Archive for December, 2019

You Are Invited To……………….

Tuesday, December 31st, 2019

You are invited to the following event:

FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – JANUARY MEETING

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A Ten Year Look Back On A RBP Group

Tuesday, December 31st, 2019

Tomorrow will mark a new plan year for one of our long time clients, the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago in lieu of traditional managed care strategies employed by most plan sponsors today.

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Hospital Roulette

Monday, December 30th, 2019

Patients qualifying for free care from one hospital might receive painful bills and lawsuits from another.

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Controlling Specialty Drug Costs Is Impossible Unless………….

Monday, December 30th, 2019

In 1990 there were only 10 specialty drugs on the market. Now there are more than 300 with nearly 700 more reportedly under development……………………..Managing domestic specialty  drug costs is impossible unless one adopts the Hot Potato Method, likes to visit foreign countries or Uncle Sam steps in…………..

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BCBS Offers Specialty Drug Solution

Sunday, December 29th, 2019

The specialty drug solution?  Require providers to buy from us…….

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Working The Spread

Saturday, December 28th, 2019

Pharmacist points to a recent PBM transaction wherein the pharmacy earns $32.08 while the PBM earns $1,057.12 on the spread……………………..

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Leveraging Charge-Master Rates Against PPO “Discounts”

Thursday, December 26th, 2019

A 50% discount off double the price? Or is it now a 50% discount off triple the price?

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Owner of Texas Urgent Care Clinics Charged in Bribery Scheme

Thursday, December 26th, 2019

Charged with bribes and kickbacks in exchange for sending patient nasal swabs to a laboratory for testing………………..

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UHC vs Houston Methodist

Tuesday, December 24th, 2019

Your Charges Are Too Damn High!

“Methodist isn’t just the most expensive health system in Texas. It’s one of the most expensive in the entire country……………………… Methodist costs 49% more than other top hospitals in Texas”

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Insurer Paid $25,865 For Common Cold With Your Money!

Tuesday, December 24th, 2019

The doctor’s office kept assuring Kasdan by phone and by email that the tests and charges were perfectly normal. The office sent a courier to her house to pick up the check…………..

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The Middlemen Behemoths of Health Care Bureaucracy

Monday, December 23rd, 2019

Some of America’s biggest companies are middlemen who profit from the system’s wastefulness….

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Rx Costs Based On Fake Pricing Game

Monday, December 23rd, 2019

“The game’s primary problem is that it is all predicated on the existence of, and reliance upon, fake prices. Fake prices for brand-name drugs beget fake prices for generic drugs……………”

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Rx Acquisition Cost

Monday, December 23rd, 2019

data.medicaid.gov/Drug-Pricing-and-Payment/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d

Disclosing Hidden Treasure

Sunday, December 22nd, 2019

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

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Plan Sponsor Announces Incredible News!

Sunday, December 22nd, 2019

Beginning in 2020 plan members will have their contributions paid for by their employer. “This remarkable achievement is made possible thanks to the application and utilization of cost containment measures……………..” 

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Picking Horses – Broker’s Broker Publishes Tip Sheet

Saturday, December 21st, 2019

Health insurance brokerage can be lucrative especially if one picks the right horse. For example, several years ago one of the highest earning horses of that year’s Brokerage Derby Bonus Race was BCBS (BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold).

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The Importance of Homework When Bidding On Political Subdivisions

Friday, December 20th, 2019

Before bidding on a political subdivision, it’s wise to do your homework first. What has been their bidding history? How were past decisions to award made? How was the process handled? Was a consultant involved, and if so, who was it? (Insurance Consultants Are Biased).

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Cross Border Drug Trafficking Expected To Increase

Wednesday, December 18th, 2019

Cross border drug trafficking importation increases under President Trump’s watch – The Canadian connection…………………..

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Puppets On A String

Wednesday, December 18th, 2019

PPO PATIENTS ARE PUPPETS ON A STRING

“We’re not sure what to do next. We have to wait for them to tell us what to do,” he said. “We’re just kind of in limbo….……………

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Walmart Presentation to Company Associates

Wednesday, December 18th, 2019

Employees Pay 11% Of Income on Premiums & Deductibles

Friday, December 13th, 2019

EMPLOYEES THINK EMPLOYERS PAY FOR HEALTH INSURANCE

Group health insurance average % of health care spend is 8-12% of payroll. If true, his article lends credence that employees pay all the cost of health care in the form of lower wages and less take home pay……………..

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Californians To Be Punished Unless They Buy Broccoli (Oops, I Mean Health Insurance)

Friday, December 13th, 2019

“Californians Without Health Insurance Will Pay A Penalty — Or Not.” What! What about illegal aliens who California has promised free health insurance? Do they pay a penalty too? Not according to this article. They are the “Nots.” But for the rest of us health insurance in California isn’t free whether you take it or not……………

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Friday, December 13th, 2019

 

NFL Players Accused Of Defrauding League’s Health Plan

Thursday, December 12th, 2019

“Many of the players named in the indictment are shocked to the allegations……………”

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Direct-To-Provider Health Plans Lowers Health Care Costs

Wednesday, December 11th, 2019

Remember back in the day when health care providers were paid directly, quickly and in cash? Gone were the vast armies of third party intermediaries driving up costs we see today.

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Private University Seeks TPA / RBP / PPO Proposals

Tuesday, December 10th, 2019

Texas based university is seeking competitive proposals for TPA services to administer a dual option Reference Based Pricing plan / PPO plan.

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Stop Hiding Behind A Logo

Tuesday, December 10th, 2019

In a previous post we discussed Hiding Behind A Logo and why self-funded plans should stop doing so. Plan members need to know who the real “insurance company” is, because it’s not who they think it is.

There are real advantages to understanding the difference, both to the plan sponsor and plan members.

For example, changing plans is never fun, with a lot of disruption and employee re-education. It’s HR’s worst nightmare. Besides, changing logos on an I.D. card doesn’t save money. However when you brand a plan for exactly what it is, changing a backroom claim administrator is as painless as changing stop loss carriers. It’s seamless and not at all disruptive to plan members.

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UIW Seeks Benefits Manager

Monday, December 9th, 2019

The Benefits Manager is responsible for directing and planning the day-to-day operations of the University of the Incarnate Word’s self-funded medical and dental plans, other ancillary insurance benefits, and the 403(b) retirement plans.

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We Know How To Fix Health Care

Sunday, December 8th, 2019

             But No One Is Listening

Pissed Off Plan Sponsors Wanted – Apply Within

Saturday, December 7th, 2019

We need to bring sanity back to health care financing. We need to stop the intimidation………

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Hiding Behind A Logo

Friday, December 6th, 2019

Why do self-funded plans hide behind a logo? Employers who self-finance their employee benefit program almost always do.

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The Farce Everyone Pays For

Thursday, December 5th, 2019

Imagine going to a restaurant and having a nice dinner. You get the bill. Everything looks good except there is a facility fee added at the bottom. A facility fee? What’s that you ask. “Its what we charge for you to use our facility” says the waiter………………”Our new owner says it’s necessary.”

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Teachers Defy Injunction, Strike Over Health Care

Thursday, December 5th, 2019

Teachers are crying foul about health insurance costs that eat into their salaries………………….

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Texas Doctor Heads To Trial Over Healthcare Scheme

Wednesday, December 4th, 2019

Dr. Jorge Zamora-Quezada

“Zamora-Quezada is accused of using his million-dollar private jet or his Maserati to go between his offices in the Rio Grande Valley and San Antonio, and of using proceeds from the alleged fraud to buy private jets, luxury vehicles, high-end clothing and real estate in the United States and Mexico.” (KSAT)

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How To Make A Killing In American Health Care

Wednesday, December 4th, 2019

A step by step guide to earning your first billion in American health care…………….

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Reference Based Pricing – Why Pay A Premium of 20% or More?

Tuesday, December 3rd, 2019

Medicare ties reimbursement to cost, health insurance doesn’t. That’s the difference………

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TPA Administration Agreements

Tuesday, December 3rd, 2019

By Molly Mulebriar

The picture above (on Linkedin this morning) reminded me of an infamous Texas based TPA known for preying upon mostly rural, clueless employers by hiding turbocharged TPA fees on the claim side of the ledger instead of the fixed cost side of the ledger. These clueless employers don’t read their contracts………………or don’t know any better, or both.

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PBM’s Under Fire

Tuesday, December 3rd, 2019

Pharmaceutical Manufacturer Concocts New Patented Drug 

PBMs have been under increased scrutiny as a potential contributor to runaway healthcare costs.

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Scientists Discover A Cure For Pancreatic Cancer ?

Tuesday, December 3rd, 2019

Israeli scientists find way to treat deadly pancreatic cancer in 14 days. The tumor in one mouse that was injected with human cancer cells completely disappeared.

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What?

Sunday, December 1st, 2019

160,000 American citizens offered a $500 cash payout, plane tickets to San Diego and free transportation to Tijuana to receive free health care services. Meanwhile California announces free health care for Mexican citizens who enter the state illegally…………

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