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.
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%……………….
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.
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.
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………………….
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