Archive for October 2nd, 2012

Texas County Faces Health Insurance Nightmare

Tuesday, October 2nd, 2012

A Texas county is facing a financial decision – continue their self-funded group medical program and go broke or discontinue it. Claims and expenses exceed funding by over $1 million per year. The county refuses to fund more into their plan and instead has bid out the contract hoping to get lower rates/costs. That won’t happen.

This problem is real simple: if funding cannot be increased to cover expenses and claims, then the county needs to spend less on expenses and claims. It is that simple.

If claims are averaging 250% of Medicare or more through their PPO network,  then why not pay just 100% of Medicare? After all, the local hospital relies on Medicare patients. Hospitals do not have to accept Medicare, but most do since they make money doing so (despite protestations otherwise from distraught hospital administrators seeking competitive advantage when negotiating PPO contracts).

So the solution is simple: pay providers less and let the county employees fight  balance billing that is sure to occur. At least that is better than having no insurance at all. Squeezing blood out of a turnip is a hard thing to do.

The county would be wise to offer two plans – one tagged at 100% of Medicare and the other using a traditional PPO network. Employees could buy up to the vaunted PPO – no balance billing plan but would pay a premium price for the privilege. A Cost Plus reimbursement approach would also solve their  financial woes but that would require a strong political backbone.

 

Maxor Announces Formation of New TPA – Maxor Administrative Services, LLC

Tuesday, October 2nd, 2012

Maxor National Pharmacy Services Corp. is pleased to announce the formation of a new company, Maxor Administrative Services, LLC (MAS), which will provide third party administration (TPA) services for self funded health benefit plans.  MaxorPlus currently provides Pharmacy Benefit Management services to many self funded groups throughout the United States, and we believe that it is a natural progression for us to expand our administrative services to all aspects of the health benefit plan.

MAS will offer the transparency and flexibility that is needed for self funded health plans to effectively manage their employee benefits.  As the landscape of healthcare continues to change at a rapid pace, employers continue to search for ways to provide a quality, cost effective healthcare benefits package for their employees.  The lack of transparency in the healthcare market today limits accurate information and encourages hidden revenue which can impede an employer’s ability to make informed decisions.  MAS will provide accurate financial information about each component of their employee benefit plan and allow the employer to act on that information by selecting the service providers that best meet the needs of the Plan and its members. MAS will also be actively pursuing innovative cost containment solutions that break the mold of traditional healthcare delivery.

About Maxor National Pharmacy Services Corporation (Maxor) Maxor is a multi-faceted pharmacy services company. Since 1926, we have grown into a nationwide provider of pharmacy and healthcare services, including MaxorPlus, Ltd., pharmacy benefit management services; Maxor Pharmacies, retail and mail order pharmacies; Maxor Specialty Pharmacy and IV Solutions, specialty pharmacy services and home infusion therapy; Maxor Pharmacy Consulting & Management Services, providing inpatient and outpatient pharmacy consulting and management services; Maxor Correctional Pharmacy Services, providing correctional pharmacy services; and PickPoint, providing intelligent pharmacy solutions for remote dispensing systems, “will call” systems, and electronic medication administration records; and our new company, Maxor Administrative Services, administration of employee healthcare benefits.  For more information about Maxor, visit www.maxor.com.

For additional information, contact:

Lori Brown, Vice President, Maxor Administrative Services

or

Dodd Nolan, Vice President, Business Development

(806) 322-5920 – Toll Free: (855) MAXOR-TPA