I wrote this book to empower every individual — and to help everyone recognize that despite yet another season of campaign promises, we do not need to wait on our legislators in Washington D.C. to change health care……………………
Chase Announces Third and Latest Book Release
October 16th, 2020A Picture Is Worth 1,000 Words
October 13th, 2020
This graph represents the dynamics characteristic of traditional managed care plans (PPO). PPO contracts are tied to the billed charges, not costs. As billed charges go up each year, so do premiums, even though costs may have not gone up at all. Employers mitigate their increasing costs by reducing benefits. It’s a vicious never ending cycle.
Shoot Out At The OK Corral
October 10th, 2020
The Shoot Out At The OK Corral is an entertaining novella worth watching. Three insurance consultants vie for the business, each giving a 15 minute presentation to the Board of Trustees at the Kingsville Independent School District last week.
Dinosaurs Are Alive & Well
October 10th, 2020“I’ll Never Retire………………………………………”
West Texas School District Who Refused To Be Bullied
October 9th, 2020
“The intent of this notice is to make you aware that we don’t recognize in any of these programs and Baptist Health will not agree to accept unilateral rates established by these reference based pricing plans…………..plan participants may be held financially responsible for up to 100% of billed charges”
Dennis Burkholder & Box 13
October 6th, 2020
Hard To Argue Against Common Sense, Reason & Logic
October 6th, 2020
“Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the flu.
How Insurance Brokers Are Augmenting Their Value Proposition
October 6th, 2020
“We see a lot of brokers making significant efforts to pull in better loss information and better claims information so they can be partners in risk with their customers, in terms of explaining to them the patterns they see, benchmarking them against peers, and then being able to say: ‘If you do this, this, and this, your total cost of risk might in fact go down, and could go down significantly.”
Butler Says It’s Not The Doctors Fault
October 5th, 2020
“It’s not the doctors, or the nurses, or the people that actually work,” said Butler. “It’s the system. It’s the billing system that they all operate under.” – Josh Butler
Show Down At The OK Corral
October 4th, 2020
Kingsville ISD went to bid for an insurance consultant to assist the district in managing their self-funded health plan. Staff made a recommendation to award the bid but the board decided to table action pending a public workshop. Three insurance consultants are bidding for the job.
Stop Loss Market Update
October 4th, 2020
Specialty drug approvals, emerging gene therapies, less relevant PPO discounts, double digit higher charge master rates in 2021, more aggressive billing practices and COBRA provisions related to the pandemic will impact rates well into the coming year.
Christus Health Plan
October 3rd, 2020
TDI Commissioner Resigns
October 3rd, 2020
Kent Sullivan has notified Governor Abbott that he will resign as Texas Insurance Commissioner in September to return to the private sector.
Texas Governor Announces Agreement With Health Insurers
October 3rd, 2020
Governor Greg Abbott today announced that Texas’ major health insurers have agreed to continue reimbursing network health care providers for telehealth appointments at the same rate which they pay for office visits through the end of 2020………………..
Low Bid Gets The Business
October 2nd, 2020
A recent post on this blog, Low Bid Gets The Business, described the Kingsville ISD’s search for an insurance consultant.
Insurance Provider Announces Preferred Partner Compensation
October 1st, 2020
Holy Smoke! Insurance brokers can do much better with this compensation schedule ……………up to +3.5% better than current average commission levels……………………………
Innovative Solutions Are Changing Health Care
October 1st, 2020
Only when the pain of higher costs exceeds the fears of change will common sense, reason and logic guide healthcare strategies………………..
Stop Loss Claim Nightmare
September 30th, 2020
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…………….
DART – Dallas Area Rapid Transit RFP for Pharmacy Benefits Consultant
September 29th, 2020
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
Small Business Stabilization Program by United Advantage
September 28th, 2020
First Financial Targets Texas School Districts
September 28th, 2020
“First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.”
Is Opopira on Your Rx Formulary?
September 28th, 2020
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.
$1 Tele-Health Visit
September 27th, 2020
Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..
Imagine If There’s No PBMs – Its Easy If You Try
September 27th, 2020
September 26th, 2020
“Hiding Cost of Healthcare an ‘Insult to Americans”
September 26th, 2020
“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
Free Rx
September 26th, 2020
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.
Dan Crenshaw’s Band of Brothers & Sisters Pledge Healthcare Reforms
September 25th, 2020Health Care:
We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.
TRS ActiveCare Enrollment / Financial Projections
September 24th, 2020
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?
Supreme Court To Hear PPACA Challenge With or Without New Justice
September 24th, 2020Single 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?
Charlie Meets The Tyler Rose & He’s Glad He Did………….
September 23rd, 2020
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……………
Dave Chase Announces Newest Book Release
September 23rd, 2020
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.
Low Bid Gets The Business
September 22nd, 2020
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.
Whoa…………………..
September 18th, 2020
10 Most Common Procedures in ASCs
September 18th, 2020
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.
Emancipation Proclamation
September 14th, 2020
King Murray
September 13th, 2020Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!
Ballot Box, Courtrooms & Smoke Filled Rooms
September 13th, 2020
The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.
MGU Founded Aboard Love Boat
September 13th, 2020
Another Austin Insurance Insurance Startup Raises $20,800,000
September 13th, 2020
Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses
Austin Insurance Startup Raises $10,000,000
September 13th, 2020
Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.
Managing The Cost of Risk vs. Insurance Brokerage
September 7th, 2020
For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.
Meet Bind – Health Insurance For Companies
September 5th, 2020
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.
Reduce Healthcare Costs by Offering a ‘Free’ Option
September 5th, 2020
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
Aetna Touts Cheap “I-35 Discount Providers”
September 4th, 2020
“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?”
The 50% Club
September 3rd, 2020
“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…………….
Protection Money Scheme Dominates HealthCare
September 3rd, 2020
The Fallacy of PPO Re-Pricing Exercise
September 3rd, 2020
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 Files To Go Public
September 2nd, 2020
GoodRx’s profitability is a rarity among start-ups filing to go public……………..
Everything You Need To Know About GoodRX
August 30th, 2020
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 Files To Go Public
August 30th, 2020
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.”
Lisa Allen Invited To Join DOL ERISA Advisory Council
August 28th, 2020
MedSave Management LLC Announces New Program
August 28th, 2020
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.
Very Smart Risk Management Strategy for Texas School Districts
August 27th, 2020
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.
A Game Changer In Health Care Financing?
August 23rd, 2020
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 Texas Force Rebels Back To The Dungeon?
August 22nd, 2020
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.
Managing Risk vs Servicing Risk – The End of Status Quo Brokers?
August 22nd, 2020
With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….
Today’s Pharma News
August 20th, 2020
Schuessler Stirs Up Florida!
August 17th, 2020
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…………….
A Medical Plan Whose Time Has Come
August 15th, 2020
Common sense dictates that medical caregivers who accept Medicare pricing should have no problem accepting Reference Based Pricing plans that uses the same pricing.
Major Ruling Against Hospital Affiliated Clinics
August 15th, 2020
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.”
Lisa’s Plan
August 14th, 2020
- Cash Pay Community Provider Network includes PCP office visits, Specialist Visits, Radiology, etc. Zero balance billing issues – Providers paid in full through electronic fund transfer at POS
- Centers of Excellence for Surgical Procedures. Zero balance billing issues
- Reference Based Pricing for all other services. Plan will attempt to resolve balance billing issues however there is no guarantee those efforts will always be successful
Mulebriar Undercover Work Exposes Unusual Risk Management Strategy
August 10th, 2020
Cigna Sued for RICO Violations
August 8th, 2020
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 …………………
A Day in My Life as a Physician
August 6th, 2020
What Does Simone and The Tyler Rose Have in Common?
August 6th, 2020“What medical school did Zuckerberg go to?”……………………………….
Patient Thicket
August 3rd, 2020
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.’’
Podcast: Alternative Medical for Texas School Districts with Russ Edwards
August 1st, 2020Here are some highlights from the podcast:
TDI Releases Report on Balance Billing Dispute Changes
July 31st, 2020
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.
Quote of The Day
July 31st, 2020RFQ’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
TBX
July 31st, 2020
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.
The Remarkable Purple Cow
July 30th, 2020
Beating Health Insurance Company Cartels
July 30th, 2020
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.
Chargemaster Maintenance Ensures Financial Viability for Hospitals
July 30th, 2020
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?
Pandemic Chaos To Subside November 4 – Women Rejoice
July 29th, 2020