Archive for October, 2015

How Doctors Became Subcontractors

Saturday, October 31st, 2015


“In our healthcare system, the “middleman” is not who you think………… In reality, it is the physician who has become a “middleman” in the healthcare transaction or, as I argued, a subcontractor to the insurer.”


Many Need to Shop Around on as Prices Jump, U.S. Says

Saturday, October 31st, 2015


GOVERNMENT SPIN DOCTOR ON CRACK: “The Affordable Care Act has created a dynamic, competitive marketplace, with considerable choice and affordable premiums in 2016.”


Health Care Cost Discrimination – Not All Prices Are Equal

Friday, October 30th, 2015


“If you want the $6,221 MRI, you should have it — but you should pay for it, not me, not my employer, not my government. If you want the $300 test, it’s yours. If you want to buy your prescription for $150, go ahead. But you should also know that if you walk two blocks, you can get it for $17. (Yes, these are real numbers.)”

Editor’s Comment: The following article is a good one. It clearly shows the convoluted pricing of health care in this country. It also brings up a valid issue: health cost discrimination in health care. Health insurance is a reimbursement benefit. Members incur medical expenses, and are then reimbursed (never mind Assignment of Benefits – all that is extended credit by providers). So why should a plan sponsor reimburse employee Jones $3000 for an MRI and only reimburse employee Smith $400 for the same exact medical procedure? That is discrimination of the worst kind…………..

“Not all prices are equal in health care” – Molly Mulebriar


ObamaCare is Falling Apart

Friday, October 30th, 2015

Trident Public Risk Solutions

Wednesday, October 28th, 2015


Trident Public Risk Solutions (Trident) strives to be the preeminent specialty commercial insurance provider for public entities. From small municipalities who need first-dollar coverage to larger public entity risks that require unique funding and reinsurance mechanisms, Trident is your single-source platform for public-sector risk management solutions.


Cadillac Tax – Controlling Behavior

Monday, October 26th, 2015

wine“If people have insurance that pays for too much, they don’t have enough skin in the game.”


Free Market Lesson – Former Hedge Fund Manager Faces Competition

Saturday, October 24th, 2015

Ex-Hedge Fund Manager Who Jacked Up Price of Drug by 5,000 Percent Gets Lesson in Free-Market Capitalism


Puerto Rico Looks To Organ Transplant Business To Cure Ailing Economy

Friday, October 23rd, 2015


“Puerto Rico’s potential as a transplant center is partly based on a macabre statistic – the Caribbean island had a murder and non-negligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the United States………….”


Protection Money Staves Off Balance Billing

Thursday, October 22nd, 2015

"Let's get this straight-who's paying who protection money?"

“We all know that the average American health care consumer seldom have the money to pay their own health insurance deductibles and co-insurance, especially now that health plans are gravitating to higher deductibles and out-of-pocket exposure. Paying these expenses is difficult enough, much less balance bills” – Molly Mulebriar


Drug Politics – A Bipartisan Issue?

Wednesday, October 21st, 2015


“Psst, we should get in the prescription drug business Godfather!”

Drug politics go Republican as Rubio criticizes industry

Oct 20, 2015 | By Drew Armstrong and Sahil Kapur

(Bloomberg) — Republican presidential candidate Marco Rubio joined the debate over U.S. drug prices, saying in a speech last week that some practices by the industry amounted to “pure profiteering.”


Amazing Rx Cash Pricing Differencials For Lantanaprost

Tuesday, October 20th, 2015


Lantanprost average retail pharmacy cost $6

Retail Cash Prices:

HEB – $90

Walgreens – $76

Independent Pharmacy – $18

Cash paying customers see this and act accordingly. Those with insurance see only a small co-pay and don’t give a damn


From a Doctor:

Check this out –

From a PBM:

You are right on it.  I looked up our MAC for Latanoprost with NDC 17478-0625-12.  Our current MAC effective for October is $3.58085 per unit and the bottle contains 2.5 units which mean ingredient cost would be $8.95.  Pretty good reference based pricing, huh.


Tuesday, October 20th, 2015


Now that ObamaCare is failing in the exact way its critics predicted more than 5 years ago, the White House is preparing to use threats to increase ObamaCare enrollment numbers next year. The threat, of course, is the ObamaCare tax.


No Ready-Made Rx For Rising Drug Costs

Monday, October 19th, 2015


When Turing Pharmaceuticals raised the price of an older generic drug by more than 5,000 percent last month, the move sparked a public outcry. How, critics wondered, could a firm charge $13.50 a pill for a treatment for a parasitic infection one day and $750 the next?


Aetna and Humana Merger A Bad Deal For Texas, Physicians Warn

Sunday, October 18th, 2015


“……if Aetna and Humana are allowed to merge, the new company would gain control of 36 percent of Texas’ health insurance market……..physician groups especially could be negatively affected by a merger as they could end up with “very little negotiating leverage to allow them to secure favorable pricing terms.”


Stories Causing Atlas To Shrug

Friday, October 16th, 2015

Your Benefit Solution

In California taxpayers pay 75% of premium for Obamacare recipients. Families making up to $96K qualify for the handouts.

The government is not prepared for the complicated 2016 Obamacare reporting required to determine who is eligible for premium handouts. As a result the IRS is going to assess penalties against employers even if an employer does not receive the legally required warning notice.

Governmental Budgeting Prowess: When held to private standards (without the ability or print money to borrow infinitely) this Obamacare fund will only be able to pay 13% of the money it owes under the statue.

The Federal Government decided that the old system of 13,000 medical codes wasn’t enough and has commanded that all medical providers move to a new system with 68,000 so that we can have codes for repeatedly walking in lampposts and getting sucked into a jet engine.


Dumb Consumers Protected Against Evil Balance Billing

Friday, October 16th, 2015


Dumb American health care consumers need big government to protect against evil balance billing by greedy health care providers. The government of New York is doing something about it……………


Four Reasons Drugs Are Expensive, Of Which Two Are False

Thursday, October 15th, 2015


“North Korea and the drug industry are the last bastions of Marxism”


What’s Driving Healthcare Spending? It’s the Drugs, Stupid!

Monday, October 12th, 2015


“This latest health care spending growth report is more proof that astronomical prescription drug pricing continues to send health care spending higher and higher for consumers, public programs and our economy”


New Study Confirms Some Women Are Charged More Than Other Women

Monday, October 12th, 2015

susan Susan B. Antony

New study reveals that some women pay more for health care services than other women. Identical health care services range for some women as much as 76 times more than for other women.


Measuring Change

Sunday, October 11th, 2015


QUESTION: How do we know we are doing much better this year than last year?

ANSWER: What was this year is last year plus or minus this year’s changes.

If change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t now how to measure what it was before. 

Source: Unknown

HIPPA Audits To Begin

Sunday, October 11th, 2015


Source: DK Pruitt

 “United States: OCR Confirms HIPAA Audits To Begin in Early 2016 – Forced to respond to a stinging audit report recently released by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) that found less than effective enforcement of the HIPAA privacy standards, HHS’s Office for Civil Rights (OCR) will commence its long-awaited HIPAA audits in early 2016.” By James E. Bowers for Mondaq, October 9, 2015

 “EHRs provide long-term savings, convenience.” (No byline, ADA News, December 6, 2013).

The 16 Most Absurd ICD-10 Codes

Sunday, October 11th, 2015


Sucked into a jet engine, survived, then sucked in again? First of all, that really, really sucks. Second of all, this patient is obviously Wolverine, and should be detained for imaging and posterity.


Forest Park Medical Center San Antonio Property Owner Files Bankruptcy

Sunday, October 11th, 2015


“….the filing was attributed, at least in part, to financing challenges and insurance company curtailment of payments to facilities that have traditionally operated as out-of-network providers….”


Take Command Health, Zane Benefits Partner to Serve Small Businesses in Texas

Sunday, October 11th, 2015


Take Command Health, a Texas-based startup dedicated to helping individuals choose and save on their health insurance, is partnering with Zane Benefits to provide Texas businesses with fewer than 50 employees with health benefits products and services.


McAllen Independent School District Seeks Insurance Consultant

Saturday, October 10th, 2015



Patient Protection? Who is the Boogie Man in the Room?

Thursday, October 8th, 2015


By Dr. Alan Preston

“Who is the boogie man in healthcare? I am going to look at three possible culprits as to cost drivers of healthcare…”


Harlandale ISD Questions Land Deal – Quid Pro Quo?

Wednesday, October 7th, 2015

quid“He bought a waterfront home near Rockport from the CEO of an insurance company that does business with the district. Diane Mullen is competing to win contracts worth more than a million dollars.”

“Madrigal recommended board members choose her, but did not disclose he had done personal business with her.”


Sierra-Berkshire Associates, Inc.

Wednesday, October 7th, 2015

riskassesmentSierra-Berkshire Associates provides actuarial consulting services for employee benefit plans sponsors, insurance carriers, hospital, physician and other provider groups, and for TPA’s and marketing firms.


Medical Community Will Compete For Business If Given The Opportunity

Wednesday, October 7th, 2015

GM&A Corporate Health Care Consultants

In 1999 several large progressive-thinking employers approached GM&A because they felt victimized by the increasingly hyper-expensive healthcare industry. They wanted to know if we could help arrest the growth of soaring medical expenditures.


Hidalgo County Seeks Insurance Consultant

Sunday, October 4th, 2015


Hidalgo County approves RFP process for professional consulting services for the Hidalgo County Self-Funded Health & Welfare plan.


Government Asks Supreme Court For Contraceptive Mandate Ruling

Sunday, October 4th, 2015
The Obama administration has asked the U.S. Supreme Court to decide if religious nonprofit groups should be exempted from the federal health care reform law’s so-called contraceptive mandate.


Asserta – A Better Way To Pay For Healthcare

Friday, October 2nd, 2015

Asserta Health provides enabling infrastructure for “cash” health plans that deliver significant cost savings by eliminating the “value drain” associated with the typical payment process. The entire healthcare transaction is simplified, transparent, and supported by a service model that effectively frees clinical and financial resources to focus on improving the cost, quality, and efficiency of the care itself. The result is a better healthcare experience—and outcome—for the consumer, the provider and the payer.


Associated Builders & Contractors Announce Medical Plan For Members

Friday, October 2nd, 2015

abc111AUSTIN, Texas, October 1, 2015 — Associated Builders and Contractors (ABC) and Fringe Benefit Group today announced the expansion of The Contractors Plan, a benefits platform designed specifically for construction contractors, to include a full suite of benefits including ACA-compliant major medical, dental, vision, life, disability, retirement and HRA plans – all managed through a single online platform.


School Superintendent’s Land Deal With Insurance Agent Draws Scrutiny

Friday, October 2nd, 2015

mullen Diane Mullen

“There needs to be some kind of investigation, that way there is transparency at Harlandale,” says Julie Gimbel, President of the Harlandale Educational Association, the union which represents teachers.


Friday, October 2nd, 2015

Thanks ObamaCare!

Friday, October 2nd, 2015

thanksI just got the first year bill from my payroll company for the extra reporting we have to do each year vis a vis Obamacare:  $7195.50 for 2015.  Note that this adds absolutely no value — this is not the cost of insurance or cost of any extra taxes sent to Uncle Sam.  This is merely the cost to handle all the new paperwork required in the law.

I will repeat what I have said before — the Republicans tend to focus narrowly on taxes and often tend to miss or downplay the regulatory issues, which I think actually loom larger in destroying economic growth.