“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.”
Month: May 2015
RiskManagers.us Website Visit Statistics
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., Announces New Website
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
XYZ Insurance Company Discloses Separate Financial Arrangements With Providers
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.
Continue reading XYZ Insurance Company Discloses Separate Financial Arrangements With Providers
Antitrust Lawsuits Target Blue Cross and Blue Shield
(click on map to enlarge)
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.
Continue reading Antitrust Lawsuits Target Blue Cross and Blue Shield
Greenberg at 90 – Still Fighting and Angry After All These Years
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.
Continue reading Greenberg at 90 – Still Fighting and Angry After All These Years
How One Supermarket Chain Is Tackling Health-Care Costs
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………..
Continue reading How One Supermarket Chain Is Tackling Health-Care Costs
Canoes, Skiffs, Submarines, Battleships and Chinese Junks
By Molly Mulebriar
Our staff is reviewing an active RFP for a self-funded employee health and welfare plan. A brief review unleashes wonderment.
Continue reading Canoes, Skiffs, Submarines, Battleships and Chinese Junks
Meet The Reality TV Star With A $15 Million Annuity Business
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.
Continue reading Meet The Reality TV Star With A $15 Million Annuity Business
Which Controls Spending – Private Insurance or Medicare/Medicaid?
From 2007 to 2013, private insurance costs increased 29%, more than twice Medicare’s growth and five times higher than Medicaid.
Continue reading Which Controls Spending – Private Insurance or Medicare/Medicaid?
Embedded Out-of-Pocket Limits – Let’s Make ACA More Confusing
Federal regulators have indicated that beginning in 2016 group health plans may be subject to a controversial interpretation regarding out-of-pocket limits…………
Continue reading Embedded Out-of-Pocket Limits – Let’s Make ACA More Confusing
Weslaco Independent School District Gets A+ For Health Care Management
The Weslaco Independent School District gets a rare Mulebriar rating of A+ for proactive management of their self-funded health & welfare plan.
Continue reading Weslaco Independent School District Gets A+ For Health Care Management
What A Hospital CEO Learned From Nordstrom
“….it will take a new skill set and a new mindset to survive in our new retail-driven market.……”
Memorial Day 2015
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
Notre Dame Birth-Control Protest Denied Again
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.
Continue reading Notre Dame Birth-Control Protest Denied Again
Is Medicaid the Answer to Crushing Health Care Costs for Inmates?
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.
Continue reading Is Medicaid the Answer to Crushing Health Care Costs for Inmates?
Milliman Report – More Evidence PPO’s Failure To Control Costs
“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.”
Continue reading Milliman Report – More Evidence PPO’s Failure To Control Costs
San Benito ISD Seeks TPA, PBM, Stop Loss Insurance Proposals
Specifications for the Employee Health Benefits-Health Products proposal and corresponding information: http://purchasing.sbcisd.net/category/bids/ If you need additional information you may contact:
Mr. Adrian Garcia, Purchasing Agent
SBCISD Purchasing Department
240 N. Crockett Street
San Benito, TX 78586
(956) 361-6390
240 N. Crockett Street
San Benito, TX 78586
(956) 361-6390
This Article Proves PPO’s Have Failed To Control Costs
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
Continue reading This Article Proves PPO’s Have Failed To Control Costs
Florida Hospitals Tell Scott To Support Medicaid Expansion, Scrap Profit-Sharing Plan
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.”
Want Free Health Insurance? Must Be Employed To Qualify
The Arizona Legislature has passed a law seeking to force anyone getting Medicaid to have a job…
Continue reading Want Free Health Insurance? Must Be Employed To Qualify
Fringe Benefit Group Purchases EPSI
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.
Value Based Care Will Drive Aetna’s Future Goals
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.
Continue reading Value Based Care Will Drive Aetna’s Future Goals
When Did Primary Care Physicians Stop Becoming Doctors?
Paul searched around the room thinking he was on a candid camera show. But he found no cameras, no laughing audience, or genial host.
Continue reading When Did Primary Care Physicians Stop Becoming Doctors?
Weslaco ISD vs Aetna
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.
More Government Diktats (Obey or Go To Jail)
This week the government released new diktats requiring, among other things, that preventative care benefits extends to transgender individuals………………
Continue reading More Government Diktats (Obey or Go To Jail)
Drug Costs Exceed $100,000 A Year For More Hyphenated-Americans
“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.
Continue reading Drug Costs Exceed $100,000 A Year For More Hyphenated-Americans
Molina Profits Surges – Fueled By Medicaid
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.
Dog Bite Is worth $32,000
4 Of The Wealthiest Families Who Lost It All
May 15, 2015 | By Lynette Gil
From these tales of loss, we can learn a lot and not repeat their mistakes.
Continue reading 4 Of The Wealthiest Families Who Lost It All
Code SixFour
A strategic ‘think-tank and back-office’ for brokers and benefits advisors
The Texas Approach to Emergency Treatment
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.”
Health Care Revolutionaries – First of A Series
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.
Continue reading Health Care Revolutionaries – First of A Series
First Capital Consulting Inc.
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.Simple Sells Reveals Proven Selling Strategy
By Simple Sells
“I have made a small fortune using this simple, soft shoe approach.”
Continue reading Simple Sells Reveals Proven Selling Strategy
Aetna To Purchase Humana?
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)Amended Version of Texas HB 3453 Passes
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.
New Machine To Replace Anesthesiologists?
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………
PPO Discounts – Shell Game
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.
Rx Encounter In Victoria – Cuero Texas
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!”
Order Your Own Lab Tests – What Could Go Wrong?
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!
Continue reading Order Your Own Lab Tests – What Could Go Wrong?
City of McAllen Seeks Competitive Proposals
The City of McAllen is inviting your company to participate in submitting a sealed formal proposal for the above referenced project.
Continue reading City of McAllen Seeks Competitive Proposals
Government Defaults On PPACA Obligation
What Promise!
“Our government is so dysfunctional that no one can trust it to honor any commitment of any kind.”
Pharmaceutical Companies Buy Rivals’ Drugs, Then Jack Up the Prices
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.
Continue reading Pharmaceutical Companies Buy Rivals’ Drugs, Then Jack Up the Prices
Update On HB 3453 – Postponed
Session ends in less than 30 days. Will HB 3453 see the light of day?
| Session | Title/Description | Last Action |
| 2015-2016 84th Legislature (Introduced) |
Relating to participation in and rates for coverage provided under the uniform group coverage program for active employees. [HB3453 2015 Detail][HB3453 2015 Text][HB3453 2015 Comments] |
2015-05-06
Postponed |
Overkill
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.”
Assurant Changes Commission Structure Prior to Market Exit
Important information for our sales partners from Assurant Health
Continue reading Assurant Changes Commission Structure Prior to Market Exit
The Case of The Missing Leg
Homicide detectives knocked on his door and asked him why his leg was found in the garbage.
The Financial Advantages of Provider-Sponsored Health Plans
“Provider sponsored health plans are gaining traction in the market” – Molly Mulebriar
Continue reading The Financial Advantages of Provider-Sponsored Health Plans
HB 3453 – Will TRS ActiveCare Survive? Floor Vote Wednesday….
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.
Continue reading HB 3453 – Will TRS ActiveCare Survive? Floor Vote Wednesday….
United Healthcare Launches Virtual Health Care Visits
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.”
Continue reading United Healthcare Launches Virtual Health Care Visits
Don’t Ask & We Won’t Tell
“Don’t Ask and We Won’t Tell” brings clarity to the issue of undisclosed kickbacks paid by some carriers/TPA’s to “independent” insurance consultants.
32% of Employers To Offer Only High Deductible Health Plans
In 2015, 32% of employers plan to fully replace their existing options with a choice of only high-deductible options……
Continue reading 32% of Employers To Offer Only High Deductible Health Plans
Oklahoma-Based The Holmes Organisation Acquired by Hub
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
RIMS Report: Uber Touts Ridesharing Insurance Solution
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.
Continue reading RIMS Report: Uber Touts Ridesharing Insurance Solution
PPACA – Game Changer For Health Care Financing
“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
Continue reading PPACA – Game Changer For Health Care Financing
America Has A Long-Term Care Crisis
“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.”
Rural Hospitals Struggle to Stay Open, Adapt to Changes
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.
Continue reading Rural Hospitals Struggle to Stay Open, Adapt to Changes
Teledoc Sues Texas Medical Board
The Texas Medical Board has gutted Teledoc’s business model. Teledoc fights back…..
Ethics Case Against Former School Board Member Tied to Insurance Consultant
Mark Cockerham
School Board member accused of soliciting favor and accepting gift from school district insurance consultant.
Continue reading Ethics Case Against Former School Board Member Tied to Insurance Consultant
Shifting From Commissions To Fees
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.
Texas Lawmaker Gathers Support To Repeal Health Insurance Fee
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.
Continue reading Texas Lawmaker Gathers Support To Repeal Health Insurance Fee