Continue reading Aetna, Baptist Health System, HealthTexas Medical Group Form ACO
Month: January 2015
Former School Board Insurance Consultant Faces Ethics Charge in Louisiana
Continue reading Former School Board Insurance Consultant Faces Ethics Charge in Louisiana
Reference Based Pricing To Become The Norm For Self-funded Plans
Continue reading Reference Based Pricing To Become The Norm For Self-funded Plans
Will Payroll Services Put Agents Out of Business?
“ADP will provide a Health Care Premium Guarantee for you and your employees from 1/1/2015 to 6/1/2016, so you know for the next 18 months that your renewal will not be higher than 12%. “
Continue reading Will Payroll Services Put Agents Out of Business?
Caprock Health Group – Health Care Forum 2015
Continue reading Caprock Health Group – Health Care Forum 2015
AMPS Seeks Two New Sales Representatives
AMPS is looking to add two top tier sales professionals to help us with the incredible demand for our Reference Based Reimbursement (RBR) solution. Do you want to continue to sell sugar water or come with us and change the self insured world? We love what we do, it’s all we do and no one does it better. If you want to LOVE what you do too, contact John Powers at jpowers@less advancedpricing.com or 630.361.2525
Physician Responds To RiskManagers.us Post
“This is what happens when you put Marxists in charge of making these decisions.”
After 17 Years Insurance Dispute Continues – Where is Perry Mason?
“This thing has really gotten uglier and uglier and uglier,” said attorney William Gast, who represents the Fulkerson family and Countrywide Insurance Agency.
Continue reading After 17 Years Insurance Dispute Continues – Where is Perry Mason?
“Historic” Medicare Reimbursement Scheme Announcement
“The Administration’s “historic” announcement on Monday marks “the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.”
Continue reading “Historic” Medicare Reimbursement Scheme Announcement
North Carolina Blues Plan Unloads Price Transparency Surprise
Amazing Revelation! Will Coke Cola Recipe Be Next?
There’s a fascinating story out of North Carolina about that state’s largest insurer unexpectedly publishing information on how much it pays healthcare providers for a wide range of elective, non-emergency services. ……Such payments normally are closely guarded business secrets……………………Providers were not pleased.
Continue reading North Carolina Blues Plan Unloads Price Transparency Surprise
I Don’t Want To Tell You My Current Premiums
“Just give me a quote along with the other five agents I have contacted. Never mind that my current agent has that information!”
“As I’ve aged and acquired more experience and am blessed with the knowledge that dinner is on the table whether or not I make a sale today, I’ve become more stubborn about insisting that if a prospect wants my involvement and engagement in seeking coverage, then they have to co-operate at minimum levels…………”
Continue reading I Don’t Want To Tell You My Current Premiums
PBMs Should be Required to Disclose Fees and Compensation
“Testimony submitted to the Council revealed that drug pricing methodologies and PBM compensation are complex and evolving, including rebates, price spreads, discounts, and other payments from retail pharmacy chains and manufacturers.”
“Substantial evidence was submitted to the Council from ERISA plan sponsors and others that many PBMs do not fully disclose compensation in a manner which is readily understandable to even the most sophisticated plan sponsors and consultants.”
Continue reading PBMs Should be Required to Disclose Fees and Compensation
Long Term Care Insurance – Reducing The Implied Leverage of Insurance
By Michael Kitches
Insurance functions best when it is used to cover high-cost low-probability risks — things that aren’t likely to occur, but would be devastating if they did. Technically, paying insurance premiums on an ongoing basis has a slightly greater expected loss than just retaining the risk, but the trade-off — converting a potential financial disaster into a manageable ongoing premium — is appealing.
Continue reading Long Term Care Insurance – Reducing The Implied Leverage of Insurance
Texas Federal Agent Guilty of Insurance Fraud
January 21, 2015, San Antonio, TX — A former deputy U.S. Marshal and Mission police officer pleaded guilty Wednesday to federal fraud charges after he falsified insurance documents and forged a doctor’s signature, prosecutors say.
Continue reading Texas Federal Agent Guilty of Insurance Fraud
The Math and Politics of Organ Transplantation
“Steve Jobs chose to be listed for a liver transplant in Tennessee rather than where he lived in Northern California, which has an average waiting time 6 years, because he was more likely to get a new liver in Memphis, which has an average waiting time of 3 months.”
Continue reading The Math and Politics of Organ Transplantation
Mpirica
Frustrated by the lack of simplified hospital quality information, MPIRICA’s founding team are healthcare consumers like you, who just happen to also be tech entrepreneurs.
The True Story of Generic Medication Prices
Continue reading The True Story of Generic Medication Prices
Refreshingly Simple – Texas Hospital Offers Contract to Local Employer
We like the simplicity of the offer. It’s refreshing and a good starting point……………..But a 50% discount off an inflated number can be anything you want it to be and 315% of Medicare seems a little outrageous……………..
Continue reading Refreshingly Simple – Texas Hospital Offers Contract to Local Employer
Brownsville Man Sentenced For Insurance Scheme
A jury on Wednesday found a Brownsville resident guilty of securities fraud and theft.
Prosecutors said Alberto Alba Villarreal, 45, sold a bogus $1 million investment contract in Nafta Holdings LLC, to help fund a new insurance company. The fraud happened in November, 2008.
Officials said Alba Villarreal instead spent the money in less than three months on personal expenses and lavish purchases.
A jury sentenced Alba Villarreal to 10 years community service and was ordered to pay $10,000 for the securities fraud. He was sentenced 5 years in prison and ordered to pay a $10,000 for the theft count.
Visiting Judge Federico Hinojosa ordered Alba Villarreal to pay $1 million in restitution to the victim.
http://m.krgv.com/news/Brownsville-Man-Sentenced-in-Securities-Fraud-Theft-Case/30759242
See: Funding New Texas Insurance Company Proves Problematic
Bastrop Independent School District Seeks Insurance Consultant
RFP #2015-02 – Insurance Benefits Consulting Services. This bid is scheduled to close on Feb 5, 2015 4:00:00 PM CST
Continue reading Bastrop Independent School District Seeks Insurance Consultant
County Commissioners Discover Motherload!
Are MEC Plans Doomed in 2015?
Arms of the U.S. Department of Health and Human Services (HHS) and the Treasury Department are lashing out against a controversial new type of group health plan.
I Love Old People, But I Will Not Accept Medicare
PAMELA WIBLE, MD | PHYSICIAN | AUGUST 7, 2014
I love caring for patients — young and old. And though I may not accept your insurance, I will always accept you. I’m still happy to care for Medicare patients even though I opted out of Medicare in 2006. Why don’t I accept Medicare? Let me fill you in.
Continue reading I Love Old People, But I Will Not Accept Medicare
Physicians Must Unionize – Here’s Why
“If were alive today, he would support the revival of labor unions in general and professional labor unions in particular.”
High Drug Costs – Low Drug Costs – Each Has a Price
PETER UBEL, MD | MEDS | JANUARY 12, 2015
India is not, yet, a wealthy country. Nevertheless its people experience many of the same expensive-to-treat illnesses as wealthier populations in the U.S. and Europe. Therefore, the country has made a series of policy decisions designed to lower the cost of medical treatments.
Continue reading High Drug Costs – Low Drug Costs – Each Has a Price
Managed Care Compliance Conference
Plan to attend if you are a compliance professional from a health plan (all levels from officers to consultant), in-house or external counsel for a health plan, an internal auditor from a health plan, regulatory compliance personnel, or a managed care lawyer.
Some Eligible Americans Turn Down Welfare
Though Brewer could pay less for a plan if she were to accept a subsidy (welfare) from the federal government, she refuses. “I want to pay my own way,” she says. “I will not take a handout.”
“Welfare is the use of force to transfer wealth from one group to another” – Ron Paul
Brit View of American Health Care – Pain In The Arse
Where Americans see “choice” in their private health insurance plans, Brits see wasted time and confusion. Where Americans say “I get to choose my doctor,” Brits ask “why on earth would you want to choose a doctor?” Where Americans talk about “out-of-pocket” and “deductibles” and “co-pays”, Brits say “what?” and get all of the above confused.
Continue reading Brit View of American Health Care – Pain In The Arse
Retail Clinics Sound Good. But If You Need Follow-Up care, Good Luck.
“These clinics pick off the easy, high margin care and then punt when push comes to shove. They have less interest in your well being and more in your wallet.”
Continue reading Retail Clinics Sound Good. But If You Need Follow-Up care, Good Luck.
Medicaid Rates Are Going Down & There Is Nothing Doctors Can Do About It
By Shirie Leng, M.D.
Medicaid is a federal program for the very poor implemented by grants to states, which do the administration. Medicaid typically pays doctors about 60 percent of what Medicare pays. In Florida, a typical primary care visit might pay the doctor $32. In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR.
Continue reading Medicaid Rates Are Going Down & There Is Nothing Doctors Can Do About It
Mutual Accident Company
Founded in 1937 by a salesman who put up $2,000 and borrowed $3,000 more to start Mutual Accident Company. The company sold only one product; a $1,000 accident policy for $3 per year. Two years later he changed the name of the company and turned it into a stock company. In 1993 the company was sold for $571,000,000. Not too bad for an initial investment of $5,000.
Why Are American Health Care Costs So High?
Consolidation: Less Competition in Health Care
“Continuing consolidation in the health industry has enabled providers to raise their prices without improving the quality of their services…….. The resulting lack of competition among hospitals and other providers allows those providers to monopolize the market and charge higher prices…….health insurance compounds the problem….”
Continue reading Consolidation: Less Competition in Health Care
The Future of Medicine Is In Your Smart Phone
“Now, at any time of day or night, you can demand and get a secure video consultation with a doctor via smartphone at the same cost (about $30-$40) as the typical copay charge through employer health plans. This may seem exotic now, but several large consulting firms—including Deloitte and PricewaterhouseCoopers—have forecast that virtual physician visits (replacing physical office visits) will soon become the norm.”
Beats calling for an appointment, waiting days to see the doctor, then making your 9:00 a.m. appointment days hence only to see the doctor at 11:00, after sitting in a room full of sick and possibly contagious patients, for a brief 5-10 minutes meeting with your harried and stressed doctor, then driving over to the pharmacy to get your prescription, waiting there for 30-45 minutes with retching, sick and possibly contagious Typhoid Marys and having to deal with Miss Grumpy the pharmacy sales clerk, then driving back to work only to hear your supervisor bitch and moan.
Continue reading The Future of Medicine Is In Your Smart Phone
Self Insurance Administration – A Competitive Market
Last March, Aetna scored one of the biggest single contracts in its history when the Teacher Retirement System of Texas shifted the administration of its self-insured healthcare benefits program from Blue Cross and Blue Shield of Texas to Aetna.
See: Selecting a Third Party Administrator
“……wellness programs, accountable-care networks, hospital bill audits and direct contracting with providers appeal to employers……help them (self-funded plans) reduce costs and improve care……..” See: The PPACA – Game Changer for Health Care Financing
Continue reading Self Insurance Administration – A Competitive Market
UHS To Open 2nd On-Site School Based Medical Clinic
University Health System has teamed up with Southwest Independent School District to open a new health center that will be open to students and siblings under the age of 18………UHS opened its first school-based health center in the Harlandale Independent School District on San Antonio’s South Side in 2013……….
Continue reading UHS To Open 2nd On-Site School Based Medical Clinic
San Antonio Facing $70 Million Cadillac Tax
Obamacare architect Jonathan Gruber and his Obamacare comic book for stupid Americans
“Gruber said that the trick to selling the “Cadillac tax” was to claim it was a tax on insurance policies and not “people” – Breibart
The City of San Antonio could be liable for huge tax penalties unless it can come to terms with police and fire unions on new collective bargaining agreements that includes less costly health benefits.
Continue reading San Antonio Facing $70 Million Cadillac Tax
Doctor On Demand
“Lack of access to health care providers in the United States is a massive, growing problem. The average wait time to see a physician is three weeks. More than half of patients with mental health issues go without treatment. We’re not getting the care that we need. We built Doctor On Demand to help address this problem.”
Antibiotics: US Discovery Labelled “Game Changer” For Medicine
The decades-long drought in antibiotic discovery could be over after a breakthrough by US scientists. The researchers turned to the source of nearly all antibiotics – soil. This is teeming with microbes, but only 1% can be grown in the laboratory. The team created a “subterranean hotel” for bacteria. One bacterium was placed in each “room” and the whole device was buried in soil.
Continue reading Antibiotics: US Discovery Labelled “Game Changer” For Medicine
Childrens Hospital of San Antonio Signs Newest Health Insurance Provider
“The signing of this agreement will allow for the Children’s Hospital of San Antonio to better meet the needs of all children, regardless of their insurance plan, in San Antonio and South Texas….”
Continue reading Childrens Hospital of San Antonio Signs Newest Health Insurance Provider
Humana’s Concentra Expands Urgent Care Network In San Antonio
Concentra Urgent Care has opened a new medical facility in the Fiesta Trails Shopping Center in Northwest San Antonio.
Concentra now has a half-dozen urgent care facilities in Bexar County. This newest center, at 12651 Vance Jackson Road, is one of the company’s largest to date.
Continue reading Humana’s Concentra Expands Urgent Care Network In San Antonio
Phia Group Announces Implant Cost Pro Service
“Implant Cost Pro” Case Study: A self-funded benefit plan, which had historically secured a 10% discount with an ambulatory surgical center for services involving implants, advanced a $91,000 implant claim to The Phia Group. Utilizing the Implant Cost Pro service, leveraging cost data and innovative arguments, The Phia Group ultimately secured a negotiated payment of only $22,000; a net 76% or $69,000 in savings.
Continue reading Phia Group Announces Implant Cost Pro Service
Reference Based Pricing, Individual Responsibility & Willing Providers
By Bill Rusteberg
Reference Based Pricing with limited balance billing advocacy and legal defense services is the “grown-up” way of offering employer sponsored health insurance.
Continue reading Reference Based Pricing, Individual Responsibility & Willing Providers
For Physicians; The Cheese Has Moved
At last month’s American Medical Association (AMA) House of Delegates Interim meeting in Dallas, attendees approved a resolution to study the impact of physician unionization based on the growing concern about physician employment arrangements by hospitals and health insurers.
While it’s not likely physician unions will sweep the country, it’s certain physicians aren’t happy. Their reasons are understandable:
Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty
WASHINGTON – For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.
Continue reading Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty
Compound Drugs – A Killer Scam
By Joe Paduda
Compound drug use is exploding – so much so that Texas has changed their employee benefits program to limit reimbursement to $300. They didn’t have much choice, as the Texas Employees’ Retirement System’s compound drug costs have gone up 4,600% over five years. That was not a typo.
Indictment Alleges Massive Rx Scam – $100 Million in Overbilling
“workers’ compensation insurers would be billed in “the $1,500 to $3,000 range” for creams that had a wholesale cost of about $70………
In October and December of 2010, Sorat wore a wire while eating lunch with Ahmed. On the tapes, Ahmed can be heard boasting of his success: “I’m a behemoth, I make 8 to 10 million a month….It’s the fee schedule man! You got to mark it up. It’s like a 200 percent markup”
Continue reading Indictment Alleges Massive Rx Scam – $100 Million in Overbilling
Humana / Concentra Seek Primary Care Market Expansion in San Antonio
Humana seeks primary care sales representative in San Antonio.
The Primary Care Sales Specialist will report to and work in conjunction with the National Field Marketing Leader to help Concentra Primary Care achieve and sustain aggressive new patient and plan membership growth goals for each neighborhood medical center in San Antonio. Responsibilities include:
- Cultivate strong relationships with insurance agents and community partners to keep Concentra Primary Care top of mind as these professionals interact with our target demographic
- To help reach our target market Medicare-eligible seniors
(Humana San Antonio job posting 18 days ago).
Continue reading Humana / Concentra Seek Primary Care Market Expansion in San Antonio
Lawyer Discovers ObamaCare Gold
New IRS Rules Crack Down On Nonprofit Hospitals
The federal government is cracking down on nonprofit hospitals in an attempt to prevent harsh collection practices and steep charges for the uninsured.
Continue reading New IRS Rules Crack Down On Nonprofit Hospitals
Walgreens Closes Deal, Begins New Era In Global Pharmacy
Walgreens (WAG) closed its deal with Alliance Boots this morning, launching under a new holding company with its eyes on global expansion, a first for the retail pharmacy industry.
Continue reading Walgreens Closes Deal, Begins New Era In Global Pharmacy
How The Kind, Humble Physician Met His Demise
There once was a kind humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients. He was open and deliberate, calm and thoughtful. He himself hired every secretary and medical assistant, every nurse and biller. His staff formed a protective family who fiercely advocated for both patient and doctor.
Continue reading How The Kind, Humble Physician Met His Demise
Fixing our broken health care system: Sometimes David wins
“You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes………….Almost everyone without a financial stake looking at the U.S. system comes to the same diagnosis that it is crazy, dangerous, and unsustainable………….” Allen Frances, M.D.
Continue reading Fixing our broken health care system: Sometimes David wins
Probability 0.0000000000001%
https://www.youtube.com/watch?v=yuiG78Al3yc
บริษัท กรุงเทพประกันภัย จำกัด (มหาชน) มีนโยบายที่ชัดเจนในการดำเนินธุรกิจ ภายใต้กระบวนการการกำกับดูแลกิจการที่ดี โดยมุ่งเน้นให้มีการเปิดเผยข้อมูลแก่ผู้มีส่วนได้เสียทุกฝ่ายไม่ว่าจะเป็นผู้ถือหุ้น ผู้ลงทุน นักวิเคราะห์ พนักงาน