The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.

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ACA and its blizzard of ever-changing regulations has created a challenging environment for even the most proficient advisors. We asked Arthur Tacchino, Chief Innovation Officer & Principal of Sync-Stream Solutions, to discuss those challenges and to examine some of the ways advisors can master and profit from providing their clients with expert and timely advice.

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IMAGINE FOR A MOMENT…  Your credit card bill showed up in the mail stating nothing more than: YOU OWE $5,000

That’s it?   …I bet you are on the phone within seconds.    

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An assorted collection of articles for those interested in Cost Plus / Reference Based Pricing models

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Growing business opportunities in Texas warrants a permanent footprint in the state. Houston targeted for AMPS newest office.

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Brooks Healthcare Solutions (BHS) has deep and broad relationships with hundreds of outpatient surgery centers across the country.

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Humana Inc. has revealed that it will sell Concentra……………

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Alexander Chatfield Burns

A 28-year-old ‘financial prodigy’ built a hundred million dollar insurance empire that now might be worthless (see article at end of this post)

An insurance empire that included two insurance carriers, two offshore reinsurers, several buildings and other insurers’ investments was built by a private equity firm in part on questionable assets and is now being dismantled, according to the Wall Street Journal.

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An idea with bi-partisan support?

If the federal government would rent their Medicare network and charge what the private market charges for access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.

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Victor Lustig “Why didn’t I think of this!”

THE FALLACY OF HOSPITAL CHARGEMASTERS 

“Hospital industry claims that the charges  don’t matter because few actually pay the “list” price “defy common sense,” Burger said. “If there is no reason for the high prices, why bother charging them?” Burger asks.  See Hospitals Dismiss Significance Of Chargemaster Prices?

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The Rio Grande City Independent School District is seeking Request for Qualifications for fee based insurance consultant to assist the district in the evaluation of their Cafeteria Plan and products. Deadline to submit a response to the RFQ is April 30.

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Aflac says it will now pay out certain voluntary benefit claims in one business day, an announcement that industry experts say will likely force competitors to follow suit.

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Asserta Health provides enabling infrastructure for “cash” health plans that deliver significant cost savings by eliminating the “value drain” associated with the typical payment process. The entire healthcare transaction is simplified, transparent, and supported by a service model that effectively frees clinical and financial resources to focus on improving the cost, quality, and efficiency of the care itself. The result is a better healthcare experience—and outcome—for the consumer, the provider and the payer.

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Texas state representative J. M. Lozano filed House Bill (3453) on March 12, 2015. If passed the bill will take effect on September 1, 2015 and will allow participating school districts to leave TRS ActiveCare.

School districts currently participating in the TRS ActiveCare program are prohibited from leaving.

If districts are allowed to come and go as they please, adverse selection will begin an irreversible death spiral – TRS ActiveCare could end up being an insurer of last resort.

Should HB 3453 become law many expect a strong “run on the bank.” Will El Paso Independent School District be the first to leave? See El Paso ISD Votes To Leave TRS ActiveCare

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“With the price of some treatments topping $100,000, patient (idiot) groups are pushing for state laws to make sure carriers (mean & nasty insurance companies) cover most of the costs. Their campaign is backed by an important ally: the drug industry.”

What these mental giants don’t seem to understand is that they are paying these costs through higher insurance premiums. The mean and nasty insurance companies simply pass on costs while taking their cut at the same time. And, with the Minimum Loss Ratio mandate in place the more the costs the more insurance companies are allowed to make. So these idiots are actually  screwing themselves by helping pharmacy manufacturers and insurance companies earn more money at their expense.

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San Benito CISD Board Meeting 3-10-15  See 1:39 – 1:43 – this four minute segment gives the viewer a snapshot of San Benito’s self-insured medical funding problem.

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Source: Clear Health Costs – www.clearhealthcosts.com

The Wall Street Journal reports that the Obama Administration is under pressure to allow uninsured women who become pregnant to enroll in Federal exchange plans at any time during the year.

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Greener Pastures Drive Move?

The El Paso Independent School District will petition the Teacher Retirement System to leave its statewide health insurance program because of rising costs to the district and employees. “It’s a hellhole” said Board President Margo

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Faster than a melting raspa, the New Mexico Superintendent of Insurance has rescinded the state’s new stop loss insurance mandate.

http://www.osi.state.nm.us/insurance-bulletins/docs/Bulletin2015-010.pdf

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Notre Dame contends the opt-out provision is insufficient to protect its religious rights.

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Are You Kidding Me! I can’t cover my husband anymore? And I lose my doctor too? What kind of plan is this!

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The Texas Medical Board is attempting to change a rule that would restrict Texas businesses and citizens from utilizing telehealth services.

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Michelle is not happy as she has Oprah and guests arriving the next morning.  The bucket fills up quickly and has to be emptied every hour, and there’s a risk the room will flood, so Obama calls Joe and pleads with him….….

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“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.

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“And all of this began with our 1967 purchase of National Indemnity for $8.6 million,” Buffett wrote…..“Last year, our premier position in reinsurance was reaffirmed by our writing a policy carrying a $3 billion single premium”

“How much is the premium did you say Warren, $3,000,000,000 for a single policy? 

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Study predicts there will be more cost shifting to workers’ compensation as ACOs gain in popularity in the group health market. A good example of unintended consequences. ACA is chock full of unintended consequences………..

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Prices for the same medical service vary widely across the country, and even within the same city. To help provide transparency on costs, some of the largest U.S. health insurers will now reveal the prices they pay for a number of medical services at Guroo.com.

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Montgomery Management, a full service MGU, has been providing flexible, innovative stop-loss and life products to the marketplace since 1986. Our professional expertise, personalized service, corporate strength and stability make Montgomery Management an industry leader.

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“To hide the scheme, Aetna claimed that North Cypress consistently overcharged for routine procedures.”

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By Darrell Pruitt, DDS

Until now, those who sell discount dentistry plans like Delta Dental, BCBSTX and AmeriPlan have always been less than transparent with naïve, vulnerable consumers about how their AmeriPlan-preferred dentists can discount their fees up to 80%, and still make a living.

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The outdated notion of assigning patients to doctors has repeatedly been shown to not work for patients or save money.

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Blue Cross and Blue Shield says it has posted its first financial loss since 1999 as a result of insuring high numbers of older and sicker people under the Affordable Care Act.

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The objectives of the audit were to review the consultant’s report and determine the reason for the difference in the consultant’s calculated change in the fund surplus versus the audited change in fund balance for the Group Health and Life Insurance Fund.

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Yet another paper has been published on the waste of time, money and morale that results from the recent infatuation with wellness programs.

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With the PPACA rules on mandatory minimum medical loss ratios (MLR) rules now in place, brokers should not be saddling clients with “fee” arrangements or underfunded commission agreements on medical policies.

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