William O. Haff

San Antonio insurance consultant’s sentencing delayed again to 30 November, 2016. Smart money bets more indictments to come, following this week’s indictment of Samuel Mullen……

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Drugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket.

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“I offer three perspectives as to why Texas should not expand Medicaid” – Alan M. Preston, MHA, Sc.D.

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In total, prosecutor Mark Roomberg said, the commissions resulting from the rigged contracts were “$2.5 million for the entire group.”

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A Medical Bill Review audit of a large, 4,500 life employer group performed in 2016 exposes the truth about PPO “discounts.”

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By Mark Flores

Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”.

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The following article illustrates the angst hospitals are undergoing in defending their indefensible and egregious pricing strategies through their PPO collaborators. The solution posed in this article by a hospital advocate is: Identify Reference Based Pricing (RBP) patients and don’t treat them! But that short sighted response brings on Cash Pricing strategies through companies like Asserta Health (www.assertahealth.com) which often times saves plan sponsors even more money than otherwise would have been paid hospitals under a typical RBP plan. Making lemonade out of lemons……………

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A 46-year-old San Antonio independent insurance consultant William O. Haff is facing up to five years in federal prison…. 

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This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to a new analysis released Wednesday by the UCLA Center for Health Policy Research.

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Most TPAs do not pass on the strong discounts for prescription drugs or do not have access to it. A quality TPA should be offering all prescription drugs at AAC + admin fee.

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“You can claim — and many do — that better access provides worthwhile value, but that’s akin to putting lipstick on a pig.” – Brian Klepper

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If Medicaid allowed overseas treatment for Hep. C (Harvoni) the savings by utilizing a five star hospital system 495 miles south of Florida would save taxpayers 753 X ($95,000 – $19,000) = +$57 million...

For Information on Health City, contact Sarah Rusk, Health City Cayman Islands
t 345-640-4257  m 345-525-2131  w healthcity.ky

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Primary care physicians presented the best return on investment for hospitals

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FOR IMMEDIATE RELEASE – September 2016
Apex Management Group (Oak Brook, Illinois) has announced a 4 Year Rate Lock on their APEX Suite of MEC Offerings. 

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It is the Obama administration, and not the insurers, who perpetrated this heist….

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“After I got off the phone with him, I realized: That’s actually just insurance for my insurance,” she said, laughing.

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See our detailed directory listing of TPAs, which includes their 2015 revenue, claims business by type and by volume, types of client managed and other contact information.

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“We guarantee no “balance bills” to our covered members for the amount taken as a discount from your provider’s retail bill.”

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“16% more likely to die if they are admitted on a Sunday compared with a Wednesday” SOLUTION: Eliminate all health care services on Sunday…………..

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Imagine being in control of your individual employee healthcare costs. Our low cost network puts you in control of your daily healthcare spend. You decide whether the employee is better off using existing insurance options or pre-paying for the specific procedure. Our pre-paid pricing is based on discounts of up to 70% and can save companies millions of dollars a year.

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Texas Super TPA with growing market share is a  TPA worth watching…….

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 Victor Lustig

Just like sticker prices on new cars, no one ever pays hospital chargemaster rates. So why have them? A previous blog posting (Hospitals Dismiss Significance Of Chargemaster Prices?) offers a possible reason, while the following article does too.

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A pack of just two EpiPens costs more than $600 in the United States. To fully comprehend the outrage of this price, you must realize that the epinephrine included in the EpiPen costs less than $10 retail. And in Mexico it’s 25 cents (EpiPen alternative costs pennies in Mexico)

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Employers, adept at tracking business expenses, are surprisingly lax when it comes to double-checking healthcare costs.

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 John Farnsley

“We learn from history that we do not learn from history” – George Hegel

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“Understanding the cost of health care is directly related to what we agree to pay, more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time.”

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McALLEN — A life-saving medication that costs more than $600 in the United States is only a few cents in Mexico.

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California medical consumers will enjoy strong new protection against surprise out-of-network medical bills..………..

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Health insurers are limiting the physician and hospital options they offer through their plans. TRANSLATION: Insurers are limiting provider choice by eliminating providers who want more money than those willing to work for less.

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“The bill would relieve patients from having to pay surprise medical bills out of pocket by requiring insurers to reimburse out-of-network doctors and other health providers a “fair amount” and doctors to accept the payments, said its author, Assemblyman Rob Bonta (D-Oakland).”

“That rate would be 125 percent of the amount Medicare pays for the same service or the insurer’s average contracted rate for the service, whichever is greater.”

Editor’s Note: If California passes this bill into law (very likely), Reference Based Pricing in California will take off in the private sector. No network plans, similar to what we have implemented in Texas since 2007, will have solved the problem of balance billing risk. And if Texas passes a similar law TPA’s like Caprock Health Plans and Continental Benefits, both of which administer Reference Based Pricing plans will achieve new business sales that will make Ben Feldman look like an amateur.

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