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FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – JANUARY MEETING
Month: December 2019
A Ten Year Look Back On A RBP Group
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.
Hospital Roulette
Patients qualifying for free care from one hospital might receive painful bills and lawsuits from another.
Controlling Specialty Drug Costs Is Impossible Unless………….
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…………..
Continue reading Controlling Specialty Drug Costs Is Impossible Unless………….
BCBS Offers Specialty Drug Solution
The specialty drug solution? Require providers to buy from us…….
Working The Spread
Pharmacist points to a recent PBM transaction wherein the pharmacy earns $32.08 while the PBM earns $1,057.12 on the spread……………………..
Leveraging Charge-Master Rates Against PPO “Discounts”
A 50% discount off double the price? Or is it now a 50% discount off triple the price?
Continue reading Leveraging Charge-Master Rates Against PPO “Discounts”
Owner of Texas Urgent Care Clinics Charged in Bribery Scheme
Charged with bribes and kickbacks in exchange for sending patient nasal swabs to a laboratory for testing………………..
Continue reading Owner of Texas Urgent Care Clinics Charged in Bribery Scheme
UHC vs Houston Methodist
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”
Insurer Paid $25,865 For Common Cold With Your Money!
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…………..
Continue reading Insurer Paid $25,865 For Common Cold With Your Money!
The Middlemen Behemoths of Health Care Bureaucracy
Some of America’s biggest companies are middlemen who profit from the system’s wastefulness….
Continue reading The Middlemen Behemoths of Health Care Bureaucracy
Rx Costs Based On Fake Pricing Game
“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……………”
Rx Acquisition Cost
Disclosing Hidden Treasure
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.
Plan Sponsor Announces Incredible News!
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……………..”
Picking Horses – Broker’s Broker Publishes Tip Sheet
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).
Continue reading Picking Horses – Broker’s Broker Publishes Tip Sheet
The Importance of Homework When Bidding On Political Subdivisions
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).
Continue reading The Importance of Homework When Bidding On Political Subdivisions
Cross Border Drug Trafficking Expected To Increase
Cross border drug trafficking importation increases under President Trump’s watch – The Canadian connection…………………..
Continue reading Cross Border Drug Trafficking Expected To Increase
Puppets On A String
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….……………
Walmart Presentation to Company Associates
Employees Pay 11% Of Income on Premiums & Deductibles
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……………..
Continue reading Employees Pay 11% Of Income on Premiums & Deductibles
Californians To Be Punished Unless They Buy Broccoli (Oops, I Mean Health Insurance)
“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……………
NFL Players Accused Of Defrauding League’s Health Plan
“Many of the players named in the indictment are shocked to the allegations……………”
Continue reading NFL Players Accused Of Defrauding League’s Health Plan
Direct-To-Provider Health Plans Lowers Health Care Costs
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.
Continue reading Direct-To-Provider Health Plans Lowers Health Care Costs
Private University Seeks TPA / RBP / PPO Proposals
Texas based university is seeking competitive proposals for TPA services to administer a dual option Reference Based Pricing plan / PPO plan.
Continue reading Private University Seeks TPA / RBP / PPO Proposals
Stop Hiding Behind A Logo
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.
UIW Seeks Benefits Manager
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.
We Know How To Fix Health Care
But No One Is Listening
Pissed Off Plan Sponsors Wanted – Apply Within
We need to bring sanity back to health care financing. We need to stop the intimidation………
Continue reading Pissed Off Plan Sponsors Wanted – Apply Within
Hiding Behind A Logo
Why do self-funded plans hide behind a logo? Employers who self-finance their employee benefit program almost always do.
The Farce Everyone Pays For
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.”
Teachers Defy Injunction, Strike Over Health Care
Teachers are crying foul about health insurance costs that eat into their salaries………………….
Continue reading Teachers Defy Injunction, Strike Over Health Care
Texas Doctor Heads To Trial Over Healthcare Scheme
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)
Continue reading Texas Doctor Heads To Trial Over Healthcare Scheme
How To Make A Killing In American Health Care
A step by step guide to earning your first billion in American health care…………….
Continue reading How To Make A Killing In American Health Care
Reference Based Pricing – Why Pay A Premium of 20% or More?
Medicare ties reimbursement to cost, health insurance doesn’t. That’s the difference………
Continue reading Reference Based Pricing – Why Pay A Premium of 20% or More?
TPA Administration Agreements
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.
PBM’s Under Fire
Pharmaceutical Manufacturer Concocts New Patented Drug
PBMs have been under increased scrutiny as a potential contributor to runaway healthcare costs.
Scientists Discover A Cure For Pancreatic Cancer ?
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.
Continue reading Scientists Discover A Cure For Pancreatic Cancer ?
What?
