4 Reasons Why Self-Funded Employers Should Choose A TPA Over An ASO

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Mike Dendy, President of AMPS (Advanced Medical Pricing Solutions)

By Mike Dendy

I have been in the healthcare business as a benefits consultant for 25 years.  10 of those years were spent as a TPA owner/manager with the last 10 as CEO of a cost management company reviewing the work of ASOs, TPAs, and PPOs.  I can say without reservation that employers with self funded (ERISA) healthcare plans should choose a quality TPA over an ASO carrier for the following four reasons.

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The Chart That Could Undo The Healthcare System

[The chart] outlines the growth of administrators in healthcare compared to physicians over the last forty years.  A picture is worth a thousand words, isn’t it?

You see, when you have that much administration, what you really have is a bunch of meetings. Lots of folks carrying their coffee from place to place. They are meeting about more policies, more protocols to satisfy government-created nonsense. But, this type of thing in healthcare isn’t fixing things. It’s not moving the needle.

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Brownsville ISD vs HealthSmart Settlement Terms Revealed

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HealthSmart to pay BISD $2 million in three payments………….

Local Brownsville blog reports on terms of Brownsville ISD vs HealthSmart settlement. The controversy concerned the promise of deep PPO discounts and the perceived notion on the behalf of BISD they were screwed. This is a classic example of suing a Ham Sandwich and winning through extortion. (type in Brownsville ISD in the search box on this blog for previous postings) – Molly Muebriar

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ScotusCare

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Scalia wrote that the justices who authored the majority displayed “no semblance of shame” in their opinion. His dissent is littered with jabs at his fellow justices. “Today’s interpretation is not merely unnatural; it is unheard of,” Scalia writes. He describes another aspect of the majority’s analysis to be “pure applesauce.”

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The Truth About Voluntary Benefits

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Marsh Consulting Group

Here’s a little-known secret: Voluntary benefits often provide the broker with a first-year commission exceeding 60%, compared to a 3-7% commission for health plans………….These products, which typically pay out less than 50% of the premiums toward actual claims, may in the end hurt employers’ creditability once their employees realize that voluntary benefits aren’t much of a benefit after all.”

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Selling ObamaCare – Gruberize The Process

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“Michelle and I don’t want anyone telling us who our family’s doctor should be – and no one should decide that for you either. Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story”. – Barack Obama

 

Some Hospitals Charge 1000% Of Medicare Rates? That’s Outrageous!

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Some hospitals charge more than 10 times the Medicare rate, according to a new study published in Health Affairs on Monday.

“…..the mystery of the chargemaster continues. “What other industry can you think of that marks up the price of their product by 1,000% and remains in business?” said co-author Gerard Anderson.

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The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

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ETMC Files $1 Million Suit – Wants To Be Included In PPO

 

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The hospital says exclusion from the preferred provider networks (PPO) of these companies has created “serious and negative consumer impact.”

Note: Another good reason to leave the managed care world and pay medical caregivers a transparent, fair and reasonable reimbursement based off pre-determined benchmarkes.

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Physician’s Group To Decide Telemedicine Policy As Insurers Expand Telehealth Coverage.

 

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Forbes  (5/31) contributor Bruce Japsen wrote that the American Medical Association is set to debate and vote on telemedicine recommendations by the AMA’s Council on Ethical and Judicial Affairs “as the nation’s largest health insurers widen coverage of telehealth to unprecedented numbers of their health plan subscribers.”

Continue reading Physician’s Group To Decide Telemedicine Policy As Insurers Expand Telehealth Coverage.