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RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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Court Case Shows How Health Insurers Rip Off You And Your Employer

ripoff“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………………Lest you think this scheme was something BCBSM dreamed up on its own, an actuary from the consulting firm Milliman Inc. testified under oath that many other insurers engaged in the same practices.”

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I Am Retiring!

retirement

Good Morning Martha,

 I AM RETIRING!! Today is my last day at work. My official day of retirement will be January 1, 2016.

 I just wanted to say thanks for the many years you and Bill have helped me do my job. When a situation arise and I was in doubt as to how help my co-workers with questions about their claims or insurance coverage, I knew  all I had to do was to contact one of you  and the situation was taken care. I will miss  you. Take care and hope you’ll have happy holidays coming up and a very happy New Year!

Jesse

Protection Money in Health Care

mulebriar

“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices.”

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State of the TPA Industry & Market + Forecast for 2016

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Personal candid comments from SPBA Active Past President Fred Hunt

I have been writing these candid report/forecasts for 35 years.  I appreciate SPBA President Anne Lennan inviting me to continue the tradition each year.  I am happy to say that the rate of accuracy (how things have turned out) of these reports & forecasts is about 90%.  These were originally designed for reading just within SPBA, but our members believe in transparency, so the total candor is open for anyone to read.  So, these are read not only by SPBA members to compare their situation to what I’m hearing from their peers….but these are also read by investors in SPBA firms, brokers, clients, etc.

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More Evidence of the Failure of PPO’s – “4th Largest City Has No PPO’s”

houston

Seth Chandler, a law professor at University of Houston’s Health Law Policy Institute, put it even more bluntly: “It’s dramatic that the fourth-largest city in the country does not have a PPO.”

In 2015 there were 19 PPOs available in Harris County, 12 from Blue Cross Blue Shield and seven from Cigna Health Insurance, Chandler said. Now there is none.

“We found that the individual PPO plan was no longer sustainable at the cost it was being offered,” the company (BCBS) said. “Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.”

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EHR State of Mind

lovehate

I have a love-hate relationship with the Electronic Health Record (EHR). To be precise, it’s 90% hate, 6% love. The missing 4%? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.

(See video at the end of this article)

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ITL Announces Upcoming Conference

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The insurance industry is in the midst of the most consequential season in its history, so ITL is proud to be partnering with Silicon Valley Innovation Center for Insurance Disrupted, Silicon Valley, 2015, a conference in Palo Alto, CA, on November 19 and 20, 2015.  This timely gathering brings together many of the smartest people and best ideas from those who are shaping the future of insurance. You do not want to miss this summit.  With limited space available, we recommend that you register today

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Pennsylvania Health System Offers Up-front Pricing, Prepayment

stlukes

A Pennsylvania health system is making a significant change in how it charges patients for procedures. Instead of sending them or their insurers a complex bill with dozens of different charges after the fact, St. Luke’s University Health Network is posting all-inclusive prices for common procedures on its website, then having patients pay in advance.

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