Archive for September, 2015


Wednesday, September 30th, 2015

SimpleSaveRx realizes that a change is needed in the healthcare industry to make prescriptions work more like everything else in business and less like healthcare. SimpleSaveRx, by focusing on prescriptions, will enable members to achieve the greatest savings possible per prescription.


The Future of Doctors

Sunday, September 27th, 2015


By Robert E.H. Khoo, M.D., F.R.C.S.(C), F.A.C.S.

I predict that within 20-30 years the computer will replace the venerable physician……


Mulebriar Offers Rx Cost Containment Strategy

Sunday, September 27th, 2015
mulebriarBy Molly Mulebriar
If Cost Plus / Reference Based pricing model uses Medicare pricing as the claim benchmark why not use 340b Rx pricing as the benchmark for Rx claims? The 340b program is a government mandated pricing scheme as is Medicare.


Court Case Exposes Industry Secret – Hidden Fees Within PPO “Discounts”

Friday, September 25th, 2015


“The hidden fees were listed in internal BCBSM documents under a variety of names:  provider network fees, contingency/risk fees, retiree surcharges, and—my personal favorite—other-than-group subsidy fees. Internal company emails showed that BCBSM knew customers were unaware of the markups and that the company actually trained its employees to downplay the hidden fees should customers suspect they were being gouged.”

Editor’s Note: How many lawsuits do you want to research before you decide the truth insurance companies don’t want you to know? Anheuser Busch vs Cigna, Oakland County vs BCBS, Weslaco ISD vs Aetna, and Hi-Lex Controls vs BCBS all expose how carriers often earn undisclosed fees through PPO contract arrangements.


Employers Shift More Costs To Workers

Thursday, September 24th, 2015


Associated Press

Employers are leaving a bigger chunk of the bill for care to workers who use their health insurance, and benefits experts see few signs of this trend slowing.


Why Single-Payer Health Coverage May Be The Nation’s Future

Thursday, September 24th, 2015

tissue1Are you kidding me? The federal government “may be tempted” to eliminate health insurers?


Drug Goes From $13.50 A Tablet To $750 Overnight

Tuesday, September 22nd, 2015


Specialists in infectious disease are protesting a gigantic overnight increase in the price of a 62-year-old drug that is the standard of care for treating a life-threatening parasitic infection.

The drug, called Daraprim, was acquired in August by Turing Pharmaceuticals, a start-up run by a former hedge fund manager. Turing immediately raised the price to $750 a tablet from $13.50, bringing the annual cost of treatment for some patients to hundreds of thousands of dollars.


Frustration of Purpose & Assignment of Benefits

Monday, September 21st, 2015


‘”When a patient offers their right to obtain benefits from their insurance, that assignment of benefits is in and of itself consideration in full, exchanged for services and treatment.  An assignment of benefits is thus not a form of access to consideration, and rather, is the consideration itself.  One might ask why a medical service provider would ever choose to accept an assignment of benefits in lieu of the right to bill a patient for 100%.” – Adam Russo

“An assignement of benefits contract may (can, will)  create a frustration of purpose” – Molly Mulebriar


Dr. Belk Issues Financials On PBM’s

Sunday, September 20th, 2015

The actual purpose of a pharmacy benefits manager (PBM) is somewhat questionable. Their stated purpose is to mediate prescription medications prices for insurance companies. What’s interesting is the fact that over 80% of prescription drugs sold since 2012 are generic which means that most of these medications are inexpensive to begin with. What’s more, there’s no evidence that PBMs provide any real discounts to the prices of brand name medications.


Big Government Grants Permission For Business To Expand

Saturday, September 19th, 2015


Feds give approval for Doctors Hospital at Renaissance to double in size

STAFF REPORT | Posted 3 days ago

EDINBURG — Federal officials have granted a request by Doctors Hospital at Renaissance to double its size, which would make it the largest hospital in the Rio Grande Valley, according to a news release Wednesday evening.


9.5% ACA Max Cost = Boon To Entitlement Crowd?

Wednesday, September 16th, 2015


By Molly Mulebriar

I recently presented a renewal to a client. The audience was the owner and his secretarial staff. When I mentioned that under the ACA, one of the requirements to maintain an “approved” plan was the prohibition of charging plan participants more than 9.5% of their gross income for individual coverage.


The Easiest $1,000 You’ve Ever Made

Tuesday, September 15th, 2015


Due to the incredible success of our Reference Based Reimbursement solution, we are looking to add two new sales professionals to the AMPS team.


Local Provider Participation Fund

Monday, September 14th, 2015
“It is a misnomer……….it should be called the Taxpayer-Consumer Participation Fund…..” – Homer G. Farnsworth, M.D.


Teacher Strike A Great Opportunity To Solve Health Care Costs

Friday, September 11th, 2015


By Dave Chase

The impact out-of-control healthcare costs has been devastating to school funding. Have you ever wondered why class sizes have increased, after school programs have been cut and most teachers haven’t received a raise since 2000 (adjusting for inflation)?

It is directly linked to healthcare as the graphic below demonstrates. In “Teacher Unions On Wrong Side Of Negotiating Table,” I included more disturbing datapoints from Bill Gates’s TED Talk about how healthcare is devastating education.

That article also includes links to how the math simply can’t work without tackling health benefits in a fundamentally different manner.


Trivia Quiz

Thursday, September 10th, 2015

googleWhat does Anheuser Busch vs Cigna, Oakland County vs BCBS and Weslaco ISD vs Aetna have in common?

A. All Three are lawsuits

B. All PPO contracts are contracts of adhesion

C. PPO “discounts” are not entirely passed on to the consumer

D. All of the above

Caution: No Cheating Allowed! Do not Google Search before taking this quiz


Not A $1,000 Toothbrush, But Close!

Friday, September 4th, 2015


“We just picked up a claim from a hospital in Nebraska with a charge for $500 to borrow a baby seat to transport a new born from the hospital to home.  Seat has to be returned of course. “


Edinburg ISD Issues Gag Order During RFP Process

Friday, September 4th, 2015

gagorder“To go from being ranked 2, 3 or 4 to #1 based upon a 20 minute presentation is a formidable task. To do so under a gag order takes it into the realm of impossibility.”


Brownsville ISD To Terminate BCBS – Hires UHC

Tuesday, September 1st, 2015


To simply change TPA’s to continue to manage claims under secretive managed care contracts which the district can’t see nor audit will not produce different results by lowering costs. The definition of insanity can be applied here.