“When I asked him what he thought of this, his response was a resounding “Hell no!” and he said he would find something else to do if this ever happened.”
“While doctors may be losing the battle for autonomy, I hope that the enterprising and fiercely independent Uber drivers never do.”
“Insurance giant Assurant is looking to sell its health insurance division……. Regardless if a buyer is found, it will pull out of the health insurance marketplace by 2016…”
Wouldn’t it be a relief to find a partner that can help you successfully navigate the health care system?
The issue in this case was whether a New Jersey government agency should pay an ambulatory surgical center out-of-network health care benefits at 160% of the Medicare rate, rather than, as required by statute, a rate determined by a “nationally recognized database.”
“There are very few market forces that limit what an out-of-network provider can charge. For that reason, non-participating providers are often reimbursed significantly more than their in-network counterparts.”
One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.
Randall Petersen
Operating under multiple business names, Randall Petersen, 49, conducted a fraudulent insurance scheme that involved his theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.
Wellness programs are popular these days. Who wouldn’t be against healthier lifestyles? But according to this study exercise does not help in reducing obesity. Eating less does. The myth follows the same pattern as the global warming myth – both are politically correct but scientifically flawed – Molly Mulebriar
Moore before and after
A fugitive in Kentucky has turned himself in to authorities after decades on the run, so he can get medical care.
“Primary care physicians have become a key element in ObamaCare, especially through ACO’s. In San Antonio, Texas there is fierce competition among the hospital systems for market share. The key to the vault are the primary care physicians…………….” – Homer G. Farnsworth, M.D.
Suing a Ham Sandwich has never been easier, especially in Brownsville, Texas. All is needed is $150 for the filing fee………….
EL RRUN RRUN: BISD TRIES TO KEEP LID ON MULTIMILLION HEALTHSMART SUIT
By Jeff Amy | April 20, 2015
An 88-year-old Mississippi physician, who has faced scrutiny because he was practicing medicine from his car, said after a meeting with regulators that he now expects to be able to continue seeing patients.
Providers across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans……….Given their growing popularity, Providers need to be proactive in understanding and managing these types of programs.
“Roosevelt’s Progressives were the first major American party to pick up the baton of health care reform”
“The only difference between Democrats and Republicans is Republicans take longer to get there. Remember Medicare in 1966? Republicans opposed it, now they support it. Standing up for one’s principles is a fleeting, temporary and convenient emotion in politics” – Don Pedro
“We have been on a RBR/Cost Plus platform for five years. We changed to AMPS several years ago and highly recommend them. AMPS provides a quality product at a competitive price” – E. Juarez
John, der irrt! Deutsch Bier und deutschen Frauen sind die besten!
“There are plenty of reasons to brag about living in America, like the fact that we have the most innovative beers on the planet (sorry Germany)”
Patients might only be able to get to a doctor during the day on the weekends because it’s too dangerous in the neighborhood to be going out at night……The patient goes to the pharmacy but is told the new medication requires pre-approval. The patient doesn’t know what to do so the patient goes to smoke a cigarette…………...
Whole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.”
San Antonio’s Methodist Healthcare System has entered into an agreement with the Frio Hospital District Board of Directors and will take over administration and management of Frio Regional Hospital in Pearsall in the Eagle Ford Shale area.
DOL has ramped up its audit efforts on health plans. And now the audits include requests for documentation based on Health Reform (PPACA). Could you come up with this list of 30 items DOL Audit
” The exemption allows fiduciaries to receive compensation when plans and IRAs enter into certain insurance and mutual fund transactions recommended by the fiduciaries as well as certain related transactions.”
The City of San Antonio, through punitive restrictions on free trade has run off Uber from the city effective April 1. Now the State of Texas, through special interests, runs off telemedicine companies too? What has happened to traditional Texan values of hard work, innovation and freedom to conduct commerce?
A study for a large group we manage is quite interesting. Over a three year period average hospital billed charges (Chargemaster Rates) have increased 27% while our costs have increased 2%.
“RBR/Cost Plus offers employers the opportunity to lower healthcare charges by 30% or more and will soon dominate the healthcare landscape replacing the current PPO system that often grossly overpays hospitals and physicians.”
Connecticut’s Medicare-based fee schedule for workers’ compensation takes effect April 1.
The new fee schedule pays 174% of Medicare for in-patient care, 210% outpatient care and 195% for ambulatory surgical centers.
This is touted as a cost savings measure. Does this mean prior to April 1 Connecticut hospitals and ambulatory centers were getting more?
So much for managed care contracts these days and another reason why Cost Plus Insurance, Medicare Plus reimbursement schemes are taking the market by storm. Payers are “mad as hell and not taking it anymore……” – Homer G. Farnsworth, M.D.
SWBC is expanding its Employee Benefits Consulting Group into the Austin and Central Texas market.
“The CEOs of the Big Five for-profit health insurance companies all took home at least $10 million in 2014, according to each insurers’ annual filings with the Securities and Exchange Commission (SEC).”
“…….the time has come for us to replace private health insurers with a more efficient, not-for-profit single-payer financing system–national health insurance (NHI)–which could be enacted by passage of H. R. 676, Expanded and Improved Medicare for All.”
“Prescription drugs grew the fastest, by 10.5%, and hospital spending also rose rapidly at 9.0%.”
SimpleSaveRx is the first 100% defined contribution, 100% transparent PCM and it is the exact opposite of PBMs today.
Elections have consequences. ObamaCare, with John Robert’s blessing, is a tax. Although Congress can’t mandate everyone must buy broccoli they can sure tax you if you don’t.
By Homer G. Farnsworth
Does it matter how good you service a fully-insured account, or how long you have had it? Under the PPACA the answer is “probably no.” Low price has become the determining factor between success or failure in retention of business in today’s fully-insured market.
Most brokers remaining in the fully-insured market live or die on rates alone.
By Kurt Orzeck
The San Benito Independent School District’s self-funded health plan is in the red. Unexpected rise in health care expenditures have the school trustees searching for a solution.
Drug costs are skyrocketing and account for as much as 25% of total health care spend for plan sponsors. Most plans continue to cover prescription drugs through an antiquated system established years ago when drugs were relatively inexpensive.
What’s up in Texas these days? San Antonio runs off Uber April 1, 2015 by passing punitive ordinance restricting free trade, now we learn the great state of Texas is considering legislation that will run off telemedicine companies that have been operating within the state for years.
Hear this: If you are a self-funded employer or third-party administrator and you don’t have anyone looking at detailed facility claims you are jeopardizing your business.
“Dear Employee: As you may be aware, Santa Claus has passed a law to help us get affordable health insurance……”
With healthcare costs on the rise, Garland ISD aspired to create an affordable and convenient resource for its employees. After months of planning, construction and fine-tuning, the GISD Employee Clinic opened Wednesday, April 1.
We are excited to announce that AXIS has acquired Ternian Insurance Group, LLC, a leading provider of voluntary, limited benefit, affordable health plans and other employee benefits coverage for hourly and part-time workers and their families.
We partner with innovative benefit consultants and employers to bring intelligent healthcare solutions to the table. These solutions are cost-cutting opportunities for mid-sized companies – regardless of industry – that are easily implemented into existing benefit plans. http://www.benefitsally.com
San Benito – Home of Baldemar Garza Huerta (Freddy Fender)
In a special called school board meeting (http://board.sbcisd.net/wp-content/uploads/2015/03/s033015.pdf ) on March 30 the San Benito Independent School District rejected the administration’s recommendation to join the TRS ActiveCare plan.
“these administrative fees were concealed in marked-up hospital claims and “no longer visible” to its customers because they falsely appeared to be money owed to hospitals “
San Antonio, Texas RiskManagers.us, a specialty company in the benefits market that works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods has been awarded a $10,000,000 insurance contract by the City of San Antonio.
“We are pleased to make this announcement today and look forward to a long and rewarding relationship with the City of San Antonio,” stated company spokeswomen Molly Mulebriar.
