PUBLIC-PLAN OPTION

January 22nd, 2021

It’s been less than 24 hours from yesterday and noise from Washington suggests changes in the way American healthcare is financed and delivered may be imminent………..

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Pricked

January 19th, 2021

The price of diabetes related medicines should be an American embarrassment……………

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The La Joya ISD Shit Show Continues………………..

January 19th, 2021

Texas insurance agent stands to gain $68,375.00 per month for the remainder of the original term of the agreement if her eight year  consulting / brokerage agreement with a Texas public school district is canceled for “any reason.” 

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Texas Senate Bill 120 – A Gift to ICHRA’s?

January 18th, 2021

If passed, this could make ICHRA’s even more attractive to employers who are tired and fed up with all the hassles of providing group health insurance for their employees along with the ever present threat of punishing government sanctions. 

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Texas House Bill 573 – Health Care Sharing Ministries

January 18th, 2021

If Texas House Bill 573 passes this legislative session Health Care Sharing Ministries will be prohibited from certain advertising such as touting their financial strength and past performance to provide health care benefits for their members…………… even if its true!

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Texas To Consider Single Payer Health Plan

January 18th, 2021

TEXAS HEALTH INSURANCE BROKER

Texas health insurance brokers who find themselves in the unemployment line by way of passage of HB 602 will be able to retrain for other careers through state provided funding. 

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Discounts Don’t Matter

January 16th, 2021

Medical discounts are a scheme used by health insurance companies, service providers, hospitals, and others in the medical supply chain to show “value” to their customers. “Look at how much we saved you! Aren’t you happy you choose us as your partner! Just imagine what you would have paid without us!”

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PPO Network Gobbles Up RBP Vendor

January 15th, 2021

MultiPlan Corporation to Acquire HST

  • Accelerates Growth by Adding a Next-Generation Reference-Based Pricing Program to the MultiPlan Solution Suite
  • Acquisition is the First Under MultiPlan’s Enhance-Extend-Expand Strategy
  • Increases Value for Customers by Adding New and Complementary Services to Better Manage Cost
  • Deepens MultiPlan’s Penetration in the TPA/Broker Segment

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Nonprofit Hospitals Are Biggest Rip Off In America

January 15th, 2021

All across the nation, cities big and small are having their pockets picked and their communities decimated by their local nonprofit hospitals.

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Teachers Union Demands Lids on All Toilets

January 14th, 2021

Fear of public toilets is nothing new and surprisingly common. But is COVID by toilet really a thing?

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The Power of Incumbency During A Pandemic

January 14th, 2021

By Molly Mulebriar

Third party administrators (TPAs)  have always enjoyed the power of incumbency and it has never been greater than now.

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Mark Cuban Cost Plus Drug Company

January 14th, 2021

The Mark Cuban Cost Plus Drug Company is dedicated to producing low-cost versions of high-cost generic drugs. We pledge to provide radical transparency in how we price our drugs.

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The Cost of U.S. Healthcare Shocks Brits

January 13th, 2021

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Medical Insurance in China

January 13th, 2021

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Chinese Government Encourages Private Health Insurance

January 13th, 2021

China’s Communist party rolls out pilot tax benefit plan in hopes to expand private health insurance because the government’s plan is not good enough…………….

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The San Antonio Free Market Medical Association

January 12th, 2021

Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the San Antonio community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.

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Cameron County Texas Seeks Insurance Consultant

January 12th, 2021

Cameron County is seeking a qualified fee based insurance consultant to assist the county in a competitive RFP process for group health insurance for county employees. 

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New, Competitive Dental Plan Hits The Market

January 12th, 2021

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Government Initiates Broker Disclosure Requirement

January 11th, 2021

Wanna hear about the broker who was making $614,000 on a South Texas 2,500 life school district while the clueless Board of Trustees thought the compensation was $128,000?.

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Blue Cross To Punish Republicans

January 11th, 2021

Politicians Chase Dollars To Remain In Power

Blue Cross, punching down, has announced they will no longer share member’s premium dollars with lawmakers except for those who pledged allegiance to Joe Biden…………….

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Healthcare Isn’t Expense – Price Gouging Is

January 11th, 2021

Healthcare isn’t expensive. It’s price-gouging and profiteering that is expensive and straightforward to eliminate………………..

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Question for RBP “Experts”

January 7th, 2021

If hospitals are required to publish their prices and they have patients sign agreements wherein the patient agrees to pay “in accordance with the regular rates and terms of the hospital” which are public for the world to see, what defense does the patient, who assigned benefits, have in disputing full billed charges when the average reimbursement accepted through the hospital’s payer mix is substantially less?

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Contracts of Adhesion

January 7th, 2021

An adhesion contract (also called a “standard form contract” or a “boilerplate contract“) is a contract that heavily restricts one party while leaving the other free (as some standard form printed contracts); implies inequality in bargaining power

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If A Health Plan Could Be A Person……………..

January 5th, 2021

Dave Chase

In this era where healthcare has been politicized (a great way to freeze status quo), I’m happy to report that Health Rosetta’s core tenets draw agreement from both ends of the political spectrum. They spell out HEALTH.

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Hyped Start Fizzles

January 4th, 2021

The Gang Disbands

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

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Famed Magician Reveals How To Create Rx Savings Out of Thin Air

January 4th, 2021

The cost for a Fully Insured Rx Card is 8-10% of the plan cost. So, if the Stop Loss Carrier carves out 15% for the Rx and the cost for the Fully Insured Rx Card is 10%, you’ve just cut the price of the group plan by 5%. 

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Hapless Plan Sponsors Are Screwed By Switch Operators

January 4th, 2021

A ‘Switch Operator’ is a Software Clearinghouse Between a Pharmacy and a PBM that Allows the Pharmacy to Check the Patient’s Drug Formulary, Copay and other Insurance Information.

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Texas County Believes All Health Care Is Local

January 3rd, 2021
All health care is local, or at least it ought to be………………….So why do most plan sponsors hire out-of -state plan management firms like UHC, Humana and the rest? They just get in the way…………………..

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Excellent 7 Minute Video Explains The Past & Possibly The Future

January 2nd, 2021

This is one of Dr. Bricker’s best videos. In 7 minutes he puts the current economic status of healthcare in historical perspective.

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Let The Sun Shine In………………..

December 31st, 2020

Effective in 2021, employee benefit plan fiduciaries will be required to get fee disclosures from service providers…………..this means hidden fees earned by many brokers (especially the large national brokerages) must be disclosed to newly horrified plan sponsors

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Employers Choice Rx Adopts RBP Approach

December 31st, 2020

Traditional PBM Representative Reacts 

In 2011 when the Employers’ Advanced Cooperative on Healthcare founded Employers’ ChoiceRx (ECRx) it was the first pharmacy BENEFIT solution built to be a transparent/cost-plus program that focused on “therapeutic equivalent” drugs to achieve a lowest net cost reference price.

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SmartHealth PayCard

December 31st, 2020

Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….

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Professor Aldine Updates SAT Test

December 30th, 2020

Professor Doug Aldine updates SAT test question/s for wannabe college students hell bent on achieving little by way of a college degree…………….

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Infections Disease Racial Disparities Task Force

December 30th, 2020

Pitting Hyphenated Americans against each other using health care as a political tool to do so……………………

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Holy Cow!

December 30th, 2020
“The pharmacy benefit managers are not going to like what we are doing when it comes to ScriptCo.”

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TRS ActiveCare Update

December 29th, 2020

Districts of Innovation offering competing health plans have impacted TRS membership this year. Market intelligence tells us one of the new competing health plans has captured approximately 12,000 employee lives with a total of 17,000 members………….

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Killing Chinese Flu Virus In 30 Seconds

December 28th, 2020

Lone Ranger Rejoices – No More Mask!

Researchers from Tel Aviv University have proven that the Chinese Flu virus can be killed efficiently, quickly and cheaply using ultraviolet light-emitting diodes……..all in 30 seconds…………

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P&C Brokerage

December 28th, 2020

In-sur-ance (in-shoor’ens) n. 1.a. The act, business, or means of insuring persons or property. b. The state of being insured. 2. A contract binding a company to indemnify an insured party against specified loss. 3. The sum of which something is insured. 4. RiskManagers

Insure (in-shoor’) v. – sured, -suring. 1. To protect against loss, damage, etc. with insurance. 2.  Also ensure (en-). To insure n. RiskManagers

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To Comply or Not To Comply, That Is The Question

December 28th, 2020

Hospitals Hate Pricing Transparency

Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..

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Providers Find Silver Lining in “No Surprises Bill”

December 27th, 2020

Why would any provider want to be in-network if they know they will always get more than what a plan pays?

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Government Acts Against Money Interests – Sides With The Common Man

December 25th, 2020

Andrew Jackson – Champion of The Common Man

After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………

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Oscar Health – San Antonio Market Rates

December 24th, 2020
Under new ICHRA’s employers can pay the cost of individual health insurance plans like Oscar Health . See Oscar’s San Antonio area benefits and rates for 2021.

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What Is Program Insurance?

December 23rd, 2020

“Although not traditionally classed as self-insurance, program business involves an intermediary assuming many of the roles of an insurance company……….”

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Program Managers

December 23rd, 2020

We provide production underwriting services on behalf of Life & Health insurers and managed care organizations for new and renewal business.

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Texas State Board of Pharmacy Has Outlawed Paper Prescriptions?

December 23rd, 2020
    Darrel Pruit, DDS
Attention Texas dental patients. You should read this.

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December 23rd, 2020

Senate Approves Repeal of Health Insurers’ Antitrust Exemption

By Allison Bell

The repeal bill, H.R. 1418, is now heading to the president’s desk. Read More

Printing Money That Has No Value

December 23rd, 2020

Late Monday, both Houses of Congress approved the Consolidated Appropriations Act, 2021 (“CAA”) providing for a sweeping $900 billion rescue package to deliver much-needed relief for small businesses.

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Professional Liability Insurance

December 21st, 2020

Professional liability, also known as Errors and Omissions Insurance (E&O), protects you if you’re sued for negligently performing services, even if you haven’t made a mistake. Coverage also includes defense costs associated with any lawsuit.

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Health Care Providers Eye Self-Funding Opportunities

December 20th, 2020

Health care providers looking to seize opportunities to drive members to their network through their own self-funded products such as hospital owned Community Based Health Plans……………….

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Congress Releases Surprise Billing Compromise

December 20th, 2020

Creates a complex arbitration process between insurers/ self-insured plans and medical providers…………Arbiters are prohibited from taking into account the provider’s “list price” billed charges……………..

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Tom & Sally Vaccinated in 1801 Amidst Pandemic

December 20th, 2020

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The Biblical Alternative to TRS ActiveCare

December 19th, 2020

TRS ActiveCare used to be a great deal for teachers, but unfortunately that’s no longer the case. Alternative choices can provide a better solution for Texas teachers and their families.

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Fully-Insured Prescription Drug Plans

December 19th, 2020

Prescription drug costs continue to escalate. Is it better to fully-insure or self-fund the risk?

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Chinese Flu Vacination Protocol Suggested By Health Policy Expert

December 19th, 2020

“All white people to the back of the bus” screams Harald……………………..

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Egregious Third Party Fees Gained At Provider’s Expense

December 18th, 2020

domino

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Reference Based Pricing may not make much sense to those in the domino parlor.”

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Move Over BCBS, Aetna, UHC & The Rest – Lisa Gets The Best Prices, Yours Suck

December 17th, 2020

Hey Doc, how much will you charge, cash, for a Carpal Tunnel Release?. If I like it I’ll pay you in full on the day of service……………………or before if you insist.

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Chinese Exports Help Reduce U.S. Health Care Costs

December 17th, 2020

Newest Chinese export benefits corporate coffers worldwide by lowering health care costs for plan sponsors……………….

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World’s Richest Man Bets His Money on Primary Care Strategies

December 17th, 2020

The service would bypass health-insurance plans and brokers and could help to lower the cost of healthcare.

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The Gift of Hardship

December 16th, 2020

The Gift of Hardship by Tatiana Denning is an excellent short 5 minute read of “Our most important life lessons come when difficulties rain upon us.” 

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An Online One-Stop Shop For Small Business’s of 2-300 Employee Lives

December 16th, 2020

An online one-stop shop for small business owners looking for medical coverage for 2 employees up to 300. Read the rest of this entry »

Lawsuits & Class Action – It’s All In The Cards

December 16th, 2020

The District (HOSPITAL) argues the insurance cards failed to adequately disclose that the patient’s ELAP plan contracts with MultiPlan only for physician services, not facility services.

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December 15th, 2020

December 15th, 2020

Surprising New Chinese Flu Test Shows Promising Results

December 13th, 2020

Please wait here in the examing room. Our lab technician will see you in just a few short minutes……

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Centivo Raises $34 Million To Serve Self-Funded Employers

December 13th, 2020

The company will use the financing to expand its offerings into new markets and further scale its operations in response to growing demand……………..

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Holy Cow Mamacita!

December 13th, 2020

In 2013, he made $5 million. Three years earlier, he made $8 million. That’s the kind of money you might expect the CEO of one of the largest hospital chains in the country to earn.

But Ray Ingham isn’t the chief executive of a major health system………………

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Underwriting TRS ActiveCare Alternative Commercial Health Plans

December 13th, 2020

TRS ActiveCare will not release claim experience for those districts who wish to offer a competitive commercial health plan alternative. Since experience rating is not possible in these cases, some other way must be employed to underwrite the risk.

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Oh Oh, The Tape Was Running………………………..

December 12th, 2020

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General Motors To Enter The Insurance Business

December 11th, 2020

The value in the insurance offering comes from GM and OnStar’s ability to leverage the businesses’ already established ecosystems and improve customers’ insurance experiences. ………….

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Rutledge v. Pharmaceutical Care Management Association

December 11th, 2020

Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell | December 10, 2020 at 04:59 PM

The justices held that Arkansas can set payment rules that affect ERISA plans’ pharmacy benefits managers.

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Supreme Court Sides With States in Drug Benefits Ruling

December 10th, 2020

Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell

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$1.1B deal will give Tenet 45 SurgCenter ASCs

December 10th, 2020

Tenet projects the transaction will generate double-digit returns within three years of its completion and 42 percent of Tenet’s adjusted-EBITDA will be generated by USPI’s ambulatory business next year, up from 4 percent in 2014.

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Antidote for Contracts of Adhesion

December 10th, 2020

Quizzify’s offering an elegant solution to fight surprise medical bills.

Download the solution now!

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Major League Sues Insurers Over Chinese Flu Losses

December 10th, 2020

“We strongly believe these losses are covered in full by our insurance policies, and are confident that the court and jury will agree.”

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Social Inflation Hurting Insurance

December 10th, 2020

Increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and larger compensatory jury awards………………….

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