Attention all TPA’s and PBM’s that may want to work with me and my clients……you will give me any and all data I ask for, in an expeditious and COMPLETE manner, without talk of extra costs or complexity. Your entire purpose is to analyze data and make decisions on that data, on behalf of our clients, with their money.
“WHY WORK FOR ANYTHING LESS THAN THE MOST YOU CAN GET?”
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Mike Dendy
Eliminating the PPO domination of healthcare financing will represent a paradigm shift but one that is long overdue.
In a move that it says will save members money, Anthem is rolling out a program that steers individuals away from hospital-based imaging services and toward less costly, freestanding imaging centers.
BCBS of Georgia held a webinar last week. From what we have been told, BCBS and Anthem are cancelling Emergency Room benefit payments that are not “emergencies.” We have done the same with some of our self-funded clients. Significant savings have been achieved. No longer will Mommy take little Johnny to the ER for a fever and pay a low co-pay. Now when Little Johnny’s mommy gets the bill, her co-pay for non-emergency ER visits will be 100%……………….
Aug 28, 2017
BY BRIAN KLEPPER
A challenge for health care purchasers is choosing vendors whose performance matches their cost and outcomes claims. A 2015 Mercer surveyfound that only 41 percent of worksite clinic sponsors think that they’re saving money. As Al Lewis and Tom Emerick have detailed, many wellness and disease management companies simply overstate their results. In many cases employers may not realize that they, not the vendor, take the risk for results.
Part-time PBM Salesman
“Costs would run an estimated 58 percent higher without PBM management tools and the pharmacy pricing and manufacturer discounts negotiated by the PBM”.
Legal groups on Monday filed a class-action lawsuit against the health insurer Aetna, alleging the company violated the privacy of its customers by sending many of them letters through which the phrase “filling prescriptions for HIV” was visible through envelope windows.
WellNet’s Fall Broker Revolution Tour is coming to a city near you. This tour is for brokers and consultants whose clients are tired of the carrier lip service.
Damn it! We can’t continue to go around selling PPO plans instead of reference based pricing plans…..…
They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges!……………
By cutting certain players, often insurers, out of the drug supply chain, disruptors are challenging the drug-pricing paradigm, as well as the value of prescription coverage…………
The bill expands a patient’s ability to mediate their claims with the insurance companies and sets new guidelines for mediation………………….
Jeff Bernhard – President of Continental Benefits
Does everyone realize that a discount guarantee is really useless/ineffective for a self-funded offer/RFP? When does a discount ever lead to lower spend? How silly!
Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.
A Shell Game Common To Health Care Financial Transactions
As a plan sponsor are you paying undisclosed fees that don’t show up on the fixed cost side of the ledger but rather on the claim cost side? There are numerous lawsuits that have exposed this industry practice and is not limited to BCBS………………….
Bill prohibits insurance providers from forcing Texas policy holders to subsidize elective abortions
A Man Before His Times – Martin Luther announcing “Free at Last” Reference Based Pricing Plan
Penn Treaty’s liquidation poses a “potential shock to the health marketplace” as the losses pile up, according to the A.M. Best credit rating firm. Industry analysts estimate the parent company has long-term claims liabilities approaching $4 billion, but only about $700 million in assets.
Many independent fee based insurance consultants are sucked into the PPO “discount” vortex……………..
“The carriers are very good at playing this game and my belief is that most consultants don’t get it or pretend not to get it, thus doing a great dis-service to their client.” – PHO Sales Representative
This program is applicable to all areas of the public education sector, including school districts, junior colleges, and colleges.
Employers can immediately reduce the cost of health insurance by 20% by simply shifting their focus to proven strategies…..
“The truth is that group health plans typically earn a percentage of total expenditures, and it is in their interest for healthcare to cost as much as possible.”
