Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.
Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.
Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.
People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.
Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….
Why Didn’t I Think of This!
The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.
Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...
“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”
The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.
The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.
The drug industry argues the 340b program has surpassed its original purpose of providing care to poor patients and now acts as a profit generator for hospitals.
One recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare……………………..
Universal health care, Medicare for All, will establish cost efficiency that eliminates major medical bills and medical related bankruptcies
Former Health Insurance Broker
Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.
Lucent is ensuring that the Plan Sponsors they serve will be provided the best fiduciary protection and objective, final appeals handling in the industry.
Ed Day, President, HST and Cindy Hom, VP of Business Development, MedWatch pride themselves in being ahead of the curve in Reference Based Pricing strategies. The HST approach makes sense. This is a must see 29 minute video:
Introducing Meritain Connect:
Now it’s even easier to stay on top of your health plan management
Meritain Health is proud to announce our new, enhanced website for members, employers, organizations and producers—Meritain Connect. It’s an all-in-one online tool for managing your employee benefits account. And this newly upgraded website will be yours to access beginning Monday, October 17, 2016.
Have you ever met a bully in your business dealings? If you say “No” you are probably lying, or too stupid to spot one. A recent experience leads us to post this excellent video on how to deal with a bully
Adam Russo, Phia Group
This past quarter has been one of the most exciting in our history, and we have all of you to thank for helping make that happen…………
In order to rebalance our existing and future book of business, we are increasing our HMO new and renewal commission rates, and reducing the commission rates for all new and renewing PPO health plans………..
10 percent annual gain in employer health care costs has held wage gains to 2 percent or so in most recent years…….Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy……
UHC customers paying $50 co-pay for a drug that cost less than $15?
“When receiving a group medical insurance proposal from the Blues, they can claim to have better discounts than the rest of the competing offers (be it a self-funded or fully insured plan) and their pricing to get the business will surely reflect substantial discounts. But now what? Will you as the client ever actually receive the full value of their hospital contracts or physician discounts? Most likely not.”
Court paperwork, however, said the corruption spread further, enabling the Mullen group to land contracts for their clients at South San ISD and Bexar Met. The FBI is also investigating the trio’s activity at school districts in the Rio Grande Valley, the documents show.
This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.
Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..
The Phia Group is pleased to support Dave Chase’s “The Big Heist” project. Dave Chase is a long-time healthcare industry consultant, entrepreneur, author, and provocateur. Mr. Chase is also the executive producer of the upcoming film, “The Big Heist.”
For years Plan Sponsors have dreamed how to transfer health care risk to the federal government. If Medicare eligible plan participants could be removed from a group’s health care plan legally, these higher risk members would no longer be a risk factor to contend with. How can one game the system? Read the rest of this entry »
Tenet Healthcare Corp. and two of its hospitals will pay $513 million and enter guilty pleas to resolve investigations into payments of kickbacks for referrals of pregnant immigrants, the U.S. Department of Justice said Monday.
William O. Haff
San Antonio insurance consultant’s sentencing delayed again to 30 November, 2016. Smart money bets more indictments to come, following this week’s indictment of Samuel Mullen……
Drugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket.
“I offer three perspectives as to why Texas should not expand Medicaid” – Alan M. Preston, MHA, Sc.D.
A Medical Bill Review audit of a large, 4,500 life employer group performed in 2016 exposes the truth about PPO “discounts.”
By Mark Flores
Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”.
The following article illustrates the angst hospitals are undergoing in defending their indefensible and egregious pricing strategies through their PPO collaborators. The solution posed in this article by a hospital advocate is: Identify Reference Based Pricing (RBP) patients and don’t treat them! But that short sighted response brings on Cash Pricing strategies through companies like Asserta Health (www.assertahealth.com) which often times saves plan sponsors even more money than otherwise would have been paid hospitals under a typical RBP plan. Making lemonade out of lemons……………
Most TPAs do not pass on the strong discounts for prescription drugs or do not have access to it. A quality TPA should be offering all prescription drugs at AAC + admin fee.
“You can claim — and many do — that better access provides worthwhile value, but that’s akin to putting lipstick on a pig.” – Brian Klepper
If Medicaid allowed overseas treatment for Hep. C (Harvoni) the savings by utilizing a five star hospital system 495 miles south of Florida would save taxpayers 753 X ($95,000 – $19,000) = +$57 million...
For Information on Health City, contact Sarah Rusk, Health City Cayman Islands
t 345-640-4257 m 345-525-2131 w healthcity.ky
Primary care physicians presented the best return on investment for hospitals
FOR IMMEDIATE RELEASE – September 2016
Apex Management Group (Oak Brook, Illinois) has announced a 4 Year Rate Lock on their APEX Suite of MEC Offerings.
It is the Obama administration, and not the insurers, who perpetrated this heist….
“After I got off the phone with him, I realized: That’s actually just insurance for my insurance,” she said, laughing.
See our detailed directory listing of TPAs, which includes their 2015 revenue, claims business by type and by volume, types of client managed and other contact information.
“We guarantee no “balance bills” to our covered members for the amount taken as a discount from your provider’s retail bill.”
“16% more likely to die if they are admitted on a Sunday compared with a Wednesday” SOLUTION: Eliminate all health care services on Sunday…………..
Imagine being in control of your individual employee healthcare costs. Our low cost network puts you in control of your daily healthcare spend. You decide whether the employee is better off using existing insurance options or pre-paying for the specific procedure. Our pre-paid pricing is based on discounts of up to 70% and can save companies millions of dollars a year.
Texas Super TPA with growing market share is a TPA worth watching…….
Just like sticker prices on new cars, no one ever pays hospital chargemaster rates. So why have them? A previous blog posting (Hospitals Dismiss Significance Of Chargemaster Prices?) offers a possible reason, while the following article does too.
A pack of just two EpiPens costs more than $600 in the United States. To fully comprehend the outrage of this price, you must realize that the epinephrine included in the EpiPen costs less than $10 retail. And in Mexico it’s 25 cents (EpiPen alternative costs pennies in Mexico)
Employers, adept at tracking business expenses, are surprisingly lax when it comes to double-checking healthcare costs.
“We learn from history that we do not learn from history” – George Hegel
“Understanding the cost of health care is directly related to what we agree to pay, more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time.”
McALLEN — A life-saving medication that costs more than $600 in the United States is only a few cents in Mexico.
California medical consumers will enjoy strong new protection against surprise out-of-network medical bills..………..
Health insurers are limiting the physician and hospital options they offer through their plans. TRANSLATION: Insurers are limiting provider choice by eliminating providers who want more money than those willing to work for less.
“The bill would relieve patients from having to pay surprise medical bills out of pocket by requiring insurers to reimburse out-of-network doctors and other health providers a “fair amount” and doctors to accept the payments, said its author, Assemblyman Rob Bonta (D-Oakland).”
“That rate would be 125 percent of the amount Medicare pays for the same service or the insurer’s average contracted rate for the service, whichever is greater.”
Editor’s Note: If California passes this bill into law (very likely), Reference Based Pricing in California will take off in the private sector. No network plans, similar to what we have implemented in Texas since 2007, will have solved the problem of balance billing risk. And if Texas passes a similar law TPA’s like Caprock Health Plans and Continental Benefits, both of which administer Reference Based Pricing plans will achieve new business sales that will make Ben Feldman look like an amateur.
The following article is based on the premise that health insurance is health insurance. In truth, “health insurance” is not insurance at all but has simply become a government mandated welfare assistance program administered by insurance companies and TPA’s.
With ObamaCare in full swing, with little likely hood of meaningful repeal, insurers are targeting population management and statistical metrics to bolster a competitive edge and revenue…..
Hospitals have charge master pricing. Pharmaceutical manufacturers have AWP pricing. Consumers pay neither. These are simply made up numbers from which sellers “discount” their wares/services.
That first number thrown out there serves as an anchor — a first reference point. Every other price becomes an adjustment of that price. Take a hospital’s charge master rates for example………..
Some consumers who pay far more than the cash price of a medication when using health insurance.
“There’s more price transparency and quality transparency regarding a refrigerator than there is about your heart surgery.”
Please Mr. Plan Sponsor, pay me direct. I really am worth it! I used to get $35,000 per year on your 75 employee life group plus an undisclosed bonus. I’m sorry I only showed up on renewal, and I promise I will change that. Please, Please, Pretty Please…………………
As long as health plans, with deep pockets, continue to roll over and play dead, health care costs will escalate to a point the entire health care finance system will implode.
Edinburg, TX–– Leaders at Doctors Hospital at Renaissance Health System (DHR) and Mission Regional Medical Center (MRMC) have signed a non-binding letter of intent (LOI) to explore collaborative opportunities between the organizations.
Today, most drug companies offer large rebates to pharmacy benefit managers on behalf of different health plans and employers to reduce patients’ out-of-pocket costs. The problem is a significant portion of the savings is not being passed onto the public.
The audience was aghast to learn that a specialty drug for Hep.C. earned PBM’s a 45% commission for one course of treatment………..