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………….
AMA: Insurers Misused CPT Codes To Hide Administrative Costs
February 27th, 2020Sleepy 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.”
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…………..”
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.
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).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.
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.”
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?”
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.”
What’s An Actuary?
February 14th, 2020
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?”
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?
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……………………….
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…………….
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…………….
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………………..
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
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.”
Dual Coverage Dilemma
January 30th, 2020
Austin Independent School District Seeks Insurance Consultant
January 29th, 2020
The RFP is essentially requesting the services of an assortment of experts…………….
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.”
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.
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
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……………
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…………
Health Policy Predictions for 2020
January 22nd, 2020
The private market will offer new funding strategies for employer-sponsored health plans……
Texas ER Doc’s Gravy Train in Jeopardy
January 22nd, 2020
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.
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.
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.
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………..
Schuessler Takes Aim At Rural Health Care
January 18th, 2020The 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.
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.
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……………..
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…….”
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……………..
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.”
$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…………….
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…..
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
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.
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
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.”
HUB International Names Stephen Cali Benefits Consultant
January 6th, 2020
Posted by: MBJ Newswires in Insurance, Newsmakers 01/06/2020
Stephen Cali is joining HUB International’s Employee Benefits division, accepting the role of Sr. Vice President / Sr. Benefits Consultant.
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………”
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.
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
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”
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.”
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.
HealthShare Works
January 2nd, 2020
For over 30 years I have helped individuals and corporations obtain the best ways of paying for medical care.
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………..
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?”
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.
Personal Care Act
January 1st, 2020
You Are Invited To……………….
December 31st, 2019
You are invited to the following event:
FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – JANUARY MEETING
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.
Hospital Roulette
December 30th, 2019
Patients qualifying for free care from one hospital might receive painful bills and lawsuits from another.
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…………..
BCBS Offers Specialty Drug Solution
December 29th, 2019
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……………………..
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?
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………………..
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”
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…………..
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….
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……………”
Rx Acquisition Cost
December 23rd, 2019
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.
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……………..”
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).
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).
Cross Border Drug Trafficking Expected To Increase
December 18th, 2019
Cross border drug trafficking importation increases under President Trump’s watch – The Canadian connection…………………..
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….……………