Archive for October, 2019

The God Father of Reference Based Pricing is…………………………

Thursday, October 31st, 2019

By Molly Mulebriar

There appears to be some confusion these days as to rightful owner of the title God Father of Reference Based Pricing.  

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Texas Sues Aliera Healthcare

Tuesday, October 29th, 2019

Texas Department of Insurance estimates that Aliera has about 17,000 customers in Texas and 100,000 nationwide.

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The Case of The $153,887 Kidney Stone

Tuesday, October 29th, 2019

“The patient spent 1 hour in the OR.  I kid you not, the facility billed $153,887……….”

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Non-Profit Hospital Defends Finances

Monday, October 28th, 2019

“Over the past few weeks, several articles and “studies” have been filled with inaccuracies and, at best, incomplete analyses of Parkview Health’s financial position, with calls to invest more in the community. I never expected having to defend what Parkview does for the community, but I will, and I’ll also provide some context regarding our financials.”

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Price Transparency Be Damned – I’m Insured Through OPM Insurance Company

Sunday, October 27th, 2019

“Americans usually put relationships ahead of money” because the money is not really theirs. “Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby” because, after all, they use Other People’s Money. No one ever cares about health care costs when using Other People’s Money (insurance). Transparency be damned………………………

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Changing TPA’s – I’d Rather Grin & Bare It!

Saturday, October 26th, 2019

By Molly Mulebriar

How many times has an employer said to you “Yes, we ARE having issues with our TPA, but changing to another one is too disruptive and challenging. Plus, we are out of time since our renewal is just around the corner. We are just going to stay put for now and live with it.” (more…)

HCA Sued Over Cover Charge

Wednesday, October 23rd, 2019

A $3,935 cover charge? No problem! I’ve got Nightclub Insurance! Let’s party………..

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Insulin Patent Sold For $1 Almost 100 Years Ago – What Happened?

Wednesday, October 23rd, 2019

By Carl C. Schuessler, Jr., DHP, DIA, GBDS

Organized crime – this is killing diabetics…………………

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Experiment Induces Confused Supposition

Tuesday, October 22nd, 2019

Do retail pharmacies make more or less money through PBM contracts?  If they make less money is it to a point they lose money?  Or do they profit? Before asking your pharmacist, try this experiment first.

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Benefit Administrative Systems, LLC

Sunday, October 20th, 2019


Founded in 1983, BAS is a results-driven third party administrator with a track record of delivering cost savings and customer satisfaction. We utilize our services, tools, and partners to create a robust partially self-funded plan as unique as each client.

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UnitedHealth Loses Two Big Accounts – Big Wins for Humana & Aetna

Thursday, October 17th, 2019

UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits.

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Teacher Retirement System Considering Big Changes

Monday, October 14th, 2019

Formerly sleepy TRS trustees are considering “big changes” to TRS ActiveCare because member districts are threatening to leave to establish their own health plans. Competition, for the first time, is clearly at play here (Texas School District Challenges TRS ActiveCare Plan Mandates).

The TRS solution? Eliminate community rating so some districts can pay more and utilize narrow networks so all districts have less choice……………………..

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What’s at Stake in the Current Court Challenge to the ACA?

Monday, October 14th, 2019

Lord Roberts -Protector & Defender of ObamaCare

“In court in July, only two of the three judges … asked questions. ‘Oral argument in front of the circuit went about as badly for the defenders of the [ACA] as it could have gone,’ says Nicholas Bagley, a professor of law at the University of Michigan.

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Specialty Drugs, Fiduciary Duties & The Hot Potato Method

Sunday, October 13th, 2019

Specialty drugs can cost hundreds of thousands of dollars per member per year, or more. One new specialty drug approved this year costs +$2,000,000 for an annual treatment………

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Schuessler To Speak at The Texas Public Policy Foundation

Saturday, October 12th, 2019

Carl Schuessler is set to speak at the upcoming Texas Public Policy Foundation event in January, 2020 in Austin, Texas. The panel discussion is on “The Way Out of America’s Broken Health Insurance System.” Knowing Carl as we do, his message may be “Grow Cojones For (a) Change.

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The Mother of All Health Care Battles Looms

Friday, October 11th, 2019

We have reached a tipping point in the battle against high cost health care. Employers have run out of money to pay for it. Employees can’t afford to use their health insurance anymore. Meanwhile hospitals continue to game the system with egregious charge-master pricing and their disco-discount game with their carrier partners. They have effectively dug their grave and are about to be pushed into it……………..

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Colorado Proposing To Adopt Reference Based Pricing Strategies

Wednesday, October 9th, 2019

Proposal will take Colorado down several relatively untraveled roads, potentially creating a health insurance market like no other in the country that could become a national model — or a cautionary tale……………..

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Introductions Are Worth Big Bucks In The Insurance Industry

Sunday, October 6th, 2019

Earning commissions forever by simply making an introduction beats working for a living………….

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The Betalin Cure

Sunday, October 6th, 2019

A team of Jerusalem-based researchers and entrepreneurs claim they have a cure for diabetes that could hit the market as early as within the next few years…………..The patient should never have to inject insulin into his body again………………

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AMPS Reports Record Growth In 2019

Sunday, October 6th, 2019

AMPS saw significant growth in its large customer portfolio this year, including customers with upwards of 150,000 members. The growth from small to midsize to large customers reflects broad embrace by employers and health systems……………..

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Risk Tolerance & Reference Based Pricing Strategies

Thursday, October 3rd, 2019

The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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Renting Medicare’s Provider Network

Thursday, October 3rd, 2019

 An idea with bi-partisan support?

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

Thursday, October 3rd, 2019

Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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Dead Peasant Insurance

Wednesday, October 2nd, 2019

According to one source, Hartford Life Insurance estimated that one-quarter of all Fortune 500 companies have COLI policies, which cover the lives of about 5 million employees.

Can proceeds go to reduce GASB 45 ?

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Individual Coverage HRA – The Good, Bad & Ugly

Wednesday, October 2nd, 2019

SOURCE: Trucker Huss

“The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year…….

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