Republicans are ecstatic over news Italian surgeon Sergio Canavero has a potential solution for Republican efforts to influence minds and souls through a new medical break through….. 

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Does this describe your broker? If so, you probably need to look for another one:

• “Shops” the insurance every year
• Facilitates insurance 1 year at a time
• Believes costs are dependent on the best offer of the carrier
• Gives limited data on where your money is going
• Provides limited ways to control underlying costs
• Doesn’t talk about their compensation or worse, is solely paid on commission, meaning more income the more rates go up
• Advocates cost shifting in the form of increased deductibles and copays to lower the employer impact of premium increases
• Blames costs exclusively on employee behavior and poor health

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“It’s Not My Fault They Read My Book!”

Hospitals use fairy tale chargemaster pricing — which are shrouded in secrecy — to negotiate with third-party payers and generate revenue, yet Hospitals Dismiss Significance Of Chargemaster Prices?. A good negotiator, seeking maximum profits, always starts out high……Hospitals know the Art of The Deal…………..
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Former Health Insurance Broker 

California single-payer healthcare bill passes first committee test…………………

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Perry Mason Has Never Lost A Case

If an ERISA Plan Sponsor has irrefutable evidence the plan is overpaying for health care, can a plan participant sue the Plan Sponsor and it’s trustees, jointly and individually, for wantonly squandering plan assets and win?

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“Health insurance is a classic example of the Law of Subsidy in action”

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It’s been eight years since I wrote Health Care Strategies for Texas Political Subdivisions: costplusinsurance.com/articles/Health%20Care%20Strategies%20for%20Texas%20Political%20Subdivisions.pdf

Since then there have been early adopters who have blazed the trail for others to follow. But most Texas political subdivisions still have their heads in the sand.

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I’ve said for years that one of the main reasons ObamaCare passed was because they did a great job of confusing Health Insurance with Healthcare financing, or Healthcare.  I recently ran across the attached article that does a great job of addressing this point and wanted to share it.  I hope you enjoy it as much as I did.

Have a great day!   Jeff Evans, Director, Benefit Services jevans@healthplan.org

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Craig Lack is “the most effective consultant you’ve never heard of,” according to Inc. magazine. He consults nationwide with C-suites and independent healthcare broker consultants to eliminate employee out-of-pocket expenses, predictably lower healthcare claims and drive substantial revenue.

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Most CFOs don’t know whether their company’s medical plan pays retail, wholesale or institutional charges.

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“Last year AMPS grew by over 70% and we are on a financial track to do the same this year,” said Dendy.  “However, beyond financing, we also see the new investors as an opportunity to build and expand our leadership footprint in healthcare cost management services for employers, health care plans, and government entities.”

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“Household salaries have remained flat over the past 20-plus years as every potential salary raise is applied to feed the healthcare beast…………”

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Medical inflation continues to rise at a rate above the growth rate in the economy. Facing rate increases year after year, plan sponsors, with their financial backs to the wall, have historically resorted to cost shifting. These continued failed attempts to control costs have […]

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The risk-adjustment program program is supposed to protect plans from covering more than their fair share of sick enrollees. Program managers at CCIIO take cash from plans with low-risk enrollees and send the cash to plans with high-risk enrollees.

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Our website (www.mollymulebriar.org) gets emails from time to time through our Tip Line exposing industry secrets……

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For decades, the price of Syprine was $1 per 250-milligram tablet, or about $1,460 a year………. Today, Valeant charges around $300,000 for a year’s worth of Syprine…………

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Connect with employer and provider peers who are actually developing and strengthening direct contracting relationships to discuss the pros and cons of direct contracting at the 3rd Annual Employer-Health System Direct Contracting & Partnership Strategies Summit on July 25 in Boston.  Gain insights into such questions as:

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An amazing discovery, an ancient manuscript found yesterday by Waring, Texas Girl Scout Troop 34, buried near an oak tree on the grounds of the Texas state capitol is purported to be one of the missing chapters in famed Nostradamus book “The Future of Government Health Care in Tejas.”

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How does your current stop loss policy premiums compare to the market? Aegis Risk’s premium survey provides average industry benchmarks…………………..

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One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.

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If you wish to continue operating your self-funded plan the old fashion way this advanced course will not be of interest to you – Homer G. Farnsworth, PHD

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Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices.

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Texas Senate Bill 789, which will gut the TRS ActiveCare health plan for Texas school districts, will pass according to our sources in Austin. (The Coming Implosion of TRS ActiveCare?) The next 14 days will tell the story.

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“Over the last 3 years, AMPS average reimbursement level on hospital claims has averaged 156% of Medicare or approximately 37% less than PPO reimbursement levels. For every 1,000 employees on an employers’ health plan, this 37% decrease in cost equates to approximately $2,550,000 in savings.” 

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Brian Klepper

I’ve decided to reconstitute my blog, Care & Cost, to be more inclusive again of other writers, and to focus on purchaser issues.

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It is no secret in our industry what plan sponsors pay towards patient advocacy, balance billing defense and legal defense. I am positive you know too.

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A new study finds that 88% of people who go for a second opinion after seeing a doctor wind up receiving a refined or new diagnosis.

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“We are building an army of volunteer attorneys prepared to represent people when the time comes. In fact, when communicating with providers and bill collectors, we’ve been asking them to sue the patient. Thus far, none have.” – David Silverstein

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Hospital system knows how to turn cost sharing health plans into 100% plans, much to the delight of plan members…………….

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The bill, H.R. 1304, would block federal efforts to regulate small stop-loss plans as health insurance by excluding the plans from the federal definition of “health insurance coverage.”

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David Silverstein –  www.BrokenHealthCare.org

Broken Health.org’s system of fighting unfair hospital billing is centered on “Denial of Payment.”

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As a citizen of the great state of Texas, I am curious about the introduction of several bills designed to “ensure health plans are discouraged from underpaying providers.” – Jeff Evans

To Jeff’s point, David Silverstien addresses a basic problem with government interference in our health care system:

“We recommend extensive legislative education. We genuinely believe that legislators do not understand the true nature of healthcare pricing and that, as the paramount issue of our time, they must. Our form of government is grounded in the expectation that the citizenry elect wise and noble people who then study the issues before them to an extent not possible by the general public. The nature of healthcare pricing is such that the limited knowledge of legislators is approaching the danger level.” – David Silverstien

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“My legacy continues!”…………..

As the Trump administration continues to debate the future of the Affordable Care Act, a new Obama-era health insurance rule is taking effect…………….

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“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”

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If an RBR provider’s marketing efforts signal pricing based on a starting point versus an actual post-negotiation result, then the Plan Sponsor will likely be very disappointed

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For those of you insured by BCBSTX, would you like to know what kind of prices have been negotiated for you at Tenet Healthcare? Maybe your prices went down?

As a BCBSTX policy holder, whether you know it or not, you have a dog in this pricing arrangement. Why don’t you ask to see a copy of the negotiated contract? After all you will be subsidizing the agreement as a premium paying card carrying member of the Caring Company, right?  

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Large employers of the Lower Rio Grande Valley have relied on third party intermediaries to negotiate pricing with local hospitals for over 35 years. Now, for the first time, some Valley school districts are learning the truth about the value of PPO discounts and they don’t like what they see…….

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He worked with Alexander Fleming and was a Prisoner of War 

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