Before we go further, I’d like to clear something up: Wellness is not the same as medicine…….
Month: December 2018
Texas School District Set To Close 12 Schools
Austin school district officials are proposing closing 12 schools, among other cost savings that total $55.1 million, as the district faces a deficit for the third year in a row…………….but will they address their second largest expense – health insurance? They can cut millions while improving benefits at the same time but no one seems to have told them that…………………….Meanwhile a large municipality near Houston continues to sell city land to pay for health care for city employees…………..
Continue reading Texas School District Set To Close 12 Schools
Underwriter Opines on Reference Based Pricing
By David Stanard VP, Underwriting Manager at Excess Risk Reinsurance Posted on Linkedin
As an underwriter, I’m always surprised by the examples given when discussing RBP. They always seem to omit the fact that RBP has almost NO impact on an employers drug spend. In today’s market, that’s 30-40% of your cost.
Continue reading Underwriter Opines on Reference Based Pricing
Reference-Based Pricing: a Welcome Disruption
Disruptors Change History in Boston – “Tea Anyone?”
These plans are a game-changer in our industry, and a much-needed disruption to the status quo……………
Continue reading Reference-Based Pricing: a Welcome Disruption
WELLNESS PROGRAMS – The Good, The Bad, and The Just Plain Silly
The good news is that the wellness industry is finally coming around (kicking and screaming at times) to the realization that their programs are not a health care cost savings strategy………………..
Continue reading WELLNESS PROGRAMS – The Good, The Bad, and The Just Plain Silly
Employer Based Food Insurance
The government bestowed a big tax break on employer-purchased food plans a few generations ago……..
High RBP Fees Offsets Plan Savings
“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”
Protection Money In Healthcare
“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to traditional American business practices.“
Merry Xmas Mulebriar!
Mulbriar receives unsolicited Christmas gift revealing best kept secrets of out-of-network reimbursement strategies among the BUCA’s…………………..
Doctors Strike
TPA / RBP Vendor Compares Fees To Competition
Commission driven broker / consultants push certain products over others. Here’s an example…….
Continue reading TPA / RBP Vendor Compares Fees To Competition
Managing Risk vs Servicing Risk – The End of Status Quo Brokers?
With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….
Continue reading Managing Risk vs Servicing Risk – The End of Status Quo Brokers?
Insulin’s Inventor Sold the Patent for $1
Insulin’s Inventor Sold the Patent for $1. Then Drug Companies Got Hold of It.
Never underestimate the greed of a pharmaceutical company.
A $5,571 Bill For Sitting In A Waiting Room
More evidence the American healthcare delivery system is in melt down………………Continued destruction of the American middle class…………….
Continue reading A $5,571 Bill For Sitting In A Waiting Room
Is 150% of Medicare The RBR Sweet Spot?
On average, commercial rates were 89 percent higher than Medicare rates……………….That means 5-% of commercial rates are less than 89% of Medicare………………..
Uh Huh, Right………………………
John Roberts – ObamaCare Savior
The Individual Mandate no longer ‘triggers a tax’ beginning in 2019……………………..
Tyrone Is At It Again Godfather!
I came across the single best explanation of AWP or Average Wholesale Price and I want to share it with you.
Telemedicine Back In The Day
https://youtu.be/79aBG1wk-oo
Blue Cross Faces Antitrust Claims
John Sherman
Blue Cross Blue Shield faces allegations of anti-competitive behavior that violates the Sherman Antitrust Act of 1890………………………………….
McAllen Independent School District Seeks Insurance Consultant
McAllen Independent School District (the “District”) invites your submittal on:
Insurance &Employee Benefits Consulting Services
Continue reading McAllen Independent School District Seeks Insurance Consultant
Free Market Fails, Government Steps In…………….
Is government mandated price controls the answer to rising health care costs……………?
Continue reading Free Market Fails, Government Steps In…………….
Why Does 100 Year Old Life Saving Drug Cost So Much?
For a product that’s nearly 100 years old prices are too high, forcing diabetes patients to ration their drugs and sacrifice their health for financial reasons………only hree drugmakers control all of the U.S. insulin supply……………..list prices for one type of insulin grew 600% over 14 years…………
Continue reading Why Does 100 Year Old Life Saving Drug Cost So Much?
ERISA Class-Action Litigation over Fees in Health and Welfare Plans
A potential mine field for health-plan fiduciaries involves failure to ensure that plan participants pay only ‘reasonable’ fees for services, including co-insurance and deductibles…………..
Continue reading ERISA Class-Action Litigation over Fees in Health and Welfare Plans
Sales Bonus or Bribe?
“The employer has no one — not the carrier, the broker, the third party administrator, the pharmacy benefit manager, the hospital or the doctor — sitting on their side of the table, with a shared incentive to lower healthcare cost.”
– Nelson Griswold, president of Bottom Line Solutions in Nashville, Tenn.
I Own You – Do What I Say or I’ll Break Your Legs!
Pssst, Godfather, Bill Is Attempting To Move Our Business!
“Tell Bill I’ll make him an offer he can’t refuse………………………………………”
Continue reading I Own You – Do What I Say or I’ll Break Your Legs!
Rebates!
Handling Health Claims: Traditional Carriers vs TPAs
“For the lion’s share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But … there are some services for which the carrier’s network rates are egregiously high — and for those services the TPA will simply apply Medicare reimbursement levels instead….”
Continue reading Handling Health Claims: Traditional Carriers vs TPAs
Sierra-Berkshire Associates
Affordable Care Act Increases Need for Actuarial Services……………
What Is AWP?
It is an elevated drug price that is rarely what is actually paid……………So why use it?
Rare View Behind The Curtain
Drug prices are difficult to determine for patients. Drug wholesalers, distributors, healthcare providers, pharmacy benefit managers and pharmacists keep prices hidden from the public. Until now…………………………..
That’s Not What We Were Told!
Hermann Ebinghaus
How effective are employee health insurance benefit meetings? Or are they a waste of time?
Texas: Short Term Medical Plans Under Attack
In January, the 86th Texas Legislature will convene in Austin. Hopefully, they will address expanding health coverage in Texas, prohibit short-term coverage from discriminating based on health status, and limit the maximum time an individual may be enrolled to less than 364 days………….
Continue reading Texas: Short Term Medical Plans Under Attack
Deep South Texas Faces Unique Health Care Challenges
25% of the population in deep South Texas receive free health care. Known as The Valley, the region has unique health care and economic challenges including a high diabetes rate, high poverty rate, and heavy dependence upon government and health care jobs…………………
Continue reading Deep South Texas Faces Unique Health Care Challenges
Tyler Man Connected To PBM Kickback Scheme
Tom Slack, of Tyler, received more than $1.5 million in illegal kickbacks………………
Texas Insurance Consultant Forfeits License
Convicted Texas insurance consultant William Haff forfeits insurance licenses……………accepted bribes to steer public school business to insurance broker………………
Continue reading Texas Insurance Consultant Forfeits License
Health Care Sharing Memberships Top 1 Million
A million Americans — a number that is growing — have rejected medical insurance for membership in one of the 104 known and active Health Care Sharing Ministries in North America…………………………….
Continue reading Health Care Sharing Memberships Top 1 Million
Decades Old BCBS Love Hate Relationship Continues……….
Hospital administrators throughout Texas say the insurance company is using “strong-arm” tactics to push unfavorable contracts……………
Continue reading Decades Old BCBS Love Hate Relationship Continues……….
Guaranteed Cost Stop Loss Insurance
Guaranteed cost stop loss insurance for today’s environment……….
RxReins
Bringing financial stability. Ensuring peace of mind.
Plan Sponsors At Risk For High Fees – Breach of Fiduciary Oversight
“Health-plan participants could conceivably choose to challenge health-plan fees with general fiduciary-breach claims. In fact, it is reasonable to expect that such claims will be made against other health-plan sponsors, given that plaintiffs’ firms have begun to solicit potential class representatives and request health-plan fee information from employers.”
Continue reading Plan Sponsors At Risk For High Fees – Breach of Fiduciary Oversight
Communist China Adopts Free Market Medical Costs Strategy
China embraces competitive bidding instead of price fixing?………….A free market approach in a communist country?…………………….Mao Zendong must be rolling over in his grave these days……………..Meanwhile back in the United States Cloned Zendong’s move forward pushing their Cultural Revolution with fervor……………..
Continue reading Communist China Adopts Free Market Medical Costs Strategy
Wallet Biopsy Determines Prognosis
Patients must be first class fund raisers – their lives depend on it…………………………
Here’s To The Crazy Ones……………….
“Here’s to the crazy ones. Misfits, rebels, troublemakers. They are not fond of rules. They have no respect for the status quo. They change things…………………….”
Turd Polish Season
Most traditional benefits brokers are wrapping up Turd Polish season (aka Open Enrollment). You know, that process of trying to make the “pay more, get less” benefits discussion that happens every year.
Get Your Healthcare Before It’s Too Late
If you’re currently without healthcare for next year or are in search of a new program heading into 2019, you need to know that the deadline to purchase health insurance through the government Exchange is December 15.
Pigs To The Rescue…………………
Pig hearts could soon be tested in humans after scientists pass important milestone…………..
Find Out If You Have Cancer in 10 Minutes
Blood test to detect cancer within just 10 minutes developed by scientists
Charge Master Rates & Magical Discounts
A client on Reference Based Pricing experienced first hand the magic of Charge Master rates and magical discounts………………………….
How to Bring the Big Health Insurers to Their Knees
The American health care revolution is in full swing and growing………………….
Continue reading How to Bring the Big Health Insurers to Their Knees
Missouri Chamber Health Plan Misses It’s Mark
“When the data is hidden, you have no choice but to hope that the insurance company is managing your money appropriately.” – Adam Berkowitz
Continue reading Missouri Chamber Health Plan Misses It’s Mark
Indemnity Insurance Plans Provide Best Coverage
Plan liability is well defined and budgetable, patient liability is too…………….
Continue reading Indemnity Insurance Plans Provide Best Coverage
4 Reasons Reference Based Pricing Could Become The Norm
Reference based pricing isn’t new, nor is it unproven. The need to control still-growing health insurance costs will make more large employers sit up and take notice of the practice……………….
Continue reading 4 Reasons Reference Based Pricing Could Become The Norm
The Wall Street Journal: Employers Change Tactics To Curb Health-Insurance Costs
Company leaders are grappling with how to deal with the rising cost of health insurance in ways that get beyond the longtime strategy of simply passing on more of the burden to workers.
Continue reading The Wall Street Journal: Employers Change Tactics To Curb Health-Insurance Costs
Health Care Lobby VS Dale Folwell
“Lobbying? We’ve got 9 million taxpayers and 720,000 participants in this plan who understand that they aren’t consuming health care, it’s consuming them.” – Dale Folwell
Folwell’s plan is attracting national attention because of its far-reaching implications………………
Montana Association of Counties Moves To Reference Based Pricing
Why The Move to a Medicare Reference Based Pricing program?
The cost of medical services continue to rise at a rate far faster than inflation of other goods/services and faster than employees’ pay. Reference based pricing is the most effective tool we have to bend that cost curve. This change will mean less money going to health care expenses and more going into employees’ pockets. It also creates a system that is more fair, transparent, comparable and predictable than how hospitals charge us now.
Continue reading Montana Association of Counties Moves To Reference Based Pricing
BCBS To Administer State’s Reference Based Pricing Plan
If You Can’t Beat Them, Join Them…………………………BCBSNC embraces Reference Based Pricing in order to retain +700,000 employee lives in the great state of North Carolina……………..
Continue reading BCBS To Administer State’s Reference Based Pricing Plan