Archive for March 14th, 2013

Fund Balance Theory

Thursday, March 14th, 2013

Assuming economies of scale, if you fund $1 and your claims are $1.23, then change to another managed care plan and fund the same $1 and claims end up at $0.89, is this conclusive evidence that the later managed care plan has better pricing than the former one?

Editor’s Note: The Fund Balance Theory is plausible and effective. Salesmanship is a science.

From A PPO Provider:

I read your “Funding” BCBS piece. Pretty funny the way they try to arrange reality. Smart marketing.

From A TPA:

Nope it just means I denied more claims then usual and sat on some more till after renewal so I could proclaim how well I managed the claims. Next year when it all catches up was an abortion, just look how good I did last year.

From an insurance consultant:

I have not heard of it. However, in looking at your blog, it doesn’t make any sense to me. How can you compare claims year to year like that? Maybe one year claims are up, the next they are down, with nothing to do with the managed care arrangement.  I prefer to have actual discount data, which Blue Cross does not provide.


Hospital Charges Bring Backlash

Thursday, March 14th, 2013

Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.


Mulebriar Reports Anonymous Tip Of The Week

Thursday, March 14th, 2013

“Use of physician only networks in conjunction with reference based pricing creates a highly successful option for those who,look to offer Cost Plus, Medicare benchmarked, and other non traditional network offering plans. There are several physician only networks now coming forth to offer access. Also ancillary only network. Incorporating these eliminates the potential for balance bill in 85 plus % of claim volume. Leaves a very attractive option for employers who are tired of paying 200% + of Medicare equivalent for claims but concerned with balance billing.”

PPACA’s Impact on Real Estate

Thursday, March 14th, 2013

When most health policy experts think about bending the cost curve, they think about reducing unnecessary testing and incentivizing cost-effective medicine.

When Scott Mason ponders the subject, he thinks about something completely different: Real sign


Delta Dental’s Race To The Bottom

Thursday, March 14th, 2013

“On the average, 65 cents of every dollar collected by the average dental practice goes to pay the cost of overhead expenses. So a 12 percent cut in fees means Delta Dental providers will lose 1/3 of their income… unless they work 1/3 faster.”