“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.”
Continue reading Montvale Surgical Center v. New Jersey Health Benefits Commission
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.
Continue reading Do Fee Based Consultants Earn Kickbacks From Carriers They Recommend?
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.
Continue reading Insurance Agent Found Guilty of Racketeering and Money Laundering
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.
Continue reading Fugitive Ends 40 Years On The Run To Get Healthcare
“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.
Continue reading Medical Consolidation Continues In San Antonio
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
Continue reading Need A Second Opinion On Your Self-funded Medical Plan?
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.
Continue reading 88-Year-Old Mississippi Doctor to Continue Practicing From His Car
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.
Continue reading Cost Plus Insurance: New Reality In Provider Payment Models
“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
Continue reading Six Ways AMPS Is The Leader In Price Transparency
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)”
Continue reading It’s Cheaper To Fly Your Employee To Europe for their Appendectomy
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…………...
Continue reading Will Accountable Care For Medicaid Work In The Ghetto?
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.
Continue reading Methodist Healthcare Strikes Deal With Eagle Ford Shale hospital
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.”
Continue reading ERISA – Fiduciary Duty: Proposed Exemption to Engaging In “Self Dealing”
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?
Continue reading San Antonio Runs Off Uber, Now Texas Uberizes Telemedicine?
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%.
Continue reading Interesting Trivia for Insurance Consultant Nurds
“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.”
Continue reading Reference Based Reimbursement: What is required to do it right!
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.
Continue reading Connecticut Fee Schedule for Hospitals, ASCs Takes Effect
SWBC is expanding its Employee Benefits Consulting Group into the Austin and Central Texas market.
Continue reading SWBC Executive Expands Consulting Group to Austin
“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).”
Continue reading Top health insurance CEO pay exceeds $10 million in 2014
“…….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.”
Continue reading Why the Private Health Insurance Industry Has to Go
“Prescription drugs grew the fastest, by 10.5%, and hospital spending also rose rapidly at 9.0%.”
Continue reading Hospitals and Prescription Drugs Leading Health Spending Acceleration
SimpleSaveRx is the first 100% defined contribution, 100% transparent PCM and it is the exact opposite of PBMs today.
Continue reading Defined Contribution Rx Plan – What A Novel Idea!
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.
Continue reading Health Insurance Brokerage: Lowest Pricing Drives Sales in Fully Insured Market
By Kurt Orzeck
Continue reading Allstate Wins $46 Million Judgement In RICO Suit Over Health Claims
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.
Continue reading San Benito ISD Struggles To Fund Health Care Plan
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.
Continue reading San Antonio Runs Off Uber, Now Texas Runs Off Telemedicine Companies?
Romeo & Juliet on Wedding Day
Health care costs increase when utilization does……..
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.
Continue reading Employers, Cover Your Assets: Employee Contributions Leave You at Risk
“Dear Employee: As you may be aware, Santa Claus has passed a law to help us get affordable health insurance……”
Continue reading Employer Announces New Santa Claus Qualified Health Plan For Employees
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.
Continue reading Garland ISD Employee Clinic Holds Grand Opening
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
Continue reading Former Benefit Consultant Offers Innovative Partnership Opportunity
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.
Continue reading San Benito ISD Rejects TRS ActiveCare – Seeks Insurance Consultant
“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 “
Continue reading TPA Earns Undisclosed Fees Through Marked Up Hospital Bills?
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.
