“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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Awstats provides statistics on traffic activity for this blog. Number of visitors per month from June 2014 to May 2015 has averaged 93,106  http://www.awstats.org/

 David Belk, M.D.

Here’s the new website with a whole new look that’s been redesigned by Modern Creations: http://truecostofhealthcare.org

There are three new sections. The first is a study of the prices of brand name medications. It shows that the price pharmacies in the US pay for brand name drugs has gone up an average of 40% in 2 1/2 years.

That’s about 18 times the rate of inflation

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Provider Affairs Editor for Monkey Business Magazine

XYZ’s compensation for the services under its administrative services agreement(s) with certain group customers can include the difference, if any, between the net claim payments reimbursed to XYZ by the group customer and the net amounts paid to health care providers by XYZ, after giving effect to XYZ’s separate financial arrangements with health care providers.

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Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently owned companies are functioning as an illegal cartel.

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Maurice “Hank” Greenberg spent some of his 90th birthday party like he’s spent much of the past decade: angry. When asked if he’s mellowed with age, he set his jaw, locked his eyes straight ahead and said the interview should end.

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By Maxwell Murphy – Wall Street Journal

In late 2012, Don Ulrich moved from the boardroom to the chief operating officer post and set about scrubbing its healthcare costs……The 8,600-employee chain operates in the $25 million to $30 million range for annual health-care costs………..

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By Molly Mulebriar

Our staff is reviewing an active RFP for a self-funded employee health and welfare plan. A brief review unleashes wonderment.

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 Vicki Gunvalson

The insurance industry is littered with the bodies of agents who didn’t make it. The failure rate is massive, with upwards of 80 percent of agents making a career change within the first five years of entering the business. The struggles were no different for Gunvalson.

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From 2007 to 2013, private insurance costs increased 29%, more than twice Medicare’s growth and five times higher than Medicaid.

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Federal regulators have indicated that beginning in 2016 group health plans may be subject to a controversial interpretation regarding out-of-pocket limits…………

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The Weslaco Independent School District gets a rare Mulebriar rating of A+ for proactive management of their self-funded health & welfare plan.

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“….it will take a new skill set and a new mindset to survive in our new retail-driven market.……”

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Reacting to a Supreme Court order to reconsider, a federal appeals court refused on Tuesday for a second time to stop enforcement of the federal government’s birth-control mandate against the University of Notre Dame.

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Medicaid will not cover the health care costs of inmates while they’re in jail or prison, with state and local governments often footing the bill. But there is an exception that could save millions of local dollars: If an eligible inmate requires a stay in a hospital outside the corrections system that lasts more than 24 hours, his or her suspended Medicaid coverage can kick in to reimburse the costs. 

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“The total cost of typical employer-sponsored preferred provider organization (PPO) coverage for a family of four has increased 6.3 percent this year, to $24,671.”

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This article proves that managed care has failed. PPO’s drive costs up, not down. Within all PPO contracts there is, among other things, an annual escalator clause that guarantees annual increases in provider reimbursement. The annual compounding effect is enough to make grandma want to go back to the good old days when a dozen eggs would buy a doctor visit in the comfort of your own home, or a bottle of tequila and a jar of honey for that nasty cold Johnny brought home from school.

The table shown in the article leaves out Cost Plus Health Insurance Plans, or Reference Based Pricing models. These plans beat medical trend.

“Medical costs are directly related to what you agree to pay” – William Rusteberg

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Florida hospitals to Scott:  “You have suggested that a new tax on hospital operating surpluses might be a way to sustain the existing LIP program. Such an arrangement is not a solution to the challenge we face.”

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The Arizona Legislature has passed a law seeking to force anyone getting Medicaid to have a job…

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May 4, 2015 – Austin, Texas – Fringe Benefit Group, an industry leader in the design, implementation and administration of benefits for hourly and part-time workers, today announced it has acquired Houston-based Employer Plan Services, Inc. (EPSI), a Third Party Administrator (TPA). Terms of the transaction were not disclosed.

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Bertolini told analysts Aetna is now in contracts with 62 ACOs. “We have almost a million members in patients that are medical homes, which is 38% growth since the beginning of ’14 and over 760,000 members in what we call our high performance networks,” the Aetna CEO said.

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Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.

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The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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This week the government released new diktats requiring, among other things, that preventative care benefits extends to transgender individuals………………

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“Really? Our drugs are cheaper!”

Research estimates that the number of Hyphenated (pick Mexican, African, Anglo, Latino, German, Irish, etc.) Americans with six-figure drug bills jumped from 49,000 to 139,000 from 2013 to 2014.

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Molina Healthcare recorded booming revenue and net income figures in the first quarter, a direct result of the Affordable Care Act’s expansion of Medicaid and private health coverage.

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Dogs are man’s best friends, especially lawyers………….

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May 15, 2015 | By Lynette Gil

From these tales of loss, we can learn a lot and not repeat their mistakes.

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A strategic ‘think-tank and back-office’ for brokers and benefits advisors

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Free standing emergency rooms which by law cannot accept Medicare or Medicaid, are located in wealthy suburbs. It’s better than driving into the city and waiting for hours to see a doctor…….

“A typical bill at a free-standing emergency center is about $1,400, compared with about $200 at urgent-care centers.”

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Health care revolutionaries are unusual people. Information nomads never rest, never quit, until their quench is satisfied. Sharing truths enlightens all.

Jeanne Pinder is a Health Care Revolutionary. She is one of the ten most disruptive health care anarchists in this country.

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First Capitol has mastered utilization of its ACA, tax, payroll, and HR expertise, data collection infrastructure and technology to support clients in implementing an optimal ACA action plan.

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By Simple Sells

“I have made a small fortune using this simple, soft shoe approach.”

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Louisville-based insurance giant Humana Inc. is having a good day on Wall Street today amid speculation it could be purchased by competitor Hartford, Conn.-based Aetna Inc. (NYSE: AET)

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An amended version of Texas House Bill 3453 passed yesterday. The original version would have allowed Texas school districts to opt out of the TRS ActiveCare health plan. Instead, the amended version creates an Interim Committee to study the issue for future consideration.

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The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old………

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It turns out that one of the reasons workers have been paying more for their coverage is allegedly a common practice among insurers:  charging their employer customers unlawful hidden fees.

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This visit was going to be another learning experience. As I drove up to the ranch house, there he was, beer in hand, waiting. “What took you so long! I have something to tell you and it’s a god damn disgrace!”

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LabCorp, one of the largest outpatient lab providers in the USA, is soon going to let you skip the tedium of a doctor’s visit to get lab work done. Want some tests? Come on down!

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 What Promise!

“Our government is so dysfunctional that no one can trust it to honor any commitment of any kind.”

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When companies hold calls discussing drug costs with investors and analysts, “I’ve heard them ask, ‘Why didn’t you price it higher.’ I’ve never heard anybody say, ‘Why don’t you price it lower?’” Mr. Kolassa said.

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Session ends in less than 30 days. Will HB 3453 see the light of day?

Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.

” Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation.”

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Important information for our sales partners from Assurant Health 

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Homicide detectives knocked on his door and asked him why his leg was found in the garbage.

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“Provider sponsored health plans are gaining traction in the market” – Molly Mulebriar

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We received an email this morning regarding the upcoming vote on HB 3453 which will allow TRS ActiveCare participating school districts to opt out of the program.

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The Tennessean  (5/4, Fletcher) reports that United Healthcare is launching “a network of virtual visits for its commercially insured consumers as a way to provide more affordable health care for simple issues like colds.”

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   In 2015, 32% of employers plan to fully replace their existing options with a choice of only high-deductible options……

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May 4, 2015

Hub International Limited (Hub) subsidiary Hub International Midwest Limited (Hub Midwest) has acquired the assets of The Holmes Organisation (Holmes), a Tulsa, Okla.-based multi-line property and casualty, employee benefits and personal lines brokerage.

Terms of the acquisition were not disclosed.

The Holmes team will continue to operate from their existing offices in Tulsa and Little Rock, Ark., and will become part of Hub Midwest, establishing Hub Midwest’s fourth location in Oklahoma. Stuart F. DeSelms, president of Holmes, will join Hub Midwest as executive vice president and chief sales officer.

Source: Hub International Limited

The gist of the concept is, a company buys the insurance to cover liability arising from vehicles used in the course of its business. A common example is a pizza delivery business.

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   “ACA is the fuel which fires the self-funded engine of employee health and welfare plans, providing flexibility, control and lower costs. It is the parking brakes of fully-insured plans.” – Bill Rusteberg

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“By 2030, nearly one fifth of our population will be over the age of 65 and 70 percent of them will require some form of long-term care.”

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This article is about tough times for rural hospitals. Many are closing their doors because they can’t make ends meet. One solution to keep doors open are hospital-run Community Health Plans providing revenue for empty hospital beds – a win win business proposition.

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The Texas Medical Board has gutted Teledoc’s business model. Teledoc fights back…..

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 Mark Cockerham

School Board member accused of soliciting favor and accepting gift from school district insurance consultant.

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Commission compression is causing advisors to rethink their business model – especially looking a few years out. One option is to shift to a more consultative fee-based approach.

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As health care costs continue to climb, the last thing Texans need is a $145 billion health care tax that translates into higher premiums for themselves and their families.

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