Helping members in border states maximize their benefits: Ternian develops new PPO network of providers in Mexico
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Month: November 2017
Indians Are Restless – “We’re Not Paying This!”
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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The Cost of Health Insurance Would Drop With This Legislation
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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Insurica
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.
Get It Done With A Freelancer Like RiskManagers.us
Grow your business with the top freelancing website.
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ERISA Experts Provides Plan Sponsor Support
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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3000 Insurance Group Specializes In Association Sponsored Insurance Plans
Oklahoma insurance agency specializes in association sponsored insurance programs since 1955………..
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As Health Care Changes, Insurers, Hospitals and Pharmacies Team UP
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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CEO: You Run a Health Care Business Whether You Like It or Not
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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Destroying Evidence – A Time Tested Strategy
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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Rx Savings Solutions
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…………………
A Thanksgiving Message From Brian Klepper
State Gifts Workers Who Have Sex – Xmas Every Day Makes For Happy Employees
Thanks To Santa having sex is less financially stressful now……….
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Does BCBS Manage Claims or Do They Just Pay Them?
One of my arguments about Blue Cross is that they do not manage claims, they just pay them…..
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PPO “Discounts” Off Billed Charges Mean Nothing
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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83% Of Business Leaders Think Their Insurance Agents Suck!
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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How One Insurer Makes A Fortune By Reducing Healthcare Costs
“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:
Continue reading How One Insurer Makes A Fortune By Reducing Healthcare Costs
Request For Proposals – Non-Disclosure Statement
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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HOLY BENEFIT MANAGEMENT, BATMAN!
TRS Care Marketing Opportunity for Insurance Agents
As expected, there are many people leaving TRS and trying to secure a new health and drug plan in 2018……
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DOL Gives Kiss of Death in “Healthcare Madoff” Scheme
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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Veterans Day 2017
How Reinsurers Help Hedge Funds Shelter Taxes
Zero tax rate attracts money offshore………………………..
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The Smart Plan
QUESTION: What’s the opposite of “Smart?”
Humana Profits Fall As Insurer Cuts 2,700 (Human) Jobs
Humana said the company is cutting the jobs in part to invest in technology………….…………
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County Continues To See Drug Savings Through Canadian Rx Mail Order
The county continued to save money this year under its Canadian prescription drug program, county officials said Friday……
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‘High-Performance’ Health Innovators Could Improve Outcomes, Lower Costs
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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Confessions of a Reformed Health Insurance Broker – From Innocence To Darkness
Slowly we saw the rise of third party administrators, the evil purveyors of self-funded employee health & welfare plans…..
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WHY AN ‘OUTRAGEOUS’ $169,600 MEDICAL BILL ACTUALLY GOT PAID
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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Cost Plus Rx Model For Self-Funded Health Plans
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 PPO Rental Network
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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The Deception Behind Those In-Network Health ‘Discounts’
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.
Continue reading The Deception Behind Those In-Network Health ‘Discounts’