People travel to visit family and attend business meetings, so why not travel for medical care?

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“Reference-based pricing is unquestionably a hot topic in the self-funded industry today. So hot, in fact, that the federal government has taken an active interest in it for the third time now……”

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Walmart, Kmart, Safeway, and Kroger all charge $45 for the sildenafil, using the discount card, while Walgreens charges $450 and RiteAid $1,000…………

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By: Peter Vieth April 22, 2016

For what may be the first time in Virginia, a judge has ordered a hospital to slash its “balance billing” charges by 75 percent to reflect the hospital’s usual write-off for uninsured patients.

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“We have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. …….The biggest sin the ACO’s commit is to distract from any real conversation about cost…………  “

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Get ready. Government men are spreading out over the fruited plains seeking to mete out punishment to employers who sponsor self-funded employee welfare plans……….

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In the first two days, we had visits from the Florida Legislature, the Florida Department of Insurance, the Florida Department of Health, Humana, UnitedHealthCare, Cigna, Aetna, the Blues, and a range of Florida hospitals.

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A researcher paid a middleman procurement company $3,340 for a fetal brain, $595 for a “baby skull matched to upper and lower limbs,” and $890 for “upper and lower limbs with hands and feet.”

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The $64,000 Question

Can a plan exclude specialty drugs? The answer is yes. Many PBM’s limit their specialty drug formularies. But, can a plan eliminate all specialty drugs and remain ACA compliant?

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How did we get here and why is this so hard to fix?

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John Smith Stunned By Cheap Medical Premiums

Nothing like screwing insurance companies….…………

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Petr Kellner got his start in the early 90’s selling office supplies……………

This year’s billionaires with connections to the insurance industry include the son of a Chicago meat-packer, a former appliance door-to-door salesman, a World War II flight navigator and a passionate environmentalist.

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Arlington Healthcare Group is an established healthcare industry consulting and professional services firm. We help healthcare providers, payers, and industry technology and service enterprises grow and optimize performance and value.

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The insurance and financial services company opened its doors 40 years ago on April 1, 1976, by principals Charlie Amato and Gary Dudley with only $1,500 in capital……“When we started this company, we had no idea of the incredible journey it would take us,” said Charlie Amato, chairman and co-founder……..

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Yes. Higher reimbursement rates for treatment under workers’ comp encourage doctors to classify injuries as work-related.

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Want to save as much as 75% or more on your health insurance premium costs? Try a short term medical policy.

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Enchiladas, tostadas, tacos – getting hungry yet? Grab a cerveza and read on.
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Sam Crafting, Health Care Editor – New York Times

“A business that operates at a loss should raise it’s prices” – Sam Crafting

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“Don’t bother doing something unless your radically different from the competition” – Richard Branson

By Bill Rusteberg

Reference Based Pricing, or Cost Plus Insurance has evolved over the past seven years from simply re-pricing claims based on established benchmarks such as Medicare pricing schedules, to a number of evolving hybrids. A Cash Pay Health Plan Option is one, quickly gaining market attention among health care revolutionaries.

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“It’s clear hospitals view owning a health plan as a way to build their population health programs by combining medical claims and clinical data.”

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      The change benefits students and visiting scholars with reduced premiums, but the new model also offers advantages to Iowa State as a whole.

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Actuary Panics – Pleads for Mercy

“There are enough people enrolled at this point that the market is sustainable. The premiums were just too low.”

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The movement to protect consumers from surprise medical bills won a major victory Thursday when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations.

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By Bill Rusteberg

Reference Based Pricing for health care has become the fastest growing trend in the American health care delivery system. Insurance agents, brokers and consultants upon which health care payers depend for market distribution, are joining the health care Reference Based Pricing revolution in droves. Selling health insurance is becoming fun again. Competing for business has reached new levels of intensity.

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Gamblers consistently overestimate the control they have over outcomes, both in gambling and in everyday life. Their belief leads them to engage in seemingly bizarre or ritualistic behaviors such as throwing dice in a certain way or wearing specific colors…….. the illusion of control is widespread, and its effects may be enhanced when people are placed in positions of authority or subjected to time pressure or competition………….

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“Only 5% of patients with obesity who lose weight keep it off. Coverage for obesity drugs is improving, but remains uncommon. Only a tiny fraction of the candidates for bariatric surgery have the operation, in part because 70% of physicians won’t give referrals.”

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 David Belk, M.D.

Hello everyone. Once again, it’s time for another case study on how our health care industry is robbing us blind.

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Region One Educational Services Center, hereinafter referred to as “ESC”, desires to solicit proposals for various firms to perform as a Third Party Administrator for the ESC’s Cafeteria Benefits Plan (IRC Section 125), Flexible Spending Accounts and Dependent Care Spending Accounts.

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“Over the past two years, hospital chains and insurance companies have snapped up urgent-care centers in a spate of mergers and acquisitions.”

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“Chronic diseases that require lifetime treatment and symptom management account for approximately 86 percent of all healthcare expenses…”

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“It’s a common practice but it’s wrong.” – Arnulfo Olivarez at his 1/24/2011 sentencing for bribery before Judge Hinojosa.

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“As someone that has made a career trying to help healthcare providers and health plans get on the same page as it relates to cost-containment initiatives, I have compiled my personal top ten lessons about RBP from 2015.” – Jason C. Davis

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Former Health Insurance Broker

“Some insurers, including Anthem and Humana, say they dropped commissions to keep rates down.”

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The proposal attempts to address what DOL and the White House claim are systemic conflicts of interest in broker advisor models………….The proposed rule clearly favors fee-based compensation models for advisors…………….

Although the proposal targets pension and investment advisers per se, the same standards may be applied to fee based insurance consultants – Molly Mulebriar

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A large Texas TPA has announced the purchase of the city of Waring, Texas.  City officials say the sale was in response to an eroding tax base and high debt. Waring was settled by Bosnian Serbs in the mid 1800’s.

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The Untouchables

“There have been numerous stories over the years, published widely, regarding “double dipping” by fee based insurance consultants. The scheme is lucrative, with little chance of punishment…..”

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