More than 50% of doctors are now in employee positions and generally beholden to “big medicine” so that doctors’ fidelity is primarily to the hospital system that employs them and away from patients.

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By Bill Rusteberg

Mr. Sidgwick: “Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this an essential health benefit under the ACA?”

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For a free copy of Dave Chase’s best seller go here: healthrosetta.org/friends/

Great leadership, great students……………..

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A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital……

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The law limits co-payments for a 30-day supply of the life-saving drug under private insurance plans to $100. It does not change the price of insulin…………………

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Blue Cross has successfully hijacked the term Reference Based Pricing  –  a damn smart marketing move……………………

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A mid-size Texas employer went from a BUCA to a Reference Based Pricing plan last year. The benefits remained the same. However, a change was made in the way providers are paid.  In lieu of paying through secretive managed care contracts, the plan paid medical providers based upon a transparent reimbursement schedule tied to a percentage of Medicare allowable charges.

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“There are three possible ways for providers to avoid application of the anti-assignment provisions in plan documents.

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“Managing health care on a local level brings needed accountability to health care financing while providing improved access to care and higher patient satisfaction. The patient-physician relationship becomes more than just a ten-minute office visit; it becomes a true partnership.”  – Alex Zuniga

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Will HRA’s replace group medical plans?

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Is it true a South Texas Hospital system is buying up primary care practices to fatten up their cash cow?

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For many people in medical debt, a trip to the emergency room leads to the courtroom

Wenzle Hufford, 76, uses a rope to tow his wife, Lucynda, with his motorized wheelchair in Kennett, Mo. Both have large medical debts. His legs were damaged when he was hit by a car; she has diabetes and heart problems. (Michael S. Williamson/The Washington Post)

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By Bill Rusteberg

As members of the +400,000 member TRS ActiveCare risk pool “The Power of Large Numbers” and “Economies of Scale” bring comfort to small Texas school districts . “We could not get comparable coverage on our own, much less at affordable rates” is the mind thought of school district officials throughout the state.

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“San Antonio has agreed to delay implementation until December 1, 2019. The stay will allow time for guidance from the Texas Supreme Court on the law’s constitutionality. In the meantime, San Antonio’s Paid Sick Leave Commission has agreed to work with business stakeholders to recommend changes in the ordinance to the San Antonio City Council.”

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Hospital billed charges total 1661% of Medicare. A typical PPO “discount” would be between the range of 50-70%. If the later, the hospital would be paid about 498% of Medicare. Plan paid 180% of Medicare. Hospital still wants more money. Plan sponsor says “Not in my lifetime!”

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“Those trying the preserve the wildly under-performing and bankruptcy-inducing status quo healthcare system will do whatever it takes to try to thwart progress” – Dave Chase

In his time at the hospital, from 1999 to 2007, his salary rose from$185,000 to $300,000, and he qualified for bonuses up to $220,000 if he met certain billing targets.

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By Bill Rusteberg

While visiting Washington DC last year on business, I ended each day with a short visit to Off The Record, a bar located at the Hay Adams Hotel across the street from the White House. This place is always packed with interesting people and I had occasion to meet a few of them. 

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Texas and Colorado issue cease and desist orders to health care sharing ministry………

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See hospital administrator morph into an insurance broker before your very own eyes…………….From Hospital administrator to power broker in under five minutes…..

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New immigration regulations leave coverage purchased with ACA subsidies off the list of positives.

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If you are a new era health insurance consultant this video will drive you nuts.

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A knee replacement surgery costs an average of about $30,000 at U.S. hospitals, but only $11,000 at Galenia Hospital in Cancun, Mexico.

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“By spending millions of dollars to oppose us and by using cartel-like tactics, these organizations were able to convince most hospitals to boycott the State Health Plan,” said Treasurer Folwell. “If big hospitals could do this to their largest customer, just think what they can do to the individual average citizen or business.

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With the lid ajar on Pandora’s box, we are likely to see employer demands pegged to price transparency and more strategies built on provider prices.

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Health plans, TPAs, and brokers can now contain costs while knowing that patients have a legal advocate standing by.

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“Anthem is determining whether an outpatient MRI, CT scan, or PET scan is “medically necessary” based on where the service is performed.”

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Answer: “NO”. Hospitals charge as much as they can get away with…..

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Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses………………..

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SOURCE: Axios

“In 1999, the average health insurance coverage for a family consumed 14% of the average household income …  By 2017, family coverage absorbed more than double that amount, to about 31% of take-home pay.

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“What do you do for a living?” asks the neighbor. “I destroy relationships” replies the salesman.

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Approved in May, the treatment’s price — set at $2.1 million — stoked concerns about the astronomical costs of potential cures for rare diseases and upset parents who initially could not get insurance coverage for the breakthrough treatment.

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Once labor unions learn the truth about what’s driving health care costs and become aware of proven methods to reduce costs while improving benefits at the same time, they will become a powerful force for change.  

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He makes millions, threatens to deprive teachers, state employees, retirees and their families of affordable health care coverage.

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The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor

Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years.

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Innovative Defined Contribution plan now available for groups of up to 99 employee lives. This could be a value add to small group health plans such as those available through Allied National (www.Alliednational.com) and others.

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There is only one known cure for the disease……… however the drug, priced at $2.1 million, is too expensive and not covered by health fund……toddler has only one more month to receive a new drug that could cure him………………

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“Specialty drugs account for about 1% of prescriptions but 95% of prescription costs.” A new drug approved this year will bankrupt health plans……………..Plan sponsors should carefully study their Rx formularies to determine if there are other “Poison Pills” lurking…….then take action.

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Seven year old boy files Tooth Fairy claim…………….No-limit tooth provision to set record reimbursement rate……….Tooth Fairy spokesman hints at bankruptcy….. 

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“These manufacturers would be able to use a new National Drug Code (NDC) in doing so, possibly enabling them to offer lower prices than are available under their existing distribution contracts…………………….”

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