Why Use PBM’s When It’s Cheaper Without Them?

Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics…………..

Editor – The problem is pharmacists are under a PBM gag order and cannot advise patients when it’s cheaper to pay cash than to use their prescription drug card

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Texas Teacher Thought He Had Great Health Insurance

This blog entry illustrates the crazy world of hospital pricing in this country. A Texas teacher insured through his employer by a major carrier thought he had good insurance. He doesn’t think so now.

See how Scott Bennett calculated the hospital’s actual cost associated with a billed charge of +$164,000 in five minutes (www.linkedin.com/feed/update/urn:li:activity:6440264900991426560

Then read the article below.
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CapRisk Consulting Group

Actuarial and Business Consulting Services

CapRisk Consulting Group brings a practical means of problem solving to all of your actuarial risk and business insurance matters. CapRisk is an independent consulting firm offering a unique combination of actuarial and business consulting services, assisting clients with local, national, and international interests.

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Is Low Bid Always The Best Bid?

The science of how to compete against “low bid” is a discipline learned by losing. Over time a seasoned salesman will learn how to beat the “low bid” and win more than he loses.(How To Win Against A Competitor’s Low-Ball Price Bid – Forbes)…………….In the article that follows the “high bidder” who lost to the “low bidder” is protesting. Is the $700,000,000 savings really true……………….? Common sense dictates otherwise.

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How Much Did You Pay For Your Banana?

Imagine a banana in a supermarket.  It costs $1 for those paying with Visa, $3 for those paying with MasterCard, and $32 for those paying with cash.  You can’t sign up for Visa until you’re 65, and you can only get a MasterCard if you have a nice employer or a decent income.  Worse, customers have no idea that such price discrepancy exists.  They don’t even know how much they’ll pay for the banana until long after they’ve eaten it…………………

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Connecting Consumers With High Performance Medical Care

It’s a fact that a huge variation exists in surgical quality by hospital. A hospital that has great outcomes in one type of surgery (such as orthopedics) may have poor outcomes for other surgery types (such as cardiac surgery or women’s health). Based on this, BridgeHealth created a program that connects members with high performance surgical facilities for their specific surgery type.

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Beware of Health Care Consultants’ Partnerships

This article exposes a common practice in our industry and should be read by every CEO. Brokers and consultants earning undisclosed commissions through recommendations they make happens all the time. I see it and expose it but CEO’s don’t. Try showing some of them the evidence and see the reaction. 

Recently I was tasked in reviewing a 2,500 employee school district in Texas. Disclosed compensation to the Agent of Record was $128,000. Actual compensation was $614,000 shared by two brokers one of which the district never met or knew. What did the district do? They fired the brokers and hired a local broker to earn the $614,000.  –  Bill Rusteberg

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Blue Cross Hit With Flurry of ERISA Lawsuits – Again

When are plan sponsors going to wake up? Hidden fees driving up health care costs are more common than you would think. But its true. We could name dozens of lawsuits filed over recent years exposing practices that would make your toenails curl up. Here is one example:Weslaco ISD vs Aetna Yet many plan sponsors look the other way and continue to fund the conspiracy…………………….

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The Attack of The Rebates (COMMISSIONS)

Health and Human Services Secretary Alex Azar has said Americans “do not have a real market for prescription drugs” because drug middlemen and insurers get a wide range of hidden rebates (COMMISSIONS) from drugmakers, but those savings may not be passed on to consumers or Medicare.

Editor’s Note: Lets not pretend any more. “Rebates” are simply “Commissions” paid to third party intermediaries to push drugs. Dressing up the English language like calling welfare “subsidies” and crippled “handicapped”, and queer “gay” may give a softer touch, but is it really necessary? The meaning is the same isn’t it?

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TRS ActiveCare Announces Benefit Changes, Rate Increase 2018-2019

The TRS Board of Trustees has adopted medical and pharmacy benefit changes to reduce a projected premium increase to 5.7 percent, instead of 7.2 percent. The main benefit changes were to add new freestanding emergency room (ER) copays and adjust specialist copays, deductibles and maximum out-of-pocket amounts.

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