Four ambulatory surgery centers alleged that two hospitals agreed to use their combined market power to compel physicians in the market not to refer patients to their competition and enlisted support from several carriers active in the health insurance market………
Archive for January, 2016
Facts Suggest Hospitals & Insurers Agreed To Antitrust Scheme
Saturday, January 30th, 2016Are You Paying For A “Lexus” Surgery & Getting a Pinto?
Friday, January 29th, 2016Money that would have otherwise gone into investments or infrastructure development is now being diverted to employee healthcare benefits, and that has implications for the long term viability of every organization. (See Most Companies Shirk Fiduciary Duties When It Comes To Health Care)
MPIRICA offers free access to Provider Quality Scores for employers and plan participants……………..
Drug Shortages Causing Rationing – Public is Clueless
Friday, January 29th, 2016Prescription drug shortages are the new normal in American medicine. But the rationing that results has been largely hidden from patients and the public.
Left Coast Voters To Consider Rx Cost Reduction Strategy
Friday, January 29th, 2016Among the catalysts for public outrage are the sky-high price of treatments for diseases such as hepatitis C and the unapologetic markups for specialty drugs by former pharmaceutical executive Martin Shkreli.
Your Next Insurance Agent Will Be A Robot
Thursday, January 28th, 2016Most Companies Shirk Fiduciary Duties When It Comes To Health Care
Wednesday, January 27th, 2016An excerpt from the preceding post on this blog (Florida Business Coalition Set to Revolutionize Health Benefits Purchasing) says it all. Some plan sponsors are better at managing fiduciary duties than others. They take these duties seriously while others simply ignore common sense, fail to understand health care financing and rely on vested interests memorialized through contracts of adhesion.
Perhaps the finger of blame for the high cost of health care should be directed at the payer, not the medical provider community – RiskManagers.us
Florida Business Coalition Set to Revolutionize Health Benefits Purchasing
Wednesday, January 27th, 2016“How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.” Rick Scott – Governor of Florida
Orlando-based Rosen Hotels have shown how straightforward it is to slay the healthcare cost beast. They spend 50% less on health benefits than a typical employer while providing outstanding benefits
Some Work-Based Health Plans Exclude Outpatient Surgeries
Wednesday, January 27th, 2016Reduce Health Care Costs 30% Through Level Funding
Wednesday, January 27th, 2016Rampant Out-Of Network Provider Litigation Continues
Tuesday, January 26th, 2016Litigation involving out-of-network providers, meaning providers who do not have a negotiated rate agreement with the respective payer, continues to be rampant. Certain issues arise frequently in these lawsuits over whether the payers had properly paid claims.
This article discusses several published decisions from 2015 that illustrate how courts across the country are handling some of these common issues.
ClearHealth Delivers Medicare-Based Pricing Programs
Monday, January 25th, 2016ClearHealth delivers comprehensive Medicare-based pricing programs that are fully configurable to allow your organization to achieve maximum savings while using a cost containment strategy tailored to meet your strategic goals.
BUCA Document Exposes Out-of-Network Reimbursement Strategies
Monday, January 25th, 2016Part of a continuing series………..(See previous two posts)
“Reasonable charges for inpatient and outpatient facilities generally equal twice a facility’s cost as reported by the facility to CMS….” (more…)
Working the “Spread” – Another PPO Revenue Stream
Monday, January 25th, 2016By Molly Mulebriar
In our continuing efforts to expose insurance industry secrets that drive up health care costs, we find more evidence of third party skimming through managed care contracts.
PPO Requires Payment of Denied Claims?
Friday, January 22nd, 2016PPO agreement requires self-funded plan to pay certain claims that otherwise would be denied……………………..
Cameron County Seeks Health Insurance Consultant
Thursday, January 21st, 2016Dear Bernie…………..
Tuesday, January 19th, 2016The current single payer system in Canada presented a solution in a time when farmers, who had little or no money for healthcare, represented the major demographic in the country and a cooperative type model was therefore attractive.
But times have changed……….…………………
The Murkey World of Actuaries
Sunday, January 17th, 2016Actuaries ponder philosophical mutterings under the basis of implied thought influenced through critical thinking……………..
Plan Sponsors: Prudent Business Practice Requires Actuarial Support
Sunday, January 17th, 2016Obamacare, Sign Me Up!
Saturday, January 16th, 2016Take A Blood Test Or Lose Your Health Insurance
Friday, January 15th, 2016Dale chose not to take his work-sponsored health assessment and biometric screening. His company responded by pulling his insurance coverage.
Kashable – Group Credit Benefit Program
Thursday, January 14th, 2016ObamaCare Fuels Growth of Concierge Medicine
Thursday, January 14th, 2016A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid and Medicare populations.
N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States?
Wednesday, January 13th, 2016By Drew Altman
Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford.
Aetna CEO Sees Humana Deal on Track to Close This Year
Wednesday, January 13th, 2016Drugmakers Raise Prices Despite Criticisms
Monday, January 11th, 2016Stress Reduction Kit For Frustrated Plan Sponsors
Drugmakers didn’t let up on price increases with the start of a new year, demonstrating the industry’s pricing power in the face of mounting criticisms of prescription costs in the U.S.
McAllen ISD Reaches Out To 1,462 Insurance Consultants
Sunday, January 10th, 2016“The District invited one thousand four hundred sixty-two (1462) vendors to submit a proposal and six (6) vendors responded.”
“Amazing stuff – who would have guessed there were that many licensed insurance consultants in the state” – Molly Mulebriar
Beating Medical Trend – Managed Care vs Reference Based Pricing
Sunday, January 10th, 2016Hand In The Cookie Jar?
Sunday, January 10th, 2016This is another of many recent examples of a third party intermediary’s alleged embezzlement of plan assets deceptively concealed through fake PPO discounts.
A BCBS survey was conducted and found that 83 percent of its self-insured clients were completely unaware of the hidden fees…………
Renting Medicare’s Provider Network
Friday, January 8th, 2016An idea with bi-partisan support?
If the federal government would rent their Medicare network and charge what the private market charges for PPO access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.
AWP As A Rx Pricing Benchmark
Thursday, January 7th, 2016Due to pricing fraud, many payers, including government payers, are no longer using AWP for pricing, and are switching to other more transparent pricing benchmarks…….AWP is subject to fradulent manipulation by manufacturers or even wholesalers. As such, the AWP, while used throughout the industry, is a controversial pricing benchmark….
Custom Design Benefits Announces Changes – True Cost Product Gains Momentum
Thursday, January 7th, 2016Munninghoff said his accounting firm’s experience with TrueCost influenced his decision to invest in Custom Design Benefits.
An exclusive new product called TrueCost, a reference-based pricing solution for firms with as few as 50 employees was developed by Custom Design Benefits in 2012, TrueCost eliminates deductibles and co-insurance and reimburses all medical providers based on Medicare plus a bonus.
Benestream – The Medicaid Migration Company
Thursday, January 7th, 2016“Reduce your costs by moving employees onto free health insurance with Medicaid Migration”……….
Are private, free enterprise employers who traditionally oppose government interference in business actively encouraging growth of a massive entitlement program many are philosophically opposed?
Employers Save By Moving Workers To Medicaid
Thursday, January 7th, 2016Companies shift insurance costs to the government….……….
Employers have not historically played a significant role in helping workers enroll in Medicaid……………..until now
Swiss Re To Purchase IHC
Wednesday, January 6th, 2016Medicare: Big Changes Coming For Hip, Knee Surgery Payments
Wednesday, January 6th, 2016“This model will incentivize providing patients with the right care the first time and finding better ways to help them recover successfully. It will reward providers and doctors for helping patients get and stay healthy.”
Health Insurers Have No Reason To Reduce Price of Health Care
Monday, January 4th, 2016The Case of The Missing + 3%
Sunday, January 3rd, 2016What Do Three Men, A Hotel & A Third Party Intermediary Have In Common With Health Care Financing?
In this illustration, you will learn how RiskManagers.us skillfully portrays an illusion to reduce inflated billed charges by almost 17% , saving each of the three men 10% while enriching a third party intermediary by approximately 7% of billed charges with an additional + 3% vanishing inexplicably into thin air.
Understanding this riddle will clearly show how opaque and illusionary health care financing can be…………………..