Flores

January 3rd, 2020

Cigna Sued for RICO Violations, “Brazen Embezzlement and Conversion Scheme” -Health Plan Litigation Tsunami: Part 2

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The New Age of Primary Care

January 3rd, 2020

Primary care has revived as it is viewed as a less expensive way to lower downstream health care spending. 

“Although maybe only 5% of health care cost is incurred in the primary [care] environment, a good or bad decision determines what the next 95% looks like”

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ERISA Class-Action Litigation over Fees in Health and Welfare Plans

January 2nd, 2020

“Health-plan participants could conceivably choose to challenge health-plan fees with general fiduciary-breach claims. In fact, it is reasonable to expect that such claims will be made against other health-plan sponsors, given that plaintiffs’ firms have begun to solicit potential class representatives and request health-plan fee information from employers.”

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Risk Tolerance & Reference Based Pricing Strategies

January 2nd, 2020

The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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HealthShare Works

January 2nd, 2020

For over 30 years I have helped individuals and corporations obtain the best  ways of paying for medical care. 

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Pocahontas Endorses Reference Based Pricing For All

January 2nd, 2020

Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate………..

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An Unhealthy Addiction

January 1st, 2020

Whenever I give a talk about healthcare, I ask the audience, “What is the worst addiction problem we have in the United States?”

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Reversing the Health Care Cost Spiral

January 1st, 2020

Health care is a business like any other, and it can follow good business principles. Like other industries it can benefit from bottom-up innovation by entrepreneurs and intrapreneurs, rather than rely solely on top-down reforms coming out of Washington, DC. That’s what this book is about.  

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Personal Care Act

January 1st, 2020

If this passes it will have a profound effect on the future of employer sponsored health plans………no longer held hostage to jobs they hate but need for health care benefits, plan members will be able to control their own health care benefit decisions………..

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You Are Invited To……………….

December 31st, 2019

You are invited to the following event:

FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – JANUARY MEETING

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A Ten Year Look Back On A RBP Group

December 31st, 2019

Tomorrow will mark a new plan year for one of our long time clients, the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago in lieu of traditional managed care strategies employed by most plan sponsors today.

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Hospital Roulette

December 30th, 2019

Patients qualifying for free care from one hospital might receive painful bills and lawsuits from another.

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Controlling Specialty Drug Costs Is Impossible Unless………….

December 30th, 2019

In 1990 there were only 10 specialty drugs on the market. Now there are more than 300 with nearly 700 more reportedly under development……………………..Managing domestic specialty  drug costs is impossible unless one adopts the Hot Potato Method, likes to visit foreign countries or Uncle Sam steps in…………..

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BCBS Offers Specialty Drug Solution

December 29th, 2019

The specialty drug solution?  Require providers to buy from us…….

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Working The Spread

December 28th, 2019

Pharmacist points to a recent PBM transaction wherein the pharmacy earns $32.08 while the PBM earns $1,057.12 on the spread……………………..

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Leveraging Charge-Master Rates Against PPO “Discounts”

December 26th, 2019

A 50% discount off double the price? Or is it now a 50% discount off triple the price?

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Owner of Texas Urgent Care Clinics Charged in Bribery Scheme

December 26th, 2019

Charged with bribes and kickbacks in exchange for sending patient nasal swabs to a laboratory for testing………………..

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UHC vs Houston Methodist

December 24th, 2019

Your Charges Are Too Damn High!

“Methodist isn’t just the most expensive health system in Texas. It’s one of the most expensive in the entire country……………………… Methodist costs 49% more than other top hospitals in Texas”

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Insurer Paid $25,865 For Common Cold With Your Money!

December 24th, 2019

The doctor’s office kept assuring Kasdan by phone and by email that the tests and charges were perfectly normal. The office sent a courier to her house to pick up the check…………..

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The Middlemen Behemoths of Health Care Bureaucracy

December 23rd, 2019

Some of America’s biggest companies are middlemen who profit from the system’s wastefulness….

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Rx Costs Based On Fake Pricing Game

December 23rd, 2019

“The game’s primary problem is that it is all predicated on the existence of, and reliance upon, fake prices. Fake prices for brand-name drugs beget fake prices for generic drugs……………”

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Rx Acquisition Cost

December 23rd, 2019

data.medicaid.gov/Drug-Pricing-and-Payment/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d

Disclosing Hidden Treasure

December 22nd, 2019

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

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Plan Sponsor Announces Incredible News!

December 22nd, 2019

Beginning in 2020 plan members will have their contributions paid for by their employer. “This remarkable achievement is made possible thanks to the application and utilization of cost containment measures……………..” 

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Picking Horses – Broker’s Broker Publishes Tip Sheet

December 21st, 2019

Health insurance brokerage can be lucrative especially if one picks the right horse. For example, several years ago one of the highest earning horses of that year’s Brokerage Derby Bonus Race was BCBS (BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold).

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The Importance of Homework When Bidding On Political Subdivisions

December 20th, 2019

Before bidding on a political subdivision, it’s wise to do your homework first. What has been their bidding history? How were past decisions to award made? How was the process handled? Was a consultant involved, and if so, who was it? (Insurance Consultants Are Biased).

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Cross Border Drug Trafficking Expected To Increase

December 18th, 2019

Cross border drug trafficking importation increases under President Trump’s watch – The Canadian connection…………………..

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Puppets On A String

December 18th, 2019

PPO PATIENTS ARE PUPPETS ON A STRING

“We’re not sure what to do next. We have to wait for them to tell us what to do,” he said. “We’re just kind of in limbo….……………

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Walmart Presentation to Company Associates

December 18th, 2019