The following article is based on the premise that health insurance is health insurance. In truth, “health insurance” is not insurance at all but has simply become a government mandated welfare assistance program administered by insurance companies and TPA’s.
With ObamaCare in full swing, with little likely hood of meaningful repeal, insurers are targeting population management and statistical metrics to bolster a competitive edge and revenue…..
Continue reading Consultants Compete To Help Insurers To Manage Costs
Continue reading Anchoring Health Care Pricing (See Previous Post)
That first number thrown out there serves as an anchor — a first reference point. Every other price becomes an adjustment of that price. Take a hospital’s charge master rates for example………..
Continue reading Anchoring – What Car Dealers & Hospitals Have In Common
Some consumers who pay far more than the cash price of a medication when using health insurance.
Continue reading When Should Patients Pay Cash for Prescriptions?
“There’s more price transparency and quality transparency regarding a refrigerator than there is about your heart surgery.”
Please Mr. Plan Sponsor, pay me direct. I really am worth it! I used to get $35,000 per year on your 75 employee life group plus an undisclosed bonus. I’m sorry I only showed up on renewal, and I promise I will change that. Please, Please, Pretty Please…………………
As long as health plans, with deep pockets, continue to roll over and play dead, health care costs will escalate to a point the entire health care finance system will implode.
Continue reading Price Gouging Continues – Deep Pockets Targeted
Consumers Flee High Cost Hospital
Texas General Hospital in Grand Prairie may be struggling to attract patients for elective services after a report named it the most costly hospital in the state, reports Dallas Observer.
Continue reading Health Care Pricing Transparency Drives Competitive Free Market
Edinburg, TX–– Leaders at Doctors Hospital at Renaissance Health System (DHR) and Mission Regional Medical Center (MRMC) have signed a non-binding letter of intent (LOI) to explore collaborative opportunities between the organizations.
Continue reading Largest Physician Owned Hospital in USA Expands Foothold
Today, most drug companies offer large rebates to pharmacy benefit managers on behalf of different health plans and employers to reduce patients’ out-of-pocket costs. The problem is a significant portion of the savings is not being passed onto the public.
Continue reading Who Is Getting Rich from the Price of Prescription Drugs?
Continue reading PBM Exposes Industry Secrets on Specialty Drugs
Pascal Metrics is the field leader in measuring and improving patient safety through advanced Patient Safety Analytics (PSA).
Continue reading Pascal Metrics Provides Patient Safety Analytics
Sen. Bernie Sanders says the ability of Aetna to disrupt the public health insurance exchange system in 2017 by withdrawing from 11 states’ programs shows why letting private companies sell health insurance is a bad idea.
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San Antonio, TX – Locally owned BMA (Third Party Administrator of Health Insurance plans) announced today that it has launched a new Web site along with enhancements to its End User Portal. Company officials are excited to make this upgrade to their Web site and enhance the user experience in their end-user Portal.
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Cutting out the middle man………………………..
Industry denials notwithstanding, reducing healthcare costs is fundamentally against nearly every healthcare organization’s perceived economic interests.
Continue reading Employers Look To Direct Health Care Contracting
Continue reading Specialty Drugs – What Can A Plan Sponsor Do?
An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects.
Continue reading Drug Crazed Elderly – America’s Other Drug Problem
“No problem Joe, I’ll make a call for you”
Continue reading Texas School Districts – Insurance Fraud & Political Empowerment
Some exchange plans are paying doctors less than Medicaid pays. Blue Cross in Dallas, for example, pays some doctors 10% less than Medicaid’s fee. If insurance buyers were forewarned, that would be one thing. But no exchange plan is advertising that access will be worse than it is for Medicaid patients.
King George III ruled England, Canada and what is now the USA. All three share the same language and are similar in many ways. But health care statistics show the USA a leader in health care delivery.
Continue reading Health Care Statistics Between USA, England & Canada
Providers across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans.
Continue reading Keeping Up with New Payment Models: “Cost Plus” or “Medicare Plus”
The first shots across the bow have been fired highlighting how benefits leaders need to pay as close attention to health benefits as they have been paying to retirement plans.
“The Number One Hidden Cost for Plan Sponsors is Embezzlement of Plan Assets” – Bill Rusteberg
Continue reading CFOs & HR Execs Facing Millions In Personal Liability Over Health Plans
This video is the second in a series and features a bold, fresh white board format to explain how a growing number of self-funded health plans are using Reference Based (or Cost Plus) Pricing to cooperate with area hospitals to agree on a pre-determined margin, thereby eliminating PPO networks.
Continue reading Video Helps TPAs To Market Reference Based Pricing Plans
Continue reading Hospitals Disposing of Organs, Refusing Transplants
Tenet Healthcare has notified Humana that as of September 30, 2016, Tenet Healthcare facilities and physicians will no longer be participating in any Humana provider networks.
Continue reading Tenet Healthcare Terminates Humana Contract
At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.
Continue reading How Common Procedures Became 20 Percent Cheaper for Many Californians
The next president could be dealing with an ObamaCare insurer meltdown in his or her very first month.
Continue reading Next President Faces Possible ObamaCare Meltdown
Aug. 10, 2016
Tips for Explaining Reference-based Pricing to ASO Employer Groups
Insurance insiders know the truth about undisclosed compensation paid to insurance agents, brokers and consultants by the BUCA’s. It is the industry’s best kept secret ( Health Insurance Consultant’s Best Kept Secret)
Continue reading Call To Action – Help Expose The Truth – Whistle Blowers Welcome
Ms. Stinson had a 99 percent blockage of an artery, and her family was forced by the hospital to pay $25,000 before she could receive treatment, Ms. Stinson’s son-in-law told the Indy Star. A second blockage was discovered, and the hospital demanded $30,000 upfront before the second operation.
Continue reading Patient Held Hostage By Hospital Over $53,000 Bill
Big California Firms Take On Health Care Giant Over Cost of Care
Continue reading Big California Firms Take On Health Care Giant Over Cost of Care
Continue reading Scheme Switches Medicare/Medicaid Patients to Private Insurance
Mr. Phelps of Mission Impossible
Your mission Jim, should you decide to accept it, is to review all documents to ensure best value for the McAllen Independent School District. As always, should you or any of your staff be caught or killed, the Secretary will disavow any knowledge of your actions. This pdf will self-destruct in five seconds. Good luck Jim.
Continue reading McAllen ISD To Award TPA Contract – Proposed ASO Agreement Made Public
It is clear that future Form 5500 reporting obligations will require more data, more resources and be subject to increased scrutiny by Federal agencies. Employer sponsors of group health plans should begin to evaluate plan documentation and the potential new disclosures required by Schedule J to ensure that each plan sponsor will be in a position to access such information and adequately communicate the new reporting requirements.
Continue reading Proposed Form 5500 Changes To Increase Plan Sponsors Obligations
“The notion that insurance companies previously charged high premiums, or withheld coverage, from “high-risk” customers because they were evil and mean and greedy, but now Daddy Obama would make them see the error of their ways, was the dumbest and most expensive political fairy tale of the modern era.”
“The illusion of lower premiums today would be financed by higher tax bills tomorrow, and of course they’d never tell you they were raising your taxes to keep the ObamaCare scam floating. They’d tell you it was for bridges, or schools, or Social Security solvency, or something.”
Continue reading Most Expensive Fairy Tale of The Modern Era
Does your TPA use Deerwalk? Deerwalk is a state of the art system that will allow, among other things, a plan sponsor to compare PPO pricing against Medicare benchmarking on a real time basis. Plan sponsors, for the first time, can determine the real value of PPO “discounts”. Many will be shocked by the results.
Continue reading Deerwalk, A Powerful Tool For Plan Analytics
By Jeff Evans
“I recently read an opinion piece that effectively summarized much of what many of us, in the health insurance and employee benefits business, have already figured out.”
Continue reading The ACA Medical Loss Ratios – “COST-PLUS” Health Insurance in Disguise
The best kept secrets of managed care are no longer the industry’s best kept secrets. The cat is out of the bag,
“The owner of Welldyn PBM and Continental Benefits has a vision to reduce health care spend in this country by 25%. With fresh capital from the sale of Welldyn, smart money bets Continental Benefits will become a national super TPA in short order. Before the Welldyne sale Continental Benefits was on a fast track. Now it will be nuclearized on an even faster track.” – Molly Mulebriar
Narrow Networks Fueling Surprise Medical Bills and Fights Between Insurers, Providers and Patients
Tenet believes it has reached an agreement in principle with the government to resolve the criminal investigation and civil litigation for $514 million.
Continue reading Tenet Increases Reserve To Settle Kickback Allegations
“Woodrow Wilson once said “the seed of revolution is repression”. Healthcare has operated on a model outside of free market forces, where consumers have paid the price, literally for decades.
Blue Cross and Blue Shield of Texas will sever ties with Houston-based Kelsey-Seybold Clinic, putting approximately 100,000 patients out of network with the providers’ physicians, the Houston Chronicle reported.
Continue reading BCBS of Texas To Drop 470 Kelsey-Seybold Physicians
Reid Rasmussen
Insurance carriers know it. If you build self-funded plans, you know it. There are ways to reduce plan costs while ‘hiding’ the reduced benefits. One of the rapidly growing methods is to shrink the provider network.
