Insurance Companies Blame Actuarys

July 5th, 2015

odds1

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

Upon hearing the news, hordes of actuarys flock to liquor stores throughout the fruited plane seeking solace……………..“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.”    

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Anonymous Responds To BISD vs HealthSmart Settlement Terms

July 5th, 2015

gorilla1The perception that BISD was screwed by HealthSmart over so called provider “pricing discounts” demonstrates common ignorance. This is understandable since the general public has no understanding whatsoever how our health care delivery system is structured.

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Aetna To Buy Humana

July 3rd, 2015

price

Aetna buys Humana for $37B amid record number of health care deals

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High-Deductible Plans – Hospital Bad Debt & 75% Lower Utilization

July 1st, 2015

chasingdollarsHigh deductible plans are creating new headaches for hospitals, including more unpaid bills and seasonal demand for some healthcare services as patients wait to hit their deductibles before seeking non-urgent care.

The bulk of the savings through high deductible plans, up to 75%, come from lower utilization. It’s not the value of the increased deductible per se, it’s the change in behavior. When it’s other people’s money it doesn’t matter, but when it’s your money it’s a completely different dynamic.

Instead of jacking up prices, hospitals should work with local health plans to achieve equitable solutions – lower reimbursement rates for lower deductibles and co-insurance. Is 250% of Medicare and chasing dollars better than 100% of Medicare and not chasing dollars?

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4 Reasons Why Self-Funded Employers Should Choose A TPA Over An ASO

June 30th, 2015

dendy

Mike Dendy, President of AMPS (Advanced Medical Pricing Solutions)

By Mike Dendy

I have been in the healthcare business as a benefits consultant for 25 years.  10 of those years were spent as a TPA owner/manager with the last 10 as CEO of a cost management company reviewing the work of ASOs, TPAs, and PPOs.  I can say without reservation that employers with self funded (ERISA) healthcare plans should choose a quality TPA over an ASO carrier for the following four reasons.

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Beating Medical Trend – Managed Care vs Reference Based Pricing

June 29th, 2015

arrow

“Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market” – Bill Rusteberg

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The Chart That Could Undo The Healthcare System

June 28th, 2015

[The chart] outlines the growth of administrators in healthcare compared to physicians over the last forty years.  A picture is worth a thousand words, isn’t it?

You see, when you have that much administration, what you really have is a bunch of meetings. Lots of folks carrying their coffee from place to place. They are meeting about more policies, more protocols to satisfy government-created nonsense. But, this type of thing in healthcare isn’t fixing things. It’s not moving the needle.

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Brownsville ISD vs HealthSmart Settlement Terms Revealed

June 27th, 2015

mulebriar

HealthSmart to pay BISD $2 million in three payments………….

Local Brownsville blog reports on terms of Brownsville ISD vs HealthSmart settlement. The controversy concerned the promise of deep PPO discounts and the perceived notion on the behalf of BISD they were screwed. This is a classic example of suing a Ham Sandwich and winning through extortion. (type in Brownsville ISD in the search box on this blog for previous postings) – Molly Muebriar

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ScotusCare

June 25th, 2015

scotus

Scalia wrote that the justices who authored the majority displayed “no semblance of shame” in their opinion. His dissent is littered with jabs at his fellow justices. “Today’s interpretation is not merely unnatural; it is unheard of,” Scalia writes. He describes another aspect of the majority’s analysis to be “pure applesauce.”

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More Proof Managed Care Doesn’t Work – The Continued Failure of PPO’s

June 24th, 2015

cog

Milliman’s report is the latest indication that health-care costs, which saw a historic slowdown in their rate of inflation in the years after the Great Recession of 2008, are headed back up toward the trends seen before the financial meltdown

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The Answers is No – Your Management Sucks

June 23rd, 2015

suck

Why Cigna Rejected $47 Billion Bid by Anthem

June 22, 2015

Cigna Corp. rejected Anthem Inc.’s $47 billion takeover bid, saying it was inadequate, not in the best interests of shareholders and that Anthem’s management wasn’t fit to lead a merged insurance giant.

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Summer Session 2015

June 22nd, 2015

Designed for Public Purchasing Professionals with special emphasis on the latestdevelopments that are essential in general purchasing.  https://napmrgvpma.org/summer-session-2015/

List of Speakers    

Medicare Part G

June 22nd, 2015

plang

Say you are an older senior citizen and can no longer take care of yourself and the government says there is no Nursing Home care available for you. So, what do you do? You opt for Medicare Part G. 

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Drug Compounding Scam – Express Scripts Reacts

June 22nd, 2015

express  In one example recently highlighted by CBS Evening News, a compound pharmacy was able to successfully bill one of our competitors $44,707 for a one-month supply of compounded resveratrol, an antioxidant found in red grapes that can be purchased over the counter for $157.

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WellDyneRx Helps Polk County Save $1.9 Million On Rx Spend

June 21st, 2015

weldyneThe key to managing pharmacy benefits is having a good pharmacy benefit manager to ensure savings while maintaining the quality of the program.

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Democrats: “Underinsurance” To Be Campaign Issue for 2016

June 19th, 2015

moneytree

“We’ve got some 17 million more people covered … but they can’t access the care they seem to be entitled to,” McDermott said. “It costs too much to use the care. That’s the deceptive part about it.”

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San Benito ISD To Close On-Site Clinic – “Clinic Drives Higher Costs”

June 18th, 2015

really

The San Benito Independent School District board of trustees has decided to close their on-site medical clinic this year.

“The clinic is driving costs because of the way the referral system has worked” said the SBISD superintendent.

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Justice Department Strikes

June 18th, 2015
omg
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice”

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The Truth About Voluntary Benefits

June 18th, 2015

carsalesman

Marsh Consulting Group

Here’s a little-known secret: Voluntary benefits often provide the broker with a first-year commission exceeding 60%, compared to a 3-7% commission for health plans………….These products, which typically pay out less than 50% of the premiums toward actual claims, may in the end hurt employers’ creditability once their employees realize that voluntary benefits aren’t much of a benefit after all.”

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United Health Care To Purchase Aetna?

June 18th, 2015
seriously
“UnitedHealth Group Inc. has approached Aetna Inc. about a takeover deal that would likely be valued at more than $40 billion, … the latest move in a frenzy of merger talks in the health-insurance industry

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The Clock

June 15th, 2015

clockClick here

South Texas Health System Defends 920% Price Markup

June 15th, 2015

Rick Scott

What business do you know that marks up their prices by 920% and still stays in business?

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Selling ObamaCare – Gruberize The Process

June 14th, 2015

barak

“Michelle and I don’t want anyone telling us who our family’s doctor should be – and no one should decide that for you either. Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story”. – Barack Obama

 

Corpus Christi ISD Hires New Health Insurance Consultant

June 12th, 2015

price

Corpus Christi Independent School District has awarded Gallagher a multi-year $200,000 per year contract for health insurance consulting services.  The previous consulting firm, Wortham, charged $85,000.

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TRS ActiveCare 2015-2016 Benefits & Rates Published

June 12th, 2015

http://www.trs.state.tx.us/active.jsp?page_id=/global/welcome_active

These 10 Hospitals Could Pick Your Pocket Clean

June 12th, 2015
pickpocket
What other business can inflate their costs by 100% and still stay in business?

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Food And The Cost of Health Care

June 12th, 2015

toyland

By Molly Mulebriar

We are all aware that health care costs continue to rise. We have fooled ourselves about why that is so. But what does this article have to do about food?

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Tenet To Buy Brownsville Doctors Hospital?

June 10th, 2015

bdhospital

Brownsville Doctor’s Hospital filed for bankruptcy on Dec. 11, 2013, and according to that filing, it had $8,093,632.54 in liabilities and $5,059,441.93 in assets.

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Tokio Marine To Buy HCC

June 10th, 2015

tokio

Tokio Marine Holdings of Japan said Wednesday that it has agreed to buy U.S. specialty insurer HCC Insurance Holdings Inc (HHC) for $7.5 billion, making the acquisition the largest by a Japanese company so far this year and the largest ever by a Japanese insurer.

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Will ObamaCare Cover Head Transplants?

June 10th, 2015

Animal testing: In 1970 Dr Robert White transplanted the head of one monkey onto the body of another, as shown in this diagram. If Spiridonov's head were to be successfully transplanted his jugular vein and spinal cords would have to be similarly fused with those of his new donor body

Will ObamaCare cover head transplants? If not, will Obama change his mind? Republicans hope so and have volunteered Ted Cruz as donor.

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Some Hospitals Charge 1000% Of Medicare Rates? That’s Outrageous!

June 9th, 2015

kidding

Some hospitals charge more than 10 times the Medicare rate, according to a new study published in Health Affairs on Monday.

“…..the mystery of the chargemaster continues. “What other industry can you think of that marks up the price of their product by 1,000% and remains in business?” said co-author Gerard Anderson.

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Small Company May Revolutionize U.S. Health Care Industry

June 8th, 2015

icucare

Company with 12 employees and $3.5 million in revenue has bid on contract that would earn more than $1 billion –  Poised to become the financial backbone of the U.S. health care system?
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Dave Belk, M.D.

June 8th, 2015
Here's my latest blog for HuffPost:
http://www.huffingtonpost.com/david-belk/the-skyrocketing-cost-of-_b_7492476.html

It addresses the skyrocketing prices of brand name prescription drugs.
Nearly every brand name medication has gone up in price over the last
couple of years; most have gone up more than 10 times the rate of
inflation.

Dave Belk MD

Preventing Low Volume Hospitals From Performing Certain Surgeries

June 8th, 2015

practice“If you’re only performing a hip replacement surgery three times a year, chances are you won’t do it as well as a surgeon who performs 200 a year. Practice makes perfect.”

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June 7th, 2015

RISKMANAGER

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

 2014 RiskManagers.us All Rights Reserved

 Email: RiskManager@RiskManagers.us

DOL Audit Letter – Are You Prepared?

June 7th, 2015

ronreagan

Are you ready for your DOL audit? Maybe you should be since plan audits are on the rise – there are 17,000 new IRS agents out of training now, hungry to prove their worth. With quotas to reach and maintain, to advance up the lucrative federal government job corp ladder demands tangible results.

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Direct Provider Contracting Pays Off

June 4th, 2015

brooks

“The opportunity is that an employer group who is self-insured has the ability to create a flexible plan best suited for its employees,” Bud Brooks, President at Brooks Healthcare Solutions, says. 

Brooks says that it all boils down to avoiding the use of big, broad-based PPOs.

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Blue Shield Loses Tax Exempt Status – Others To Follow?

June 4th, 2015

bcbs“They act like a regular insurance company: big profits, generous salaries, and high rates.” That’s the conclusion Johnson came to as the state was auditing Blue Shield’s 76-year-old tax exemption.”

‘We’ve served our purpose and it’s time to disband and the assets can go back to the public.’”

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Dr. Bilhartz Rebuts Dr. Gawande

June 4th, 2015

titanic

“Alternative payment models are just another illusion for affordable care that has a different name. ACOs are merely one more bureaucratic experiment that shuffles chairs around on the deck of the Titanic, while the boat remains in fast pursuit of the iceberg.”

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ETMC Files $1 Million Suit – Wants To Be Included In PPO

June 3rd, 2015

 

etmc

The hospital says exclusion from the preferred provider networks (PPO) of these companies has created “serious and negative consumer impact.”

Note: Another good reason to leave the managed care world and pay medical caregivers a transparent, fair and reasonable reimbursement based off pre-determined benchmarkes.

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Data Shows Large Increases In Hospital Charge Master Rates

June 2nd, 2015

lustig Victor Lustig

http://www.nytimes.com/2015/06/02/business/medicare-payments-billing-hospitals-doctors.html?ref=business&_r=1

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Physician’s Group To Decide Telemedicine Policy As Insurers Expand Telehealth Coverage.

June 1st, 2015

 

telemedicine12

Forbes  (5/31) contributor Bruce Japsen wrote that the American Medical Association is set to debate and vote on telemedicine recommendations by the AMA’s Council on Ethical and Judicial Affairs “as the nation’s largest health insurers widen coverage of telehealth to unprecedented numbers of their health plan subscribers.”

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Insurance Agent Touts Cost Plus Insurance – Is School District Receiving Fair Value?

May 31st, 2015

domino

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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RiskManagers.us Website Visit Statistics

May 30th, 2015

visitor

Awstats provides statistics on traffic activity for this blog. Number of visitors per month from June 2014 to May 2015 has averaged 93,106  http://www.awstats.org/

 

David Belk, M.D., Announces New Website

May 30th, 2015

belk David Belk, M.D.

Here’s the new website with a whole new look that’s been redesigned by Modern Creations: http://truecostofhealthcare.org

There are three new sections. The first is a study of the prices of brand name medications. It shows that the price pharmacies in the US pay for brand name drugs has gone up an average of 40% in 2 1/2 years.

That’s about 18 times the rate of inflation

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XYZ Insurance Company Discloses Separate Financial Arrangements With Providers

May 28th, 2015

monkey

Provider Affairs Editor for Monkey Business Magazine

XYZ’s compensation for the services under its administrative services agreement(s) with certain group customers can include the difference, if any, between the net claim payments reimbursed to XYZ by the group customer and the net amounts paid to health care providers by XYZ, after giving effect to XYZ’s separate financial arrangements with health care providers.

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Antitrust Lawsuits Target Blue Cross and Blue Shield

May 28th, 2015

bcbs

(click on map to enlarge)

Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently owned companies are functioning as an illegal cartel.

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Greenberg at 90 – Still Fighting and Angry After All These Years

May 28th, 2015

greenberg1

Maurice “Hank” Greenberg spent some of his 90th birthday party like he’s spent much of the past decade: angry. When asked if he’s mellowed with age, he set his jaw, locked his eyes straight ahead and said the interview should end.

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How One Supermarket Chain Is Tackling Health-Care Costs

May 28th, 2015

 

By Maxwell Murphy – Wall Street Journal

In late 2012, Don Ulrich moved from the boardroom to the chief operating officer post and set about scrubbing its healthcare costs……The 8,600-employee chain operates in the $25 million to $30 million range for annual health-care costs………..

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Canoes, Skiffs, Submarines, Battleships and Chinese Junks

May 27th, 2015

mulebriarBy Molly Mulebriar

Our staff is reviewing an active RFP for a self-funded employee health and welfare plan. A brief review unleashes wonderment.

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Meet The Reality TV Star With A $15 Million Annuity Business

May 27th, 2015

Image result for Vicki Gunvalson Vicki Gunvalson

The insurance industry is littered with the bodies of agents who didn’t make it. The failure rate is massive, with upwards of 80 percent of agents making a career change within the first five years of entering the business. The struggles were no different for Gunvalson.

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Which Controls Spending – Private Insurance or Medicare/Medicaid?

May 27th, 2015

life

From 2007 to 2013, private insurance costs increased 29%, more than twice Medicare’s growth and five times higher than Medicaid.

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Embedded Out-of-Pocket Limits – Let’s Make ACA More Confusing

May 26th, 2015

confused-face2

Federal regulators have indicated that beginning in 2016 group health plans may be subject to a controversial interpretation regarding out-of-pocket limits…………

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Weslaco Independent School District Gets A+ For Health Care Management

May 25th, 2015

mulebriar

The Weslaco Independent School District gets a rare Mulebriar rating of A+ for proactive management of their self-funded health & welfare plan.

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What A Hospital CEO Learned From Nordstrom

May 25th, 2015

nordstrom

….it will take a new skill set and a new mindset to survive in our new retail-driven market.……”

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Memorial Day 2015

May 20th, 2015

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

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Notre Dame Birth-Control Protest Denied Again

May 20th, 2015

birthcontrol

Reacting to a Supreme Court order to reconsider, a federal appeals court refused on Tuesday for a second time to stop enforcement of the federal government’s birth-control mandate against the University of Notre Dame.

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Is Medicaid the Answer to Crushing Health Care Costs for Inmates?

May 20th, 2015

Medicaid will not cover the health care costs of inmates while they’re in jail or prison, with state and local governments often footing the bill. But there is an exception that could save millions of local dollars: If an eligible inmate requires a stay in a hospital outside the corrections system that lasts more than 24 hours, his or her suspended Medicaid coverage can kick in to reimburse the costs. 

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Milliman Report – More Evidence PPO’s Failure To Control Costs

May 19th, 2015

insanity“The total cost of typical employer-sponsored preferred provider organization (PPO) coverage for a family of four has increased 6.3 percent this year, to $24,671.”

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San Benito ISD Seeks TPA, PBM, Stop Loss Insurance Proposals

May 19th, 2015

sanbenitoisd

Specifications for the Employee Health Benefits-Health Products proposal and corresponding information:   http://purchasing.sbcisd.net/category/bids/  If you need additional information you may contact:

Mr. Adrian Garcia, Purchasing Agent

This Article Proves PPO’s Have Failed To Control Costs

May 19th, 2015

GRANDMOTHER

This article proves that managed care has failed. PPO’s drive costs up, not down. Within all PPO contracts there is, among other things, an annual escalator clause that guarantees annual increases in provider reimbursement. The annual compounding effect is enough to make grandma want to go back to the good old days when a dozen eggs would buy a doctor visit in the comfort of your own home, or a bottle of tequila and a jar of honey for that nasty cold Johnny brought home from school.

The table shown in the article leaves out Cost Plus Health Insurance Plans, or Reference Based Pricing models. These plans beat medical trend.

“Medical costs are directly related to what you agree to pay” – William Rusteberg

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Florida Hospitals Tell Scott To Support Medicaid Expansion, Scrap Profit-Sharing Plan

May 19th, 2015

Rick Scott

Florida hospitals to Scott:  “You have suggested that a new tax on hospital operating surpluses might be a way to sustain the existing LIP program. Such an arrangement is not a solution to the challenge we face.”

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Want Free Health Insurance? Must Be Employed To Qualify

May 18th, 2015

free1

The Arizona Legislature has passed a law seeking to force anyone getting Medicaid to have a job…

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Fringe Benefit Group Purchases EPSI

May 18th, 2015

fringe

May 4, 2015 – Austin, Texas – Fringe Benefit Group, an industry leader in the design, implementation and administration of benefits for hourly and part-time workers, today announced it has acquired Houston-based Employer Plan Services, Inc. (EPSI), a Third Party Administrator (TPA). Terms of the transaction were not disclosed.

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Value Based Care Will Drive Aetna’s Future Goals

May 18th, 2015

AetnaBertolini told analysts Aetna is now in contracts with 62 ACOs. “We have almost a million members in patients that are medical homes, which is 38% growth since the beginning of ’14 and over 760,000 members in what we call our high performance networks,” the Aetna CEO said.

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When Did Primary Care Physicians Stop Becoming Doctors?

May 18th, 2015

candid

Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.

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Weslaco ISD vs Aetna

May 17th, 2015

tellme

The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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More Government Diktats (Obey or Go To Jail)

May 16th, 2015

bath

This week the government released new diktats requiring, among other things, that preventative care benefits extends to transgender individuals………………

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Drug Costs Exceed $100,000 A Year For More Hyphenated-Americans

May 16th, 2015

drugdealer

“Really? Our drugs are cheaper!”

Research estimates that the number of Hyphenated (pick Mexican, African, Anglo, Latino, German, Irish, etc.) Americans with six-figure drug bills jumped from 49,000 to 139,000 from 2013 to 2014.

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Molina Profits Surges – Fueled By Medicaid

May 16th, 2015

molinaMolina Healthcare recorded booming revenue and net income figures in the first quarter, a direct result of the Affordable Care Act’s expansion of Medicaid and private health coverage.

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Dog Bite Is worth $32,000

May 15th, 2015

dog111

Dogs are man’s best friends, especially lawyers………….

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4 Of The Wealthiest Families Who Lost It All

May 15th, 2015
From these tales of loss, we can learn a lot and not repeat their mistakes.

May 15, 2015 | By Lynette Gil

From these tales of loss, we can learn a lot and not repeat their mistakes.

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Code SixFour

May 15th, 2015

codesix

A strategic ‘think-tank and back-office’ for brokers and benefits advisors

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The Texas Approach to Emergency Treatment

May 15th, 2015

erroom

Free standing emergency rooms which by law cannot accept Medicare or Medicaid, are located in wealthy suburbs. It’s better than driving into the city and waiting for hours to see a doctor…….

“A typical bill at a free-standing emergency center is about $1,400, compared with about $200 at urgent-care centers.”

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Health Care Revolutionaries – First of A Series

May 14th, 2015

pinder

Health care revolutionaries are unusual people. Information nomads never rest, never quit, until their quench is satisfied. Sharing truths enlightens all.

Jeanne Pinder is a Health Care Revolutionary. She is one of the ten most disruptive health care anarchists in this country.

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