Archive for July 11th, 2009

Testimony Provides Clues to Provider Contracts

Saturday, July 11th, 2009

“We seek to pay providers at market appropriate levels………….” And just what are market appropriate levels?


Highmark Requests Changes in Provider Reimbursements

Saturday, July 11th, 2009


PCP Visit – Cash Only

Saturday, July 11th, 2009

This picture was taken this morning on the way to Starbucks in Brownsville. The location is on the frontage road of Highway 77. According to the sign in the window, total charge for an office visit is $35 – cash or credit card only. No appointment necessary.

So the question is, if I have an insurance policy with a $20 office visit co-pay, do I go to this clinic and pay $35 or go to a PPO doctor down the street and only pay $20?  What is interesting is that the PPO network fee is probably a multiplier of 2008 RBRVS (Medicare), say 100% of Medicare for example. In that case, the PPO doctor down the street gets paid $80-$145 for the office visit, which the employer’s health plan pays for. This makes no economic sense at all – pay $35 cash or as much as $145 or 400% more  with insurance – for an office visit?

Plantiffs Claim Hidden Fees in Car Purchases

Saturday, July 11th, 2009

This is an excerpt that appeared in today’s issue of the Brownsville Herald:

A lawsuit has been filed against Cardenas Motors Inc., a Rio Grande Valley auto dealer, seeking to collect damages because of “misleading or deceptive acts or practices,” court documents say.

The lawsuit was filed Wednesday by The Zavaletta Law Firm, which is representing eight individuals who bought nine used automobiles from the Cardenas location in Brownsville and claim they where charged an unknown fee for services they didn’t receive.

The case was filed in Brownsville’s Cameron County Court-at-Law No. 3, with Judge Menton Murray Jr. presiding.

The fee in question is listed in the motor vehicles buyer’s order as “VIN REG” and it ranges from $392.18 to $798.18, said attorney Peter Zavaletta.

Editor’s Note: This is exactly what is happening in the group health insurance business, in our opinion. Hidden fees, or fees disclosed that offer nothing in return. Consumers should be incensed.