US Supreme Court To Weigh Expedited Review Of Health Reform Case

The U.S. Supreme Court on April 15 will convene a private conference to consider an appeal by Virginia Attorney General Ken Cuccinelli (R) for an expedited review of a federal judge’s ruling in the state’s lawsuit against the federal health reform law, CQ HealthBeat reports (Norman, CQ HealthBeat, 3/23).

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The Only Thing A PPO Can Guarantee Is No Balance Billing

The Phia Group, LLC
March 22, 2011

Balance Billing… it happens. With health care reform in effect and costs of providing benefits soaring, our industry has become increasingly careful with their claims dollars. Plan Administrators, seeking to cut costs and enforce their plan documents, are combating provider overcharges with a new vigor.

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In Texas Two Insurers Account For 60% of Insureds

Rather than moving  toward a competitive world, we seem to be moving toward the opposite extreme: monopoly. Major consolidation is underway both on the provider and insurer sides of the market. And while this trend was already underway before Barack Obama became president, without doubt it is accelerating because of ObamaCare.

The graph below shows what things look like in the market for commercial insurance in major Texas cities:

Blue Cross already has 70% of the market in three of the nine largest metropolitan areas. In all of them, and for the state as a whole, more than 60% of all customers buy from only two insurers.

Is Common Sense Missing In Employee Health Plans?

Financing and administering health care through a self-funded employee welfare plan takes many forms. Financing is accomplished through mix of employee and employer contributions – determining the money value of the plan, current and projected is easy. Determining the actual value is not as easy. Determining who shares in the money sometimes takes a path of convoluted twists and turns.

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Cost Plus – Paying Less For The Same Coverage

Cost Plus groups pay less for the same coverage. It is that simple.  What better way is there to save on medical costs than by paying providers less?

Providers have the right to appeal claims which will end up with either one of  two outcomes; they either win or they lose. If they lose, providers can sue. If they sue, the Cost Plus group is indemnified by an outside insurance policy.

Attempts by providers to balance bill the patient becomes a non-issue, fast.

Cost Plus clients do not rely on contracts with medical care facilities much like consumers don’t have contracts with their local grocery store.

The first Cost Plus group  who led the Cost Plus revolution in Texas was Bill Miller Bar B Q in San Antonio – Bill Miller Forbes. Their story has been repeated by over 50 other Texas employers since.

There are a lot of rumors and misconceptions in the marketplace these days regarding the Cost Plus revolution. If you have any specific questions that need truthful answers, write

White Glove – Are House Calls Back?

  Nurse Practicioner

A service that sends caregivers to an employee’s home or office delivers health-care savings to its corporate clients.

David McCann – | US

March 15, 2011

Among the many innovations designed to reduce the cost of health care, one is decidedly counterintuitive: house calls.

WhiteGlove House Call Health, a company that has built a strong corporate following in Texas over the last four years, says its house-call medical care will improve the health-care experience while lowering costs.

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Obama Care or Crony Care? You Decide

The Obama administration has granted waivers or adjustments to five states and more than 1,000 unions, companies, and other organizations representing nearly 3 million people who no longer have to comply with healthcare-reform requirements — for now.

That news comes despite two looming congressional investigations into whether politics influences who received a waiver — what one GOP congressman is calling “crony care.”

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Capson Physicians Insurance Licensed In Six More States

Austin, Texas-based Capson Physicians Insurance Co. announced it is licensed to underwrite in six additional states: Alaska, Arizona, Louisiana, Indiana, Missouri and Nevada.

Capson’s medical malpractice protection is now available to healthcare providers in a total of 18 states.

Capson, which launched late last year with investors including BlueCross BlueShield Venture Partners L.P. and Beazley Investments Ltd., allows users to acquire medical malpractice coverage through an online model.

John Goodman Opines

In any other field, Jeffrey Brenner would be a millionaire. But because he’s in health care, he doesn’t know how he’s going to make ends meet. Like entrepreneurs in every market, Brenner thought outside the box. He discovered an ingenious way of lowering health care costs: focus on the “hot spots” of medicine — the high-utilizing, high spending patients — and solve their problems with unconventional care.

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Special Alert From National Center For Policy Analysis

I’m sending you a special alert to let you know that tomorrow, March 9 at 10:30 AM Eastern, I will testify before the House Energy and Commerce Committee Health Subcommittee. More information about the hearing is available at

The hearing will examine five specific provisions in the Patient Protection and Affordable Care Act (ACA) and five related bills to eliminate advanced appropriations made in the law. I will be speaking about the issues associated with health care policy mandates and the ten fatal flaws in the ACA.

Live streaming of the testimony will be available at

John Goodman

Workers Comp For Illegal Workers? Supreme Court – States Must Decide


The U.S. Supreme Court recently declined to hear a workers’ compensation insurance case that concerned an illegal immigrant in Louisiana who had sought coverage after a workplace accident. The Court’s refusal to consider the case means states are left to decide the issue of whether workers who entered the United States illegally may benefit from workers’ compensation coverage.

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Workers Compensation – Medical Losses Drive Costs – Loss of 8 Million Jobs = 20% Premium Loss Nationwide

The workers’ compensation industry in the years ahead will exist much as it has for decades in many respects. Policyholders will purchase coverage from either an agent or a company, with a portion of the market deciding to join the self-insured crowd. Some will be interested in few company attributes other than price, while some will look to their insurance provider for true value-added services. The most commonly seen services would be in the area of loss prevention, policyholder access to claims data, and a relationship with their insurance provider that leads to lower experience mods, and ultimately, lower costs.

Continue reading Workers Compensation – Medical Losses Drive Costs – Loss of 8 Million Jobs = 20% Premium Loss Nationwide

Spring Break in Mexico – New Business Opportunity for Kidnap & Ransom Insurance Brokers

With college spring break fast approaching many college students will be traveling with their friends to various locations to celebrate the week off of school. One of the most popular locations to visit has become one of the most dangerous locations to visit for US citizens. It may surprise you to learn that the most dangerous location to travel to is Mexico. Everyone knows not to drink the water in Mexico, but that is not the biggest threat in Mexico these days. Continue reading Spring Break in Mexico – New Business Opportunity for Kidnap & Ransom Insurance Brokers