Month: May 2019

Transparency in health care pricing doesn’t make a whole lot of sense when it’s other people’s money paying for all of this. Who cares what the cost is when all you have to pay is a small co-pay, or some sort of deductible. Then, when you enter that Magical Kingdom called Maximum-Out-Of-Pocket Limit you tend to go crazy in getting more health care to (1) milk it for all it’s worth and (2) revenge against the evil insurance carrier that makes you pay so much in co-pays and deductibles while charging you an arm and a leg in insurance premiums.

Health care pricing transparency does makes sense when Reference Based Pricing strategies are employed. “My plan will pay you $500 for that procedure, so how much will you charge me? Oh, never mind, I think I can find someone else that will do it for $500………………………

Continue reading Trump Ready To Force Transparency In Healthcare Pricing With An Executive Order

If you live anywhere on this planet and need free health insurance that covers pre-existing conditions without any waiting period what so ever, come quickly to California now! No passport needed nor pesky immigration hurdles to jump through. Just cross the border at any point of your choosing, turn yourself in and get a free airplane or bus ticket to the Golden State.

Continue reading California – Free Health Insurance For Planet Inhabitants

“If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back”………………Three (lonely) patients visited the hospital 500 times in one year………………..

Continue reading Hospitals Foster Lonely Hearts Club Memberships

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”

Continue reading The Cost of Convenience

Victor Lustig

“Percentage of savings fees is the greatest fraud foisted upon consumers since Victor Lustig sold the Eiffel Tower in 1925.  To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.”

Continue reading Hospitals Dismiss Significance Of Chargemaster Prices?

Continue reading Are Carriers and PPO Networks Slowly Becoming Obsolete?

Insurance Brokers Fight For Markets

We received notice / invitation to bid from the McAllen Independent School District along with 211 other vendors shown as email recipients. The brokers among them will be stumbling all over themselves to get quotes from the same four or five markets……………………This is exactly why smart brokers stay away from public RFP’s…………….

Continue reading McAllen ISD Invites 212 Vendors To Submit Bids – Chaos & Madness

“In 2018, Blue Cross members seen at South Florida Sanitas clinics—which opened in late 2015—had 32 percent fewer inpatient admissions, 34 percent fewer outpatient visits and 20 percent fewer emergency room visits compared with members who went to nonaffiliated clinics.”

Continue reading Blue Cross Joins The Doctors Practice Party

At $2.1 million, newly approved Novartis gene therapy will be world’s most expensive drug

Continue reading New Drug Will Bankrupt Your Plan by $2,100,000.00

Status Quo Health Insurance brokers are in for a lot of explaining to do. “Mr. Employer, I’m receiving $340,000 more than the $124,000 I’ve disclosed to you in the past. Plus, if I convince you to renew with your current carrier, I get an additional $25,000 renewal bonus! You OK with that? “

Continue reading A Status Quo Broker’s Worst Nightmare Just Happened In D.C.

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. 

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

Continue reading Memorial Day 2019

By Charles Specht

I love this stuff! Targeting signed Broker of Record Letters makes so much more sense than blindly quoting policy renewals, throwing mud against the wall to see what sticks, and “hoping for the best.”

Continue reading Working Smart – It’s All About Destroying Relationships

By Bill Rusteberg

Health share plans are growing in popularity these days. Cost is significantly lower than insurance plans as you will see by clicking the link below. However beware these plans are not insurance and there is no guarantee claims will be paid/covered.

Continue reading Health Sharing Plans

By Bill Rusteberg

Hidden fees in health care delivery earned by third party intermediaries can be significant.

Continue reading Hidden Fees

Texas insurance officials have scheduled a hearing to consider a similar order against Aliera, which has 100,000 members nationwide and reported revenue of $180 million in 2018, documents showed……

Continue reading ‘Sham’ Sharing Ministries Test Faith Of Patients And Insurance Regulators

“As recently as 2000, private payers were paying only 10% more than Medicare. Since then, the gap has been growing by leaps and bounds.” That has since grown to 200-300% and as much as 400%……….

Continue reading Why Employers Are Getting Screwed In Health Care Pricing

Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging. 

Continue reading PPOs and the $444 Box of Kleenex

Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, the Raymondville Independent School District in deep South Texas has decided to act.

Continue reading Texas School District Challenges TRS ActiveCare Plan Mandates

Local school districts voice concern over rising costs for health coverage

Continue reading More TRS ActiveCare Angst Among School Administrators

“To attract providers, Washington lawmakers chose a relatively high figure to start: The plan caps payouts at 160 per cent of federal Medicare rates……..”

Plan is expected to be competitive “in part to savings from a cap on rates paid to providers……………..”

Continue reading Another State Adopts Reference Based Pricing

The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:

1. increase premiums
2. lower benefits
3. or a combination of both

Really?

Meanwhile, smart plan sponsors have solved the rising cost of health care in Texas and it ain’t by increasing premiums and lowering benefits. Rather, it’s by lowering costs and improving benefits at the same time……sounds crazy doesn’t it?

(The Texas legislature’s answer to addressing rising health care costs is House Bill 3987, that if passed, will authorize a committee to study the issue and report back in two years. But some Texas school districts are not waiting……..)

Continue reading TRS Strategy To Control Health Care Costs Screws Plan Members

Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices

Continue reading Let The Sun Shine In…………………..

The El Paso Independent School District is set to adopt an exemption to Texas Education Code 22.004(i), which prohibits a District that has implemented employee group health coverage pursuant to Chapter 1579 of the Insurance Code (TRS ActiveCare) from providing any kind of alternative group health coverage at their May 14 board meeting.

Continue reading El Paso ISD To Adopt Exemption To TRS ActiveCare Requirement

Continue reading Too Damn HIgh!

The Real David in David & Goliath 

By David Contorno

Employers…..contrary to what you think, health insurance carriers make MORE revenue and profit as your health care costs go up. It’s federal law.

Continue reading Fearless Agitator Rattles Cages For Fun

Pssst…Godfather, Mulebriar Is At It Again!

“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 nor audit, violates fiduciary duties and is contrary to basic, common American business practices. “

Continue reading Protection Money Scheme Dominates HealthCare

Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore. 

Continue reading The Fallacy of PPO Re-Pricing Exercise

If you’re an insurance company, the simplest way to make more money, is to PAY MORE for medical services. In fact, provider negotiations should go like this:

Doctor: I want $100 for this procedure.

Insurance Company: No, we won’t pay you a penny less than $250. 

Continue reading Who’s The Dick That’s Going To Explain Our Healthcare Tragedy?

Hospitals have overplayed their hand. Galeforce blowback has arrived.

Continue reading Hospitals Are Committing Financial Suicide But Don’t Know It

This is what a +400,000 life group plan offering status quo healthcare strategies gets you these days…………

Continue reading Size Means Nothing in Health Care Financing – Common Sense Does

“For-profit hospitals charge 700% more than Medicare prices, while non-profit hospitals charge 550% more. Traditional PPO plans offering a 50% discount may end up paying 300% more than the Medicare price”.  In Texas where Reference Based Pricing strategies have been around since 2007, plan sponsors are paying between 120% to 150% of Medicare…………………….The Reference Based Pricing Blitzkreig is gaining market share quickly……………

Continue reading Reference Based Pricing Blitzkreig

A long time friend who has spent almost all of his working life in the pubic purchasing arena in Texas has a perspective that many of us in the insurance community have failed to acknowledge. 

Continue reading Astute Purchasing Agent Nails It

 “Please don’t leave us Grandpaw!!!”

Hey Grandpaw, I’m thinking of giving my children (your grandchildren) a few free gifts this year but I may decide later to take them back. But………. I’m worried the government will require you to disown us under penalty of sanctions!

Continue reading Grandpaw-hood At Risk?