“You can keep your current health plan if you like it.”
A South Texas long haul trucking firm’s request (http://blog.riskmanagers.us/?p=3900) to keep their existing employee health care plan has been rejected (for now) by an Obamacrat in Washington – HHS Waiver Response. This well written, cogent response sheds focus on literacy skills of government bureaucrats.
Redacted Email received this afternoon:
Are you tired of worrying about what health care reform will do to your business? We can help! Our defined benefit plans are exempt from the new regulations. Guarantee issued, group size as low as 2, and you don’t have to worry about MLR issues. Your client can even name their own price, and we will configure benefits to match their budget.
Please visit us at TMed Plus.
Editor’s Note: Mini-Med plans are popular with certain employers, like McDonalds. Under ObamaCare, these plans must meet certain requirements, such as increased plan limits. Many cannot afford the cost of a comprehensive health plan. A defined benefit plan, like the one above, accomplishes the same thing as mini-med plans but are exempt from the long reach of government Obamacrates. At least that is the claim made by the TMed Plus Plan.
If large claimants whose claims individually exceeded $100,000 represent 24% to total claims for the group, what effect would that have on PPO “discounts?”
Answer: A significant effect. Overall “discounts” would be lower in the aggregate.
Hospital contracts contain “outliers.” What does that mean? It means that when a claim exceeds a certain pre-set level, the entire claim all the way back to dollar one is discounted by as little as 20% off billed charges. Gone are the better “discounts” such as per diems, global pricing, etc. To our knowledge, there is not one PPO contract currently in place in the Brownsville medical community that has an “outlier” higher than $100,000.
So, if the average PPO “discount” for the group is 62% excluding claims that are subject to the outlier, what effect will 24% of total claims subject to an outlier have on the overall “discount?” Would it be less, or more?
Answer: Less
So, if PPO “discounts” decrease from one year to the next, could it be due to 24% of claims being discounted less? Or could higher costs charged by local health care providers who dont publish their prices, and dont reveal their pricing agreements with PPO networks, cause costs to increase as well? Or a combination of both?
Editor’s Note: Discounts mean nothing.
HealthSmart Adds Adam Stadler To Texas Sales Force
October 14, 2010/PR WB
HealthSmart is proud to announce that Adam Stadler has joined their sales staff and will primarily concentrate on enhancing the company’s market presence in North Texas. Adam has over 7 years of experience in managed healthcare sales and implementing benefit plans. He has proven experience in developing new business relationships and executing successful cross-sell initiatives by working closely with account executives.
(PRWEB) October 14, 2010 — HealthSmart is proud to announce that Adam Stadler has joined their sales staff and will primarily concentrate on enhancing the company’s market presence in North Texas. Adam has over 7 years of experience in managed healthcare sales and implementing benefit plans. He has proven experience in developing new business relationships and executing successful cross-sell initiatives by working closely with account executives.
While many managed care companies are downsizing due to the recent federal legislation on healthcare reform, HealthSmart has seen a historic increase in business. The last quarter of 2010 looks to be the company’s most successful in regards to the number of sales because of the unique HealthSmart Insight product, featuring a completely integrated solution for self-funded benefit plans. Mr. Stadler will initially concentrate on selling Insight and HealthSmart’s Hospital Partnership Program which focuses on clinical integration and performance. Both managed care products are administered on a single platform designed to reduce the cost of ever-increasing medical trend.
Mr. Stadler’s career has included a sales position with Holmes Murphey & Associates and national account management with Aetna, Inc. He received his BA in Marketing at TCU and spent a summer in Köln, Germany studying international business with an emphasis in marketing, management, finance and accounting.
Alex Arnet, Chief Sales Officer said, “Adam will be a truly valued addition to HealthSmart’s sales team in North Texas where the Company has made a strong commitment to growth. He has a great opportunity to help expand our reach due to recently completed Accel Network contracts with most of the area’s influential hospitals and providers.” HealthSmart Accel is the Company’s top tier network with the best rates currently available and unbeatable benefits for employers, their members and providers.
About HealthSmart
HealthSmart is a managed healthcare benefit solutions company serving more than 1.85 million members and managing more than $3.5 billion in claims through service operations around the country. The Company’s wholly-owned healthcare related subsidiaries include employee benefit administration, nationwide primary and secondary provider networks, full service predictive population management, wellness programs, prescription benefit management, on-site primary care clinics and stop-loss management all on a single administrative platform. HealthSmart’s mission is to improve member health, reduce costs and deliver “smarter” healthcare solutions.
