Archive for June 7th, 2010

Walgreens Pulling Out of Caremark

Monday, June 7th, 2010

Hopeful Signs for Continuation of Mini-Med Plans to 2014?

Monday, June 7th, 2010

The following is an excerpt of an article written by Fred Hunt of SPBA:

Let me end with some hopeful news.  The scariest issue for all types of employee benefit plans and insurers and employer plan sponsors is no annual and no lifetime limits.  Immediately, the reg-writers asked SPBA for insights from which to start their decisions on how this legislative language emerge as something livable.  There is nothing final yet, but here is some food for thought to avoid rushing into action prematurely.

The law says that plans may have restricted annual limits until 2014, and that the regulatory agencies will define what “restricted annual limits” means.  SPBA immediately told the reg-writers that low annual limits should be allowed at least until 2014 or there will be a spike in the number of uninsured and without low annual limit plan, many workers will be left with no affordable options. Because the reg-writers in charge have many years of brainstorming with SPBA members and staff about the “real word” of employment and benefits, we are guardedly optimistic that they will recognize the logic & wisdom and not totally eliminate low annual limits right away.   Then, afterwards, common sense reality has a way of showing itself everyone can take a step back from the brink.

Monday, June 7th, 2010

Texas Supreme Court Denies Review of Stop-Loss Case

MyHealthGuide Source:, 6/2/2010, StreetInsider Article
AUSTIN, TX — The Texas Supreme Court has declined to review a case involving the amount some hospitals marked up workers’ compensation-related bills under rules in effect until 2008.
“Texas employers realized a great victory today,” Mary Barrow Nichols, general counsel and senior vice president for Texas Mutual, said. “A small number of hospitals were marking up a $4,000 item to $40,000 or more, or they’d turn a two-day admission into a $120,000 bill. These inflated charges could have cost the system hundreds of millions of dollars and continued to affect the workers’ compensation premiums of every Texas employer.”
The interpretation issue in this case between Texas Mutual and Vista Medical Center affects any remaining fee disputes under the stop-loss exception to the now-repealed rule.
Hospitals that treat workers’ compensation patients in Texas are reimbursed under the state’s workers’ compensation in-patient fee schedule. The 1997 fee schedule, which was repealed in 2008, included a stop-loss exception. Under the stop-loss exception, hospitals could be paid more than the fee schedule if they met certain criteria. The dispute between Texas Mutual and Vista centered on those criteria.
Texas Mutual argued that the stop-loss exception should be applied to admissions involving charges of more than $40,000 and “unusually extensive services.” Vista countered that the exception applied to all admissions for which they charged more than $40,000. The 353rd Judicial District Court of Travis County ruled for Vista. Texas Mutual appealed to the Austin Court of Appeals, which reversed the lower court. Vista then asked the Supreme Court to review the case.
About Texas Mutual Insurance Company
Austin-based Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance, with approximately 29% of the market. Since 1991, the company has provided a stable, competitively priced source of workers’ comp insurance for all Texas employers. Preventing workplace accidents and minimizing their consequences is a major part of Texas Mutual’s mission. Visit