Archive for May 29th, 2012

HealthSmart Settles With Lubbock

Tuesday, May 29th, 2012


Media Reports Amazing Story – Astounding Findings! Timid Reporter Scores Hit

Tuesday, May 29th, 2012

Sierra-Berkshire Associates, Inc. – Visionaries Ahead Of Their Time

Tuesday, May 29th, 2012

Sierra-Berkshire Associates, Inc., is a Reno based actuarial consulting firm for insurance carriers, Physician Hospital Organizations, Independent Practice Associations, Plan Sponsors, TPA’s and marketing organizations. One aspect of their work is designing group health insurance plans for insurance carriers.

In 2005, well before the market began to move away from managed care contracts,  Sierra-Berkshire  designed a program to approximate Medicare coverage features, employing an approach to medical expense treatment that already had wide acceptance by consumers and by the medical community. After all, most  hospitals and doctors accept Medicare patients  and almost never balance bill. So if a provider is happy to accept Medicare and the fees paid to them, they should be quite satisfied with the plan Sierra-Berkshire designed.

Attached is the Business Plan for the product developed by Sierra-Berkshire in 2005. Apparently the concept did not fly with the carrier/s and the product was never marketed.

ComparaMed Care

One of the principals of Sierra-Bershire writes: “We were too visionary in 2005 . . . no carriers were interested in our concept. Funny how stupid ideas become smart as wisdom is gained from the suffering of pain.”

Editor’s Note: The ComparaMed Care Plan would sell today, fully insured or self-funded. If almost all hospitals and doctors accept Medicare and don’t balance bill patients, why should they object to a Medicare Look-Alike Plan that provides the same exact benefits with the same exact reimbursement rates? “Hey doc, since you take Medicare patients, accept assignment of benefits, and dont balance bill,  you should have no problem with my insurance either.”


Private Insurance Exchange – Health Insurance Brokers To Join Travel Agents In The Unemployment Line

Tuesday, May 29th, 2012

In a nutshell, a private insurance exchange is an online marketing tool. You may look up rates, but underwriting will ultimately determine what the real rates are going to be. Don’t get too excited about these exchanges – you already experienced  a similar version over the years, it’s called a spreadsheet. But, as you will see in the commentary below, some get quite excited about the ability to purchase insurance in the privacy of their homes without a pesky salesman breathing down their neck.