A Con Victor Lustig Would  Have Approved

Lab billing jumped more than 22,000 percent from August 2017 to May 2018, from an average of $37,400 per month to about $8.5 million per month………………..

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San Patricio County is seeking qualifications from licensed insurance consultants to assist the county with its self-funded employee health & welfare plan. Firms / individuals are invited to submit their qualifications for consideration in providing a proposal for this scope of work.

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Making Money Off Medical Debt

As Tenet and other hospital companies struggle to make money providing medical care, they are turning to the profitable and growing business of collecting debt…………….

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 The story underneath is more complicated,” often reflecting a “black-box negotiation process between drugmakers, insurers and the middlemen who haggle behind closed doors over how much money changes hands……………….

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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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“How Sweet It Is……………….”

Making $1,000,000 has never been easier……………………..

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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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Even as they look back on several years of steady growth and success, many owners of independent insurance agencies now find themselves at a crossroad where they are pressed to make critical strategic decisions about the future of their firms……………….

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Hospital’s net patient service revenue was nearly flat year over year, but its premium revenue grew 13.5 percent to $1.3 billion………………

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“Never in our history has the administration of the program been as flawless, smooth and efficient as it has been since Gilsbar has been our third party administrator. Gilsbar’s ‘can-do’ attitude and willingness to go the extra mile in support of the health program are welcome changes to our experience of past years.” – Texas Farm Bureau

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What will Texas do to reign in health care costs for the public good. We may soon find out………….

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Lawsuit highlights one risk associated with reference-based pricing models: balance billing…..

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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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Shared savings programs entitle the health plan to retain a percentage of any savings generated by their focused interventions in a given area……………..

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Ohio’s Pharmacy Benefit Managers (PBMs) charged the state a “spread” of more than 31 percent for generic drugs – nearly four times as much as the previously reported average spread across all drugs, according to a new report by Ohio Auditor of State Dave Yost…………….

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Will pharmacy benefit managers (PBM) could go the way of the travel agent? After all, PBM’s function the way travel agents used to and benefit from price inflation………………………

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Feared government mandate may lead to massive pandemic in Central Texas…………………

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Ruben Edelstein practiced managed care in his own way……………………….

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Steady increases in health care costs is one of the main forces driving this school district towards the proverbial fiscal cliff. Two school years from now, the district projects it will be spending $450 million more than it takes in…………………….

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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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This anonymous agent reveals the dirtiest secrets of his profession, and the rules for building your personal safety net

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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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Jeff Bernhard and David Contorno interview  William Rusteberg on Reference Based Pricing

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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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August 15, 2018 by Alex Mulvenna

IRVINE, Calif–August 15, 2018–Competitive Health, Inc., a leader and innovator in network and ancillary product solutions (CHI), today announced that it has been named to the Inc. 5000 list.

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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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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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Have you ever wondered why healthcare spending is so high? We did. So we decided to peel back all the layers in the system and really look at where all the money was going. We were surprised by what we found……………………..

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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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A potential upcoming preliminary injunction could block enforcement of the entire ACA or, alternatively, of the individual mandate, guaranteed issue, community rating, and preexisting condition exclusion ban provisions of the ACA………………….

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Frustration with the US health care system is mounting. There’s a disconnect between what we spend and what we get in terms of high-quality outcomes and a good patient experience. Employers have the power to change that………………………….

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Employee Benefit Adviser has just published an article this week listing the top social media users among insurance advisers across the United States. The usual suspects were listed, like Carl Schuessler the famed inventor of the ever so popular Schuessler Stick……………………………….

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A San Diego whistleblower will receive $17.2 million with the settlement of a 7-year-old false claims lawsuit against Prime Health Care regarding overbilling for Medicare services at 14 California hospitals.

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Passing along losses to consumers is one pen stroke away……………Will Prime Healthcare renegotiate their managed care contracts?

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David “Nosradamos” Contorno

I’ve hesitated to predict this publicly…but I am ready to now…………………….(Drum roll please)

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Companies that negotiate for better prices on specialty drugs without the incentive of discounts and rebates…………………………..

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It came as something of a surprise when Health and Human Services Secretary Alex Azar announced that the administration was exploring the importation of prescription drugs to fight high domestic prices……………………

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“If you employ a workforce and offer benefits, your business IS a healthcare business” – Jim Immelt

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“[In] 2016, total US expenditures on pharmaceutical drugs, including the gross profits of all the intermediaries, were $480 billion … Two-thirds of this total ($323 billion) was captured by drug manufacturers in the form of net revenues. The remaining third ($157 billion) was retained as gross profits in the supply chain.

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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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On June 25, the US Supreme Court issued a 5–4 opinion in a case that may have significant implications for health care……………….The case of the two-sided transaction………………

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“The DOL acknowledged that AHPs will be MEWAs and that states will retain their existing authority related to MEWA regulation and enforcement….

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Article Referred By Dan Meyland – Allied National

HHS announcement below – 12 month STM Contracts renewable for 36 months (details below)

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