“What is an health insurance salesman daddy?”

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A 2017 webinar will cover hospital’s view of Reference Based Pricing. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements.

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Revenue has  increased 4.2 percent year over year, to $10.3 billion in the third quarter of 2016. Could the ever present annual escalator clause found in managed care contracts be driving revenue increases?
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Your decision to continue your current PPO program is understandable. You are not out of money yet.

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Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.

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Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.

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People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.

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Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….

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Why Didn’t I Think of This!

The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.

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Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...

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“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”

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The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.

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The drug industry argues the 340b program has surpassed its original purpose of providing care to poor patients and now acts as a profit generator for hospitals.

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One recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare……………………..

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Universal health care, Medicare for All, will establish cost efficiency that eliminates major medical bills and medical related bankruptcies

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Former Health Insurance Broker

Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.

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The Texas insurance regulators have fined human resources software startup, Zenefits, $550,000 for its past use of unlicensed health insurance brokers.

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Lucent is ensuring that the Plan Sponsors they serve will be provided the best fiduciary protection and objective, final appeals handling in the industry.

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Ed Day, President, HST and Cindy Hom, VP of Business Development, MedWatch  pride themselves in being ahead of the curve in Reference Based Pricing strategies. The HST approach makes sense. This is a must see 29 minute video:

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Introducing Meritain Connect: 

Now it’s even easier to stay on top of your health plan management

Meritain Health is proud to announce our new, enhanced website for members, employers, organizations and producers—Meritain Connect. It’s an all-in-one online tool for managing your employee benefits account. And this newly upgraded website will be yours to access beginning Monday, October 17, 2016.

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Have you ever met a bully in your business dealings? If you say “No” you are probably lying, or too stupid to spot one. A recent experience leads us to post this excellent video on how to deal with a bully

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Adam Russo, Phia Group

This past quarter has been one of the most exciting in our history, and we have all of you to thank for helping make that happen…………

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In order to rebalance our existing and future book of business, we are increasing our  HMO new and renewal commission rates, and reducing the commission rates for all new and renewing  PPO health plans………..

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10 percent annual gain in employer health care costs has held wage gains to 2 percent or so in most recent years…….Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy……

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UHC customers paying $50 co-pay for a drug that cost less than $15? 

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“When receiving a group medical insurance proposal from the Blues, they can claim to have better discounts than the rest of the competing offers (be it a self-funded or fully insured plan) and their pricing to get the business will surely reflect substantial discounts. But now what? Will you as the client ever actually receive the full value of their hospital contracts or physician discounts? Most likely not.”

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Court paperwork, however, said the corruption spread further, enabling the Mullen group to land contracts for their clients at South San ISD and Bexar Met. The FBI is also investigating the trio’s activity at school districts in the Rio Grande Valley, the documents show.

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This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.

Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..

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The Phia Group is pleased to support Dave Chase’s “The Big Heist” project. Dave Chase is a long-time healthcare industry consultant, entrepreneur, author, and provocateur. Mr. Chase is also the executive producer of the upcoming film, “The Big Heist.” 

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For years Plan Sponsors have dreamed how to transfer health care risk to the federal government. If Medicare eligible plan participants could be removed from a group’s health care plan legally, these higher risk members would no longer be a risk factor to contend with. How can one game the system? (more…)

Tenet Healthcare Corp. and two of its hospitals will pay $513 million and enter guilty pleas to resolve investigations into payments of kickbacks for referrals of pregnant immigrants, the U.S. Department of Justice said Monday.

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