County Demonstrates Political Courage To Challenge Local Provider Community

May 1st, 2016

bot“The leadership of Botetourt County has, like many municipalities, been searching for innovative ways to reduce their health costs without increasing deductibles and co-pays to the members….”

Botetourt County, Virginia and San Patricio County, Texas have something in common – the political will to seek innovative strategies to rein in ever increasing, tax payer supported, health care costs for their employees. Challenging the status quo within their respective local health care community takes a rare political courage to prevail – Bill Rusteberg

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Affordable Health Care Is Just A Road Trip Away

April 29th, 2016

normanrockwel

People travel to visit family and attend business meetings, so why not travel for medical care?

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Specialty Drugs

April 29th, 2016
mulebriar
Bill, I have confirmed that a plan sponsor may exclude specialty drugs and remain ACA compliant – Molly Mulebriar

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Regulators Scrutinize Reference Based Pricing Plans – Phia Group To Host Webinar

April 28th, 2016

PHIA“Reference-based pricing is unquestionably a hot topic in the self-funded industry today. So hot, in fact, that the federal government has taken an active interest in it for the third time now……”

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CVS Buys Target Pharmacies, Jacks Up Prices

April 28th, 2016

drug12

Walmart, Kmart, Safeway, and Kroger all charge $45 for the sildenafil, using the discount card, while Walgreens charges $450 and RiteAid $1,000…………

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Challenge To ‘Balance Billing’ Hits Hospital

April 27th, 2016

Virginia Lawyers Weekly

By: Peter Vieth April 22, 2016

For what may be the first time in Virginia, a judge has ordered a hospital to slash its “balance billing” charges by 75 percent to reflect the hospital’s usual write-off for uninsured patients.

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Specialty Drugs

April 25th, 2016
drugs1111111
QUESTION: Can a plan sponsor completely eliminate specialty drugs and remain ACA compliant?

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The ACO Delusion

April 25th, 2016

delusion

“We have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. …….The biggest sin the ACO’s commit is to distract from any real conversation about cost…………  “

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Punishment Phase of ObamaCare Begins

April 25th, 2016

helpyouGet ready. Government men are spreading out over the fruited plains seeking to mete out punishment to employers who sponsor self-funded employee welfare plans……….

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Jeanne Pinder – Health Care Revolutionary

April 25th, 2016

pinder

In the first two days, we had visits from the Florida Legislature, the Florida Department of Insurance, the Florida Department of Health, Humana, UnitedHealthCare, Cigna, Aetna, the Blues, and a range of Florida hospitals.

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In the Market for Fetal Body Parts, a Baby’s Brain Sells for $3,340

April 23rd, 2016

baby11111

A researcher paid a middleman procurement company $3,340 for a fetal brain, $595 for a “baby skull matched to upper and lower limbs,” and $890 for “upper and lower limbs with hands and feet.”

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Can A Health Plan Exclude Specialty Drugs?

April 23rd, 2016

sixtyfourdollar

The $64,000 Question

Can a plan exclude specialty drugs? The answer is yes. Many PBM’s limit their specialty drug formularies. But, can a plan eliminate all specialty drugs and remain ACA compliant?

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David Belk Publishes New Conclusion Regarding Health Care Costs

April 22nd, 2016

belk

How did we get here and why is this so hard to fix?

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Short Term Medical Insurance – How To Beat The System

April 22nd, 2016

realy

John Smith Stunned By Cheap Medical Premiums

Nothing like screwing insurance companies….…………

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Meet The World’s 16 Insurance Billionaires

April 21st, 2016

check

Petr Kellner got his start in the early 90’s selling office supplies……………

This year’s billionaires with connections to the insurance industry include the son of a Chicago meat-packer, a former appliance door-to-door salesman, a World War II flight navigator and a passionate environmentalist.

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Arlington Healthcare Group

April 21st, 2016

arlington

Arlington Healthcare Group is an established healthcare industry consulting and professional services firm. We help healthcare providers, payers, and industry technology and service enterprises grow and optimize performance and value.

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SWBC – A Texas Based Success Story

April 19th, 2016

swbc

The insurance and financial services company opened its doors 40 years ago on April 1, 1976, by principals Charlie Amato and Gary Dudley with only $1,500 in capital……“When we started this company, we had no idea of the incredible journey it would take us,” said Charlie Amato, chairman and co-founder……..

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Do Healthcare Costs Shift to Work Comp?

April 19th, 2016

confusedYes. Higher reimbursement rates for treatment under workers’ comp encourage doctors to classify injuries as work-related.

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ACA’s Unintended Consequences: People Buy Short-Term Policies

April 19th, 2016

shortWant to save as much as 75% or more on your health insurance premium costs? Try a short term medical policy.

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Government Approves Corn Tortillas

April 19th, 2016

mexicanfood

Enchiladas, tostadas, tacos – getting hungry yet? Grab a cerveza and read on.
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Were Out Of Here!

April 19th, 2016

monkey

Sam Crafting, Health Care Editor – New York Times

“A business that operates at a loss should raise it’s prices” – Sam Crafting

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Cost Plus Insurance Evolves – What A Difference 5 Years Makes

April 17th, 2016

Branson

“Don’t bother doing something unless your radically different from the competition” – Richard Branson

By Bill Rusteberg

Reference Based Pricing, or Cost Plus Insurance has evolved over the past seven years from simply re-pricing claims based on established benchmarks such as Medicare pricing schedules, to a number of evolving hybrids. A Cash Pay Health Plan Option is one, quickly gaining market attention among health care revolutionaries.

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Enrollment In Provider-Owned Health Plans Is Rising

April 17th, 2016

Enrollment in provider-owned health plans is rising

“It’s clear hospitals view owning a health plan as a way to build their population health programs by combining medical claims and clinical data.”

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New Health Plan Lowers Cost For Students

April 16th, 2016

iowastate      The change benefits students and visiting scholars with reduced premiums, but the new model also offers advantages to Iowa State as a whole.

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Insurers Warn Losses From ObamaCare Are Unsustainable

April 15th, 2016

odds1

Actuary Panics – Pleads for Mercy

“There are enough people enrolled at this point that the market is sustainable. The premiums were just too low.”

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Rick Scott Signs Law Shielding Patients From Balance Billing

April 15th, 2016

RickThe movement to protect consumers from surprise medical bills won a major victory Thursday when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations.

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The Phenomenon of Reference Based Pricing – Are Cash Pay Plans Next?

April 14th, 2016

By Bill Rusteberg

Reference Based Pricing for health care has become the fastest growing trend in the American health care delivery system. Insurance agents, brokers and consultants upon which health care payers depend for market distribution, are joining the health care Reference Based Pricing revolution in droves. Selling health insurance is becoming fun again. Competing for business has reached new levels of intensity.

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The Science of Choosing Wisely — Overcoming the Therapeutic Illusion

April 14th, 2016

gambling

Gamblers consistently overestimate the control they have over outcomes, both in gambling and in everyday life. Their belief leads them to engage in seemingly bizarre or ritualistic behaviors such as throwing dice in a certain way or wearing specific colors…….. the illusion of control is widespread, and its effects may be enhanced when people are placed in positions of authority or subjected to time pressure or competition………….

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Overcoming Stigma Essential to Improving Payer Coverage for Obesity

April 13th, 2016

obese“Only 5% of patients with obesity who lose weight keep it off. Coverage for obesity drugs is improving, but remains uncommon. Only a tiny fraction of the candidates for bariatric surgery have the operation, in part because 70% of physicians won’t give referrals.”

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The Cost of Insurance Denials

April 12th, 2016

belk David Belk, M.D.

Hello everyone. Once again, it’s time for another case study on how our health care industry is robbing us blind.

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Region One Educational Services Center Seeks TPA

April 9th, 2016

regionn one

Region One Educational Services Center, hereinafter referred to as “ESC”, desires to solicit proposals for various firms to perform as a Third Party Administrator for the ESC’s Cafeteria Benefits Plan (IRC Section 125), Flexible Spending Accounts and Dependent Care Spending Accounts.

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Doctor Shortages? Cut Tax Rates

April 9th, 2016

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Traditional Providers Get Into the Urgent-Care Game

April 9th, 2016

urgent12

“Over the past two years, hospital chains and insurance companies have snapped up urgent-care centers in a spate of mergers and acquisitions.”

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Healthcare Initiative is Changing the Way Hospitals Do Business

April 9th, 2016

hospital bill

“Chronic diseases that require lifetime treatment and symptom management account for approximately 86 percent of all healthcare expenses…”

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Bid Rigging and Collusion in South Texas

April 6th, 2016

wolf2

“It’s a common practice but it’s wrong.” – Arnulfo Olivarez at his 1/24/2011 sentencing for bribery before Judge Hinojosa.

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Top Ten Lessons Of A Reference Based Pricer

April 6th, 2016

PHIA“As someone that has made a career trying to help healthcare providers and health plans get on the same page as it relates to cost-containment initiatives, I have compiled my personal top ten lessons about RBP from 2015.” – Jason C. Davis

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Insurers Cut Commissions

April 5th, 2016

beggar

Former Health Insurance Broker

“Some insurers, including Anthem and Humana, say they dropped commissions to keep rates down.”

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Fixing Systemic Conflicts of Interest In Broker Adviser Models

April 4th, 2016

conflictofinterestThe proposal attempts to address what DOL and the White House claim are systemic conflicts of interest in broker advisor models………….The proposed rule clearly favors fee-based compensation models for advisors…………….

Although the proposal targets pension and investment advisers per se, the same standards may be applied to fee based insurance consultants – Molly Mulebriar

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Texas TPA Purchases Entire City

April 1st, 2016

waringA large Texas TPA has announced the purchase of the city of Waring, Texas.  City officials say the sale was in response to an eroding tax base and high debt. Waring was settled by Bosnian Serbs in the mid 1800’s.

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Are Insurance Consultants Unbiased? Or Does Money Affect Behavior?

April 1st, 2016

untouchables

The Untouchables

“There have been numerous stories over the years, published widely, regarding “double dipping” by fee based insurance consultants. The scheme is lucrative, with little chance of punishment…..”

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FBI Says School District Consultant Helped Insurance Broker Get Contracts

March 31st, 2016

William O. Haff leaves the John Wood Federal Courthouse Thursday March 31, 2016. Haff pleaded guilty to conspiracy to commit wire fraud stemming from an F.B.I. public corruption investigation. Photo: John Davenport /San Antonio Express-News / ©San Antonio Express-News/John Davenport

William O. Haff leaves the John Wood Federal Courthouse Thursday March 31, 2016. Haff pleaded guilty to conspiracy to commit wire fraud stemming from an F.B.I. public corruption investigation.

William Oliver Haff, 46, of San Antonio admitted that while working for the consulting company hired by the school districts — Wortham Insurance and Risk Management — he was also getting paid on the side by an insurance agent/broker so its clients would land contracts to provide employee insurance there.

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Will The Anthem-Express Scripts Battle Change The PBM Landscape?

March 31st, 2016

battle

After months of public frustration, Anthem sued Express Scripts  Monday for more than $15 billion. Anthem argued the St. Louis-based PBM did not share enough drug savings with Anthem, which led to “an obscene profit windfall” for Express Scripts, according to a copy of the lawsuit (PDF).

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ACA – The Individual Mandate Does Not Exist

March 30th, 2016

what1

SOURCE: Benefitrevolution.com

“You can simply “believe” that Obamacare plans are too costly or experience any of another limitless form of hardship and get yourself out of the law.  So in reality, the 4 million Americans that are estimated to pay this fine should receive an “F” in creative writing and imagination. The individual mandate does not exist.  It is a mirage.”

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How Much are Doctors Paid by Drug Companies and Medical Device Makers?

March 30th, 2016

sunshineThe Open Payments Program creates a national database of payments made by pharmaceutical companies and medical device companies to doctors and academic medical centers.

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Health Savings Act of 2016: Will it change HSAs?

March 30th, 2016

nobrainer“During the past twelve years HSAs have experienced explosive annual growth rates of 25 to 30 percent and are expected to have assets over thirty billion dollars with over 19.7 million Americans currently having accounts.”

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Why Healthcare Costs Bleed Firms Dry

March 29th, 2016

costofhealthcare

 “It is impossible to prove something to someone whose salary depends on believing the opposite.” – Upton Sinclair

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One Hospital Tells You What You Must Pay – BEFORE The Surgery

March 28th, 2016

shocked

How refreshing to find a hospital that quotes package prices in advance and is willing to compete for patients based on price and quality. Why are they doing it? For the simplest reason of all: to attract patients.

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Free Market Medical Association – TPA Call To Action

March 25th, 2016

freemarket“Self-funded employers have been forced to rely on PPOs to give a percent off billed charges from these providers.  This has done nothing to curb the rising cost of care as most PPOs are taking a portion of ‘savings’ as an additional revenue stream.  It benefits them if the billed charge is excessive.  In additional to the PPO, many more layers between the patient and the provider further add to the cost. “

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David Returns To Rome – To Start Wellness Initiative

March 25th, 2016

statue

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Repeal-Obsessed Republicans Don’t Understand Obamacare Is Kind Of A Gift

March 25th, 2016

angrydoctor1“In Dallas, Texas Blue Cross, in its Exchange plan, is paying 10 percent less than what Medicaid pays. So these are low rates. They take all the doctors who accept that fee—and that typically doesn’t include the best doctors, by the way—and that’s how they get their premiums down. They’re convinced that healthy people buy on price.” – John Goodman

Editor’s Note: Nothing in the ACA mandates the reimbursement levels paid to medical care givers. In this case BCBSTX is paying less than Medicaid on their narrow network If BCBSTX can pay an arbitrary number which is less than Medicaid reimbursement rates, what prevents an employer doing the same thing? The employer could build a Base Plan with reimbursement rates half of Medicaid’s and thus limit risk while complying with the ACA. The employer could then offer a Buy Up Plan for those who want “real” insurance

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The Narrowing of the Network

March 23rd, 2016

sense

“Narrow networks are simply an aggregation of health caregivers willing to earn less. For example, if Dr. Jones wants $250 for a routine office visit while Dr. Smith wants $55, and if Hospital “A” wants 450% of Medicare while Hospital “B” will take 115% of Medicare, guess which providers are invited to join these narrow networks?“- Homer G. Farnsworth M.D.

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Telehealth is Working in Texas. Here’s Why

March 23rd, 2016

telephone123Texas providers and hospitals are taking full advantage of the benefits of technology, and it’s yielding results………….
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Irrational Hospital Pricing

March 22nd, 2016

stop“Hospital prices are almost completely irrational. They bear no relationship to the cost of providing the services, they are opaque, and the prices vary wildly among hospitals and payers.”

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The Redoubtable Chargemaster

March 22nd, 2016

hospitalchargemaster

“Charge-master rates, in reality, serve as nothing more than the starting point for negotiations with the payer”……………….”The ‘full charges’ reflected on hospital Charge Masters are unconscionable”…………………..

“Hospital discounts mean nothing” – Bill Rusteberg

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BCBS Brings Hospital Contract Negotiations Public

March 21st, 2016

dirtylaundry“We cannot in good conscience agree to terms that would increase the amounts our customers pay…….” – BCBSTX

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Former Hospital President Blows Whistle on Predatory Pricing

March 19th, 2016

toodamnhigh

“The price is too damn high!”

Florida attorney Steven I. Weissman agreed to become interim president of a Miami hospital when its founder, a friend and client of 35 years, died. He quickly got an insider’s view of the healthcare system and found it sickening. Risking long-standing relationships, he has gone public.

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Why Hospitals Bill High

March 16th, 2016

lustig Victor Lustig

The scheme behind turbocharged hospital bills is to provide false value and hidden revenue streams………….a Victor Lustig wet dream

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Insurance Company Has A Deal For Utah Employers

March 16th, 2016

aaaaaaaaaam“I gotta a deal for you!”

“The insurance company owned by Intermountain Healthcare is promising employers an annual 4% growth in healthcare costs……”

Is a 4% annual increase in health care costs a good deal? No says Homer G. Farnsworth, M.D. – “That’s outrageous! Under Reference Based Pricing, Direct Contracting, and the Asserta Health Cash Plan our clients are reducing health care costs, not increasing them!”

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Segal Consulting Stop Loss Statistics 2016

March 15th, 2016

segal1Interesting statistics from Segal Consulting. For example, 20% of clients purchase SSL of $500,000 or more.

Segal – Stop Loss Statistics 2016

Finally, a Solution to Poor Physician Penmanship

March 15th, 2016

prescriptio n1

From the founding of the Republic, Americans have joked about the poor handwriting of physicians.  Well, all the Americans except the ones who got the wrong medicine because pharmacists misread handwritten prescriptions.

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Healthcare and Guns; What Do They Have in Common?

March 15th, 2016

gun

Am  I being denied my right to bear arms if I can’t afford the price of a handgun?

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Life Partners – Historic Fraud?

March 15th, 2016

scam“The Life Partners fraud deserves a place in Texas history as one of the largest and longest-standing fraud schemes ever perpetrated in this State”

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Health Care Cash Pricing

March 12th, 2016

The largest health care system in Oklahoma publishes transparent cash pricing……

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Big Government To Enter ACA Punishment Phase

March 12th, 2016

prisoners111

Government to be quicker to punish free enterprise this year, government officials say……eager bureaucrats gearing up for punishment phase…………..prison farms to be expanded to accept newly minted criminals……..Citizens flee to sanctuary cities…………Canada closes border, says USA must pay for fence………

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ECISD & DHR Establish On-site Health Care Clinic

March 11th, 2016

ecisddhr

Edinburg Consolidated Independent School District (ECISD) and Doctors Hospital at Renaissance Health System (DHR) are proud to announce the creation of the Edinburg CISD School Based Health Center, a facility dedicated to the healthcare needs of our students, families, and employees.

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Dependent Eligibility Audits Increasingly Important

March 11th, 2016

fraudInsurance fraud is rampant in health care. For example, we have found numerous instances where nephews, nieces, grandchildren, live-in girl friends and others are added to health insurance policies that are never audited.  Dependent eligibility audits should be performed by plan sponsors.

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How To Build A Sustainable Onsite Clinic

March 11th, 2016

On-Site_Clinics

Onsite health clinics are rapidly becoming the hottest trend in population health.

Fairfield County School District in Ohio became the first suburban school system in the country to offer health, dental, vision and mental health services in a single location.

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Weslaco ISD To Consider Settlement With Aetna?

March 8th, 2016

mulebriarThe Weslaco ISD vs Aetna & Robert J Garza lawsuit is a fascinating read. The original pleadings are worth reading for those students interested in peeling back the onion of the opaque world of health care costs.

It appears this six year case is winding down through arbitration ………

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Ending Discrimination in Health Care

March 6th, 2016

mulebriarEveryone understands there are inequities within our health care delivery system. Will stringent government control be expanded to confront health care discrimination?

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TrumpCare

March 3rd, 2016

trumpcare

Donald Trump released a seven-point health care policy paper this week, boasting that his plank would reduce health care costs and dubbing his plan “healthcare reform to make America great again.”

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Fiduciary Rule Will Force Brokers Out

March 2nd, 2016

beggar

Unemployed Broker

“I’m afraid by imposing that DOL ERISA fiduciary duty [on brokers] that you will have people exit that business,” Champ said. “Brokers will say that ‘I can’t deal with this.’” The rule will “drive advice out of that space,” he said.

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Supreme Court Finds ERISA Preempts State Claims Reporting

March 1st, 2016

bam The Employee Retirement Income Security Act’s reporting requirements trump those of individual states, including a Vermont requirement that self-insured employee health plans must report claims data, the U.S. Supreme Court ruled Tuesday in a victory for Liberty Mutual Insurance Co.

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Pay Less With Cash or More With Insurance?

March 1st, 2016

insurancecimopabuesCutting Out The Middle Man

Cash pay health plans are catching of fast. Hospitals are taking note…….

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Are All Texas Insurance Consultants Properly Licensed?

February 28th, 2016
snooZe
How many Texas insurance consultants have acted beyond the scope of their insurance license/s ?

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Paying Cash Cuts Medical Bills

February 26th, 2016
paycashmedical1An increasing number of hospitals, imaging centers, surgery centers, and pharmacies are offering deep discounts to cash paying patients.

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