Standard HR demands include:
Month: June 2018
Medical Trend For 2019
Medical cost trend – Behind the numbers 2019
Employer medical cost trend has plateaued. PwC’s Health Research Institute projects employer medical cost trend will be 6 percent for 2019, the same as 2018. Cost reduction efforts will shift to prices.
David Belk
Hello Everyone!
I know it’s been a while since I’ve sent out an update, but I’m still busy writing my book (which is taking a lot of my time). I’m nearly done and currently trying to find a publisher (which is also quite difficult). In the meantime, I have updated one of the pages in my website, so I thought I’d share my recent findings with all of you since I think most people will be surprised with what I’ve found.
Transparency In Retirement Plans – Why Not Health Insurance Plans?
Employer thought they were paying their broker $126,000 per year. They were actually paying more than that………………………
Continue reading Transparency In Retirement Plans – Why Not Health Insurance Plans?
Status Quo Under Attack
Traditional health insurers, hospitals and independent physicians who refuse to change will become obsolete…………………………….
Spreadsheet Fiasco Leads To Firing
AUSTIN — The state has canceled five new managed-care contracts for low-income youngsters enrolled in the Children’s Health Insurance Program after finding errors in a spreadsheet used to evaluate bids.
Texas County Believes in Magic
A Texas county believes in magic. Facing ever increasing health care costs the county resorts to status quo strategies to temper increases – it’s called cost shifting……………………Meanwhile back at the ranch some Texas political subdivisions are improving benefits and lowering costs at the same time…………………………Health Care Strategies for Political Subdivisions
Oklahoma Welcomes Medica
Major Health Insurer Medica Brings New Competition to Individual and Family Health Insurance Market in Oklahoma…………………….
Insurance Giant Acquires Wortham
Wortham Insurance has agreed to a buyout by Marsh, a wholly owned subsidiary of New York-based Marsh & McLennan Companies Inc., combining two well-known names……………..
Health Insurers Love The “Affordable Care Act”
Continue reading Health Insurers Love The “Affordable Care Act”
Is It Legal?
Does anyone know for sure if the Texas Department of Insurance has any jurisdiction over Reference Based Pricing vendors who for a fee indemnify plan members against the risk of lawsuits and balance billing? Is the act of indemnification for a fee through transfer of risk the business of insurance?
What Causes Hyperinflation in Medical Costs? It’s Health Insurance Stupid!
Medical insurance directly causes price hyperinflation, because it insulates the patient from the financial impact of their medical care decisions…………………
Continue reading What Causes Hyperinflation in Medical Costs? It’s Health Insurance Stupid!
The Latest In Texas v. United States
Following the Trump administration’s surprise move not to defend major components of the Affordable Care Act (ACA), much more attention is being paid to litigation over the individual mandate known as Texas v. United States.
Amazon, Berkshire Hathaway, JP Morgan Target Point of Service Claim Adjudication
POSCA is coming and it’s gonna be really cool……………………….
Continue reading Amazon, Berkshire Hathaway, JP Morgan Target Point of Service Claim Adjudication
Why Work For A Living When Stealing Is Easier?
Continue reading Why Work For A Living When Stealing Is Easier?
The Impact of Catastrophic Claims (Plan on Continuing Rate Increases)
The Affordable Care Act did anything but make health care and health insurance more affordable. The law that was supposed to drive costs down actually did the exact opposite……………………….
Continue reading The Impact of Catastrophic Claims (Plan on Continuing Rate Increases)
BREAKING: Xerox Can’t Blame Doctors In $1B Texas Medicaid Fraud Row
Texas filed suit in May 2014 alleging the Xerox unit then known as ACS State Healthcare LLC, which administered claims for Texas from 2004 until 2012, signed off on $1.1 billion in claims for orthodontic services, a “substantial percentage” of which were allegedly paid in violation of Medicaid policies….…………….
Continue reading BREAKING: Xerox Can’t Blame Doctors In $1B Texas Medicaid Fraud Row
Government-Enabled Kickbacks Escalate Medical Prices
“Since the federal healthcare Anti-Kickback Statute GPO exception was created 30 years ago, the landscape has changed. The current GPO funding structure’s incentive is to ‘negotiate’ higher prices for its customers. The vendors with the most money can afford to pay the high fees and buy themselves into the game. The term ‘payola’—pay to play—comes to mind. The situation is exacerbated because insurers absorb the higher prices and thus hospitals may have less incentive to monitor pricing.”
Continue reading Government-Enabled Kickbacks Escalate Medical Prices
Must Reference Based Pricing Vendors Be Licensed?
Hospitals and their attorneys are getting creative. One issue of particular interest outlined in the article is apparently a new line of attack……………………..
Continue reading Must Reference Based Pricing Vendors Be Licensed?
We’re not good golfers…………………
This is one of the best insurance agency websites I have seen in a long time. They memorialize their philosophy in a compelling manner………………………….
Embodiment of Corruption: Your Health Insurance Network
Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..
Continue reading Embodiment of Corruption: Your Health Insurance Network
Government Control of Health Care Loosened in Bold Move
Move keeps the government officials from using its power and influence to direct the practice of medicine……………………….
Continue reading Government Control of Health Care Loosened in Bold Move
Why Do Prescription Prices Vary By Up to 1,300%
Learn how a recent study found that prices for 5 commonly prescribed prescription drugs varied but up to 1,300% based on where the drugs were purchased.
Montana Experiences “Holy Cow” Moment
Montana’s high-stakes game of chicken designed to change how the state did business with its 60 hospitals, which accounted for 43 percent of employee health care costs, turning the normal purchasing process on its head……………………..
Sana
Are you looking for new commission and bonus opportunities: Join us for a catered lunch at one of our local Texas events to learn how Sana is changing health insurance. Plus meet the founders.
Reference-Based Pricing Litigation: Brick By Brick
By Scott Bennett – www.linkedin.com/in/scott-bennett-72014594/
Whether you believe modern Reference-Based Pricing models are presently being built, remodeled, or dismantled “brick by brick” truly depends on your perspective. Either way, this is an interesting time to review the recent challenges, results, and future risk created by this important approach to health care reimbursement, which has saved employers millions of dollars and sparked fierce conversations about reasonable value across the nation.
Continue reading Reference-Based Pricing Litigation: Brick By Brick
Renting Medicare’s Provider Network
Association Health Plans Go Into Effect
This expansion of health care choices returns certain risk manager tools stolen by the government with the passage of the Affordable Care Act (ACA):
☐ Allows plans to exclude coverage for maternity care, prescription drugs, mental-health services and other ‘essential health benefits’ the ACA requires of coverage
☐ Plans will have more freedom to charge different prices depending on customers’ ages, genders and locations — something ACA coverage cannot do.
☐ The regulations erase a requirement that any association must already have existed for a purpose unrelated to health insurance.
☐ These plans will also be able to reduce administrative costs and strengthen negotiating power with providers from larger risk pools and greater economies of scale….
☐ Moves health-insurance regulation from the state level to the federal level.
Peeling Back The Health Care Onion
“Colorado hospitals statewide are paid an average of 290% of Medicare for inpatient services and 520% of Medicare for outpatient services…………………”
Unwieldy Health Costs Often Stand Between Teachers And Fatter Paychecks
In an era of $100,000-a-year drugs and government budget cuts, school districts are struggling to find the money to keep up their end of the bargain (providing benefits), forced to take away from classroom funding and even modest, cost-of-living raises. Many cash-strapped school boards, cities and legislatures view health care benefits as an unpredictable budget-buster.
Continue reading Unwieldy Health Costs Often Stand Between Teachers And Fatter Paychecks
Don’t Hire An Actuary Because You May Get Really Bad News
As a benefits consultant, if you not employing a licensed actuary providing these services your competition will……………………………..
Continue reading Don’t Hire An Actuary Because You May Get Really Bad News
McAllen Independent School District Seeks Reference Based Pricing Vendor
The McAllen Independent School District in deep South Texas is seeking competitive proposals for Reference Based Pricing plan administrator. Sources say the district is facing increasing health care costs and seeks to adopt a Reference Based Pricing plan option to offer in addition to their current PPO plan.
Continue reading McAllen Independent School District Seeks Reference Based Pricing Vendor
Why You Will Never Win
This was sent to several of us this afternoon from the one and only, Carl Schuessler, health care disruptor extraordinaire.
Introductions Are Worth Big Bucks In The Insurance Industry
Earning commissions forever by simply making an introduction beats working for a living………….
Continue reading Introductions Are Worth Big Bucks In The Insurance Industry
Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club
Continue reading Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club
Everyone Is Paying For Mary’s Deductible Because Mary Isn’t
Lucky Mary is even more lucky now that her employer decided enough was enough…………………….
Continue reading Everyone Is Paying For Mary’s Deductible Because Mary Isn’t
Saving Rural Hospitals By Gaming The System?
GAMING THE SYSTEM: Remote billing by rural hospitals is becoming a strategy to remain solvent? Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs………………………………
Continue reading Saving Rural Hospitals By Gaming The System?
Medicare For All & Reference Based Pricing
Since Medicare For All is only a few elections away some employers are asking “Why wait? Let’s do it!
Schools Buying Insurance Against Mass Shootings On The Rise
McGowan Cos., the largest underwriter of “active shooter” coverage, said they’re having a tough time keeping up with hundreds of inquiries from schools and other customers……………….
Continue reading Schools Buying Insurance Against Mass Shootings On The Rise
PUNISHMENT LETTER 226-J
The government of the United States has sent out 30,000 punishment letters to employers who have failed to comply with the ever so popular AFFORDABLE HEALTH CARE ACT…………………………..
Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional
Is it a tax if it raises no revenue………………………………….?
Continue reading Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional
Single Payer System Is One Election Away
The Elephant In The Room is stirring, anxiously awaiting the fall mating season……………………….
Accidents Of History Created U.S. Health System
How did Americans end up with a system in which employers pay for our health insurance? After all, they don’t pay for our groceries or our gas……………
Continue reading Accidents Of History Created U.S. Health System
Welcome To The ATM World of Pharmacy
Pharmacist-supported self-service kiosk pharmacies ………………….
Christian Healthcare Ministries – Alternative To Traditional Health Insurance
Christian Healthcare Ministries, one of several “health sharing ministries” whose members pool their resources to pay for one another’s health care expenses and has not had a rate increase in ten years……………………
Continue reading Christian Healthcare Ministries – Alternative To Traditional Health Insurance
Co-Pay Tactic by Benefit Managers Credited with Cutting Prescription Drug Prices
“It’s a constant cat and mouse game,” said Express Scripts Chief Medical Officer Steve Miller………………..
Continue reading Co-Pay Tactic by Benefit Managers Credited with Cutting Prescription Drug Prices
Will California Criminalize PPOs?
California would use Medicare rates as a floor for determining base amounts for providers and Medicare Advantage rates to set payments to health plans. Providers and health plans would be allowed to appeal for a higher amount based upon outstanding factors.
Wellness Programs Don’t Work
On its surface, who can argue with the concept of workplace wellness? How could there be anything wrong with corporations helping their employees reduce their risk of disease while saving money in the process?
Renowned Texas Heart Transplant Program Suspends Operations
Over 30% of patients who received heart transplants at St. Luke’s since the start of 2018 have died…………………………
Continue reading Renowned Texas Heart Transplant Program Suspends Operations
Drugmakers Blamed For Blocking Generics Have Jacked Up Prices And Cost U.S. Billions
By Sydney Lupkin MAY 23, 2018
The Trump administration is shaming brand-name drug makers who refuse to sell samples so generics can be made from their products.
Sex Sells – Winning Sales Quota by Banging Doctors?
In 2012, Insys hired a new sales executive: Sunrise Lee, a Florida escort service manager and former strip club dancer with no academic degree, according to Guzman’s complaint. Burlakoff allegedly defended the decision, claiming, “Doctors really enjoyed spending time with her and found Sunrise to be a great listener.” He added, “She’s more of a closer.”
The regional sales manager reported that the new employee was “dumb as rocks, but that she was sleeping with another doctor and getting a lot of prescriptions out of him.” Continue reading Sex Sells – Winning Sales Quota by Banging Doctors?