Aetna Inc., Aetna Life Insurance Co. and Optumhealth Care Solutions Inc. allegedly misused CPT codes to pass on administrative charges under the guise of medical care………….
Continue reading AMA: Insurers Misused CPT Codes To Hide Administrative Costs
Month: February 2020
Sleepy TRS ActiveCare Trustees & Clueless Texas Legislators
“Legislative inaction has now led to an insurance program for school district employees that is more burdensome than beneficial, and for many educators, it amounts to a pay cut year after year.”
Continue reading Sleepy TRS ActiveCare Trustees & Clueless Texas Legislators
Coronavirus Highlights Chinese Drug Dependency
Coronavirus has jeopardized the “domestic supply of some 150 prescription drugs, including antibiotics, generics, and branded drugs…………..”
Continue reading Coronavirus Highlights Chinese Drug Dependency
The Great American Healthcare Scam
The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States.
BCBSMN ASO Agreement
A self-funded plan using BCBSMN as the Plan Administrator pays out-of-network providers 200% of Medicare. What do they pay in-network providers (Hint: it’s more).Ruben Edelstein
By Bill Rusteberg
Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.
Survey Reveals “Me Too” Brokers In The Majority
“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”
Continue reading Survey Reveals “Me Too” Brokers In The Majority
Turning Bronze Into Gold
Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?”
China Can Shut Down U.S. Pharmacies & Hospitals in Months
“China’s stated aim is to become the pharmacy to the world with its own companies. And what we’re seeing with Western generic drug companies, they’re collapsing because they can’t compete.”
Continue reading China Can Shut Down U.S. Pharmacies & Hospitals in Months
What’s An Actuary?
How do we know we are doing much better this year than last year?
The Payer You Never Heard Of
You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”
Quizzify’s Surprise Medical Bills Solution
“If a hospital (y) later turns down “two times Medicare (2x) and it goes to court, their lawyer is going to say, ‘We could lose this thing……………………..”
200% of Medicare represents a “savings” over a typical 60% PPO discount?
TRS ActiveCare Can Be Fixed, But We’re Tired of Waiting
Rather than kicking the can down the road to the next legislative session, sleepy TRS ActiveCare trustees should take note and consider adoption of newer, proven risk management strategies as other risk pools have done……………………….
Continue reading TRS ActiveCare Can Be Fixed, But We’re Tired of Waiting
Everyone Is Paying For Mary’s Deductible Because Mary Isn’t
Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….
Continue reading Everyone Is Paying For Mary’s Deductible Because Mary Isn’t
Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club
Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….
Continue reading Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club
TASB Issues Health Insurance Survey Results For Texas School Districts
Hard working Matamoros street vendors may make more than Texas school teachers………………..
Continue reading TASB Issues Health Insurance Survey Results For Texas School Districts
Pricing Customers Out of Health Care
You Want How Much!
As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care