Archive for July, 2012

Plan Sponsors Demand Answers

Tuesday, July 31st, 2012

ObamaCare is constitutional. That decision is final. No matter what happens in the November elections, ObamaCare is here to stay. It will not be repealed, entitlements are immune. That is reality, it is what it is.

In the meantime, employers who sponsor employee welfare programs have two questions:

  1. How much will PPACA impact our bottom line in 2014?
  2. What can we do to mitigate the financial and administrative impact of PPACA?

We were asked these two basic questions last week from one of our clients. We responded with a well thought out and researched answer, an impressive five page memorandum even a college professor, we suspect, would approve as “brilliant.”

A new, intense and demanding service to provide plan sponsors with expert guidance through ObamaLand’s health care landscape is upon us. Insurance consultants have only 17 months to figure out all the angles.

Editor’s Note: There are big consulting fees to be earned under ObamaCare. Praise The Lord!




Valley Baptist Health Plans Announces Health Insurance Premium Rebates For 2011

Tuesday, July 31st, 2012

Valley Baptist MLR LTR

LexisNexis Insurance Exchange

Tuesday, July 31st, 2012

LexisNexis Risk Solutions introduced LexisNexis® Insurance Exchange mobile application on Wednesday.


IRS Powerless To Collect ObamaCare Punishment Tax

Tuesday, July 31st, 2012

Now that the Supreme Court has decided that ObamaCare’s mandate to buy health insurance is a tax, will the IRS be able to collect it?


Insurance Agent Survival Course

Wednesday, July 25th, 2012
The American College
What You Must Know About Healthcare Reform to Make Your Agency Successful
Advisors who understand the practical implications of healthcare reform and how to move to a consulting-based practice will win in this environment.

The American College, leading accredited educator of financial advisors, has prepared two 10-week Chartered Healthcare Consultant™ webinar courses to help you stay ahead of this historic legislation:

Essentials of Healthcare Reform (HS 345): All of the practical basics, timelines, terminology, and overview of how the new laws will impact you and your clients. Professor: Arthur Tacchino, JD Tuition: $750 per course Next Start: July 23, from 1 — 3 pm ET

The Healthcare Consultant (HS 346): How to create a vibrant healthcare consulting practice under the new legal and regulatory landscape. Professor: Arthur Tacchino, JD Tuition: $750 per course Next Start: July 24, from 1 — 3 pm ET


Call today! 888-795-6306

or visit

Self-Pay Plans Rule! Hospitals Step In “It”

Tuesday, July 24th, 2012

The old saying, “Better be careful what you ask for” characterizes a strategy some hospitals have developed against certain health plan provider reimbursement schemes.  The Good Guys always win. Details to be posted soon.

Editor’s Note: ObamaCare has a silver lining. Acknowledging opportunities and seizing the moment ensures financial success for seasoned health care consultants and their self-funded clients.

Health Insurance Companies & ObamaCare: Extinction or Re-Invention?

Tuesday, July 24th, 2012

“We need to move the system from underwriting risk to managing populations.  We want to have a different relationship with the providers, physicians and hospitals we do business with.”


The Logical Argument Of Why Employers Will Drop Coverage

Tuesday, July 24th, 2012

By Jim Demint

Analysts at the health care consulting firm Truven Health Analytics recently released a “study” that some observers are suggesting could undermine the case that employers will drop health insurance coverage thanks to Obamacare: “‘In no case could there be a win-win for the employer and the employee,’ says Ray Fabius, Truven’s chief medical officer.  ‘Someone ends up paying more.’  This is true in all four of the scenarios Truven modeled.”

There’s only one problem with this analysis, and it’s a huge one:  At no point does it consider the thousands of dollars of federal insurance subsidies that most workers will be eligible to receive if their firms drop coverage — yet up to 63 percent of non-elderly Americans will be eligible for taxpayer-funded insurance under Obamacare.  According to the Census Bureau, there are 266.5 million individuals under age 65.  Of those, 169.2 million, or 63.5 percent, have incomes under 400 percent of the federal poverty level — the threshold under which individuals can receive insurance subsidies.  Yet at no point in the Truven study did the analysis of net employee costs show that most workers will be subject to some type of federal insurance subsidy to offset the loss of an employer’s health insurance contribution.

This major omission makes the Truven study theoretically interesting, but largely irrelevant.  Of course employers are not going to drop coverage — at least not without major employee unrest — if subsidized insurance isn’t available elsewhere.  But if the federal government will pick up the tab for most, or perhaps even all, of a firm’s workers’ insurance, why wouldn’t an employer re-structure its benefits package to send its low- and middle-income workers to Exchanges for subsidies, and/or dump health insurance entirely?  That’s an inherently logical question that even Truven’s illogical and flawed study can’t deny.

Employee Benefit Captives & Health Care Captives: Effect of Supreme Court Ruling

Tuesday, July 24th, 2012

Summary: Supreme Court ruling has little effect on health care captives.

Most Favored Nation Clauses Restricted By Michigan Insurance Commissioner

Monday, July 23rd, 2012

Michigan’s insurance commissioner has issued an order that insurers can’t put  certain restrictions in their hospital contracts without his approval.

In an order dated Wednesday, Insurance Commissioner R. Kevin Clinton said he  is giving insurers six months to get approval for existing or future hospital  contract requirements.

Starting on Feb. 1, Clinton will prohibit the use of “most favored nation”  clauses — requirements that opponents argue stifle competition and drive up  rates for consumers — unless he approves them. Any attempts by insurers to  enforce those kinds of requirements after Feb. 1 are banned and would result “in  appropriate administrative action,” Clinton said in his order.

Aetna Inc., the federal government and former state Attorney General Mike Cox  have filed antitrust lawsuits against Blue Cross Blue Shield of  Michigan for the use of the controversial hospital contract requirements. In  some cases, the Blues’ contract conditions prevent hospitals from charging other  insurers lower rates than the Blues or boost reimbursement to hospitals if they  charge higher rates to other insurers.

Federal judges have rejected requests by Blue Cross to dismiss the federal  and Aetna lawsuits and are letting them proceed to trial.

Although the order said most favored nation clauses “may violate the Michigan  Insurance Code,” Clinton said the order isn’t a “determination regarding the  permissibility of the use of any particular most favored clause, nor is it  issued with the intent to preempt general antitrust enforcement in this  area.”

“This action by the state of Michigan is a fair, formal regulatory review of  both existing and new contracts to ensure any MFN provisions are proper,” said  Jeffrey Rumley, Blue Cross Blue Shield of  Michigan vice president and general counsel.

The Blues have argued that the hospital contract requirements help lower  rates and get discounts for its more than 1 million customers.

Rumley added in a statement that commissioner’s oversight re-enforcesthe  Blues’ argument that the hospital contract provisions are overseen by state  regulation, not federal regulation.

Critics disagreed.

“These orders will help create a more competitive market for health insurance  in Michigan and are a start toward leveling a playing field that has been tipped  toward Blue Cross for many years,” said Rick Murdock, executive director of the  Michigan Association of Health Plans.

From The Detroit News:

Editor’s Note: See

BCBSTX – Notice Of Health Insurance Premium Rebate

Monday, July 23rd, 2012

“In Texas, BCBSTX did not meet the Medical Loss Ratio standard. In 2011, BCBSTX spent only 71.0% of a total of $1,054,029,473 in premium dollars on health care and activities to improve health care quality.”

BCBS Premium Rebate

Editor’s Note: When will we get our HEB rebate check?

Uncle Herrman, Why Would I Want To Pay More When I Can Pay Less?

Thursday, July 19th, 2012

The posting immediately following this one has spurred a reaction from Molly Mulebriar, resident intern in training.

“Bill, first of all, Uncle Herrmann is doing fine, fishing at Lake Guerrero with his buddies. But, the real purpose of this email is to ask you, why would anyone want to pay more for a drug when they can get the same drug down the street at CostCo, Walmart or HEB  for as much as half the price? It just does not make sense. And why would a PBM include a string of retail pharmacies on their panel, knowing that drugs purchased there are priced higher, in some cases much higher, than the same exact drug down the street from a pharmacy also on the network panel?

We advised Molly to read previous postings on this very same subject:,

This growing phenomenon is called an SBPPO – which some call a “narrow” network –


Editor’s Note: It’s all about marketing, Molly. A broad PPO network listing is more popular with consumers whose only skin in the game are silly co-pays, than a narrow and limited panel of providers.

Uncle Herrman, They Kissed & Made Up!

Thursday, July 19th, 2012

Express Scripts and Walgreens Announce New Pharmacy Network Agreement
Dear Benefit Adviser,We are pleased to inform you that earlier today Express Scripts and Walgreens announced a multi-year agreement. As of Sept. 15, 2012, Walgreens will begin to participate in the broadest Express Scripts retail pharmacy network for new and existing clients. 

The Sept. 15 date should provide a reasonable timeframe for you to communicate to your clients. Here is a brief overview of how this agreement will affect them:


Legacy Express Scripts clients with broad networks: As of Sept. 15, Walgreens will begin to participate in the broadest Express Scripts retail pharmacy network for your new and existing clients.


Legacy Medco clients with broad networks: The broad network for legacy Medco clients includes Walgreens. This agreement does not affect your clients’ current network and has no impact on their members.


Clients with narrow networks: The agreement does not apply to our narrow networks.  Clients in these networks will not be affected as Walgreens continues to not participate.


Express Scripts is developing an internal communication package to help your clients convey this information within their organizations and anticipates making these materials available in the coming days.


Express Scripts members can log in to to see pharmacies that are currently in their network. By Sept. 15, Walgreens pharmacies will be visible on the Express Scripts pharmacy locator for members who are in the broadest network.


Express Scripts continues its commitment to making the use of prescription drugs more affordable, and aligning with your best interests to provide a clinically sound and economically responsible pharmacy benefit. Express Scripts has a variety of pharmacy network offerings to address the needs, member access and economic objectives of your clients.


Over the past year, we never lost sight of our goal: alignment with our clients’ interests. We appreciate your business and are passionate about improving the health outcomes of your clients’ members.


If you have any questions or comments, please contact your Express Scripts Strategic Relations Director.


Best regards,


Express Scripts

See –

Whats Wrong With The Health Care Media?

Thursday, July 19th, 2012

“……health reporters aren’t functioning like real reporters these days. All too often they are uncritically passing along messages that appear in White House press releases…..”


Demise Of The Solo Doctor

Wednesday, July 18th, 2012


The demise of the solo doctorIndependent doctors are closing up shop or going to work at hospitals or bigger group practices where they aren’t directly responsible for overhead costs.

Health Insurance Rebates: Taxable or Tax Free?

Wednesday, July 18th, 2012–taxable-or-tax-free-.html

Health Mandate Cost Calculator

Wednesday, July 18th, 2012

Do you want to know what ObamaCare will cost your organization in 2014? Try this Health Mandate Calculator:

Blue Cross Wages War With Hospitals Over “Wasteful” Radiology Charges

Wednesday, July 18th, 2012

“It’s unfair for our members to pay more than once for items only supplied one time,” said Barbara Morales Burke, vice president of Health Policy for Blue Cross. “We are reducing wasteful spending.”


Cost Of Dropping Health Insurance

Wednesday, July 18th, 2012

In the health reform debate, we do a lot of crystal ball gazing over whether employees will keep offering health insurance in 2014, or send employees to the new health insurance marketplaces where some could purchase subsidized coverage. The companies would face a $2,000 per employee fine for not providing coverage, but that’s a whole lot less than the cost of providing health insurance.

Truven Health Analytics recently took a deep dive into the financial decision employers face. It looked at health plan data for 33 large companies, including universities, retailers, those in financial and manufacturing industries. It found that moving employees into the exchanges would save employers a little – but also cost workers a lot.

“In no case could there be a win-win for the employer and the employee,” says Ray Fabius, Truven’s chief medical officer. “Someone ends up paying more.”

This is true in all four of the scenarios that Truven modeled. It started by looking at a a company that moves its employees into an exchange, but gives them enough money to buy comparable benefits. That’s the part in the key below referred to as “grossing up” the employee’s compensation:

The cost of health benefits jumps for two key reasons. First, when large companies purchase insurance, they buy in bulk and tend to get a better deal. “Big employers can lower the cost of an individual premium by spreading risks across a bigger pool,” says Fabius. Economies of scales, in other words, disappear in the individual market.

Then, there’s the tax advantage: Employer-sponsored benefits do not get taxed. Any policy purchased on the health insurance exchange, however, would have to be purchased with post-tax earnings.

That gets layered on top of some other fees, like the $2,000 penalty for not providing health insurance. The company’s other benefits, such as life and disability insurance, would likely become more expensive as companies that usually buy them as a bundle with health care would be shopping for stand-alone products.

That’s if employers keep paying for insurance. Truven also models an alternative situation, where an employer decides to drop insurance coverage altogether and let the worker handle it herself.

That saves the company about $5,000 per employee. The worker, meanwhile, ends up spending an average of $12,888 more on health care costs than they did when they had an employer plan. That figure, it’s worth noting, includes any tax subsidies that the law would provide to the employees in this study:

Truven’s research aligns well with other work, from consulting firms, that have modeled the impact of employers dropping insurance. Benefits firm Lockton has research estimating that an employee who loses employer-sponsored insurance would spend 79 to 125 percent more buying benefits on the exchange.

This doesn’t mean companies won’t drop coverage: There are, after all, some savings at stake here. It does, however, add a bit more complexity to companies’ financial calculations. Employers would see some savings – and also difficult conversations about why health care costs were spiking.

Uncertainty of PPACA – Employers Must Be Nimble

Wednesday, July 18th, 2012

Employers need to be prepared to act quickly when regulatory guidance is  issued on new health care rules that go into effect in 2014 under the Obama  administration’s health care overhaul, as there are a number of uncertainties  that the federal government must still clear up by then, a health care analyst  said July 12 in a Mercer webcast.


Will Long Term Care Insurance Survive In The Market?

Wednesday, July 18th, 2012

 Leading insurance carriers have withdrawn from the group long-term care insurance market, prompting employers to think twice about implementing new programs — are we witnessing the death throes of worksite LTC?

Health Care Reform Fees Add Up

Tuesday, July 17th, 2012

“There’s just all sorts of fees,” says Tracy Watts, a partner and senior health care consultant at Mercer. “This challenge of cost is huge.”

Higher Prices Charged By Hospitals, Other Providers, Drove Health Spending During Downturn

Tuesday, July 17th, 2012

“The report shows that people with job-based insurance “are paying more and getting less”


Surgery Prices Vary Significantly Across Hospitals

Tuesday, July 17th, 2012

“For example, a Cesarean section costs $48,000 in high-priced San Mateo, while hospitals in low-priced Fresno charged less than $13,000 for the same procedure.”


Virtual Office Visit

Friday, July 13th, 2012

Soluta Care allows physicians to give treatment for minor illnesses and injuries anywhere. From your computer, you will see the answers to questions about your patient’s symptoms and their history. Your session will then move to a Soluta Health exam room where you will be set up for an instant messaging session with your patient. You can answer your patient’s questions and and respond to your patient’s concerns in the Exam Room. Your patient can even upload images for a better diagnosis. You can recommend treatment and even send prescriptions to your patient’s preferred pharmacy.


Penn State Had No Risk Management Review To Stop Sandusky Abuse

Friday, July 13th, 2012

STATE COLLEGE, Pa.—Pennsylvania State University did not have a process or structure to regularly receive reports on potential risks and failed in its duty to make inquiries into the child sexual abuse by former assistant football coach Gerald A. Sandusky, according to an independent report released


Delivery System Needs to Be Re-Examined

Friday, July 13th, 2012

By Harvey Billig

With the pending expansion of healthcare insurance to  millions of newly insured, it is time to re-examine the delivery system if one  wants true reform that is financially sustainable. This requires an analysis of  how to integrate doctors, hospitals, other providers, insurance companies and  pharmaceutical suppliers in a workable and affordable delivery model that can be  adopted relatively rapidly in most areas of the country.

Self-Funded Health Insurance Plans Expected to Grow in Number

Thursday, July 12th, 2012
Following Court Ruling, Attention Turns to Self-Funded Benefits
Health care law may affect the ability of smaller employers to self-fund their benefits.

Insurers Pay Big Markups As Doctors Dispense Drugs

Thursday, July 12th, 2012

At a time of soaring health care bills, experts say that doctors, middlemen and drug distributors are adding hundreds of millions of dollars annually to the costs borne by taxpayers, insurance companies and employers through the practice of physician dispensing.

San Benito CISD Seeks Competitive Proposals

Thursday, July 12th, 2012

REQUEST FOR PROPOSALS RFP-0712-TPACP Description: Third Party Administration Services to Administer the tax deferred annuity and custodial plans under Section 403(b) and 403 (b)(7), the Cafeteria Benefits Plan vendor IRC Section 125, the Part-Time, Seasonal and Temporary (PST) 457 and the Regular 457 Deferred Compensation Plans, Voluntary Plans, and other Supplemental Plan PROPOSAL DEADLINE:               Tuesday, July 24th, 2012                                                 2:00 p.m. San Benito Consolidated Independent School District (SBCISD) is interested in receiving proposals for the above item.  Sealed proposals will be received at the office of Ms. Emma McCall, Business Manager, 240 North Crockett  Street, San Benito, Texas  78586. Interested offerors may obtain specifications and information by accessing our website at:  www.sbcisd.netYou must use the proposal form included therein as your response to this request.  If you are unable to access our website or need additional information you may contact Mr. Adrian Garcia, Purchasing Agent, SBCISD, 240 North Crockett Street, San Benito, Texas  78586, telephone number (956) 361-6390, e-mail

SBCISD Purchasing Department 240 N. Crockett Street San Benito, TX 78586 (956) 361-6390
Editor’s Note: See background information here –

Concierge Medicine Not Just For The Rich – The Beginning Of A Two Tier Health Care Delivery System

Wednesday, July 11th, 2012

Flat-fee payment option is increasingly popular with doctors and patients.  If you’re one of the millions of Americans who have received a letter from your doctor informing you they’re changing things up to become a “members only” practice, you know the growth of so-called “concierge medicine.”


Health Insurance Agents: Guide to Survival

Tuesday, July 10th, 2012

A recent article in Forbes reports the immenent demise of commissioned health insurance agents. Although independent agents provide valuable services to their clients, insurance companies under pressure from Minimum Loss Ratio requirements under ObamaCare, will jettison their preferred method of distribution out of neccessity. It is estimated that 100,000 independent agents will be “fired” by health insurance carriers in the next year.

Our advice to health insurance agents to survive, and thrive in their choosen field is to quit. Yes, quit receiving commissions from health insurance companies. Write every carrier you represent and tell them you no longer require them to act a payroll master for you and for your clients. Tell them you have decided to get paid directly from the clients you represent, thank you very much!

By this simple act, you become an agent for your client, not the insurance company. You will truly represent their interest, probably for the first time. Your value will be determined by the clients who agree to pay you, You will enjoy new friendships and you will earn more money than you ever thought possible. You will be truly independent.

In Texas you will have to be licensed to receive fees directly from your clients. A Life & Health Insurance Counselors License and a Risk Managers License are required. You should apply for these licenses right away, or face the unemployment line next year.

Good Luck!

Lawyers: Health Care Law Will Spur Employees To Sue Their Employers

Tuesday, July 10th, 2012

“They  (lawyers) are expecting employees to take companies to court not only for violations of the massive and complex law, but also for technical issues—such as documentation of benefits, change notices and the interpretation of arcane provisions—that workers may claim are preventing them from getting benefits they deserve.”


The Future: A Two Tier Health Care Delivery System

Tuesday, July 10th, 2012
With ObamaCare now firmly in place, and with the outside chance the Republicans will repeal and replace it, the bottom line is health care delivery as we have known it is gone for good.

83% Of Doctors Consider Quitting Profession Due To ObamaCare

Tuesday, July 10th, 2012

Eighty-three percent of American physicians have considered leaving their  practices over President Barack Obama’s health care reform law, according to a  survey released by the Doctor Patient Medical Association.


Texas to Obama: We Intend To Stop Your Brazen Intrusions Into Our Sovereignty

Tuesday, July 10th, 2012

AUSTIN, Texas—The state of Texas will not set up a state health insurance exchange where the uninsured, among others, could use health care reform law authorized premium subsidies to buy coverage, Gov. Rick Perry said Monday.In addition, Texas will not expand Medicaid to cover more low-income state residents, Gov. Perry said.“I oppose both the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act and the creation of a so-called ‘state’ insurance exchange, because both represent brazen intrusions into the sovereignty of our state,” Gov. Perry wrote in a letter sent to Health and Human Services Secretary Kathleen Sebelius.“Neither a ‘state’ exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better ‘patient protection’ or in more ‘affordable care.’ What they would do is make Texas a mere appendage of the federal government when it comes to health care,” Gov. Perry wrote.Under the health care reform law, the federal government can set up a health insurance exchange in states that decline to do so. Last month, the U.S. Supreme Court struck down a health care reform law provision that would have stripped federal funding of Medicaid from states that did not expand eligibility for Medicaid.

Health Care Repeal Waste Of Time?

Tuesday, July 10th, 2012

“……an effort to repeal the full law, given the likely political makeup of Congress in the years ahead, seems pointless.”


Insurance Confusion in San Benito, Texas

Sunday, July 8th, 2012

San Benito Indedpendent School District assigns lucrative insurance contract to exclusive Agent of Record – San Benito Agent of Record Letter

Can a Texas political subdivision assign an Agent of Record for insurance purposes? Commissioner’s Bulletin #B-0041-07


Molly Mulebriar Opines

Sunday, July 8th, 2012

“Blue Cross, Aetna, United Healthcare, Cigna and Humana compete against stop-loss carriers, not third party administrators. At the end of the day,  Plan Sponsor decisions are often driven by artificial liability limits, not who can do the best job administering and managing claims.”

Editor’s Note: Plan Sponsors who base their buying decision on stop loss cover are uninformed and need immediate rehab.


Insurance Agents Lose Job Security With ObamaCare Ruling

Sunday, July 8th, 2012

Group Health Plans Costs Expected To Increase Double Digits

Tuesday, July 3rd, 2012

Group health care plan costs are expected to increase by double-digit amounts in most parts of the world in 2012, according to a Towers Watson & Co. survey released Monday.The biggest cost increases are expected in North America, where costs are projected to rise 11% in 2012, according to the survey of health insurers. It is followed by Latin America, where costs are projected to rise by 10.5%, and Asia/Pacific, where insurers project cost increases of 10.2%.The smallest projected cost increase—8.1%—was in Europe, followed by the Middle East/Africa with projected cost increases of 10%.The three biggest reasons cited by respondents for rising costs are new medical technology, cited by 52%; medical providers recommending too many services, cited by 50%; and providers’ efforts to boost profits, cited by 31%.The survey is based on the responses of 237 insurers operating in 48 countries.

GlaxoSmithKline To Pay $3,000,000,000 (Billion) In U.S. Drug Fraud Scandal

Monday, July 2nd, 2012

Attention Blue Cross Blue Shield Members

Sunday, July 1st, 2012

The Godbey Group, ( ) a national consulting firm, is conducting a research project in and around Victoria, Texas. If you have been a recent Inpatient or Outpatient in one of the Victoria area hospitals, we are collecting Blue Cross Blue Shield Explanation of Benefits (EOB) that you would have received for your Hospital stay or use of Outpatient Services for the period from May 1, 2011 through May 31, 2012.

If you are interested in participating, please black out any personal information on the EOB (patient name, address, SSN, etc) and mail a copy of the Hospital EOB to The Godbey Group. Please note that no Physician office visit EOB’s will be accepted. The Godbey Group will pay $10.00 per qualified EOB as determined by The Godbey Group. The Godbey Group will not return your EOB to you. If you have any questions, please contact us at (972) 714-0004. The research project ends July 15, 2012 but is subject to earlier discontinuation without prior notice.

The Godbey Group – 1320 Greenway Drive, Suite 170, Irving, Texas  75038

The above solicitation appeared in the July 1, 2012 edition of the Victoria Advocate.