Busy Jill – She Had 18 Children In Less Than 10 Years
Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….
Dallas Area Rapid Transit is a transit agency serving the Dallas–Fort Worth metroplex of Texas. It operates buses, light rail, commuter rail, and high-occupancy vehicle lanes in Dallas and twelve of its suburbs. Wikipedia
“First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.”
Twin brothers invented Opopira, considered a miracle drug back in the day, a pasty mass consisting of a drug mixed with sugar and water or honey suitable for oral administration. This complex compound drug was used to treat diverse maladies including paralysis.
Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..
“When the patient gets the bill, it looks like the insurer haggled on their behalf. Yet the final charge is still much higher than it should have been. The patient loses, while the insurer and provider win.” – Nikki Haley
Trolling the internet on Chinese Flu quarantine day # 267 (and counting) we came across a website touting “Free Rx.” As we suspected, it was just another third party intermediary offering to assist consumers in applying for Rx manufacturer assistance programs. For a fee of course.
We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.
What are the statistics for TRS plan year 2020-2021? How many employees have moved over to heretofore illegal, competing commercial health plans and away from the state sponsored TRS ActiveCare government plan? What is the financial impact?
Single payer system by 2028? Will Republicans embrace Obama Care as the better of two evils? Will whatever the Supreme Court decides have little effect on political realities?
After talking with The Tyler (Grow Some Balls) Rose, Charlie was convinced he could achieve his goal of creating a better health plan — one his 150 employees deserved……………
I’ve been hard at work on something I’m very proud of: a roadmap for communities, large and small, to restore hope, health and well-being.
Beginning an initial dialog with “How much will you charge us” is never a good indication things will go well with your chances of gaining a new client as long as pricing is the driving consideration.
Angie Stewart – Friday, January 10th, 2020
Eye and gastroenterology procedures are some of the most common services proliferated in ASCs, according to a March 2019 report by the Medicare Payment Advisory Commission.
Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!
The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.
Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses
Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.
For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.
With Bind, costs and choices are transparent and easy to compare. There is no deductible or coinsurance to meet before the plan starts contributing, and members can change and shape their coverage as their health needs change.
If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.
This is what manufacturing firms are doing now with their benefit plans
“Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.
“Holy Smoke guys, we’ve singled out our cheapest providers, much cheaper than all the others, 20% cheaper! We call it the I-35 Performance Network.” says the Aetna rep.
“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”
“I Was Raised To Pay My Debts On Time…………..”
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…………….
Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore.
GoodRx’s profitability is a rarity among start-ups filing to go public……………..
When you go to fill a prescription, do you present your health insurance card at the pharmacy and assume you’re getting the lowest price? You may be paying too much. The cash price for many prescription drugs — especially generics — is often less than insurance co-pays.
GoodRx, a digital health startup that helps users track prescription drug prices, filed for an IPO on Friday. The company hasn’t yet priced its shares, but plans to be listed on Nasdaq as “GDRX.”
Effective September 1, 2020 MEDSAVE will be improved to include a new plan option members may choose when seeking medical care.
All patient financial responsibility for covered medical expenses will be waived each time a member requests plan assistance in selecting high quality medical providers and services.
TSHBP offers Texas school districts a TRS ActiveCare alternative for 2020-2021 school year. A careful review of benefits and rating structures indicates smart risk management strategies to control health care costs for members.
Effective September 1, 2020 we are trying out something new which I believe could be the future in health care financing – A cash pay centric plan coupled with a PCP referral process to the highest quality providers with the best medical outcomes.
Will the TRS ActiveCare trustees act to stop the TRS ActiveCare rebellion? They better think this through because it would be political suicide to take away competitive benefits and force members back to the TRS ActiveCare dungeon.
With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….
Psst…GodFather, Carl’s At It Again!
We just received word that Florida Schuessler Stick (The Schuessler Stick™) sales have recently spiked straining manufacturing capacity at plants world wide. So staff set out to find out why. The following is their report…………….
Common sense dictates that medical caregivers who accept Medicare pricing should have no problem accepting Reference Based Pricing plans that uses the same pricing.
ANGRY HOSPITAL ADMINISTRATOR REACTS TO THE NEWS……………
“The goal of the rule is to reduce a disparity in Medicare payments where hospital-affiliated clinics get paid more than physician offices for the same services. Some critics have said the gap has helped fuel a race towards hospital-physician consolidation.”
Court records allege Cigna uses four distinct schemes to embezzle and convert funds by defrauding patients, healthcare providers, and their own Self-Insured Health Plan clients …………………
“What medical school did Zuckerberg go to?”……………………………….
Why price of Humira keeps rising despite FDA approval of generic competition
“Patent thicketing, and Humira is the poster child for this, builds a patent fortress around their product to protect their ability to continue their monopoly pricing.’’
Here are some highlights from the podcast:
ARTICLE REFERRED BY: Charles Luke
7/29 TDI Releases Preliminary Report on Balance Billing Dispute Changes
The Texas Department of Insurance has released a preliminary report on the effects of recent balance billing dispute resolution procedures passed during the 86th Session in Senate Bill 1264. In the report, TDI examined 9,000 requests over the first six months of SB 1264 implementation.
RFQ’s for Insurance Consultants
“The problem with these outdated methods of procuring consutlants services is how many windows you have in your office is irrelevant” – Carl Schuessler
We know a thing or two when it comes to employee benefits. Actually we’re what you might call an “industry leader” in all aspects of online employee benefits communication, education, enrollment and administration.
Whether you own a company it, run it, invest or influence it- WellNet refuses to play by the rules of the ‘health insurance company cartels’ that seem to only be interested in protecting their revenue streams.
Hospitals are becoming increasingly proactive in updating their Charge Master’s and doing so on more than a quarterly or annual basis yet Hospitals Dismiss Significance Of Chargemaster Prices?
At the stroke of midnight, August 31, 2020 as much as 5% of TRS ActiveCare membership may vanish……………
Texas school district to over TRS ActiveCare alternative health plan effective September 1, 2020
First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools……………….
TAKE COMMAND HEALTH touts cost saving alternative to TRS ActiveCare………………
Mike, in a recent post, you said you’ve been to Tennessee and Georgia, giving speeches and filming for your new show. Before that, you were on the road shooting for Dirty Jobs. Is it really so important to film a television show in the midst of pandemic? Is it responsible of you to encourage this kind of behavior when infection rates are spiking? Don’t you watch the news? More and more cases every day – aren’t you concerned? – Darlene Gabon
Reference Based Pricing vendors rejoiced when a jury sided with a patient over an egregious hospital bill (Jury-sides-with-patient-in-hospital-bill-lawsuit/) But plaintiff’s attorneys were singing It Ain’t Over Til It’s Over………..
Fred Rusteberg wasn’t interested in the limelight, but he was always there to help the people of Brownsville, his beloved hometown, and he left an indelible mark in the process.
A couple of weeks ago I was interviewed by someone in the U.K. for a podcast called The Jist. I spent about an hour trying to explain our crazy healthcare system to someone who’s had no firsthand experience with any of it. As you can imagine, most of what I told him sounded quite insane to him.
Will Texas finally do something to fix health care for state employees and Texas educators? Fighting a $4.6 billion budget deficit can start with injecting common sense, reason and logic into how Texas funds health care………………….Or Is Texas still searching for their missing cajones? Hint: The little lady in Montana has them…………….
Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:
“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Mr. Yost said. “I intend to shed light on their business model………”
“We knew that this was a time bomb because the percentage of obesity, hypertension, diabetes is so high,” said Dr. Adolfo Kaplan, a critical care physician who works with Dr. Brown at DHR Health in Edinburg, Texas. “
