Mike Reagan
Fiduciary risks are major concerns for most employers and their advisors, especially when the employer’s healthcare plan is self-funded……………
Continue reading Are you the Fiduciary or Co-Fiduciary for RBR balance billing claims? Why?
Mike Reagan
Fiduciary risks are major concerns for most employers and their advisors, especially when the employer’s healthcare plan is self-funded……………
Continue reading Are you the Fiduciary or Co-Fiduciary for RBR balance billing claims? Why?
After some digging with the help of attorney Steve Cohen she discovered the insurer “deliberately exaggerated the benefits available under the plan, while understating the uncovered costs that must be paid by members……………..”
Continue reading Whistleblower Claims BCBS Scammed Taxpayers Out of $1 Billion
Medicare Extra is a Reference Based Pricing program that mandates government price controls.
Continue reading Will Government Price Controls Fix Health Care?
The states also say in the suit that because the health law doesn’t have a “severability clause” — a provision that says if one part of the law is struck by the courts, the rest would stand — if one part of it is struck down, the rest is invalid.
May I suggest that this time you order a pizza with ricotta, arugula, sun-dried tomatoes and olives on a whole wheat gluten-free thin crust?
Continue reading Ordering Pizza? Let’s Check Your Medical Records First
Patient blindsided by $17,850 urine test that insurer said was worth $100………………….
Continue reading How To Become Independently Wealthy In The Urine Business by I.P. Freely
Does one’s refusal to sign a non disclosure agreement indicate a sign of dishonesty? Or does it indicate something else?
Continue reading Are Non-Disclosure Agreements For Dishonest People?
Here’s a simple calculation of the stock price growth of major health plans – United, Aetna, CIGNA, Humana and Anthem – over a period of just less than 9 years since the passage of the Affordable Care Act. Stock price has grown a breathtaking 5.3x-9.6x, about 3x the growth of the Dow Jones Index and 2.5x the growth of the S&P over this period.
Continue reading Are The BUCA’s Invested In Higher Medical Costs?
The cost of coverage would be offset significantly by reducing health care costs. The payment rates for medical providers would reference current Medicare rates—and importantly, employer plans would be able to take advantage of these savings.
Continue reading Medicare Extra – The Ultimate Reference Based Pricing Plan?
“Derek understands that taking control of the healthcare spend has to start in the C-suite”
Region One Education Services Center is seeking competitive proposals for voluntary employee benefits as well as certain employer paid benefits.
RFP 19-AGENCY-000042 is now available. Region One ESC and its Cooperatives have a new online procurement system e-BuyOne! Click here and register today! à www.esc1.net/eBuyOne
Continue reading Region One Education Service Center Seeking Competitive Proposals
“Is it any wonder that when you tell an employer they can return 30% of their number two business expense to the bottom line, stabilize future cost and make their employees raving fans of their healthcare funding plan, they would like to see proof? ” – Tommy Taylor
Continue reading Healthcare Disruptor Declares War Is Won Despite More Battles Ahead
Continue reading Changing The Paradigm For Texas Public Employers
This is how the fraud is committed, and this information is not provided in any reports provided by the hospital or insurance company so the hospital commits the fraud and the systems in place (Artificial Intelligence or lack thereof) is how the claims get through without touching a human hand……………….
An Amarillo Farmers Agent, Scott Houdashell and his friend Curtis McGill hit it big on the Shark Tank this week receiving multiple offers to invest in their multi-million dollar eggmazing business which began with an electric screw driver, hot glue stick and a spoon……………………
Continue reading Texas Insurance Agent Hits It Big On Shark Tank
Lawyers standing by…………………………….
Continue reading Attention Plan Members: Sue Your Employer For Breach of Fiduciary Duties
An entire strategy for solving health care is centered upon the power of knowledge squarely based on reason and logic against which status quo special interests cannot prevail…………...
Continue reading Health Care Strategies for Political Subdivisions
“We recently repriced the top five highest drugs utilized by a client. We simply entered the data on a site we found on the internet for retail Canadian drug prices. The pricing differential was a whopping 80% ” – Bill Rusteberg
When healthcare providers are unable to collect payment on medical bills, they sometimes sell the debt to collection agencies, often for as little 1 cent for each dollar owed.
Continue reading TV Station Buys $1 Million Worth of Medical Debt for $12,000
An intentionally small “concierge” consulting firm offering a unique approach to benefits management to a select group of clients, Benefit Strategies provides Insurance, Risk Management and Employee Benefits Consulting.
Serving as a Population Health Manager specializing in Cost Containment and Risk Mitigation, the partners pride themselves on their ability to be creative in designing innovative, optimum plans and helping companies and individuals make the most of their financial resources by serving as a Fiduciary and Steward of health plan dollars. With more than 25 years of experience in employee and executive benefits consulting and financial planning experience, Carl offers clients improved cash flow, saves money and retains top talent with well-structured employee benefit and financial planning solutions. He is also an accomplished speaker and author.
“Will my premiums increase?”
(Reuters) — A federal judge has ruled the U.S. Justice Department can move forward with a lawsuit claiming UnitedHealth Group Inc. wrongly retained more than $1 billion from the government health care program Medicare.
Continue reading United States Government Can Sue UnitedHealth Group in $1 Billion Medicare Case
What a difference 290 miles can make in how one State Governor’s administration and legislature can view health care rights of a population. Is health care a right?
In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s ability to guard against healthcare billing fraud, waste, and abuse.
Under Affordable Care Act, companies with more than 50 employees must offer health insurance. Now some getting hit with penalties are disputing the fines………………………….
Continue reading Businesses Challenge IRS Bid to Start Enforcing Insurance Mandate
Texas political subdivisions are struggling to address rising medical costs which, in most cases, represents their second largest budgetary expense after wages. Seeking economies of scale, some counties, cities and school districts have joined risk pools such as TML, TAC and TRS ActiveCare. However the concept of the power of large numbers has failed to control costs.
We know why………………………………………….
Continue reading
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Continue reading Recording Phone Calls Makes Your E&O Provider Happy
Insurance carriers typically start with a high quote to provide room for negotiation……………….
Continue reading Understanding How Carriers Calculate Renewals
“There’s one trend driving the CVS/Aetna merger that the industry isn’t talking about: referenced-based pricing.”
The Experience To Drive Change
The transition to value-based care is accelerating. Evolent Health partners with provider organizations who are leading the change within their communities, providing the infrastructure and financial support providers need to achieve clinical and financial success.
During a recent renewal meeting an employer asked if (BUCA) would object if they hired an outside audit firm to review claims. Before the rep. could answer I jumped in and read the BUCA rep. the HealthCare Miranda Rights :
When Peoria Public Schools began working with AIMM the medical cost PMPM was close to $500 dollars. The group was eager to avoid cost-shifting and benefit erosion………………..Within three years, the medical cost PMPM have decreased by 25%.
Continue reading School District Adopts Cost Saving Strategies – Reduces Cost 25%
. “Americans act in ignorance of, and thus against, their own economic interest, making health care inexcusably expensive…..”.
Continue reading Why Do Americans Act Against Their Own Economic Interests?
Finding the right doctor at the right time, the right place, and at the right price is not something consumers are prepared to do. SprrmoHealth provides the solution………………….
Away from the noise in Washington, there’s a quiet movement to improve healthcare and lower costs—and it’s making progress. The movement is led by employers and other large purchasers of health benefits, like unions and retirement plans, which cover the majority of Americans. Starting with this post, I will periodically profile the pros and cons, as well as some of the more influential and promising strategies used by these purchasers. Today I will focus on a strategy called “reference pricing.”
Continue reading Reference Based Pricing Alone Is Not Enough – THE MISSING PIECE
There is one job that plays a central role to fixing the healthcare mess: the benefits consultant. No one has a bigger influence over health purchasing than benefits advisors.
Saying the online retailer was attempting to get ahead of the anticipated rush, Amazon CEO Jeff Bezos announced Wednesday that his company’s warehouses have been stocked with 20,000 doctors in preparation for the launch of his new healthcare initiative.
Continue reading Amazon Warehouses Stocked With 20,000 Doctors In Preparation For Healthcare Launch
The coverage of the JPMorgan/Amazon/Berkshire Hathaway healthcare initiative has been universal, breathless, and mostly superficial.
Continue reading Media Coverage of Amazon/Berkshire/JPMorgan Misses the Point.
Our group medical plan is doing much better this year than last year! Really, how do you know?
Working the Spread – “He also recounted an extreme case in which a pharmacist lost more than $100 on a psychiatric drug for which he was reimbursed $431. Meanwhile, the patient’s explanation of benefits from Arkansas Blue Cross indicated that his insurance had paid $1,005 for the drug, leaving a “spread” of $574 that was presumably retained by Caremark/CVS.”
Continue reading Pharmacists: New Reimbursement Rates for Drugs Unsustainable
“You can always count on Americans to do the right thing – after they’ve tried everything else.” – Winston Churchill
Continue reading American Healthcare Revolution – The Militia Has Formed
“If interested I had a very insightful interview with Dr. David Nash yesterday on PopHealth Week. For those who don’t know David, he is the Founding Dean of the College of Population Health at Jefferson, an Internist and on the Humana Board. I have never heard him so negative, he stated PCMH doesn’t work, ACOs don’t work, and finally just said doctors need to look in the mirror, there are too many mistakes and deaths, too many tests ordered etc. Very interesting 30 minutes if you have time.” – Frederic Goldstein
The old world died a few years ago, so it’s time to quit thinking in the same terms as you did before…………
Continue reading Are Fully Insured Health Insurance Programs Obsolete?
“There are proven but mostly untapped approaches in the market that effectively manage health care clinical, financial and administrative risk, consistently delivering better health outcomes at significantly lower cost. In the main, legacy health care organizations have ignored these solutions, because efficiencies would compromise their financial positions.”
Brian Klepper
I have a very complicated benefits question. Many years ago, I married a widow who had an 18 year old daughter. After the wedding, my father, a widower, came to visit a number of times, and he fell in love with my step daughter. My father eventually married her without my authorization.
SAUGATUCK, Mich. — Michael Ryder had been approved for $360 every week in Michigan unemployment benefits — until the state learned he’d been dogging it at the Detroit-area restaurant chain where he supposedly worked.
Continue reading Michael Ryder Receives Letter Granting Unemployment Benefits