Will Payroll Services Put Agents Out of Business?

January 30th, 2015

ADP

“ADP will provide a Health Care Premium Guarantee for you and your employees from 1/1/2015 to 6/1/2016, so you know for the next 18 months that your renewal will not be higher than 12%. “

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Caprock Health Group – Health Care Forum 2015

January 27th, 2015
email logo
Caprock Health Group will hold their annual 2015 Health Care Forum in San Antonio, February 19.

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AMPS Seeks Two New Sales Representatives

January 27th, 2015

AMPS is looking to add two top tier sales professionals to help us with the incredible demand for our Reference Based Reimbursement (RBR) solution. Do you want to continue to sell sugar water or come with us and change the self insured world? We love what we do, it’s all we do and no one does it better. If you want to LOVE what you do too, contact John Powers at jpowers@less advancedpricing.com or 630.361.2525

Physician Responds To RiskManagers.us Post

January 27th, 2015

“This is what happens when you put Marxists in charge of making these decisions.”

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After 17 Years Insurance Dispute Continues – Where is Perry Mason?

January 27th, 2015

mason

“This thing has really gotten uglier and uglier and uglier,” said attorney William Gast, who represents the Fulkerson family and Countrywide Insurance Agency.

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“Historic” Medicare Reimbursement Scheme Announcement

January 27th, 2015

“The Administration’s “historic” announcement on Monday marks “the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.

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North Carolina Blues Plan Unloads Price Transparency Surprise

January 26th, 2015

Amazing Revelation! Will Coke Cola Recipe Be Next? 

There’s a fascinating story out of North Carolina about that state’s largest insurer unexpectedly publishing information on how much it pays healthcare providers for a wide range of elective, non-emergency services. ……Such payments normally are closely guarded business secrets……………………Providers were not pleased.

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I Don’t Want To Tell You My Current Premiums

January 26th, 2015

“Just give me a quote along with the other five agents I have contacted. Never mind that my current agent has that information!”

“As I’ve aged and acquired more experience and am blessed with the knowledge that dinner is on the table whether or not I make a sale today, I’ve become more stubborn about insisting that if a prospect wants my involvement and engagement in seeking coverage, then they have to co-operate at minimum levels…………”

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PBMs Should be Required to Disclose Fees and Compensation

January 25th, 2015

onionPeeling Back The Onion

Testimony submitted to the Council revealed that drug pricing methodologies and PBM compensation are complex and evolving, including rebates, price spreads, discounts, and other payments from retail pharmacy chains and manufacturers.”

“Substantial evidence was submitted to the Council from ERISA plan sponsors and others that many PBMs do not fully disclose compensation in a manner which is readily understandable to even the most sophisticated plan sponsors and consultants.”

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Long Term Care Insurance – Reducing The Implied Leverage of Insurance

January 24th, 2015

risk

By Michael Kitches

Insurance functions best when it is used to cover high-cost low-probability risks — things that aren’t likely to occur, but would be devastating if they did. Technically, paying insurance premiums on an ongoing basis has a slightly greater expected loss than just retaining the risk, but the trade-off — converting a potential financial disaster into a manageable ongoing premium — is appealing.

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Texas Federal Agent Guilty of Insurance Fraud

January 23rd, 2015

January 21, 2015, San Antonio, TX — A former deputy U.S. Marshal and Mission police officer pleaded guilty Wednesday to federal fraud charges after he falsified insurance documents and forged a doctor’s signature, prosecutors say.

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The Math and Politics of Organ Transplantation

January 22nd, 2015

jobs

“Steve Jobs chose to be listed for a liver transplant in Tennessee rather than where he lived in Northern California, which has an average waiting time 6 years, because he was more likely to get a new liver in Memphis, which has an average waiting time of 3 months.”

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Mpirica

January 21st, 2015

Frustrated by the lack of simplified hospital quality information, MPIRICA’s founding team are healthcare consumers like you, who just happen to also be tech entrepreneurs.

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The True Story of Generic Medication Prices

January 20th, 2015
belk
By David Belk, M.D.
A number of generic medications have skyrocketed in price recently and quite a few people have asked me about it. In order to comprehensively address this problem (or at least define it) I did a survey of what pharmacies in the US have paid for 1,240 listings (including different doses and preparations) of over 400 generic prescription medications each quarter from October 4, 2012 through January 7, 2015). I tracked how the price of each listing changed each quarter and in total.

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Refreshingly Simple – Texas Hospital Offers Contract to Local Employer

January 19th, 2015

mollyBy Molly Mulebriar

We like the simplicity of the offer. It’s refreshing and a good starting point……………..But a 50% discount off an inflated number can be anything you want it to be and 315% of Medicare seems a little outrageous……………..

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Brownsville Man Sentenced For Insurance Scheme

January 19th, 2015

BROWNSVILLE – A jury on Wednesday found a Brownsville resident guilty of securities fraud and theft.

Prosecutors said Alberto Alba Villarreal, 45, sold a bogus $1 million investment contract in Nafta Holdings LLC, to help fund a new insurance company. The fraud happened in November, 2008.

Officials said Alba Villarreal instead spent the money in less than three months on personal expenses and lavish purchases.

A jury sentenced Alba Villarreal to 10 years community service and was ordered to pay $10,000 for the securities fraud. He was sentenced 5 years in prison and ordered to pay a $10,000 for the theft count.

Visiting Judge Federico Hinojosa ordered Alba Villarreal to pay $1 million in restitution to the victim.

http://m.krgv.com/news/Brownsville-Man-Sentenced-in-Securities-Fraud-Theft-Case/30759242

See: Funding New Texas Insurance Company Proves Problematic

 

Bastrop Independent School District Seeks Insurance Consultant

January 16th, 2015

help

RFP #2015-02 – Insurance Benefits Consulting Services. This bid is scheduled to close on Feb 5, 2015 4:00:00 PM CST

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County Commissioners Discover Motherload!

January 16th, 2015

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Are MEC Plans Doomed in 2015?

January 16th, 2015

mec1Arms of the U.S. Department of Health and Human Services (HHS) and the Treasury Department are lashing out against a controversial new type of group health plan.

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I Love Old People, But I Will Not Accept Medicare

January 15th, 2015

oldpeople

PAMELA WIBLE, MD | PHYSICIAN | AUGUST 7, 2014

I love caring for patients — young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare in 2006. Why don’t I accept Medicare? Let me fill you in.

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Physicians Must Unionize – Here’s Why

January 15th, 2015

 havelik

“If were alive today, he would support the revival of labor unions in general and professional labor unions in particular.”

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High Drug Costs – Low Drug Costs – Each Has a Price

January 15th, 2015

patent

PETER UBEL, MD | MEDS | JANUARY 12, 2015

India is not, yet, a wealthy country. Nevertheless its people experience many of the same expensive-to-treat illnesses as wealthier populations in the U.S. and Europe. Therefore, the country has made a series of policy decisions designed to lower the cost of medical treatments.

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Managed Care Compliance Conference

January 14th, 2015

Plan to attend if you are a compliance professional from a health plan (all levels from officers to consultant), in-house or external counsel for a health plan, an internal auditor from a health plan, regulatory compliance personnel, or a managed care lawyer.

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Some Eligible Americans Turn Down Welfare

January 13th, 2015

welfare1111

Though Brewer could pay less for a plan if she were to accept a subsidy (welfare) from the federal government, she refuses. “I want to pay my own way,” she says. “I will not take a handout.”

“Welfare is the use of force to transfer wealth from one group to another” – Ron Paul

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Brit View of American Health Care – Pain In The Arse

January 13th, 2015

pain

Where Americans see “choice” in their private health insurance plans, Brits see wasted time and confusion. Where Americans say “I get to choose my doctor,” Brits ask “why on earth would you want to choose a doctor?” Where Americans talk about “out-of-pocket” and “deductibles” and “co-pays”, Brits say “what?” and get all of the above confused.

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Retail Clinics Sound Good. But If You Need Follow-Up care, Good Luck.

January 12th, 2015

doctor11111

“These clinics pick off the easy, high margin care and then punt when push comes to shove.  They have less interest in your well being and more in your wallet.”

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Medicaid Rates Are Going Down & There Is Nothing Doctors Can Do About It

January 12th, 2015

medicaid

By Shirie Leng, M.D.

Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR.

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Mutual Accident Company

January 10th, 2015

colonial1

Founded in 1937 by a salesman who put up $2,000 and borrowed $3,000 more to start Mutual Accident Company. The company sold only one product; a $1,000 accident policy for $3 per year. Two years later he changed the name of the company and turned it into a stock company. In 1993 the company was sold for $571,000,000. Not too bad for an initial investment of $5,000.

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Why Are American Health Care Costs So High?

January 10th, 2015

Consolidation: Less Competition in Health Care

January 10th, 2015

“Continuing consolidation in the health industry has enabled providers to raise their prices without improving the quality of their services…….. The resulting lack of competition among hospitals and other providers allows those providers to monopolize the market and charge higher prices…….health insurance compounds the problem….”

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The Future of Medicine Is In Your Smart Phone

January 9th, 2015

smartphone

Now, at any time of day or night, you can demand and get a secure video consultation with a doctor via smartphone at the same cost (about $30-$40) as the typical copay charge through employer health plans. This may seem exotic now, but several large consulting firms—including Deloitte and PricewaterhouseCoopers—have forecast that virtual physician visits (replacing physical office visits) will soon become the norm.”

Beats calling for an appointment, waiting days to see the doctor, then making your 9:00 a.m. appointment days hence only to see the doctor at 11:00, after sitting in a room full of sick and possibly contagious patients, for a brief 5-10 minutes meeting with your harried and stressed doctor, then driving over to the pharmacy to get your prescription, waiting there for 30-45 minutes with retching, sick and possibly contagious Typhoid Marys and having to deal with Miss Grumpy the pharmacy sales clerk, then driving back to work only to hear your supervisor bitch and moan.

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Self Insurance Administration – A Competitive Market

January 9th, 2015

tpa

Last March, Aetna scored one of the biggest single contracts in its history when the Teacher Retirement System of Texas shifted the administration of its self-insured healthcare benefits program from Blue Cross and Blue Shield of Texas to Aetna.

See: Selecting a Third Party Administrator

“……wellness programs, accountable-care networks, hospital bill audits and direct contracting with providers  appeal to employers……help them (self-funded plans) reduce costs and improve care……..” See: The PPACA – Game Changer for Health Care Financing

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UHS To Open 2nd On-Site School Based Medical Clinic

January 9th, 2015

uhs

University Health System has teamed up with Southwest Independent School District to open a new health center that will be open to students and siblings under the age of 18………UHS opened its first school-based health center in the Harlandale Independent School District on San Antonio’s South Side in 2013……….

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San Antonio Facing $70 Million Cadillac Tax

January 9th, 2015

gruber

Obamacare architect Jonathan Gruber and his Obamacare comic book for stupid Americans

“Gruber said that the trick to selling the “Cadillac tax” was to claim it was a tax on insurance policies and not “people” – Breibart

The City of San Antonio could be liable for huge tax penalties unless it can come to terms with police and fire unions on new collective bargaining agreements that includes less costly health benefits.

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Doctor On Demand

January 8th, 2015

dod

“Lack of access to health care providers in the United States is a massive, growing problem. The average wait time to see a physician is three weeks. More than half of patients with mental health issues go without treatment. We’re not getting the care that we need. We built Doctor On Demand to help address this problem.”

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Antibiotics: US Discovery Labelled “Game Changer” For Medicine

January 8th, 2015

tractor2

The decades-long drought in antibiotic discovery could be over after a breakthrough by US scientists. The researchers turned to the source of nearly all antibiotics – soil. This is teeming with microbes, but only 1% can be grown in the laboratory. The team created a “subterranean hotel” for bacteria. One bacterium was placed in each “room” and the whole device was buried in soil.

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Childrens Hospital of San Antonio Signs Newest Health Insurance Provider

January 7th, 2015

christus santa rosa

“The signing of this agreement will allow for the Children’s Hospital of San Antonio to better meet the needs of all children, regardless of their insurance plan, in San Antonio and South Texas….”

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Humana’s Concentra Expands Urgent Care Network In San Antonio

January 7th, 2015

concentra1

Concentra Urgent Care has opened a new medical facility in the Fiesta Trails Shopping Center in Northwest San Antonio.

Concentra now has a half-dozen urgent care facilities in Bexar County. This newest center, at 12651 Vance Jackson Road, is one of the company’s largest to date.

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Phia Group Announces Implant Cost Pro Service

January 6th, 2015

PHIA

“Implant Cost Pro” Case Study:  A self-funded benefit plan, which had historically secured a 10% discount with an ambulatory surgical center for services involving implants, advanced a $91,000 implant claim to The Phia Group.  Utilizing the Implant Cost Pro service, leveraging cost data and innovative arguments, The Phia Group ultimately secured a negotiated payment of only $22,000; a net 76% or $69,000 in savings.

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Reference Based Pricing, Individual Responsibility & Willing Providers

January 6th, 2015

booker

By Bill Rusteberg

Reference Based Pricing with limited balance billing advocacy and legal defense services is the “grown-up” way of offering employer sponsored health insurance.

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For Physicians; The Cheese Has Moved

January 6th, 2015

sniff

At last month’s American Medical Association (AMA) House of Delegates  Interim meeting in Dallas, attendees approved a resolution to study the  impact of physician unionization based on the growing concern about  physician employment arrangements by hospitals and health insurers.

While it’s not likely physician unions will sweep the country, it’s certain physicians aren’t happy. Their reasons are understandable:

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Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty

January 5th, 2015

collegeprof-By ROBERT PEAR

WASHINGTON – For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

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Compound Drugs – A Killer Scam

January 5th, 2015

rxcompoundscam

By Joe Paduda

Compound drug use is exploding – so much so that Texas has changed their employee benefits program to limit reimbursement to $300.  They didn’t have much choice, as the Texas Employees’ Retirement System’s compound drug costs have gone up 4,600% over five years.  That was not a typo.

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Indictment Alleges Massive Rx Scam – $100 Million in Overbilling

January 5th, 2015

rxscam

“workers’ compensation insurers would be billed in “the $1,500 to $3,000 range” for creams that had a wholesale cost of about $70………

In October and December of 2010, Sorat wore a wire while eating lunch with Ahmed. On the tapes, Ahmed can be heard boasting of his success: “I’m a behemoth, I make 8 to 10 million a month….It’s the fee schedule man! You got to mark it up. It’s like a 200 percent markup”

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Humana / Concentra Seek Primary Care Market Expansion in San Antonio

January 4th, 2015

concentra

Humana seeks primary care sales representative in San Antonio.

The Primary Care Sales Specialist will report to and work in conjunction with the National Field Marketing Leader to help Concentra Primary Care achieve and sustain aggressive new patient and plan membership growth goals for each neighborhood medical center in San Antonio. Responsibilities include:

  • Cultivate strong relationships with insurance agents and community partners to keep Concentra Primary Care top of mind as these professionals interact with our target demographic
  • To help reach our target market Medicare-eligible seniors

(Humana San Antonio job posting 18 days ago).

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Lawyer Discovers ObamaCare Gold

January 2nd, 2015
gold rush
The 2015 ObamaCare Gold Rush reaches fever pitch………………………….

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New IRS Rules Crack Down On Nonprofit Hospitals

January 2nd, 2015

er

The federal government is cracking down on nonprofit hospitals in an attempt to prevent harsh collection practices and steep charges for the uninsured.

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Walgreens Closes Deal, Begins New Era In Global Pharmacy

January 2nd, 2015

wallgreenWalgreens (WAG) closed its deal with Alliance Boots this morning, launching under a new holding company with its eyes on global expansion, a first for the retail pharmacy industry.

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How The Kind, Humble Physician Met His Demise

January 2nd, 2015

doctors

There once was a kind humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients.  He was open and deliberate, calm and thoughtful.  He himself hired every secretary and medical assistant, every nurse and biller.  His staff formed a protective family who fiercely advocated for both patient and doctor.

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Fixing our broken health care system: Sometimes David wins

January 2nd, 2015

david

“You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes………….Almost everyone without a financial stake looking at the U.S. system comes to the same diagnosis that it is crazy, dangerous, and unsustainable………….” Allen Frances, M.D.

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