Helping members in border states maximize their benefits: Ternian develops new PPO network of providers in Mexico
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We’ve heard of shareholders’ lawsuits – it’s high time Plan members hold decision-making entities responsible through Plan member lawsuits……………….

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One reason health insurance companies are so strong and controlling is that they are exempt from antitrust regulations, allowing them to conspire on premium pricing…………………

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Placing nearly $1 billion in annual premiums for our clients, INSURICA is among the 50 largest insurance brokers in the United States and is currently the 27th largest privately-held independent agency in the country.

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Grow your business with the top freelancing website.

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The Employee Retirement Income Security Act (ERISA) of 1974 establishes minimum standards for retirement, health, and other welfare benefit plans, including life insurance, disability insurance, and apprenticeship plans.

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Oklahoma insurance agency specializes in association sponsored insurance programs since 1955………..

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Now that federal officials have quashed the mega-mergers proposed by the biggest insurers and blocked a deal between two large community pharmacy chains, established players in the health care industry are venturing beyond their traditional lines of business……………

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WHO, ME?

Warren Buffett said it all: “GM is a health and benefits company with an auto company attached.” In fact, it spends more on health care than steel, just as Starbucks spends more on health care than coffee beans………….

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Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge……

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For the more than 1 million members with access to the Rx Savings Solutions desktop and mobile app, saving money on a medication can sometimes require a new prescription from their prescriber. They can now request and initiate this switch in a matter of seconds…………………

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Thanks To Santa having sex is less financially stressful now……….

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One of my arguments about Blue Cross is that they do not manage claims, they just pay them…..

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A fascinating study by Alan T. Sorensen in 2003 on PPO discount patterns is an instructive read. The State of Connecticut’s data of the state’s hospital industry provided Sorensen a rare opportunity to study payer-level differences in negotiated discounts for hospital services and gives the reader insight into certain myths the managed care industry (including carriers, TPAs, agents and brokers) have successfully foisted upon clueless consumers for the past 35 years.

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Benefits represent a company’s second largest expenditure, yet only 17 percent of business leaders think their programs are being managed effectively…………..

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“The best way to lower health care costs is to lower health care costs”……………”Healthcare costs are directly related to what we agree to pay for healthcare”…………………..”The secret to lowering health care costs is to find providers willing to take less and discarding providers who want more – it’s called Free Market”…………. “If you want to cut your health care costs by 50% and more, without sacrificing quality or level of benefits, you can…………………”

The following article proves all of the above:

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By Bill Rusteberg

Acting as a fee based insurance consultant in managing a formal, public Request For Proposal process requires adherence to certain guidelines memorialized in statutes pertaining to political subdivisions.

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Employers are unhappy with their PBM relationships. Only one-third of employers rated their PBM as “very trustworthy.”

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By Mark Flores

The Complaint also alleges multiple violations of ERISA including, using plan assets to pay excessive fees and expenses, assessing undisclosed fees to the contribution amounts, failing or refusing to pay approximately $16 million for member’s medical claims, then transferring unpaid monies to offshore bank accounts in Bermuda.

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Zero tax rate attracts money offshore………………………..

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QUESTION: What’s the opposite of “Smart?”

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Humana said the company is cutting the jobs in part to invest in technology………….…………

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The county continued to save money this year under its Canadian prescription drug program, county officials said Friday……

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Consider what might happen if you could, say, guarantee a benefits manager a 25% reduction over current healthcare spend, with better outcomes. That would be an offer that she couldn’t refuse, especially if her CFO heard about it.

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Slowly we saw the rise of third party administrators, the evil purveyors of self-funded employee health & welfare plans…..

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OUTRAGED CONSUMER

Would you pay $169,600 for a $3,000 – $4,000 procedure? Well, guess what, you have already – it’s embedded in your health insurance premiums…………………..

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We bring you a network of independent pharmacies with a simple and unique pharmacy payment model. Our cost plus model reimburses drug costs via the nationally published public NADAC list and a fixed drug dispensing fee. No more arcane acronyms like MAC, AWP, and WAC and no more lengthy contracts detailing complex generic and brand definitions.

Editor’s Note: If you are in the pharmacy business I would like to hear from you – any comments or suggestions you may have I will post in a follow-up blog posting………….Rx costs are out of control and the PBM world doesn’t seem to care. Perhaps PBM’s are the bad guys? If not, convince me please………………Write to RiskManager@RiskManagers.us

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Blue Cross Blue Shield of Arizona (BCBSAZ) provides large, self insured groups access to the BCBSAZ provider network……………..But how do they keep their PPO payment methodologies secret from the TPAs and more importantly, plan sponsors who pay the bills?

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UnitedHealthcare  boasts that its PPO—a network of more than 780,000 professionals—cuts the cost of typical doctor visits by 52%, while saving 69% on MRIs. Pull back the curtain, and you’ll see these discounts are an accounting trick. To allow PPOs to advertise big discounts, providers simply inflate their billed charges on a whole range of services and treatments.

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