What Advisers Should Know About The First Reference-Based Pricing Lawsuit

In Martinsville, Virginia, there is a reference-based pricing lawsuit pending that industry insiders are watching closely, because it could set a precedent for these types of lawsuits moving forward. In this case, a Virginia hospital has been pursuing an $84,000 balance bill from a former patient for nearly four years and through two separate courts……………………

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Gotcha Clause

Recently a Texas school district awarded a contract for TPA administration based, in part, upon representations made to the Board of Trustees by salaried representatives of the TPA. After the contract  was awarded it was discovered material misrepresentations were made prior to contract award and upon which the Board of Trustees placed paramount importance in their decision making process.

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Government Overreach Ends in Whimper

The government’s attempt to prosecute Shafer as a dangerous FBI-stalking villain ended with a whimper instead of the bang the prosecutor hoped for…………………..Badge heavy FBI agents created private hell for Shafer and his family………………(Badge Heavy – A police officer who believes wearing a uniform with a badge makes him king of the universe. An arrogant police officer).

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Rx Copay $20, Pharmacist Paid $1.75, PBM Keeps The Difference

CIGNA Sued for Rx pricing practices…………………..

A federal judge in Connecticut has denied most of Cigna Health and Life Insurance’s claims in its request to dismiss a lawsuit which alleges it artificially inflated prescription drug costs in violation of the health insurance policies of its clients………………

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Resistance To Change Frustrates Health Care Disruptor

Thanks, but no thanks. We don’t believe you and we don’t want to save money and improve benefits at the same time. The fear of pissing off employees far outweighs our bottom line. Plus, we have less employees than we could have by redirecting health care dollars to grow our business. And, we pay our employees less because as the cost of health care increases the less they receive in wage increases. It’s a system we are used to after 40 years of managed care. So, go away please…………

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Budgetary Constraints & Rising Health Care Costs

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………………………….

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“All advisors must endeavor to systematize their practices as much as possible so that they can remain competitive, highly profitable, and be in a position to grow in a disruptive and fee sensitive environment.”

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Is “Free” Cafeteria Plan Administration In Exchange For Products Legal?

 

Many purveyors of voluntary employee benefits offer “free” Cafeteria Plan administration in return for the opportunity to sell voluntary products such as cancer plans. A portion of the commissions earned by writing agents are shared with the Cafeteria Plan administrator thus affording “free” administration services to the plan sponsor.

Is this practice legal?

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This is your opportunity to speak with some of the nation’s leading experts as they outline new solutions to the current market………………..

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