In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.

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“We can afford to do it” – Warren Buffett

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Sources: Kaiser Family Foundation analysis of data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners and California’s Department of Managed Health Care. Mini-med companies with a medical focus were included.

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Compensation paid to producers under these agreements is usually based on growth and persistency of a producer’s overall book of business. The costs of these programs are not directly included in the premiums or fees for the producer’s customers, but are included in our general distribution costs.

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Last year our agents earned over 114 million dollars in commissions and we plan to double that in 2017!  (more…)

SA Benefit Services, LLC principals have more than 30 years of combined stop loss experience. We provide stop loss services to third party administrators, consultants, brokers and direct with self-funded groups who have no broker of record. We use only A Rated stop loss carriers.

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Medicaid in Texas is a $29,000,000,000 ($29 BILLION) business………………...

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Staying on top of new developments occurring at breakneck speed poses a challenge for healthcare professionals……………

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Hint: A QSEHRA is something conjured up at the Puzzle Palace in Washington DC…..

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The Atlanta Chapter of the Association for Corporate Growth has identified AMPS among the top 40 fastest growing middle market companies in Georgia………….

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“Last year AMPS grew by over 70% and we are on a financial track to do the same this year, and we see this strategic investment extending the significant growth we have enjoyed over the past five years.” – Mike Dendy

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The hospital claims BCBS of Georgia is refusing to pay contractually agreed-upon rates.

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“Acting in secret in the interests of the profiteering insurance companies late Friday afternoon abandons all those people already threatened by Congress and the Trump administration” – Deborah Burger

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Get Insured 24/7 has the lowest rates for Errors and Omissions Insurance, providing affordable, easy access to protection for the unexpected. Use our secure portal to enroll and bind in minutes, wherever you are, whenever you want. Pajamas welcome.

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“What I’d like to do is legalize inexpensive insurance, and you should be able to get insurance for $1 a day” – Rand Paul

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The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial…………….

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MRI’s can start as low as $250…………Compare that to $2,000, $3,000, $4,000 and more elsewhere………..

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Vxtra Partners was founded in 2004 to address the financial inequities, lack of transparency, and technology challenges associated with traditional health care benefits.

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Hospital stock prices jumped on Thursday as investors reacted to the Senate’s proposal for repealing and replacing the Affordable Care Act.

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Congressional Aide Drafts Healthcare Bill 

The bill will “ultimately transition away from Obamacare’s collapsing system entirely so more Americans won’t be hurt,” McConnell said Thursday on the Senate floor.

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Accresa is an innovative payment platform that connects physicians, employers and employees…………..

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“As any person being bullied knows, and as Freud has written, there are two options: 1. Fight or 2. Flight” – Shawn Gretz

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“This could be a career opportunity of a lifetime. We are building something unique……….”

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“Your insurance committee is way out in left field! Why would anyone want lower benefits at a higher price!” offered the consultant.

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Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it…………..

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Selerix Systems produces software (BenSelect) to facilitate communication, enrollment, and end-to-end benefits administration for both core and voluntary insurance products. This software is licensed to and used by carriers, brokers, and employers.

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In 1967, our population was 204 million and our national health expenditures were 46.5 billion, 5.7% of our GDP or $253 per person. Today, for our population of 330 million, they’re $3.2 trillion, 17.8% of our GDP and $9990 per person…….

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“It is a program without any sense of risk management, so this will continue to be the pattern until they kill it.  One of the biggest issues is the consulting firm, which has worked with them forever and is not even located in the State.” – Insurance Consultant

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Gov. Brian Sandoval vetoed a bill that would have would have made Nevada the first state to attempt a Medicaid-for-all approach to health insurance

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The TAGCO Multiple Employer Trust offers employers the benefits and advantages of buying Retiree Medical through the pooling of statewide Retiree Medical risk(s). The program serves residents of Arkansas, California, Louisiana, Montana, Oklahoma, South Carolina, Texas, Virginia, Colorado, Illinois, Iowa, Michigan, Nebraska, North Carolina, New Mexico, Tennessee, Utah, and Wyoming.

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Take a total benefits approach. This approach could help minimize liabilities while maximizing total benefits spend. Additionally, savings in one benefits area could allow additional funding for new retiree healthcare solutions……………….Coupling retirement healthcare with Reference Based Pricing strategies may accomplish this goal…………..

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The law requires drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin…………….

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This paper will address the cost drivers and why the traditional solutions are becoming more and more ineffective…………….

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Is the fox is watching the henhouse? The abuses that can and do exist under this model are egregious…….

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 Mike Dendy

I recently met with a Fortune 100 company and posed the question, “how much are you paying for hospital services within your PPO network”? They had absolutely no idea. I was not at all surprised, as the actual cost of services is well hidden within a labyrinth constructed by big healthcare companies, their PPO organizations, and their “partner” hospitals.

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The number of employers implementing RBR plans is increasing, especially in markets where providers have shown a willingness to accept “reasonable” reimbursement……………..

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Nashville, Tennessee, June 7, 2017- Lucent Health (@LucentHealth), the leading Healthcare Risk Management, Administration and Advisory Services company, announced today that it has acquired Appleton, Wisconsin-based  Cypress Benefit Administrators.

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Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

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Mildred Honeycomb, Famed PBM Professor at MMU

A two sentence tutorial on how to evaluate a PBM proposal…………………..

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Switch operators are like the Wizard of Oz: They’re hidden behind a curtain and being paid by manufacturers to end-run your cost-savings efforts. Therefore, you need to pull back the curtain, understand their machinations, and respond.

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A large taxpayer supported employer now knows they are overpaying for health care……

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In 1993, before the Blues went for-profit, insurers spent 95 cents out of every dollar of premiums on medical care, which is called their “medical loss ratio.”

The average medical loss ratio is now closer to 80 percent. Some of the Blues were spending far less than that a decade into the new century.

The medical loss ratio at the Texas Blues, where the whole concept of health insurance started, was just 64.4 percent in 2010.

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Another form of direct contracting is when a plan sponsor outsources the administrative systems and support functions required to operate as a PBM, to a third-party vendor. These vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services.

The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsor’s of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.

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

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“In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.”

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“So we spit-balled some ideas around and came up with this: The one package people are highly pleased with is Medicaid………………”

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Politicians act the way they do because Santa Claus is here and here to stay………..

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  David Chase

Emerging Litigation Could be the Savior to Our Dysfunctional Healthcare System. Here’s how………………..

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As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year. Then he joined the Traitors Club of former pharma reps……….

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HelloMD is a service that uses telemedicine to connect people with doctors willing and able to prescribe medical marijuana…………………

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“Taken from a scene in the holiday classic, A Christmas Story, I double dog dare you now to ignore the new information I’m about to share with you” – Tyrone Squires

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“The total of all Sun Life Stop-Loss claims reimbursements from 2013 to 2016 was $2.7 billion. If those stop-loss claims reimbursements are added to first-dollar catastrophic claims costs (the amount that employers pay before reaching the stop-loss deductible), the overall cost for catastrophic conditions was $6.1 billion…. Million-dollar+ claimants were up 26% compared to 2012-2015. In 2016, this group represented only 2.2% of claimants but accounted for 23% of all stop-loss claims reimbursements.”

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I’m angry that people who don’t understand and can’t help themselves and don’t know how to fight back are getting ripped off every day.” – David Silverstein

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We learned back in 2007 that we can reduce health care costs for our clients by 40-50% while improving benefits at the same time. Few listened then, afraid to break away from the status quo. Now we find articles like the following one by Dave Chase. This, and his upcoming book, is a Must Read for employer sponsored health plans – Bill Rusteberg

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In the summer of 2016, over 100 of CIGNA’s self-insured health plan clients were sued with the complaint alleging breach of the defendants’ fiduciary duties under ERISA for engaging in widespread fraudulent behavior involving the use of plan funds. This case should serve as a wake-up call for employers sponsoring health plans nationwide – this will not be the last case of its kind to be filed.

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The Aetna insurance company has been based in Hartford, Conn., since 1853, but this week it said it is looking to move to another state…………

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Need practice in responding to a Request for Proposal for Group Health Insurance? If so the San Benito Independent School District is here to help you……………..

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No one has been able to determine how much a  PBM is profiting from its secret “deals” with manufacturers………..Express Scripts lawsuit raises eyebrows…………..

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Blue Cross and Blue Shield of Georgia  has just informed its members that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their claim won’t be paid…………

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TEXAS HOUSE BILL 3867 – AN ACT relating to unconscionable prices charged by certain health care facilities for medical care.

For purposes of Section 17.46(a), the term “false, misleading, or deceptive acts or practices” includes an emergency facility taking advantage of an individual’s medical condition by:

(1)  providing emergency care at an unconscionable price; or

(2)  demanding or charging an unconscionable price for or in connection with emergency care or other care at the facility.

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“For the record, C-suite executives are actively engaged in reducing health care costs in the US, not by what they consider penny ante changes in plan design, but by replacing workers with robots and automation, self checkout machines, push button ordering in restaurants and drive thru food serves, etc etc etc. That not only cuts benefit costs but wages, workers comp, payroll taxes, sick leave, life insurance, training, on and on.  This is not to mention the rush to send US jobs to India and Mexico.  That’s how the c-suite is engaged.” – Tom Emerick  (www.emerickconsulting.com)

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Without disclosure to Plan Sponsor or the providers – the TPA simply misappropriated the difference between what Plaintiffs paid the TPA and what the TPA negotiated to pay the providers. Working the spread is a lucrative business………………..

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How the Molina Brothers Got Bounced From the Family Health-Care Firm…..

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“Everyone is trying to avoid the $12 million-man,. Because whoever catches him basically can’t make money.”

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“I want you to know that your long ordeal will soon be over,” Trump promised………….

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