Lt. Col. Rusteberg, May 1944, London

West Point 1934

Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

The President of the United States of America, authorized by Act of Congress July 9, 1918, takes pleasure in presenting the Silver Star to Lieutenant Colonel (Infantry) Edwin Rusteberg (ASN: 0-19542), United States Army, for gallantry in action while serving with Headquarters, 1st Battalion, 242d Infantry Regiment, 42d Infantry Division, in action on 9 January 1945 at Hatten, France. As Commanding Officer of the First Battalion, 242d Infantry Regiment, during the action at Hatten, France, Colonel Rusteberg planned and executed the defense of that area with outstanding success. In spite of point blank fire from enemy tanks supported by Infantry that raked his positions with fire, Colonel Rusteberg by personal example held his troops in position and withstood the enemy attack. Fighting side by side with his men in the face of overwhelming odds without mechanized or artillery support, Colonel Rusteberg by his courageous leadership, tenacity and devotion to duty played a major role in the successful defense of the town of Hatten.

General Orders: Headquarters, 42d Infantry Division, General Orders No. 131 (1945)

Action Date: 9-Jan-45 Service: Army Rank: Lieutenant Colonel Company: Headquarters Battalion: 1st Battalion Regiment: 242d Infantry Regiment Division: 42d Infantry Division

Contract risk is in the eye of the party to the contract—and that’s your client, not you.

(more…)

The Rio Hondo and La Feria Independent School Districts have entered into a direct agreement with Mobile CT Imaging to provide high quality, professional, convenient and affordable imaging for members of each district’s health insurance program.

(more…)

Commissioners Court of Kleberg County, located in South Texas,  voted this afternoon to seek competitive proposals for group medical and dental insurance. For more information, contact Riskmanager@sbcglobal.net .

Blue Cross is accused of price fixing in a lawsuit filed last year. Could it be that Blue Cross agreed to hospital pricing demands, with the understanding that the hospitals would charge other PPO’s more?

Did the negotiating process look something like this “Ok, we will pay you those high whorehouse prices you demand, but you must agree to charge our competitiors more!”

(more…)

It has been a long time since PPO networks actually saved participating plans any cost. If you ever deal with a PPO directly, as we do everyday, it quickly becomes apparent that the PPO’s real customer is the provider community not the plans that pay for them.

(more…)

                Recently, a South Texas school district hired a fee based insurance consultant to assist the district in a competitive Request for Proposal process and to make recommendations to the Board of Trustees. The “consultant” assured the district that he was properly licensed.

(more…)

Most insureds have no idea what their insurance plan pays for an MRI. And they really don’t care since “insurance pays the bills.”

But they should care. After all, their premium rates are directly proportional to medical care costs. Insurance companies are simply conduits for health care revenue flows, taking their cut as money cascades  it’s way through the health care system honey pot.

Insurance companies are not the only ones with a vested financial interest in health care costs. Many intermediaries participate in the cash cow we call the American Health Care System. Brokers of all sorts earn high fees. Some medical providers have partnership agreements with these brokers and participate in revenue streams.

Ever heard of an MRI broker? They exist. Their sales pitch is something like this: “Our services are free! Just call our toll free number and we will find the best and lowest cost MRI for your employees, as needed. We will even set the appointment! While the average MRI charge in your area is a whopping $2,500 after the PPO discount, we have been able to get the same MRI in the same area for as low as $900! And you pay us nothing – we participate in the $900 “discounted” price and the MRI center pays us!”

And, some doctors refer patients to MRI centers that pay the doctor a “kickback.” Unfortunately, in some localities, this is very common practice.

The MRI business model, as practiced by most, is extremely lucrative for many participants. Very lucrative.

Now enters RPN of California. Their MRI business model is based upon the novel concept of connecting the payer directly with the provider and eliminating all the middle men. For $295 per MRI, this company makes a nice profit, and the payer saves money. Keep your eye on RPN. You will hear more about them in San Antonio, Texas.

Why San Antonio? A market analysis shows 37 MRI locations and their average costs: http://www.newchoicehealth.com/Directory/CityProcedureType/Texas/San%20Antonio/15/MRI . Statistics show that there are 91.2 MRI’s per 1,000 population. Based on this statistic, there are approximately 192,000 MRI’s performed annual in the San Antonio area, or 524 MRI’s per day.

For more information on RPN, visit www.rpnofcalifornia.com

Editor’s Note: See similar posting – http://blog.riskmanagers.us/?p=5864 Health care professionals like RPN bring competition to the health care marketplace. That is good for consumers.

“Once we rid ourselves of traditional thinking we can get on with creating the future”

– James Bertrand

http://www.benefitspro.com/2011/05/17/governor-signs-maine-health-insurance-overhaul

Blunt honesty about dental insurance

(more…)

“Even though that sounds unethical to outsiders, that is not only true in dentistry but throughout medicine. It’s just that nobody talks about it.”

(more…)

Curt W. Olson COlson@TexasBudgetSource.com

The state will pay a hefty price tag for prisoner health care — nearly $1 billion in the next biennium. That comes from a recent audit that State Rep. Jerry Madden, R-Richardson, requested from the state Health and Human Services Commission.

(more…)

CALIFORNIA: The 2011 version of a hospital transparency bill was unanimously voted out of the Senate Health Committee last week. The legislation would prohibit hospitals from including provisions, commonly referred to as “gag-clauses,” in contracts with health insurers.

These provisions prevent disclosure of hospital cost and quality information to health plan members. Individual hospital systems, the UC System and the California Hospital Association continue to oppose the bill, while insurers, payers and labor unions support the measure.

Editor’s Note: Texas is doing the same – http://blog.riskmanagers.us/?p=5451

New report on top ten states for claims involving dog bites, shows Texas in top ten. Pit Bulls are considered dangerous animals and usually excluded.

(more…)

An association representing 900 physicians in the Amarillo area has agreed to a Federal Trade Commission order barring it from jointly negotiating the prices it charges insurance providers, according to a news release.

The FTC alleged in a complaint filed with the order that Southwest Health Alliances, Inc. and BSA Provider Network, a division of Baptist St. Anthony’s Health System, has violated federal law since 2000 by fixing the prices its member doctors would charge insurers.  This led to higher prices for consumers and businesses.

(more…)

Valley Business Report May 2011

A Rio Grande Valley company has launched the first mobile CT scanner service south of Dallas. Manuel Figueroa and Orlando Rivera, Registered Radiologic Technologists launched their business after working on the concept for over a year.

Medical insurance payers can save up to 75% off their CT Scan costs.

For more information, contact Mobile CT Imaging at 956-230-0109.

Editor’s Note: Self funded medical plans in the Valley, such as the Brownsville Independent School District, should look into a direct contract with these two Valley businessmen.  CT costs could be drastically reduced while still maintaing quality care.

NEW YORK, NY–(Marketwire – 04/14/11) – MultiPlan, Inc. was been named as a defendant in a lawsuit brought over a year ago against Sutter hospitals alleging false billing of certain anesthesia services. California Insurance Commissioner Dave Jones recently intervened in the lawsuit, and issued a press release announcing that action.

(more…)

The United States faces a physician shortage. In Massachusettes, where almost all residents have health insurance, patients must wait as long as seven weeks to see a primary care physician. And, many physicians are either not taking on new patients, or are not accepting Medicaid or low income patients due to low medical reimbursements.

(more…)

The City of Lubbock is seeking proposals for “Self-Insured Health Care Claims Auditing.” Will the city’s contract with third party administrator allow for audits, and if so, under what parameters?

(more…)

“……..A few years ago, however, he changed TPAs to eliminate hidden charges and gain direct interaction with the managed care company with which his undisclosed TPA contracts.”……………”For example, he now pays a flat amount per bill for fee schedule bill reviews, rather than paying on a percentage-of-savings basis.

“The fees per bill were just outrageous compared to what I am paying today,” Mr. Tilley said……………….”

(more…)

Texas Health Resources (THR) and BCBSTX  negotiated a new contract last year – http://blog.riskmanagers.us/?p=4692 . What reimbursement levels were agreed to by both parties on behalf of hundreds of thousand patients? A BCBS memorandum may provide clues.

(more…)

Since 1980 companies of all shapes and sizes have taken advantage of insured executive medical reimbursement plans. With the passage of the Patient Protection and Affordable Care Act last year, prospects for the continued marketing of these plans looked bleak at best, but isn’t it strange sometimes how quickly things change?

(more…)

The HealthSmart PPO network is used by numerous payers across Texas and the nation. Most payers are self-funded plans, while others are fully insured programs.

(more…)

IRVING, TX — In a recent Annual Report to the Pharr/San Juan/Alamo (PSJA) Independent School District, HealthSmart reported a total healthcare plan savings of $707,685 for 2010 and a total average annual savings of $464,768 for the past six years.

(more…)